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Home My WebLink AboutCalifornia Professional Engineering, Inc. - 2010-11-01RECEIVED BY: (Name-) -I (Date) TO: --Sh:j-ri--F-reiden rich, City Treasurer (- FROM: 1TV DATE: SUBJECT: Bond Acceptance I have received the bonds for Faithful Performance Bond No. Labor and Material Bond No. Monument Bond No. Maintenance Bond No. I Guarantee and Warranty Bond No. Re: Tract No. CC No. MSC No. A) Approved (Council Approval Date) CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office after signing/dating (Company Name) I 19 e-111,1 -;z-6 Agenda Item No. City Clerk Vault No. &x) #27 g1followup/bondletter.doc FROM: John S. Griffin DATE: 08/24/2011 SUBJECT: Retention Release Payment Company Name: Address: City, State and Zip Code: Phone Number: Business License Number: Local Address: Notice of Completion Date: California Professional Engineering, Inc. 917 Otterbein Ave. Unit #E La Puente, CA 91748 (626) 810-1338 A265898 exp.01/31/2012 N/A 06/06/2011 Contract Purpose: Retention release for Capital Improvement Project's 1204,1246 & 1247 Traffic Signal Modifications The conformed copy of the Notice of Completion for the above contract has been filed. The thirty-five (35) day waiting period has elapsed or will elapse before payment is made. Processing of the retention payment is recommended so long as no stop notices or outstanding invoices are on file with the City. I certify that no stop notices are on file on the Date A ravis K eject at this time. I certify that there are no outstanding invoices on file. Date ins, Public Works Director Zacks,/Doputy City Treasurer I certify that no stop notices are on file on the subject contract, and that a guaranty bond has been filed with this office. n JLdVFlynn, City rk Retention Release 3 signatue form 8/24/2011 3:47:00 PM RECEIVED BY: (Name) (Date) all TO: --.qri, City Treasurer FROM: e DATE: Z— SUBJECT: Bond Acceptance I have received the bonds for Faithful Performance Bond No. Labor and Material Bond No. Monument Bond No. Maintenance Bond No. Guarantee and Warranty Bond No. CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office after signing/dating •' we (Company Name) Re: Tract No. CC No. l & /Z7 MSC No. Approved l �� Agenda Item No. (Cou cil Approval Date) City Clerk Vault No 0 #27 g1followup/bondletter.doc BOND NUMBER: 1941176 BOND ISSUED IN DUPLICATE ' -J KNOW ALL MEN BY TdESE PRESEI►ITS: That: CALIFORNIA PROFESSIONAL ENGINEERING, INC. DBA CALIFORNIA PROFESSIONAL ELECTRICAL ENGINEERING r*niracWs nam] 929 Otterbain Avenue, Ste, E, L-a_ Puente. CA 91748 [canttac Ws sheet address, city and state and zip code] as Principal (hereinafter called Contractor), and: THE HANOVER INSURANCE COMPANY rsurws,r." 2. ACAIIZUjjR PLACE_ 2ND FLOOR- SANT ANA- CA 92707 isurety's shed address, city and state and zip code] a Corporation organized and existing Under the laws of the State of _ NEXAMPsHIRE With its principal office in the City of ORANGE, CA as Surety (hereinafter called Surety), are held firmly, fund unto CITY OF HUNTINGTON BEACH as Obligee (hereinafter called Owner), in the amount of TW HUNDRED THTRTY FOUR THOUSAND TWO HUNDRED payment whereof Contractor and Surety bind themselves, their heirs, and assigns, jointly and severally, firmly by these presents, ($ 234213.67 �, for the executors, administrators, successors, WHEREAS, Contractor has by written agreement dated entered into a contract with Owner for the TRAFFIC SIGNAL MODIFICATIONS HES CC 1204 (5181-139),1246 (5181-162) -- in accordance with drawinge and spedfications prepared by which contract is by reference made a part hereof (hereinafter referred to as the C-contract); and 11107HEREAS, the Contract provides that the principal will guaranty, for a period of one year, the work performed as part of the Contract from and against all defects in materials and worionanship;,and WHEREAS, the Contract also provides that the Contractor shall secure Contractor's obligations during the one- year period with a bond executed by a surety duly admitted in the state of California; and *14EREAS, the Contract has been completed, and the Owner, Contractor and Surety agree that the commencement date for this Guarantee and Bond shall be .TUNE 9 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if Contractor shall, for a period of one year from and after the date of completion and acceptance of the Contract key Owner, repair and/or replace any and all defects. arising in the Work, whether resulting from defective materials or deferdive workmanship, then this obligation shall be null and void; otherwise it will remain in full force and e'%ct. T�e Surety hereby waives notice of any alteration or extension of time made by the Owner. k"enever Contractor shall be, and declared by Owner to be in default under the Contract the Surety shall, within thirty (30) following Owner's written notice of default, either (a) remedy the debut or (b) shall promptly complete the Contract in accordance ;with its terms and conditions. Surety shall save the Owner harmless from any claims, judgments, liens or lo��es arising from the Surety's failure to either remedy the default or to complete the Contract in accordance with its terms and conditions in a tirrlely manner. Whenever the Principal shall be, anc declared by the Owner to be in default under the Contract, which shall include Without limitation, any breach: or default of the Contract, then, after written notice from the Owner to the Surety, as provided for below, the Surety shall either. (a) remedy the default or -preach by the Principal; or (b) shall promptly and faithfully take charge of the Work and complete the Work in accordance with the requirements of the Contract with a contractor other than the Principal, at its own expense, and make available a 1"—%7150593 as work progresses sufficient funds to pay the cost of completion less the unpaid balance of the Contract ir.cduding other costs and damages .for which the surety maos liable hereunder, provided, however, that the procedure by ut tic i' the Surety undertakes to discharge its obligations under this Bond shall be subject to the advance written approval of the Owner. t` Within thirty (30) days after Surety's receipt of a written notice from Owner of the failure of performance of the dontr✓act by the Principal, it shall bQ the duty of the Surety to give to the CoW ier a notice, in writing, of the Surety's election to (a) remedy the b. efauit(s) of the Principal promptly, or (b) tirrange for performance of the Contract promptly by a contractor oiler than the Principal, time being of to this Bond. In said fltoioce of Election, the Surety shall state the date of commencement of its cure or remedo, of the Principal's default(s) or its performance of the Contract The Surety's obligations for cure or remedyfi"include but are not limited to: correcbon of defective worts and completion of the Con additional legal idesign professional and delay costs arising from Surety's actions or failure to actand liquoked damages (6. , if no liquidated damages are soecifred in the Contract actual damages caused by delayed performance;:; or iron- performance by the Principal). The Surety shall give prompt written notice to the Owner upon completion of the cure or remedy of the Principal's defaults) of its performance of the Contract. If the Surety does issue its Notice of Election and does not to , cure or remedy the Principa's defaul(s) of its performance $f the Work within thirty (30) days after 4 a written notice from Owner, Surety shall be deemed to be in default on this bond, and the Owner shall be entitled to enforce any remedy available to Owner. No right of action shall accrue on this bond to or for the use of any person or corporation other than the Owner named herein or the successors of Owner. Signed and sealed this 9TH day of JUNE 2011 ,; r: CALIFORNIA PROFESSIONA , ENGINEERING, INC. DBA Principal Barred Corporate Seal CALIFORNIA PROFESSIONAL ELECTRICAL ENGINEERING [MUST BE AFFIXED]:., (Carrtractcsi; ) f ;'t By: (Seal) Principal Raised Corporate Seal OUST BE AFFIXED) ALL-PURPOSE ACKNOWLEDGMENT State of California SS. County of Ln n,0�� e S On � lx �tiC (L � 2 C� � � ,before me, a c, S QO �-, �� cA7n r y � v� b � i c DATE personally appeared \ 0," (�, _� eh , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instnmment 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. TRACY SOOC Comm # 1804694 "0Los our'" N MY Court. Exp. DUNE 28, 2012 NOTARY'S SIGNATURE PLACE NOTARY SEAL Rd ABOVE SPACE OPTIONAL INFORMATION The information below is optional. However, it may prove valuable and could prevent fraudulent attachment of this form to an unauthorized document. CAPACITY CLAIMED BY SIGNER (PRINCIPAL) ❑ INDIVIDUAL ffrC--6RPORATE OFFICER /-A ❑ PARTNER(S) TITLE(S) ❑ ATTORNEY -IN -FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: SIGNER (PRINCIPAL) IS REPRESENTING: NAM E OF PERSON(S) OR ENTITYCIES) DESCRIPTION OFATTA�CpHED DOCUMENT mi�,N a ..CQ.. nj TITLE OR TYPE OF DOCUMENT NUMBER OF PAGES DATE OF DOCUMENT RIGHT THUMBPRINT OF SIGNER OTHER ACKNOWLEDGMENT State of California County of Orange ) ;; On June 9, 2011 before me, Jennifer C. Giboney, Notary Public (insert name and tjtle of the officer) personally appeared Yung T. Mullick , who proved to me on the basis of satisfactory evidence. to be the person(s) whose name(s) is/m subscribed to the within instrument and acknowledged to me that hehWiedlM executed the same in hiss authorized capacity(*, and that by hishaimAboik signature(&) on the instrument the person(*), 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. stKDP�h JF.NNIF'ER C. OIBONEY WITNESS my hand and officialal. COMM. � 1711 � w wTARY Par.WORIYIA X r ORANGE COUNTY Rfy Cow. Exp 0 MAY t, 212 Signature (Seal) THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWERS OF ATTORNEY CERTIFIED COPY KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a corporation organized and existing under the laws of the State of Michigan, do hereby constitute and appoint James W. Moilanen, Jennifer C. Giboney and/or Yung T. Mullick of Mission Viejo, CA and each is a true and lawful Attorney(s)-in-fact to sign, execute, seal, acknowledge and deliver for, and on its behalf, and as its act and deed any place within the United States, or, if the following line be filled in, only within the area therein designated any and all bonds, recognizances, undertakings, contracts of indemnity or other writings obligatory in the nature thereof, as follows: Any such obligations in the United States, not to exceed Ten Million and No/100 ($10,000,000) in any single instance and said companies hereby ratify and confirm all and whatsoever said Attorney(s)-in-fact may lawfully da; in the premises by virtue of these presents. These appointments are made under and by authority of the following Resolution passed by the Board bf,Directors of said Companies which resolutions are still in effect: '? "RESOLVED, That the President or any Vice President, in conjunction with any Assistant Vice President, be and they are hereby authorized and empowered to appoint Attorneys -in -fact of the Company, in its name and as its acts, to execute and acknowledge for and on its behalf as Surety any and all bonds, recognizances, contracts of indemnity, waivers of citation and all other writings obligatory in the nature thereof, with power to attach thereto the seal of the Company. Any such writings so executed by such Attomeys-in-fact shall be as binding upon the Company as if they had been duly executed and acknowledged by thi regularly elected officers of the Company in their own proper persons." (Adopted October 7, 1981 - The Hanger In Company; Adopted April 14, 1982 — Massachusetts Bay Insurance Company; Adopted September 7, 2001 - Citizens Insurance Company ol!Amenca) IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPA&Y and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by a Vice President and an Assistant Vice President, this 14th day of April 2011. THE HANOVER INSURANCE COMPANY MASSACHt)36TTS SAY INSURANCE COMPANY 0.6ZEN SURANCE COMPANY OF AMERICA 97 Mary:Jesnne d tiin,. m-e PTes;d t tc. Gferirrsn, As"sistgn Ice President THE COMMONWEALTH OF MASSACHUSETTS ) I COUNTY OF WORCESTER ) ss. On this, 14th day of April 2011, before me came the above named Vice President and Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and officers described herein, and acknowledged that.the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. emu Am ¢ARuac ca e+rceeswam�a Not&ry Public My commission expires on November 3, 2011 I, the undersigned Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Companies, and do hereby further certify that the said Powers of Attorney are still in force and effect. This Certificate may be signed by facsimile under: and by authority of the following resolution of the, Board of Directors of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America. .'RESOLVED, That any and all Powers of Attomey and Certified Copies of such Powers of Attorney and. certification in respect thereto, granted and executed by the President or any Vice President in conjunction with any Assistant Vice President of the Company, shall be binding on the Company to the ;same extent as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile." (Adopted ,October 7, 1981 - The Hanover Insurance Company; Adopted April 14, 1962 Massachusetts Bay Insurance Company; Adopted September 7, 2001 - Citizens Insurance Company of America) GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts, this 9 day of DUNE 2011 . THE HANOVER INSURANCE COMPANY MASSACHUSETTS SAY INSURANCE COMPANY CITI S INSU .. CE C % ANY OF ERICA Ste 8rau1, : sF5la t Vice Pres - of Certification of Compliance with Prevailing 'Wage Paws To: City of HundVan Beach Department of Public Works 2000 Maia Street/P.O. Box 190 Huntington Beach, CA 92648 Re: Certification. of Compliance with Prevailing Wage Laws Contract: CC #1204, 1246 &1247 Project: Traffic Signal Modifications Brookhurst & Yorktown— Magnolia & Atlanta, Newland Atlanta The undersigned contractor on the above -referenced project C Project"} he: --by certifies that all laborers, mechanics, apprentices, trainees, watchmen and guards employed by him or by any subcontractor performing work under the contract for the Project have been paid pursuaut to the Minimum wage and bona fide fringe benefit • oquirements specified for each particular classification of work, as set forth in the wage -rate determinations of the State of California, Department of Industrial Relations, and/or the Udted States Department of Labor. I declare under penalty of perjury under the laws of tfie State of California that the foregoing is true and correct. Executed this s day of June .20 11., at La Puente , California. California Professional Enc (3yjJ� rNam4 By: Name: Van Nguyen Title: General Manager 2475411 Van Nguyen state and certify that: (Name of DwJarano California Professional Engineering, Inc. is the general contractor to the City of Huntington Beach ("City') on Contract No. 1204, 1246 & 1247 (the "Contrael for the construction, of the public work of improvement entitled: Traffic Signal Modifications a Brookhurst & Ynr�tnwn Magnolia & 6tiqnta Newland & Atlanta (the "Project"). 2. All worst to be performed pursuant to the Contract has been completed in accordance with the Contract Documents (as such term is defned in the Contrast). 3. Except for the claims listed.below and the disputed claims listed in paragraph five (5), all persons supplying labor, services, materials and equipment to the Project, including all claims against the Contractor arising from the performance of the Contract, have been paid and satisfied (list unpaid debts and claims; if none, write `NOW'): None 4. Attached hereto are the lien waivers required by the Contract Documents, which lien waivers have been executed by all persons who performed work on or supplied labor, services, materials, and/or equipment for use at the Project. 5. Set forth below is a list of disputed claims or claims dirt are the subject of a Notice to. Withhold filed pursuant to the Civil Code of ft State of California (list all disputed claims; if none, write `WONV }: None I declare under penalty of perjury under the laws of the State of California that' the foregoing is true and correct Executed at La Puente, California` on this. day of due 2011 , (Signsture APPRO'VM AS TO FORM By. - By i!J 3- y0• (Q Name: [Type Name] Title: Rype Tit1q] t459i41 Ceramcation of Compliance with Title VD: of the Civil Rights Act and Equal Employment Opportunity Act of 1972 To: City of Huntington Beach Department ofPublic Works 2000 Main Street/P.O. Box 190 Himfington Beacla, CA 92648 Re: Certification of Compliance with Title VII of the Civil Rights Act and Equal Employment Opportunity Act of 1972 Contract: CC #1204, 1246, 1247 Project: Traffic Signal Modifications 0). Brookhurst & Yorktown_ Magnolia & Atlanta. Newland & Atlanta The undersigned contractor on the above -referenced project (?mjecn hereby certifies that it has complied with Title VII of the Civil Rights Act, the Equal Opportunity Act of 102 and Executive Order 11246, and has not discriminated against any employee or applicant for employment because of race, creed, color, sex, national origin, age or disability. The undersigned contractor also certifies that it bas not maintained any segregated facilities at its establishments on the basis of race, creed, color, se); national origin, age or disability (with the exception of access for the disabled). I declare under penalty of perjury under dw laws of the State of California that the foregoing is true and correct. Executed this 6 day of ,rune , 20 11 , at La Puente , California. California (Type on rt Name By: Name: Van Nguyen Title: General Manager 24911 i J-L) B •-ab - C9p PLEASE COMPLETE THIS INFORMATION This Document was electronically recorded by City of Huntington Beach RECORDING REQUESTED BY: WHEN RECORDED MAIL TO: CITY OF HUNTINGTON BEACH Attn: John Griffin P.O. Box 190 — 2000 Main Street Huntington Beach, CA 92648 TITLE OF DOCUMENT Recorded in Official Records, Orange County Tom Daly, Clerk -Recorder 11111111111111111111111111111111111111111111111111111111111111111 NO FEE 2011000277354 12:14pm 06/06/11 93 401 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THIS SPACE FOR RECORDER'S USE ONLY NOTICE OF COMPLETION NOTICE IS HEREBY GIVEN by the City of Huntington Beach, owner in fee, 2000 Main Street, Huntington Beach, CA 92648, that the contract heretofore awarded to California Professional Engineering, Inc. who was the company thereon for doing the following work to -wit: TRAFFIC SIGNAL MODIFICATIONS, CONSTRUCTION CONTRACTS -1204, 1246 & 1247 That said work was completed June 01, 2011 by said company according to plans and. specifications and to the satisfaction of the City Engineer of the City of Huntington Beach and that said work was accepted by the Director of Public Works on June 01, 2011, per City Council Resolution No. 2003-70 adopted October 6, 2003. That upon said contract The Hanover Insurance Company was surety for the bond given by the said company as required by law. This document is solely for the official business of the City of Huntington Beach, as contemplated under Government Code Section 6103 and should be recorded free of charge. Dated at Huntington Beach, California, this June 01, 2011. rector of Public Works or City Engineer pvCity of Huntington Beach, California STATE OF CALIFORNIA) County of Orange ) ss: City of Huntington Beach ) I, the undersigned, say: I am an Agent of the City of Huntington Beach, owner in fee, in the foregoing NOTICE OF COMPLETION. I have read said NOTICE OF COMPLETION and know the contents thereof; the same is true of my knowledge. I declare under penalty of perjury that the foregoing is true and correct, and that said NOTICE OF COMPLETION was duly and regularly ordered to be recorded in the Office of the County Re7;//v Orange County. Dated at Huntington Beach, California, this June 01, 2011. p0w_' &�ctor of Public Works or City Engineer City of Huntington Beach, California THIS PAGE IS ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION (Additional recording fee applies) RECEIVED BYE.--- (Name) (Date) TO: Shari Freidenrich, City Treasurer r FROM: DATE: / i G . 11ol SUBJECT: Bond Acceptance 1 have received the bonds for Faithful Performance Bond No Labor and Material Bond No. Monument Bond No. Maintenance Bond No. Guarantee and Warranty Bond No. Re: Tract No CC No. MSC No. Approved pp (Council Approval Date) CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office after signing/dating .-/t i Fr.')!`�-it.J,%1�y� j,?" Lc:�:�rC:e",..)./�� .:=-+"�f,ii��#.:?`t.,'•i"'J'� (Company Name) /�V Agenda Item No. City Clerk Vault No ADD �.- #27 gAollowup/bondletter.doc 77 Ao,46A .5 ,it) Council/Agency Meeting Held:_/-Z /D Deferred/Continued to: Ap roy ed. Conditio ally , roy d ❑Denied City Clex.'s Sign re Council Meeting Date: November 1, 2010 Department ID Number: PW 10-058 CITY OF HUNTINGTON BEACH REQUEST FOR CITY COUNCIL ACTION SUBMITTED TO: Honorable Mayor and City Council Members SUBMITTED BY: Fred A. Wilson, City Administrator PREPARED BY: Travis K. Hopkins, PE, Director of Public Works SUBJECT: Approve project plans and specifications and award Construction Contract in the amount of $212,383 to California Professional Engineering, Inc. for three traffic signal modifications, CC-1204, CC- 1246, and CC-1247; authorize the Mayor and City Clerk to execute a contract in a form approved by the City Attorney; and, authorize the Director of Public Works to execute change orders not to exceed 15% Statement of Issue: On October 7, 2010, bids were opened for the modification of traffic signals at three locations (CC-1204, CC-1246, and CC-1247). This project will add left turn arrows at the intersections of Atlanta Avenue at Newland Street, Atlanta Avenue at Magnolia Street and at Brookhurst Street and Yorktown Avenue. City Council action is requested to award the contract to California Professional Engineering, Inc., the lowest responsive and responsible bidder. Financial Impact: Funds totaling $665,000 are appropriated in the current budget year for the traffic signal modifications at these three locations. Funding is $244,800 from federal Hazard Elimination Safety (HES) grants with matching local Measure M funds (81490007.82700) of $420,200. The engineer's cost estimate for this project is $385,000. Recommended Action: Motion to: A) Approve the project plans and specifications for the modifications of three traffic signals under the federal Hazard Elimination Safety (HES) program (CC-1204, CC-1246, and CC-1247); and, B) Accept the lowest responsive and responsible bid submitted by California Professional Engineering, Inc., in the amount of $212,383.00; and, C) Authorize the Mayor and City Clerk to execute a construction contract in a form approved by the City Attorney; and, D) Authorize the Director of Public Works to execute change orders not to exceed a total of 15 percent of the contract construction costs. HB -147- Item 7. - 1 REQUEST FOR COUNCIL. ACTION MEETING DATE: 11/1/2010 DEPARTMENT ID NUMBER: PW 10-058 Alternative Action(s): Reject all bids and provide staff with alternative direction. Analysis: Three intersections have been awarded competitive funding under the Hazard Elimination Safety program administered by the Federal Highway Administration and the California State Department of Transportation. These projects were funded to address a higher than expected incidence of left -turn collisions at each of the intersections. The construction work consists of installing east -west protected left turn arrows at Yorktown Avenue and Brookhurst Street, installing north -south protected left turn arrows at Newland Street and Atlanta Avenue, and installing protected left turn arrows in all directions at the intersection of Atlanta Avenue and Magnolia Street. The work will include the installation of new traffic signal poles, signal heads and conduit installation to accomplish the proposed operation. There will also be some minor curb and gutter work and access ramp installation to comply with the current requirements of the Americans with Disabilities Act. A complete set of plans and specifications are available for review at the Public Works counter during normal business hours. Bids were opened publicly on October 7, 2010, and are listed in ascending order: Bidder Submitted Bid 1 California Professional Engineering, Inc. $212,383.00 2 PTM General Engineering Services, Inc. $215,215.00 3 Lincoln Pacific Builders, Inc. $239,432.00 4 Terno $245,456.00 5 C.T. & F., Inc. $272,130.88 6 Steiny & Company, Inc. $286,000.00 The engineer's estimate for the bid items is $260,000. The total estimated cost for this project is $385,000 which includes the City's direct purchase of all major equipment. This practice ensures consistency of equipment among the traffic signals and street lighting maintained by the City. Direct purchase also provides the added benefit of reduced costs to the City due to elimination of contractor mark-ups, typically in excess of 20 percent on this type of equipment. Staff is requesting that the Director of Public Works be given authorization to approve change orders on this project up to 15 percent of the construction cost rather than the standard 10 percent. The request equates to a 10 percent contingency based on the total of the construction contract and the materials purchased by the City. This authorization will provide the added flexibility needed to complete a typical construction project yet still be consistent with the intent of the 10 percent limit. Public Works Commission Action: The Public Works Commission recommended this project on September 15, 2010, by a vote of 5-0-2. (Kirkhorn and Spencer absent) Item 7. - 2 HB -148- REQUEST FOR COUNCIL ACTION MEETING DATE: 11/1/2010 DEPARTMENT ID NUMBER: PW 10-058 Environmental Status: This project is categorically exempt pursuant to the California Environmental Quality Act, Section 15303 (c). Strategic Plan Goal: Maintain, improve and obtain funding for public improvements. Attachment(s): Ng -14- Item 7. - 3 ATTACHMENT - 4 Item 7. - 4 NB -1 50- I CITY OF HUNTINGTON BEACH * PUBLIC WORKS * TRAFFIC ENGINEERING PROJECT LOCATION MAP ATTACHMENT BROOKHURST STREET & YORKTOWN AVENUE, NEWLAND STREET & ATLANTA AVENUE 1 AND MAGNOLIA STREET & ATLANTA AVENUE i HB -151- Item 7. - 5 CITY OF HUNTINGTON BEACH ;,0 FEES TRAFFIC SIGNAL MODIFICATIONS CC-1204, 1246 & 1247 BID OPENING: OCTOBER 7, 2010 @ 2:OOPM ENGINEER'S ESTIMATE: $450,000 BIDS SUBMITTED (AS READ AT OPENING) 1 California Professional Engineering, Inc. ,. I-) 2 Christopher R. Morales, Inc. •'3 C. T. & F., Inc. j j o 4 Dynaelectric 5 Lincoln Pacific Builders, Inc. 6 Loy Clark Pipeline 7 MSL Electric, Inc. 8 Republic ITS 9 Steiny & Company, Inc.�� 10 Terno 11 VT Electric 12 13 14 15 16 17 18 19 20 21. 22. 23. 24. 25. � �7 o Iffy _.. ---------- 101 �10 AM CITY OF I- UNTINGTON 2000 Main Street P.O. Box 190 Huntington Beach, CA Attention: Joan L. Flynn To: City Clerk's Office 2000 Main Street Huntington Beach, CA 92648 92 64 8 Fax (714) 374-1573 Date: September 9, 2010 ProjectlC.C. No.: C.C. Nos, 1204, 1246 & 1247 Regarding: Traffic Signal Modifications Sealed Bids ❑ We are sending you: ❑ By Mail ❑ By Fax Mail(Number of pages including this sheet:) ® We are hand delivering: ❑ Attached ❑ Under a separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change Order ® Other: Notice Inviting Sealed Bids Item # Copies I Pages Dekriptio,n ;; 1 1 1 1 Notice Inviting Sealed Bids for CC-1204, 1246 & 1247 2 (Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Street & Atlanta Avenue and Magnolia Street & Atlanta Avenue 3 These are transmitted as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ® For your use ❑ Approved as noted ❑ Submit copies for distribution ® For your action ❑ Returned for corrections ❑ Return corrected prints ❑ For review/comment ❑ Other: Remarks: Per Resolution 2009-50 (adopted on September 8, 2009), the City Council authorized the advertisement of the above Projects. Please find attached the Notice Inviting Sealed Bids for advertisement on 9/16/10, 9/23/10, & 9/30/10. The bid opening is scheduled for 10/7/10. Please contact me at 374-1628 with any questions you may have. c: file By: 2:��--, L William F. Janusz, Poopal Civil Enginee GACONSTRUCTION CONTRACTS (CCS) \CC1246 NEWLAND-ATLANTA TRAFFIC SIGNAL MODIFICATIONS\OCTOBER 2010 BID\NISB TRANSMITAL TO CLERK-CC- 1204, 1246 & 1247.DOC NOTICE INVITING SEALED BIDS for CC-1204,1246 and 1247 Notice is hereby given that sealed bids will be received by the City of Huntington Beach at the office of the City Clerk at City Hall, 2000 Main Street, Huntington Beach, CA 92648, until the hour of 2:00 PM on October 7, 1010, at which time bids will be opened publicly and read aloud in the Council Chambers for the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Street & Atlanta Avenue and Magnolia Street & Atlanta Avenue, CC-1204, CC-1246 and CC-1247 in the City of Huntington Beach. A set of plans, specifications, and contract documents may be obtained starting September 16, 2010 at City Hall, Department of Public Works upon receipt of a non-refundable fee of $40.00, sales tax included, if picked up or $50.00 if mailed. Each bid shall be made on the Proposal Form provided in the contract documents, and shall be accompanied by a certified or cashier's check or a bid bond for not less than 10% of the amount of the bid, made payable to the City of Huntington Beach. The Contractor shall, in the performance of the work and improvements, conform to the Labor Code of the State of California and other Laws of the State of California applicable thereto, with the exception only of such variations that may be required under the special statutes pursuant to which proceedings hereunder are taken and which have not been superseded by the provisions of the Labor Code. Preference to labor shall be given only in the manner provided by law. No bid shall be considered unless it is made on a form furnished by the City of Huntington Beach, Department of Public Works, and is made in accordance with the provisions of the proposal requirements. Each bidder must be licensed as required by law. The City Council of the City of Huntington Beach reserves the right to reject any or all bids. By order of the City Council of the City of Huntington Beach, California on the 8th day of September 2009, by RESOLUTION 2009-50. Joan L. Flynn City Clerk of the City of Huntington Beach 2000 Main Street. (714) 536-5431 File :CC-1246 CLASSIFIED rir-) r0r F Daily Pilot ADVERTISING Daily Pilot Printed by: 9966 Sandrine Salesperson: e o o Gann Sep 13, 2010, 9:03 am , H.B.I. Phone: Ad-433771069 Account information Ad Information Phone#: (714)536-5227 Startdate 09-16-10 Size 3x41.960 Name: CITY OF HUNTINGTON BEACH Stop date 09-30-10 Billed size 4.50 TCN Inch Address: P.O. BOX 784 Insertions 3 Keyword HUNTINGTON BEACH, CA 92648 Ratecode &Legal Huntington Beach Ad type Liner Takeriby 9966SandrineGann Acct #: 277391004 Classification 13000-Legal Notices Publications TCN HBI Client: Clerk's off ice -City Huntington Beach Piacedby: Patty Esparza Fax #: (714) 374-1557 Ad Copy: for CC-] 204,1246 and 1247 Notice is hereby given that sealed bids will be received by the City of Huntington Beach at the office of the City Clerk at City Hall, 2000 Main Street, Huntington Beach, CA 92648, until the hour of 2:00 PM on October 7, 2010, at which time bids will be opened publicly and read aloud in the Council Chambers for the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Street 8. Atlanta Avenue and Magnolia Street & Atlanta Avenue, CC-1204, CC-1246 and CC-1247 in the City of Huntington Beach. A set of plans, specifications, and contract documents may be obtained starting September 16, 2010 at City Hall, Department of Public Works upon receipt of a non-refundable fee of S40.00, sales tax included, if picked up or S50.00 if mailed. Each bid shall be made on the Proposal Form provided in the contract documents, and shall be accompanied by a certified or cashiers check or a bid bond for not less than 10 0 of the amount of the bid, made payable to the City of Huntington Beach. The Contractor shall, in the performance of the work and improvements, conform to the Labor Code of the State of California and other Laws of the State of California applicable thereto, with the exception only of such variations that may be required under the special statutes pursuant to which proceedings hereunder are taken and which have not been superseded by the provisions of the Labor Code. Preference to labor shall be given only in the manner provided by law. No bid shall be considered unless it is made on a form furnished by the City of Huntington Beach, Department of Public Works, and is made in accordance with the provisions of the proposal requirements. Each bidder must be licensed as required by law. The City Council of the City of Huntington Beach reserves the right to reject any or all bids. By order of the City Council of the City of Huntington Beach, California on the 8th day of September 2009, by RESOLUTION 2009-50. Joan L. Flynn City Clerk of the City of Huntington Beach 2000 Main Street. (714) 536-5431 Published Huntington Beach Independent September 16, 23, 30, 2010 --- ad proof pg. 1 --- Huntington Beach Independent has been adjudged a newspaper of general circulation in Huntington Beach and Orange County by Decree of the Superior Court of Orange County, State of California, under date of Aug. 24, 1994, case A50479. PROOF OF PUBLICATION STATE OF CALIFORNIA) ) SS. COUNTY OF ORANGE ) I am the Citizen of the United States and a resident of the County aforesaid; I am over the age of eighteen years, and not a party to or interested in the below entitled matter. I am a principal clerk of the HUNTINGTON BEACH INDEPENDENT, a newspaper of general circulation, printed and published in the City of Huntington Beach, County of Orange, State of California, and the attached. Notice is a true and complete copy as was printed and published on the following date(s): September 16, 23, 30, 2010 I declare, under penalty of perjury, that the foregoing is true and correct. Executed on September 30, 2010 at Costa Mesa, California Signature -..........for......__._. (C'-1204,1 246 and 12477 Notice is hereby given that sealed bids will be received by the City of luntington Beach at the office of the City Clerk at City Hall, 2000 Main street, Huntington Beach, CA 92648, until` the hour of 2:00 PM on October 7, 2010, at which time bids will be' opened publicly and read loud in the Council Chambers for the Traffic Signal Modifications at Irookhursf Street & Yorktown AvOaue, Newland Street & Atlanta venue and Magnolia Street 8 Atlanta Avenue, CC-1204, CC-1246 and CC-1247 in the City of Huntington Beach. set of: plans, specifications, and contract documents. may be obtained tar,ting September ,16, 2010 at City -Hall, Department of Public Works ppn 'receipt of ,a non-refundable fee of $40.00, sales,tax, included, if irked up or $50.00 if mailed. ach bid shall be made on the Proposal Form provided in the contract ocuments, and shall be accompanied.by'a certified or cashier's check rl a bid bond for 'not less than 10% of the amount of the bid, made ayable to the City of Huntington Beach. The Contractor shall, , in the erformance of the work and improvements, conform to the Labor Code f the State of, California and other' Laws of the State. of California pblicable thereto, with the exception only of such variations that may e1 required under the special statutes pursuant' to which proceedings ereunder are taken and which have not been superseded by the provisions flthe Labor :Code. Preference to labor shall be given only in the manner rovided bylaw. o.bid shall be considered unless it is made on a form furnished by thei ity .of Huntington Beach, Department .of Public Works; and is made ,in, ccordance with the provisions of.the proposal requirements. ach bidder must be licensed as required bylaw. h'e' City Council of the City of. Huntington Beach reserves the right to ;ject any or all bids. y order of the City Council of the City of Huntington Beach,. California n the 8th day of September 2009, by RESOLUTION'2009-50. )an L. Flynn ity Clerk of the City of Huntington Beach 2000 Main Street. (714) 536-5431 Published Huntington Beach Independent September. 16, 23, 30, 2010 Flynn, Joan From: timkarpinski@verizon.net Sent: Monday, November 01, 2010 3:07 PM To: Flynn, Joan Cc: timkarpinski@verizon.net Subject: Late Communication - City Council Meeting - 11/1/2010 Importance: High Hi Joan - Can you include this for tonight's meeting in Late Communication. To: City Council From: Tim Karpinski Subject: Added Left Turn arrows - Consent Calendar Item #7 - City Council Meeting 11/1/2010 I would like to thank the Public Works Department and their staff personnel for their work in securing funding for the added left turn arrows at Brookhurst and Yorktown streets in Huntington Beach. As stated, their have been many collisions at this intersection, many involving left turns in the east -west direction. One of the latest victims was a resident of Aragon Circle and fortunately, no one was seriously injured. I think everyone is looking forward to this improvement. Thanks again. Best Regards, Tim Karpinski HB Resident - Aragon Circle Atlanta St. City of Huntington Beach 2000 Main Street ® Huntington Beach, CA 92646 OFFICE OF THE CITY CLERIC JOAN L. FLYNN CITY CLERIC March 4, 2011 C. T. & F., Inc. Estimating Dept. 7228 Scout Ave. Bell Gardens, CA 90201 RE: CC-1204, CC-1246, & CC-1247 — Various Traffic Signal Modifications Enclosed please find your original bid bond for CC-1204, CC-1246 & CC-1247. Sincerely, Joan L. Flynn, CMC City Clerk JF:pe enclosure Sister Cite�i�oit9,Xr1��7�ar�t�tS�.C�cNew Zealand (Telephone- 714-536-5227) 2010 OCT -1 Ph' 1* 45 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 For Traffic Signal Modifications at Brookhurst Street and Yorktown Avenue & Newland Street and Atlanta Avenue & Magnolia Street and Atlanta Avenue, CC-1204, 1246 and 1247 September 27, 2010 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES DATED September 24, 2010. The Federal Labor Rates contained in Appendix I of the specifications for the: Traffic Signal Modifications at Brookhurst Street and Yorktown Avenue & Newland Street and Atlanta Avenue & Magnolia Street and Atlanta Avenue, CC-1204, 1246 and 1247 shall be replaced with the following attached documents: The Federal Labor Rates dated September 24, 2010 shall be the labor rates in effect for the subject project. 2) Sheet 2 of 4 (Traffic Signal Modification Plan — Brookhurst Street and Yorktown Avenue, CC-1204) The new conduit depicted between the westerly terminus of conduit #2 and the pull box south of the new southwest corner access ramp shall be 3-inch. Conduit #1 shall be extended to connect to the new pull box south of the new access ramp. All conductors in conduits #1, 2, 3 and 4 shall be new. All conductors to poles 5, 6, 7, 8 and 9 shall be new. This is to acknowledge receipt and review of Addendum Number One, dated September 27, 2010. Company Name By Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F. Janusz at (714) 536-5431. SECTION C PROPOSAL for the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue FEDERAL NOS. STPLHG-5181(139), STPLHG-5181(162) & STPLHG-5181(163) CC Nos. 1204,1246 & 1247 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and incident insurance necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within 50 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE .ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find a gid P a� in the amount of $ 0% Of -Ma bid said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or "Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: C-z Section C PROJECT BID SCHEDULE For CC Nos. 1204,1246 and 1247 PROJECT BID: Project Bid Summary: CC-1204 Brookhurst Street and Yorktown Avenue $ 714 07'Z • 1qIO CC-1246 Newland Street and Atlanta Avenue $ 1 `a1.1407. 7 Z CC-1247 Magnolia Street and Atlanta Avenue $ '� y 50.."Zo Total Bid Amount in ]Figures: $ Zi 2- 0 1.310, Total Bid Amount in Words: C-2.1 C-2.1 Project Bid Schedule Traffic Signal Modification at Brookhurst Street and Yorktown Avenue CC-1204 NEW .��iiy'_ w. ..A. Ima ..:C! rj.... xYS'. .C'^. trR.� �_l 4•��i.: .�W 1 1 L.S. Mobilization. Per L.S. 2 1 L.S. Survey Monument Preservation. Per L.S. 3 I L.S. Furnish Project Traffic Control. - 7/ + Q -3 3110 Per L.S. 4 I L.S. Modify Traffic Signal at Brookhurst Street and Yorktown Avenue. $i�l $ B Per L.S. 5 1 EA. Construct Curb Ramp per Caltrans Standard Plan A88A (Includes Adjacent Gutter Plate and AC $ S13 3 $ 0.4 Paving Replacement), Per EA. 6 1 EA. Construct Modified Curb Ramp (Located on the pf�5 i �i t Southwest Corner) per Caltrans Standard Plan $ $ A88A (Includes Adjacent Gutter Plate and AC Paving Replacement). Per EA. 7 2 EA Remove and Reconstruct Median Island Nose Including Curb, Stamped Concrete and A.C. yg $ Cl 10 $ Pavement. Per EA. Total Amount Bid in Figures: $ ., �+1`2-• ��c7 Total Amount Bid in Words: $��s`'d�►i� Note for CC-1204: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.2 Project Bid Schedule Traffic Signal Modification at Newland Street and Atlanta Avenue CC-1246 >. , .w, '� - �k - � �; L �yzs < � � �' I" "3 '�. '�. m ��-ae _`c' • „,.. �.ata:nTF�'x-:x,.� , r. �� ` � � -�'"V'..'^k •�`'N' f-- k`��y^ ' �'' •�� s +t •�� ^-�:T'.'L�ax..r. s^x,LS±.. I I L.S. Mobilization. Per L. S. 2 I L.S. Furnish Project Traffic Control. $ 'Zi C12,-e $ �� Per L.S. 3 1 L.S. Modify Traffic Signal at Newland Street and Atlanta Avenue. $ Per L.S. 4 4 EA. Construct Curb Ramp per Caltrans Standard Plan A88A (Includes Adjacent Gutter Plate and AC 5z ZO 3 ® '� Paving Replacement). Per EA. Total Amount Bid in Figures: $ i 1 i • 1 Z Total Amount Bid in Words: $firu�tLp�� o��^�+�� ► Note for CC-1246: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.3 Project Bid Schedule Traffic Signal Modification at Magnolia Street and Atlanta Avenue CC-1247 ... ` CL •'th, 'r r'irE'L^ `d� c..� ,sC'r..Yti tt 4 Sc,'r•^ ;V . ',w.rwr _ a" .:f..�J�nnY wn. `S [wROIa z..". 1 1 L.S. Mobilization. $ 2,5*31� $ L, 5196 Per L.S. 2 1 L.S. Survey Monument Preservation. Per L.S. 3 1 L.S. Furnish Project Traffic Control. 11 $ ��11-7 $ 7., ci 1 Per L.S. 4 1 L.S. Modify Traffic Signal at Magnolia Street and Atlanta Avenue. $ -T $ -7 Z.0 3'0�. Per L.S. 5 2 EA. Construct Curb Ramp per Caltrans Standard Plan A88A (Includes Adjacent Gutter Plate and AC $ .,51 t3 $ o" _ Paving Replacement. Per EA. Total Amount Bid in Figures: $ B-7,to S 0. ` -o Total Amount Bid in Words: $ �� 5 ° �7 Ci -A -vevD6t+D 1 o Note for CC-1247: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.4 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Portion Name andAddress. o, f :Subcoitractor State License ; Class : o work Ni SN�TNS��'rD�t.8U"'f�iC.►�a.l.l. _ . a 3i� • iLa►rs flv ice. Air C�1 �'71 0 i 4 'S1 t3 C- 1 "?b 4oz-f-I -met t-. one dr= l ,,ya wa .Q 11 By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 !MM i' iy ri i State of California ss. County of Orange RAL/ C?"qd l o rid , being first duly sworn, deposes and says that he or she is fires I dyit of LT SS E , The the party making the foregoing bid that the bid is not made in the interest of, or on the behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or, sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price, or that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. C T i Name of Bidder 'x�' A, ,a4 Siknaturr in,8 Scoot AyQ: 13t1 L 6vr&y6' Address of Bidder Cf goZ01 Subscribed and sworn to before me this day of _�_ , 20 NOTARY PUBLIC NOTARY SEAL C-4 See �► Bch State of California County of Los Angeles Subscribed and sworn to (or affirmed) before me on this 7th day of October , 20 10 , by Ruby Galland proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. LUKE GARCIA Commission * 1892580 �s Notary Public - California i a Los Angeles County Mix Comm. Ex ires Jun 13, 2014 (Seal) Signature �,,..- UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue, (1)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved." The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: (D 10 C-s LT Contractor By ark m is Via-- mA=n t Title DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury, the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? U Yes )(No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CER'TIFICA"TE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. Date: I am aware of the provisions of Section 3700 of the Labor Code which require 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. C-7 Contractor By maa aare",K- Vie't- f1roidtofi Title UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-4224133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: F T...�i Contractor Y V i at- Fre6'An-` Title Date: 10 10 Note: This form is required for every Dig Alert Identification Number issued by USA. during the course of the Work. Additional forms may be obtained from the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Bidder Name ,'22-$ Scoot Am Business Address City, State Zip Telephone Number 18 7,5 7Z- Ci 04 A, C i Z State Contractor's License No. and Class 4/1S/ t4 Original Oate Issued '30 Date 0IZ The work site was inspected by -odd �� 1f110i1�of our office on 5k t 22 , 201b The following are persons, firms, and corporations having a principal interest in this proposal: UW iraUdnd , r/5 ' T rzasurer osVia - 1 6' (� �t Vl1 �10 QS � 1 u (i ,Ma& C-arcd, Viet-I� �, C-9 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Company Name 6I Printed or Typed Signature Subscribed and sworn to before me this Z day of IFZ - , 200/. NOTARY PUBLIC NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: 1. Please set aftc&ed of 1 1P16 Name and Address of Public Agency 2. a Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed C-10 State of California County of Los Angeles Subscribed and sworn to (or affirmed) before me on this 7th day of October , 2010 , by Ruby Galland proved to me on the basis of satisfactory evidence to be the p rs o-ai)oaarad-befoxame. LUKE GARCIA Commission * 1892580 a i Notary Public • California z z Los Angeles County My Comm. Ex ires Jun 13, 2014 (Seal) Signature "� Job# Agog 7 Title Contract ' Com letion Date Contact Contact Phone# 5255 Los Angeles Security Lighting Unit 15 $308,000 1 Currently Active I Aboul Hosn (213) 847-1430 Brief Description: Going Green! CT&F got the call to furnish and install the first solar street lighting project in Los Angeles County 5300 1 Los Angeles I ATSAC: Platt Ranch 1 $3,736,300 1 Currently Active I Manoochehr Adhami (213) 847-0303 Brief Description: CT&F is the General Contractor on this project, coordinating multiple subcontractors while modifying traffic signals, street lighting, and installing an interconnect system of four miles with our own forces Job# I Agency Title I Contract Com letion Date Contact Contact Phone# 5207 1 Newport Beach I Jamboree Road TS Mod. 1 $520,300 Currently Active Brad Summers (949) 644-3326 Brief Description: Interconnect system and upgrading of traffic signals at various intersections Job # Actency 7 Title I Contract Com letion Date I Contact Contact Phone# 5029 Los Angeles I Valley Grade Separation 1 $2,525,000 Currently Active I Mac Delaney (949) 470-0500 Brief Description: This job consists of traffic signal modifications and street lighting with multiple move -ins. Job # I A enc 7 Title Contract I Completion Date Contact Contact Phone# 5019 1 Los Angeles I L.A. Live Project $1,700,000 1 Currently Active Bill Grauten (562) 929-1128 Brief Description: Upgrade existing traffic signal system, install street lighting, traffic signal interconnect, CCTV, and fiber optic work Job # A enc Title I Contract I Completion Date Contact Contact Phone# 5170 Los Angeles I West L.A. Unit II Conversion 1 $2,740,000 1 Currently Active Robert Tom (213) 847-1811 Brief Description: Conversion of street lighting system in west Los Angeles from series circuit to multiple circuit, including installation of over 60, 000 feet of conduit. 5201 1 Torrance I Rolling Hills Way 1 $530,000 1 Currently Active I Craig Bilezerian (310) 618-3054 Brief Description. CT&F was the General on this project while installing a new traffic signal ourselves we subcontracted the installation of a new landscaped median island area. Job# I Kgo-sy 7 Title I Contract Com letion Date Contact Contact Phone# 5207 1 Santa Monica I Street & Park Lighting 1 $921,500 Currently Active Anthony Antrich (310) 458-8721 Brief Description. Replace street and park lighting at various locations in Santa Monica (For federally funded projects, use this following page) BIDDER'S CERTIFICATION* HOUSING AND URBAN DEVELOPMENT ACT OF 1968 AS AMMENDED 1N 1992, SECTION 3 TITLE 24, Code of Federal Regulations, Part 135* Economic Opportunities for Low and Very Low -Income Persons The bidder, under penalty of perjury, certifies that except as noted below, any person associated therewith in the capacity of owner, partner, director, officer, or manager (initial the applicable selections): Will ensure that 10% of all new hires as a result of this project shall meet all requiremnents of Section 3 of CFR Part 135 of the HUD Act of 1968; or Will hire no new employees in conjunction with this project. Will award 10% of its sub -contracts to Section 3 businesses. This certification shall apply to the prime contractor's sub -contracts related to this project. Contractor: _L T � E , 1h01- Contact Person: Mark Cnare,i a Contact Phone: �� I 7,�39 Signed: Date- i 0 % 1® �T *Note: The above certification is required by the Department of Housing and Urban Development (24 CFR 135 and Subtitle A et al) and must be submitted by the bidders and proposed sub -contractors only in connection with contracts and subcontracts which are subject to Section 3 of the 1968 Housing and Urban Development Act, as amended in 1992 (HUD). Previous non-compliance with Section 3 could result in disqualification. C-11 Local Assistance Procedures Manual EXIIJBIT 12-E PS&E Checklist Instructions Attachment B (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder C. , g , proposed subcontractor hereby certifies that he has_ e- has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts, which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-13(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Page 12-79 LPP 01-04 C-12 March 15, 2001 Public Contract Code Section 10285.1 Statement In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has _, has not Vbeen convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of; or performance of, any public work contract, as defined in Public Contract Code Section 1101, with a any public entity, as defined in Public Contract Code Section 1100, including Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Public Contract Code Section. 10162 Questionnaire In conformance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire: Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or safety regulation? Yes No If the answer is yes, explain the circumstances in the following space. C-13 Public Contract Code Section 10232 Statement In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final non -appealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor with an order of the National Labor Relations Board. Note: The above Statement and Questionaire are part of the bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. C-14 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment D Noncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY / COUNTY of ®ra n �q DEPARTMENT 01 PUBLIC WORKS_ In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that 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, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Page 12-81 LPP 01-04 C-15 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment E DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, and manager: ® Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; • Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past 3 years; 6 Does not have a proposed debarment pending; and 9 Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Page 12-83 LPP 01-04 C-16 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment lF NONLOBB'YING CERTIFICATION FOR FEDERAL -AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that- (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify and disclose accordingly. Page 12-85 LPP O1-04 C-17 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment G DISCLOSURE OF LOBBYING ACTIVITIES 1'VKM "1V VINULV5.b LUBBY1NUAUJIVITWS PURSUANT 'lU 31 U.S.U. 135Z 1. Type of Federal Action: a. contract b. grant c. cooperative agreement d. loan e. loan guarantee f. loan insurance 2. Status of Federal Action: Fla. bid/offer/application b. initial award c. post -award 4. Name and Address of Reporting Entity 13 Prime 11 Su ardee ier Congressional D/trict,fknown 6. Federal Devar 8. Federal Action NumOv. if known: 3. Report Type: Fla. initial b. material change For Material Change Only: year _ quarter date of last report _ 5. If Reporting EnHfYtiWo., 4 is Subawardee, Enter Name and Address of 11rime; if known dot ieabli_ f Tonal District, if known 7. Federal Program Name/Description: CFDA Number, if applicable 9. Award Amount, if known: 10. a. Name and Address of Lobby Entity b. Individuals Performing Services (including (If individual, last name, first name, MI) address if different from No. I Oa) (last name, first name, MI) (attach Continuation Sheet(s) if necessary) 11. Amount of Payment (check all that apply) $ ❑ actual planned 12. Form of Payment (check all that apply): 8 a cash b. in -kind; specify: nature value 13. Type of Payment (check all that apply) a. retainer b. one-time fee c. commission d. contingent fee e deferred ff, other, specify 14, Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if necessary) 15. Continuation Sheet(s) attached: Yes 11 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only: No 11 Signature: Print Name: __ffla rIC V g ai a— Title: '"Vi eu��n Telephone No.:'Z Jif Date: 10 Authorized for Local Reproduction Standard Form - LLL Rev. Page 12-87 LPP 01-04 C-18 March 15, 2001 EXHIBIT 12-E Attachment G Local Assistance Procedures Manual PS&E Checklist Instructions INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient, at the initiation or receipt of covered federal action or a material change to previous filing pursuant to title 31 U.S.C. Section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered federal action. 2. Identify the status of the covered federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subawadd recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, State and zip code of the prime federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate federal identifying number available for the federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the federal agency). Include prefixes, e.g., "RFP-DE-90-001." 9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter the federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in -kind contribution, specify the nature and value of the in -kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. Page 12-88 March 15, 2001 C-19 LPP 01-04 Local Assistance Procedures Manual PS&E Checklist Instructions EXHIBIT 12-E Attachment G 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with federal officials. Identify the federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. SF-LLL-Instructions Rev.06-04-90<(ENDM) Page 12-89 LPP 01-04 C-20 March 15, 2001 KNOW ALL BY THESE PRESENTS, That we, C.T.& F.-INC. of 7228 SCOUT AVE. BELL GARDENS, CA 90201 (hereinafter called the Principal), as Principal, and BERKLEY REGIONAL INSURANCE COMPANY (hereinafter called the Surety), as Surety are held and fu-mly bound unto CITY OF HUNTINGTON BEACH (hereinafter called the Obligee) in the penal sum of TEN PERCENT OF AMOUNT BID Dollars ($ 10% ) for the payment of which the Principal and the Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, Firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, That WHEREAS, the Principal has submitted or is about to submit a proposal to the Obligee on a contract for TRAFFIC SIGNAL MODIFICATIONS AT BROOKHURST ST. & YORKTOWN AVE. & NEWLAND ST. AND ATLANTA AVE & MAGNOLIA ST. AND ATLANTA AVE. NOW, THEREFORE, If the said Contract be timely awarded to the Principal and the Principal shall, within such time as may be specified, enter into the Contract in writing, and give bond, if bond is required, with surety acceptable to the Obligee for [lie faithful performance of the said Contract, then this obligation shall be void; otherwise to remain in full force and effect. Signed and sealed this 28TH day of SEPTEMBER 2010 C.T.&F. INC. (Sea)) Principal Witness Title Witness By INSURANCE COMPANY PHILZIGA Attorney -in -Fact No. i916a POWER OF ATTORNEY BERKLEY REGIONAL INSURANCE COMPANY WILMINGTON, DELAWARE NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof Please review carefully. KNOW ALL MEN BY THESE PRESENTS, that BERKLEY REGIONAL INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Delaware, having its principal office in Urbandale, Iowa, has made, constituted and appointed, and does by these presents make, constitute and appoint: Philip Vega, Frank Morones or Jadon H. Smith of C & D Bonding & Insurance Services, Inc. of Covina, CA its true and lawful Attorney -in -Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver any and all bonds and undertakings, with the exception of Financial Guaranty Insurance, providing that no single obligation shall exceed Fifty Million and 001100 Dollars ($50,000,000.00), to the same extent as if such bonds had been duly executed and acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on August 21, 2000: "RESOLVED, that the proper officers of the Company are hereby authorized to execute powers of attorney authorizing and qualifying the attorney -in -fact named therein to execute bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the corporate seal of the Company to powers of attorney executed pursuant hereto; and further RESOLVED, that such power of attorney limits the acts of those named therein to the bonds, undertakings, recognizances, or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the manner and to the extent therein stated; and further RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney -in -fact named; and further RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have ceased to be such at the time when such instruments shall be issued." IN WITNESS WHEREOF, the Company has caused these presents to be signed and attested by its appropriate officers and its corporate seal hereunto affixed this day of Y�'---�� , 2010. Attest: Berkley nal Insurance Company (Seal) By By ra S. Lecferman Robert P. Cole Senior Vice President & Secretary Senior Vice President WARNING: THIS POWER INVALID IF NOT PRINTED ON BLUE "BERKLEY" SECURITY PAPER. STATE OF CONNECTICUT ) ss: COUNTY OF FAIRFIELD ) Sworn to before me, a Notary Public in the State of Connecticut, this day of , 2010, by Robert P. Cole and Ira µ: S. Lederman who are sworn to me to be the Senior Vice President, and the Senior Vice President and Secretary, respectively, of -Berkley Regional Insurance Company. EILEEV ' ' �;rN ' No TI-1 _30,-012 Notary Public, State,of Connecticut 3 c7 2 tb 1 CERTIFICATE 1, the undersigned, Assistant Secretary of BERKLEY REGIONAL INSURANCE COMPANY, DO HEREBY CERTIFY that the foregoing is a true, correct and complete copy of the original Power of Attorney; that said Power of Attorney has not been revoked -or rescinded and that the authority of the Attorney -in -Fact set forth therein, who executed the bond or undertaking to which this ;_Power of Attorney is attached, is in full force and effect as of this date. September 2010 Given under my hand and seal of the Company, this 2 8 day of p (Seal) AA�--�t-�r�. Steven Coward CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Los Angeles On 0 9 / 2 8 / 2 010 before me, Monica Blaisdell, Notary oats re Irmed Name andd the Ofter personally appeared Philip Vejja Names of signer(s) A____4 MONICA BLAISDI:LL Commission # 1794078 z ; - Notary Public - Californiazz z Y ' Orange County Comm. ss Mor26, 2012 who proved to me on the basis of satisfactory evidence to be the personal whose name(h) is/f t subscribed to the within instrument and acknowledged to me that he/56FItMexecuted the same in hi1s1W/jh6&authorized capacity(baX and that by his)k t signature(4(on the instrument the person(), or the entity upon behalf of which the person(x) acted, executed the instrument. I certify under PENALTY OF PERJURY under the taws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. ` Signature Flare Notary Seal Above Signature of Notary Public OPTIONAL Though the information below is not required by law, if may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Blame: C7 'Individual ❑ Corporate Officer — Title(s): _ ❑ Partner — ❑ Limited © General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: R'GNT TliL'(i78F?NINT' _ t)1=,SIGlJE�1 Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer — Titfe(s): ❑ Partner — 0 Limited ❑ General _ ❑ Attorney in Fact ° O Trustee Top of thumb here ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 02007N:onalNotaryA360dellon-9350oeSoto Ave- P.O. Box 2402•Chatswanh,CA91313-2402•wvnv.Nedonaftlaryorg Itemt15907 Aemder:CagTdl-Frees-900876-6827 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT ATE OF CALIFORNIA OUNTY OF LOS ANGELES On October 7, 2010 before me, LUKE GARCIA, NOTARY PUBLIC Name and Title of Officer (e g. " Jane Doe, Notary Publice) personally appeared Ruby Galland Name of signer(s) LUKE GARCIA Commission # 1892580 i , -a Notary Public - California a z ' Los Angeles County My Comm. Ex ires Jun 13, 2014 Place Notary Seal Above aPersonally known to me Proved to me on the basis of satisfactory evidence to be the person(&) whose name(&) is/afe subscribed to the within instrument and acknowledged to me that he/she" executed the same in-#is/herAhe+r authorized capacity (+es), and that by his/her/theif signature(-&-) on the instrument the person(s), or the entity upon behalf of which the person(O acted, executed the instrument. WITNESS my hand and official seal. j2 4, &;, Signature of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached document Title or Type of Document: _ and Document Date: 20140 Number of Pages: v\b+atf J Signer(s) Other than Named Above: P6,1 P Vgget Capacity(ies) Claimed by Signer Signer's Name: . RIGHT THUMBi=Rl9F OF SIGNER Individual - TOP OF RHUMB HERE ® Corporate Officer-Title(s) PRESIDENTITREASURER Partner-F-1 Limited-❑ General-❑ Attorney -in-fact Trustee Guardian or Conservator Other: Signer is Representing: C.T.& F., INC. City ®f Huntington Beat 2000 Main Street ® Huntington Beach, CA 91648 OFFICE OF THE CITY CLERIC JOAN L. FLYNN CITY CLERK March 4, 2011 Lincoln Pacific 4501 Littlejohn St. Baldwin Park, CA 91706 RE: CC-1204, CC-1246, & CC-1247 —Various Traffic Signal Modifications Enclosed please find your original bid bond for CC-1204, CC-1246 & CC-1247. . -- Joan L. Flynn, CMC City Clerk J F: pe enclosure Sister Ci@fgRlloAvfW (SalWigaWetuWiYkW , New Zealand (Telephone: 714-536- a227 ) 201HU -7 PIN l; 5 f clqy o� �-v►�Z� rJ�To�I T tr1t e-t Tom/ Ssr,f&�- C L 9264t for the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue FEDERAL NOS. STPLHG-5181(139), STPLHG-5181(162) & STPLHG-5181(163) CC Nos.1204,1246 & 1247 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL, OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and incident insurance necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within 50 working days, starting from the date -of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void, Accompanying this proposal of bid, find M aN in the amount of $ to % which said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or "Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: Addenda No. Date Received Bidder." s Si nature.. ; . . `II C-z Section C PROJECT BID SCHEDULE For CC Nos. 1204, 1246 and 1247 PROJECT BID: Project Bid Summary: CC-1204 Brookhurst Street and Yorktown Avenue $ (6-1/ -7160 - " CC-1246 Newland Street and Atlanta Avenue $ 1?.9 t 110 ° CC-1247 Magnolia Street and Atlanta Avenue $ -71 6 -7 9 '2 ° Total Bid Amount in Figures: $ Z 341 3 ° UD Total Bid Amount in Words: C-2.1 M 41 Project Bid Schedule Traffic Signal Modification at Brookhurst Street and Yorktown Avenue CC-1204 E-M 1 1 L.S. Mobilization. Per L.S. 2 1 L.S. Survey Monument Preservation. $$.Qom $ ZQOA .A'9 Per L.S. 3 1 L.S. Furnish Project Traffic Control. $ $'3110 d 00 Per L.S. 4 1 L.S. Modify Traffic Signal at Brookhurst Street and Yorktown Avenue. $ t $ Per L.S. 5 1 EA. Construct Curb Ramp per Caltrans Standard Plan A88A (Includes Adjacent Gutter Plate and AC $ 1(m° $ $t Paving Replacement), Per EA. _ 6 1 EA. Construct Modified Curb Ramp (Located on the Southwest Corner) per Caltrans Standard Plan $ L/tU �� ° $ A88A (Includes Adjacent Gutter Plate and AC Paving Replacement). Per EA. 7 2 EA Remove and Reconstruct Median Island Nose Including Curb, Stamped Concrete and A.C. $ L o $ 30 Pavement. Per EA. �+ Total Amount Bid in Figures: $ C/ `VO a 7(d . Rio Total Amount Bid in Words: $ S 1'XT `- NPJ L TIh 114 X 9V SORI573 Note for CC-1204: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2,2 Project Bid Schedule Traffic Signal Modification at Newland Street and Atlanta Avenue CC -1246 1 1 L.S. Mobilization. $S, 0OU 01 $ 91CW u a Per L. S. 2 1 L.S. Furnish Project Traffic Control. Per L.S. 3 1 L.S. Modify Traffic Signal at Newland Street and Atlanta Avenue. $ (y74 $ �67i 6Od - ft Per L.S. 4 EA. Construct Curb Ramp per Caltrans Standard Plan 3 114-� ff gm r A88A (Includes Adjacent Gutter Plate and AC $ e7OV •ni $ Paving Replacement). Per EA. Total Amount Bid in Figures: $ tl �y l a U Total Amount Bid in Words: $ �l 6 H_rY -_ l f1i f `rov USA74P t N ®AJ e � 0 t Note for CC-1246: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. G2.3 Project Bid Schedule Traffic Signal Modification at Magnolia Street and Atlanta Avenue CC-1247 �' .. J8i�1' ..^n.`. � T L"a( sif: "✓"�, '9y��'C•�t �. � t ..�'i �'�,"l' u, `rr".... .'f. "-::5+?::r„x.� �.£'y."S.h ..�f,''�u".,.'y i1 ,;+.` •"•• , �" . r�u .N' � 'au't�'.4.^ `may, i '�,.N" w.,xz,u, ai ;�w4�,`�}„`�w,-a �.s'-""ceei^' „� C~ _ _ - t-'��4'�''�^;:• e 1 1 L.S. Mobilization. Per L.S. 2 1 L.S. Survey Monument Preservation. $�gv®v• 40 $ Z®OV3 o 66 Per L.S. 3 1 L.S. Furnish Project Traffic Control. Per L.S. 4 1 L.S. Modify Traffic Signal at Magnolia Street and Atlanta Avenue. o t Cm .' Per L.S. 5 2 EA. Construct Curb Ramp per Caltrans Standard Plan __ J/ 7®�3�-• ANA (Includes Adjacent Gutter Plate and AC $ $ Paving Replacement. Per EA. Total Amount Bid in Figures: $ -76 o -7 a" Total Amount Bid in Words: $ 5CPVVJ� " r �'� T ► VVJ9 eye�i i7 WIP —' !^J Note for CC-1247: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street, Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.4 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Podion: Name artd-Address:w':.Sub'cantructor tateaicense 'lass f.. 0 lark = wumber 64 t4NW -9a-6`A WrMe4oj C d b?o By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ss. County of Orange wo"4&14 C44AA , being first duly sworn, deposes and says that he or she is Cq519 of UN=N PACIFIC BUILDERS, M the party making the foregoing bid that the bid is not made in the interest of, or on the behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price, or that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay fee -to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. UNCOLN PACIFIC BUILDERS, NO Address of Bidder Subscribed and sworn to before me this �P" day of aG c)i ,i , 20 t 0 . NOTARY PUBLIC C-4 Te?o& DAVID A. T188 Commission # 188013� 1 = i Notary Public - California z Riverside County r AA Comm. Ex ires Feb 13, 2014 NOTARY SEAL UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue, (1)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises -and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall -take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: 10- ®6. t® C-5 UNCOIN PACIFIC BUMPERS, INC Contractor LOM Title DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury, the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? Cl Yes I/ No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. 1 am aware of the provisions of Section 3700 of the Labor Code which require 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 1 will comply with such provisions before commencing the performance of the work of this contract. Date; 10.0610 C-7 Title L INCOLN PACIFIC BUILDERS, INC UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: -My LINCOLN PACIFIC BUILDERS, INC Date: l® Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work. Additional forms may be obtained from the AGENCY upon request. C-s BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: LINCOLN PACIFIC BUILDERS, INC Bidder Name qR0(_ L#-rr *joHtj i Business Address City, State Zip Telephone Number / 025 q& d sus l C-10 State Contractor's License No. and Class Original Date Issued Expiration Date The work site was inspected by 0 06QJ W ® SJ t,, of our office on O C-T. 6 , 20 90 The following are persons, firms, and corporations having a principal interest in this proposal: � r' �. J lr IW 111 � KAN'rell Mim 11. C-9 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. LINCOLN PACIAC RJADERS. INC Company of Bidder _ 1164 toL Printed or Typed Signature Subscribed and sworn to before me this (A day of W66— , 20,V1 DAVID A. TAFT Commission # 18801351z -r' Notary Public - California zz Riverside County �vMy Comm. Expires Feb 13, 2014 NOTARY PUBLIC 7•►� w+�►r NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: Name and Address of Public Agency Name and Telephone No. of Project Manager: 500 CvA99®AlGf-Z-, ( &3&) 74gv 44Pg3 Contract Amount Type of Work Name and Address of Public Agency OCT. &101® Date Completed Name and Telephone No. of Project Manager: /`,�HMptA® A .j(PJV HoA* a 313, 0 0 a %57#ef yr JUde 2-PeQ Contract Amount Type of Work Date Completed Name and Address of Public Agency Name and Telephone No. of Project Manager: 149N L� JeM"/Ad (812,)5d1V -J?` r 1�5 -7y 1, 000 'S''zSe-9 &140i3 4 %fire- .L/WA L J444).0 2�0!� Contract Amount Type of Work Date Completed C-10 (For federally funded projects, use this following page) BIDDER'S CERTIFICATION* HOUSING AND URBAN DEVELOPMENT ACT OF 1968 AS AMMENDED IN 1992, SECTION 3 TITLE 24, Code of Federal Regulations, Part 135* Economic Opportunities for Low and Very Low -Income Persons The bidder, under penalty of perjury, certifies that except as noted below, any person associated therewith in the capacity of owner, partner, director, officer, or manager (initial the applicable selections): Will ensure that 10% of all new hires as a result of this project shall meet all requiremnents of Section 3 of CFR Part 135 of the HUD Act of 1968; or Will hire no new employees in conjunction with this project, Will award 10% of its sub -contracts to Section 3 businesses. This certification shall apply to the prime contractor's sub -contracts related to this project. Contractor: UNCOLN PACIFIC BUILDERS, INC Contact Person: Contact Phone: Signed: Date: *Note: The above certification is required by the Department of Housing and Urban Development (24 CFR 135 and Subtitle A et al) and must be submitted by the bidders and proposed sub -contractors only in connection with contracts and subcontracts which are subject to Section 3 of the 1968 Housing and Urban Development Act, as amended in 1992 (HUD). Previous non-compliance with Section 3 could result in disqualification. C-11 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH AREA PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder UNCOLN PACIFIC BUILDERS, INC proposed subcontractor , hereby certifies that he has ! has not_, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41-CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts, which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Page 12-79 LPP 01-04 C-12 March 15, 2001 PUBLIC CONTRACT CODE Public Contract Code Section 10285.1 Statement In conformance with Public Contract Code Section 10285.1(Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has has not / been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of; or performance of, any public work contract, as defined in Public Contract Code Section 1101, with a any public entity, as defined in Public Contract Code Section 1100, including Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Statement. -Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Public Contract Code Section 10162 Questionnaire In conformance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire: Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or safety regulation? Yes _ No d If the answer is yes, explain the circumstances in the following space. C-13 Public Contract Code Section 10232 Statement In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final non -appealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor with an order of the National Labor Relations Board. Note: The above Statement and Questionaire are part of the bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. C-14 Local Assistance Procedures Manual PS&E Checklist Instructions Noncoiiusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY /"MRtMY of M(AeJ-r1 d 4--r&A WACq DEPARTMENT OF PUBLIC WORKS_ EXHIBIT 12-E Attachment D In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that 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, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Page 12-81 LPP 01-04 C-15 March 15, 2001 Local Assistance Procedures Manual PS&E Checklist Instructions ]DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE Or FEDERAL REGULATIONS, PART 29 EXHIBIT 12-E Attachment E The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, and manager: v Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; • Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past 3 years; • Does not have a proposed debarment pending; and • Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Page 12-83 LPP 01-04 C-16 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment F NONLOBBYYING CERTIFICATION FOR FEDERAL -AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify and disclose accordingly. Page 12-85 LPP 01-04 C-17 March 15, 2001 b�dl (� Local Assista a Procedures Manual PS&E Che i' st Instructions EXHIBIT 12-E Attachment G DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352 1. Ty e of Federal Action: 22.. Status of Federal Action: 3. Report Type: F] a. contra �J a. bid/offer/application ❑ a. initial b. grant b. initial award b. material change c. cooperative a eement c. post -award d. loan For Material Change Only: e, loan guarante year, quarter f. loan insuran daze of last report 4. Name and Ad ress of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Prime Subawardee Tier , if known Congressional District, if known Congressional District, if known 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable 8. Federal Action Number, if known: 9. Award Amount, if known:: 10. a. Name and Address of Lobby utity b. Individuals Performing Services (including (If individual, last name, first n e MI) address if different from No. 10a) —�� (last name, first name, MI) 11. 12. 14. (attach Continuation Sheet(s) ifnecessary) Amount of Payment (check all that apply) 13. f Type of Payment (check all that apply) $ ❑ actual planned a. retainer b. one-time fee Form of Payment (check all that apply): c. commission 8 a. cash d. contingent fee b. in -kind; specify: nature a deferred value f other, specify Brief Description of Services Performed or to be performed and Date(s) of Service, ' cluding officer(s), empioyee(s), or member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if necessary) 15. Continuation Sheet(s) attached: Yes ❑ No 16. information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above when his transaction was made or entered into, This disclosure is required pursuant to 31 print Name: U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any Title: person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Telephone No.. - Federal Use Only: LLL Rev. 09-12-97 Authorized for Local Standard Form - LLL Page 12-87 LPP 01-04 C-18 March 15, 2001 EXHIBIT 12-E Attachment G Local Assistance Procedures Manual PS&E Checklist Instructions INSTRUCTIONS FOR COMPLETION OF SF•LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient, at the initiation or receipt of covered federal action or a material change to previous filing pursuant to title 31 U.S.C. Section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. l . Identify the type of covered federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered federal action. 2. Identify the status of the covered federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, State and -zip code of the prime federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate federal identifying number available for the federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the federal agency). Include prefixes, e.g., "RFP-DE-90-001." 9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter the federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Cheek all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in -kind contribution, specify the nature and value of the in -kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. Page 12-88 March 15, 2001 C-19 LPP 01-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment G 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with federal officials. Identify the federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. SF-LLL-Instructions Rev.06-04-90«ENDIF» Page 12-89 LPP 01-04 C-20 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 15-G1 Local Agency Bidder UDBE Coruadtment (Construction Contracts) EXHIBIT 15-G1 LOCAL AGENCY BIDDER UDBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCALAGENCY: C-1-04 AE! R%4%,jT1Q I 06qqj LOCATION: paT1tJ��IZ)t�I 136ACAJa CA PROJECT DESCRIPTION: `ram TOTAL CONTRACT AMOUNT: $ 259 IF Q a BID DATE: 10• la-7- I O BIDDER'S NAME: UNCOLN PACIRC BUILDERS, INC CONTRACT UDBE GOAL: 5. ! B 04 CONTRACT ITEM NO. ITEM OF WORK AND DESCRIPTION OR SERVICES TO BE SUBCONTRACTED OR MATERIALS O BE PROVIDED (or contracted if the bidder is a UDBE) UDBE CERT NO, AND EXPIRATION DATE NAME OF EACH UDBE (Must be certified on the date bidSUDBE are opened - include UDBE address and phone number) DOLLAR AMOUNT �1�.0 �1, 1 ��s�+3 a-1NGO1. c- :7sg 000. C-&-l2 IR � 3 � -4111 ®� qq MM For Local Agency to Complete: Local Agency Contract Number: Federal -aid Project Number: Federal Share: Contract Award Date: Local Agency certifies that all UDBE certifications have been verified and information is complete and accurate. Print Name Signature Date Local Agency Representative (Area Code) Telephone Number: Total Claimed UDBE Participation $ -75I ®QU . --IVA Sign re of Bidder J Date 1 (Area Code) Tel. No. / ,1�(� /�pQ,,,J, Person to Contact (Please Type or Print) Local Agency Bidder UDBE Commitment (Construction Contracts) (Rev 6/26/09) Distribution: (1) Original — Local agency files Page 15-31 LPP 09-02 C-21 July 31, 2009 EXHIBIT 15-GI Local Assistance Procedures Manual Local Agency Bidder UDBE Commitment (Construction Contracts) INSTRUCTIONS - LOCAL, AGENCY BIDDER UDBE COMMITMENT (CONSTRUCTION CONTRACTS) ALL BIDDERS: PLEASE NOTE: It is the bidder's responsibility to verify that the UDBE(s) falls into one of the following groups in order to count towards the UDBE contract goal: 1) African Americans; 2) Asian -Pacific Americans; 3) Native Americans; 4) Women. This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must submitted and received as specified in the Special Provisions. Failure to submit the required UDBE commitment will be grounds for finding the bid nonresponsive A UDBE is a firm meeting the definition of a DBE as specified in 49 CFR and is one of the following groups: African Americans, Asian -Pacific Americans, Native Americans, or Women. The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract UDBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by UDBEs. Prime contractors shall indicate all work to be performed by UDBEs including, if the prime is a UDBE, work performed by its own forces, if a UDBE. The UDBE shall )rovide a certification number to the Contractor and expiration date. Enter the UDBE prime's and subcontractors' certification numbers.The form has a column for the Names of UDBE contractors to perform the work (who must be certified on the date bids are opened and include the UDBE address and phone number). IMPORTANT: Identify all UDBE firms participating in the project regardless of tier. Names of the First -Tier UDBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the UDBE participation dollar amount. Enter the Total Claimed UDBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the UDBE, describe exact portion of time to be performed or furnished by the UDBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of UDBE firms. Exhibit 15-G1 must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Leal agencies should complete the Local Agency Contract Award, Federal -aid Project Number, Federal Share, Contract Award Date fields and verify that all information is complete and accurate before signing and filing. Page 15-32 July 31, 2009 C-22 LPP 09-02 Local Assistance Procedures Manual Exhibit 15-H UDBE Information - Good Faith Effort EXHIBIT 15-H UDBE INFORMATION ----GOOD FAITH EFFORTS UDBE INFORMATION - GOOD FAITH EFFORTS u FLHCT-5181 (131) Federal -aid Project No. (16va-) "® (p 63 N Bid Opening Date 90> 07-1® WWRO1,7VO The /County of) 82%*f established an Underutilized Disadvantaged Business Enterprise (UDBE) goal of %o for this project. The information provided herein shows that a good faith effort was made. Lowest, second lowest and third lowest bidders shall submit the following information to document adequate good faith efforts. Bidders should submit the following information even if the "Local Agency Bidder UDBE Commitment" form indicates that the bidder has met the UDBE goal. This will protect the bidder's eligibility for award of the contract if the administering agency determines that the bidder failed to meet the goal for various reasons, e.g., a UDBE firm was not certified at bid opening, or the bidder made a mathematical error. Submittal of only the "Local Agency Bidder UDBE Commitment" form may not provide sufficient documentation to demonstrate that adequate good faith efforts were made. The following items are listed in the Section entitled "Submission of UDBE Commitment" of the Special Provisions: A. The names and dates of each publication in which a request for UDBE participation for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications Dates of Advertisement B. The names and dates of written notices sent to certified UDBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the UDBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Nantes of UDBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation Page 15-33 LPP 09-02 C-23 July 31, 2009 -Exhibit 15-H Local Assistance Procedures Manual UDBE Information -Good Faith Effort C. The items of work which the bidder made available to UDBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate UDBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate UDBE participation was made available to UDBE firms. Items of Work Bidder Normally Breakdown of Performs Item Items Amount Percentage ($) Of Contract D. The names, addresses and phone numbers of rejected UDBE firms, the reasons for the bidder's rejection of the UDBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each UDBE if the selected firm is not a UDBE: Names, addresses and phone numbers of rejected UDBEs and the reasons for the bidder's rejection of the UDBEs: Names, addresses and phone numbers of firms selected for the work above: E. Efforts made to assist interested UDBEs in obtaining bonding, lines of credit or insurance, and any technical assistance or information related to the plans, specifications and requirements for the work which was provided to UDBEs: Page 15-34 July 31, 2009 C-24 LPP 09-02 Local Assistance Procedures Manual Exhibit 15-H UDBE Information - Good Faith Effort F. Efforts made to assist interested UDBEs in obtaining necessary equipment, supplies, materials or related assistance or services, excluding supplies and equipment the UDBE subcontractor purchases or leases from the prime contractor or its affiliate: G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using UDBE firms (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.): Name of Agency/Organization Method/Date of Contact Results I H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. Page 15-34a LPP 09-02 C-25 July 31, 2009 Local Assistance Procedures Manual EXHIBIT 15-G2 Local Agency Bidder DBE Information (Construction Contracts) ]EXHIBIT 15-G2 LOCAL AGENCY BIDDER DBE INFORMATION (CONTRUCTION CONTRACTS) (Inclusive of all DBEs including the UDBEs listed at bid proposal) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCALAGENCY: OF* 64kATINcVIJ Cft( LOCATION: WNT6 4 PROJECT DESCRIPTION: M C-h IN t`�'t C`A Ir 10 1�1 TOTAL CONTRACT AMOUNT: $ BIDDATE t0•• 10 BIDDERS NAME: UNCOLN PACIFIC BUILDERS, INC CONTRACT UDBE GOAL: 5^ 1 -.,� Y. CONTRACT ITEM NO. ITEM OF WORK AND DESCRIPTION OR SERVICES TO BE DBE CERT NO. AND EXPIRATION NAME OF EACH DBE (Must be certified on the date bids DOLLAR AMOUNT DBE SUBCONTRACTED OR MATERIALS DATE are opened - include DBE address O BE PROVIDED (or contracted if the and phone number) bidder is a DBE -12 t , i® ftig cc, IN 3 cc- -1 41 Lt For Local Agency to Complete: Total Claimed DBE s �� Local Agency Contract Number: Participation -- Federal -aid Project Number: O Federal Share: Contract Award Date: Local Agency certifies that all DBE certification have been verified and �L�1 Information is complete and accurate. Signa ofBidAder Print Name Signature Date Local Agency Representative Date (Area Code) Tel. No. L. Area Code Telephone Number: L l A) (,0 LO Ci&iAiJ . CC-Icil For Caltrans Review: Person to Contact (Please Type or Print) Print Name Signature Date Caltrans District Local Assistance Engineer Local Agency Bidder DBE Information (Constriction Contarcts) (Rev 6/26/09) Distribution: (1) Copy — Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within 15 days of contract execution. Failure to send a copy to the DLAE within 15 days of contract execution may result in de -obligation of funds for this project. (2) Copy — Include in award package to Caltrans District Local Assistance (3) Original — Local agency files Page 15-32a LPP 09-02 C-26 July 31, 2009 EXHIBIT 15-G2 Local Assistance Procedures Manual Local Agency Bidder DBE Information (Construction Contracts) INSTRUCTIONS - LOCAL AGENCY BIDDER DBE INFORMATION (CONSTRUCTION CONTRACTS) SUCCESSFUL BIDDER: The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract UDBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including work performed by its own forces, if a DBE.The DBE shall provide a certification number to the Contractor and expiration date. Enter DBE prime and subcontractors certification number. The DBE contractors should notify the Contractor in writing with the date of the decertification if their status should change during the course of the contract. The form has a column for the Names of DBE certified contractors to perform the work (must be certified on the date bids are opened and include DBE address and phone number. IMPORTANT: Identify all DBE firms participating in the project --including all UDBEs listed on the UDBE Commitment form (Exhibit 15-G1), regardless of tier. Names of the First -Tier DBE subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts) to determine how to count the participation of DBE firms. Exhibit 15-G2 must be signed and dated by the successful bidder. Also list a phone number in the space provided and print the name of the person to contact. Local agencies should complete the Local Agency Contract Number, Federal -aid Project Number, Federal Share, Contract Award Date fields and verify that all information is complete and accurate before signing and sending a copy of the form to the District Local Assistance Engineer within 15 days of contract execution. Failure to submit a completed and accurate form within the 15-day time period may result in the de -obligation of funds on this project. District DBE Coordinator should verify that all informations is complete and accurate. Once the information has been verified, the District Local Assistance Engineer signs and dates the form. Page 15-32b July 31, 2009 C-27 LPP 09-02 EX IT 12-G Local Assis, Procedures Manual .. a Bidder's List of Subcontractors (DBE and Non -DBE) • BIDDER'S LIST OF SUBCONTRACTORS (DBE and NON -DBE)- PART I The bidder shall list all subcontractors (both DBE and non -DBE) in accordance with Section 2-1.054 of the Standard Specifications and per Title 49, Section 26.11 of the Code of Federal Regulations. This listing is required in addition to listing DBE Subcontractors elsewhere in the proposal. Photocopy this form for additional firms. Phone/ Waal. Ef ��i"•0�� Tirm Name/ . _ Address ax F tioubf Portion of Work;to e.ero scri < - ae. Si cGl t ' �?M v a )T=. °>: �Ci '. MEN �� S Phone $1 million El<$5 million - f`J ® 9 .3 `T [ O ❑ < $10 million w:�zx:�_12-' 1- =?" ''' �Ft Address t } ' / E -t V 1 /� y NT Fax t�. �/q� t� ❑ < $15 million - _- __ _.. — -_ --- - 3"}` �rrA''e`°`fl�zri»'`" N{��a°�hv;`��;�.�: n u >$15million - --- - --- QtV S WD �% j� /•� `/'''}� /fit) ON 2 U 1" &! V �L�� 0 0 ❑ < $1 million � XO° ✓" "`aid K-' Name Phonee� _ _ a, : .t,�. a=:•�, clz 0. � �� ❑ < $5 million. li e Ax` ,`= =fit •�' h2'y!r y�Y tfS'ES'IsLDl3# j'� _t c. -:�. ,_;r�c�,��^%-- � ' a ` �,� +' kk �.� ❑ < $10 million Address 7-0 �i �� &V S M70 `y 1 �� ra9 w ',." �'�-.�";k• ��_::. . $15 million v _ City state ZIP vim, �,y.. - Phone I �' . e 'ti �k: a•+cr�� S, v a8� ��;.,,.3,a , ! a ,5 3 v uPill •,:€� +.ia < million 11 < 10 million --- - Address i ®sai✓t U � LL, Yy.,, ,;: ..,. _^, Fax <$15million ❑ > $15 million --- ----- ('1'ty State ZIP � %�_ o � � ` �+ � ::�=r �:t r.., � ��-� z� r `(�;�•,:�=,,. 'i:A?'in4a!4, c�' �iuf.:$, t�. :l�.M'ls?•n 42d^ ....Sn t`."'"%�%=e - --- ��iNlM�e' Phone [J <$1 million _ ;{v ��f-. w y . Name < $5 million —---------- _..-•- ,: -%�Y�� .•�a-- yy i•; 3r,x<41'2.,i "�•i+.{'N \'^+k},`. :mot',-': < $ l 0 million Address Fax < $15 million [I > $15 million City State ZIP �''r.-="i - � -•: "".- L+ ` !'.aacf�Id�S�' �'di,4.�:�w:.`:':YAtN�:'tl ..„i.:y.�.yi•..ui'r �k`: Distribution: 1) Original - Local Agency File Page 12•-111 November 14, 2006 LPP 06-06 n N a•0 Local Assistance ProceL a Manual EXHIBIT 1, Bidder's List of Subcontractors (DBE and Non -DBE) BIDDER'S LIST OF SUBCONTRACTORS (DBE and NON -DBE)- PART i1 The bidder shall list all subcontractors who provided a quote or bid but were not selected to participate as a subcontractor on this project. This is required for compliance with Title 4Z- 49, Section 26 of the Code of Federal Regulations. Photocopythis form far addittona1 ,. ,. Firm Name/ horiel Alums tt1; .. Address/ Fax Gross Descri lion of Pdrtion of Work;to be :Performed':. P.: „� fin .Gi ' 'State• ..s =�',a kx_,,,x-,��,:,x �;. Phone ❑ < $1 million Nameff El <$5 million 3 % UIT V44. ^=1 ; �tzi, ❑ $10 millions:..; �y13:;x"_:., h . Address Fax ❑ < $15 million3<ntx ❑ > $15 million _-------- ... •, Tz:?.i;s-:,:ii«:' f city State ZIP „y.K .4r-.:.. av= y .., ,,�,"- l`�ie;-f'-i`-7r,�^J'�� { � �.�: rtt tY'.^.;y,�.,y{.•,-.«".,i� .;.. m•�C'',o.�i.. �rvX'�?��'�:x,e•�i^��'rh'=.•.1,#rZ.r.,i-. . � 4i Name Phone ❑ < $1 million F hS S million:?�•r�� •• -_--_..... �,ffS�i's1';�BL�'e#-i:.=tsr�h"`1��. � `�S r 'Lxa, zS1; @�T`Ljj' < 10 million Address y ,` Fax ❑ < $15 million • > $15 million.`dfl$%j?n3st,-�s»? City State ZIP"rs< •'k'-€.j,,�,ik'+G��'d�n�ryah% '.`a,',r, urelt3Y,:�'°'• .:�. ;�i:•"•�aeyS'N•s! Name Phone ❑ < $1 million ; •- E i ., s `' %y "s?>;�cs /n�••'{,�:>.,M-•.:�� • - :��. _ '•"mil ,.', ��'Mr h" :�:. 5 million:.,�!,t«„y,•�'�., _._. Address $15 million _ :`� LO,71'"-Ititi �� e 'citl•3�3'?ES'';S:;s Tfn:;:�kl• ❑ $1S million ---—._— -- .—..�__.__—. __>:'� city State ZIP �»k';lfi$s%?'��' �SQtrry!:%,.r.F�� z�#`Y`�� -°': _a�v�`,•s``t�=-i< Name Phone <$i million AM.,a. � D �.._ v geK' 'rSt'K,x '"�`z',7 �, iM C. •" r, s' . 4. �>"��:;,ff.��,,.•„'�1•0��``�:z«,�., i _ .: $E xr #�k , r. f. WA MO. ❑ $10million Address _._.—`� __._.. _- .—__._.—. �— — �— €��YY ;��;�`�;z? v rrNnr; r': ; :sty ``'' <r•: Fax < $15 million _go$>: v.t i Y.y.„�: -�� y��•mart'r,:v_fy'y�aef"=`:h�:�c�`'�"'°�J�4 �.Lt'?tt,�l. �4.fr3:rDt=r... > $15 mil - -� _ _ _.... _..__ -----_ 5C4_ CityState ZIP g� Distribution: 1) Original - Local Agency File Page 12-112 LPP 06-06 November 14, 2006 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 For Traffic Signal Modifications at Brookhurst Street and Yorktown Avenue & Newland Street and Atlanta Avenue & Magnolia Street and Atlanta Avenue, CC-1204, 1246 and 1247 September 27, 2010 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES DATED September 24, 2010. The Federal Labor Rates contained In Appendix I of the specifications for the: Traffic Signal Modifications at Brookhurst Street and Yorktown Avenue & Newland Street and Atlanta Avenue & Magnolia Street and Atlanta Avenue, CC-1204,1246 and 1247 shall be replaced with the following attached documents: The Federal Labor Rates dated September 24, 2010 shall be the labor rates In effect for the subject project. 2) Sheet 2 of 4 (Traffic Signal Modification Plan — Brookhurst Street and Yorktown Avenue, CC-1204) The new conduit depicted between the westerly terminus of conduit #2 and the pull box south of the new southwest corner access ramp shall be 3-inch. Conduit #1 shall be extended to connect to the new pull box south of the new access ramp. All conductors in conduits #1, 2, 3 and 4 shall be new. All conductors to poles 5, 6, 7, 8 and 9 shall be new. This is to acknowledge receipt and review of Addendum Number One, dated September 27, 2010. L,N (,v L. l ? fi Company Name y Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F. Janusz at (714) 536-5431. AIA Document A31 1 2010' Bid Bond This document has important legal consequences. Consultation with an attorney is encouraged with respect to its completion or modification. Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR: (Name, legal status and address) LINCOLN PACIFIC BUILDERS, INC. 4501 LITTLEJOHN STREET BALDWIN PARK, CA 91706 SURETY: (Name, legal status and principal place of business) THE OHIO CASUALTY INSURANCE COMPANY 9920 PACIFIC HEIGHTS BLVD. SUITE 425 SAN DIEGO, CA 92121 OWNER: (Name, legal status and address) CITY OF HUNTINGTON BEACH 2000 MAIN STREET HUNTINGTON BEACH, CA 92648 BOND AMOUNT: TEN AND 001100 PERCENT, 10% OF BID AMOUNT PROJECT: (Name, location or address and Project number, if any) INVITATION NO. 1204,1246,1247; TRAFFIC SIGNAL MODIFICATION AT BROOKHURST AND YORKTOWN, NEWLAND AND ATLANTA, MAGNOLIA AND ATLANTA The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal require nt shall a deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. Whe so furnis ed, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. Signed and sealetj this 5thAy oJ_gctoldr, 2010. (Seal) THE OHIO (Seal,' CAUTION: You should sign an original AIA Contract Document, on which this text appeafsin RED. An original assures thatchanges will not be obscured. � AIA Document A310Tm — 2010. Copyright © 1963, 1970 and 2010 by The American In to of Architects. All rights reserved. WARNING: This AIA® Document is protected by U.S. Copyright Law and International Treaties. Unautho ized reproduction or distribution of this AIA0 Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possWe under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. 061110 r OFFICIAL CALIFORNIA NOTARIAL CERTIFICATE OF ACKNOWLEDGEMENT State of California } County of Los An eles ) On October 6, 2010 before me, David A. Taft, Notary Public personally appeared Lincoln Chan 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 �illp�( r� — DAVID A. TAFT Commission # 1880135 Notary Public - California zz Riverside County M Comm. Ex Tres Feb 1312014 (Notary Seal) Additional Information DOCUMENT INFORMATION Title or Description of Document Bid Bond Document Date October 5, 2010 Number of Pages 1 TYPE OF IDENTIFICATION ❑ Personal Knowledge of the Notary Public ® Satisfactory Evidence — Identification Card ❑ One Credible Witness Acknowledging Identity of Principal ❑ Two Credible Witnesses Acknowledging Identity of Principal ACKNOWLEDGMENT State of California County of — Orange } On October S, 2010 before me, Peter Austin Neff, Notary Public (insert name and title of the officer) personally appeared Yuny, T. Mullick who proved to me on the basis of satisfactory evidence to be the person(z) whose name(z) is/aN& subscribed to the within instrument and acknowledged to me that heMmektIM executed the same in hiskmmAkeir authorized capacity( , and that by his/imi tbtsignature(s) on the instrument the person(z), or the entity upon behalf of which the person(is) 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. PETER AUSTIN NEFF N $'� °a COMM, 011799389 ca 7® � � "' NOTAft'l Pt�.1GCAiJP�dIA � . ORANGE COUNTY Signature (Seal) MY corm E> om MAY V,2012 THIS POWER OF ATTORNEY IS NOT VALID'UNLESS-IT IS, PRINTED ON RED BACKGROUND. CERTIFIED COPY OF POWER OF.ATTORNEY THE OHIO CASUALTY INSURANCE COMPANY No. 41-818 Kriow All Men ' by These Presents: That THE OHIO CASUALTY INSURANCE COMPANY, an Ohio Corporation, pursuant to the authority granted by Article III, Section 9 of the Code of Regulations and -By -Laws of said Company, does hereby nominate, constitute and appoint: James W. Moilanen : ; Yung T..Mullick or Jennifer C. Giboney of Mission Viejo, California its true and lawful agent (s).and;attomey (s)-in-fact, to make, execute, 'seal ".and (deliver for and on its.:behalf'as surety, and As, its act and deed any and all BONDS, UNDERTAKINGS, and RECOGNIZANCES,.not exceeding in any single instance TWENTY.' MILLION ($20,000,00.00) Dollars, excluding, however, any bond(s) or undertaking(s) guaranteeing ihi payment of notes ;arid interest thereon And the execution 'of such bontfis or undertakings in pursuance of these presents Shall: be as binding upon""said Company; as fully and amply, to all intents and purposes, as if they had_lieen duly executed and -acknowledged by the regularly elected offrcers:of the Company at its office in Fairfield, Ohio, in their own proper persons "-_ The authority granted hereunder supersedes arty.previous authority heretofore granted the above named attorneys) -in -fact. In WITNESS WHEREOF, the, undersigned officer of the saidTheOhio Casualty Insurance Company has hereunto subscribed his name and the Corporate Seal ofthe.said The Ohio Casualty Insurance Company this_2Dth day of November, 2008: -- oe Mark E. Schmidt, Assistant Secretary STATE OF OHIO, COUNTY OF BUTLER On this.20th day of November, 2008 before the subscriber, a Notary Public of the State of Ohio, in and for the County of Butler, duly, commissioned and qualified, came Mark E.-Schmidt, Assistant Secretary of THE-OHIO CASUALTY INSURANCE COMPANY, to me personally known -to be the individual and officer described in', and who executed"the preceding instrument, and he acknowledged the execution of the same, and being by me duly sworn deposes and says, that he is the officer of the Company aforesaid; and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of Hamilton, State of Ohio, the day and year first above written. ? �{ Notary Public in and for County of Butler, State of Ohio My Commission exfires August 5, 2012. This power of attorney is granted under and,by authority of Article III, Section 9 of the'Code of Regulations and By -Laws of The Ohio Casualty Insurance'Company, cxtracts'from which read: Article III, Section 9. Appointment of Attorneys -in -Fact. The Chairman of the Board, the President, any Vice -President, the Secretary or any ry Assistant "Secretaof the corporation shall be and is hereby vested with full power and authority to appoint attorneys -in -fact for the purpose of signing the name of the corporation as surety to, and to execute; -attach the seal of the corporation to, acknowledge and deliver anyand.all bonds, recognizances, stipulations, undertakings or other instruments of suretyship and policies of insurance to be given in favor of any individual, firm, corporation, partnership, limited liability. company or other entity, or the official representative" thereof, or to any county or state, or any official board or boards of any county or state, or the United States of America or any agency thereof, or to any other political subdivision thereof This instrument is signed and sealed as authorized by the following resolution adopted by the Boards of Directors of the Companies on October 21, 2004: RESOLVED; That the signature of any officer. of the Company authorized under Article -III, Section 9 of its.Code of Regulations and By-laws and the Company seal may be.affixed by facsimile to any power of attorney or "copy thereof issued on behalf of, the Company to make, execute, seal and deliver for and on its behalf as surety _any" and all bonds, undertakings. or. other written obligations in the nature thereof-, to prescribe their respective duties and the respective limits of their authority; and to revoke any such_ appointment. Such signatures and seal are hereby adopted by the Company as original signatures and;seal and shall, with respect to any bond, undertaking or other written obligations in the nature thereof to which it is attached, be valid and binding upon. the Company with the same force and effect as though manually affixed. CERTIFICATE 1, the undersigned Assistant Secretary of. The Ohio Casualty Insurance Company, do hereby certify that the foregoing power of attorney, the referenced By -Laws of the Company and the above resolution of its_Board -of Directors are true and correct copies and_are in full force and effect on this date. IN WITNESS WHEREOF, I have hereunto set my hand and the seal of the Company this 5 day of CA.D.' TOBEfj, 2010 c} Assistant Secretary City ®f Huntington Beach 2000 Main Street • Huntington Beach, CA 92648 OFFICE OF THE CITY CLERIC JOAN L. FLYNN CITY CLERK March 4, 2011 PTM General Engineering Services, Inc. 5942 Acorn St. Riverside, CA 92504 RE: CC-1204, CC-1246, & CC-1247 — Various Traffic Signal Modifications Enclosed please find your original bid bond for CC-1204, CC-1246 & CC-1247. Sincerely, 9"4%, j +-0j Joan L. Flynn, CMC City Clerk J F: pe Enclosure Sister New Zealand (Telephone: 73 4-536-5227) Federal no. STPLHG-5181(139), (162), & (163) Project Desc: T/S Modifications at Brookhurst. Yorktown ave. & Newland St. & Adanta Ave. &, Magnolia St & Atlanta St. B.113 Enclosed Do Not Open With Regular Mai/ ', SECTION C PROPOSAL for the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue FEDERAL NOS. STPLHG-5181(139), STPLHG-5181(162) & STPLHG-5181(163) CC Nos.1204,1246 & 1247 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and incident insurance necessary therefor, in accordance with the plans and specifications on file in the off -ice of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within 50 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find Bid Bond in the amount of $io o total bi*hich said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or "Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: Addendo-N� Date Rece etl : ' ; ` ;. _ : , " _.::: ;': Ah iA"A ..nature. 1 2 2410 C-2 Section C PROJECT BID SCHEDULE For CC Nos.1204,1246 and 1247 PROJECT BID: Project Bid Summary: CC-1204 Brookhurst Street and Yorktown Avenue $ (OC�F�ZC)— CC-1246 Newland Street and Atlanta Avenue $ 'N5 Z-9 -7. 5C3 CC-1247 Magnolia Street and Atlanta Avenue $ i69 J -ct -7 . XR6 Total Bid Amount in Figures: $ 2L�5ZJ'$ Total Bid Amount in Words: C-2.1 Project Bid Schedule Traffic Signal Modification at Brookhurst Street and Yorktown Avenue CC-1204 1 1 L.S. Mobilization. $ Z�C $ WM Per L.S. 2 1 L.S. Survey Monument Preservation. Per L.S. 3 1 L.S. Furnish Project Traffic Control, Per L.S. 4 1 L.S. Modify Traffic Signal at Brookhurst Street and Yorktown Avenue. $ ��J� $ tiZ> I Per L.S. 5 1 EA. Construct Curb Ramp per Caltrans Standard Plan A88A (Includes Adjacent Gutter Plate and AC $ �o Paving Replacement). Per EA. 6 1 EA. Construct Modified Curb Ramp (Located on the _ Southwest Corner) per Caltrans Standard Plan $ qu:�Ob $ �y�J b A88A (Includes Adjacent Gutter Plate and AC Paving Replacement). Per EA, 7 2 EA Remove and Reconstruct Median Island Nose Including Curb, Stamped Concrete and A.C. $ 2Z50 $ 4 k 6Cl Pavement. Per EA. Total Amount Bid in Figures: Total Amount Bid in Words: $ %A&MgI � M Note for CC-1.204: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.2 Project Bid Schedule Traffic Signal Modification at Newland Street and Atlanta Avenue X45I Mobilization. $ wy $ ?coo r Per L.S, Furnish Project Traffic Control. Per L.S. 3 I L. S. Modify Traffic Signal at Newland Street and Atlanta Avenue. w �Q $ 7. $ �� .� 50 Per L.S. 4 4 EA. Construct Curb Ramp per Caltrans Standard Plan SR56 A88A (Includes Adjacent Gutter Plate and AC $ Paving Replacement). Per EA. Total Amount Bid in Figures: $ !M 29• �Jd Total Amount Bid in Words: $ * A�tCj ` � • Note for CC-1246: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.3 r Project Bid Schedule Traffic Signal Modification at Magnolia Street and Atlanta Avenue CC-1247 1 +I 1 L.S. Per $$ Z-p0y' 2 I I L.S. IJ Survey Monument Preservation. II $ O $ tsIf —. II 3 I L.S. Furnish Project Traffic Control. Per L.S. F ify Traffic Signal at Magnolia Street and nta Avenue. $ l0�(27.5b $ 5 Den « 5'd L.S. 5 2 EA. Construct Curb Ramp per Caltrans Standard Plan A88A (Includes Adjacent Gutter Plate and AC $ t_ $ �2- Paving Replacement. Per EA. 11 Total Amount Bid in Figures: $ 6R Fs?-7 . ):-0 Total Amount Bid in Words: $WiA( X �ive WwdAoec 1�ty�-w*� Note for CC-1247: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.4 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. .Poain:-:; ...:....... 1w�me��an.�Addt..,ess�-o �u..ficoritrnci�r:::�t_=:;•: _:;: .......:.....::........:... . .:;,�'ir�te:r : ic-errse;�'::, ::::C..- s �,..,::= 32 Ptn. of Freeway Electric Inc. 947817 ;C10;C31; electrical install. 5942 Acorn St. Riverside, TA 92504 HAC Construction HAC Construction------- -- - - uses N . 883 Licenses No. 883826, Class A s� 5747 Lucretia Avenue, Mira Loma, CA 91752 Tel: 726 drags CT & T Construction Inc. CT & T Construction Inc. Licenses No. 868434, Class C12 & C8 324 S. Diamond Bar Blvd., PMB 275 Tel: 909-396-8453 Diamond Bar, CA 91765 OR J&S Striping J&S Striping — 10715 Bloomfield Ave., Santa Fe Springs, CA Licenses No, 538211, Class A & C32 90670 Tel: (562) 777-2411 By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOI. LUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California River4j.de County of txgex Elizabeth H. Mendoza de McR Being first duly sworn, deposes and says that he or she is President/CFO PTM general Engineering Svcs. tEg}party making the foregoing bid that the bid is not made in the interest of, or on the behalf of, any undisclosed s person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price, or that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. PTM General Engineering vices Inc. Ttf Bidder lizabeth H. Mendoza de McRae President/CFO Signature of Bidder 5942 Acorn St. Riverside, Ca 92504 Address of Bidder Subscribed and sworn to before me this 6th day ofOctober 2610 NOTARY PUBLIC See attached C-4 NOTARYSEAL CAF,13IFORN11A ALL-PURPOSE A9_PKNOV 1LEDGMEN p :-�N��.i'1!.`.��.�"t�,t�`h'��'L�"�C�•",(�.`;l'iX�• -. •�: -•,�':��'�-Z?'.L�'�'.i?��:�CE1—`�C��"��-C%'�� •,t"%-'�':Y•`�;i�' State of California County of ORANGE On 1010e 1-241D before me, Philip Vega, Notary -public Dste Here Insen Name md Tam at t o Offlcor personally appeared Elizabeth H. Mendoza de Mcrae amo . gnor(F) - who proved to me on the basis of satisfactory evidence to be,the person(4) whose namo�) is%gre subscribed to the within Instrument and acknowled9 to me that hel�ilt rAt � executed the same in hik /6ir authorized capacity(%), and that by hldNeAl/ eir signatA(s) on the PHILIP VEGA instrument the person(d), or the entity upon behalf of Commission # 1799866 }, n Notary Public - California z which the person(4) acted, executed the Instrument. � Los Angeles County My Comm. Expires May 31, 2012 1 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 s al Signature Place Notary Seal Abova 619hetore op o y Public -----�-----•- OPTIONAL Though the information below is not required by law, If may prove vdluable to persons relying on th ooument and could prevent fraudulent removal and reatta0nment of this form to another document, Description of Attached Document Tltle or Type of Document: Document bate: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer($) Signer's Name: Individual Corporate Officer —Title($): Partner --- CJ Limited ❑ General Attorney in Fact Trustee Guardian or Conservator ❑ Cther: Signer is Representing: Top of thumb We Signer's Name: ❑ individual ❑ Corporate Officer — Title(s): ❑ Partner -- ❑ Limited ❑ General ❑ Attorney in Fact Top of thumb Isere n Trustee Cl Guardian or Conservator ❑ Other: Signer Is Representing: V2007NetlonelNotary AesociaUori•9350DoSoto Avo„P0,Box2402•Chetewo(tI1,CA91313.2402•www,NallonalNoisry.ot9 Ilemh5907 Roordor.Call Toll-Frees-000.078.8927 UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue, (1)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved." The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: 10/06/2010 G5 PTM General Engineering Services, Inc. C tractor Brian Mendoza C Vice President/Secretary Title DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury, the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? Yes ® No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. M COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. 1 am aware of the provisions of Section 3700 of the Labor Code which require 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. Date: 10/06/2010 C-7 PTM General Engineering Services, Inc. Contractor `- Brian Mendoza E Vice President/Secretary Title UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: PTM General Engineering Services, Inc. Contractor (2'Brian Mendoza i Vice President/Secretary Title - Date: 10/06/2010 Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work. Additional forms may be obtained from the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: PTM General Engineering Services, Inc. Bidder Name 5942 Acorn St. Business Address Riverside, Ca 92504 City, (951.)710.1000 Telephone Number 891265 Class A; C10; C31 State Contractor's License No. and Class 02/2007 Original Date Issued 02/2011 Expiration Date State Zip The work site was inspected by Brian Mendozaof our office on 10 / 05 12010 The following are persons, firms, and corporations having a principal interest in this proposal: Elizabeth H. Mendoza de McRae, President/CFO Brian Mendoza, Vice President/Secretary C-9 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. PTM General Engineering Services, Inc. Company Name Signature of Bidder Brian Mendoza, Vice President/Secretary Printed or Typed Signature Subscribed and sworn to before me this 6 t4ay ofOctober 20{ - 10 See attached. NOTARY PUBLIC NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: 1. City of National City 1234 National City Blvd. National City, CA 91950 Name and Address of Public Agency Mr. Manganiello 619.336.4380 Name and Telephone No. of Project Manager: 594,536.17 Safe Routes to School 01/2010 Contract Amount Type of Work Date Completed 2 City of Diamond Bar 21825 Copley Drive Diamond Bar, Ca 91765 Name and Address of Public Agency Mr. John Huie 951.205.2856 Name and Telephone No. of Project Manager: 436,000.00 T/S Interconnect Ph. #1 10/08 Contract Amount Type of Work Date Completed 3. Cal Trans 1727 30th St. Sacramento, Ca 95816 Name and Address of Public Agency Mr. Joe Obadike 951.830.6821 Name and Telephone No. of Project Manager: 492,155.00 CDOT 08-OM5504 Install Electrical 06/09 Contract Amount Type of Work Date Completed C-10 More references attached. Brian Mendoza P.O. Box 7745 Riverside, CA 92513-7745 Email: brian@ptm-eug.com • Cell 951.722.5755 Chief Estimator and Supervisor of Outside Operations Supervisor of outside operations with over 18 years of experience. Electrician with over 20 years of experience. An effective communicator and team leader; experienced in coordinating and executing large and fast -paced projects. CAREER EXPERIENCE Freeway Electric/PTM General Engineering -Services, Inc. Riverside, CA 06/2006 to Date Chief Estimator/Supervisor of Outside Operations In charge of managing the estimating department and finalizing bid packages; coordinating the beginning phase of an awarded project between the company and agency. Project submittals, contract review. Coordinated and managed crews California region; handled various sized projects ranging in size from $1,000 to $4.5 million dealing with dry utilities, wet utilities, traffic signals, and road improvements. Maintained coordination Freeway Electric/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 equipment purchase and rentals. High Light Electric Inc./Pete & Sons Construction Inc. Riverside, CA 10/96 to 0612006 Chief Estimator In charge of managing the estimating department and finalizing bid packages. Coordinating the beginning phase of an awarded project between the company and agency or prime contractor; project submittals, contract review. Successfully bid on projects totaling $12 million with an average spread 6%. Area Supervisor Coordinated and managed 10 crews consisting of 6 members per team in the southern California region; handled various sized projects ranging in size from $1,000 to $4.5 million dealing with dry utilities, wet utilities, traffic signals, and road improvements. Maintained coordination between High Light Electric Inc and subcontractor, general contractor and project owners. In charge of handling project's administrative work; monthly gross estimates, project progress schedule, materials requisitions, contract change order negotiations and equipment purchase and rentals. Continued... BRIAN MENDOZA • Page 2 CAREER EXPERIENCE CONTINUED MBE Electric Inc. in Riverside, CA 10/1998-10/1996 Vice President and .Head of Outside Operations Managed outside operations for all projects ranging in size from $1 to $2.5 million. Headed an around the clock electric crew and coordinated with CC Meyes to repair the I-10 Santa Monica Freeway after it collapsed during the 1994 Northridge Earthquake to complete the fast paced project in 66 days. Maintain coordination between MBE Electric and subcontractors, general contractor and project owners; implemented and enforced safety guidelines. Handled administrative work; monthly progress estimates, material requisitions, contract change order negotiations. Vasco Corporation in San Fernando, CA 10/1987-06/1998 Foreman (Part Time) Managed day to day operations of work crews and various projects ranging in size from $1,000 to $5,000 in Eastern Los Angeles County; traffic signals, streetlighting, signal interconnect. Raymor Electric in Rosemead, CA 06/1986-10/1987 Crew Leader (Part Time) In charge of work crew on projects ranging from $25,000 to $250,000 through out Los Angeles County. WORK SHILLS • Capable of operating heavy equipment such as skip loaders, cranes, and backhoes; • Hands-on experience with hand tools and power tools; • Capable of overseeing fast -paced and high profile projects;' • An effective communicator and leader; EDUCATION • International Brotherhood of Electrical Workers Completed training course (1988-1989) in'street lighting and traffic signal installations, code enforcement and blue print reading. • South Gate High School Received High School diploma in 1988 BRIAN MENDOZA • Page 3 CAREER EXPERIENCE CONTINUED PROFESSIONAL MEMBERSHIPS • International Brotherhood of Electrical Workers (IBEW) • National Electrical Contractors .Association (NECA) ACCREDITATION IBEW-Journeyman Wireman; CSLB-Electrical Contractors; Certified Trench Safety Coordinator. • English (Native) • Spanish (Fluent) LANGUAGES AWARD RECEIVED • Recipient of the U.S. Small Business "Young Entrepreneur of the Year" 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 "Small Business" in 1997. • Recipient of the Certificate of Recognition by the State Assembly,' Assemblyman Mr. Rod Pacheco, for the "top 500 Inland Empire Small Business" in 1997. • Ranked among the "Top 500 Inland Empire Hispanic Owned Companies" since 1997. ® Certification of Appreciation for our participation and maximization in the "Century Freeway Affirmative Action" by CFAAC. PROFESSIONAL AND PERSONAL REFERENCES Caltrans project #07-I224U4 (Electrical contract amount $4.5 million) Project completed in 2005 Description of project: Installation of traffic signals, ramps metering, sign illumination, Highway lighting, fiber optic communication, and electrical irrigation along the I-10 Freeway in Los Angeles County. • Doug Dwason-Project Manager for prime contractor, Balfour Beatty Cell (949)232-3276 and Office (909)397-8040 • Patty Galvan- Resident Engineer. Office (909)594-4270 • Veronica Ross -Electrical Inspector. Cell (714)606-6311 BRIAN MENDOZA • ]Page 4 CAREER EXPERIENCE CONTINUED City of Redlands Contract #208300-72304/41008 (Electrical contract amount is $218,800) Project completed in 2003 Description of project: Installation of traffic signals, modification of ramp metering, lighting and sign illumination. Bill Hensley -Senior Civil Engineer- Office (909)798-7586 ext 2 Juan Olvera-Project Manager for general contractor, H&H Construction- Cell (951)453-7712 and Office (909)473 -73 3 1. Caltrans project #08-4567V4) Electrical contract amount is $938,238) Project completed in 2005 Description of project: Installation of lighting system along the I-5 Freeway in San Bernardino County. • Gary Vogel -Project Manager form prime contractor, Granite Construction Cell: (661)549-3953 and Office (661)726-4447 Sanbag Projects, Segment 1, 2, 3, early segment 9, segment 9, and alder Ave. (Total electrical contract amount was $3.2 million) Project completed in 2004. Description of projects: Installation of traffic signals, ramp metering, .sign illumination,' highway lighting, fiber optic communication, and electrical irrigation along the I-10 Freeway in San Bernardino County. • Harold Lantis-Sanbag Contract Manager- Cell (760)802-7730 and Office (909)875-8029 ext 213. • Tim Hanable-Caltrans Inspector- Cell (951)712-0021 • Al Ortega- Project Manager for prime contractor, Yeager Shanska- Cell (714)240- 5333. City of Indio Project #ST0137 (Electrical contract amount was $1.4 million) Project completed in 2005 Description of project: Installation of street. lighting system, traffic signals, electrical irrigation, and dry utilities. • Gary Baxter -Area Manager for prime contractor, Yeager Shanska Construction - Cell (909)721-9749 and Office (760)343-5472 • Tommy Young -Project Manager for prime contractor- Cell (951)232-6618 and Office (760)343-5472 • Mehran Sepehri-City Engineer- Cell (760)250-2201 Additional Professional References: • Zale Harris-Caltrans Inspector- Cell (951)289-0047 • Ray Robles-Caltrans area supervisor. Cell (909)799-0646 (For federally funded projects, use this following page) BIDDER'S CERTIFICATION* HOUSING AND URBAN DEVELOPMENT ACT OF 1968 AS AMMENDED IN 1992, SECTION 3 TITLE 24, Code of Federal Regulations, Part 135* Economic Opportunities for Low and Very Low -Income Persons The bidder, under penalty of perjury, certifies that except as noted below, any person associated therewith in the capacity of owner, partner, director, officer, or manager (initial the applicable selections): Will ensure that 10% of all new hires as a result of this project shall meet all requiremnents of Section 3 of CFR Part 135 of the HUD Act of 1968; or X Will hire no new employees in conjunction with this project. Will award 10% of its sub -contracts to Section 3 businesses. This certification shall apply to the prime contractor's sub -contracts related to this project. Contractor: PTM General Engineering Services, Inc. Contact Person: Brian Mendoza 951.710.1000 Contact Phone: Signed: Date: 10/06/2010 *Note: The above certification is required by the Department of Housing and Urban Development (24 CFR 135 and Subtitle A et ao and must be submitted by the bidders and proposed sub -contractors only in connection with contracts and subcontracts which are subject to Section 3 of the 1968 Housing and Urban Development Act, as amended in 1992 (HUD). Previous non-compliance with Section 3 could result in disqualification. C-11 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B (THE BIDDER'S EXECUTIONON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE ANENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder x , proposed subcontractor hereby certifies that he has x , ' has not_, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has fled with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts, which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Page 12-79 LPP 01-04 C-12 March 15, 2001 Local Assistance Procedures Manual PS&E Checklist Instructions EXHIBIT 12-B Attachment B (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE ANENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICHARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder , proposed subcontractor hereby certifies that he has___, has not_, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts, which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Page 12-79 LPP 01-04 C-12 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B. (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE ANENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICHARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder , proposed subcontractor hereby certifies that he has has not, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts, which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Page 12-79 LPP 01-04 C-12 March 15, 2001 PUBLIC CONTRACT CODE Public Contract Code Section 10285.1 Statement In conformance with Public Contract Code Section 10285.1(Chapter 376, Stats.1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has _, has not X been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public work contract, as defined in Public Contract Code Section 1101, with a any public entity, as defined in Public Contract Code Section 1100, including Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Public Contract Code Section 10162 Questionnaire In conformance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire: Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or safety regulation? Yes No X If the answer is yes, explain the circumstances in the following space. C-13 Public Contract Code Section 10232 Statement In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final non -appealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor with an order of the National Labor Relations Board. Note: The above Statement and Questionaire are part of the bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. C-14 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment D Noncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY / COUNTY of Huntington Beach, Orange County DEPARTMENT OF PUBLIC WORKS. In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that 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, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Page 12-81 LPP 01-04 C-15 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment E DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, and manager: ® Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; o Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past 3 years; ® Does not have a proposed debarment pending; and ® Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Page 12-83 LPP 01-04 C-16 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment 1F' ,fp ;; '1'= � 111I 1° �M The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) if any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify and disclose accordingly. Page 12-85 LPP 01-04 C-17 March 15, 2001 N/A = Not Applicable ]Local Assistance Procedures Manual EXHIBIT 12 E PS&E Checklist Instructions Attachment G DISCLOSURE OF LOBBYING ACTrMM 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: ®N/A N/A Fla. N/A a. contractOa. bid/offer/application initial b. grant b. initial award b. material change c. cooperative agreement c. post -award d. loan e. loan guarantee f loan insurance 4. Name and Address of Reporting Entity ® Prime ❑ Subawardee N/A Tier , if known Congressional District, if known 6. Federal Department/Agency: N/A S. Federal Action Number, if known: N/A 10. a. Name and Address of Lobby Entity (If individual, last name, first name, MI) N/A For Material Change Only: year+, quarter_ date of last report ____ 5. If Reporting Entity in No. 4 Is Subawardee, Enter Name and Address of Prime: N/A Congressional District, if known 7. Federal Program Name/Description: N/A CFDA Number, if applicable 9. Award Amount, if known: N/A b. Individuals Performing Services (including address if different from No. 104) (last name, first name, MI) N/A (attach Continuation Sheet(s) if necessary) 11. Amount of Payment (check all that apply) 13. Type of Payment (check all that apply) $ N/A ® actual planned a. retainer N/A b. one-time fee 12. Form of Payment (check all that apply): c. corrunission 8 a. cash d. contingent fee b, in -kind; specify: nature N/A e deferred value f. other, specify 14. Brief Description of Services Performed or to be performed and Date(s) of Service, Including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 1I: N/A (attach Continuation Sheet(s) if necessary) 15. Continuation Sheet(s) attached: Yes[] No El 16. information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure oflobbying reliance Signature: was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 print Name: Brian Mendoza L'.S.C. 1352. This information will be reported to Congress semiannually and will be available for public. inspection. Any V . P . /Secretary Person who fails to file the required disclosure shall be subject Title: to a civil penalty ofnot less than $10,000 and not more than 951.710.1000 10 / 0 6 / 2 $100,000 for each such failure. Telephone No.: Date: Federal Use Only: 09-12-97 Authorized for Local Reproduction Standard Form - LLL Rue Page 12-87 LPP 01-04 C-18 March 15, 2001 EXBIBIT 12-E Local Assistance Procedures Manual Attachment G PS&E Checklist Instructions INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient, at the initiation or receipt of covered federal action or a material change to previous filing pursuant to title 31 U.S.C. Section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered federal action. 2. Identify the status of the covered federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred_ Enter the date of the last, previously submitted report by this reporting entity for this covered federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the fast subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, State and zip code of the prime federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate federal identifying number available for the federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the federal agency). Include prefixes, e.g., "RFP-DE-90-00 L" 9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter the federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (Ml). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in -kind contribution, specify the nature and value of the in -kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. Page 12-88 March 15, 2001 C-19 LPP 01-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment G 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with federal officials. Identify the federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, ' including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. SF-U.I.-Instructions Rev.06-04-90c<ENDIF» Page 12-89 LPP 01-04 C-20 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 15-G1 Local Agency Bidder UDBE Commitment (Construction Contracts) EXHIBIT 15-G1 LOCAL AGENCY BIDDER UDBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCAL AOENCy;City of Huntington Beach LOCATION: Huntington Beach, CA PROJECT DESCRIPTION: Traffic Signal modifications at Brookhurst St. & Yorktown Ave & Newland t. and Atlanta Ave. & -Magnolia St. & At ante ve. TOTAL CONTRACT AMOUNT: $ 7 1 9� ?A_=� BID DATE: 10/07/2010 BIDDEKSNAME: PTM General Engineering Services, Inc. CONTRACPUDBECOAL. 5.13% Race Conscious & 3.21% Race Neutral CONTRACT TEM OF WORK AND DESCRIPTION UDI3E CERT NO. r4AME OF EACH UDBE DOLLAR AMOUNT ITEM NO. R SERVICES TO BE AND EXPIRATION (Must be certified on the date bids UDBE UBCONTRACTED OR MATERIALS DATE are opened - include UDBE BE PROVIDED (or contracted if the address and phone number) idder is a UDBE) Ptn. #4,3,RP n. of electrica material. 9994 3rand Electric Supply Inc. Ski 2430 S. Sta. Fe Ave. `2 ✓ #510 Vista, CA 92084 760.744.5981 For Local Agency to Complete: Total Claimed UDBE Local Agency Contract Number: Participation Federal -aid Project Number: Federal Share: Contract Award Date: Brian Mendoza Local Agency certifies that all UDBE certifications have been verified and Signature of Bidder information is complete and accurate. 10/06/2010 951.710.1000 Date (Area Code) Tel. No. Print Name Signature Date Elizabeth McRae Local Agency Representative Person to Contact (Please Type or Print) (Area Code) Telephone Number: Local Agency Bidder UDBE Cottunitment (Construction Contracts) (Rev 6/26109) Distribution: (1) Original —Local agency files LPP 09-02 C-21 Page 15-31 July 31, 2009 EXMBIT 15-GI Local Assistance Procedures Manual Local Agency Bidder UDBE Conunitment (Construction Contracts) INSTRUCTIONS - LOCAL AGENCY BIDDER UDBE COMMITMENT (CONSTRUCTION CONTRACTS) ALL BIDDERS: PLEASE NOTE; It is the bidder's responsibility to verify that the UDBE(s) falls into one of the following groups in order to count towards the UDBE contract goal: 1) African Americans; 2) Asian -Pacific. Americans; 3) Native Americans; 4) Women. This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must submitted and received as specified in the Special Provisions. Failure to submit the required UDBE commitment will be grounds for finding the bid nonresponsive A UDBE is a firm meeting the definition of a DBE as specified in 49 CFR and is one of the following groups: f African Americans, Asian -Pacific Americans, Native Americans, or Women. The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract UDBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by UDBEs. Prime contractors shall indicate all work to be performed by UDBEs including, if the prime is a UDBE, work performed by its own forces, if a UDBE. The UDBE shall )rovide a certification number to the Contractor and expiration date. Enter the UDBE prime's and subcontractors' certification numbers.The form has a column for the Names of UDBE contractors to perform the work (who must be certified on the date bids are opened and include the UDBE address and phone number). IMPORTANT: Identify all UDBE firms participating in the project regardless of tier. Names of the First -Tier UDBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the UDBE participation dollar amount. Enter the Total Claimed UDBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the UDBE, describe exact portion of time to be performed or famished by the UDBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of UDBE firms. Exhibit 15-01 must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local agencies should complete the Local Agency Contract Award, Federal -aid Project Number, Federal Share, Contract Award Date fields and verify that all information is complete and accurate before signing and filing. Page 15-32 July 31, 2009 C-22 LPP 09-02 Local Assistance Procedures Manual Exhibit 15-H UDBE Information - Good Faith Effort EXHIBIT 15-H UDBE INFORMATION —GOOD FAITH EFFORTS UDBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. STPLHG-5181(139), (162), & (163) Bid Opening Date 10/07/2010 The (Ci /County of) established an Underutilized Disadvantaged Business Enterprise (UDBE) goal of-5 - 13 s % for this project. The information provided herein shows that a good faith effort was made. Lowest, second lowest and third lowest bidders shall submit the following information to document adequate good faith efforts. Bidders should submit the following information even if the "Local Agency Bidder UDBE Commitment" form indicates that the bidder has met the UDBE goal. This will protect the bidder's eligibility for award of the contract if the administering agency determines that the bidder failed to meet the goal for various reasons, e.g., a UDBE firm was not certified at bid opening, or the bidder made a mathematical error. Submittal of only the "Local Agency Bidder UDBE Commitment" form may not provide sufficient documentation to demonstrate that adequate good faith efforts were made. The following items are listed in the Section entitled "Submission of UDBE Commitment" of the Special Provisions: A. The names and dates of each publication in which a request for UDBE participation for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications Dates of Advertisement Goals Met B. The names and dates of written notices sent to certified UDBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the UDBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of UDBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation Goals Met Page15-33 LPF 09-02 C-23 July 31, 2009 Exhibit 15-$ Local Assistance Procedures Manual UDBE Information -Good Faith Effort C. The items of work which the bidder made available to UDBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate UDBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate UDBE participation was made available to UDBE firms. Items of Work Bidder Normally Breakdown of Amount Performs Item Items ($) Goals Met Percentage Of Contract D. The names, addresses and phone numbers of rejected UDBE firms, the reasons for the bidder's rejection of the UDBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each UDBE if the selected firm is not a UDBE: Names, addresses and phone numbers of rejected UDBEs and the reasons for the bidder's rejection of the UDBEs: Goals Met Names, addresses and phone numbers of firms selected for the work above: Goals Me E. Efforts made to assist interested UDBEs in obtaining bonding, lines of credit or insurance, and any technical assistance or information related to the plans, specifications and requirements for the work which Was provided to UDBEs: Goals Met Page 15-34 July 31, 2009 C-24 LPP 09-02 Local Assistance Procedures Manual Exhibit 15-H UDBE Information - Good Faith Effort F. Efforts made to assist interested UDBEs in obtaining necessary equipment, supplies, materials or related assistance or services, excluding supplies and equipment the UDBE subcontractor purchases or leases from the prime contractor or its affiliate: Goals Met G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using UDBE farms (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.): Name of Agency/Organization Method/Date of Contact Results Goals Met H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): Goals Met NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. Page15-34a LPP 09-02 C-25 July 31, 2009 1rr Uy-Uc %--AD July Jl, LUUY Local Assistance Procedures Manual EXHIBIT 15-G2 Local Agency Bidder DBE Information (Construction Contracts) EXHIBIT 15-G2 LOCAL AGENCY BIDDER DBE INFORMATION (CONTRUCTION CONTRACTS) (Inclusive of all DBEs including the UDBES listed at bid proposal) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCALAGENCY• City of Huntington Beach LOCATION: Huntington Beach, CA Traffic Signal Mo ifications at Brookhurst St. & Yor wotn Ave. & Newland St. PRO)ECTDESCRIPTTON: - 1 Atlanta ave c Maynnl i a st & atl ant- A— TOTALCONTRACT AMOUNT- S 2I ZI 10/07/2010 BID DATE: BIDDER'S NAME: PTM General Engineering Services, Inc. CONTRACT UDBB GOAL- 5.13% Race Consious and 3.21% Race Neutral CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE DOLLAR AMOUNT rIEMNO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE ate opened - include DBE address TO BE PROVIDED (or contracted if the and phone number) bidder is a DBE Ptn. #4 Ptn. of electrical material. 9994 Grand Electric Supply Inc. � 2 i 760.744.5981 For Local Agency to Comtplete: Total Claimed DBE $q� Local Agency Contract Number: Participation Federal -aid ProjectNumber: Federal Share: Contract Award Date: Local Agency certifies that all DBE certification have been verified and Information is complete and accurate. Brian Mendoza Signature of Bidder 10/06/2010 951.710.1000 Print Name Signature Date Local Agency Representative Date (Area Code) Tel. No. Area Code Telephone Number; Elizabeth McRae Person to Contact (Please Type or Print) For Caltrans Review: Print Name Signature Date Caltrans District Local Assistance Engineer Local Agency Bidder DBE lntom�ation (Consauction Contarcts) (Rev G/26l09) Distribution: (1) Copy —Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within 15 days of contract execution. Failure to send a copy to the DLAE within 15 days of contract execution may result in de -obligation of funds for this project. (2) Copy — Include in award package to Caltrans District Local Assistance (3) Original — Local agency files wq Page 15-32a LPP 09-02 C-26 July 31, 2009 EXHIBIT 1542 Local Assistance Procedures Manual Local Agency Bidder DBE Information (Construction Contracts) .I INSTRUCTIONS - LOCAL AGENCY BIDDER DBE INFORMATION (CONSTRUCTION CONTRACTS) SUCCESSFUL BIDDER: The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract UDBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including work performed by its own forces, if a DBE.The DBE shall provide a certification number to the Contractor and expiration date. Enter DBE prime and subcontractors certification number. The DBE contractors should notify the Contractor in writing with the date of the decertification if their status should change during the course of the contract. The form has a column for the Names of DBE certified contractors to perform the work (must be certified on the date bids are opened and include DBE address and phone number. IMPORTANT: Identify all DBE firms participating in the project —including all UDBEs listed on the UDBE Commitment form (Exhibit 15-G1), regardless of tier. Names of the First -Tier DBE subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts) to determine how to count the participation of DBE firms. Exhibit 15-G2 must be signed and dated by the successful bidder. Also list a phone number in the space provided and print the name of the person to contact. Local agencies should complete the Local Agency Contract Number, Federal -aid Project Number, Federal Share, Contract Award Date fields and verify that all information is complete and accurate before signing and sending a copy of the form to the District Local Assistance Engineer within 15 days of contract execution. Failure to submit a completed and accurate form within the 15-day time period may result in the de -obligation of funds on this project. District DBE Coordinator should verify that all informations is complete and accurate. Once the information has been verified, the District Local Assistance Engineer signs and dates the form. Page 15-32b July 31, 2009 C-27 LPP 09-02 h r : Local Assis, Procedures Manual Eli ;1 Y 12-G Bidder's List of Subcontractors (DBE and Non -DBE) 13IDDERIS LIST OF SUBCONTRACTORS (DBE and NON -DBE)- PART I The bidder shall list all subcontractors (both DBE and non -DBE) in accordance with Section 2-1.054 of the Standard Specifications and per Title 49, Section 26.11 of the Code of Federal Regulations. This listing is required in addition to listing DBE Subcontractors elsewhere in the proposal. Photocopy this form for additional firms. Name rnone CT & T Construction Inc. 324 S. Diamond Bar Blvd., PMB 275 Diamond Bar, CA 91765 z�- - Name Phone J&S Striping 10715 Bloomfield Ave., Santa Fe Springs, CA 90670 , 91%a a47-Wck Distribution: 1) Original - Local Agency File <$1 million Ptn < $5 million <$10 million < $15 million > 115 million <$1 million < $5 million <$10 million < 515 million > $15 million <$1 million <$5 million < $10 million < $15 million > $15 million < $1 million < $5 million <$10 million <$15 million > $15 million ngfxoii :ofEoriono' :.f::,.... ,.::..:,:::......, Work to'be Performed of electrical installation. T Page 12-111 LPP 06-06 November 14, 2006 EXIHBrr L. Local Assistance ProcelL s manual Bidder's List of Subcontractors (DBE and Non -DBE) BIDDER'S LIST OF SUBCONTRACTORS (DBE and NON -DBE)- PART 11 The bidder shall list all subcontractors who provided a quote or bid but were not selected to participate as a subcontractor on this project This is required for compliance with Title 49, Section 26 of the Code of Federal Re lations. Photocopy this form for additional firms. Firmi; mine/ hone. ku AddPess escrioldow. w6rikib" ... .. . .. Name Phone CC!�q) ❑ < $1 million 41 q Ranch Rock CorporationISCI Pavement < $5 trillion Y Services, LP Ll < $10 milli —on 1450 Fitzgerald Ave, Rialto CA 92376 rev qf Gq< $15 million) Wff U > $15 trillion a* I Ivk&-loo Name Phone —1 14) 95c" 1 (959— Lj556 Orange County Striping Service 183 N. Pixley Street, Orange, CA 92868 (4 -7 ) *36c? - &, q3 10,9 N.. Phone Sterndahl Enterprises, Inc. cb3L( C'q 11861 Branford Street, Sun Valley, CA 91352 ' - rkv Name Superibr Pavement Markings 14656 Industry Circle, La Mirada, CA 90638 Ct 0 < $1 trillion X<Zrniflion 0 < $10 million 0 <$15Tnillion $15 —nolion < $1 trillion —C-Z-s-5million N < $10 million 0 twHion < $15 0 > $15 trillion 0 <$I million 0 < $5 trillion 0 < $10 million 0 < $15 rnillior. 0>s1stnillion ffl�14 W, Distribution: 1) Original — Local Agency File Page 12-112 November 14,2006 LPP 06-06 Local Assistance ProceL j manual Bidder's List of Subcontractors (DUE and Non -DBE) BIDDERIS LIST OF SUBCONTRACTORS (DBE and NON -DBE)- PART Al The bidder shall list all subcontractors who provided a quote or bid but were not selected to participate as a subcontractor on this project. This is required for compliance with Title 49, Section 26 of the Code of Federal 9spdations. Photocopy this form for additional firms. Fft*Nima. Phil es A'ddr Ka: -ZIP M .Stale Name Phone 'o?) El $1 ME. a< $5 million PCB 0 < w million P.O. Box 16118, Long Beach, CA 90806-0618 far <$15million 0 > $15 nilfflon Name Phone ❑ < $1 million < $5 million Address l3 < $to mill -Ion Fax Li<sisnzitlion City State ZIP [I > $15 million Name Phone ❑ < $1 million Address H<$10million Far < $15 million City State ZIP > $15 million Name Phone D <$I million [I < $5 million Address C1 < $10 million PDX CJ < $15 million City State ZIP T_ E > $15 iWillio. Distribution- 1) Original - Local Agmey File Page 12-112 November 14, 2006 LPP 06-06 EXFBBiT 1. .. Local Assistance ProceL s irianua . Bidder's ]List of Subcontractors (DBE and Nam -DBE) EI®®ER°S LIST OF SUBCONTRACTORS (DBE and NON -DBE)- PART i$ The bidder shall list all subcontractors who provided a quote or bid but were not selected to participate as a subcontractor on this project. This is required for compliance with Title Distribution: 1) Original - Local Agency File Page 12-112 November 14, 2006 LPP 06-06 lt �� i►� .. _ .�, ;�. pi. � .r i, �►� ,�� .fix THE ATTACHED WAGE RATES ARE FOR REFERENCE ONLY. THE CONTRACTOR IS SOLEY RESPONSIBLE FOR PAYING THE ACTUAL AND CURRENT WAGES REQUIRED BY THE LAWS APPLICABLE FOR THIS PROJECT. Local Assistance Procedures Manual PS&E Checklist Instructions EXHIBIT 12-E Attachment A SECTION 14. FEDERAL REQUIREMENTS FOR FEDERAL -AID CONSTRUCTION PROJECTS GENERAL. —The work herein proposed will be financed in whole or in part with Federal funds, and therefore all of the statutes, rules and regulations promulgated by the Federal Gov- ernment and applicable to work financed in whole or in part with Federal finds will apply to such work. The "Required Contract Provisions, Federal -Aid Construction Contracts, "Form FHWA I273, are included in this Section 14. Whenever in said required contract provisions references are made to "SHA contracting officer," "SHA resident engineer," or "authorized representative of the SHA," such references shall be construed to mean "Engineer" as defined in Section 1-1.18 of the Standard Specifications. PERFORMANCE OF PREVIOUS CONTRACT. —In ad- dition to the provisions in Section 11, "Nondiscrimination," and Section VII, "Subletting or Assigning the Contract," of the re- quired contract provisions, the Contractor shall comply with the following: The bidder shall execute the CERTIFICATION WITH RB- GARD TO THE PERFORMANCE OF PREVIOUS CON- TRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND THE FILING OF REQUIRED REPORTS located in the proposal. No request for subletting or assigning any portion of the contract in excess of $10,000 will be considered under the provisions of Section VII of the required contract provisions unless such request is accompanied by the CERTIFICATION referred to above, executed by the proposed subcontractor. NON -COLLUSION PROVISION. —The provisions in this section are applicable to all contracts except contracts for Federal Aid Secondary pro.ects. 'Title 23, UmteT States Code, Section 112, requires as a condi- tion precedent to approval by the Federal Highway Administrator of the contract for this work that each bidder file a swom statement executed by, or on behalf of, the person, firm, association, or corporation to whom such contract is to be awarded, certifying that such person, firm, association, or corporation has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with the submitted bid. A form to make the non -collusion affidavit statement required by Section 112 as a certification under penalty of perjury rather than as a sworn statement as permitted by 28, USC, Sec. 1746, is included in the proposal. PARTICIPATION BY DISADVANTAGED BUSINESS EN- TERPRISES IN SUBCONTRACTING: Part 26, Title 49, Code of Federal Regulations applies to this Federal -aid project. Pertinent sections of said Code are incorporated in part or in its entirety within other sections of these special provisions. Schedule 13---Information for Determining Joint Venture Eli- gibility FR-1 (This form need not be filled in if all joint venture firms are BB owned.) 1. Name of joint venture 2. Address of joint venture 3. Phone number of joint venture 4. Identify the firms which comprise the joint venture. (The DBE partner must complete Schedule A.) a. Describe the role of the DBE firm in the joint venture. b. Describe very briefly the experience and business qualifications of each non -DBE joint venturer: 5. Nature of the joint venture's business 6. Provide a copy of the joint venture agreement. 7. What is the claimed percentage of DEE ownership? _ 8.Ownership of joint venture: (This need not be filled in if described in the joint venture agreement, provided by question 6.). Revised a-95 08-07-95 Page 12-65 LPP 01-04 March 15, 2001 EXH MIT 12-E Local Assistance Procedures Manual Attachment A PS&E Checklist Instructions a. Profit and loss sharing. b. Capital contributions, including equipment. a Other applicable ownership interests. 9. Control of and participation in this contract. Identify b name, race, sex, and "firm" those individuals (and their titieZ who are responsible for day-to-day management and policy decision making, including, but not limited to, those with prime responsibility for: a. Financial decisions b. Management decisions, such as: 1. Estimating 2. Marketing and sales 3. Hiring and firing of management personnel _ 4. Purchasing of major items or supplies e. Supervision of field operations Note. lf; after filing this Schedule B and before the comple- tion of the joint venture's work on the contract covered by this regulation, there is any significant change in the information submitted, the joint venture must inform the grantee, either di- rectly or through the prime contractor if the joint venture is a subcontractor. Affidavit "The undersigned swear that the foregoing statements are cor- rect and include all material information necessary to identify and explain the terms and operation of our joint venture and the intended participation by each joint venturer in the undertaking. Further, the undersigned covenant and agree to provide to grantee current, complete and accurate information regarding ac- tual joint venture work and the payment therefor and any pro- posed changes in any of the joint venture arrangements and to permit the audit and examination of the books, records and files of the joint venture, or those of each joint venturer relevant to the joint venture, by authorized representatives of the grantee or the Federal funding agency.. Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initiating action under Federal or State laws concerning false statements." Name of Firm . Name of Firm ...................................................................................................... Signature Signature ........................ ............................... Name I...............� .................. ....................................................................................... Title Title ...................................................................................................... Date Date Date State of County of On this _day of , 19 before me appeared (Name) to me personally known, who, being duly sworn, did execute the foregoing affi- davit, and did state that he or she was properly authorized by (Name of firm) to execute the affidavit and did so as his or her free act and deed. Notary Public T Commission expires [Seal] Date State of County of On this —day of , 19 _, before me appeared (Name) to me personally known, who, being duly sworn, did execute the foregoing affidavit, and did state that he or she was properly authorized by (Name of firm) to execute the affidavit and did so as his or her free act and deed. NotaryPublic Commission expires [Seal] Revised 3-95 08-07-95 Not applicable since we are not bidding as a joint venture. FR 2 Page 12-66 March 15, 2001 UP 01-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B REQUIRED CONTRACT PROVISIONS FEDERAJ AID CONSTRUCTION CONTRACTS (Exclusive of Appalachian Contracts) I. General..................................................................... U. Nondiscrimination..................................................... IIL Nonsegregated Facilities ........................................... IV. Payment ofPredetermined Minimum Wage ............. V. Statements and Payrolls ............................................ VI. Record of Materials, Supplies, and Labor ................. VII. Subletting or Assigning the Contract ........................ Vlll. Safety: Accident Prevention ..................................... IX. False Statements Concerning Highway Project.......... X. Implementation of Clean Air Act and Federal Water Pollution Control Ad ................................................. X1. Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion ..................... XII. Certification Regarding Use of Contract Funds for Lobbying.................................................................. ATTACHMENTS FR 3 Page 6. Selection of Labor: During the performance of this contract, 3 3 the contractor shall not: 5 a. discriminate against labor from an other State, possession, 6 or territoryof the United States any for employment 8 preference for Appalachian contracts, when applicable, as 9 specified in Attachment A), or 9 b. employ convict labor for any purpose within the limits of 10 the project unless it is labor performed by convicts who are on 10 parole, supervised release, or probation. 10 11. NONDISCRIMINATION 11 (Applicable to all Federal -aid construction contracts and to all related subcontracts of $10,000 or more.) M A. Employment Preference for Appalachian Contracts (included in Appalachian contracts only) GENERAL 1. These contract provisions shall apply to all work performed on the contract by the contractor's own organization and with the assistance of workers under the contractor's immediate superintendence and to all work performed on the contract by piecework, station work, or by subcontract. 2. Except as otherwise provided for in each section, the con- tractor shall insert in each subcontract all of the stipulations contained in these Required Contract Provisions, and further re- quire their inclusion in any lower tier subcontract or purchase order that may in turn be made. The Required Contract Prbvisions shall not be incorporated by reference in any case. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with these Required Contract Provisions. 3. A breach of any of the stipulations contained in these Re- quired Contract Provisions shall be sufficient grounds for termi- nation of the contract. 4. A breach of the following clauses of the Required Contract Provisions may also be grounds for debarment as provided in 29 CFR 5.12 Section 1, paragraph 2; Section IV, paragraphs 1, 2, 3, 4, and 7; Section V, paragraphs 1 and 2a through 2g. 5, Disputes arising out of the labor standards provisions of Section IV (except paragraph 5) and Section V of these Required Contract Provisions shall not be subject to the general disputes clause of this contract. Such disputes shall be resolved in accor- dance with the procedures of the U.S. Department of Labor (DOL) as set forth in 29 CFR 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, the DOL, or the contractor's employees or their representatives. 1. Equal Employment Opportunity: Equal employment opportunity (EEO) requirements not to discriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, rules, regulations (28 CFR 35, 29 CFR 1630, and 41 CFR 60) and orders of the Secretary of Labor as modified by the provisions prescribed herein, and im- posed pursuant to 23 U.S.C. 140 shall constitute the EEO and specific affirmative action standards for the contractor's project activities under this contract. The Equal Opportunity Construction Contract Specifications set forth under 41 CFR 60-4.3 and the provisions of the American Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) set forth under 28 CFR 35 and 29 CFR 1630 are incorporated by reference in this contract. In the execution of this contract, the contractor agrees to comply with the following minimum specific requirement activities of EEO: a. The contractor will work with the State highway agency (SRA) and the Federal Government in carrying out EEO obli- gations and in their review of his/her activities under the con- tract. b. The contractor will accept as his operating policy the following statement: "It is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age or disability. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment ad- vertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprentice- ship, preapprenticeship, and/or on-the-job training." 2. EEO Officer: The contractor will designate and make known to the SHA contracting officers an EEO Officer who will have the responsibility for and must be capable of effectively Page 12-67 LPP 01-04 March 15, 2001 EXMIT 12 E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions administering and promoting an active contractor program of EEO and who must be assigned adequate authority and responsibility to do so. 3. Dissemination of Policy: All members of the contractor's staff who are authorized to hire, supervise, promote, and discharge employees, or who recommend such action, or who are substantially involved in such action, will be made fully cognizant of, and will implement, the contractor's EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above agreement will be met, the following actions will be taken as a minimum: a. Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and then not less often than once every six months, at which time the contractor's EEO policy and its implementation will be re- viewed and explained. The meetings will be conducted by the EEO Officer. b. All new supervisory or personnel office employees will be given a thorough indoctrination by the EEO Officer, covering all major aspects of the contractor's EEO obligations within thirty days following their reporting for duty with the contractor. c. All personnel who are engaged in direct recruitment for the project will be instructed by the EEO Officer in the contractor's procedures for locating and hiring minority group employees. d. Notices and posters setting forth the contractor's EEO policy will be placed in areas readily accessible to employees, applicants for employment and potential employees. e. The contractor's EEO policy and the procedures to im- plement such policy will be brought to the attention of em- ployees by means of meetings, employee handbooks, or other appropriate means. 4. Recruitment: When advertising for employees, the contractor will include in all advertisements for employees the notation. "An Equal Opportunity Employer." All such adver- tisements will be placed in publications having a large circulation among minority groups in the area from which the project work force would normally be derived. a. The contractor will, unless precluded by a valid bargaining agreement, conduct systematic and direct recruitment through public and private employee referral sources likely to yield qualified minority group applicants. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such identified sources procedures whereby minority group applicants may be referred to the contractor for employment consideration. b. In the event the contractor has a valid bargaining agreement providing for exclusive hiring hall referrals, he is expected to observe the provisions of that agreement to the extent that the system permits the contractor's compliance with EEO contract provisions. (The DOL has held that where implementation of such agreements have the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Executive Order 11246, as amended.) c. The contractor will encourage his present employees to Form 1273 — Revised 3.95 08.07-95 Page 12-68 Form 1273 — Revised 3.9S 08-07-95 refer minority group applicants for employment. Information and procedures with regard to referring minority group applicants will be discussed with employees. S. Personnel Actions: Wages, working conditions, and employee benefits shall be established and administered, and personnel actions of every type, including hiring, upgrading, promotion, transfer, demotion, layoff, and termination, shall be taken without regard to race, color, religion, sex, national origin, age or disability. The following procedures shall be followed: a. The contractor will conduct periodic inspections of project sites to ensure that working conditions and employee facilities do not indicate discriminatory treatment of project site personnel. b. The contractor will periodically evaluate the spread of wages paid within each classification to determine any evidence of discriminatory wage practices. c. The contractor will periodically review selected personnel actions in depth to determine whether there is evidence of discrimination. Where evidence is found, the contractor will promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all affected persons. d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor in connection with his obligations under this contract, will attempt to resolve such complaints, and will take appropriate corrective action within a reasonable time. If the investigation indicates that the discrimination may affect persons other than the complainant, such corrective action shall include such other persons. Upon completion of each investigation, the contractor will inform every complainant of all of his avenues of appeal. FR-4 6. Training and Promotion: a. The contractor will assist in locating, qualifying, and increasing the skills of minority group and women employees, and applicants for employment. b. Consistent with the contractor's work force requirements and as permissible under Federal and State regulations, the contractor shall make full use of training programs, apprenticeship, and on-thejob training programs for the ge- ographical area of contract performance. Where feasible, 25 percent of apprentices or trainees in each occupation shall be in their first year of apprenticeship or training. In the event a special provision for training is provided under this contract, this subparagraph will be superseded as indicated in the special provision. c. The contractor will advise employees and applicants for employment of available training programs and entrance re- quirements for each. d. The contractor will periodically review the training and promotion potential of minority group and women employees and will encourage eligible employees to apply for such training and promotion. March 15, 2001 LPP 01-04 Local Assistance Procedures Manual EXHIBIT Im PS&E Checklist Instructions Attachment B 7. Unions: If the contractor relies in whole or in part upon unions as a source of employees, the contractor will use his/her best efforts to obtain the cooperation of such unions to increase opportunities for minority groups and women within the unions, and to effect referrals by such unions of minority and female employees. Actions by the contractor either directly or through a contractor's association acting as agent will include the procedures set forth below: a. The contractor will use best efforts to develop, in coop- eration with the unions, joint training programs aimed toward qualifying more minority group members and women for membership in the unions and increasing the skills of minority group employees and women so that they may qualify for higher paying employment. b. The contractor will use best efforts to incorporate an EEO clause into each union agreement to the end that such union will be contractually bound to refer applicants without regard to their race, color, religion, sex, national origin, age or disability. c. The contractor is to obtain information as to the referral practices and policies of the labor union except that to the extent such information is within the exclusive possession of the labor union and such labor union refuses to furnish such information to the contractor, the contractor shall so certify to the SHA and shall set forth what efforts have been made to obtain such information. d.In the event the union is unable to provide the contractor with a reasonable flow of minority and women referrals within the time limit set forth in the collective bargaining agreement, the contractor will, through independent recruitment efforts, fill the employment vacancies without regard to race, color, religion, sex, national origin, age or disability; making full efforts to obtain qualified and/or qualifiable minority group persons and women. (The DOL has held that it shall be no excuse that the union with which the contractor has a collective bargaining agreement providing for exclusive referral failed to refer minority employees.) In the event the union referral prac- tice prevents the contractor from meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, such contractor shall immediately notify the SHA. S. Selection of Subcontractors, Procurement of Ksiterials and Leasing of Equipment: The contractor shall not discriminate on the grounds of race, color, religion, sex, national origin, age or disability in the selection and retention of subcontractors, including procurement of materials and leases of equipment. a. The contractor shall notify all potential subcontractors and suppliers of his/her EEO obligations under this contract. b. Disadvantaged business enterprises (DBE), as defined in 49 CFR 26, shall have equal opportunity to compete for and perform subcontracts which the contractor enters into pursuant to this contract. The contractor will use his best efforts to solicit bids from and to utilize DBE subcontractors or subcontractors with meaningful minority group and female representation among their employees. Contractors shall obtain lists of DBE construction firms from SHA personnel. c. The contractor will use his best efforts to ensure subcon- tractor compliance with their EEO obligations. 9. Records and Reports: The contractor shall keep such records as necessary to document compliance with the EPA requirements. Such records shall be retained for a period of three years following completion of the contract work and shall be available at reasonable times and places for inspection by au- thorized representatives of the SHA and the FHWA. a. The records kept by the contractor shall document the following: (1) The number of minority and non -minority group members and women employed in each work classification on the project; (2) The progress and efforts being made in cooperation with unions, when applicable, to increase employment op- portunities for minorities and women; (3) The progress and efforts being made in locating, hiring, training, qualifying, and upgrading minority and female employees; and (4) The progress and efforts being made in securing the services of DBE subcontractors or subcontractors with meaningful minority and female representation among their employees. b. The contractors will submit an annual report to the SHA each 7uly for the duration of the project, indicating the number of minority, women, and non -minority group employees currently engaged in each work classification required by the contract work. This information is to be reported on Form FHWA-1391. If on-the-job training is being required by special provision, the contractor will be required to collect and report training data. III NONSEGREGATED FACILITIES (Applicable to all Federal -aid construction contracts and to all related subcontracts of $10,000 or mote.) FR-5 a. By submission of this bid, the execution of this contract or subcontract, or the consummation of this material supply agreement or purchase order, as appropriate, the bidder, Federal - aid construction contractor, subcontractor, material supplier, or vendor, as appropriate, certifies that the firm does not maintain or provide for its employees any segregated facilities at any of its establishments, and that the firm does not permit its employees to perform their services at any location, under its control, where segregated facilities are maintained. The firm agrees that a breach of this certification is a violation of the EEO provisions of this contract. The firm further certifies that no employee will be denied access to adequate facilities on the basis of sex or disability. b. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms, and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive, or are, in fact, seg- regated on the basis of race, color, religion, national origin, age or disability, because of habit, local custom, or otherwise. The only exception will be for the disabled when the demands for accessibility override (e.g. disabled parking). Form 1273 — Revised 3.95 08.07.95 Page 12-69 LPP 01-04 March 15, 2001 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions c. The contractor agrees that it has obtained or will obtain identical certification from proposed subcontractors or material suppliers prior to award of subcontracts or consummation of material supply agreements of $10,000 or more and that it will retain such certifications in its files. 1V. PAYMENT OF PREDETERMINED M NIMUM WAGE (Applicable to all Federal -aid construction contracts exceeding $2,000 and to all related subcontracts, except for projects located on roadways classified as local roads or mural minor collectors, which are exempt.) 1. General: a. Ail mechanics and laborers employed or working upon the site of the work will be paid unconditionally and not less often than once a week and without subsequent deduction or rebate on any account except such payroll deductions as are permitted by regulations (9 CFR 3)] issued by the Secretary of Labor under the Copeland Act (40 U.S.C. 276c) the full amounts of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment. The payment shall be computed at wage rates not less than those contained in the wage determination of the Secretary of Labor (hereinafter "the wage determination") which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the contractor or its subcontractors and such laborers and mechanics. The wage determination (including any additional classifications and wage rates conformed under paragraph 2 of this Section IV and the DOL poster (WH-1321) or Form FHWA-1495) shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. For the purpose of this Section, contributions made or costs reasonably anticipated for bona fide fringe benefits under Section I(b)(2) of the Davis -Bacon Act (40 U.S,C. 276a) on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of Section IV, paragraph 3b, hereof. Also, for the purpose of this Section, regular contributions made or costs incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs, which cover the particular weekly period, are deemed to be constructively made or incurred during such weekly period, Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage deter- mination for the classification of work actually performed, without regard to skill, except as provided in paragraphs 4 and 5 of this Section IV. b. Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein, provided, that the employer's payroll records accurately set forth the time spent in each classification in which work is performed. a All rulings and interpretations of the Davis -Bacon Act and related acts contained in 29 CFR 1, 3, and 5 are herein incorporated by reference in this contract. Form 1273 —Revised 3-95 08.07.95 FR-6 Page 12-70 2. Classification: a. The SHA contracting officer shall require that any class of laborers or mechanics employed under the contract, which is not listed in the wage determination, shall be classified in conformance with the wage deWmmmination. b. The contracting officer shall approve an additional classification, wage rate and fringe benefits only when the following criteria have been met: (1) the work to be performed by the additional classifi- cation requested is not performed by a classification in the wage determination; (2) the additional classification is utilized in the area by the construction industry; (3) the proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination; and (4) with respect to helpers, when such a classification prevails in the area in which the work is performed, c.If the contractor or subcontractors, as appropriate, the laborers and mechanics (if known) to be employed in the addi- tional classification or their representatives, and the contracting officer agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate), a report of the action taken shall be sent by the contracting officer to the DOL, Administrator of the Wage and Hour Division, Employment Standards Administration, Washington, D.C. 20210. The Wage and Hour Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30-day period that additional time is necessary. d.In the event the contractor or subcontractors, as appro- priate, the laborers or mechanics to be employed in the addi- tional classification or their representatives, and the contracting officer do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions, including the views of all interested parties and the recommendation of the contracting officer, to the Wage and Hour Administrator for determination. Said Administrator, or an authorized representative, will issue a determination within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30-day period that additional time is necessary e. The wage rate (including fringe benefits where appropriate) determined pursuant to paragraph 2c or 2d of this Section W shall be paid to all workers performing work in the additional classification from the first day on which work is performed in the classification, 3. Payment of Fringe Benefits: a. Whenever the minimum wage rate prescribed in the con- tract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate, the contractor or subcontractors, as appropriate, shall either pay the benefit March 15, 2001 LPP 01-04 Local Assistance Procedures Manual EXHIBIT 12-B PS&E Checklist Instructions Attachment B as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly case equivalent thereof. b. If the contractor or subcontractor, as appropriate, does not make payments to a trustee or other third person, he/she tray consider as a part of the wages of any laborer or mechattic the amount of any costs reasonably anticipated in providing bona fide fringe benefits under a plan or program, provided, that the Secretary of Labor has found, upon the written request of the contractor, that the applicable standards of the Davis -Bacon Act have been met. The Secretary of Labor may require the contractor to set aside in a separate account assets for the meeting of obligations under the plan or program. 4. Apprentices and Trainees (Programs of the U.S. DOL) and Helpers: a. Apprentices: (1) Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the DOL, Employment and Training Administration, Bureau of Apprenticeship and Training, or with a State apprenticeship agency recognized by the Bureau, or if a person is employed in his/her first 90 days of probationary employment as an apprentice in such an apprenticeship program, who is not individually registered in the program, but who has been certified by the Bureau of Apprenticeship and Training or a State apprenticeship agency (where appropriate) to be eligible for probationary employment as an apprentice. (2) The allowable ratio of apprentices to joumeymm-level emplloyees on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any employee listed on a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rate listed in the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor or subcontractor is performing construction on a project in a locality other than that in which its program is registered, the ratios and wage rates (expressed in percentages of the journeyman -level hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. (3) Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's level of progress, expressed as a percentage of the journeyman - level hourly rate specified in the applicable wage detemrination. Apprentices shall be paid fringe benefits in accordance with the provisions of the apprenticeship program. If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator for the Wage and Hour Division determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. FR-7 (4) In the event the Bureau of Apprenticeship and Training, or a State apprenticeship agency recognized by the Bureau, withdraws approval of an apprenticeship program, the contractor or subcontractor will no longer be perntted to utilize apprentices at less than the applicable predetermined rate for the comparable work performed by regular employees until an acceptable program is approved b. Trainees: (1) Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by formal certification by the DOL, Employment and Training Administration. (2) The ratio of trainees to journeyman -level employees on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Any employee listed on the payroll at a trainee rate who is not registered and participating in a training plan approved by the Employment and Training Administration shall be pall not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any trainee performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. (3? Every trainee must be paid at not less than the rate specified in the approved program for his/her level of progress, expressed as a percentage of the journeyman -level hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding joumeyman-level wage rate on the wage determination which provides for less than full fringe benefits for apprentices, in which case such trainees shall re- ceive the same fringe benefits as apprentices. . (4) In the event the Employment and Training Adminis- tration withdraws approval of a training program, the con- tractor or subcontractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. c. Helpers: Helpers will be permitted to work on a project if the helper classification is specified and defined on the applicable wage determination or is approved pursuant to the conformance procedure set forth in Section IV.2. Any worker listed on a payroll at a helper wage rate, who is not a helper under an approved definition, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. Form 1273 --- Revised 3-95 08.07.95 Page 12-71 LPP 01-04 March 15, 2001 EI11IBIT 12-E Attachment B 3. Apprentices and Trainees (Programs of the U.S. DOT): Apprentices and trainees working under apprenticeship and skill training programs which have been certified by the Secretary of Transportation as promoting EEO in connection with Federal -aid highway construction programs are not subject to the requirements of paragraph 4 of this Section 1V. The straight time hourly wage rates for apprentices and trainees under such programs wilI be established by the particular programs, The ratio of apprentices and trainees to journeymen shall not be greater than permitted by the terms of the particular program. 6. Withholding: The SHA shall upon its own action or upon written request of an authorized representative of the DOL withhold, or cause to be withheld, from the contractor or subcontractor under this contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to Davis -Bacon prevailing wage requirements which is held by the same prime contractor, as much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees, and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contract In the event of failure to pay any laborer or mechanic, including any apprentice, trainee, or helper, employed or working on the site of the work, all or part of the wages required by the contract, the SHA contracting officer may, a&er written notice to the contractor, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. 7. Overtime Requirements: No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers, mechanics, watchmen, or guards (including apprentices, trainees, and helpers described in paragraphs 4 and 5 above) shall require or permit any laborer, mechanic, watchman, or guard in any workweek in which he/she is employed on such work, to work in excess of 40 hours in such workweek unless such laborer, mechanic, watchman, or guard receives compensation at a rate not less than one -and -one-half times his/her basic rate of pay for all hours worked in excess of 40 hours in such workweek. S. Violation: Liability for Unpaid 'Wages; Liquidated Damages: In the event of any violation of the clause set forth in paragraph 7 above, the contractor and any subcontractor responsible thereof shall be liable to the affected employee for his/her unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory) for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer, mechanic, watchman, or guard employed in violation of the clause set forth in paragraph 7, in the sum of $10 for each calendar day on which such employee was required or permitted to work in excess of the standard work week of 40 hours without payment of the overtime wages required by the clause set forth in paragraph 7. Fonn 1273 — Revised 3-95 08-D7.95 Page 12-72 Local Assistance Procedures Manual PS&B Checklist Instructions 9. Withholding for Unpaid Wages and Liquidated Damagest The SHA shall upon its own action or upon written request of any authorized representative of the DOL withhold, or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety tandards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph g above. V. STATEMENTS AND PAYROLLS (Applicable to all Federal -aid construction contracts exceeding $2,000 and to all related subcontracts, except for projects located on roadways classified as local roads or rural collectors, which are exempt) 1. Compliance with Copeland Regulations (29 CFR 3). The contractor shall comply with the Copeland Regulations of the Secretary of Labor which are herein incorporated by reference. 2. Payrolls and Payroll Records: FR-8 a. Payrolls and basic records relating thereto shall be maintained by the contractor and each subcontractor during the course of the work and preserved for a period of 3 years from the date of completion of the contract for all laborers, mechanics, apprentices, trainees, watchmen, helpers, and guards working at the site of the work. b. The payroll records shall contain the name, social security number, and address of each such employee; his or her correct classification; hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalent thereof the types described in Section I(b)(2XB) of the Davis Bacon Act); daily and weekly number of hours worked; deductions made; and actual wages paid. In addition, for Appalachian contacts, the payroll records shall contain a notation indicating whether the employee does, or does not, normally reside in the labor area as defined in Attachment A, paragraph 1. Whenever the Secretary of Labor, pursuant to Sec- tion IV, paragraph 3b, has found that the wages of any laborer or mechanic include the amount of any casts reasonably anticipated in providing benefits under a plan or program described in Section I(b)(2)(B) of the Davis Bacon Act, the contractor and each subcontractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, that the plan or program has been communicated in writing to the laborers or mechanics affected, and show the cost anticipated or the actual cost incurred in providing benefits. Contractors or subcontractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprentices and trainees, and ratios and wage rates prescribed in the applicable programs. March 15, 2001 LPP 01-04 Local Assistance Procedures Manual EXE[IBIT 12 E PS&E Checklist instructions Attachment B e. Each contractor and subcontractor shall furnish, each week in which any contract work is performed, to the SHA resident engineer a payroll of wages paid each of its Imploym (including apprentices, trainees, and helpers, described in Section paragraphs 4 and 5, and watchmen and guards en- gaged on work during the preceding weekly payroll period). The payroll submitted shall set out accurately and completely all of the fnfommation required to be maintained under paragraph 2b of this Section V. This information may be submitted in any form desired. Optional Form WH-347 is available for this purpose and may be purchased from the Superintendent of Documents (Federal stock number 029-005-0014-1), U.S. aoverrmtent printing Office, Washington, D.C. 20402. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. d. Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or sub- contractor or his/her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (1)that the payroll for the payroll period contains the infotnxition required to be maintained under paragraph 2b of this Section V and that such information is correct and complete; (2) that such laborer or mechanic (including each helper, apprentice, and trainee) employed on the contract during the payroll period has been paid the full weekly wages earned, without rebate, either directly or indirectly, and that no deductions have been made either directly or indirectly from the full wages earned, other than pernmissible deductions as set forth in the Regulations, 29 CFR 3; (3)that each laborer or mechanic has been paid not less that the applicable wage rate and fringe benefits or cash equivalent for the classification of worked performed, as specified in the applicable wage determination incorporated into The contract. e. The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH-347 shall satisfy the requirement for submission of the "Statement of Compliance" required by paragraph 2d of this Section V. L The falsification of any of the above certifications may subject the contractor to civil or criminal prosecution under 18 U.S,C. 1001 and 31 U.S.C. 231. g. The contractor or subcontractor shall make the records re- quired under paragraph 2b of this Section V available for in- spection, copying, or transcription by authorized representatives of the SHA, the FHWA, or the DOL, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the re- quired records or to make them available, the SHA, the FHWA, the DOL, or all may, after written notice to the contractor, sponsor, applicant, or owner, take such actions as may be nec- essary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR. S.12. VI. RECORD OF MATERIALS, SUPPLIES, AND LABOR 1.On all Federal -aid contracts on the National Highway System, except those which provide solely for the installation of protective devices at raihoad grade crossings, those which are constructed on a force account or direct labor basis, highway beautification contracts, and contracts for which the total final construction cost for roadway and bridge is less than S 1,000,000 (23 CFR 635); the contractor shall: a. Become familiar with the list of specific materials and supplies contained in Form FHWA-47, "Statement of Materials and Labor Used by Contractor of Highway Construction Involving Federal Funds," prior to the commencement of work under this contract. b. Maintain a record of the total cost of all materials and supplies purchased for and incorporated in the work, and also of the quantities of those specific materials and supplies listed on Form FHWA-47, and in the units shown on Form FHWA47. c. Fumish, upon the completion of the contract, to the SHA resident engineer on Form FHWA47 together with the data required in paragraph lb relative to materials and supplies, a final labor summary of all contract work indicating the total hours worked and the total amount earned. 2. At the prime contractor's option, either a single report covering all contract work or separate reports for the contractor and for each subcontract shall be submitted. VII. SUBLETTING OR ASSIGNING THE CONTRACT 1. The contractor shall perform with its own organization contract work amounting to not less than 30 percent (or a greater percentage if specified elsewhere in the contract) of the total original contract price, excluding any specialty items designated by the State. Specialty items may be performed by subcontract and the amount of any such specialty items performed may be deducted from the total original contract price before computing the amount of work required to be performed by the contractor's own organization (23 CFR 635). a. "Its own organization" shall be construed to include only workers employed and paid directly by the prime contractor and equipment owned or rented by the prime contractor, with or without operators. Such term does not include employees or equipment of a subcontractor, assignee, or agent of the prime contractor. U+R-9 b. "Specialty Items" shall be construed to be limited to work that requires highly specialized knowledge, abilities, or equipment not ordinarily available in the type of contracting organizations qualified and expected to bid on the contract as a whole and in general are to be limited to minor components of the overall contract. Form 1273 —Revised 3-95 08-07-95 Page 12-73 LPP 08-04 December 31, 2008 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions 2. The contract amount upon which the requirements set forth in garding the seriousness of these and similar acts, the following paragraph I of Section VII is computed includes the cost of notice shall be posted on each Federal -aid highway project (23 naterial and manufactured products which are to be purchased or CFR 635) in one or more places where it is readily available to all produced by the contractor under the contract provisions. persons cmeemed with the project: 3. The contractor shall furnish (a) a competent tendent or supervisor who is employed by the fimy has fill a 04ty to direct performance of the work in accordance with the contract requirements, and is in charge of all construction operations (regardless of who performs the work) and (b) such other of its own organizational resources (supervision, management and engineering services) as the SHA contracting officer determines is necessary to assure the performance of the contract. 4. No portion of the contract shall be sublet, assigned or otherwise disposed of except with the written consent of the SHA contracting officer, or authorized representative, and such consent when given shall not be construed to relieve the contractor of any responsibility for the fulfillment of the contract. Written consent will be given only after the SHA has assured that each subcontract is evidenced in writing and that it contains all pertinent provisions and requirements of the prime contract. VIII. SAFETY: ACCIDENT PREVENTION I.In the performance of this contract the contractor shall comply with all applicable Federal, State, and local laws governing safety, health, and sanitation (23 CFR 635). The contractor shall provide all safeguards, safety devices and protective equipment and take any other needed actions as it determines, or as the SHA contracting officer may determine, to be reasonably necessary to protect the life and health of employees on the job and the safety of the public and to protect property in connection with the performance of the work covered by the contract. 2. It is a condition of this contract, and shall be made a con- lition of each subcontract, which the contractor enters into pur- suant to this contract, that the contractor and any subcontractor shall not permit any employee, in performance of the contract, to work in surroundings or under conditions which are unsanitary, hazardous or dangerous to his/her health or safety, as determined under construction safety and health standards (29 CFR 1926) promulgated by the Secretary of Labor, in accordance with Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 333). 3. Pursuant to 29 CFR 1926.3, it is a condition of this contract that the Secretary of Labor or authorized representative thereof, shall have right of entry to any site of contract performance to inspect or investigate the matter of compliance with the construction safety and health standards and to carry out the duties of the Secretary under Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 333). IX. FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS In order to assure high quality and durable construction in conformity with approved plans and specifications and a high degree ot` reliability on statements and representations made by engineers, contractors, suppliers, and workers on Federal -aid highway projects, it is essential that all persons concerned with the project perform their functions as carefully, thoroughly, and honestly as possible. Willful falsification, distortion, or mis- representation with respect to any facts related to the project is a violation of Federal law. To prevent any misunderstanding re - Form 1273 — Revised 3-95 08-07.95 NOTICE TO ALL PERSONNEL ENGAGED ON FEDERAL -AID HIGHWAY PROJECTS 18 U.S.C. 1020 reads as follows: "Whoever being an ofeer, agent, or employee of the Untied States, or any State or Territory, or whoever, whether a person. association, jirm, or corporation, knowingly makes any false statement, false representation, or false report as to the character, quality, quantity, or cost of the material used or to be used, or the quantity or quality of the work performed or to be perjorme% or the cost thereof in connection with the submission of pilaans, maps, spec ions, contracts, or costs of construction on any highway or related project submitted for approval to the Secretary of Transportation; or Whoever knowingly makes any false statement, false repre- sentation, false report or false claim with respect to the character, quality, quantity, or cost of any work performed or to be per- formed, or materials furnished or to be furnished, in connection with the construction of any highway or related project approved by the Secretary of Transportation; or Whoever knowingly makes any false statement or false repre- sentation as to material fact in any statement, certificate, or report submitted pursuant to provisions of the Federal -aid Roads Act approved July 1, 1916, (39 Star, 355), as amended and sup- plemented; Shall be fated not more that $10,000 or imprisoned not more than 5 years or both.' X. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT (Applicable to all Federal -aid construction contracts and to all related subcontracts of $100,000 or more.) By submission of this bid or the execution of this contract, or subcontract, as appropriate, the bidder, Federal -aid construction contractor, or subcontractor, as appropriate, will be deemed to have stipulated as follows: I. That any facility that is or will be utilized in the performance of this contract, unless such contract is exempt under the Clean Air Act, as amended (42 U.S.C. 1857 et seq., as amended by Pub. L. 91-604), and under the Federal Water Pollution Control Act, as amended (33 U.S.C. 1251 et seq., as amended by Pub. L. 92-500), Executive Order 11738, and regulations in implementation thereof (40 CFR 15) is not listed, on the date of contract award, on the U.S. Environmental Protection Agency (EPA) List of Violating Facilities pursuant to 40 CFR 15.20. 2. That the firm agrees to comply and remain in compliance with all the requirements of Section 114 of the Clean Air Act and Section 308 of the Federal Water Pollution Control Act and all regulations and guidelines listed thereunder. 3. That the firm shall promptly notify the SHA of the receipt of any communication from the Director, Office of Federal Activities, EPA, indicating that a facility that is or will be utilized FR-10 Page 12-74 March 15, 2001 LPP 01-04 Local Assistance Procedures Manual EXHIBIT 12 B PS&E Checklist Instructions Attachment B for the contract is under consideration to be listed on the EPA List of Violating Facilities. 4. That the firm agrees to include or cause to be included the requirements of paragraph 1 through 4 of this Section X t every nonexempt subcontract, and further agrees to take such action as the government may direct as a means of enforcing such re- quirements. XL CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION I. Instructions for Certification - Primary Covered Transactions; (Applicable to all Federal -aid contracts - 49 CFR 29) a. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. b. The inability of a person to provide the certification set out below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. however, failure of the prospective primary participant to fumish a certification or an explanation shall disqualify such a person from participation in this transaction. c. The certification in this clause is it material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause of default. d. The prospective primary participant shall provide im- mediate written notice to the department or agency to whom this proposal is submitted if any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. e_The terms "covered transaction," "debarred," "suspended," "ineligible," "lower Her covered transaction," "`participant;" "person," "primary covered transaction," "principal,' "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is submitted for assistance in obtaining a copy of those regulations, f. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower Her covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. FR-11 g. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Susens pion, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. h. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower Her covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the el- igibility of its principals. Each participant may, but is not required to, check the nonprocurernent portion of the "Lists of Parties Excluded From Federal Procurement or Nonproeurement Program" (Nonprocurement List) which is compiled by the General Services Administration. i. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. j. Except for transactions authorized under paragraph f of these instructions, if a participant in a covered transaction knowingly enters into a lower Her covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the de- partment or agency may terminate this transaction for cause or default. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion —Primary Covered Transactions 1. The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; b. Have not within a 3-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph lb of this certification; and Fern 1273 —Revised 3-95 08-07-95 Page 12-75 LPP 01-04 March 15, 2001 EXHIBIT 12-B Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions d. Have not within a 3-year period preceding this ap- plicatio�/proposal had one or iron public transactions (Federal, $fate or local) terminated for cause or default. 2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. L Instructions for Certification - Lower Tier Covered Transactions: (Applicable to all subcontracts, purchase orders and other lower tier transactions of $25,000 or more - 49 CFR 29) a. By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. c. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended," "Ineligible," "primary covered transaction," "participant," "person;" "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. e. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. f. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. g. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, sus ended, ineligible, or voluntarily excluded from the coverff transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the el- igibility of its principals. Each participant may, but is not Form 1273 —Revised 3.95 08.07-95 Page 12-76 required to, check the Nonprocurement List. h. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in food faith the certification required by this clause. The nowledge and information of participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. i. Except for transactions authorized under paragraph a of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the de- partment or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. XII. CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING (Applicable to all Federal -aid construction contracts and to all related subcontracts which exceed $100,000 - 49 CFR 20) 1. The prospective participant certifies by signing and submitting this bid or proposal, to the best of his or her knowledge and belief; that: a. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or wyloyee of any Federal agency, a Member of Congress, an otlicer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, FR-12 March 15, 2001 LPP 01-04 Local Assistance Procedures Manual UUMIT 12-E PS&E Checklist Instructions Attachment B grant, loan, or cooperative agreement, the undersigned s complete and submit Standard Form-LLL, "Disclosure Form Report Lobbying," in accordance with its instructions. A be subject to a civil penalty of not less than $10,000 and not more to than $100,000 for each such failure. 2. This certification is a material representation of fact upon which reliance was placed when this transaction was made or en- tered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall 3. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such recipients shall certify and disclose accordingly. Mnority Utilization Goals Economic Area Goal (Percent) 174 Redding CA: Non-SMSA Counties: 6.8 CA Lassen; CA Modoc; CA Plumas; CA Shasta; CA Siskiyou; CA Tebama 175 Eureka, CA Non-SMSA Counties: 6.6 CA Del Norte; CA Humboldt; CA Trinity 176 San Francisco -Oakland -San Jose, CA: SMSA Counties: 7120 Salinas -Seaside -Monterey, CA 28.9 CA Monterey 7360 San Francisco -Oakland 25.6 CA Alameda; CA Contra Costa; CA Marin; CA San Francisco; CA San Mateo 7400 San Jose, CA CA Santa Clara, CA 19.6 7485 Santa Cruz, CA CA Santa Cruz 14.9 7500 Santa Rosa CA Sonoma 9.1 8720 Vallejo -Fairfield -Napa, CA CA Napa; CA Solano 17.1 Non-SMSA Counties: CA Lake; CA Mendocino; CA San Benito 23.2 177 Sacramento, CA: SMSA Counties: 6920 Sacramento, CA 16.1 CA Placer; CA Sacramento; CA Yolo Non-SMSA Counties 14.3 CA Butte; CA Colusa; CA El Dorado; CA Glenn; CA Nevada; CA Sierra; CA Sutter; CA Yuba 178 Stockton -Modesto, CA: SMSA Counties: 5170 Modesto, CA 12.3 CA Stanislaus 8120 Stockton, CA 24.3 CA San Joaquin Non-SMSA Counties 19.8 CA Alpine; CA Amador; CA Calaveras; CA Mariposa; CA Merced; CA Toulumne FR-13 Page 12-77 LPP 09-02 July 31, 2009 EXIIIBBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions 179 Fresno -Bakersfield, CA SMSA Counties: 0680 Bakersfield, CA CA Kern 2840 Fresno, CA CA Fresno Non-SMSA Counties: CA Kings; CA Madera; CA Tulare 19.1 26.1 23.6 180 Los Angeles, CA: SMSA Counties: 0360 Anaheim -Santa Ana -Garden Grove, CA 11.9 CA Orange 4480 Los Angeles -Long Beach, CA 28.3 CA Los Angeles WW Oxnard -Simi Valley -Ventura, CA 21.5 CA Ventura 6780 Riverside -San Bernardino-Ontmio, CA 19.0 CA Riverside; CA San Bernardino 7480 Santa Barbara -Santa Maria -Lompoc, CA 19.7 CA Santa Barbara Non-SMSA Counties 24.6 CA Inyo; CA Mono; CA San Luis Obispo 181 San Diego, CA: SMSA Counties 7320 San Diego, CA 16.9 CA San Diego Non-SMSA Counties 18.2 CA hn erial For each July during which work is performed under the contract, you and each non -material -supplier subcontractor with a subcontract of $10,000 or more must complete Form FHWA PR-1391 (Appendix C to 23 CFR 230). Submit the forms by August 15. Training This section applies if a number of trainees or apprentices is specified in the special provisions. As part of your equal opportunity affirmative action program, provide on-the-job training to develop full journeymen in the types of trades or job classifications involved. You have primary responsibility for meeting this training requirement. If you subcontract a contract part, determine how many trainees or apprentices are to be trained by the subcontractor. Include these training requirements in your subcontract. Where feasible, 25 percent of apprentices or trainees in each occupation must be in their 1st year of apprenticeship or training. FR-14 Page12-78 July 31, 2009 LPP 09-02 Local Assistance Procedures Manual EXHIBIT 12-1E PS&E Checklist instructions Attachment H SECTION 2. PROPOSAL REQUIREMENTS AND CONDITIONS 2-1.01 GENERAL, The bidder's attention is directed to the provisions in Section 2, "Proposal Requirements and Conditions," of the Standard Specifications and these special provisions for the requirements and conditions which the bidder must observe in the preparation of and the submission of the bid. The bidder's bond shall conform to the bond form in the Bid book for the project and shall be properly filled out and executed. The bidder's bond form included in that book may be used. In conformance with Public Contract Code Section 7106, a Noncollusion Affidavit is included in the Bid book. Signing the Bid book shall also constitute signature of the Noncollusion Affidavit. The Contractor, sub -recipient or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of Title 49 CFR (Code of Federal Regulations), Part 26 in the award and administration of US DOT -assisted contracts. Failure by the Contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy, as the recipient deems appropriate. Each subcontract signed by the bidder must include this assurance. Failure of the bidder to fulfill the requirements of the Special Provisions for submittals required to be furnished after bid opening, including but not limited to escrowed bid documents, where applicable, may subject the bidder to a determination of the bidder's responsibility in the event it is the apparent low bidder on a future public works contracts. 2-1.015--FEDERAL LOBBYING RESTRICTIONS, --Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower -tier sub -recipient of a Federal -aid contract to pay for any person for influencing or attempting to influence a Federal agency or Congress in connection with the awarding of any Federal -aid contract, the making of any Federal grant or loan, or the entering into of any cooperative agreement. If any funds other than Federal funds have been paid for the same purposes in connection with this Federal -aid contract, the recipient shall submit an executed certification and, if required, submit a completed disclosure form as part of the bid documents. A certification for Federal -aid contracts regarding payment of funds to lobby Congress or a Federal agency is included in the Bid book. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Bid book. Signing the Bid book shall constitute signature of the Certification. The above referenced certification and disclosure of lobbying activities shall be included in each subcontract and any lower -tier contracts exceeding $100,000. All disclosure forms, but not certifications, shall be forwarded from tier to tier until received by the Engineer. The Contractor, subcontractors and any lower -tier contractors shall file a disclosure form at the end of each calendar quarter in which there occurs any event that requires disclosure or that materially affects the accuracy of the information contained in any disclosure form previously filed by the Contractor, subcontractors and any lower -tier contractors. An event that materially affects the accuracy of the information reported includes: Page 12-91 LPP 09-02 July 31, 2009 EXHIB1r 12-E Attachment $ Local Assistance Procedures Manual PS&E Checklist Instructions ^rood faith efforts documentation must include the following information and supporting documents, as necessary: 1. Items of work you have made available to UDBE firms. Identify those items of work you might otherwise perform with its own forces and those items that have been broken down into economically feasible units to facilitate UDBE participation. For each item listed, show the dollar value and percentage of the total contract. It is your responsibility to demonstrate that sufficient work to meet the goal was made available to UDBE firms. 2. Names of certified UDBEs and dates on which they were solicited to bid on the project. Include the items of work offered. Describe the methods used for following up initial solicitations to determine with certainty if the UDBEs were interested, and the dates of the follow-up. Attach supporting documents such as copies of letters, memos, facsimiles sent, telephone logs, telephone billing statements, and other evidence of solicitation. You are reminded to solicit certified UDBEs through all reasonable and available means and provide sufficient time to allow UDBEs to respond. 3. Name of selected firm and its status as a UDBE for each item of work made available. Include name, address, and telephone number of each UDBE that provided a quote and their price quote. If the firm selected for the item is not a UDBE, provide the reasons for the selection. 4. Name and date of each publication in which you requested UDBE participation for the project. Attach copies of the published advertisements. 5. Names of agencies and dates on which they were contacted to provide assistance in contacting, recruiting, and using UDBE firms. If the agencies were contacted in writing, provide copies of supporting documents. b. Dist of efforts made to provide interested UDBEs with adequate information about the plans, specifications, and requirements of the contract to assist them in responding to a solicitation. If you have provided information, identify the name of the UDBE assisted, the nature of the information provided, and date of contact. Provide copies of supporting documents, as appropriate. 7. List of efforts made to assist interested UDBEs in obtaining bonding, lines of credit, insurance, necessary equipment, supplies, and materials, excluding supplies and equipment that the UDBE subcontractor purchases or leases from the prime contractor or its affiliate. If such assistance is provided by you, identify the name of the UDBE assisted, nature of the assistance offered, and date. Provide copies of supporting documents, as appropriate. 8. Any additional data to support demonstration of good faith efforts. Page 12-92 July 31, 2009 LPP 09-02 Local Assistance Procedures Manual EKWIT 12-E PS&E Checklist Instructions Attachment H Only UDBE participation will count towards the UDBE goal. DBE participation will count towards the Agency's Annual Anticipated DBE Participation Level and the California statewide goal. Credit for materials or supplies you purchase from UDBEs counts towards the goal in the following manner: 1. 100 percent counts if the materials or supplies are obtained from a UDBE manufacturer. . 2. 60 percent counts if the materials or supplies are obtained from a UDBE regular dealer. 3. Only fees, commissions, and charges for assistance in the procurement and delivery of materials or supplies count if obtained from a UDBE that is neither a manufacturer, nor a regular dealer. 49 CFR = 26.55 defines "manufacturer" and "regular dealer." You receive credit towards the goal if you employ a UDBE trucking company that performs a commercially useful function as defined in 49 CFR 26.55. UDBE Commitment Submittal Submit UDBE information on the "Local Agency Bidder UDBE Commitment (Construction Contracts)," Exhibit 15-G1 form, included in the Bid book If the form is not submitted with the bid, remove the form from the Bid book before submitting your bid. If the UDBE Commitment form is not submitted with the bid, the apparent low bidder, the 2nd low bidder, and the 3rd.low bidder must complete and submit the UDBE Commitment form to the Agency. UDBE Commitment form must be received by the Agency no later than 4:00 p.m. on the 4th business day after bid opening. Other bidders do not need to submit the UDBE Commitment form unless the Agency requests it. If the Agency requests you to submit a UDBE Commitment form, submit the completed form within 4 business days of the request. Submit written confirmation from each UDBE stating that it is participating in the contract. Includeconfirmation with the UDBE Commitment form. A copy of a UDBE's quote will serve as written confirmation that the UDBE is participating in the contract. If you do not submit the UDBE Commitment form within the specified time, the Agency finds your bid nonresponsive. Good Faith Efforts Submittal If you have not met the UDBE goal, complete and submit the "UDBE Information - Good Faith Efforts," Exhibit 15-H form with the bid showing that you made adequate good faith efforts to meet the goal. Only good faith efforts directed towards obtaining participation by UDBEs will be considered. If good faith efforts documentation is not submitted with the bid, it must be received by the Agency no later than 4:00 p.m. on the 4th business day after bid opening. If your UDBE Commitment form shows that you have met the UDBE goal or if you are required to submit the UDBE Commitment form, you must also submit good faith efforts documentation within the specified time to protect your eligibility for award of the contract in the event the Agency finds that the UDBE goal has not been met. Page 12-93 LPP 09-02 July 31, 2009 EXHIBIT 12-E Local Assistance Procedures Manual Attachment H PS&E Checklist Instructions 3ood faith efforts documentation must include the following information and supporting documents, as necessary: 1. Items of work you have made available to UDBE firms. Identify those items of work you might otherwise perform with its own forces and those items that have been broken down into economically feasible units to facilitate UDBE participation. For each item listed, show the dollar value and percentage of the total contract. It is your responsibility to demonstrate that sufficient work to meet the goal was made available to UDBE firms. 2. Names of certified UDBEs and dates on which they were solicited to bid on the project. Include the items of work offered Describe the methods used for following up initial solicitations to determine with certainty if the UDBEs were interested, and the dates of the follow-up. Attach supporting documents such as copies of letters, memos, facsimiles sent, telephone logs, telephone billing statements, and other evidence of solicitation. You are reminded to solicit certified UDBEs through all reasonable and available means and provide sufficient time to allow UDBEs to respond. 3. Name of selected firm and its status as a UDBE for each item of work made available. Include name, address, and telephone number of each UDBE that provided a quote and their price quote. If the firm selected for the item is not a UDBE, provide the reasons for the selection. 4. Name and date of each publication in which you requested UDBE participation for the project. Attach copies of the published advertisements. 5. Names of agencies and dates on which they were contacted to provide assistance in contacting, recruiting, and using UDBE firms. If the agencies were contacted in writing, provide copies of supporting documents. 6. List of efforts made to provide interested UDBEs with adequate information about the plans, specifications, and requirements of the contract to assist them in responding to a solicitation. If you have provided information, identify the name of the UDBE assisted, the nature of the information provided, and date of contact. Provide copies of supporting documents, as appropriate. 7. List of efforts made to assist interested UDBEs in obtaining bonding, lines of credit, insurance, necessary equipment, supplies, and materials, excluding supplies and equipment that the UDBE subcontractor purchases or leases from the prime contractor or its affiliate. If such assistance is provided by you, identify the name of the UDBE assisted, nature of the assistance offered, and date. Provide copies of supporting documents, as appropriate. 8. Any additional data to support demonstration of good faith efforts. Page 12-94 July 31, 2009 LPP 09-02 Local Assistance Procedures Manual EXMBIT 12-E PS&E Checklist Instructions Attachment I SECTION 3. AWARD AND EXECUTION OF CONTRACT The bidder's attention is directed to the provisions in Section 3, "Award and Execution of Contract," of the Standard Specifications and these special provisions for the requirements and conditions concerning award and execution of contract. Bid protests are to be delivered to the following address. (Agency to provide information) The award of the contract, if it be awarded, will be to the lowest responsible bidder whose bid complies with all the requirements prescribed. The contract shall be executed by the successful bidder and shall be returned together with the contract bonds, to the Agency so that it is received within 10 days, not including Saturdays, Sundays and legal holidays, after the bidder has received the contract for execution. Failure to do so shall be just cause for forfeiture of the proposal guaranty. The executed contract documents shall be delivered to the following address: (Agency to provide detailed information if this paragraph is used) A "Local Agency Bidder DBE Information (Construction Contracts)," Exhibit 15-G2 form is included in the Bid book to be executed by the successful bidder. The purpose of the form is to collect data required under 49 CFR 26. Even if no DBE participation will be reported, the successful bidder must execute and return the form. The successful bidder's "Local Agency Bidder DBE Information (Construction Contracts)," Exhibit 15-G2 form should include the names, addresses and phone numbers of DBE firms that will participate, with a complete description of work or supplies to be provided by each and the dollar value of each DBE transaction. When 100 percent of a contract item of work is not to be performed or fwmished by a DBE, a description of the exact portion of that work to be performed or furnished by that DBE should be included in the DBE information, including the planned location of that work. A successful bidder certified as a DBE should describe the work it has committed to performing with its own forces as well as any other work that it has committed to be performed by DBE subcontractors, suppliers and trucking companies. The successful bidder is encouraged to provide written confirmation from each DBE that the DBE is participating in the contract. A copy of a DBE's quote will serve as written confirmation that the DBE is participating in the contract. If a DBE is participating as a joint venture partner, the successful bidder is encouraged to submit a copy of the joint venture agreement. The "Local Agency Bidder DBE Information (Construction Contracts)," Exhibit 15-G2 form shall be completed and returned to the Agency by the successful bidder with the executed contract and contract bonds. SECTION 4. BEGINNING OF WORK, TIME OF COMPLETION AND LIQUIDATED DAMAGES Attention is directed to the provisions in Section 8-1.03, "Beginning of Work" in Section 8-1.06 "Time of Completion," and in Section 8-1.07, "Liquidated Damages," of the Standard Specifications and these special provisions. The Contractor shall begin work within 15 calendar days after the ntract 11as been approved by the attorney appointed and authorized to represent the City/County of 13 D 1-- Page 12-95 LPP 09-02 July 31, 2009 EXH BIT 12-E Local Assistance Procedures Manual Attachment I PS&E Checklist Instructions IThis work shall be diligently prosecuted to completion before the expiration of 5DWORKING DAYS beginning on the 15 calendar day after approval of the contract. (INSERT AMOUNT OF LIQUIDATED DAMAGES) The Contractor shall pay to the City/County of the sum of $' per day, for each and every calendar day's delay in finishing the work in excess of the number of working days prescribed above. Liquidated Damages Liquidated Damages are based on the estimated cost of field construction engineering. In special cases, liquidated damages greater than the estimated field construction engineering cost may be specified, provided detailed reasons are given to support the greater amount. In every case, show the calculations that support the recommended rate. Liquidated damages are not to be used as disincentives to encourage timely completion. Use the following formula for highway construction projects to avoid excessive liquidated damages: L% (See Table below) x Engineer's Estimate + RE Office Expenses * = Liq Danilcalendar day Working Days ** { * Resident Engineer office expenses over the life of the contract should be added unless the cost is already included in the Engineer's Estimate. ** Working days used to calculate liquidated damages should not include water pollution establishment or plant establishment days. Page 12-96 July 31, 2006 LPP 09-02 Local Assistance (Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment I LIQUIDATED DAMAGES FABLE (L%) Project Estimate Project e Resurfacing*/Rehab New Highway Realignment/ Widening Landscaping Soundwall Others Over $30 million 10 % 14 % 13% 15% 15% 15% $10million to $30 million 10% 12% 15% 15 0 15% 15% $5 million to $10 million 10 % 15 % 15% 15 % 15 % 15 $750kto $5 million 15% 1549 15% 18% 18% 15% Less Than $750k 1 15 * Resurfacing projects include AC Surfacing, seal coats, slurry seals, and so on. The calculated liquidated damages should be rounded up in $100 increments to determine the amount to be specified. Page 12-97 LPP 09_02 July 31, 2009 EXHIBIT 12-E Local Assistance Procedures Manual Attachment I PS&E Checklist Instructions Page 12-98 July 31, 2006 LPP 09-02 Local Assistance Procedures Manual EXHIBIT 12 E PS&E Checklist Instructions Attachment J Required for ALL construction contracts administered under the Caltrans Standard Specifications 5-1.— SUBCONTRACTOR AND DBE RECORDS The Contractor shall maintain records showing the name and business address of each first -tier subcontractor. The records shall also show the name and business address of every DBE subcontractor, DBE vendor of materials and DBE trucking company, regardless of tier. The records shall show the date of payment and the total dollar figure paid to all of these firms. DBE prime contractors shall also show the date of work performed by their own forces along with the corresponding dollar value of the work. Upon completion of the contract, a summary of these records shall be prepared on "Final Report Utilization of Disadvantaged Business Enterprises (DBE), First -Tier Subcontractors" Form CEM-2402(F) and certified correct by the Contractor or the Contractor's authorized representative, and shall be famished to the Engineer. The form shall be furnished to the Engineer within ninety days from the date of contract acceptance. The amount of $10,000 will be withheld from payment until a satisfactory form is submitted. Prior to the fifteenth of each month, the Contractor shall submit documentation to the Engineer showing the amount paid to DBE trucking companies. The Contractor shall also obtain and submit documentation to the Engineer showing the amount paid by DBE trucking companies to all firms, including owner -operators, for the leasing of trucks. If the DBE leases trucks from a non -DBE, the Contactor may count only the fee or commission the DBE receives as a result of the lease arrangement. The Contractor shall also obtain and submit documentation to the Engineer showing the truck number, owner's name, California Highway Patrol CA number, and if applicable, the DBE certification number of the owner of the truck for all trucks used during that month. This documentation shall be submitted on "Monthly DBE Trucking Verification" Form CEM-2404(F). 571._DBE CERTIFICATION STATUS If a DBE subcontractor is decertified during the life of the project, the decertified subcontractor shall notify the contractor in writing with the date of decertification. If a subcontractor becomes a certified DBE during the life of the project, the subcontractor shall notify the Contractor in writing with the date of certification. The Contractor shall furnish the written documentation to the Engineer. Upon completion of the contract, "Disadvantaged Business Enterprises (DBE) Certification Status Change" Form CEM-2403(F) indicating the DBE's existing certification status shall be signed and certified correct by the Contractor. The certified form shall be furnished to the Engineer within ninety days from the date of contract acceptance. Page 12-99 LPP 09-02 July 31, 2009 EXHIBIT 12-B Local Assistance Procedures Manual Attachment J PS&E Checklist Instructions Page 12-100 July 31, 2006 UP 09-02 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment K 5-1-,_ PERFORMANCE OF SUBCONTRACTORS The subcontractors listed by you in Bid book shall list therein the name and address of each subcontractor to whom the bidder proposes to subcontract portions of the work in an amount in excess of one-half of one percent of the total bid or $10,000, whichever is greater, in accordance with the Subletting and Subcontracting Fair Practices Act, commencing with Section 4100 of the Public Contract Code. The bidder's attention is invited to other provisions of the Act related to the imposition of penalties for a failure to observe its provisions by using unauthorized subcontractors or by making unauthorized substitutions. UDBEs must perform work or supply materials as listed in the "Local Agency Bidder UDBE Commitment" form specified under Section 2, "Bidding," of these special provisions. Do not terminate a UDBE listed subcontractor for convenience and perform the work with your own forces or obtain materials from other sources without prior written authorization from the Agency. The Agency grants authorization to use other forces or sources of materials for requests that show any of the following justifications: 1. Listed UDBE fails or refuses to execute a written contract based on plans and specifications for the project. 2. You stipulate a bond is a condition of executing the subcontract and the listed UDBE fails to meet your bond requirements. 3. Work requires a contractor's license and listed UDBE does not have a valid license under Contractors License Law. 4. Listed UDBE fails or refuses to perform the work or furnish the listed materials. 5. Listed UDBE's work is unsatisfactory and not in compliance with the contract. 6. Listed UDBE delays or disrupts the progress of the work. 7. Listed UDBE becomes bankrupt or insolvent. If a listed UDBE subcontractor is terminated, you must make good faith efforts to find another UDBE subcontractor to substitute for the original UDBE. The substitute UDBE must perform at least the same amount of work as the original UDBE under the contract to the extent needed to meet the UDBE goal. The substitute UDBE must be certified as a DBE at the time of request for substitution. The Agency does not pay for work or material unless it is performed or supplied by the listed UDBE, unless the UDBE is terminated in accordance with this section. Page 12-101 LPP 09-02 duly 31, 2009 EXHIBIT 12-E Local Assistance Procedures Manual Attachment K PS&E Checklist Instructions Page12-102 July 31, 2009 LPP 09-02 Local Assistance Procedures Manual ENMBIT 12-E Ps&E Checklist Instructions Attachment L 5-1-- SUBCONTRACTING No subcontract releases the Contractor from the contract or relieves the Contractor of their responsibility for a subcontractor's work. If the Contractor violates Pub Cont Code § 4100 et seq., the City/County of * may exercise the remedies provided under Pub Cont Code § 4110. The City/County of * may refer the violation to the Contractors State License Board as provided under Pub Cont Code § 4111. The Contractor shall perform work equaling at least 30 percent of the value of the original total bid with the Contractor's own employees and equipment, owned or rented, with or without operators. Each subcontract must comply with the contract. Each subcontractor must have an active and valid State contractor's license with a classification appropriate for the work to be performed (Bus & Prof Code, § 7000 et seq.). Submit copies of subcontracts upon request by the Engineer. Before subcontracted work starts, submit a Subcontracting Request form. Do not use a debarred contractor, a current list of debarred contractors is available at the Department of Industrial Relations web site at: http://www.dir.ca.gov/dlse/debar.html Upon request by the Engineer, immediately remove and not again use a subcontractor who fails to prosecute the work satisfactorily. Each subcontract and any lower -tier subcontract that may in turn be made shall include the "Required Contract Provisions Federal -Aid Construction Contracts" in Section 14 of these special provisions. Noncompliance shall be corrected. Payment for subcontracted work involved will be withheld from progress payments due or to become due, until correction is made. Failure to comply may result in termination of the contract. 5-1._ PROMPT PROGRESS PAYMENT TO SUBCONTRACTORS A prime contractor or subcontractor shall pay any subcontractor not later than 10 days of receipt of each progress payment in accordance with the provision in Section 7108.5 of the California Business and Professions Code concerning prompt payment to subcontractors. The 10 days is applicable unless a longer period is agreed to in writing. Any delay or postponement of payment over 30 days may take place only for good cause and with the agency's prior written approval. Any violation of Section 7108.5 shall subject the violating contractor or subcontractor to the penalties, sanctions and other remedies of that section. This requirement shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the contractor or subcontractor in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance, or noncompliance by a subcontractor. *City of Huntington Beach/County of Orange Page 12-103 LPP 09-02 July 31, 2009 EXHIBIT 12 E Local Assistance Procedures Manual Attachment L PS&E Checklist Instructions 5-1._ PROMPT PAYMENT OF FUNDS WITEOEIELD TO SUBCONTRACTORS The local agency must include one of the following three provisions (if using Caltrans Standard Spectficatlon, modify or delete paragraphs 9-1.06 and 9-1.065) to ensure prompt and full payment of any retainage from the prime contractor, or subcontractor to a subcontractor. (EITHER) No retainage will be withheld by the agency from progress payments due the prime contractor. Retainage by the prime contractor or subcontractors is prohibited and no retainage will be held by the prime contractor from progress due subcontractors. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the California Business and Professions Code. This requirement shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcontractor, in the event of a 'dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance or noncompliance by a subcontractor. (OR) No retainage will be held by the agency from progress payments due the prime contractor. Any retainage held by the prime contractors or subcontractors from progress payments due subcontractors shall be promptly paid in full to subcontractors within 30 days after the subcontractor's work is satisfactorily completed. Federal law (49 CFR 26.29) requires that any delay or postponement of payment over the 30 days may take place only for good cause and with the agency's prior written approval. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code. These requirements shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcontractor, in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance or noncompliance by a subcontractor. (OR) The agency shall hold retainage from the prime contractor and shall make prompt and regular incremental acceptances of portions, as determined by the agency, of the contract work and pay retainage to the prime contractor based on these acceptances. The prime contractor or subcontractor shall return all monies withheld in retention from a subcontractor within 30 days after receiving payment for work satisfactorily completed and accepted including incremental acceptances of portions of the contract work by the agency. Federal law (49 CFR 26.29) requires that any delay or postponement of payment over 30 days may take place only for good cause and with the agency's prior written approval. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code. These requirements shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcontractor, in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance or noncompliance by a subcontractor. Page 12-104 July 31, 2009 LPP 09-02 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment L 5-1.-„_ FEDERAL REQUIREMENTS (AMERICAN RECOVERY AND REINVESTMENT ACT) Under the American Recovery and Reinvestment Act (ARRA) of 2009, 9 USC § 902: SEC. 902. ACCESS OF GOVERNMENT ACCOUNTABILITY OFFICE. (a) ACCESS. --Each contract awarded using funds made available in this Act shall provide that the Comptroller General and his representatives are authorized: (1) to examine any records of the contractor or any of its subcontractors, or any State or local agency administering such contract, that directly pertain to, and involve transactions relating to, the contract or subcontract; and (2) to interview any officer or employee of the contractor or any of its subcontractors, or of any State or local government agency administering the contract, regarding such transactions. (b) RELATIONSHIP TO EXISTING AUTHORITY. —Nothing in this section shall be interpreted to limit or restrict in any way any existing authority of the Comptroller General. Under ARRA of 2009, 9 USC § 1515(a): SEC.1515. ACCESS OF OFFICES OF INSPECTOR GENERAL TO CERTAIN RECORDS AND EMPLOYEES. (a) ACCESS. —With respect to each contract or grant awarded using covered funds, any representative of an appropriate inspector general appointed under section 3 or 8G of the inspector General Act of 1978 (5 U.S.C. App.), is authorized: (1) to examine any records of the contractor or grantee, any of its subcontractors or subgrantees, or any State or local agency administering such contract, that pertain to, and involve transactions relating to, the contract, subcontract, grant, or subgrant; and (2) to interview any officer or employee of the contractor, grantee, subgrantee, or agency regarding such transactions. (b) RELATIONSHIP TO EXISTING AUTHORITY. —Nothing in this section shall be interpreted to limit or restrict in any way any existing authority of an inspector general. Immediately notify the Engineer if you have been contacted by the U.S. Comptroller, inspector General, or their representatives. Used in projects with ARRA Federal -aid funds. Used in projects with American Recovery and Reinvestment Act Federal -aid funds. 5-1. MONTHLY EMPLOYMENT REPORT (AMERICAN RECOVERY AND REINVESTMENT ACT) For the purpose of complying with the American Recovery and Reinvestment Act of 2009, submit a completed Monthly Employment Report form by the fifth of each month for the previous month. For the form, go to: http://www.dot.ca,gov/hq/construe/forms/ceml 204.pdf If you fail to submit a complete and accurate report, the Department withholds 2 percent of the monthly progress estimate. The Department does not withhold more than $10,000 or less than $1,000, The Department releases the withhold upon submission of the completed form. Page 12-104a LPP 09-02 July 31, 2009 EXHIBIT 12-E Local Assistance Procedures Manual Attachment L PS&E Checklist Instructions Used in projects with American Recovery and Reinvestment Act Federal -aid funds 3-1.02 DATA UNIVERSAL NUMBERING SYSTEM (D-U N-S) NUMBER For the purpose of complying with the American Recovery and Reinvestment Act of 2009, the successful bidder must provide the Department a D-U-N-S number. Complete and sign the Data Universal Numbering System (D U-N-S) Number form included in the contract documents. This form must be submitted with the executed contract. If your company does not have a D-U-N-S number, you can obtain one by contacting Dun & Bradstreet at: http://dnb.com/us/ * If you fail to submit this information with the executed contract, the City/County of will not approve the contract. *City of Huntington Beach/County of Orange Page12-104b July 31, 2009 LPP 09-02 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment M 5-1. BUY AME1RICA REQUIREMENTS. — Attention is directed to the "Buy America" requirements of the _ Title 23 United States Code, Section 313 and the regulations adopted pursuant thereto. In accordance with said law and regulations, all manufacturing processes for steel and iron materials furnished for incorporation into the work on this project shall occur in the United States; with the exception that pig iron and processed, pelletized and reduced iron ore manufactured outside of the United States may be used in the domestic manufacturing process for such steel and iron materials. The application of coatings, such as epoxy coating, galvanizing, painting, and any other coating that protects or enhances the value of such steel or iron materials shall be considered a manufacturing process subject to the `Buy America" requirements. A Certificate of Compliance, conforming to the provisions in Section 6-1.07, Certificates of Compliance, of the Standard Specifications, shall be furnished for steel and iron materials. The certificates, in addition to certifying that the materials comply with the specifications, shall also specifically certify that all manufacturing processes for the materials occurred in the United States, except for the exceptions allowed herein. The requirements imposed by said law and regulations do not prevent a minimal use of foreign steel and iron materials if the total combined cost of such materials used does not exceed one -tenth of one percent (0.1'Yo) of the total contract cost or $2,500, whichever is greater. The Contractor shall furnish the Engineer acceptable documentation of the quantity and value of any foreign steel and iron prior to incorporating such materials into the work. Page 12-105 LPP 08-04 December 31, 2008 SEC.1552. SET- S a E F/®,�81y�STA�+YryJ�!''1��L`7f/l' D LOCL' L GO E' Rl®li�AL` NT REPORTING AND RECGRDKEEPING. Federal agencies receiving fiends under this Act, may, after following the notice and comment rulemaking requirements under the Administrative Procedures Act (5 U.S.C. 500), reasonably adjust applicable limits on administrative expenditures for Federal awards to help award recipients defray the costs of data collection requirements initiated pursuant to this Act. SEC.1553. PROTECTING STATE AND LOCAL GOVERNMENT AND CONTRACTOR Wl[-1ISTLEDLOWERS. (a) Prohibition of Reprisals. — An employee of any non -Federal employer receiving covered funds may not be discharged, demoted, or otherwise discriminated against as a reprisal for disclosing, including a disclosure made in the ordinary course of an employee's duties, to the Board, an inspector general, the Comptroller General, a member of Congress, a State or Federal regulatory or law enforcement agency, a person with supervisory authority over the employee (or such other person working for the employer who has the authority to investigate, discover, or terminate misconduct), a court or grand jury, the head of a Federal agency, or their representatives, information that the employee reasonably believes is evidence of— (1) gross mismanagement of an agency contract or grant relating to covered funds; (2) a gross waste of covered funds; (3) a substantial and specific danger to public health or safety related to the implementation or use of covered funds; (4) an abuse of authority related to the implementation or use of covered funds; or (5) a violation of law, rule, or regulation related to an agency contract (including the competition for or negotiation of a contract) or grant, awarded or issued relating to covered funds. (b) investigation of Complaints.— (1) In General. — A person who believes that the person has been subjected to a reprisal prohibited by subsection (a) may submit a complaint regarding the reprisal to the appropriate inspector general. Except as provided under paragraph (3), unless the inspector general determines that the complaint is frivolous, does not relate to covered funds, or another Federal or State judicial or administrative proceeding has previously been invoked to resolve such complaint, the inspector general shall investigate the complaint and, upon completion of such investigation, submit a report of the findings of the investigation to the person, the person's employer, the head of the appropriate agency, and the Board. (2) Time Limitations for Actions. — (A) In General. -- Except as provided under subparagraph (B), the inspector general shall, not later than 180 days after receiving a complaint under paragraph (1}-- (i) make a determination that the complaint is frivolous, does not relate to covered funds, or another Federal or State judicial or administrative proceeding has previously been invoked to resolve such complaint; or (ii) submit a report under paragraph (1). (B) Extensions.— (i) Voluntary extension agreed to between inspector general and complainant.---- If the inspector general is unable to complete an investigation under this section in time to submit a report within the 180-day period specified under subparagraph (A) and the person submitting the complaint agrees to an extension of time, the inspector general shall submit a report under paragraph (1) within such additional period of time as shall be agreed upon between the inspector general and the person submitting the complaint. (ii) Extension Granted by Inspector General. — If the inspector general is unable to complete an investigation under this section in time to submit a report within the 180-day period specified under subparagraph (A), the inspector general may extend the period for not more than 180 days without agreeing with the person submitting the complaint to such extension, provided that the inspector general provides a written explanation (subject to the authority to exclude information under paragraph (4)(C)) for the decision, which shall be provided to both the person submitting the complaint and the non -Federal employer. (iii) Semi-annual report on extensions. -- The inspector general shall include in semi-annual reports to Congress a list of those investigations for which the inspector general received an extension. (3) Discretion not to Investigate Complaints. — (A) In General. — The inspector general may decide not to conduct or continue an investigation under this section upon providing to the person submitting the complaint and the non -Federal employer a written explanation (subject to the authority to exclude information under paragraph (4)(C)) for such decision. (B) Assumption of Rights to Civil Remedy. — Upon receipt of an explanation of a decision not to conduct or continue an investigation under subparagraph (A), the person submitting a complaint shall immediately assume the right to a civil remedy under subsection (c)(3) as if the 210-day period specified under such �. subsection has already passed. (C) Semi-annual Report. — The inspector general shall include in semi-annual reports to Congress a list of those investigations the inspector general decided not to conduct or continue under this paragraph. (4) Access to investigative file of inspector general. — (A) In General. — The person alleging a reprisal under this section shall have access to the investigation file of the appropriate inspector general in accordance with section 552a of title S, United States Code (commonly referred to as the "Privacy Act"). The investigation of the inspector general shall be deemed closed for purposes of disclosure under such section when an employee files an appeal to an agency head or a court of competent jurisdiction. (B) Civil action. — In the event the person alleging the reprisal brings suit under subsection (c)(3), the person alleging the reprisal and the non -Federal employer shall have access to the investigative file of the inspector general in accordance with the Privacy Act. (C) Exception. — The inspector general may exclude from disclosure— (i) information protected from disclosure by a provision of law; and (ii) any additional information the inspector general determines disclosure of which would impede a continuing investigation, provided that such information is disclosed once such disclosure would no longer impede such investigation, unless the inspector general determines that disclosure of law enforcement techniques, procedures, or information could reasonably be expected to risk circumvention of the law or disclose the identity of a confidential source. (5) Privacy of Information. — An inspector general investigating an alleged reprisal under this section may not respond to any inquiry or disclose any information from or about any person alleging such reprisal, except in accordance with the provisions of section 552a of title 5. United States Code, or as required by any other applicable Federal law. (c) Remedy and Enforcement Authority.— (1) Burden of Proof. — (A) Disclosure as contributing factor in reprisal.— (i) In General. — A person alleging a reprisal under this section shall be deemed to have affirmatively established the occurrence of the reprisal if the person demonstrates that a disclosure described in subsection (a) was a contributing factor in the reprisal. (ii) Use of circumstantial evidence. — A disclosure may be demonstrated as a contributing factor in a reprisal for purposes of this paragraph by circumstantial evidence, including— (1) evidence that the official undertaking the reprisal knew of the disclosure; or (11) evidence that the reprisal occurred within a period of time after the disclosure such that a reasonable person could conclude that the disclosure was a contributing factor in the reprisal. (B) Opportunity for Rebuttal. — The head of an agency may not find the occurrence of a reprisal with respect to a reprisal that is affirmatively established under subparagraph (A) if the non -Federal employer . demonstrates by clear and convincing evidence that the non -Federal employer would have taken the action constituting the reprisal in the absence of the disclosure. (2) Agency Action. — Not later than 30 days after receiving an inspector general report under subsection (b), the head of the agency concerned shall determine whether there is sufficient basis to conclude that the non -Federal employer has subjected the complainant to a reprisal prohibited by subsection (a) and shall either issue an order denying relief in whole or in part or shall take 1 or more of the following actions: (A) Order the employer to take affirmative action to abate the reprisal. (B) Order the employer to reinstate the person to the position that the person held before the reprisal, together with the compensation (including back pay), compensatory damages, employment benefits, and other terms and conditions of employment that would apply to the person in that position if the reprisal had not been taken. (C) Order the employer to pay the complainant an amount equal to the aggregate amount of all costs and expenses (including attorneys' fees and expert witnesses' fees) that were reasonably incurred by the complainant for, or in connection with, bringing the complaint regarding the reprisal, as determined by the head of the agency or a court of competent jurisdiction. (3) Civil Action. — If the head of an agency issues an order denying relief in whole or in part under paragraph (1), has not issued an order within 210 days after the submission of a complaint under subsection (b), or in the case of an extension of time under subsection (b)(2)(B)(i), within 30 days after the expiration of the extension of time, or decides under subsection (b)(3) not to investigate or to discontinue an investigation, and there is no showing that such delay or decision is due to the bad faith of the complainant, the complainant shall be deemed to have exhausted all administrative remedies with respect to the complaint, and the complainant may bring a de novo action at law or equity against the employer to seek compensatory damages and other relief available under this section in the appropriate district court of the United States, which shall have jurisdiction over such an action without regard to the amount in controversy. Such an action shall, at the request of either party to the action, be tried by the court with a jury. (4) Judicial Enforcement of Order. — Whenever a person fails to comply with an order issued under paragraph (2), the head of the agency shall file an action for enforcement of such order in the United States district court for a district in which the reprisal was found to have occurred. In any action brought under this paragraph, the court may grant appropriate relief, including injunctive relief, compensatory and exemplary damages, and attorneys fees and costs. (5) Judicial Review. — Any person adversely affected or aggrieved by an order issued under paragraph (2) may obtain review of the order's conformance with this subsection, and any regulations issued to carry out this section, in the United States court of appeals for a circuit in which the reprisal is alleged "in the order to have occurred. No petition seeking such review may be filed more than 60 days after issuance of the order by the head of the agency. Review shall conform to chapter 7 of title 5. United States Code. (d) Nonenforceability of Certain Provisions Waiving Rights and Remedies or Requiring Arbitration of Disputes.— (1) Waiver of rights and remedies. — Except as provided under paragraph (3), the rights and remedies provided for in this section may not be waived by any agreement, policy, form, or condition of employment, including by any predispute arbitration agreement. (2) Predispute arbitration agreements. — Except as provided under paragraph (3), no predispute arbitration agreement shall be valid i or enforceable if it requires arbitration of a dispute arising under this section. (3) Exception for collective bargaining agreements. — Notwithstanding paragraphs (1) and (2), an arbitration provision in a collective bargaining agreement shall be enforceable as to disputes arising under the collective bargaining agreement. (e) Requirement to Post Notice of Rights and Remedies. — Any employer receiving covered funds shall post notice of the rights and remedies provided under this section. - (f j Rules of Construction.— (1) No implied authority to retaliate for non -protected disclosures. — Nothing in this section may be construed to authorize the discharge of, demotion of, or discrimination against an employee for a disclosure other than a disclosure protected by subsection (a) or to modify or derogate from a right or remedy otherwise available to the employee. (2) Relationship to State Laws. — Nothing in this section may be construed to preempt, preclude, or limit the protections provided for public or private employees under State whistleblower laws. (g) Definitions. — In this section; (1) Abuse of authority. — The term "abuse of authority" means an arbitrary and capricious exercise of authority by a contracting official or employee that adversely affects the rights of any person, or that results in personal gain or advantage to the official or employee or to preferred other persons. (2) Covered funds. — The term "covered funds" means any contract, grant, or other payment received by any non -Federal employer if — (A) the Federal Government provides any portion of the money or property that is provided, requested, or demanded; and (B) at least some of the funds are appropriated or otherwise made available by this Act. (3) Employee. — The term "employee" — (A) except as provided under subparagraph (B), means an individual performing services on behalf of an employer; and (B) does not include any Federal employee or member of the uniformed services (as that term is defined in section 101(a)(5) of title 10, United States Code). (4) Non-federal employer. — The term "non Federal employer (A) means any employer— (i) with respect to covered funds— (1) the contractor, subcontractor, grantee, or recipient, as the case may be, if the contractor, subcontractor, grantee, or recipient is an employer; and (II) any professional membership organization, certification or other professional body, any agent or licensee of the Federal government, or any person acting directly or indirectly in the interest of an employer receiving covered funds; or (ii) with respect to covered funds received by a State or local government, the State or local government receiving the funds and any contractor or subcontractor of the State or local government; and (B) does not mean any department, agency, or other entity of the Federal Government. (5) State or local government. — The term "State or local government" means — (A) the government of each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, American Samoa, the Virgin Islands, the Commonwealth of the Northern Mariana Islands, or any other territory or possession of the United States; or (B) the government of any political subdivision of a government listed in subparagraph (A). SEC. 1554. SPECIAL CONTRACTING PROVISIONS. To the maximum extent possible, contracts funded under this Act shall be awarded as fixed -price contracts through the use of competitive procedures. A summary of any contract awarded with such funds that is not fixed -price and not awarded using competitive procedures shall be posted in a special section of the website established in section 1526. Local ASsisL, a Procedures Manual EM IT 17-F Final Report-Ufilizaiion of Disadvantaged Business Enterprises (DBE), First -Tier Subcontractors n[: n a 1 ICAOA1f A _ r1CO AOTAa CIUT nC TCA7JCOr10TATf1N FINAL REPORT -UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES ADA Notice (DBE), FIRST -TIER SUBCONTRACTORS For Individuals. with sensory disabilities, this document Is avallable in altennt" Waeta. For Information call (916) 654-6410 or TDD (916) 854 1880 orwdte Records and Forms Managemen41120 N 6Uee4 MS49, Saaament% CA 95814 CEM-2402F REV 021200 CONTRACT NUMBER COUNTY ROUTE POST MILES FEDERALAiD PROJECT NO. ADMINISTERING AGENCY CONTRACT COMPLETION DATE PRIME CONTRACTOR BUSINESS ADDRESS ESTIMATED CONTRACT AMOUNT 'OM DESCRIPTION OF WORK PERFORMED AND MATERIAL PROVIDED COMPANY NAME AND BUSINESS ADDRESS CERT.DBE NUMBER CONTRACT PAYMENTS DATE WORK COMPLETE OF DATE L PAYMENT NON -DBE DBE BA UDBE APA UDBE NA UDBE W UDBE $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ORIGINAL COMMITMENT BA -Black American $ TOTAL $ $ $ $ APA-Asian-Pacific Islander UDBE NA -Native American W-Woman Uilz1l First Tter$ubcoabactors, Disadvantaged Business Enterprises(OeEs) and underutilized 08E8(UOBFs)regarNeseottier, whetherornotthafnme were originally listed forgoal aedat. if actual UDBE utilization (oritem of work)was differenttim that approved at8lneof award, provide commeNa on baekef form. Ustacluat amountpaid to each golk. :ONTRACTOR REPRESENTATIVE'S SIGNATURE BUSINESS PHONE NUMBER DATE TO THE BEST OF MY INFORMATION AND BELIEF THE ABOVE INFORMATION IS COMPLETE AND CORRECT RESIDENT ENGINEER'S SIGNATURE BUSINESS PHONE NUMBER DATE Copy Di MWuoa-Cahans Co.%. r Original - District Construction Copy- Business Enterprise Program Copy. Contractor Copy Resident Erotmer Copy Detnbatiou-Local Agency contracts: Origlrml - District Local Assistance Engineer Copy District Local Assistance Engineer Copy. Local Agency file (submitted with the Report of Expenditure) Page 17 21 LPP 09-02 duly 31, 2009 EXHIBIT 17-F Local Assistance Procedures Manual Final Report -Utilization of Disadvantaged Business Enterprises (DBE), First -Tier Subcontractors FINAL REPORT- UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES (DBE), FIRST -TIER SUBCONTRACTORS CEM 2402(F) (Rev. 0212008) The form requires specific information regarding the construction project: Contract Number, County, Route, Post Miles, Federal -aid Project No., the Administering Agency, the Contract Completion Date and the Estimated Contract Amount. It requires the prime contractor name and business address. The focus of the form is to describe who did what by contract item number and descriptions, asking for specific dollar values of item work completed broken down by subcontractors who performed the work both DBE and non -DBE work forces. DBE prime contractors are required to show the date of work performed by their own forces along with the corresponding dollar value of work. The form has a column to enter the Contract Item No. (or Item No's) and description of work performed or materials provided, as well as a column for the subcontractor name and business address. For those firms who are DBE, there is a column to enter their DBE Certification Number. The DBE should provide their certification number to the contractor and notify the contractor in writing with the date of the decertification if their status should change during the course of the project. The form has six columns for the dollar value to be entered for the item work performed by the subcontractor. The Non -DBE column is used to enter the dollar value of work performed for firms who are not certified DBE. The decision of which column to be used for entering the DBE dollar value is based on what program(s) status the firm is certified. This program status is determined by the California Unified Certification Program by ethnicity, gender, ownership, and control issues at time of certification. To confirm the certification status and program status, access the Department of Transportation Civil Rights web site at: http://www.dot.ca.gov/hq/bep or by calling (916) 324-1700 or the toll free number at (899) 810-6346. Based on this DBE Program status, the following table depicts which column to be used: DBE Pro am Status Column to be used If program status shows DBE onl with no other programs listed DBE If program status shows DBE, Black American BA UDBE If program status shows DBE, Asian -Pacific Islander APA UDBE If program status shows DBE, Native American NA UDBE If Vrograin status shows DBE Woman W UDBE If a contractor performing work as a DBE on the project becomes decertified and still performs work after their decertification date, enter the total dollar value performed by this contractor under the appropriate DBE identification column. If contractor performing work as a non -DBE on the project becomes certified as a DBE, enter the dollar value of all work performed after certification as a DBE under the appropriate identification column. Enter the total of each of the six columns in Form CEM-2402(F). Any changes to DBE certification must also be submitted on Form-CEM 2403(F). Enter the Date Work Completed as well as the Date of Final Payment (the date when the prime contractor made the "final payment" to the subcontractor for the portion of work listed as being completed). The contractor and the resident engineer sign and date the form indicating that the information provided is complete and correct. Page 17-22 July 31, 2009 LPP 09-02 Local Assist... -e Procedures Manual EX :IT 17-0 Disadvantaged Business Enterprises (DBE) Certification Status Change STATE OF CALIFORNIA— DEPARTMENT OF TRANSPORTATION DISADVANTAGED BUSINESS ENTERPRISES (DBE) CERTIFICATION STATUS CHANGE CP-CEM-2403(F) (New. 10/99) CONTACT NUMBER COUNTY KOUTE POST MILES ADMINISTERING AGENCY CONTRACT COMPETION DATE PRIME CONTRACTOR BUSINESS ADDRESS ESTIMATED CONTRACT AMOUNT Prime Contractor. List all DBEs with changes in certification status (certified/decertified) while in your employ, whether or not firms were orfginaQy listed forgood credit, Attach DRE cerdfTcatlomDecertificatlon letter in accordance with the Special Provisions CONTRACT ITEM NO. SUBCONTRACT NAME AND BUSINESS ADDRESS BUSINESS PHONE CERTIFICATION NUMBER AMOUNT PAID V411I.E CERTIFIED CERTIFICATION/ DECERTIFICATION DATE Letter attached $ $ Comments: I CERTIFY THAT THE ABOVE INFORAL&TION IS COMPLETE AND CORRECT CONTRACTOR REPRESENTATIVE SIGNATURE i TITLE BUSINESS PHONE NUMBER DATE TO THE BEST OF MY KNOWLEDGE THE ABOVE INFORMATION IS COMPLETE AND CORRECT RESIDENT ENGINEER BUSINESS PHONE NUMBER DATE Distribution Original copy-DLAE Copy -1) Business Enterprise Program 2) Prime Contactor 3) Local Agency 4) Resident Engineer Page 17-43 LPP 06-03 Daly 21, 2006. E=BIT 17-0 Local Assistance Procedures Manna] Disadvantaged Business Enterprises (DBE) Certification Status Change Form CP-CEM 2403(F) (New 10/99) DISADVANTAGED BUSINESS ENTERPRISES (DBE) CHANGE IN CERTIFICATION STATUS REPORT The top of the form requires specific information regarding the construction project: Contract Number, County, Route, Post Miles, the Administering Agency, the Contract Completion Date, and the Estimated Contract Amount. It requires the Prime Contractor's name and Business Address. The focus of the form is to substantiate and verify the actual DBE dollar amount paid to contractors on federally funded projects that had a changed in Certification status during the course of the completion of the contract. The two situations that are being addressed by CP-CEM 2403(F) are, if a firm certified as a DBE and doing work on the contract during the course of the project becomes Decertified, and if a non -DBE firm doing work on the contract during the course of the project becomes Certified as a DBE. The form has a column to enter the Contract Item No (or Item Nos.) as well as a column for the Subcontractor's Name, Business Address, Business Phone, and contractor's Certification Number. The column entitled Amount Paid While Certified will be used to enter the actual dollar value of the work performed by those contractors who meet the conditions as outlined above during the time period they are Certified as a DBE. This column on the CP-CEM-2403(F) should only reflect the dollar value of work performed while the firm was Certified as a DBE. The column called Certification/Decertification Date (Letter attached) will reflect either the date of the Decertification Letter sent out by the Civil Rights Program or the date of the Certification Certificate mailed out by the Civil Rights Program. There is a box to check that support documentation is attached to the CP-CEM-2403 (F) form. There is a Comments section for any additional information that may need to be provided regarding any of the above transactions. The CEM-2403(F) has an area at the bottom where the Contractor and the Resident Engineer sign and date that the information provided is complete and correct. There is a Comments section for any additional information that may need to be provided regarding any of the above transactions. The CEM-2403(F) has an area at the bottom where the Contractor and the Resident Engineer sign and date that the information provided is complete and correct. Page 17-44 July 21, 2006 LPP 06-03 0635.108 49 CFR part 26, the STD shall ensure equal opportunity for disadvantaged business enterprises (DBEs) particl- pating in the Federal -aid highway pro- gram. (b) In the case of a design -build project funded with title 23 funds, the requirements of 49 CFR part 26 and the State's approved DBE plan apply. If DBE goals are set, DBE commitments above the goal must not be used as a proposal evaluation factor in deter- mining the successful offeror. 167 FR 75925, Dec. 10, 2002) §635.108 Health and safety. Contracts for projects shall include provisions designed: (a) To insure full compliance with all applicable Federal, State, and local laws governing safety, health and sani- tation; and (b) To require that the contractor shall provide all safeguards, safety de- vices, and protective equipment and shall take any other actions reason- ably necessary to protect the life and health of persons working at the site of the project and the safety of the public and to protect property in connection with the performance of the work cov- ered by the contract. § 635.109 Standardized changed condi- tion clauses. (a) Except as provided in paragraph (b) of this section, the following changed conditions contract clauses shall be made part of, and incorporated in, each highway construction project approved under 23 U.S.C. 106: (1) Differing site conditions. (i) During the progress of the work, if subsurface or latent physical conditions are en- countered at the site differing materi- ally from those indicated in the con- tract or if unknown physical condi- tions of an unusual nature, differing materially from those ordinarily en- countered and generally recognized as Inherent in the work provided for in the contract, are encountered at the site, the party discovering such condi- tions shall promptly notify the other party in writing of the specific dif- fering conditions before the site is dis- turbed and before the affected work is performed. 23 CFR Ch. 1(4-1-05 Edition) (11) Upon written notification, the en- gineer will investigate the conditions, and if it is determined that the condi- tions materially differ and cause an in- crease or decrease in the cost or time required for the performance of any work under the contract, an adjust- ment, excluding anticipated profits, will be made and the contract modified in writing accordingly. The engineer will notify the contractor of the deter- mination whether or not an adjust- ment of the contract is warranted. (fii) No contract adjustment which results in a benefit to the contractor will be allowed unless the contractor has provided the required written no- tice. (iv) No contract adjustment will be allowed under this clause for any ef- fects caused on unchanged work. (This provision may be omitted by the STD's at their option.) (2) Suspensions of work ordered by the engineer. (1) If the performance of all or any portion of the work is suspended or delayed by the engineer in writing for an unreasonable period of time (not originally anticipated, customary, or inherent to the construction industry) and the contractor believes that addi- tional compensation and/or contract time is due as a result of such suspen- sion or delay, the contractor shall sub- mit to the engineer in writing a re- quest for adjustment within 7 calendar days of receipt of the notice to resume work. The request shall set forth the reasons and support for such adjust- ment. (ii) Upon receipt, the engineer will evaluate the contractor's request. If the engineer agrees that the cost and/ or time required for the performance of the contract has increased as a result of such suspension and the suspension was caused by conditions beyond the control of and not the fault of the con- tractor, its suppliers, or subcontractors at any approved tier, and not caused by weather, the engineer will make an ad- justment (excluding profit) and modify the contract in writing accordingly. The contractor will be notified of the engineer's determination whether or not an adjustment of the contract is warranted. 166 Federal Highway Administration, DOT § 636.110 all) No contract adjustment will be allowed unless the contractor has sub- mitted the request for adjustment within the time prescribed. (iv) No contract acjustment will be allowed under this clause to the extent that performance would have been sus- pended or delayed by any other cause, or for which an adjustment is provided or excluded under any other term or condition of this contract. (3) Significant changes 1n the character of work. (1) The engineer reserves the right to make, in writing, at any time during the work, such changes in quan- tities and such alterations in the work as are necessary to satisfactorily com- plete the project. Such changes In quantities and alterations shall not In- validate the contract nor release the surety, and the contractor agrees to perform the work as altered. (ii) If the alterations or changes in quantities significantly change the character of the work under the con- tract, whether such alterations or changes are in themselves significant changes to the character of the work or by affecting other work cause such other work to become significantly dif- ferent in character, an adjustment, ex- cluding anticipated profit, will be made to the contract, The basis for the ad- justment shall be agreed upon prior to the performance of the work. If a basis cannot be agreed upon, then an adjust- ment will be made either for or against the contractor in such amount as the engineer may determine to be fair and equitable. (III) If the alterations or changes in quantities do not significantly change the character of the work to be per- formed under the contract, the altered work will be paid for as provided else- where in the contract, (iv) The term "significant change" shall be construed to apply only to the following circumstances: (A) When the character of the work as altered differs materially in kind or nature from that involved or included In the original proposed construction; or (B) When a major item of work, as defined elsewhere in the contract, is in- creased in excess of 125 percent or de- creased below 75 percent of the original contract quantity. Any allowance for an increase in quantity shall apply only to that portion in excess of 125 percent of original contract item quan- tity, or in case of a decrease below 75 percent, to the actual amount of work performed. (b) The provisions of this section shall be governed by the following: (i) Where State statute does not per- mit one or more of the contract clauses included in paragraph (a) of this sec- tion, the State statute shall prevail and such clause or clauses need not be made applicable to Federal -aid high- way contracts. (2) Where the State transportation department has developed and imple- mented one or more of the contract clauses included in paragraph (a) of this section, such clause or clauses, as developed by the State transportation department may be included in Fed- eral -aid highway contracts in lieu of the corresponding clause or clauses in paragraph (a) of this section. The State's action must be pursuant to a specific State statute requiring dif- fering contract conditions clauses. Such State developed clause or clauses, however, must be in conformance with 23 U.S.C., 23 CFR and other applicable Federal statutes and regulations as ap- propriate and shall be subject to the Division Administrator's approval as part of the PS&) . (c) In the case of a design -build project, STDs are strongly encouraged to use "suspensions of work ordered by the engineer" clauses, and may con- sider "differing site condition" clauses and "significant changes in the char- acter of work" clauses which are ap- propriate for the risk and responsibil- ities that are shared with the design - builder. (56 FR 37004, Aug. 2, 1991; 57 FR 10062, Mar. 23, 1992, as amended at 67 FR 75925, Dec. 10, 20021 § 635,110 Licensing and qualification of contractors. (a) The procedures and requirements a STD proposes to use for qualifying and licensing contractors, who may bid for, be awarded, or perform Federal -aid highway contracts, shall be submitted to the Division Administrator for ad- vance approval. Only those procedures and requirements so approved shall be effective with respect to Federal -aid 167 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 For Traffic Signal Modifications at Brookhurst Street and Yorktown Avenue & Newland Street and Atlanta Avenue & Magnolia Street and Atlanta Avenue, CC-1204, 1246 and 1247 September 27, 2010 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL. LABOR RATES DATED September 24, 2010. The Federal Labor Rates contained in Appendix I of the specifications for the: Traffic Signal Modifications at Brookhurst Street and Yorktown Avenue & Newland Street and Atlanta Avenue & Magnolia Street and Atlanta Avenue, CC-1204,1246 and 1247 shall be replaced with the following attached documents: The Federal Labor Rates dated September 24, 2010 shall be the labor rates in effect for the subject project. 2) Sheet 2 of 4 (Traffic Signal Modification Plan — Brookhurst Street and Yorktown Avenue, CC-1204) The new conduit depicted between the westerly terminus of conduit #2 and the pull box south of the new southwest corner access ramp shall be 3-inch. Conduit #1 shall be extended to connect to the new pull box south of the new access ramp. All conductors in conduits #1, 2, 3 and 4 shall be new. All conductors to poles 5, 6,7,8and 9shall benow. This is to acknowledge receipt and review of Addendum Number One, dated September 27, 2010. PTM General Engineering -P Services, Inc. Brian Mendoza Company Name By 10/06/2010 Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F, Janusz at (714) 536-5431. GENERAL DECISION: CA20100035 09/24/2010 CA35 Date: September 24, 2010 General Decision Number: CA20100035 09/24/2010 Superseded General Decision Number: CA20080035 State: California Construction Types: Building, Heavy (Heavy and Dredging) and Highway County: Orange County in California. BUILDING CONSTRUCTION PROJECTS; DREDGING PROJECTS (does not include hopper dredge work); HEAVY CONSTRUCTION PROJECTS (does not include water well drilling); HIGHWAY CONSTRUCTION PROJECTS Modification Number 0 1 2 3 4 5 6 7 8 9 10 11 12 ASEE0005-002 01/01/2010 Publication Date 03/12/2010 03/26/2010 04/02/2010 04/16/2010 06/25/2010 07/02/2010 07/23/2010 08/06/2010 08/13/2010 08/27/2010 09/03/2010 09/10/2010 09/24/2010 Rates Fringes Asbestos Workers/Insulator (Includes the application of all insulating materials, protective coverings, coatings, and finishes to all types of mechanical systems) ..... $ 32.93 15.32 Fire Stop Technician (Application of Firestopping Materials for wall openings and penetrations in walls, floors, ceilings and curtain walls) ...........................$ 24.21 13.76 ASBE0005-004 01/01/2010 Rates Fringes Asbestos Removal worker/hazardous material handler (Includes preparation, wetting, stripping, removal, Page 1 of 24 http://frwebgate.access.gpo.gov/cgi-binlgetdoe.cgi?dbname=Davis-Bacon&docid=CA20l.,, 9/27/2010 Page 2 of 24 scrapping, vacuuming, bagging and disposing of all insulation materials from mechanical systems, whether they contain asbestos or not)....$ 18.85 8.03 BRCA0004-010 05/01/2010 Rates Fringes BRICKLAYER, MARBLE SETTER ........ $ 34.55 11.56 ---------------------------------------------------------------- BRCA0018-004 06/01/2008 Rates Fringes MARBLE FINISHER ..................$ 25.52 9.08 TILE FINISHER ....................$ 21.07 7.88 TILE LAYER .......................$ 32.05 11.99 ---------------------------------------------------------------- BRCA0018-010 09/01/2009 Rates Fringes TERRAZZO FINISHER ................$ 26.59 9.62 TERRAZZO WORKER/SETTER ........... $ 33.63 10.46 ---------------------------------------------------------------- CARP0409-001 07/01/2010 Rates Fringes CARPENTER (1) Carpenter, Cabinet Installer, Insulation Installer, Hardwood Floor worker and acoustical installer ...................$ 37.35 11.08 (2) Millwright ..............$ 37.85 11.08 (3) Piledriver/Derrick Bargeman, Bridge or Dock Carpenter, Heavy Framer, Rock Bargeman or Scowman, Rockslinger, Shingler (Commercial) ... ............$ 37.48 11.08 (4) Pneumatic Nailer, Power Stapler ...............$ 37.60 11.08 (5) Sawfiler...............$ 37.44 11.08 (6) Scaffold Builder ....... $ 28.55 11.08 (7) Table Power Saw Operator ....................$ 37.45 11.08 FOOTNOTE: Work of forming in the construction of open cut sewers or storm drains, on operations in which horizontal lagging is used in conjunction with steel H-Beams driven or placed in pre- drilled holes, for that portion of a lagged trench against which concrete is poured, namely, as a substitute for back forms (which work is performed by piledrivers): $0.13 per hour additional. Certified Welder - $1.00 per hour premium. ---------------------------------------------------------------- http://frwebgate.access.gpo.gov/cgi-binlgetdoc.cgi?dbnanie=Davis-Bacon&docid=CA201... 9/27/2010 Page 3 of 24 CARP0409-005 07/01/2010 Rates Fringes Drywall DRYWALL INSTALLER/LATHER .... $ 37.35 11.08 STOCKER/SCRAPPER ............ $ 10.00 6.67 ---------------------------------------------------------------- BLEC0011-002 02/01/2010 COMMUNICATIONS AND SYSTEMS WORK Rates Fringes Communications System Installer ...................$ 26.99 3$+8.64 - Technician ..................$ 28.79 3W+8.64 SCOPE OF WORK: Installation, testing, service and maintenance of systems utilizing the transmission and/or transference of voice, sound, vision and digital for commercial, educational, security and entertainment purposes for the following: TV monitoring and surveillance, background -foreground music, intercom and telephone interconnect, inventory control systems, microwave transmission, multi -media, multiplex, nurse call systems, radio page, school intercom and sound, burglar alarms, fire alarm (see last paragraph below) and low voltage master clock systems in commercial buildings. Communication Systems that transmit or receive information and/or control systems that are intrinsic to the above listed systems; inclusion or exclusion of terminations and testings of conductors determined by their function; excluding all other data systems or multiple systems which include control function or power supply; excluding installation of raceway systems, conduit systems, line voltage work, and energy management systems. Does not cover work performed at China Lake Naval Ordnance Test Station. Fire alarm work shall be performed at the current inside wireman total cost package. ELEC0441-001 06/28/2010 Rates Fringes CABLE SPLICER ....................$ 41.36 13.79 ELECTRICIAN ......... ............. $ 39.54 13.74 ---------------------------------------------------------------- * ELRC0441-003 11/30/2009 COMMUNICATIONS & SYSTEMS WORK (excludes any work on Intelligent Transportation Systems or CCTV highway systems) Rates Fringes Communications System Installer ...................$ 27.03 396+8.60 Technician ..................$ 28.63 3%+8.60 SCOPE OF WORK The work covered shall include the http://frwebgate.access.gpo.gov/cgi-binlgetdoe. cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Page 4 of 24 installation, testing, service and maintenance, of the following systems that utilize the transmission and/or transference of voice, sound, vision and digital for commercial, education, security and entertainment purposes for TV monitoring and surveillance, background foreground music, intercom and telephone interconnect, inventory control systems, microwave transmission, multi -media, multiplex, nurse call system, radio page, school intercom and sound, burglar alarms and low voltage master clock systems. A. Communication systems that transmit or receive information and/or control systems that are intrinsic to the above listed systems SCADA (Supervisory control/data acquisition PCM (Pulse code modulation) Inventory control systems Digital data systems Broadband & baseband and carriers Point of sale systems VSAT data systems Data communication systems RF and remote control systems Fiber optic data systems B. Sound and Voice Transmission/Transference Systems Background -Foreground Music Intercom and Telephone Interconnect Systems Sound and Musical Entertainment Systems Nurse Call Systems Radio Page Systems School Intercom and Sound Systems Burglar Alarm Systems Low -Voltage Master Clock Systems Multi-Media/Multiplex Systems Telephone Systems RF Systems and Antennas and Wave Guide C. *Fire Alarm Systems -installation, wire pulling and testing. D. Television and Video Systems Television Monitoring and Surveillance Systems Video Security Systems Video Entertainment Systems Video Educational Systems CATV and CCTV E. Security Systems, Perimeter Security Systems, Vibration Sensor Systems Sonar/Infrared Monitoring Equipment, Access Control Systems, Card Access Systems *Fire Alarm Systems 1. Fire Alarms -In Raceways: Wire and cable pulling in raceways performed at the current electrician wage rate and fringe benefits. Installation and termination of devices, panels, startup, testing and programmming performed by the Technician. 2. Fire Alarms -Open Wire Systems: installed by the Technician. ---------------------------------------------------------------- ELEC0441-004 08/27/2009 Rates Fringes ELECTRICIAN (TRANSPORTATION SYSTEMS, TRAFFIC SIGNALS & STREET LIGHTING) Cable Splicer/Fiber optic Splicer .....................$ 40.14 3W+11.90 Electrician .................$ 39.54 3%+11.90 http://frwebgate.access. gpo.gov/cgi-binlgetdoc.egi?dbname=Davis-Bacon&docid=CA20l ... 9/27/2010 Page 5 of 24 Technician ..................$ 29.66 3$+11.90 SCOPE OF WORK: Electrical work on public streets, freeways, toll -ways, etc, above or below ground. All work necessary for the installation, renovation, repair or removal of Intelligent Transportation Systems, Video Surveilance Systems (CCTV), Street Lighting and and Traffic Signal work or systems whether underground or on bridges. Includes dusk to dawn lighting installations and ramps for access to or egress from freeways, toll -ways, etc. Intelligent Transportation Systems shall include all systems and components to control, monitor, and communicate with pedestrian or vehicular traffic, included but not limited to: installation, modification, removal of all Fiber optic Video System, Fiber Optic Data Systems, Direct interconnect and Communications Systems, Microwave Data and Video Systems, Infrared and Sonic Detection Systems, Solar Power Systems, Highway Advisory Radio Systems, highway Weight and Motion Systems, etc. Any and all work required to install and maintain any specialized or newly developed systems. All cutting, fitting and bandaging of ducts, raceways, and conduits. The cleaning, rodding and installation of "fish and pull wires". The excavation, setting, leveling and grouting of precast manholes, vaults, and pull boxes including ground rods or grounding systems, rock necessary for leveling and drainagae as well as pouring of a concrete envelope if needed. JOURNEYMAN TRANSPORTATION ELECTRICIAN shall perform all tasks necessary toinstall the complete transportation system. JOURNEYMAN TECHNICIAN duties shall consist of: Distribution of material at job site, manual excavation and backfill, installation of system conduits and raceways for electrical, telephone, cable television and comnmunication systems. Pulling, terminating and splicing of traffic signal and street lighting conductors and electrical systems including interconnect, dector loop, fiber optic cable and video/data. ---------------------------------------------------------------- ELEC1245-001 06/01/2010 Rates Fringes LINE CONSTRUCTION (1) Lineman; Cable splicer..$ 46.14 13.41 (2) Equipment specialist (operates crawler tractors, commercial motor vehicles, backhoes, trenchers, cranes (50 tons and below), overhead & underground distribution line equipment) ........... $ 36.85 12.36 (3) Groundman...............$ 28.19 12.10 (4) Powderman...............$ 41.20 12.53 HOLIDAYS: New 'Year's Day, M.L. King Day, Memorial Day, Independence Day, Labor Day, Veterans Day, Thanksgiving Day and day after Thanksgiving, Christmas Day http://frwebgate.access.gpo.gov/cgi-binlgetdoc.egi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Page 6 of 24 BLEV0018-001 01/01/2010 Rates Fringes ELEVATOR MECHANIC ................$ 45.33 20.035 FOOTNOTE: PAID VACATION: Employer contributes 8% of regular hourly rate as vacation pay credit for employees with more than 5 years of service, and 61 for 6 months to 5 years of service. PAID HOLIDAYS: New Years Day, Memorial Day, Independence Day, Labor Day, Veterans Day, Thanksgiving Day, Friday after Thanksgiving, and Christmas Day. ---------------------------------------------------------------- RNGIO012-003 07/01/2009 Rates Fringes OPERATOR: Power Equipment (All Other Work) GROUP 1....................$ 36.83 17.22 GROUP 2....................$ 37.61 17.22 GROUP 3....................$ 37.90 17.22 GROUP 4....................$ 39.39 17.22 GROUP 5.... ..............$ 40.49 17.22 GROUP 6....................$ 39.61 17.22 GROUP 7.................... $ 40.71 17.22 GROUP 8....................$ 39.72 17.22 GROUP 9....................$ 40.82 17.22 GROUP 10....................$ 39.84 17.22 GROUP 11....................$ 40.94 17.22 GROUP 12....................$ 40.01 17.22 GROUP 13....................$ 40.11 17.22 GROUP 14....................$ 40.14 17.22 GROUP 15....................$ 40.22 17.22 GROUP 16....................$ 40.34 17.22 GROUP 17....................$ 40.51 17.22 GROUP 18....................$ 40.61 17.22 GROUP 19....................$ 40.72 17.22 GROUP 20....................$ 40.84 17.22 GROUP 21....................$ 41.01 17.22 GROUP 22....................$ 41.11 17.22 GROUP 23....................$ 41.22 17.22 GROUP 24....................$ 41.34 17.22 GROUP 25....................$ 41.51 17.22 OPERATOR: Power Equipment (Cranes, Piledriving & Hoisting) GROUP I ....................$ 38.18 17.22 GROUP 2....................$ 38.96 17.22 GROUP 3....................$ 39.25 17.22 GROUP 4....................$ 39.39 17.22 GROUP 5....................$ 39.61 17.22 GROUP 6....................$ 39.72 17.22 GROUP 7....................$ 39.84 17.22 GROUP 8....................$ 40.01 17.22 GROUP 9....................$ 40.1B 17.22 GROUP 10....................$ 41.18 17.22 GROUP 11....................$ 42.18 17.22 http://frwebgate.access. gpo.gov/cgi-binlgetdoc,egi?dbname=Davi s-Bacon&docid=CA201... 9/27/2010 Page 7 of 24 GROUP 12 ....................$ 43.18 17.22 GROUP 13 ....................$ 44.18 17.22 OPERATOR: Power Equipment (Tunnel Work) GROUP 1 ....................$ 38.68 17.22 GROUP 2 ....................$ 39.46 17,22 GROUP 3 .................... 39.75 17.22 GROUP 4 ....................$ 39.89 17.22 GROUP 5 ....................$ 40.11 17.22 GROUP 6 ....................$ 40.22 17.22 GROUP 7 ....................$ 40.34 17.22 PREMIUM PAY: $3.75 per hour shall be paid on all Power Equipment Operator work on the followng Military Bases: China Lake Naval Reserve, Vandenberg APB, Point Arguello, Seely Naval Base, Fort Irwin, Nebo Annex Marine Base, Marine Corp Logistics Base Yermo, Edwards AFB, 29 Palms Marine Base and Camp Pendleton Workers required to suit up and work in a hazardous material environment: $2.00 per hour additional. Combination mixer and compressor operator on gunite work shall be classified as a concrete mobile mixer operator. SEE ZONE DEFINITIONS AFTER CLASSIFICATIONS POWER EQUIPMENT OPERATORS CLASSIFICATIONS GROUP 1: Bargeman; Brakeman; Compressor operator; Ditch Witch, with seat or similar type equipment; Elevator operator -inside; Engineer Oiler; Forklift operator (includes loed, lull or similar types under 5 tons; Generator operator; Generator, pump or compressor plant operator; Pump operator; Signalman; Switchman GROUP 2: Asphalt -rubber plant operator (nurse tank operator); Concrete mixer operator -skip type; Conveyor operator; Fireman; Forklift operator (includes loed, lull or similar types over 5 tons; Hydrostatic pump operator; oiler crusher (asphalt or concrete plant); Petromat laydown machine; PJU side dum jack; Screening and conveyor machine operator (or similar types); Skiploader (wheel type up to 3/4 yd. without attachment); Tar pot fireman; Temporary heating plant operator; Trenching machine oiler GROUP 3: Asphalt -rubber blend operator; Bobcat or similar type (Skid steer); Equipment greaser (rack); Ford Ferguson (with dragtype attachments); Helicopter radioman (ground); Stationary pipe wrapping and cleaning machine operator GROUP 4: Asphalt plant fireman; Backhoe operator (mini -max or similar type); Boring machine operator; Boxman or mixerman (asphalt or concrete); Chip spreading machine operator; Concrete cleaning decontamination machine operator; Concrete Pump Operator (small portable); Drilling machine operator, small auger types (Texoma super economatic or similar types - Hughes 100 or 200 or similar types - drilling depth of 30' maximum); Equipment greaser (grease truck); Guard rail post driver operator; Highline cableway bttp://frwebgate.access.gpo.gov/cgi-binlgetdoe.cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Page 8 of 24 signalman; Horizontal Directional Drilling Machine; Hydra-hammer-aero stomper; Micro Tunneling (above ground tunnel); Power concrete curing machine operator; Power concrete saw operator; Power -driven jumbo form setter operator; Power sweeper operator; Rock Wheel Saw/Trencher; Roller operator (compacting); Screed operator (asphalt or concrete); Trenching machine operator (up to 6 ft.).; Vacuum or much truck GROUP 5: Equipment Greaser (Grease Truck/Multi Shift). GROUP 6: Articulating material hauler; Asphalt plant engineer; Batch plant operator; Bit sharpener; Concrete joint machine operator (canal and similar type); Concrete planer operator; Dandy digger; Deck engine operator; Derrickman (oilfield type); Drilling machine operator, r bucket or auger types (Calweld 100 bucket or similar types - Watson 1000 auger or similar types - Texoma 330, 500 or Goo auger or similar types - drilling depth of 45' maximum); Drilling machine operator; Hydrographic seeder machine operator (straw, pulp or seed), Jackson track maintainer, or similar type; Kalamazoo Switch tamper, or similar type; Machine tool operator; Maginnis internal full slab vibrator, Mechanical berm, curb or gutter(concrete or asphalt); Mechanical finisher operator (concrete, Clary -Johnson -Bidwell or similar); Micro tunnel system (below ground); Pavement breaker operator (truck mounted); Road oil mixing machine operator; Roller operator (asphalt or finish), rubber -tired earth moving equipment (single engine, up to and including 25 yds. struck); Self-propelled tar pipelining machine operator; Skiploader operator (crawler and wheel type, over 3/4 yd. and up to and including 1-1/2 yds.); Slip form pump operator (power driven hydraulic lifting device for concrete forms); Tractor operator -bulldozer, tamper -scraper (single engine, up to 100 h.p. flywheel and similar types, up to and including D-5 and similar types); Tugger hoist operator (1 drum); Ultra high pressure waterjet cutting tool system operator; Vacuum blasting machine operator GROUP 7: Welder - General GROUP 8: Asphalt or concrete spreading operator (tamping or finishing); Asphalt paving machine operator (Barber Greene or similar type); Asphalt -rubber distribution operator; Backhoe operator (up to and including 3/4 yd.), small ford, Case or similar; Cast -in -place pipe laying machine operator; Combination mixer and compressor operator (gunite work); Compactor operator (self-propelled); Concrete mixer operator (paving); Crushing plant operator; Drill Doctor; Drilling machine operator, Bucket or auger types (Calweld 150 bucket or similar types - Watson 1500, 2000 2500 auger or similar types - Texoma 700, 800 auger or similar types - drilling depth of 60' maximum); Elevating grader operator; Grade checker; Gradall operator; Grouting machine operator; Heavy-duty repairman; Heavy equipment robotics operator; Kalamazoo balliste regulator or similar type; Kolman belt loader and similar type; Le Tourneau blob compactor or similar type; Loader operator (Athey, Euclid, Sierra and similar types); Mobark Chipper or similar; Ozzie padder or http://frwebgate, access. gpo.gov/cgi-bin/getdoc.cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Page 9 of 24 similar types; P.C. slot saw; Pneumatic concrete placing machine operator (Hackley-Presswell or similar type); Pumperete gun operator; Rock Drill or similar types; Rotary drill operator (excluding caisson type); Rubber -tired earth -moving equipment operator (single engine, caterpillar, Euclid, Athey Wagon and similar types with any and all attachments over 25 yds. up to and including 50 cu. yds. struck); Rubber -tired earth -moving equipment operator (multiple engine up to and including 25 yds. struck); Rubber -tired scraper operator (self -loading paddle wheel type -John Deere, 1040 and similar single unit); Self- propelled curb and gutter machine operator; Shuttle buggy; Skiploader operator (crawler and wheel type over 1-1/2 yds. up to and including 6-1/2 yds.); Soil remediation plant operator; Surface heaters and planer operator; Tractor compressor drill combination operator; Tractor operator (any type larger than D-5 - 100 flywheel h.p. and over, or similar -bulldozer, tamper, scraper and push tractor single engine); Tractor operator (boom attachments), Traveling pipe wrapping, cleaning and bendng machine operator; Trenching machine operator (over 6 ft. depth capacity, manufacturer's rating); trenching Machine with Road Miner attachment (over 6 ft depth capacity): Ultra high pressure waterjet cutting tool system mechanic; Water pull (compaction) operator GROUP 9: Heavy Duty Repairman GROUP 10: Drilling machine operator, Bucket or auger types (Calweld 200 B bucket or similar types -Watson 3000 or 5000 auger or similar types-Texoma 900 auger or similar types -drilling depth of 105' maximum); Dual drum mixer, dynamic compactor LDC350 (or similar types); Monorail locomotive operator (diesel, gas or electric); Motor patrol -blade operator (single engine); Multiple engine tractor operator (Euclid and similar type -except Quad 9 cat.); Rubber -tired earth -moving equipment operator (single engine, over 50 yds. struck); Pneumatic pipe ramming tool and similar types; Prestressed wrapping machine operator; Rubber -tired earth -moving equipment operator (single engine, over 50 yde. struck); Rubber tired earth moving equipment operator (multiple engine, Euclid, caterpillar and similar over 25 yds. and up to 50 yds. struck), Tower crane repairman; Tractor loader operator (crawler and wheel type over 6-1/2 yds.); Woods mixer operator (and similar Pugmill equipment) GROUP 11: Heavy Duty Repairman - Welder Combination, Welder - Certified. GROUP 12: Auto grader operator; Automatic slip form operator; Drilling machine operator, bucket or auger types (Calweld, auger 200 CA or similar types - Watson, auger 6000 or similar types - Hughes Super Duty, auger 200 or similar types - drilling depth of 175' maximum); Hoe ram or similar with compressor; Mass excavator operator less tha 750 cu. yards; Mechanical finishing machine operator; Mobile form traveler operator; Motor patrol operator (multi -engine); Pipe mobile machine operator; Rubber -tired earth- moving equipment operator (multiple engine, Euclid, Caterpillar http://frwebgate.access.gpo.gov/cgi-binlgetdoc.cgi?dbname=Davis-Bacon&docid=CA201... 9127/2010 Page 10 of 24 and similar type, over 50 cu. yds. struck); Rubber -tired self- loading scraper operator (paddle -wheel -auger type self -loading - two (2) or more units) GROUP 13: Rubber -tired earth -moving equipment operator operating equipment with push-pull system (single engine, up to and including 25 yds. struck) GROUP 14: Canal liner operator; Canal trimmer operator; Remote- control earth -moving equipment operator (operating a second piece of equipment: $1.00 per hour additional); Wheel excavator operator (over 750 cu. yds.) GROUP 15: Rubber -tired earth -moving equipment operator, operating equipment with push-pull system (single engine, Caterpillar, Euclid, Athey Wagon and similar types with any and all attachments over 25 yds. and up to and including 50 yds. struck); Rubber -tired earth -moving equipment operator, operating equipment with push-pull system (multiple engine -up to and including 25 yds. struck) GROUP 16: Rubber -tired earth -moving equipment operator, operating equipment with push-pull system (single engine, over 50 yds. struck); Rubber -tired earth -moving equipment operator, operating equipment with push-pull system (multiple engine, Euclid, Caterpillar and similar, over 25 yds. and up to 50 yds. struck) GROUP 17: Rubber -tired earth -moving equipment operator, operating equipment with push-pull system (multiple engine, Euclid, Caterpillar and similar, over 50 cu. yds. struck); Tandem tractor operator (operating crawler type tractors in tandem - Quad 9 and similar type) GROUP 18: Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps and similar types in any combination, excluding compaction units - single engine, up to and including 25 yds. struck) GROUP 19: Rotex concrete belt operator (or similar types); Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps and similar types in any combination, excluding compaction units - single engine, Caterpillar, Euclid, Athey Wagon and similar types with any and all attachments over 25 yds.and up to and including 50 cu. yds. struck); Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps and similar types in any combination, excluding compaction units - multiple engine, up to and including 25 yds. struck) GROUP 20: Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps and.similar types in any combination, excluding compaction units - single engine, over 50 yds. struck); Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps, and similar types in any combination, excluding compaction units - multiple engine, Euclid, Caterpillar and similar, over 25 yds. and up to 50 yds. struck) http://frwebgate.access.gpo. gov/cgi-binlgetdoc. cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Page 11 of 24 GROUP 21: Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps and similar types in any combination, excluding compaction units - multiple engine, Euclid, Caterpillar and similar type, over 50 cu. yds. struck) GROUP 22: Rubber -tired earth -moving equipment operator, operating equipment with the tandem push-pull system (single engine, up to and including 25 yds. struck) GROUP 23: Rubber -tired earth -moving equipment operator, operating equipment with the tandem push-pull system (single engine, Caterpillar, Euclid, Athey wagon and similar types with any and all attachments over 25 yds. and up to and including 50 yds. struck); Rubber -tired earth -moving equipment operator, operating with the tandem push-pull system (multiple engine, up to and including 25 yds. struck) GROUP 24: Rubber -tired earth -moving equipment operator, operating equipment with the tandem push-pull system (single engine, over 50 yds. struck); Rubber -tired earth -moving equipment operator, operating equipment with the tandem push-pull system (multiple engine, Euclid, Caterpillar and similar, over 25 yds. and up to 50 yds. struck) GROUP 25: Concrete pump operator -truck mounted; Rubber -tired earth -moving equipment operator, operating equipment with the tandem push-pull system (multiple engine, Euclid, Caterpillar and similar type, over 50 cu. yds. struck) CRANES, PILEDRIVING AND HOISTING EQUIPMENT CLASSIFICATIONS GROUP 1: Engineer oiler; Fork lift operator (includes Toed, lull or similar types) GROUP 2: Truck crane oiler GROUP 3: A -frame or winch truck operator; Ross carrier operator (jobsite) GROUP 4: Bridge -type unloader and turntable operator; Helicopter hoist operator GROUP 5: Hydraulic boom truck; Stinger crane (Austin -Western or similar type); Tugger hoist operator (1 drum) GROUP 6: Bridge crane operator; Cretor crane operator; Hoist operator (Chicago boom and similar type); Lift mobile operator; Lift slab machine operator (Vagtborg and similar types); Material hoist and/or manlift operator; Polar gantry crane operator; Self Climbing scaffold (or similar type); Shovel, backhoe, dragline, clamshell operator (over 3/4 yd. and up to 5 cu, yds. mrc); Tugger hoist operator GROUP 7: Pedestal crane operator; Shovel, backhoe, dragline, clamshell operator (over 5 cu. yds. mrc); Tower crane repair; Tugger hoist operator (3 drum) http://frwebgate.access.gpo.gov/cgi-binlgetdoe.cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Page 12 of 24 GROUP 8: Crane operator (up to and including 25 ton capacity); Crawler transporter operator; Derrick barge operator (up to and including 25 ton capacity); Hoist operator, stiff legs, Guy derrick or similar type (up to and including 25 ton capacity); Shovel, backhoe, dragline, clamshell operator (over 7 cu. yds., M.R.C.) GROUP 9: Crane operator (over 25 tons and up to and including 50 tons mrc); Derrick barge operator (over 25 tons up to and including 50 tons mrc); Highline cableway operator; Hoist operator, stiff legs, Guy derrick or similar type (over 25 tons up to and including 50 tons mrc); K-crane operator; Polar crane operator; Self erecting tower crane operator maximum lifting capacity ten tons GROUP 10: Crane operator (over 50 tons and up to and including 100 tons mrc); Derrick barge operator (over 50 tons up to and including 100 tons mrc); Hoist operator, stiff legs, Guy derrick or similar type (over 50 tons up to and including 100 tons mrc), Mobile tower crane operator (over 50 tons, up to and including 100 tons M.R.C.); Tower crane operator and tower gantry GROUP 11: Crane operator (over 100 tons and up to and including 200 tons mrc); Derrick barge operator (over 100 tons up to and including 200 tons mrc); Hoist operator, stiff legs, Guy derrick or similar type (over 100 tons up to and including 200 tons mrc); Mobile tower crane operator (over 100 tons up to and including 200 tons mrc) GROUP 12: Crane operator (over 200 tons up to and including 300 tons mrc); Derrick barge operator (over 200 tons up to and including 300 tons mrc); Hoist operator, stiff legs, Guy derrick or similar type (over 200 tons, up to and including 300 tons mrc); Mobile tower crane operator (over 200 tons, up to and including 300 tons mrc) GROUP 13: Crane operator (over 300 tons); Derrick barge operator (over 300 tons); Helicopter pilot; Hoist operator, stiff legs, Guy derrick or similar type (over 300 tons); Mobile tower crane operator (over 300 tons) TUNNEL CLASSIFICATIONS GROUP 1: Skiploader (wheel type up to 3/4 yd. without attachment) GROUP 2: Power -driven jumbo form setter operator GROUP 3: Dinkey locomotive or motorperson (up to and including 10 tons) GROUP 4: Bit sharpener; Equipment greaser (grease truck); Slip form pump operator (power -driven hydraulic lifting device for concrete forms); Tugger hoist operator (1 drum); Tunnel locomotive operator (over 10 and up to and including 30 tons) GROUP 5: Backhoe operator (up to and including 3/4 yd.); Small Ford, Case or similar; Drill doctor; Grouting machine http://frwebgate. access.gpo. gov/cgi-binlgctdoe.cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Page 13 of 24 operator; Heading shield operator; Heavy-duty repairperson; Loader operator (Athey, Euclid, Sierra and similar types); Mucking machine operator (1/4 yd., rubber -tired, rail or track type); Pneumatic concrete placing machine operator (Hackley-Presswell or similar type); Pneumatic heading shield (tunnel); Pumperete gun operator; Tractor compressor drill combination operator; Tugger hoist operator (2 drum); Tunnel locomotive operator (over 30 tons) GROUP 6: Heavy Duty Repairman GROUP 7: Tunnel mole boring machine operator ENGINEERS ZONES $1.00 additional per hour for all of IMPERIAL County and the portions of KERN, RIVERSIDE & SAN BERNARDINO Counties as defined below: That area within the following Boundary: Begin in San Bernardino County, approximately 3 miles NE of the intersection of 1-15 and the California State line at that point which is the NW corner of Section 1, T17N,m R14E, San Bernardino Meridian. Continue W in a straight line to that point which is the SW corner of the northwest quarter of Section 6, T27S, R42E, Mt. Diablo Meridian. Continue North to the intersection with the Inyo County Boundary at that point which is the NE corner of the western half of the northern quarter of Section 6, T25S, R42E, MDM. Continue W along the Inyo and San Bernardino County boundary until the intersection with Kern County, as that point which is the BE corner of Section 34, T24S, R40E, MDM. Continue W along the Inyo and Kern County boundary until the intersection with Tulare County, at that point which is the SW corner of the BE quarter of Section 32, T248, R37E, MDM. Continue W along the Kern and Tulare County boundary, until that point which is the NW corner of T25S, R32E, MDM. Continue S following R32E lines to the NW corner of T31S, R32E, MDM. Continue W to the NW corner of T31S, R31E, MDM. Continue S to the SW corner of T32S, R31E, MDM. Continue W to SW corner of BE quarter of Section 34, T32S, R30E, MDM. Continue S to SW corner of T11N, R17W, SBM. Continue E along south boundary of T11N, SBM to SW corner of T11N, R7W, SBM. Continue S to SW corner of T9N, R7W, SBM. Continue E along south boundary of T9N, SBM to SW corner of T9N, RIB, SBM. Continue S along west boundary of R1E, SM3 to Riverside County line at the SW corner of TiS, RIE, SBM. Continue E along south boundary of Tis, SBM (Riverside County Line) to SW corner of T1S, R10E, SBM. Continue S along west boundary of R10E, SBM to Imperial County line at the SW corner of TBS, R10E, SBM. Continue W along Imperial and Riverside county line to NW corner of T9S, R9E, SBM. Continue S along the boundary between Imperial and San Diego Counties, along the west edge of R9E, SBM to the south boundary of Imperial County/California state line. Follow the California state line west to Arizona state line, then north to Nevada state line, then continuing NW back to start at the point which is the NW corner of Section 1, T17N, R14E, SBM - $1.00 additional per hour for portions of SAN LUIS OBISPO, KERN, SANTA BARBARA & VENTURA as defined below: http://frwebgate,access, gpo.gov/cgi-binigeldoe,cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Page 14 of 24 That area within the following Boundary: Begin approximately 5 miles north of the community of Cholame, on the Monterey County and San Luis Obispo County boundary at the NW corner of T25S, R16E, Mt. Diablo Meridian. Continue south along the west side of R16E to the SW corner of T30S, R16E, MDM. Continue B to SW corner of T30S, R17E, MDM. Continue S to SW corner of T31S, R17E, MDM. Continue E to SW corner of T31S, RiBE, MDM. Continue S along West side of R18E, MDM as it crosses into San Bernardino Meridian numbering area and becomes R30W. Follow the west side of R30W, SBM to the SW corner of T9N, R30W, SBM. Continue E along the south edge of T9N, SBM to the Santa Barbara County and Ventura County boundary at that point whch is the SW corner of Section 34.T9N, R24W, SBM, continue S along the Ventura County line to that point which is the SW corner of the SE quarter of Section 32, T7N, R24W, SBM. Continue E along the south edge of T7N, SBM to the SE corner to T7N, R21W, SBM. Continue N along East side of R21W, SBM to Ventura County and Kern County boundary at the NE corner of TSN, R21W. Continue W along the Ventura County and Kern County boundary to the SE corner of T9N, R21W. Continue North along the East edge of R21W, SBM to the NE corner of T12N, R21W, SBM. Continue west along the north edge of T12N, SBM to the SE corner of T32S, R21E, MDM. [T12N SBM is a think strip between T11N SBM and T32S MDMI. Continue North along the East side of R21E, MUM to the Kings County and Kern County border at the NE corner of T25S, R21E, MDM, continue West along the Kings County and Kern County Boundary until the intersection of San Luis Obispo County. Continue west along the Kings County and San Luis Obispo County boundary until the intersection with Monterey County. Continue West along the Monterey County and San Luis Obispo County boundary to the beginning point at the NW corner of T25S, R16E, MDM. $2.00 additional per hour for INYO and MONO Counties and the Northern portion of SAN BERNARDINO County as defined below: That area within the following Boundary: Begin at the intersection of the northern boundary of Mono County and the California state line at the point which is the center of _ Section 17, T10N, R22E, Mt. Diablo Meridian. Continue S then SE along the entire western boundary of Mono County, until it reaches Inyo County at the point which is the NE corner of the Western half of the NW quarter of Section 2, TBS, R29E, MDM. Continue SSE along the entire western boundary of Inyo County, until the intersection with Kern County at the point which is the SW corner of the SE ❑ of Section 32, T24S, R37E, MDM. Continue E along the Inyo and Kern County boundary until the intersection with San Bernardino County at that point which is the SE corner of section 34, T248, R40E, MDM. Continue E along the Inyo and San Bernardino County boundary until the point which is the NE corner of the Western half of the NW quarter of Section 6, T25S, R42E, MDM. Continue S to that point which is the SW corner of the NW quarter of Section 6, T27S, R42E, MDM. Continue E in a straight line to the California and Nevada state border at the point which is the NW corner of Section 1, T17N, R14E, San Bernardino Meridian. Then continue NW along the state line to the starting point, which is the center of Section 18, T10N, R22E, MDM. http://frwebgate,access.gpo.gov/cgi-binlgetdoe, cgi?dbname=D avis-Bacon&docid=CA201... 9/27/2010 Page 15 of 24 REMAINING AREA NOT DEFINED ABOVE RECIEVES BASE RATE ---------------------------------------------------------------- ENGI0012-004 08/01/2009 Rates Fringes OPERATOR: Power Equipment (DREDGING) (1) Leverman................$ 44.83 17.22 (2) Dredge dozer............$ 40.36 17.22 (3) Deckmate................$ 40.25 17.22 (4) Winch operator (stern winch on dredge)............$ 39.70 17.22 (5) Fireman -oiler, Deckhand, Bargeman, Leveehand...................$ 39.16 17.22 (6) Barge Mate... ........... ---------------------------------------------------------------- $ 39.77 17.22 IRON0002-004 07/01/2010 Rates Fringes Ironworkers: Fence Erector ...............$ 26.58 15.26 Ornamental, Reinforcing and Structural ..............$ 33.00 23.73 PREMIUM PAY: $6.00 additional per hour at the following locations: China Lake Naval Test Station, Chocolate Mountains Naval Reserve-Niland, Edwards AFB, Fort Irwin Military Station, Fort Irwin Training Center -Goldstone; San Clemente Island, San Nicholas Island, Susanville Federal Prison, 29 Palms - Marine Corps, U.S. Marine Base - Barstow, U.S. Naval Air Facility - Sealey, Vandenberg AFB $4.00 additional per hour at the following locations: Army Defense Language Institute - Monterey, Fallon Air Base, Naval Past Graduate School - Monterey, Yermo Marine Corps Logistics Center $2.00 additional per hour at the following locations: Port Hueneme, Port Mugu, U.S. Coast Guard Station - Two Rock ------------------------------------------------------------ LAB00300-001 09/01/2010 Rates Fringes Brick Tender .....................$ 27.17 14.72 ---------------------------------------------------------------- LAB00300-003 07/01/2010 Rates Fringes http://frwebgate.access. gpo. gov/cgi-binlgetdoe.cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Page 16 of 24 LABORER (GUNITE) GROUP 1 .....................$ 30.04 17.37 GROUP 2 .....................$ 29.09 17.37 GROUP 3 .....................$ 25.55 17.37 LABORER (TUNNEL) GROUP I .....................$ 31.24 14.98 GROUP 2 .....................$ 31.56 14.98 GROUP 3 .....................$ 32.02 14.98 GROUP 4 .....................$ 32.71 14.98 LABORER GROUP I .....................$ 26.33 14.75 GROUP 2 .....................$ 26,88 14.75 GROUP 3 .....................$ 27.43 14.75 GROUP 4 .....................$ 28.98 14.75 GROUP 5 .....................$ 29.33 14.75 FOOTNOTE: GUNITE PREMIUM PAY: Workers working from a Bosn'n's Chair or suspended from a rope or cable shall receive 40 cents per hour above the foregoing applicable classification rates. workers doing gunite and/or shotcrete work in a tunnel shall receive 35 cents per hour above the foregoing applicable classification rates, paid on a portal-to-portal basis. Any work performed on, in or above any smoke stack, silo, storage elevator or similar type of structure, when such structure is in excess of 75'-0" above base level and which work must be performed in whole or in part more than 75'-011 above base level, that work performed above the 75'-0" level shall be compensated for at 35 cents per hour above the applicable classification wage rate. LABORER CLASSIFICATIONS GROUP 1: Cleaning and handling of panel forms; Concrete screeding for rough strike -off; Concrete, water curing; Demolition laborer, the cleaning of brick if performed by a worker performing any other phase of demolition work, and the cleaning of lumber; Fire watcher, limber, brush loader, piler and debris handler; Flag person; Gas, oil and/or water pipeline laborer; Laborer, asphalt -rubber material loader; Laborer, general or construction; Laborer, general clean-up; Laborer, landscaping; Laborer, jetting; Laborer, temporary water and air lines; Material hose operator (walls, slabs, floors and decks); Plugging, filling of shee bolt holes; Dry packing of concrete; Railroad maintenance, repair track person and road beds; Streetcar and railroad construction track laborers; Rigging and signaling; Scaler; Slip form raiser; Tar and mortar; Tool crib or tool house laborer; Traffic control by any method; Window cleaner; Wire mesh pulling - all concrete pouring operations GROUP 2: Asphalt shoveler; Cement dumper (on 1 yd. or larger mixer and handling bulk cement); Cesspool digger and installer; Chucktender; Chute handler, pouring concrete, the handling of the chute from readymix trucks, such as walls, slabs, decks, floors, foundation, footings, curbs, gutters and sidewalks; Concrete curer, impervious membrane and form oiler; Cutting torch operator (demolition); Fine grader, highways and street paving, airport, runways and http://frwebgate.access. gpo.govlcgi-binlgetdoe.egi?dbname=Davis-Bacon&docid=CA201. ,. 9/27/2010 Page 17 of 24 similar type heavy construction; Gas, oil and/or water pipeline wrapper - pot tender and form person; Guinea chaser; Headerboard person - asphalt; Laborer, packing rod steel and pans; Membrane vapor barrier installer= Power broom sweeper (small); Riprap stonepaver, placing stone or wet sacked concrete; Roto scraper and tiller; Sandblaster (pot tender); Septic tank digger and installer(lead); Tank scaler and cleaner; Tree climber, faller, chain saw operator, Pittsburgh chipper and similar type brush shredder; Underground laborer, including caisson bellower GROUP 3: Buggymobile person; Concrete cutting torch; Concrete pile cutter; Driller, jackhammer, 2-1/2 ft. drill steel or longer; Dri-pak-it machine; Gas, oil and/or water pipeline wrapper, 6-in. pipe and over, by any method, inside and out; High scaler (including drilling of same); Hydro seeder and similar type; Impact wrench multi -plate; Kettle person, pot person and workers applying asphalt, lay-kold, creosote, lime caustic and similar type materials ("applying" means applying, dipping, brushing or handling of such materials for pipe wrapping and waterproofing); Operator of pneumatic, gas, electric tools, vibrating machine, pavement breaker, air blasting, come-alongs, and similar mechanical tools not separately classified herein; Pipelayer's backup person, coating, grouting, making of joints, sealing, caulking, diapering and including rubber gasket joints, pointing and any and all other services; Rock slinger; Rotary scarifier or multiple head concrete chipping scarifier; Steel headerboard and guideline setter; Tamper, Barko, Wacker and similar type; Trenching machine, hand -propelled GROUP 4: Asphalt raker, lute person, ironer, asphalt dump person, and asphalt spreader boxes (all types); Concrete core cutter (walls, floors or ceilings), grinder or sander; Concrete saw person, cutting walls or flat work, scoring old -or new concrete; Cribber, shorer, lagging, sheeting and trench bracing, hand -guided lagging hammer; Head rock slinger; Laborer, asphalt- rubber distributor boot person; Laser beam in connection with laborers' work; Oversize concrete vibrator operator, 70 lbs. and over; Pipelayer performing all services in the laying and installation of pipe from the point of receiving pipe in the ditch until completion of operation, including any and all forms of tubular material, whether pipe, metallic or non-metallic, conduit and any other stationary type of tubular device used for the conveying of any substance or element, whether water, sewage, solid gas, air, or other product whatsoever and without regard to the nature of material from which the tubular material is fabricated; No -joint pipe and stripping of same; Prefabricated manhole installer; Sandblaster (nozzle person), water blasting, Porta Shot -Blast GROUP 5: Blaster powder, all work of loading holes, placing and blasting of all powder and explosives of whatever type, regardless of method used for such loading and placing; Driller: All power drills, excluding jackhammer, whether core, diamond, wagon, track, multiple unit, and any and all other types of mechanical drills without regard to the form of motive power; Toxic waste removal http://frwebgate.access.gpo.gov/cgi-bin/getdoe.egi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Page 18 of 24 TUNNEL LABORER CLASSIFICATIONS GROUP 1: Batch plant laborer; Bull gang mucker, track person; Changehouse person; Concrete crew, including rodder and spreader; Dump person; Dump person (outside); Swamper (brake person and switch person on tunnel work), Tunnel materials handling person GROUP 2: Chucktender, cabletender; Loading and unloading agitator cars; Nipper; Pot tender, using mastic or other materials (for example, but not by way of limitation, shotcrete, etc.); Vibrator person, jack hammer, pneumatic tools (except driller) GROUP 3: Blaster, driller, powder person; Chemical grout jet person; Cherry picker person; Grout gun person; Grout mixer person; Grout pump person; Jackleg miner; Jumbo person; Kemper and other pneumatic concrete placer operator; Miner, tunnel (hand or machine); Nozzle person; Operating of troweling and/or grouting machines; Powder person (primer house); Primer person; Sandblaster; Shotcrete person; Steel form raiser and setter; Timber person, retimber person, wood or steel; Tunnel Concrete finisher GROUP 4: Diamond driller; Sandblaster; Shaft and raise work GUNITE LABORER CLASSIFICATIONS GROUP 1: Rodmen, Nozzlemen GROUP 2: Gunmen GROUP 3: Reboundmen ---------------------------------------------------------------- LAB00300-005 08/05/2009 Rates Fringes LABORER PLASTER CLEAN-UP LABORER....$ 26.65 14.70 _ PLASTER TENDER ..............$ 29.20 14.70 ------------------------------------�---------------------------- LAB00882-002 01/01/2010 Rates Fringes Asbestos Removal Laborer ......... $ 26.15 14.25 SCOPE OF WORK: Includes site mobilization, initial site cleanup, site preparation, removal of asbestos -containing material and toxic waste, encapsulation, enclosure and disposal of asbestos- containing materials and toxic waste by hand or with equipment or machinery; scaffolding, fabrication of temporary wooden barriers and assembly of decontamination stations. LABO1184-001 07/01/201D http://frwebgate.access. gpo.govlcgi-binlgetdoe.cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 Rates Fringes Laborers: (HORIZONTAL DIRECTIONAL DRILLING) (1) Drilling Crew Laborer ... $ 27.05 11.65 (2) Vehicle Operator/Hauler.$ 27.22 11.65 (3) Horizontal Directional Drill Operator ..............$ 29.07 11.65 (4) Electronic Tracking Locator .....................$ 31.07 11.65 Laborers: (STRIPING/SLURRY SEAL) GROUP I .....................$ 28.50 14.56 GROUP 2.....................$ 29.80 14.56 GROUP 3........ ............. $ 31.81 14.56 GROUP 4.....................$ 33.55 14.56 LABORERS - STRIPING CLASSIFICATIONS GROUP 1: Protective coating, pavement sealing, including repair and filling of cracks by any method on any surface in parking lots, game courts and playgrounds; carstops; operation of all related machinery and equipment; equipment repair technician GROUP 2: Traffic surface abrasive blaster; pot tender - removal of all traffic lines and markings by any method (sandblasting, waterblasting, grinding, etc.) and preparation of surface for coatings. Traffic control person: controlling and directing traffic through both conventional and moving lane closures; operation of all related machinery and equipment GROUP 3: Traffic delineating device applicator: Layout and application of pavement markers, delineating signs, rumble and traffic bars, adhesives, guide markers, other traffic delineating devices including traffic control. This category includes all traffic related surface preparation (sandblasting, waterblasting, grinding) as part of the application process. Traffic protective delineating system installer: removes, relocates, installs, permanently affixed roadside and parking delineation barricades, fencing, cable anchor, guard rail, reference signs, monument markers; operation of all related machinery and equipment; power broom sweeper GROUP 4: Striper: layout and application of traffic stripes and markings; hot thermo plastic; tape traffic stripes and markings, including traffic control; operation of all related machinery and equipment ---------------------------------------------------------------- * PAIN0036-001 08/01/2010 Rates Painters: (Including Lead Abatement) (1) Repaint .................$ 26.05 (2) All Other Work .......... $ 29.32 Fringes 9.68 10.35 Page 19 of 24 http: //frwebgate.access.gpo. gov/cgi-binlgetdoe.cgi?dbname=Davis-Bacon&docid=CA20 i ... 9/27/2010 Page 20 of 24 REPAINT of any previously painted structure. Exceptions: ,work involving the aerospace industry, breweries, commercial recreational facilities, hotels which operate commercial establishments as part of hotel service, and sports facilities. ---------------------------------------------------------------- PAIN0036-008 01/06/2010 Rates Fringes DRYWALL FINISHER/TAPER ........... $ 33.22 12.19 ---------------------------------------------------------------- PAIN0036-015 08/01/2010 Rates Fringes GLAZIER ..........................$ 36.90 20.53 FOOTNOTE: Additional $1.25 per hour for work in a condor, from the third (3rd) floor and up Additional $1.25 per hour for work on the outside of the building from a swing stage or any suspended contrivance, from the ground up ---------------------------------------------------------------- PAIN1247-002 01/01/2010 Rates Fringes SOFT FLOOR LAYER .................$ 30.85 10.54 ---------------------------------------------------------------- PLAS0200-009 08/04/2010 Rates Fringes PLASTERER ........................$ 30.21 14.23 ---------------------------------------------------------------- PLAS0500-002 07/01/2010 Rates Fringes CEMENT MASON/CONCRETE FINISHER ... $ 29.50 19.85 ---------------------------------------------------------------- PLUM0016-001 07/01/2009 Rates Fringes PLUMBER/PIPEFITTER (1) Work on strip malls, light commercial, tenant improvement and remodel work ........................$ 28.84 14.47 (2) Work on new additions and remodeling of bars, restaurant, stores and commercial buildings not to exceed 5,000 sq. ft. of floor space .................$ 35.97 15.86 (3) All other work .......... $ 37.10 16.84 PLUM0250-002 01/02/2006 http://frwebgate.access.gpo. gov/cgi-binlgetdoe. cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 incluaing air poliution Page 21 of 24 Rates Fringes REFRIGERATION MECHANIC Refrigeration Fitter ........ $ 33.30 13.95 ---------------------------------------------------------------- PLUM0345-001 07/01/2009 Rates Fringes PLUMBER Landscape/Irrigation Fitter.$ 26.70 13.84 Sewer & Storm Drain Work .... $ 25.18 15.67 ---------------------------------------------------------------- ROOF0036-002 08/01/2010 Rates Fringes ROOFER ...........................$ 34.65 9.07 FOOTNOTE: Pitch premium: Work on which employees are exposed to pitch fumes or required to handle pitch, pitch base or pitch impregnated products, or any material containing coal tar pitch, the entire roofing crew shall receive $1.75 per hour "pitch premium" pay. ---------------------------------------------------------------- SFCA0669-008 04/01/2010 DOES NOT INCLUDE SAN CLEMENTE ISLAND, THE CITY OF SANTA AMA, AND THAT PART OF ORANGE COUNTY WITHIN 25 MILES OF THE CITY LIMITS OF LOS ANGELES: Rates Fringes SPRINKLER FITTER .................$ 33.35 17.60 ---------------------------------------------------------------- SFCA0709-003 01/01/2010 SAN CLEMENTE ISLAND, THE CITY OF SANTA ANA, AND THAT PART OF ORANGE COUNTY WITHIN 25 MIKES BEYOND THE CITY LIMITS OF LOS ANGELES: Rates Fringes SPRINKLER FITTER (Fire) .......... $ 39.08 21.95 ---------------------------------------------------------------- SHEE0105-003 07/01/2010 LOS ANGELES (South of a straight line drawn between Gorman and Big Pines)and Catalina Island, INYO, KERN (Northeast part, East of Hwy 395), MONO ORANGE, RIVERSIDE, AND SAN BERNARDINO COUNTIES Rates Fringes SHEET METAL WORKER (1) Commercial - New Construction and Remodel work ............ ............ $ 42.54 17.72 (2) Industrial work including air pollution control systems, noise http://f`rwebgate.access. gpo. gov/cgi-bin/getdo e.egi?dbname=Davis-Bacon&docid=CA201. ,. 9/27/2010 Page 22 of 24 abatement, hand rails, guard rails, excluding aritechtural sheet metal work, excluding A-C, heating, ventilating systems for human comfort ... $ 35.56 22.90 ---------------------------------------------------------------- TEAM0011-002 07/01/2008 Rates Fringes TRUCK DRIVER GROUP I ....................$ 26.44 18.24 GROUP 2....................$ 26.59 18.24 GROUP 3....................$ 26.72 18.24 GROUP 4....................$ 26.91 18.24 GROUP 5....................$ 26.94 18.24 GROUP 6....................$ 26.97 18.24 GROUP 7....................$ 27.22 18.24 GROUP 8....................$ 27.47 18.24 GROUP 9....................$ 27.67 18.24 GROUP 10....................$ 27.97 18.24 GROUP 11....................$ 28.47 18.24 GROUP 12....................$ 28.90 18.24 WORK ON ALL MILITARY BASES: PREMIUM PAY: $3.00 per hour additional. (29 palms Marine Base, Camp Roberts, China Lake, Edwards AFB, E1 Centro Naval Facility, Fort Irwin, Marine Corps Logistics Base at Nebo & Yermo, Mountain Warfare Training Center, Bridgeport, Point Arguello, Point Conception, Vandenberg AFB] TRUCK DRIVERS CLASSIFICATIONS GROUP 1: Truck driver GROUP 2: Driver of vehicle or combination of vehicles - 2 axles; Traffic control pilot car excluding moving heavy equipment permit load; Truck mounted broom GROUP 3: Driver of vehicle or combination of vehicles - 3 axles; Boot person; Cement mason distribution truck; Fuel truck driver; Water truck - 2 axle; Dump truck, less than 16 yds. water level; Erosion control driver GROUP 4: Driver of transit mix truck, under 3 yds.; Dumperete truck, less than 6-1/2 yds. water level GROUP 5: Water truck, 3 or more axles; Truck greaser and tire person ($0.50 additional for tire person); Pipeline and utility working truck driver, including winch truck and plastic fusion, limited to pipeline and utility work; Slurry truck driver GROUP 6: Transit mix truck, 3 yds, or more; Dumperete truck, 6-1/2 yds. water level and over; Vehicle or combination of vehicles - 4 or more axles; oil spreader truck; Dump truck, 16 yds. to 25 yds. water level http://frwebgate.access.gpo.gov/cgi-binlgetdoo.cgi?dbname=Davis-Bacon&docid=CA201,.. 9/27/2010 Page 24 of 24 Branch of Construction Wage Determinations Wage and Hour Division U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 2.) If the answer to the question in 1.) is yes, then an interested party (those affected by the action) can request review and reconsideration from the Wage and Hour Administrator (See 29 CFR Part 1.8 and 29 CFR Part 7). Write to: Wage and Hour Administrator U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 The request should be accompanied by a full statement of the interested party's position and by any information (wage payment data, project description, area practice material, etc.) that the requestor considers relevant to the issue. 3.) If the decision of the Administrator is not favorable, an interested party may appeal directly to the Administrative Review Board (formerly the Wage Appeals Board). Write to: Administrative Review Board U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 4.) All decisions by the Administrative Review Board are final. END OF GENERAL DECISION hUp;//frwebgate.access.gpo.gov/cgi-binlgetdoe.cgi?dbname=Davis-Bacon&docid=CA201... 9/27/2010 10U7lh KNOW ALL BY THESE PRESENTS, That we, PTM GENERAL ENGINEERING SERVICES. INC. of 5942 ACORN ST. RIVERIDE, CA 92504 ('hereinafter called the Principal), as Principal, and BERKLEY REGIONAL INSURANCE COMPANY {hereinafter called the Surety), as Surety are held and firmly bound unto CITY OF HUNTINGTON BEACH (hereinafter called the Obligee) in the penal sum of TEN PERCENT OF AMOUNT BID Dollars ($ 10% ) Far the payment of which the Principal and the Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, That VRER'EAS, the Principal has submitted or is about to submit a proposal to the Obligee on a contract for TRAFFIC SIGNAL MODIFICATIONS AT BROOKHURST ST. & YORKTOWN AVE. & NEWLAND ST. AND ATLANTA AVE. & MAGNOLIA ST. & ATLANTA AVE. FEDERAL NO. STPLHG-5181(139), STPLHG-5181(162) & STPLHG-5181(163) NOW, THEREFORE, tf the said Contract be timely awarded to the Principal and the Principal shall, within such time as may be specified, enter into the Contract in writing, and give bond, if bond is required, with surety acceptable to the Obligee for the faith Ell performance of the said Contract, then this obligation shall be void; otherwise to remain in full force and effect, Signed and sealed this 4TH day of OCTOBER PTM GENERAL Witness 6- Witness �BE By 2010 INEERING SERVICES, INC. (Seal) Principal Title INSURANCE COMPANY Attorney -in -Fact No. 7916a POWER OF ATTORNEY BERKLEY REGIONAL INSURANCE COMPANY WILMINGTON, DELAWARE NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully. KNOW ALL MEN BY THESE PRESENTS, that BERKLEY REGIONAL INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Delaware, having its principal office in Urbandale, Iowa, has made, constituted and appointed, and does by these presents make, constitute and appoint: Philip Vega, Frank Morones or Jadon H. Smith of C & D Bonding & Insurance Services, Inc. of Covina, CA its true and lawful Attorney -in -Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver any and all bonds and undertakings, with _ the exception of Financial Guaranty Insurance, providing that no single obligation shall exceed Fifty Million and 00/100 Dollars ($50,000,000.00), to the same extent as if such bonds had been duly executed and acknowledged by the regularly elected officers f Of the Company at its principal office in their own proper persons. This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, 1 without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following r resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on August 21, 2000: "RESOLVED, that the proper officers of the Company are hereby authorized to execute powers of attorney authorizing and qualifying the attorney -in -fact named therein to execute bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the corporate seal of the Company to powers of attorney executed pursuant hereto; and further RESOLVED, that such power of attorney limits the acts of those named therein to the bonds, undertakings, recognizances, or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the manner and to the extent therein stated; and further RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney -in -fact named; and further RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or = other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have ceased to be such at the time when such instruments shall be issued." IN WITNESS WHEREOF, the Company has caused these presents to be signed and attested by its appropriate officers and its corporate seal hereunto affixed this day of 2010. Attest: Berkley nal Insurance Company (Seal) By By ra S. Le erman Robert P. Cole Senior Vice President & Secretary Senior Vice President `vVARNING: THIS POWER INVALID IF NOT PRINTED ON BLUE "BERKLEY" SECURITY PAPER. STATE OF CONNECTICUT ) } ss: COUNTY OF FAIRFIELD ) Sworn to before me, a Notary Public in the State of Connecticut, this day of YV --A-111 , 2010, by Robert P. Cole and Ira S. Lederman who are sworn to me to be the Senior Vice President, and the Senior Vice President and Secretary, respectively, of _ '=Berkley Regional Insurance Company. EHLREP° JWTf mycomwss;= _..: ,?t9t Notary Public, State,of Connecticut v b ! CERTIFICATE d I, the undersigned, Assistant Secretary of BERKLEY REGIONAL INSURANCE COMPANY, DO HEREBY CERTIFY that the :=foregoing is a true, correct and complete copy of the original Power of Attorney; that said Power of Attorney has not been revoked .,or rescinded and that the authority of the Attorney -in -Fact set forth therein, who executed the bond or undertaking to which this 'Power of Attorney is attached, is in full force and effect as of this date. Given under my hand and seal of the Company, this 4 day of October 2010 (Seal) Steven Coward CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Los Angeles On 1 0 / 04 / 2010 before me, Monica Blaisdell, Notary Dale Here Insert Nwiie and T#le of the Mow personally appeared Philip VPaa Names} of sgneqs- MONICA BLAISDELL '•. Commisslon # 1794078 Notary Public - California £ orange County Nycomm. Expires mar 26, 2012 I who proved to me on the basis of satisfactory evidence to be the personW whose name(h) is/ggs subscribed to the within instrument and acknowledged to me that helVielwexecuted the same in his1WPb4&authorized capacity(ioXX and that by his/k4( signature(4(on the instrument the person(), or the entity upon behalf of which the person(x) 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. Place Notary Seal Above Signature 'J mature of Notary Pub1c OPTIONAL Though the information below is not required by taw, it may prove valuable to persons retying on the document and could prevent fraudulent removal and reattachment of this form to another document Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Marne: ❑ 'Individual ❑ Corporate Officer --- Title(s): ❑ Partner — ❑ Limited 0 General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator fl tither: Signer Is Representing; R C'HTTTl1L"fti78PAlNT _,.e_O_ FSIGNER! .. rif thumb here Number of Pages: _ Signer's Name: El Individual ❑ Corporate Officer — lltte(s): ❑1 Partner — ❑ Limited Ci General ❑ Attorney in Fact ❑ Trustee O Guardian or Conservator ❑ Other: Signer Is Representing: ReIGHTTHUf 4l3PRiNT 02007 National Notary Assmallon • 9350 De Soto Ave., P.O. Box 2402 •Chace arth, CA M13-2409 - W W&NOWANotaryorg Item #5907 Reorder: Call Toll -Free 7 4 g�, 1,1104 .' State of California County of Riverside t On 12,01D before me, 2e._ t (Here inset name and title of officer) personally appeared Brian Mendoza who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islsubscribed to the within instrument and acknowledged to me that he/sMUby executed the same in hisUrIOXIV authorized capacity(Ws), and that by hisAwr/tkoimignature(x) on the instrument the person(*), 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. ..►►rrrr,,. WFINESS my an \ �`•. Signatureary Public �— -. DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Tide or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Tide) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other 2008 version CAPA vl2.10.07 800-873-9865 www.NotmyClasses.com INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in Calforma must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, arty alternative acbnowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California f.e. cerrifyirg the authorized capacity of the signer). Please check the document carefidlyforproper notarial wordirgand attach thisform f requinad • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notari-ation must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. hWsheNkay;- is late ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. 4 Additional information is not requited but could help to ensure this acknowledgment is not misused or attached to a different document. • Indicate tide or type of attached document, number of pages and date- • Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document C�AM{*ORNIA ALL-PURPOSE ACKNOV41LEIDG ENT State of California County of ORANGE On Dste before me, Philip Vega, Notarypublic Hate Insert Name a.)d Two of t o officer personally appeared Elizabeth H. Mendoza de Mcrae amc �cil9�o<ta1 - 9 who proved to me on the basis of satisfactory evidence to be.the person(% whose namLRS) is%bre subscribed to the within instrument and acknowled99 to me that hel�t<i��t% executed the same In hid/ft� 16111r authorized capaCdy(�ds), and that by hid/h`ef6Nelr slgnatA(s) on the PHILIP VEGA instrument the person(d), or the entity upon behalf of Commission # 1799866 which the person(g) acted, executed the instrument. '< .m Notary Public - California z Z Los Angeles County I certify under PENALiY OF PERJURY under the laws Mmm. Expires May 31, 2012 of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official Piece Notary Signature Seal Above _ -- OPTIONAL Though the information below is not required by law, It may prove valuable to persons retl and could prevent fraudulent removal and reattachment of this torm to another Description of Attached Document Title or Type of Document; Document bate: Signers) Other Than Named Above: — Capacity(ies) Claimed by Signer(s) Signer's Narm: Individual Corporate Officer — Title(s): Partner --- 0 Limted ❑ General Attorney.in Fact Trustee Guardian or Conservator Other: Signer Is Representing: Number of Pages: dpoument Signer's Name: O individual ❑ Corporate Off lccr — Title(s): ❑ Partner -- ❑ Limited 0 General ❑ Attorney in Fact C1 Trustee Top of thumb here Q Guardian or Conservator ❑ Other: Signer Is Representing: ¢72007NetlonalNotaryAaeociadan•9350DoSomA.o„P,O,Box2402•Chstewonh,CAB1373.2ao2,wrw,NallonalNotary019 Itemh5907 Aoador.Call Toll-Preei-8o0-M-h927 j� Brian Mendoza , Secretary of PTM General Engineering Services Inc. (Corporation) do hereby certify that at a duly constituted 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 b day of(�) ivy '40 to (year). A TRUE RECORD ATTEST Brian Mendoza Secretary/Clerk Vice President/Secretary (Corporate Seal) 53 City of Huntington Beach 2000 Main Street ® Huntington Beach, CA 926483 OFFICE OF THE CITY CLERIC JOAN L. FLYNN CITY CLERK March 4, 2011 Steiny and Company, Inc. P. O. Box 8100 12907 E. Garvey Ave. Baldwin Park, CA 91706 RE: CC-1204, CC-1246, & CC-1247 —Various Traffic Signal Modifications Enclosed please find your original bid bond for CC-1204, CC-1246 & CC-1247. Sincerely, 00"110) 0�_ ji") Joan L. Flynn, CMC City Clerk J F: pe Enclosure Sister Citiy-.hb& RcjMhj/ret r �@j r& New Zealand ( Telephone: 714-536-5227 ) 2010 CC! -7 Pil 12: 38 for the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue FEDERAL NOS. STPLHG-5181(139), STPLHG-5181(162) & STPLHG-5181(163) CC Nos.1204,1246 & 1247 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and incident insurance -necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction, of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned -agrees to complete the work within 50 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER`S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find /O e in the amount of $ oJUX — which said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or "Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: c-z Project Bid Schedule Traffic Signal Modification at Brookhurst Street and Yorktown Avenue CC-1204 R" WIN ft C Nsmm, ..�...yy 3S" mm - "_ Y✓{" 'W^` .: l 1 L.S. Mobilization. Per L.S. 2 1 L.S. Survey Monument Preservation. Per L.S. 3 1 L.S. Furnish Project Traffic Control. Per L.S. 4 1 L.S. Modify Traffic Signal at Brookhurst Street and Yorktown Avenue. _ $ $- 55,300 ✓ Per L.S. 5 1 EA. Construct Curb Ramp per Caltrans Standard Plan A88A (Includes Adjacent Gutter Plate and AC $ 7 a /� $ Paving Replacement), Per EA. 6 1 EA. Construct -Modified Curb Ramp (Located -on the Southwest Corner) per Caltrans Standard Plan //// $ 7� A88A (Includes Adjacent Gutter Plate and AC Paving Replacement). Per EA. 7 2 EA Remove and Reconstruct Median Island Nose Including Curb, Stamped Concrete and A.C. $ 41666) Pavement. Per EA. L/ Total Amount Bid in Figures: $ Total Amount Bid in Words: $ r Note for CC-1204: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015, C-2.2 Project Bid Schedule Traffic Signal Modification at Newland Street and Atlanta Avenue CC-1246 .. lp. m I � I - I I L.S. Mobilization. $ $ Per L.S. 2 1 L.S. Furnish Project Traffic Control, Per L.S. 3 1 L.S. Modify Traffic Signal at Newland Street and Atlanta Avenue. $ 67 , F 3,? $8^0 3 Per L.S. 4 4 EA. Construct Curb Ramp per Caltrans Standard Plan A88A (Includes Adjacent Gutter Plate and AC -111070 Paving Replacement). Per EA. Total Amount Bid in Figures: $ 11,211 Aplo Total Amount Bid in Words: Note for CC-1246: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.3 Section C PROJECT BID SCHEDULE For CC Nos.1204,1246 and 1247 PROJECT BID: Project Bid Summary: „ CC-1204 Brookhurst Street and Yorktown Avenue $ ,1570 !!� _% .-- CC-1246 Newland Street and Atlanta Avenue $10�, C��o CC- t247 Magnolia Street and Atlanta Avenue $ Total Bid Amount in Figures: $ 94 eng Total Bid Amount in Words: C-2.1 Project Bid Schedule Traffic Signal Modification at Magnolia Street and Atlanta Avenue CC-1247 NM ma"p-, E" NON 215. Mobilization. ? Per L.S. 2 1 L.S. Survey Monument Preservation. Per L.S. 3 1 L.S. Furnish Project Traffic Control. $ Per L.S. Ila I L.S. Modify Traffic Signal at Magnolia Street and Atlanta Avenue. $ Per L.S. 5 2 EA. Construct Curb Ramp per Caltrans Standard Plan A88A (Includes Adjacent Gutter Plate and AC $ $ Paving Replacement. Per EA. [Total Amount Bid in Figures: $ '1900 Total Amount Bid in Words: $ Aiw4l�aj:64 Waa0;4 Note for CC-1247: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.4 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. ;Portion Name and Address o Subcontru�tor Stutelcense Class . :ovrk , Number NSf4/ ccvv fu / 5 / .,ErylErslLD h� / G /. i✓f!%r� C'A 6� / /S7y.�e �av �� 8l�Z C 32 p nvvlzdo By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. r IW11 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ss. County of Orange Vincent P. Mauch , being first duly sworn, deposes and says that he or she is CFO Of Steiny and Company, Inc. the party making the foregoing bid that the bid is not made in the interest of, or on the behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price, or that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Vincent P. Mauch, CFO Name of Bidder 0;;�� --- - W'' Signature of Bidder 12907 E. Garvey Avenue, Baldwin Park, CA 91706 Address of Bidder Subscribed and sworn to before me this day of �� , 20 __ NOTARY PUBLIC C-4 NOTARY SEAL )DRAT WITH AFFIANT STATEMENT State of California County of Los Angeles ss. 0 See Attached Document (Notary to cross out lines 1-7 below) See Statement Below (Lines 1-7 to be completed only by document signer(s), not Notary) 1 2 3 4 5 6 7 Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) Subscribed and sworn to (or affirmed) before me this 28 day of September Date Month 2010 , by Kathy M. Edwards (1) Vincent P. Mauch Name of Signer(s) (2) Name of Signer(s) proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. t i nature of Noraty Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Top of thumb here Top of thumb here 50 KATHY M. EDWARDS Commission # 1808321 z @My Notary Public - California:Los Angeles County Comm. Expires Aug 3, 2012 Place Notary Seal Above Further Description of Any Attached Document : Title or Type of Document: CITY OF HUNTINGTON BEACH -NON COLLUSION AFFIDAVIT Document Date: 09/28/10 Number of Pages: Signer(s) Other Than Named Above: NIA uu UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue, (1)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: e> � ' _vl U C-s Steiny and Company, Inc. Contractor By Vincent P. Mauch CFO Title DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury, the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? ® Yes ® No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. 1 am aware of the provisions of Section 3700 of the Labor Code which require 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. Date: � � Zot 0 C-7 Steiny and Company, Inc. Contractor By Vincent P. Mauch CFO Title UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: Contractor :A Title Date: Note: This form is required for every Dig Alert Identflcation Number issued by U.S.A. during the course of the Work. Additional forms may be obtained from the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Steiny and Company,Inc. Bidder Name 12907 E. Garvey Avenue Business Address Baldwin Park, CA 91706 City, State Zip 626 ) 338-338-8343 Telephone Number 161273 A, B, C-7, C-10 State Contractor's License No. and Class 7/1/56 Original Date Issued 5/31/11 Expiration Date The work site was inspected by Mike Heffernan of our office on 9/27 , 2010 The following are persons, firms, and corporations having a principal interest in this proposal: *See Attached Corporate Resolution C-9 4-,- - /- re- e-q STEINY AND COMPANY, INC. Certification by Secretary of Corporate Resolution At the meeting of the Directors of Steiny and Company, Inc., a corporation organized and existing under the laws of the State of California, duly called and held in accordance with the articles of incorporation and bylaws of the corporation at its office on May 03, 2010 at which a quorum of the directors were present the following resolution was adopted to wit: Resolved, that: President and Treasurer Chief Financial Officer Vice President Vice President Secretary Susan Steiny Vincent P. Mauch Willie B. Hadley Walter E. Johansen III Gayle C. Kappelman Are hereby authorized to sign contracts/agreements in the name of and on behalf of Steiny and Company, Inc. I Gayle C. Kappelman, Secretary of Steiny and Company, Inc., do hereby certify that I am the Secretary of Said corporation and that the above is a full, true, and correct copy of a resolution of the Board of Directors of said corporation, duly adopted at the meeting held on May 03, 2010 and that said resolution has not been revoked or rescinded. In witness whereof, I have hereunto subscribed my name and affixed the seal of said corporation. Gayle C. Kappern an, Secretary The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Steiny and Company, Inc. Company Name Signature of Bidder Vincent P. Mauch, CFO Printed or Typed Signature Subscribed and sworn to before me this _ day of / , 200— A NOTARY PUBLIC NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: City of Rancho Cucamonga L 10500 Civic Center Drive, Rancho Cucamonga, CA 91729 Name and Address of Public Agency Jim Harris (909) 477-2740 Name and Telephone No. of Project Manager: $1,084,541.47 Traffic Signals 12/1/08 Contract Amount Type of Work Date Completed County of Los Angeles 2. 900 S. Fremont, 8th Floor, Alhambra, CA 91803 Name and Address of Public Agency Name and Telephone No. of Project Manager: Robert Eisenhamer (626) 458-3155 $913,319.23 Traffic Signals 5/18/09 Contract Amount Type of Work Date Completed County of Los Angeles 3. 900 S. Fremont, 8th Floor, Alhambra, CA 91803 Name and Address of Public Agency Name and Telephone No. of Project Manager: Issa Adawlya (626) 458-5100 $933,524.51 Traffic Signal Contract Amount Type of Work C-10 4/17/09 Date Completed JURAT WITH AFFIANT STATEMENT State of California County of Los Angeles ss. 1 2 3 4 5 6 7 See Attached Document (Notary to cross out lines 1-7 below) See Statement Below (Lines 1-7 to be completed only by document signer(s), not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) Subscribed and sworn to (or affirmed) before me this 28 day of September Date Month 2010 by Kathy M. Edwards KATHY M. EDWARDS Commission # 1808321 Notary Public - California Z (1) Vincent P. Mauch Name of Signer(s) :' Los Angeles County = (2) ----------------- My Comm. Expires Aug 3, 2012 Name of Signer(s) proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Place Notary Seal Above 3-)- � - a Sighature of Noraty Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Further Description of Any Attached Document : Title or Type of Document: CITY OF HUNTINGTON BEACH -BIDDERS INFORMATION Document Date: 09/28/10 Number of Pages: 1 Signer(s) Other Than Named Above: N/A (For federally funded projects, use this following page) BIDDER'S CERTIFICATION* HOUSING AND URBAN DEVELOPMENT ACT OF 1968 AS AMMENDED IN 1992, SECTION 3 TITLE 24, Code of Federal Regulations, Part 135* Economic Opportunities for Low and Very Low -Income Persons The bidder, under penalty of perjury, certifies that except as noted below, any person associated therewith in the capacity of owner, partner, director, officer, or manager (initial the applicable selections): Will ensure that 10% of all new hires as a result of this project shall meet all requiremnents of Section 3 of CFR Part 135 of the HUD Act of 1968; or Will hire no new employees in conjunction with, this project. Will award 10% of its sub -contracts to Section 3 businesses. This certification shall apply to the prime contractor's sub -contracts related to this project. Contractor: Steiny :and Company, Inc. Contact Person: Vincent P. Mauch Contact Phone: 626-338-8343 Signed: Date: *Note: The above certification is required by the Department of Housing and Urban Development (24 CFR 135 and Subtitle A et al) and must be submitted by the bidders and proposed sub -contractors only in connection with contracts and subcontracts which are subject to Section 3 of the 1968 Housing and Urban Development Act, as amended in 1992 (HUD). Previous non-compliance with Section 3 could result in disqualification. C-11 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder Steiny andl Company, Inc. proposed subcontractor ------- , hereby certifies that he haste, has not___, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed -subcontractors only in connection with contractsi and subcontracts, which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Page 12-79 LPP 01-04 C-12 March 15, 2001 PUBLIC CONTRACT CODE Public Contract Code Section 10285.1 Statement In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has _, has not _`___ been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public work contract, as defined in Public Contract Code Section 1101, with a any public entity, as defined in Public Contract Code Section 1100, including Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Public Contract Code Section 10162 Questionnaire in conformance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire: Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or safety regulation? Yes No X If the answer is yes, explain the circumstances in the following space. C-13 Public Contract Code Section 10232 Statement In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final non -appealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor with an order of the National Labor Relations Board. Note: The above Statement and Questionaire are part of the bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. C-14 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment D Noncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY / of Huntington Beach DEPARTMENT OF PUBLIC WORKS. In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that 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, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Page 12-81 LPP 01-04 C-15 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment E DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, and manager: • Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; • Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past 3 years; • Does not have a proposed debarment pending; and i Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Page 12-83 LPP 01-04 C-16 March 15, 2001 Local Assistance Procedures Manual PS&E Checklist Instructions NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS EXHIBIT 12-E Attachment F The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) 1f any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify and disclose accordingly. T Page 12-85 LPP 01-04 C-17 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment G DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Repo/awardee, e: aa. contract 1:1 a. bid/offer/application F] in b. grant b. initial award b. mange c. cooperative agreement c. post -award d. loan For Maange nty: e. loan guarantee yeaqu er f. loan insurance datrt 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. awardee,Enter Name and Address : QPrime Subawardee Tier , if known Congressional District, if known 6. Federal Department/Agency: 8. Federal Action Number, if known: 10. a. Name and Address of Lobby Entity Of individual, last name, first name, MI) Congressional Dist ct, if known 7. Federal Progra Name/Description: CFDA N her, if applicable Q. Awar mount, if known: b Individuals Performing Services (including address if different from No. I0a) (last name, first name, MI) (attach Contin ion Sheet(s) if necessary) 11. Amount of Payment (check all that apply) 13. Type of Payment (check all that apply) $ actual p ned a, retainer b. one-time fee 12. Form of Payment {check all that a ty): c. commission 8 a. �h d. contingent fee b. in -kind; specify: n re a deferred 14. Brief Description of officer(s), employee( value U f. other, specify ees Performed or to be performed and Date(s) of Service, including member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if necessary) 15. Continuation heet(s) attached: Yes No 16. Information r ested through this form is authorized by Title 31 U.S.C. S tion 1352. This disclosure of lobbying reliance Signature: was place y the tier above when his transaction was made or enter into. This disclosure is required pursuant to 31 Print Name: U.S. 1352. This information will be reported to Congress se . nnually and will be available for public inspection. Any p on who fails to file the required disclosure shall be subject Title: o a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Telephone No.: Date: Use Only: standard Form LLL Rev. Authorized for Local Reproduction Standard Form - LLL Page 12-87 LPP 01-04 C-18 March 15, 2001 EXHIBIT 12-E Local Assistance Procedures Manual Attachment G PS&E Checklist Instructions INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient, at the initiation or receipt of covered federal action or a material change to previous filing pursuant to title 31 U.S.C. Section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. I . Identify the type of covered federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered federal action. 2. Identify the status of the covered federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to -subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, State and zip code of the prime federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate federal identifying number available for the federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (1FB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the federal agency). Include prefixes, e.g., "RFP-DE-90-001." 9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter the federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in -kind contribution, specify the nature and value of the in -kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. Page 12-88 March 15, 2001 C-19 LPP 01-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment G 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with federal officials. Identify the federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. SF-ULAnstructions Rev.06-04-90<(ENDMF Page 12-89 LPP 01-04 C-20 March 15, 2001 h t N ab Local Assis, z Procedures Manual EX -TT 12-G Bidder's List of Subcontractors {DBE and Non-DBI BIDDER'S LIST OF SUBCONTRACTORS (DBE and NON -DBE)- PART 1 The bidder shall list all subcontractors (both DBE and non -DBE) in accordance with Section 2-1.054 of the Standard Specifications and per Title 49, Section 26.11 of the Code of Federal Regulations. This listing is required in addition to listing DBE Subcontractors elsewhere in the proposal. Photocopy this form for additional firms. Annual.: 1'3 hone/ Firm Name/ .....� .. ... AA e— gs/ : .. .. ross .. Descri taon of Poron of Wont to rie Performed P .�j � � r _ ReceY fs G State'.ZfP Name Phone / < $ million / , �. .--- — n OEM � �01 s ,tr �'. ,�.�rZ0^�027" �it%/ �!G�J /- <$5million ❑ < $10 million _-/VS�� _ -- ----- - —_ __._ _.---------_— __ __ - =� xr�y�,; ha. l }�tg #} tF� rf . IPE `iti� �s Address n per/ h T72, 97 S• / ",E�`r�!✓ S/ F 7 <$15million ❑ > $15 million City State IP Name C� Phone C,;�2 < sl million r C <$5 million �.,_._.___�_.__._-__.___— rrf�ttib�La�r � � TO < $10 "Ilion _..___ Address F- //, t�_ i/1/ �1� &, El < $15 million > $15 million City State ZIP _ �/ J' %r O is f'L' • ! Name Li o J p Phone C /�Jl -„�'-� ., =111 .4,3�:1,�; ❑ < $1 million //►/D%1 r..� y^ i'� t'.L}Ny�" d ) xREV ®` z�;; i y � <, �� ,°.t �. � i x Y fs r ..� �H � .�, ��. /��' P < $5 million < $10 _ _. .._ �_,gE7�t�F1ri4LY y �f '.'}��`el < Address /✓V Flux �y/�jy� /n Eir $15 million City State ZIP ?2�17 cog Name ❑ < $1 million �y � Phone C LT1 `0q < $5 million _ Ys ��' }' `ri' �'J �/ 7,01/1 $"RDA �i 7 t sa' S - x £ ❑ <$10 million Address /_ W �� F (qQ� ❑ < $15 million ❑ > $15 million �� City Slate ZIP V \OO • //////'''jjJ � f/A�I <=r is 0D Y/ 7 /2 • .- K x .Y. N.�i f\S�f.��i: � V.. .. kr�.�s f ).t4„�Sk (Y\.� ^i� Distribution. 1) Qriginal - Local Agency File Page 12-111 November 14, 2006 LPP 06-06 Local Assistance PrOceL s Manual EXHIBIT 1. Bidder's List of Subcontractors (DBE and Non -DBE) BND®ER fS LIST OF SUBCONTRACTORS (DBE and NON -DBE)- PART 11 The bidder shall list all subcontractors who provided a quote or bid but were not selected to participate as a subcontractor on this project. This is required for compliance with Title 49, Section 26 of the Code of Federal Re ahons. Photocopy this form Phone . for addincinal Annual : firms may{ 1; Firm Name/ ; . .. '. - . , ,. ... .. Address/ .' . _ ..: g Fa Gross I�escriptron of Portion of Wot'k to be Performed Yr Sr`1 ar: '. N . f tfr Recei fs WW , t '...: ..Cl .- state, LJil'.. '. .. r.. ..� Phone ❑ < $1 million -ik �s _ fx4{l` tYv}�u t 1� � -"lx . �V < $5 million ❑-- -- Name r � � � , � e r�((� �•"�' ry �,�Y�r Y` < W rriillton _ _-- $$� �,�a�'�i ��ii yT ++{�� { �� Address ❑ < $15 Fax million ❑ > $15 million d s City State ZIPME . '3K"..Yi....t{9�� it 3NMI [I<$1 million E ti„t Kayy�$. Alt r i t Name Phone < $5 million_ < $10 million _._._..._...._-...-- ------ _._._.. - ._ _ _ _._..-_ _ _ �._ _ k N, e f Y..% 4� 17Sitb -a zl r� : Address Fax ❑ < $15 million > $IS million City State ZIP Name Phone El < $1 million F! i`� he M° z�aSt d1� tL. Nt*T g 9 ��J#b , sS�1 ' �i{ �� I�:t ; r ❑ < $5 million _�-----' <$IOmillion ----._-----------•- ._-- ._--..----- Address Fax < $15 million ❑ > $15 million --�,agt��1 —.._ _ City State, ZIP ��` ;:, m,.. Name Phone ❑ < $1 million stEstj.�w'Ss.:EcFi-: y 3 q < $5 million ❑ < $20 million Address Fax ❑ <$15 million > $15 milliongoflt�� .... ..... ..-__...._...._..�__._.......___._..... ...___'�'._._.....— AY 3 ii �t ti �)F.i G,Ct'�l}1•`a4 y { City State ZIP t Distribution: 1) Original - Local Agency File Page 12-112 LPP 06-06 November 14, 2006 notice by the Sur>rty shall, noi,;appb, to aro, ea -tension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified m the bid documents, and the Owner and Contractor shall obtain the: Surctv's.conseut for au e�ttensQnbeyond sixty: (bad domes:" Tf'tbis Bond is isst>ed in connection with a.stibcontiactor's bid to a Contractor; the terns Contractor in this Bond shall be deemed to be Subcontractor and the tents Owner shall be deemed to be Contractor. When this Bond has been.,fiuYiished to comply with a statutory or other legal requirement in the location of the Project, a 5-prvvistonin this Bond conflicting: with said statutory or legal requirement shall be deemed deleted herefrom'and proN7s1ons coilfQn*ng to such.statutory or other legal requirement shall be deemed incorporated herein. When so. furnished; the intent is that this Bond shaUbe construed as a statutory bond and not as a coiutnon:lasv bond. Signed and sealed this ath day of October, 2010 STEINY AND COMPANY, INC. _ (Princip 6eah {tl•=rtnessi �,F�y � ��ictuli�s - y�6% {Tile) Vincent P. Mauch CFO SAFECO INSURANCE COMPANY OF AMERICA (l'i ess) Rhonda C. Adel h) Jeri Apodaca, ttorney in Fact AIA Document A3101" — 2010. Copyright® 1963, 1970 and 2010 by The American Institute of Arehitecl& All rights reserved. I UAILMU"lA UhK1'1V1UA'1'E UV AUKNOWLEI)GV1Lt XI State of California County of Los Angeles ss. On October 5, 2010 before me, Kathy M. Edwards - Notary Public Daze Name and Title of Officer (e.g. "Jane Doe, Notary Public") personally appeared Vincent P. Mauch Name(s) of Signer(s) - 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%hey executed the same in his hen4he� authorized capacity(ies), and that by his,hen4he4 signature(6) 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. KATHY M. EW ARDS Commission # 1808321 IL Notary Public - California a a Los Angeles County My Comm. Expires Aug 3, 2012 Signature (Seal) OPTIONAL Though the information below is not required bylaw, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document: Title or Type of Document: BID BOND - CITY OF HUNTINGTON BEACH Document Date: 10/4/2010 Number of Pages 1 Signer(s) Other Than Named Above: Jeri Apodaca - Safeco Insurance Co. of America Capacity(ies) Claimed by Signer Signer's Name: Vincent P. Mauch ❑ Individual ❑X Corporate Officer - Title(s): ❑ Partner(s) - ❑ Limited ❑ Attorney -in -Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: ❑ General CFO Signer is Representing: Steiny and Company, Inc. Top of thumb here \\Ssbp02\Users\kedw68\My Documents\excel\BILLINGS\Notary Acknowledgement 09 10/5/2010 State of California County of Orange On OCT 0 4 010 personally appeared before me Rhonda C. Abel, Notary Public , (Here insert name and title of the officer) . Jeri Apodaca 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. RHONDA C. ABEL � WITNESS m hand an fficial seal. 5 .. COMM. # 1868284 y �' �•► NOTARY PUBLIC - CALIFORNIA n ORANGE COUNTY 0 .. . COMM. EXPIRES flCT. i6 2013 j Signature o otary Public i k C (Aiotary Seal) ADDITIONAL, OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ® Attorney -in -Fact ❑ Trustee(s) ❑ Other 2008 Version CAPA v12.10.07 800-873-9865 www.NotaiyClasses.com INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate adwtowledgmeru form must be properly completed and attached to that docamtent 77w only exception Is if a document Is to be recorded outside ojCalifornia. In such Instances, any alternative acbwwledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that Is illegal for a notary in . California (ie. cert}fytng the authorized capacity of the signer). Please check the document carefully for proper notarial wordrngand attach thisform if required • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization • Indicate the coned singular or plural forms by crossing off incorrect forms (i.e. Wshel# j ,- is hxe ) or cirding the comet[ forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment fort. • Signature of the notary public must match the signattae on file with the office of the county clerk. t Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. 4% Indicate title or type of attached document, number of pages and date. 8- Indicate the capacity claimed by the signer. ff the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document ra Lib,Jy POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS: No. 9675 Safeco Insurance Company of America General Insurance Company of America 1001 4th Avenue Suite 1700 Seattle, WA 98154 That SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA, each a Washington corporation, does each hereby appoint **RHONDA C. ABEL; JERI APODACA; LISA K CRAIL; LINDA ENRIGHT; JANE KEPNER; NANETTE MARIELLA-MYERS; MIKE PARIZINO; RACHELLE RHEAULT, JAMES A. SCHALLER; Irvine, California*********************************** its true and lawful attomey(s)-in-fact, with full authority to execute on its behalf fidelity and surety bonds or undertakings and other documents of a similar character issued in the course of its business, and to bind the respective company thereby. IN WITNESS WHEREOF, SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA have each executed and attested these presents this 21 st day of March 1 2009 --- PAX*_ Dexter R Legg Secretary Timothy A. Mikolaiewski Vice President CERTIFICATE Extract from the By -Laws of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA: "Article V, Section 13. - FIDELITY AND SURETY BONDS ... the President, any Vice President, the Secretary, and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations, shall each have authority to appoint individuals as attomeys-in-fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business... On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided, however, that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA adopted July 28, 1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (i) The provisions of Article V, Section 13 of the By -Laws, and (ii) A copy of the power -of -attorney appointment, executed pursuant thereto, and (iii) Certifying that said power-of-attomey appointment is in full force and effect, the signature of the certifying officer may be by facsimile, and the seal of the Company may be a facsimile thereof." 1, Dexter R. Legg , Secretary of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA, do hereby certify that the foregoing extracts of the By -Laws and of a Resolution of the Board of Directors of these corporations, and of a Power of Attorney issued pursuant thereto, are true and correct, and that both the By -Laws, the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the facsimile seal of said corporation this OCT 0 4 2010 day of b=EL 1 Z� . Dexter R. Legg, Secretary S-0974/DS 3109 WEB PDF City of Huntington Beach 2000 Main Street • Huntington Beach, CA 92648 OFFICE OF THE CITY CLERK JOAN L. FLYNN CITY CLERK March 4, 2011 Terno, Inc. 15701 Heron Ave. La Mirada, CA 90638 RE: CC-1204, CC-1246, & CC-1247 —Various Traffic Signal Modifications Enclosed please find your original bid bond for CC-1204, CC-1246 & CC-1247. Sincerely, Joan L. Flynn, CMC City Clerk JF:pe Enclosure Sister Citi(ds/tc , t/feWntt L%6W.g0c.New Zealand i Telephone: 714-536-5227 ) 1. ' '~s' ' i �� City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 For Traffic Signal Modifications at Brookhurst Street and Yorktown Avenue & Newland Street and Atlanta Avenue & Magnolia Street and Atlanta Avenue, CC-1204, 1246 and 1247 September 27, 2010 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES DATED September 24, 2010. The Federal Labor Rates contained in Appendix I of the specifications for the: Traffic Signal Modifications at Brookhurst Street and Yorktown Avenue & Newland Street and Atlanta Avenue & Magnolia Street and Atlanta Avenue, CC-1204,1246 and 1247 shall be replaced with the following attached documents: The Federal Labor Rates dated September 24, 2010 shall be the labor rates in effect for the subject project. 2) Sheet 2 of 4 (Traffic Signal Modification Plan — Brookhurst Street and Yorktown Avenue, CC-1204) The new conduit depicted between the westerly terminus of conduit #2 and the pull box south of the new southwest corner access ramp shall be 3-Inch. Conduit #1 shall be extended to connect to the new pull box south of the new access ramp. All conductors in conduits #1, 2, 3 and 4 shall be new. All conductors to poles 5, 6, 7, 8 and 9 shall be new. This is to acknowledge receipt and review of Addendum Number One, dated September 27, 2010. Company Name By Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F. Janusz at (714) 536-5431 SECTION C PROPOSAL for the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue FEDERAL NOS. STPLHG-5181(139), STPLHG-5181(162) & STPLHG-5181(163) CC Nos. 1204,1246 & 1247 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and incident insurance necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within 50 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 • If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find btd d6) bZMt the amount of $ which said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or "Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: Addenda No. Date Received Bidder's Signature C-2 Section C PROTECT BID SCHEDULE For CC Nos.1204,1246 and 1247 PROJECT BID: Project Bid Summary: 4�0 CC-1204 Brookhurst Street and Yorktown Avenue $ �o CC-1246 Newland Street and Atlanta Avenue $ CC-1247 Magnolia Street and Atlanta Avenue $ "c Total Bid Amount in Figures: $ Total Bid Amount in Words: C-2.1 Project Bid Schedule Traffic Signal Modification at Brookhurst Street and Yorktown Avenue CC-1204 1 1 L.S. tat Uff Mobilization. E Per L.S. 2 1 L.S. Survey Monument Preservation. a� Per L.S. 3 1 L.S. Furnish Project Traffic Control. $ i; env. o�� cU $ % c��l� . Per L.S. 4 1 L.S. Modify Traffic Signal at Brookhurst Street and Yorktown Avenue. $ �S , ` L $ Per L.S. 5 1 EA. Construct Curb Ramp per Caltrans Standard Plan A88A (Includes Adjacent Gutter Plate and AC $ y 170e. , $ Paving Replacement). Per EA. 6 1 EA. Construct Modified Curb Ramp (Located on the Southwest Corner) per Caltrans Standard Plan $ 7, ZCy . 6J�? $'— A88A (Includes Adjacent Gutter Plate and AC Paving Replacement). Per EA. 7 2 EA Remove and Reconstruct Median Island Nose Including Curb, Stamped Concrete and A.C. Pavement. Per EA. $ Z� �� f �� $ Total Amount Bid in Figures: $ (� Total Amount Bid in Words: $ ��/�/� �� /r/L��l�✓ ti/�i/�% %aa°r�/ Note for CC-1204: The City will provide all poles (includes anchor bolts), mast anus, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.2 Project Bid Schedule Traffic Signal Modification at Newland Street and Atlanta Avenue CC-1246 1 I L.S. Mobilization. $ 7 '1 GV $ - n 1 Per L.S. 2 1 L.S. Furnish Project Traffic Control. Per L.S. 3 1 L.S. Modify Traffic Signal at Newland Street and Atlanta Avenue. $ / /, �� $ 77, evK, Per L.S. 4 4 EA. Construct Curb Ramp per Caltrans Standard Plan �� say cY? A88A (Includes Adjacent Gutter Plate and AC $ `Ti Me. sl i / "'pd ` Paving Replacement). Per EA. Total Amount Bid in Figures: $ 0 IITotal Amount Bid in Words: $ ��✓��l✓/��%�� /�/ Note for CC-1246: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.3 Project Bid Schedule Traffic Signal Modification at Magnolia Street and Atlanta Avenue CC-1247 1 1 L.S. Mobilization. $ Z, Socy. 09 $ Z, SUS , Per L.S. 2 1 L.S. Survey Monument Preservation. 4,2 Per L.S. 3 1 L.S. Furnish Project Traffic Control. $ �` �G�G�+-� $ Per L.S. 4 1 L.S. Modify Traffic Signal at Magnolia Street and / a Atlanta Avenue. $ � `S` $ Per L.S. 5 2 EA. Construct Curb Ramp per Caltrans Standard Plan t! 7 �: A88A (Includes Adjacent Gutter Plate and AC $ � 91 $ Paving Replacement. Per EA. I' Total Amount Bid in Figures: $ �73, IITotal Amount Bid in Words: $ �1510 y-1711r '7�1��i�/✓ ®NG� i!�N�/c��/' 7� -f/�� Note for CC-1247: The City will provide all poles (includes anchor bolts), mast arms, luminaries, vehicle heads, pedestrian heads, push buttons, internally illuminated street name signs, emergency vehicle pre-emption sensors, block information signs and fittings at no cost to the contractor. The contractor is to pick up the materials at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 375-5015. C-2.4 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Portion Name and Address of Subcontractor. State License Class of Work 'Number 1 -&01n (:�AADV&AM n.1-i W9 i 05T.Ao A'_ i'9Ai.ar.l�t� By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ss. County of Orange d='y f)7V ► 4►j Cam. , being first duly sworn, deposes and says that he or she is c d _-_P 115 i ( . f of `Tp,t n) , ,l , no . the parry making the foregoing bid that the bid is not made in the interest of, or on the behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price, or that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. SHAWN'R. BRA! DFIELD Commission # 1738049 z "-ew a Notary Public - California i z - Riverside County '- My Comm. Expires May 9, 2011 Name of Bidder Signature of Bidder Address of Bidder 01 Subscribed and sworn to before me this I ?A�)_ day of 6cc—tu , 20 [Q. NOTARY PUBLIC NOTARY SEAL C-4 UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue, Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue, (I)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: �i},. (p , ��10 `16RC) , a [1'L. Contractor Title C-5 DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury, the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? Yes )4 No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require 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. Date: (NA c -00— r n��—uh ' ) Contractor 0 Title C-7 UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: Contractor Vi ugv '1. Title Date: Q pi.. I,Q , )1)1® Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work. Additional forms may be obtained from the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Bidder Name Business Address City, State Zip ('119) �Ag-%31 Telephone Number WM D} C, 10 mil- -A State Contractor's License No. and Class Original Date Issued Date The work site was inspected by �) U An LH-haM of our office on Qc 1 1 , 20J-O The following are persons, firms, and corporations having a principal interest in this proposal: ►�hn,�rc\.-"-Q,-)ori a u co -�)Us Va A (U-1rC,0 C-9 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Vr no , -L nC, . Company Name Signature of Bidder Printed or Typed Signature Subscribed and sworn to before me thisA day of QC+L`�b U , 20' SHAWN R. BRA FIELD Commission # 1738049 a `-ca Notary Public - California Z Z:,.wi: Riverside County My Comm. Expires May 9, 2011 NOTARY PUBLIC-P NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: 2. 3. Su- wiachuL Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Name and Address of Public Agency Type of Work Name and Telephone No. of Project Manager: Contract Amount Name and Address of Public Agency Type of Work Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed Date Completed Date Completed C-10 Project Name: Cal Trans Routes 10/215 ITS Contract Amount: $9,872,606.00 Date Completed: 09/09 Owner's Name: State of California Contact Person: Kee Ooi Telephone Number: (909) 383-4563 Project Name: Traffic Signal/Streeting Light & Fiber Optics Contract Amount: $2,165,000.00 Date Completed: In progress Owner's Name: City of Glendale General Contractor: Sequel Contractors Contact Person: Mike Mahler Telephone Number: (562)802-7227 Project Name: T.S Modifications Contract Amount: $2,815,466.00 Date Completed: 09/07 Owner's Name: City of Long Beach Contact Person: Douglas Mc Laughlin Telephone Number: (562) 570-6895 Project Name: Traffic Signalization Intersection Improvement Contract Amount: $1,299,417.00 Date Completed: 01 /07 Owner's Name: City of Rialto Contact Person: Emilio Ramirez Telephone Number: (909) 820-2525 Project Name: Unit Pricing for Traffic Signal Rehabilitation Contract Amount: $3,100,000.00 Date Completed: 10/09 Owner's Name: City of Irvine Contact Person: Dave Flanagan Telephone Number: (714) 724-7634 Project Name: John James Audubon Bridge Contract Amount: $2,534,493.00 Date Completed: In Progress Owner's Name: Louisiana Department of Transportation And Development Contract Person: Matthew Curtiss Telephone Number: (225) 618-0009 Page 1 of 2 Experience ®f Bidder Project Name: Interstate 5 and Magic Mountain Parkway Contract Amount: $2,774,006.00 Date Completed: 07/2009 Owner's Name: City of Santa Clarita General Contractor: Security Paving Contact Person: Juan Ramirez Telephone Number: (818) 612-0079 Project Name: Hyde Park East ATSAC Contract Amount: $5,770,711.00 Owner's Name: City of Los Angeles Contact Person: Moises Delgado Project Name: Irwindale Ave ET/AL Contract Amount: $ 1,306,219 Owner's Name: County of Los Angeles Contact Person: Abigail Flores Page 2 of 2 Date Completed: 03/10 Telephone Number: (818)-391-3289 Date Completed: 06/08 Telephone Number: (626) 458-3157 (For federally funded projects, use this following page) BIDDER'S CERTIFICATION* HOUSING AND URBAN DEVELOPMENT ACT OF 1968 AS AMMENDED IN 1992, SECTION 3 TITLE 24, Code of Federal Regulations, Part 135* Economic Opportunities for Low and Very Low -Income Persons The bidder, under penalty of perjury, certifies that except as noted below, any person associated therewith in the capacity of owner, partner, director, officer, or manager (initial the applicable selections): Will ensure that 10% of all new hires as a result of this project shall meet all requiremnents of Section 3 of CFR Part 135 of the HUD Act of 1968; or Will hire no new employees in conjunction with J this project. Will award 10% of its sub -contracts to Section 3 businesses. This certification shall apply to the prime contractor's sub -contracts related to this project. Contractor: f Rt) �1►n C . Contact Person: l i hay (L Utz r i U n Contact Phone: 1 [- 2 U31 Signed: Date: Q C- bk) Q,e, p l 0 *Note: The above certification is required by the Department of Housing and Urban Development (24 CFR 135 and Subtitle A et al) and must be submitted by the bidders and proposed sub -contractors only in connection with contracts and subcontracts which are subject to Section 3 of the 1968 Housing and Urban Development Act, as amended in 1992 (HUD). Previous non-compliance with Section 3 could result in disqualification. C-11 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL. EMPLOYMENT OPPORTUNITY CERTIFICATION The bidderproposed subcontractor , hereby certifies that he has"+ , has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by -bidders and proposed subcontractors only in connection with contracts and subcontracts, which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Page 12-79 LPP 01-04 C-12 March 15, 2001 PUBLIC CONTRACT CODE Public Contract Code Section 10285.1 Statement In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has _, has not been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public work contract, as defined in Public Contract Code Section 1101, with a any public entity, as defined in Public Contract Code Section 1100, including Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution_ Public Contract Code Section 10162 Questionnaire In conformance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire: Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or safety regulation? Yes NoN",4 If the answer is yes, explain the circumstances in the following space. C-13 Public Contract Code Section 10232 Statement In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final non -appealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor with an order of the National Labor Relations Board. Note: The above Statement and Questionaire are part of the bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. C-14 Local Assistance Procedures Manual PS&E Checklist Instructions EXHIBIT 12-E Attachment D Noncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY / C®>;NTY-of lA 1)i) n fn \ —bk C_� DEPARTMENT OF PLIC WORKS. In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that 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, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Page 12-81 LPP O1-04 C-15 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment E DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, and manager: 6 Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; • Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past 3 years; • Does not have a proposed debarment pending; and • Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Page 12-83 LPP 01-04 C-16 March 15, 2001 Local. Assistance Procedures Manual PS&E Checklist Instructions EXHIBIT 12-E Attachment F NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all .lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify and disclose accordingly. Page 12-85 LPP O1-04 C-17 March 15, 2001 Local Assistance Procedures Manual PS&E Checklist Instructions EXHIBIT 12-E Attachment G DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352 1. Type of Federal Action: Fla. contract b. grant c. cooperative agreement d. loan e. loan guarantee f.`loan insurance 2. Status of Federal Action: Fla. bid/offer/application b. initial award c. Dost-award NA 4. Name�and Address of Reporting Entity Prime Subawardee Tier , if known Congressional District,,Jknown 6. Federal Department/ 8. Federal Action Number, if known: 10. a. Name and Address of Lobby Entity (If individual, last name, first name, MI) 3. Report Type: Fla. initial b. material change For Material Change Only: year _ quarter date of last report 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Congressional District, if known 7. Federal Program Name/Description: CFDA Number, if applicable 9. Award Amount, if known: b. Individuals Performing Services (including address if different from No. 1 Oa) (last name, first name, MI) (attach Continuation Sheet(s)'ifnecessary) 11. Amount of Payment (check all that apply) 13. Type of Payment (check all that apply) $ actual planned a.\retainer b. one-time fee 12. For of Payment (check all that apply): c. commission Ea. cash d. continge\,feeb. in -kind; specify: nature a deferredvalue f. other, sp 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11: x (attach Continuation Sheet(s) if necessary) \ 15. Continuation Sheet(s) attached: Yes11 No 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 Print Name: U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject Title: to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Telephone No.: Date: Federal Use Only: qt—A.M Vn TT T. Rev 09-1 Authorized for Local Reproduction Standard Form - LLL Page 12-87 LPP 01-04 C-18 March 15, 2001 EXHIBIT 12-E Local Assistance Procedures Manual Attachment G PS&E Checklist Instructions INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient, at the initiation or receipt of covered federal action or a material change to previous filing pursuant to title 31 U.S.C. Section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial fling and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered federal action. 2. Identify the status of the covered federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, State and zip code of the prime federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate federal identifying number available for the federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the federal agency). Include prefixes, e.g., "RFP-DE-90-001." 9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter the federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in -kind contribution, specify the nature and value of the in -kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. Page 12-88 March 15, 2001 C-19 LPP 01-04 Local Assistance Procedures Manual PS&E Checklist Instructions EXHIBIT 12-E Attachment G 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with federal officials. Identify the federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. SF-LLL-Instructions Rev.06-04-90«ENDIF» Page 12-89 LPP O1-04 C-20 March 15, 2001 Local Assistance Procedures Manual EXHIBIT 15-G1 Local Agency Bidder UDBE Commitment (Construction Contracts) EXHIBIT 15-G1 LOCAL AGENCY BIDDER UDBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: ((P,�L��EASTErREtF`ER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCAL AGENCY: CA") arrtar••flunf1 ��—&Q`LOCATION: 11( Dk-{hGYJ4 4 U0f1 L�LNr----- PROJECT DESCRIPTION: I � 04- G i TOTAL CONTRACT AMOUNT: $ il BID DATE: ia Cb. b u � , pO L to BIDDER'S NAME: "FQX , CONTRACT UDBE GOAL: CONTRACT ITEM NO. ITEM OF WORK AND DESCRIPTION OR SERVICES TO BE SUBCONTRACTED OR MATERIALS O BE PROVIDED (or contracted if the bidder is a UDBE) UDBE CERT NO. AND EXPIRATION DATE NAME OF EACH UDBE (Must be certified on the date bids are opened - include UDBE address and phone number) DOLLAR AMOUNT UDBE For Local Agency to Complete: Local Agency Contract Number: Federal -aid Project Number: Federal Share: Contract Award Date: Local Agency certifies that all UDBE certifications have been verified and information is complete and accurate. Print Name Signature Date4 Local Agency Representative (Area Code) Telephone Number: Total Claimed UDBE Participation % Signature of Bidder Date (Are"a Code) Tel. No. , i (JhCIY c�.��oriD Person to Contact (Please Type or Print) Local Agency Bidder UDBE Cormnitment (Construction Contracts) (Rev 6/26/09) Distribution: (1) Original — Local agency files Page 15-31 LPP 09-02 C-21 July 31, 2009 EXHIBIT 15-G1 Local Assistance Procedures Manual Local Agency Bidder UDBE Commitment (Construction Contracts) INSTRUCTIONS - LOCAL AGENCY BIDDER UDBE COMMITMENT (CONSTRUCTION CONTRACTS) ALL BIDDERS: PLEASE NOTE: It is the bidder's responsibility to verify that the UDBE(s) falls into one of the following groups in order to count towards the UDBE contract goal: 1) African Americans; 2) Asian -Pacific Americans; 3) Native Americans; 4) Women. This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must submitted and received as specified in the Special Provisions. Failure to submit the required UDBE commitment will be grounds for finding the bid nonresponsive A UDBE is a firm meeting the definition of a DBE as specified in 49 CFR and is one of the following groups: African Americans, Asian -Pacific Americans, Native Americans, or Women. The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract UDBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by UDBEs. Prime contractors shall indicate all work to be performed '�-,y UDBEs including, if the prime is a UDBE, work performed by its own forces, if a UDBE. The UDBE shall ovide a certification number to the Contractor and expiration date. Enter the UDBE prime's and subcontractors' certification numbers.The form has a column for the Names of UDBE contractors to perform the work (who must be certified on the date bids are opened and include the UDBE address and phone number). IMPORTANT: Identify all UDBE firms participating in the project regardless of tier. Names of the First -Tier UDBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the UDBE participation dollar amount. Enter the Total Claimed UDBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the UDBE, describe exact portion of time to be performed or furnished by the UDBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of UDBE firms. Exhibit 15-G1 must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local agencies should complete the Local Agency Contract Award, Federal -aid Project Number, Federal Share, Contract Award Date fields and verify that all information is complete and accurate before signing and filing. Page 15-32 July 31, 2009 C-22 LPP 09-02 Local Assistance Procedures Manual Exhibit 15-H UDBE Information - Good Faith Effort EXHIBIT 15-H UDBE INFORMATION —GOOD FAITH EFFORTS Federal -aid Project No. UDBE INFORMATION - GOOD FAITH. EFFORTS Bid Opening Date The (City/County of) established an Underutilized Disadvantaged Business Enterprise (UDBE) goal of % for this project. The information provided herein shows that a good faith effort was made. Lowest, second lowest and third lowest bidders shall submit the following information to document adequate good faith efforts. Bidders should submit the following information even if the "Local Agency Bidder UDBE Commitment" form indicates that the bidder has met the UDBE goal. This will protect the bidder's eligibility for award of the contract if the administering agency determines that the bidder failed to meet the goal for .various reasons, e.g., a UDBE firm was not certified at bid opening, or the bidder made a mathematical error. Submittal of only the "Local Agency Bidder UDBE Commitment" form may not provide sufficient documentation to demonstrate that adequate good faith efforts were made. The following items are listed in the Section entitled "Submission of UDBE Commitment" of the Special Provisions: A. The names and dates of each publication in which a request for UDBE participation for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications Dates of Advertisement B. The names and dates of written notices sent to certified UDBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the UDBEs were interested (please attach copies of solicitations, telephone records, fax confirmations,. etc.): Names of UDBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation Page 15-33 LPP 09-02 C-23 July 31, 2009 Exhibit 15-H . Local Assistance Procedures Manual UDBE Information -Good Faith Effort C. The items of work which the bidder made available to UDBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate UDBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate UDBE participation was made available to UDBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items M Of (Y/N) Contract D. The names, addresses and phone numbers of rejected UDBE firms, the reasons for the bidder's rejection of the UDBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each UDBE if the selected firm is not a UDBE: Names, addresses and phone numbers of rejected UDBEs and the reasons for the bidder's rejection of the UDBEs: Names, addresses and phone numbers of firms selected for the work above: E. Efforts made to assist interested UDBEs in obtaining bonding, lines of credit or insurance, and any technical assistance or information related to the plans, specifications and requirements for the work which was provided to UDBEs: Page 15-34 July 31, 2009 C-24 LPP 09-02 Local Assistance Procedures Manual Exhibit 15-H UDBE Information - Good Faith Effort F. Efforts made to assist interested UDBEs in obtaining necessary equipment, supplies, materials or related assistance or services, excluding supplies and equipment the UDBE subcontractor purchases or leases from the prime contractor or its affiliate: G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using UDBE firms (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.): Name of Agency/Organization Method/Date of Contact Results H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): NOTE: USE ADDITIONAL SHEETS OF PAPER IF -NECESSARY. Page 15-34a LPP 09-02 C-25 July 31, 2009 Local Assistance Procedures Manual EXHIBIT 15-G2 Local Agency Bidder DBE Information (Construction Contracts) EXHIBIT 15-G2 LOCAL AGENCY BIDDER DBE INFORMATION (CONTRUCTION CONTRACTS) (Inclusive of all DBEs including the UDBEs listed at bid proposal) NOTE: IS FORM REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS LOCAL AGENCY: Ul a ®I1�fLY*i0Y� -4 UUHU;� Icy Ulu ACATION PROJECT DESCRIPTION: TOTAL CONTRACT AMOUNT: $ .{ � BID DATE: O Lib a J ' 1 4 g).b 10 BIDDER'S NAME: ��IiD�YiCr CONTRACT UDBE GOAL: CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE DOLLAR AMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened - include DBE address �'�O BE PROVIDED (or contracted if the bidder is a DBE and phone number) For Local Agency to Complete: Total Claimed DBE Local Agency Contract Number: Participation Federal -aid Project Number: yy_ t/>g Federal Share: Contract Award Date: Local Agency certifies that all DBE certification have been verified and Information is complete and accurate. Signature of Bidder Print Name Signature Date Local Agency Representative D` VZ) -f Date I (Area ode) Tel. No. (Area Code) Telephone Number: (�A X Y .�bu 1(LYC7 For Caltrans Review: Person to Contact (Please Type or Print) Print Name Signature Date Caltrans District Local Assistance Engineer Local Agency Bidder DBE Information (Construction Contarcts) (Rev 6/26109) Distribution: (1) Copy —Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within 15 days of contract execution. Failure to send a copy to the DLAE within 15 days of contract execution may result in de -obligation of funds for this project. (2) Copy — Include in award package to Caltrans District Local Assistance (3) Original — Local agency files Page 15-32a LPP 09-02 C-26 July 31, 2009 EXHIBIT 15-G2 Local Assistance Procedures Manual Local Agenfy Bidder DBE Information (Construction Contracts) INSTRUCTIONS - LOCAL AGENCY BIDDER DBE INFORMATION (CONSTRUCTION CONTRACTS) SUCCESSFUL BIDDEN: The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract UDBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including work performed by its own forces, if a DBE.The DBE shall provide a certification number to the Contractor and expiration date. Enter DBE prime and subcontractors certification number. The DBE contractors should notify the Contractor in writing with the date of the decertification if their status should change during the course of the contract. The form has a column for the Names of DBE certified contractors to perform the work (must be certified on the date bids are opened and include DBE address and phone number. IMPORTANT: Identify all DBE firms participating in the project --including all UDBEs listed on the UDBE Commitment form (Exhibit 15-G1), regardless of tier. Names of the First -Tier DBE subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars id percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts) to determine how to count the participation of DBE firms. Exhibit 15-G2 must be signed and dated by the successful bidder. Also list a phone number in the space provided and print the name of the person to contact. Local agenciesshould complete the Local Agency Contract Number, Federal -aid Project Number, Federal Share, Contract Award Date fields and verify that all information is complete and accurate before signing and sending a copy of the form to the District Local Assistance Engineer within 15 days of contract execution. Failure to submit a completed and accurate form within the 15-day time period may result in the de -obligation of funds on this project. District DBE Coordinator should verify that all informations is complete and accurate. Once the information has been verified, the District Local Assistance Engineer signs and dates the form. Page 15-32b July 31, 2009 C-27 LPP 09-02 Local Assis, Procedures Manual EX -T 12-G Bidder's List of Subcontractors (DBE ai. on -DBE) BIDDER'S LIST OF SUBCONTRACTORS (DBE and NON -DBE)- PART 1 The bidder shall list all subcontractors (both DBE and non -DBE) in accordance with Section 2-1.054 of the Standard Specifications and per Title 49, Section 26.11 of the Code of Federal Regulations. This listing is required in addition to listing DBE Subcontractors elsewhere in the proposal. Photocopy this form for additional firms. Firm Name/ Phone/ Annual 3 Address/Fax Gross Description of Portion of Work to be. Performed City,State, ZIP Receipts Name Phone ❑<$1 million .. ...... .. n) 'f^uii y • ';` L'I m enlrA•J l0' - u,%" r 1 ❑ < $5 million J2 < $10 million � k Address Fax E3 < $15 million ❑ > $15 million��uc�ti�'s� ........ _.__.._._._.___._—..._..._.._....... _. City State ZIP ..__.._..._....`... .......... ..�__.......... _,.—.__._.___....__. Name Phone ❑ < $1 million El< $5 million ; p l�5t��(9 <$10million Address Fax < $15 million, -_._......_......._...._......_... - _......._.................... .._.._._.....—_.__...... — Agedittm City Ci State ZIP > $15 million __...__._.........-.--...... --........ --..... _............ __.......... _._............................. • . EE Name Phone ❑ < $1 million * ^� Nye ❑ < $5 million � /��{q� cC9gq9SY �l �,,��`l�p ._..SF..__........_ 1..f_R.._!.._..____...._._.._.__._ _._..._ ...__.__......__ .___..._..._—._._ 1 _........... __.... ....... _.... . _ _ _.......... _.._.... ._... —..--- ...................... _............. ......................... _.__._................ __...................... .- a—.,. �.hN4 CiK•'.� 46 P. e, Address � (��®��] Fax < $10 million�� ❑ < $15 million ❑ >$15 million ........................ _................. ..... _....... ___...._........... ............ ..._... _...... __.—.__.... _._.........--.- City State ZIP Name Phone ❑ < $1 million JbIft ® ��(�.��e�i��9 ❑ < $5 million�� ❑ <$10 million Address Fax ❑ < $15 million` City State ZIP > $15 million rv�, WIN -1 �'r -. '� i - WIN ` Fa Distribution: 1) Original - Local Agency File LPP 06-06 Page 12-111 November 14, 2006 EXHIBIT 1. Local Assistance Procet Manual Bidder's List of Subcontractors (DBE and Non -DBE) BIDDER'S LIST OF SUBCONTRACTORS (DBE and NON -DBE)- PART 11 The bidder shall list all subcontractors who provided a quote or bid but were not selected to participate as a subcontractor on this project. This is required for compliance with Title 49- Section 26 of the Code of Federal Regulations. Photocoov this form for additional fmns. Firm Name/ Phone/ Annual ��-° Address/- . Fax Gross Description of Portion of Work to be Performedva- Ci , State, ZIP _ Receipts Name Phone ❑ <$1 million _ �s S ❑ < $5 million,Q 7x�w rA l4,62-1 `M < $10 million } k ry w s u Address Fax T" ❑<$15million ❑ > $15 million ........ ry i WY 'x CityState ZIP TWi� ... ..... _................ _... _... _............. _...... ........................................... _._ ..................... _.......... _.......... _... ............ _...................... _..... ...., Name Phone ❑ < $1 million --......_—_.._.___.__.__...._^.___.._._....-...... __.__...._._...___.._....._._..._..._._..._.._ _......_----.___...._. ti •y ❑ < $5 million' ❑ < $10 million ............... .... _....................... ..............................._.._... __....._.................... _........ _......................................... _....... _.... _... _......... _...-....._...... --................. ._......_......._-_..._.._.--.--__..-_ Address ,� {� Fax ❑ < $15 millions ❑ > $15 million ............._.__..............................._........................._........................._..........................._...._................._-.._..._.__...._. City State ZIP iV Name Phone ❑ < $1 million ❑ < $5 millionQ� ❑ < $10 million .._.......... _...__.................. ._.......... ............. _._.......__ .... _..... _............... _._............................................... _............................ __._..................._.� �a . * } Address Fax ❑ < $15 million ❑ > $15 milliong�? ......._._.....__. ..............................._... _....... _...................... .._.._...... ._..............._................. _...... .... ................... .._._....__ ........................_. Ta r s a City State ZIP ... ....... —_..__.__....—_..___.....__.._...__.._..--__...__..._.___....... ._�_._-..__...... Name Phone ❑ < $1 million ❑< $5 million ❑ < $10 million —_ _.........__......_.._._..._...__._......__................._...._. m1 1%tJIF,��v Address Fax ❑<$15million � r �iY ❑ > $15 million�?�` _.....----...__..._..._.... .._.._............._......__...._......_....._.—..__._..._.__....._._._.................._...---..... _.._............ .._.... _.........._7 ax f City State ZIP _ ._....__...._._...- ........ _............. __................... _. _._._....__..................... _... _....... —__...__..•-_ ...--- ... _..... ..... __..__�_. Distribution: 1) Original - Local Agency File Page 12-112 November 14, 2006 LPP 06-06 THE AMERICAN INSTITUTE OF ARCHITECTS a Bond No. F00644 AIA Document A310 Bid Bond KNOW ALL MEN BY THESE PRESENTS, THAT WE TERNO, Inc. 15701 Heron Avenue, La Mirada, CA 90638 as Principal, hereinafter called the Principal, and Travelers Casualty and Surety Company of America One Tower Square, Hartford, CT 06183 a corporation duly organized under the laws of the State of CT as Surety, hereinafter called the Surety, are held and firmly bound unto City of Huntington Beach 200 Main Street Huntington Beach CA 92648 as Obligee, hereinafter called the Obligee, in the sum of Ten Percent of Amount Bid Dollars ($ 10% }, for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for Traffic Signal Modifications at Brookhurst Street & Yorktown Avenue Newland Avenue & Atlanta Avenue and Magnolia Street & Atlanta Avenue; Federal Nos STPLHG-5181(139) STPLHG-5181(162) &_STPLHG-518 (163); CC Nos. 1204.1246 & 1247 in the Citv of Huntinaton Beach NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and materials furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this 5th day of October 2010 TERNO, Inc. (7 ' pal) (Seal) �( (Witness) fib i J 0. (Title) • mar,; COWc' r*� Travelers Casualty and Surety Company of America )� l��?�•� z7' , surety) / i (Seal) (Title) AIA DOCUMENT A310 • BID BOND • AIA ® FEBRUARY 1970 ED. a THE AMERICAN INSTITUTE OF ARCHITECTS,1735 N.Y. AVE., N.W., WASHINGTON, D.C.20006 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Los Angeles On October 6, 2010 before me, Shawn R. Bradfield, Notary Public Date Here Insert Name and Title of the Officer (e.g., "Jane Doe, Notary Public") personally appeared Richard Tesoriero Name(s) of Signer(s) SHAWN R. BRADFIEID Commission # 1738049 -ee _ Notary Public - California = _ ' Riverside County My Comm• Expires May 9, 2011 who proved to me on the basis of satisfactory evidence to be the personN whose name( is/am subscribed to the within instrument and acknowledged to me that he/she,tthoy executed the same in his/ho;4heir authorized capacity(iN, and that by his/ho4heir signatureXon the instrurent the persons or the entity upon behalf of which the personN 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. Signatur Signature of Notary Public OPTIONAL Though the information below is not required bylaw, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Bid Bond Document Date: October 5, 2010 Number of Pages: Signer(s) Other Than Named Above: Mary R. McKee Travelers Casualty & Surety Capacity(ies) Claimed by Signer(s) Signer's Name: Richard Tesoriero ❑ Individual ❑ Corporate Officer — Title(s): Vice President ❑ Partner — []Limited ❑ General ❑ Attorney -in -Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer's Name: ❑ Individual ❑ Corporate Officer — Title(s): _ ❑ Partner — ❑ Limited ❑ General ❑ Attorney -in -Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Terno, Inc. Signer Is Representing: �_ CORPORATE ACKNOWLEDGMENT Form 152 STATE OF NEW JERSEY COUNTY OF BERGEN On this 5TH day of OCTOBER, 2010, before me personally came MARY R. MCKEE to me known, who, being by me duly sworn, did depose and say that she/he resides SADDLE BROOK, NJ that she/he is the ATTORNEY -IN -FACT of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA the corporation described in and which executed the above instrument that she/he knows the seal of said corporation; that the seal affixed to said instrument is such corporate seal; that it was so affixed by.order of the Board of Directors of said corporation, and that she/he signed her/his name thereto by like order. (SEAL) t 1 Maria L. pad ini, otary Public MARIA L. SPADACCH NOTARY PUBLIC OF NEW JERSEY COMMISSION EXPIRES MARCH 6, 2013 I t , TRAVELERS CASUALTY AND SUR.-tY COMFAKY Of AMERICA tiARTr-OFm,,C0NX---CTICUT 06183 FINANCIAL STATEM-:4T.AS W DECEMBER 31.2WO CAPITAL STOCK S S.AW,000 ASS' LIABILI 'TIES &SUP PLUS. CASH & INVESTED CASH S 91.w.2,T74 UNEAR140 PREMIUMS Bohm 3A?3.3-98,656 LOSSES. WE"EtiT INOOI& DUE AND ACCRUED 51,425,446 LOSSIADJUSTMEW17 EXPENSES 3ne84:= PREWUM BALANCES_ 183.501015 CommissioNs 34 M,068 NEt DEFERRED TAX ASSET 72,2B5,753 TAXES, LICENSE$ AND FEES 0,474,472 REWSURANCE PMSCQVERABLE slTm,= REItT5UFW4CE RECEIVABLE INTERCOMPANY 247.774;291 FUNDS PIEMUNPER RENSURM7 TRMMES . e oyliffk ASS571 S AL AND pokbm INODME TAXES A14D ITEMS NOT ALLOCATED .1 A a-AP480 BYGcitilPMY FOR OT14M 47. POLIC)(1-IOLDERDWIDEN DS PRIW15WK.FOR REINSURANCE CEDED REINSURANCE MET PREMIUMS PAYABLE, (47.131706"): PAYABLE TO SLISSIDIARIESAND AFMATES Gog58=1 C-11-ER ACCRUED 6S�-Iiiit AND;-Vap-tn-zs I =zwl To rAL uABiLn -F-s S, Za4g57-039, CAF [TAL S TO G K PAID IN SURPLUS 433,803j$0 0` IiER SURPLUS 1.3W594.90-, OTAL SURPLUS T 0 POLICYHOLDERS 3" 1X5048,6131 TOTAL ASSETS — =3.1331 7�03J01 TOTAL ULAZILITIES 9 SURPLUS S 4,331.705,701 571 ATE OF MWECTICUT COUNTY OF HARTFORD CITY OF HART F0140 WCtiAEL J. DdC4)Y, BEING DULY SMIRN; SAYS THAT HE IS SECONDV.,CE PRESIDENT. OF TRAVELERS CASUALTY AND SLRETY COMPANYOF AMERIC& AND THAT TO THE BEST OF HIS ;KNOWLEDGE AND BELIEF. THE F0f2EGOING IS A TRU=AqD CORRECT EM EKTOFTHE FWANC3Al CONDITION OFSfIDCOIJPANYASC)FT;iE31stDAY OFDEi,-kiaFr.2W SECOND vtC-pRE T SUB -SCRIBED A14D SMFa� 70 SC(GREM;-: ROTARY PUBLIC-- MYCOMeSSRkEXPIRES I lQVM12 ,M0AYOFAPAV-2DI0 WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER eftI s POWER OF ATTORNEY TRAVEE EW S " Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 219813 Certificate No. 003430283 KNOW ALL MEN BY THESE PRESENTS: That St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company, and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut; that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Sandra K. Wolf, Alice McLaughlin, Mary R. McKee, and Sherryanne M. DePirro of the City of Woodcliff Inke , State of New 3gr5:ay , their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to'be signed and their corporate seals to be hereto affixed, this day of April 2008 `. 16th Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company, _ r Travelers Casualty and Surety Company Fidelity and Guaranty Insin ance'Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company GASU,��1 Jy FtRE 4q'c �pN MSG •�t �ruq •v P TY 4Np cl tiv �C LORFVR�>!i Q4' n'E' 4 G9 a Q n �t f;m �y, rGpRPOR f:• m� 8T � � ! ? . S :n•�;oi W CONK. WIBf. $ J+ F :SEA > 1896 o..........= I v.•..� a r e �unn..N State of Connecticut City of Hartford ss. By: Georg Thompson, enior ice President On this the 16th day of April , 1008 , before me personally appeared George W. Thompson, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G,TEY ,� In Witness Whereof, I hereunto set my hand and official seal. TAIi My Commission expires the 30th day of June, 2011. �j0l/6UG$ Marie C. Tetreault, Notary Public 58440-4-09 Printed in U.S.A.