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HomeMy WebLinkAboutCHI Construction, Inc. - 2015-01-20�"`°�''a,��.;��',�'aa�}r��xan.,,�f;t;d .emu;. �^�r,�t� �'s�..... � � ,�. - . � r " C ;a r-r �.•;n ,ter t r , � � , a�� . ,. `+.�."� ' M. ^ � ''fie^ z+� . �`�; "i�, 3_ Y , r RECEIVED BY f f' ' 4• , - �- (Name) � --------------- (Date) CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office after signing/datirig CITY OF HUNTINGTON BEACH � INTERDEPARTMENTAL COMMUNICATION TO City Treasurer FROM City Cle k DATE /.w;- SUBJECT Bond Acceptance I have received the bonds for CAPITAL PROJECTS (Includes CC's and MSG's) Performance Bond No. Payment Bond (Labor and Materials) Bond No. Warranty or Maintenance Bond No. TRACT AND DEVELOPMENT Faithful Performance Bond No. Labor and Material Bond No. Guarantee and Warranty Bond No. Monument Bond No. Franchise Bond No. Letter of Credit Bond No. Other , Re: Tract No CC No .f�g5o MSC No Other No g /forms/bond transmittal to treasurer Approved (Council Approval Date) Agenda Item No I City Clerk Vault No 6LIU, SIRE System ID No F OB DATE: TO: CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION 7/20/2015 THOSE LISTED HEREON 7 FROM: David Verone, PW Contract Administrator 0�" i SUBJECT. Retention Release Payment - PO #20538 OJ Supplier #96112 Co #201 Lake Street Bicycle Treatments and Downtown Bicycle Parking, Project # CC 1468 Contractor's Name CHI Construction Address 701 E Ball Road, Suite 101 City, State and Zip Code Anaheim, CA 92805 Phone Number 714 758-1767 City Business License Number A292494 Notice of Completion (Date by City Clerk) 5/13/2015 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 -7/Z 7`iS Date I certify that there are no outstanding invoices on file Date Travis K Joyce Director of Public Works Deputy City Treasurer I certify that no stop notices are on file, and that a guaranty bond has been filed with the City Clerk's Office V Z A FIR, � i Ps - c Joan 14 ity Clerk Attachments 11 U — 1 Certificate of Compliance with PrevadwWage Laws ii"�� 2 Contractor's Certificate 3 Certificate of Compliance with Title VI of the Civil Rights Act and Equal Employment Opportunity Act of 1972 4 Consent for Release letter from the Surety Company 5 Maintenance Bond 6 Notice of Completion Certification of Compliance with Prevailing Wage Laves To City of Huntington Beach Department of Public Works 2000 Main Street/P O Box 190 Huntington Beach, CA 92648 Re Certification of Compliance with Prevailing Wage Laws Contract CC No 1468 Project Lake Street bicycle treatment and Downtown bicvcle t)arkina Downtown Main Street The undersigned contractor on the above -referenced project ("Project") hereby certifies that all laborers, mechanics, apprentices, trainees, watchmen and guards employed by him or by any subcontractor performing work under the contract for the Protect have been paid pursuant to the minimum wage and bona fide fringe benefit requirements 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 United States Department of Labor. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct Executed this 23rd day of July M. 2015 , at Anaheim _, California Creative Home/ DBA CHI Construction (Contractor Name) APPROVED,A O FO Mte aael E Gates City Attorney 1 CONTRACTOR'S CERTIFICATE I Mitch Darwish state and certify that. ()Name of Declaranr) I Creative Home/ DBA CHI Construction is the general contractor to the City of Huntington Beach ("City") on Contract No CC No 1468 (the "Contract") for the construction of the public work of improvement entitled. Lake Street bicycle treatment and Downtown bicycle parking Downtown _ Main Street (the -Project") 2 All work to be performed pursuant to the Contract has been completed in accordance with the Contract Documents (as such term is defined in the Contract) 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 "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 that are the subject of a Notice to Withhold filed pursuant to the Civil Code of the State of California (list all disputed claims; if none, write "NONE") 1 declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct Executed at Anaheim on this 23rd APPROVED AS3 jbRRM MichaelT. Gates Citv�kttorney day of July (Signature of Declarant) ,2015 Certification of Compliance with Title VII of the Civil Rights Act and Equal Employment Opportunity Act of 1972 To City of Huntington Beach Department of Public Works 2000 Main Street/P.O Box 190 Huntington Beach, CA 92648 Re Contract- Project - Certification of Compliance with Title V11 of the Civil Rights Act and Equal Employment Opportunity Act of 1972 CC No 1468 Lake Street bicycle treatment and Downtown bicvcle parkina Downtown Main St The undersigned contractor on the above -referenced project (``Project") hereby certifies that it has complied with title VI1 of the Civil Rights Act, the Equal Opportunity Act of 1972 and Executive Order 11246, and has not discriminated against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age or disability. The undersigned contractor also certifies that it has not maintained any segregated facilities at its establishments on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age or disability (with the exception of access for the disabled) I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct Executed this 23rd day of July 2015 , at Anaheim , California Creative Home/ DBA CHI Construction (Contractor Name) APPROVED T By Micjdel E Gates City Attomey 1 Executed Four Counterparts MAINTENANCE BOND KNOW ALL PERSONS BY THESE PRESENTS Bond Number 756634P-1 Premium Included in charge for Performance Bond Bond effective 5/1912015 through 5/18/2016 That Creative Home dba CHI Construction (contractor's name) 701 East Ball Road #101 Anaheim, CA 92805 (contractors street address, city and state and zip code) as Principal (hereinafter called Contractor), and Developers Surety and Indemnity Company (surety's name) owan, bte 100, 1 rvine, CA 92614 (surety's street address, city and state and zip code) a corporation organized and existing under the laws of the State of Iowa with its principal office in the City of Irvine as Surety (hereinafter called Surety), are held firmly bound unto CITY OF HUNTINGTON BEACH as Obligee (hereinafter called Owner), in the amount of Dollars (s 20,808 00 ), equivalent to the entire contract amount including all orders, for the payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents, * Twenty Thousand Eight Hundred Eight and No/100 WHEREAS, Surety is a duly admitted surety insurer under the laws of the State of California, and Surety is certified and listed in the U S Department of the Treasury Circular 570, and able to provide proof of bonding limitation shown in said circular is sufficient to provide bonds in the amount required by said Contract, and Surety has provided financial strength ratings from reputable companies, such as from A M Best, Moody's, Standard & Poor's, to validate that Surety has positive ratings of being secure or stable, and Surety is registered and listed with the California Department of Insurance, and Contractor has by written agreement dated 20_, entered into a contract with Owner for the Lake Street Bicycle Treatments with drawings and specifications prepared by reference made a part hereof (hereinafter referred to as the Contract), and in accordance which contract is by The Contract provides that the principal will guarantee, for a period of one year, the work performed as part of the Contract from and against all defects in materials and workmanship, and The Contract also provides that the Contractor shall secure Contractors obligations during the one-year period with a bond executed by a surety duly admitted in the state of California, and The Contract has been completed, and the Owner, Contractor and Surety agree that the commencement date for this Guarantee and Bond shall be May 19 12015 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 by Owner, repair and/or replace any and all defects arising in the Work, whether resulting from defective materials or defective workmanship, then this obligation shall be null and void, otherwise it will remain in full force and effect The Surety hereby waives notice of any alteration or extension of time made by the Owner Whenever Contractor shall be, and declared by Owner to be in default under the Contract, the Surety shall, within thirty (30) days following Owners written notice of default, either (a) remedy the default, 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 losses 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 timely manner 15-4584/118138 Whenever the Principal shall be, and 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 breach 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 as work progresses sufficient funds to pay the cost of completion less the unpaid balance of the Contract including other costs and damages for which the surety may be liable hereunder, provided, however, that the procedure by which the Surety undertakes to discharge its obligations under this Bond shall be subject to the advance written approval of the Owner Within thirty (30) days after Surety's receipt of a written notice from Owner of the failure of performance of the Contract by the Principal, it shall be the duty of the Surety to give to the Owner a notice, in writing, of the Surety's election to (a) remedy the default(s) of the Principal promptly, or (b) arrange for performance of the Contract promptly by a contractor other than the Principal, time being of essence to this Bond In said Notice of Election, the Surety shall state the date of commencement of its cure or remedy of the Principal's default(s) or its performance of the Contract The Surety's obligations for cure or remedy, include but are not limited to correction of defective work and completion of the Contract, additional legal, design professional and delay costs arising from Surety's actions or failure to act, and liquidated damages (or if no liquidated damages are specified in the Contract, actual damages caused by delayed performance or non-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 default(s) of its performance of the Contract If the Surety does issue its Notice of Election and does not proceed to cure or remedy the Principal's default(s) of its performance of the Work within thirty (30) days after receipt of 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 19th day of May 120 15 Principal Raised Corporate Seal [MUST BE AFFIXED] NOTES Acknowledgments must be completed and returned as part of the bond Raised Corporate Seals are mandatory Please attach Power of Attorney 15A584/118138 Creative Home dba CHI Construction (Contractor Name) By (Seal) (Title) Developers Surety and Indemnity Company (Surety Name) B eaI) Cynt / a J Youn , At rney -Fact APPROVED AS TO FORM By Michael E Gates, City Attorney y% 0v CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT A notary public or other officer completing this certificate verifies only the Identity of the Individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document State of California ss County of San Bernardino ) On May 19, 2015 before me,Laune B personally appeared Cynthia J Young LAURIE B DRUCK Commission # 1982312 Z QNotary Public - California Z Z Y Z San Bernardino County v My Comm Expires Jul 14 2016 Name and Title of Officer (e g , "Jane Doe, Notary Public") Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her authorized capacity, and that by her signature on the Instrument the person, or the entity upon behalf of which the person 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 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 Document Date Signer(s) Other Than Named Above Capacity(ies) Claimed by Signer(s) Signer's Name O Individual O Corporate Officer Title O Partner -- O Limited O General O Attorney -in -Fact O Trustee O Guardian or Conservator Other Signer is Representing Number of Pages POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box 19725, IRVINE, CA 92623 (949) 263-3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each hereby make, constitute and appoint ***Cynthia J Young, Jay P Freeman, Laurie B Druck, Pamela McCarthy, jointly or severally' as their true and lawful Attomey(s)-in-Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of suretyship giving and granting unto said Attomey(s)-in-Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attorney(s)-in-Fact, pursuant to these presents, are hereby ratified and confirmed This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2008 RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice -President, Senior Vice -President or any Vice President of the corporations be, and that each of them hereby is, authorized to execute this Power of Attorney, qualifying the attorney(s) named in the Power of Attorney to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship, and that the Secretary or any Assistant Secretary of either of the corporations be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney, RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective officers and attested by their respective Secretary orAssistant Secretary this January 29, 2015 \ / `S IG'. v— tftaftifi .tJD aj 4I `7 ., ,PANY AND ,. By O 4�,,,.N,,... �p Daniel Young, Senior Vice -President „r'tto��; OCT z` ? OCT 5 n w 10 ci By Z a0. 1936 if w 1967 OY Mark Lansdon, Vice -President " ;' ., P i`'�� "y� �9LJFO0 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document State of California County of Orange On January 29, 2015 before me, Lucille Raymond Notary Public Date Here Insert Name and Title of the Officer personally appeared Daniel Young and Mark Lansdon Name(s) of Signer(s) 5 LUCI�RAYrMONDCommi Notary Public - Caldornla a Z Orange County My Comm Ex Tres Oct 13, 2018 Place Notary Seal Above who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islare subscribed to the within instrument and acknowledged to me that helshelthey executed the same in hislherltheir authorized capacity(ies), and that by hislherltheir 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 CERTIFICATE Notary Public The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETY AND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth in the Power of Attorney are in force as of the date of this Certificate - This Certificate is executed in the City of Irvine, California, this `14 By ` Cassie Olmsford, Assistant Se tary day of /%l'� � (j5 ID-1380(Rev01115) Executed Four Counterparts CONSENT OF SURETY COMPANY TO FINAL PAYMENT AIA DOCUMENT G707 OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY OTHER ❑ PROJECT Lake Street Bicycle Treatments (name, address) TO (Owner) City of Huntington Beach 2000 Main Street Huntington Beach, CA 92648 ARCHITECT'S PROJECT NO CONTRACT DATE L I CONTRACTOR Creative Home dba CHI Construction In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) Developers Surety and Indemnity Company 17771 Cowan, Suite 100 Irvine, CA 92614 ,Surety on bond Of (here insert name and address of Contractor) Creative Home dba CHI Construction 701 E Ball Road #101 Anaheim, CA 92805 ,CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company Of any Of Its obligations t0 (here insert name and address of Owner) City of Huntington Beach 2000 Main St Huntington Beach, CA 92648 ,OWNER, as set forth in the said Surety Company's bond number 756634P IN WITNESS WHEREOF, the Surety Company has hereunto set Its hand this day of May 19, 2015 Developers Surety and Indemnity Company Ssty Company SigiAture of Authoriz96 R p esentativ Attest Cynthia J Young, Attorney -in -Fact (Seal) Title Attorney -in -Fact NOTE This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAII0S Cu,rent Ed.tion AIA DOCUMENT G707 • CONSENT OF SURETY COMPANY TO FINAL PAYMENT • APRIL 1970 EDITION • AIA® ONE PAGE 0 1970 • THE 1MERICAN INSTITUTE OF ARCHITECTS 1735 NEW YORKAVE, NW, WASHINGTON, D C 20006 POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box 19725, IRVINE, CA 92623 (949) 263-3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each hereby make, constitute and appoint ***Cynthia J Young, Jay P Freeman, Laune B Druck, Pamela McCarthy, jointly or severally' as their true and lawful Attomey(s)-in-Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of suretyship giving and granting unto said Attomey(s)-in-Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attomey(s)-in-Fact, pursuant to these presents, are hereby ratified and confirmed This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2008 RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice -President, Senior Vice -President or any Vice President of the corporations be, and that each of them hereby is, authorized to execute this Power of Attorney, qualifying the attorney(s) named in the Power of Attorney to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship, and that the Secretary or any Assistant Secretary of either of the corporations be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney, RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective officers and attested by their respective Secretary or Assistant Secretary this January 29, 2015 iiiittisiif[YRYR(IRt By �yG a` gy AND,F,y�''*�� O � Daniel Young, Senior Vice -President o=� ogPORq 1.0 QVipo ,qT p ,x :tGT c s 1 _W t0 cs By p,'. 1936 Mark Lansdon, Vice -President =; x; . r p A ".«•ss'y�� A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document State of California County of Orange On January 29, 2015 before me, Lucille Raymond, Notary Public Date Here Insert Name and Title of the Officer personally appeared LUCILLE fiAYAlIOND Commission # 208/945 zNotary Public - California z Orange County a My Comm Ex Tres Oct 13, 2018 Place Notary Seal Above Daniel Young and Mark Lansdon 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/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 CERTIFICATE Notary Public The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETY AND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth in the Power of Attorney are in force as of the date of this Certificate This Certificate is executed in the City of Irvine, California, this 'I - By �i.i,' (� At�* �� Cassie 16,msford, Assistant Se tary day of /91' t ID-1380(Rev 01/15) RECEIVED BY: (Name) (Date) TO FROM DATE. SUBJECT CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office after signingidating CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION City Treasurer City Cie k lovy T Bond Acceptance I have received the bonds for CAPITAL PROJECTS (Includes CC's and MSC's) Performance Bond No. Payment Bond (Labor and Materials) Bond No. Warranty or Maintenance Bond No. TRACT AND DEVELOPMENT Faithful Performance Bond No. Labor and Material Bond No. Guarantee and Warranty Bond No. Monument Bond No. Franchise Bond No. Letter of Credit Bond No. Other Re: Tract No / CC No. a MSC No Other No g /forms/bond transmittal to treasurer Approved / —, Y) —/T (Councrl Approval Date) Agenda Item No City Clerk Vault No j SIRE System ID No. A6 This Document was electronically recorded by City of Huntington Beach PLEASE COMPLETE THIS INFORMATION RECORDING REQUESTED BY: WHEN RECORDED MAIL TO: CITY OF HUNTINGTON BEACH PUBLIC WORKS DEPARTMENT Attn.: David Verone tl ) P.O. Box 190 — 2000 Main Street Huntington Beach, CA 92648 Recorded in Official Records, Orange County Hugh Nguyen, Clerk -Recorder 1111111111111111111111111111111111111111111111111 IIIIIIN0 FEE 2015000249918 03:06pm 05/13/15 217 Sec4 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 CHI Construction, who was the company thereon for doing the following work to -wit: Lake Street Bicycle Treatments and Downtown Bicycle Parking, Project # CC 1468 That said work was completed 05/10/2015 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 05/10/2015, per City Council Resolution No. 2003-70 adopted October 6, 2003. That upon said contract Developers Surety and Indemnity Company, was surety for the bond given by the said company as required 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. S �3 is D i r4ptof of , u i ork or City Engineer Datb City of Hunting on 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 Recorder of Orange C nty. This document is solely the official business of the City of er of P b i orks or City Engineer Oate Huntington Beach, as contemplated under Government City of Huntingt n Beach, California code section. 6103 and should be recorded free of charge. THIS PAGE IS ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION (Additional recording fee applies) FEDERALLY FUNDED CONSTRUCTION CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND CHI CONSTRUCTION, INC. FOR LAKE STREET BICYCLE TREATMENTS & DOWNTOWN BICYCLE PARKING TABLE OF CONTENTS Page No. I. STATE OF WORK; ACCEPTANCE OF RISK 1 2. ACCEPTANCE OF CONDITIONS OF WORK; PLANS AND SPECIFICATIONS 2 3. COMPENSATION 4 4. COMMENCEMENT OF PROJECT 4 5. TIME OF THE ESSENCE 4 6. CHANGES 5 7. NOTICE TO PROCEED 5 8. BONDS 6 9. WARRANTIES 6 10. INDEPENDENT CONTRACTOR 6 11. LIQUIDATED DAMAGES/DELAYS 7 12. DIFFERING SITE CONDITIONS 8 13. VARIATIONS IN ESTIMATED QUANTITIES 9 14. PROGRESS PAYMENTS 10 15. WITHHELD CONTRACT FUNDS, SUBSTITUTION OF SECURITIES 11 16. AFFIDAVITS OF SATISFACTION OF CLAIMS 11 17. WAIVER OF CLAIMS 11 18. INDEMNIFICATION, DEFENSE, HOLD HARMLESS 11 19. WORKERS' COMPENSATION INSURANCE AND EMPLOYER'S LIABILITY INSURANCE 12 20. INSURANCE 12 21. CERTIFICATES OF INSURANCE; ADDITIONAL INSURED ENDORSEMENTS 13 22. NOTICE OF THIRD PARTY CLAIM 14 23. DEFAULT & TERMINATION 14 24. TERMINATION FOR CONVENIENCE 15 25. DISPOSITION OF PLANS, ESTIMATES AND OTHER DOCUMENTS 15 26. NON -ASSIGNABILITY 16 27. CITY EMPLOYEES AND OFFICIALS 16 28. STOP NOTICES; RECOVERY OF ADMINISTRATIVE COSTS 16 29. NOTICES 16 30. SECTION HEADINGS 17 31. IMMIGRATION 17 32. LEGAL SERVICES SUBCONTRACTING PROHIBITED 17 i FEDERALLY FUNDED CONSTRUCTION CONTRACT TABLE OF CONTENTS continued Page No. 33. ATTORNEY'S FEES 18 34. INTERPRETATION OF THIS AGREEMENT 18 35. GOVERNING LAW 18 36. DUPLICATE ORIGINAL 19 37. CONSENT 19 38. CALIFORNIA FAIR EMPLOYMENT AND HOUSING ACT 19 39. CALIFORNIA PREVAILING WAGE LAW 19 40. CALIFORNIA EIGHT -HOUR LAW 20 41. PAYMENT OF TRAVEL AND SUBSISTENCE ALLOWANCE 21 42. EMPLOYMENT OF APPRENTICES 21 43. PAYROLL RECORDS 21 44. FEDERAL PARTICIPATION 21 45. ADDITIONAL FEDERAL REQUIREMENTS 22 46. DAVIS-BACON ACT 22 47. DISCRIMINATION, MINORITIES, ALIENS 23 48. EQUAL EMPLOYMENT OPPORTUNITY 23 49. COPELAND "ANTI -KICKBACK" ACT 24 50. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT 24 51. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT 25 52. ENERGY CONSERVATION 26 53. HOUSING AND URBAN DEVELOPMENT 26 54. SIGNATORIES 26 55. ENTIRETY 26 11 FEDERALLY FUNDED CONSTRUCTION CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND CHI CONSTRUCTION, INC. FOR LAKE STREET BICYCLE TREATMENTS & DOWNTOWN BICYCLE PARKING THIS AGREEMENT ("Agreement") made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY," and CHI Construction, Inc., a [type of entity and State] California Corporation, hereinafter referred to as "CONTRACTOR." WHEREAS, CITY has solicited bids for a public works project, hereinafter referred to as "PROJECT," more fully described as Lake Street Bicycle Treatments & Downtown Bicycle Parking in the City of Huntington Beach in the City of Huntington Beach; and CONTRACTOR has been selected to perform said services, NOW, THEREFORE, in consideration of the promises and agreements hereinafter made and exchanged, the parties covenant and agree as follows: 1. STATEMENT OF WORK: ACCEPTANCE OF RISK CONTRACTOR shall complete and construct the PROJECT pursuant to this Agreement and the Contract Documents (as hereinafter defined) and furnish, at its own cost and expense, all labor, plans, tools, equipment, supplies, transportation, utilities and all other items, services and facilities necessary to complete and construct the PROJECT in a good and workmanlike manner. CONTRACTOR agrees to fully assume the risk of all loss or damage arising out of the nature of the PROJECT, during its progress or prior to acceptance by CITY, from the action of the elements, from any unforeseen difficulties which may arise or be encountered in the prosecution g/agree/ surfnet/federa[ const Page 1 of 27 12/11 of work, and for all other risks of any description in connection with the work, including, but not limited to, all expenses incurred by or in consequence of the suspension or discontinuance of work, except such as are herein expressly stipulated to be borne by CITY, and for well and faithfully completing the work within the stipulated time and in the manner shown and described in this Agreement, and in accordance with the requirements of CITY for the compensation set forth in the accepted bid proposal. 2. ACCEPTANCE OF CONDITIONS OF WORK; PLANS AND SPECIFICATIONS CONTRACTOR acknowledges that it is fully familiar with all the terms, conditions and obligations of this Agreement and the Contract Documents (as defined below in this Section), the location of the job site, and the conditions under which the work is to be performed, and that it enters into this Agreement based upon its thorough investigation of all such matters and is relying in no way upon any opinions or representations of CITY. It is agreed that the Contract Documents are incorporated into this Agreement by this reference, with the same force and effect as if the same were set forth at length herein, and that CONTRACTOR and its subcontractors, if any, shall be bound by the Contract Documents insofar as they relate in part or in any way, directly or indirectly, to the work covered by this Agreement. "Contract Documents" as defined herein mean and include: A. This Agreement; B. Bonds covering the work herein agreed upon; C. The CITY's standard Plans and Specifications and special contractual provisions, including those on file in the office of the Director of Public Works of CITY and adopted by the City Council, and any revisions, amendments or addenda thereto; g/agree/ surfnet/federal const Page 2 of 27 12/11 D. The current edition of Standard Specifications for Public Works Construction, published by Builders' News, Inc., 10801 National Boulevard, Los Angeles, CA 90064, and all amendments thereto, written and promulgated by the Southern California chapter of the American Public Works Association and the Southern California District Associated General Contractors of the California Joint Cooperative Committee; E. Bid documents including the Notice Inviting Bids, the Special Instructions to Bidders, the CONTRACTOR's proposal, (which is attached hereto as Exhibit "A" and incorporated herein by this reference), and the Federal Requirements from FHWA 1273 and additional requirements (which is attached hereto as Exhibit "B"); F. The particular Plans, Specifications, Special Provisions and Addenda applicable to the PROJECT. Anything mentioned in the Specifications and not indicated in the Plans or indicated in the Plans and not mentioned in the Specifications, shall be of like effect as if indicated and mentioned in both. In case of a discrepancy between any Plans, Specifications, Special provisions, or Addenda, the matter shall be immediately submitted by CONTRACTOR to the Department of Public Works of CITY (hereinafter referred to as "DPW"), and CONTRACTOR shall not attempt to resolve or adjust the discrepancy without the decision of DPW, save only at its own risk and expense. g/agree/ surfnet/federal const Page 3 of 27 12/11 Should there be any conflict between the terms of this Agreement and the bid or proposal of CONTRACTOR, then this Agreement shall control and nothing herein shall be considered as an acceptance of the terms of the bid or proposal which is in conflict herewith. 3. COMPENSATION CITY agrees to pay and CONTRACTOR agrees to accept as full compensation for the faithful performance of this Agreement, subject to any additions or deductions made under the provisions of this Agreement or the Contract Documents, a sum not to exceed Twenty Thousand Eight Hundred Eighty Dollars ($20,808.00), as set forth in the Contract Documents, to be paid as provided in this Agreement. 4. COMMENCEMENT OF PROJECT CONTRACTOR agrees to commence the PROJECT within ten (10) working days after the Notice To Proceed is issued and diligently prosecute the PROJECT to completion within Ten (10) consecutive working days from the day the Notice to Proceed is issued by DPW, excluding delays provided for in this Agreement. 5. TIME OF THE ESSENCE The parties hereto recognize and agree that time is of the essence in the performance of this Agreement and each and every provision of the Contract Documents. CONTRACTOR shall prepare and obtain approval as required by the Contract Documents for all shop drawings, details and samples, and do all other things necessary and incidental to the prosecution of its work in conformance with the progress schedule set forth in the Contract Documents. CONTRACTOR shall coordinate its work with the work of all other contractors, subcontractors, and CITY forces working on the PROJECT in a manner that will facilitate the efficient completion of the PROJECT and in accordance with the terms and provisions ;/agree/ surfnet/federal const Page 4 of 27 12/11 of this Agreement. CITY shall have complete control of the premises on which the work is to be performed and shall have the right to decide the time and order in which the various portions of the work shall be performed and the priority of the work of other contractors, subcontractors and CITY forces and, in general, all matters concerning the timely and orderly conduct of the work of CONTRACTOR on the premises. 6. CHANGES CONTRACTOR shall adhere strictly to the plans and specifications set forth in the Contract Documents unless a change therefrom is authorized in writing by DPW. CONTRACTOR agrees to make any and all changes, furnish materials and perform all work necessary within the scope of the PROJECT as DPW may require in writing. Under no condition shall CONTRACTOR make any changes without the prior written order or acceptance of DPW, and CITY shall not pay any extra charges made by CONTRACTOR that have not been agreed upon in writing by DPW. When directed to change the work, CONTRACTOR shall submit immediately to DPW a written cost proposal reflecting the effect of the change. Should DPW not agree to such cost proposal, the work shall be performed according to the changes ordered in writing by DPW and the proper cost thereof shall be negotiated by the parties upon cost and pricing data submitted by CONTRACTOR; thereupon, CITY will promptly issue an adjusted change order to CONTRACTOR and the Agreement price will be adjusted upward or downward accordingly. 7. NOTICE TO PROCEED No work, services, material, or equipment shall be performed or furnished under this Agreement unless and until a Notice to Proceed has been given to CONTRACTOR by CITY. CITY does not warrant that the work will be available on the date the Notice to Proceed is issued. In the event of a delay in commencement of the work due to unavailability of the job site, for any g/agree/ surfiiet/federal const Page 5 of 27 12/11 reason, relief to CONTRACTOR shall be limited to a time extension equal to the delay due to such unavailability. 8. BONDS Only bonds issued by California admitted sureties will be accepted. CONTRACTOR shall, prior to its performance of this Agreement, furnish the following two (2) bonds approved by the City Attorney: One in the amount of one hundred percent (100%) of the Agreement price to guarantee the CONTRACTOR's faithful performance of the work, and one in the amount of one hundred percent of the Agreement price to guarantee payment of all claims for labor and materials furnished. In addition, CONTRACTOR shall submit to CITY a bond in the amount of one hundred percent (100%) of the final Agreement price, including all change orders, to warrant such performance for a period of one (1) year after CITY's acceptance thereof within ten (10) days of filing of the Notice of Completion. 9. WARRANTIES CONTRACTOR unconditionally guarantees all work done under this Agreement including, but not limited to, any workmanship, installation, fabrication, material or structural facilities constructed. CONTRACTOR, within ten (10) days after notice by CITY of any defect in the work, shall have the option to make appropriate repairs or replace the defective item or items. Upon expiration of such ten- (10) day period, CITY may then make appropriate repair or replacement at CONTRACTOR's risk and own cost and expense. 10. INDEPENDENT CONTRACTOR It is understood and agreed that CONTRACTOR is, and shall be, acting at all times hereunder as an independent contractor and not an employee of CITY. CONTRACTOR shall g/agree/ surfnet/federal const Page 6 of 27 12/11 secure at its own cost and expense, and be responsible for any and all payment of all taxes, social security, state disability insurance compensation, unemployment compensation and other payroll deductions for CONTRACTOR and its officers, agents and employees and all business licenses, if any, in connection with the PROJECT and/or the services performed hereunder. 11. LIQUIDATED DAMAGES/DELAYS It is agreed by the parties hereto that in case the total work called for hereunder is not in all parts and requirements finished or completed within the number of calendar days as set forth herein, damage will be sustained by CITY; and that it is, and would be, impractical and extremely difficult to ascertain and determine the actual damage which CITY would sustain in the event of and by reason of such delay. It is, therefore, agreed that CONTRACTOR will pay to CITY, as. liquidated damages and not as a penalty, the sum of Five Hundred Dollars ($500.00) per day for each and every working day's delay in completing the work in excess of the number of working/calendar days set forth herein, which represents a reasonable endeavor by the parties hereto to estimate a fair compensation for the foreseeable damages CITY would sustain in the event of and by reason of such delay; and CONTRACTOR agrees to pay these damages herein provided, and further agrees that CITY may deduct the amount thereof from any monies due or that may become due to CONTRACTOR hereunder. For projects on the National Highway System (NHS), the local formula for liquidated damages will be provided. CONTRACTOR will be granted an extension of time and will not be assessed damages for any portion of the delay in the completion of the work due to unforeseeable causes beyond the control and without the fault or negligence of CONTRACTOR, including, but not limited to, acts of God or of the public enemy, fire, floods, epidemics, quarantine restrictions, strikes, unsuitable weather, or delays of subcontractors due to such causes. g/agree/ surfnet/federal const Page 7 of 27 12/11 CONTRACTOR shall, within fifteen (15) days from the beginning of any such delay (unless DPW shall grant a further period of time), notify DPW in writing of the cause of the delay and CITY shall extend the time for completing the work if, in its judgment, the findings of fact thereon justify the delay; and the decision of DPW shall be conclusive on the parties hereto. Should CONTRACTOR be delayed in the prosecution or completion of the work by the act, neglect or default of CITY, or should CONTRACTOR be delayed by waiting for materials required by this Agreement to be furnished by CITY, or by damage caused by fire or other casualty at the job site for which CONTRACTOR is not responsible, or by the combined action of the workers, in no way caused by or resulting from default or collusion on the part of CONTRACTOR, or in the event of a lockout by CITY, then the time herein fixed for the completion of the work shall be extended by the number of days CONTRACTOR has thus been delayed, but no allowance or extension shall be made unless a claim therefor is presented in writing to CITY within fifteen (15) days of the commencement of such delay. No claims for additional compensation or damages for delays, irrespective of the cause thereof, and including without limitation the furnishing of materials by CITY or delays by other contractors or subcontractors, will be allowed and an extension of time for completion shall be the sole remedy of CONTRACTOR. 12. DIFFERING SITE CONDITIONS A. Notice: CONTRACTOR shall promptly, and before such conditions are disturbed, notify DPW in writing of: (1) Subsurface or latent physical conditions at the job site differing materially from those indicated in this Agreement or the Contract Documents; or g/agree/ surfnet/federal const Page 8 of 27 12/11 (2) Unknown physical conditions at the job site, of an unusual nature, differing materially from those ordinarily encountered and generally recognized as inherent to work of the character to be performed under this Agreement. DPW shall promptly investigate the conditions and if it finds that such conditions do materially so differ and cause an increase or decrease in the time required for performance of any part of the work under this Agreement, whether or not changed as a result of such conditions, an equitable adjustment shall be made and the agreement modified in writing accordingly. B. Time Extension: No claim of CONTRACTOR under this Section shall be allowed unless CONTRACTOR has given the notice required hereunder provided, however, the time prescribed therefor may be extended by CITY. 13. VARIATIONS IN ESTIMATED QUANTITIES The quantities listed in the bid schedule will not govern final payment. Payment to CONTRACTOR will be made only for the actual quantities of Agreement items used in construction of the PROJECT, in accordance with the plans and specifications. Upon completion of the PROJECT, if the actual quantities used are either more than or less than the quantities listed in the bid schedule, the bid price shall prevail subject to the provisions of this Section. DPW may, at its sole discretion, when warranted by the facts and circumstances, order an equitable adjustment, upwards or downwards, in payment to CONTRACTOR where the actual quantities used in construction of the PROJECT are in variation to the quantities listed in the bid schedule. No claim by CONTRACTOR for an equitable adjustment in price or time for completion shall be allowed if asserted after final payment under this Agreement. If the quantity variation is such as to cause an g/agree/ surfiiet/federal const Page 9 of 27 12/11 increase in the time necessary for completion, DPW shall ascertain the facts and circumstances and make such adjustment for extending the completion date as in its sole judgment the findings warrant. 14. PROGRESS PAYMENTS Each month DPW will make an estimate in writing of the work performed by CONTRACTOR and the value thereof. From each progress estimate, five percent (5%) will be deducted and retained by CITY and the remainder of the progress estimate, less the amount of all previous payments since commencement of the work, will be paid to CONTRACTOR. CITY's final payment to CONTRACTOR, if unencumbered, or any part thereof unencumbered, shall be made thirty-five (35) days after the acceptance of the work and the filing of a Notice of Completion by CITY. Provided, however, that in the event of a dispute between CITY and CONTRACTOR, CITY may withhold from the final payment an amount not to exceed 150 percent of the value of any disputed amount of work. Payments shall be made on demands drawn in the manner required by law, each payment to be accompanied by a certificate signed by DPW, affirming that the work for which payment is demanded has been performed in accordance with the terms of the Agreement and that the amount stated in the certificate is due under the terms of the Agreement. Partial payments on the contract price shall not be considered as a acceptance of any part of the work. 15. WITHHELD CONTRACT FUNDS SUBSTITUTION OF SECURITIES At the request and at the sole cost and expense of CONTRACTOR, who shall retain beneficial ownership and receive interest, if any thereon, CITY shall permit the substitution and deposit therewith of securities equivalent to the amount of any monies withheld by CITY to ensure performance under the terms of this Agreement. &/ab ee/ surfnet/federal const Page 10 of 27 12/11 16. AFFIDAVITS OF SATISFACTION OF CLAIMS After the completion of the work contemplated by this Agreement, CONTRACTOR shall file with DPW its affidavit stating that all workers and persons employed, all firms supplying materials and all subcontractors working upon the PROJECT have been paid in full and that there are no claims outstanding against the PROJECT for either labor or material, except certain items, if any, to be set forth in CONTRACTOR's affidavit covering disputed claims, or items in connection with Notices to Withhold, which have been filed under the provisions of the statutes of the State of California. 17. WAIVER OF CLAIMS The acceptance by CONTRACTOR of the payment of the final certificate shall constitute a waiver of all claims against CITY under or arising out of this Agreement. 18. INDEMNIFICATION DEFENSE HOLD HARMLESS CONTRACTOR hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all, claims, damages, losses, expenses, judgments, demands defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to CONTRACTOR's employees and damage to CONTRACTOR's property, arising directly or indirectly out of the obligations or operations herein undertaken by CONTRACTOR, caused in whole or in part by any negligent act or omission of the CONTRACTOR, any subcontractors, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the CITY, its officers, elected or appointed officials, employees, agents, and g/agree/ surfnet/federal const Page 11 of 27 12/11 volunteers. CONTRACTOR will conduct all defense at its sole cost and expense and CITY shall approve selection of CONTRACTOR's counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by CONTRACTOR. 19. WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY INSURANCE Pursuant to California Labor Code Section 1861, CONTRACTOR acknowledges awareness of Section 3700 et seq. of this Code, which requires every employer to be insured against liability for workers' compensation; CONTRACTOR covenants that it will comply with such provisions prior to commencing performance of the work hereunder. CONTRACTOR shall maintain workers' compensation and employer's liability insurance in an amount of not less than the State statutory limits. CONTRACTOR shall require all subcontractors to provide such workers' compensation and employer's liability insurance for all of the subcontractors' employees. CONTRACTOR shall furnish to CITY a certificate of waiver of subrogation under the terms of the workers' compensation and employer's liability insurance and CONTRACTOR shall similarly require all subcontractors to waive subrogation. 20. INSURANCE In addition to the workers' compensation and employer's liability insurance and CONTRACTOR's covenant to indemnify CITY, CONTRACTOR shall obtain and furnish to CITY, a policy of general public liability insurance, including motor vehicle coverage covering the PROJECT. This policy shall indemnify CONTRACTOR, its officers, employees and agents while acting within the scope of their duties, against any and all claims arising out or in connection with the PROJECT, and shall provide coverage in not less than the following amount: combined single g/agree/ surfnet/federal const Page 12 of 27 12/11 limit bodily injury and property damage, including products/completed operations liability and blanket contractual liability, of One Million Dollars ($1,000,000) per occurrence. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than One Million Dollars ($1,000,000) for this PROJECT. This policy shall name CITY, its officers, elected or appointed officials, employees, agents, and volunteers as Additional Insureds, and shall specifically provide that any other insurance coverage which may be applicable to the PROJECT shall be deemed excess coverage and that CONTRACTORs insurance shall be primary. Under no circumstances shall said above -mentioned insurance contain a self -insured retention without the prior written consent of CITY; however an insurance "deductible" of $5,000.00 or less is permitted. 21. CERTIFICATES OF INSURANCE; ADDITIONAL INSURED ENDORSEMENTS Prior to commencing performance of the work hereunder, CONTRACTOR shall furnish to CITY certificates of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverages as required by this Agreement; the certificates shall: 1. provide the name and policy number of each carrier and policy; 2. state that the policy is currently in force; and 3. promise to provide that such policies will not be canceled or modified without thirty (30) days' prior written notice of CITY. CONTRACTOR shall maintain the foregoing insurance coverages in force until the work under this Agreement is fully completed and accepted by CITY. The requirement for carrying the foregoing insurance coverages shall not derogate from the provisions for indemnification of CITY by CONTRACTOR under the Agreement. CITY or its representative shall at all times have the right to demand the original or a copy of all the e/agee/ surfnet/federal const Page 13 of 27 12(11 policies of insurance. CONTRACTOR shall pay, in a prompt and timely manner, the premiums on all insurance hereinabove required. CONTRACTOR shall provide a separate copy of the additional insured endorsement to each of CONTRACTOWs insurance policies, naming CITY, its officers, elected and appointed officials, employees, agents and volunteers as Additional Insureds, to the City Attorney for approval prior to any payment hereunder. 22. NOTICE OF THIRD -PARTY CLAIM Pursuant to Public Contracts Code §9202, CITY shall provide notice to CONTRACTOR of receipt of any claim filed with CITY or a court of competent jurisdiction which arises out of performance of this agreement within ten (10) days of receipt of such claim or claims. 23. DEFAULT AND TERMINATION If CONTRACTOR fails or refuses to prosecute the work hereunder with diligence, or fails to complete the work within the time specified, or is adjudged bankrupt or makes an assignment for the benefit of creditors or becomes insolvent, or violates any provision of this Agreement or the Contract Documents, CITY may give CONTRACTOR notice in writing of its intention to terminate this Agreement. Unless the violation is cured within ten (10) days after such Notice of Intention has been served on CONTRACTOR, CITY may, without prejudice to any other remedy it may have, terminate this Agreement upon the expiration of that time. Upon such default by CONTRACTOR, CITY may elect not to terminate this Agreement; in such event CITY may make good the deficiency in which the default consists and deduct the resulting costs from the progress payments then or to become due to CONTRACTOR. If it is subsequently determined by a court of competent jurisdiction that CITY's termination of this Agreement under this Section was wrongful, such termination shall be converted ;/agree/ surfnet/federal const Page 14 of 27 12/11 to a termination for convenience under Section 24 and any damages shall be assessed as set forth in Section 23. 24. TERMINATION FOR CONVENIENCE CITY may terminate this Agreement for convenience at any time with or without cause, and whether or not PROJECT is fully complete upon seven (7) calendar days written notice to CONTRACTOR. In the event of termination, under this Section CITY shall pay CONTRACTOR for value of work in place on the PROJECT through the termination period less all such payments already made. In case of such termination for convenience, the CONTRACTOR shall be entitled to receive payment for work executed, and costs incurred by reason of such termination. In no event shall CONTRACTOR be entitled to recover overhead, profit or CONTRACTOR's fee on work not performed. Such payment by CITY shall be CONTRACTOR's sole and exclusive remedy for termination by CITY for its convenience and CITY shall have no further obligation to CONTRACTOR. 25. DISPOSITION OF PLANS ESTIMATES AND OTHER DOCUMENTS CONTRACTOR agrees that upon completion of the work to be performed hereunder, or upon expiration or earlier termination of this Agreement, all original plans, specifications, drawings, reports, calculations, maps and other documents pertaining to this Agreement shall be delivered to CITY and become its sole property at no further cost. 26. NONASSIGNABILITY CONTRACTOR shall not sell, assign, transfer, convey or encumber this Agreement, or any part hereof, or any right or duty created herein, without the prior written consent of CITY and the surety. g/agree/ surinet/federal const Page 15 of 27 12/11 27. CITY EMPLOYEES AND OFFICIALS CONTRACTOR shall employ no CITY official nor any regular CITY employee in the work performed pursuant to this Agreement. No officer or employee of CITY shall have any financial interest in this Agreement in violation of the California Government Code. 28. STOP NOTICES• RECOVERY OF ADMINISTRATIVE COSTS CITY shall be entitled to all reasonable administrative costs and necessary disbursements arising out of the processing of Stop Notices, Notices to Withhold, or any similar legal document. This obligation shall be provided for in the labor and materials payment bond required of CONTRACTOR. CITY may charge an administrative fee of One Hundred Dollars ($100) for every Stop Notice filed in excess of two (2), regardless of whether or not CITY is named in an action to enforce such stop notices. CITY may set off any unreimbursed cost or expense so incurred against any sum or sums owed by CITY to CONTRACTOR under this Agreement. 29. NOTICES Any notices, certificates, or other communications hereunder shall be given either by personal delivery to CONTRACTOR's agent (as designated in Section 1 hereinabove) or to CITY as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and depositing the same in the United States Postal Service, to the addresses specified below; provided that CITY and CONTRACTOR, by notice given hereunder, may designate different addresses to which subsequent notices, certificates or other communications will be sent: TO CITY: City of Huntington Beach ATTN: David Verone 2000 Main Street Huntington Beach, CA 92648 d'agree/ surfneUfederal const Page 16 of 27 12/11 TO CONTRACTOR: CHI Construction 701 E. BA11 Road #101 Anaheim, CA 92805 30. SECTION HEADINGS The titles, captions, section, paragraph, and subject headings, and descriptive phrases at the beginning of the various sections in this Agreement are merely descriptive and are included solely for convenience of reference only and are not representative of maters included or excluded from such provisions, and do not interpret, define, limit or describe, or construe the intent of the parties or affect the construction or interpretation of any provision of this Agreement. 31. IMMIGRATION CONTRACTOR shall be responsible for full compliance with the immigration and naturalization laws of the United States and shall, in particular, comply with the provisions of the Immigration Reform and Control Act of 1978 (8 USC Section 1324a) regarding employment verification. 32. LEGAL SERVICES SUBCONTRACTING PROHIBITED CONTRACTOR and CITY agree that CITY is not liable for payment of any subcontractor work involving legal services, and that such legal services are expressly outside the scope of services contemplated hereunder. CONTRACTOR understands that pursuant to Huntington Beach City Charter Section 309, the City Attorney is the exclusive legal counsel for CITY; and CITY shall not be liable for payment of any legal services expenses incurred by CONTRACTOR. 33. ATTORNEY'S FEES In the event suit is brought by either party to construe, interpret and/or enforce the terms and/or provisions of this Agreement or to secure the performance hereof, each party shall bear g/agree/ sur&iet/federal const Page 17 of 27 12111 its own attorney's fees and the prevailing party shall not be entitled to recover its attorney's fees from the nonprevailing party. 34. INTERPRETATION OF THIS AGREEMENT The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties. If any provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining covenants and provisions of this Agreement. No covenant or provision shall be deemed dependent upon any other unless so expressly provided here. As used in this Agreement, the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the context so indicates or requires. Nothing contained herein shall be construed so as to require the commission of any act contrary to law, and wherever there is any conflict between any provision contained herein and any present or future statute, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law. 35. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 36. DUPLICATE ORIGINAL The original of this Agreement and one or more copies hereto have been prepared and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of the g/agree/ surfnet/federal const Page 18 of 27 12/11 date of its execution and delivery, be deemed an original. Each duplicate original shall be deemed an original instrument as against any party who has signed it. 37. CONSENT Where CITY's consent/approval is required under this Agreement, its consent/approval for one transaction or event shall not be deemed to be consent/approval to any subsequent occurrence of the same or any other transaction or event. 38. CALIFORNIA FAIR EMPLOYMENT AND HOUSING ACT CONTRACTOR agrees to comply with all requirements and utilize fair employment practices in accordance with California Government Code Sections 12900 et seq. 39. CALIFORNIA PREVAILING WAGE LAW. A. The CITY has ascertained from the Director of Industrial Relations of the State of California the general prevailing rate of per diem wages and the general prevailing rate for legal holiday and overtime work in the locality in which the work is to be performed for each craft or type of work needed to execute this Agreement, and the same has been set forth by resolution on file in the office of the City Clerk of CITY. CONTRACTOR and any subcontractor under it shall pay not less than said prevailing wage rates to all workers employed on this public works Agreement, as required by California Labor Code Sections 1771 and 1774. In accordance writh the provisions of Section 3700 of the California Labor Code, CONTRACTOR agrees to secure payment of compensation to every employee. B. Pursuant to this Agreement and in accordance with Section 1774 and 1775 of the California Labor Code, CONTRACTOR shall, as penalty to CITY, forfeit g/agree/ surfnet/federa[ const Page 19 of 27 12/11 twenty-five dollars ($25) for each calendar day or portion thereof for each worker paid (either by CONTRACTOR or any of its subcontractors) less than the prevailing wage rate established for that particular craft or type of work. 40. CALIFORNIA EIGHT -HOUR LAW A. California Labor Code, Sections 1810 et seq, shall apply to the performance of this Agreement; thereunder, not more than eight (8) hours shall constitute one day's work and CONTRACTOR and each subcontractor employed by its hereunder, shall not require more than eight (8) hours of labor per day or forty (40) hours per week from any one person employed by it hereunder, except as stipulated in California Labor Code Section 1815. CONTRACTOR and each subcontractor employed by it hereunder shall, in accordance with California Labor Code Section 1812, keep an accurate record, open to inspection at all reasonable hours, showing the name and actual hours worked each calendar day and each calendar week by each worker employed in connection with the PROJECT. B. Pursuant to this Agreement and in accordance with California Labor Code Section 1813, CONTRACTOR shall, as a penalty to CITY, forfeit twenty- five dollars ($25) for each worker employed hereunder by CONTRACTOR or any subcontractor for each calendar day during which such worker is required or permitted to work more than eight (8) hours in any one (1) calendar day or forty (40) hours in any one (1) calendar week in violation of California Labor Code Section 1815. giagree/ surfnet/federal const Page 20 of 27 12111 41. PAYMENT OF TRAVEL AND SUBSISTENCE ALLOWANCE Section 1773.8 of the California Labor Code, regarding the payment of travel and subsistence allowance is applicable to this PROJECT. 42. EMPLOYMENT OF APPRENTICES Section 1777.5 of the California Labor Code, regarding the employment of apprentices is applicable to this PROJECT. 43. PAYROLL RECORDS CONTRACTOR agrees to keep accurate payroll record showing the name, address, social security number, work classification, straight time and overtime hours worked each day and week, and the actual per diem wages paid to each journeyman, apprentice or worker employed by it in connection with the PROJECT and agrees to require each of its subcontractors to do the same. CONTRACTOR further agrees that its payroll records and those of its subcontractors, if any, shall be available at all reasonable times to the CITY, and the employee or his representative, and the Division of Labor Standards Enforcement and the Division of Apprenticeship Standards, and to comply with all of the provisions of California Labor Code Section 1776, in general. 44. FEDERAL PARTICIPATION The PROJECT pursuant to which the work covered by this Agreement is being executed is being assisted by the United States of America. Several Agreement provisions embodied herein are included in this Agreement in accordance with the provisions applicable to such federal assistance. As federal funds are financing all or part of thiswork, all of the statutes, rules and regulations promulgated by the Federal Government and applicable to the work will apply, and CONTRACTOR agrees to comply therewith. Attached is FHWA Form 1273, known as Exhibit "B", which describes required contract provisions for federal -aid construction contracts. g/agree/ surfnet/federal const Page 21 of 27 12/11 Additionally, the CONTRACTOR shall insert in each subcontract all of the stipulations contained in the Required Contract Provisions of Form 1273, and further require their inclusion in any lower tier subcontract or purchase order that may in turn be made. The Required Contract Provisions 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. Certain sections of Form 1273 may not be applicable depending upon the project and will be crossed out. 45. ADDITIONAL FEDERAL REQUIREMENTS CONTRACTOR agrees to abide by the additional requirements necessary for federal aid (see pgs. 12-14 of Exhibit "B"). The CONTRACTOR agrees to buy only steel and iron made in the United States for all federal -aid construction projects (`Buy America"). The CONTRACTOR also agrees to be subject to the legislative and regulatory Disadvantaged Business Enterprise (DBE) requirements (42 USC Section 2000d, et seq.). If the CONTRACTOR does not specify the goals for this program, then the CONTRACTOR's obligation under these regulations will be determined by the CITY. The CONTRACTOR shall also sign a non -collusion certification. Select projects may also require "Federal Trainee" or "On -the -Job Training" provisions to comply with federal regulations. 46. DAVIS-BACON ACT CONTRACTOR agrees to pay and require all subcontractors to pay all employees on said PROJECT a salary or wage at least equal to the prevailing rate of per diem wage as determined by the Department of Labor (29 CFR part 5) in accordance with the Davis -Bacon Act (40 USC Section 276a to 276a-7) for each craft or type of worker needed to perform this Agreement. aiagee/ surfnet/federal const Page 22 of 27 12/ 11 CONTRACTOR agrees to comply with all applicable federal labor standards provisions; said provisions are incorporated herein by this reference. 47. DISCRIMINATION MINORITIES ALIENS The CONTRACTOR 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 49 CFR, Part 26 in the award and administration of 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 recipient deems appropriate. 48. EQUAL EMPLOYMENT OPPORTUNITY The CONTRACTOR will comply with all provisions of Executive Order 11246, entitled "Equal Employment Opportunity," and amended by Executive Order 11375, and as supplemented in Department of Labor regulations (41 CFR part 60). The CONTRACTOR will also comply with all provisions detailed in FHWA Form 1273 Exhibit "13") CONTRACTOR is required to have an affirmative action plan which declares that it does not discriminate on the basis of race, color, religion, creed, national origin, sex or age to ensure equality of opportunity in all aspects of employment. Section 503 of the Rehabilitation Act of 1973 (29 USC Section 701, et seq.) prohibits job discrimination because of handicap and requires affirmative action to employ and advance in employment qualified handicapped workers. Section 402 of the Vietnam Era Veterans Readjustment Assistance Act of 1974 (38 USC Section 219 et seq.) prohibits j ob discrimination and requires affirmative action to comply and advance in employment (1) qualified Vietnam veterans during the first four (4) years after their g/agree/ surfnet/federal const Page 23 of 27 IJII discharge and (2) qualified disabled veterans throughout their working life if they have a thirty percent (30%) or more disability. To ensure compliance with these requirements, the CONTRACTOR shall provide the CITY its written affirmative action plan prior to commencement of work. The CONTRACTOR is required to provide the CITY with a listing of its subcontractors together with a completed affirmative action program from each subcontractor when applicable. 49. COPELAND "ANTI -KICKBACK" ACT CONTRACTOR and its subcontractors shall comply with the provisions of the Copeland "Anti -Kickback" Act (18 USC Section 874), as supplemented in Department of Labor regulations (29 CFR part 3), which Act provides that each shall be prohibited from including, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he is otherwise entitled. 50. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT The CONTRACTOR shall comply with the provisions of Section 103 and 107 of the Contract Work Hours and Safety Standards Act (40 USC 327-330) as supplemented by Department of Labor regulations (29 CFR, part 5). Under Section 103 of the Act each CONTRACTOR shall be required to compute the wages of every mechanic and laborer on the basis of a standard workday of eight (8) hours and standard workweek of forty (40) hours. Work in excess of the standard workday or workweek is permissible provided that the worker is compensated at a rate of not less than 1-1/2 times the basic rate of pay for all hours worked in excess of eight (8) hours in any calendar day or forty (40) hours in the workweek. Section 107 of the Act is applicable to construction work and provides that no laborer or mechanic shall be required to work in surroundings or under working conditions which are unsanitary, hazardous, or dangerous to his health and safety as determined g/agree/ surfnet/federal const Page 24 of 27 12/11 under construction, safety and health standards promulgated by the Secretary of Labor. These requirements do not apply to the purchase of supplies or materials or articles ordinarily available on the open market or contracts for transportation. 51. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT. A. CONTRACTOR stipulates that all facilities to be utilized in the performance of this Agreement were not listed, on the date of Agreement award, on the United States Environmental Protection Agency (EPA) List of Violating Facilities, pursuant to 40 CFR 15.20. B. The CONTRACTOR agrees to comply with all of the requirements of Section 306 of the Clean Air Act and section 508 of the Federal Water Pollution Control Act and all regulations and guidelines listed thereunder. C. The CONTRACTOR shall promptly notify the CITY of the receipt of any communication from the Director, Office of Federal Activities, EPA, indicating that a facility to be utilized pursuant to this Agreement is under consideration to be listed on the EPA List of Violating Facilities. D. The CONTRACTOR agrees to include or cause to be included the requirements of paragraph (a) thorough (d) of this section in every nonexempt subcontract, and further agrees to take such action as the Government may direct as a means of enforcing such requirements. g/agree/ surfnetlfederal const Page 25 of 27 l2/1 L 52. ENERGY CONSERVATION Agreements with federal participation shall recognize mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (42 USC Section 6201, et seq.). 53. HOUSING AND URBAN DEVELOPMENT CONTRACTOR agrees to comply with any and all rules, regulations, guidelines, procedures and standards of the United States Department of Housing and Urban Development and complete any and all reports and forms that may be required in accordance therewith. 54. SIGNATORIES Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. 55. ENTIRETY The foregoing, and Exhibits "A" and "B" attached hereto, set forth the entire Agreement between the parties. No waiver or modification of this Agreement shall be valid unless in writing duly executed by both parties. The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiations, and that each has had the opportunity to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no representations, inducements, promises, agreements or warranties, oral or otherwise, have been made by that party or anyone acting on that party's behalf, which are not embodied in this Agreement, and that that party has not executed this Agreement in reliance on any representation, g/agree/ surfnet/£ederal const Page 26 of 27 12111 inducement, promise, agreement, warranty, fact or circumstance not expressly set forth in this Agreement. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers on 20 CONTRACTOR By: print name ITS: (circle one) Chairman/President/Vice President AND By: Al print name IT ' (circle one) Secretary/Chief Financial Officer/Asst. Secret Treasurer CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California INITIATED AND APPROVED: Director of Public Wor s T1- APPROVED: REVIE g/agree/ surfnet/federal const Page 27 of 27 12/11 SECTION C PROPOSAL for the construction of LADE STREET BICYCLE TREATMENTS And DOWNTOWN BICYCLE PARKING CC No. CC 1468 — CML 5181 (179) 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 10 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 and 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 �3: i3, in 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 for_% ", as the case may be) Any standard Surety Bid Bond form is acceptable. Bidder shall signify receipt of all Addenda here, if any: Addenda No. Date Received Bidder's Signature.. C-2 Project Bid Schedule Lake Street Bicycle Treatments and Downtown Bicycle Parking CC-1468 Federal Project Number-5181(179) 1 II 1 L.S. II Mobilization. 11 11 Per L.S. 271 1 L.S. Furnish Project Traffic Control. $ ` 0txo 11$ :0!�0 $2e J$-2 &I f Per L.S. II 11 I 3 1 L.S. Furnish and Install Traffic Striping p and Signing. $ 0 o Per L.S. 4 L. S. Install City Furnished Peak Bicycle Racks (156 Total Bicycle $ $— ! C, Slots) Using City Furnished Tamper Resistant Mounting Hardware. � 11 h Per L.S. II II Total Amount Bid in Figures: Total Amount Bid in Words: C-2.1 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. Bid Item(s) Name and Address of Subcontractor State License Number Class Dollar Amount % of Contract -C,0' ce CA 17Z/60 -- 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 DID I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on � ,y , at CA Date City State being first duly sworn, deposes and says that he or she is r of Cc,,e-7',, ®.--) 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. Name of Bidder Signature of Bidder —7 jZ-�': Sar/T6- 10 C , Ci Address of Bidder 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 Lake Street Bicycle Treatments and Downtown Bicycle Parking, (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: // iq C-5 Contractor By Title DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 10162, 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 dNo 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: /4 C-7 Contractor By Title -wiz =S,/�>&ri r BIDDER'S I BIDDER certifies that the following information is true and correct: Bidder Name / C3 i Business Address City, State Zip (7/4) —7S S 1-76"7 Telephone Number 1,� S5 �'L-ass State Contractor's License No. and Class Original Date Issued 2C1�5 Expiration Date The work site was inspected by-� S of our office on41, 201. P49,69r/0 The following are persons, firms, and corporations having a principal interest in this proposal: CL11 C,o�y rl/2 CiC'%/G N C-s 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. (NA4-�f �i/x�--- A/a/Ve& Company Nam —;, Signature of Bidder Printed or Typed Signature Subscribed and sworn to before me this �Jq day of 0V , 201 A. NOTARY PUBLIC C-9 NOTARY SEAL M. JIMENEZ Commission 0 2069908 Notary Pubbe • California Los Anplts County Comm. Ex ice, 20t6 Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work. Bidders are encouraged to submit supplemental relevant project history in addition to the projects listed herein. Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past five years: I-7- j OA P1:`ZftO 3e��3iaJ��hl ���`t%2�� 1.4 <io`z2 Name and Address of Public Agency Name and Telephone No. of Project Manager: l41 `Z',4 -7i4 S 4:;Z 3 L?,Z gscco i�2C �Y �.�A? ��,�%T �'v is%—"'ITr�li C3��r3/'2C'S Contract Amount Type of Work Date Comp el ted Provide additional project description to show similar work: 2. Name and Address of Public Agency 6>'I yc z-..Oi Name and Telephone No. of Project Manager: PLLy "C4 & O SC3 fl,4 ,0 4b, `2-0 C-CO P2 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Name and Address of Public Agency � / -79Q-- 340 Name and Telephone No. of Project Manager: %u �� 62 6 5 - i 4600 Contract Amount Type of Work^ Provide additional project description to show similar work: C-10 Date `243v'W Bidder's Critical Staff Listed below are the names of the bidders proposed Construction Project Manager, and Superintendent. For each of these critical positions, please list at least three projects for which the critical staff has performed similar work within the last five years. These projects do not have to be under the employment of the bidder of this project. Bidders are encouraged submit supplemental relevant project history in addition to the projects listed herein. 1. /%"Tcl /-SA z ,/ Name of proposed Project Manager Telephone No. of proposed Project Manager: 714 75"Z 1746-7 Cr-'yoF- ZA I -A /-7$ 423 zLEY % ,q..fTl�iG -r�o/U "/A Project Name & Contract Amount Type of Work 7,zom -r Date Comp CAL -soER r/--F J-•' i 1# eb7 %,iir�C f`' 6-cC C' Mt $, �3�Q L2-,, r� Project Name & Contract Amount Type of Work Date Completed &*soy $ -z, 2-C- cmo PJq-r(--4 9ZCC'/a4� 7LO�As�-�, Project Name & Contract Amount Type of Work Date Completed 2. A-//6i/&=,,-;. Name of proposed Superintendent Telephone No. of proposed Superintendent: -7114, 23 2.7391 Project Name & Contract Amount Type of Work 1'•2c1Ec , Date Coml OG lZ,Ff iSc r JOy i/V/tz Project Name & Contract Amount Type of Work i,,s,, , Ty e Date Completed (/✓C5T N/� 1170 7 Sri $ (�,.ya?�2tdLi emit) /�7 7A (e /CD% Project Name & Contract Amount Type of Work Date Completed C-11 (For federally funded projects, use this following page) BIDDER'S CER'TIFICAT'ION* 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: r­w_i_l Contact Person: Contact Phone: 714 7-S- 1'767 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-12 Local Assistance Procedures Manual Exhibit 12-H Sample Bid (THE BIDDER'S E iECUT10N ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENTAND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder f ��1 Cr�rj—►rZartCT/GeU , proposed subcontractor -Sr, hereby certifies that he hasX., 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 1 of 8 C-13 Junell,2014 Local Assistance Procedures Manual Exhibit 12-H Sample Bid 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 works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the 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 checkmark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal 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 a safety regulation? Yes No If the answer is yes, explain the circumstances in the following space. Page 2 of 8 C-14 June 11, 2014 Local Assistance Procedures Manual Exhibit 12-H Sample Bid PUBLIC CONTRACT CODE 10232 STATEMENT In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable 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 to comply with an order of the National Labor Relations Board. Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal 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. Page 3 of 8 C-15 .Tune 11, 2014 Local Assistance Procedures Manual Exhibit 12-11 Sample Bid Noncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY / COUNTY of 1/�,�,.rri..:C, .y 1'S4EJCJ-/ '/okA qj 0 ("'.,fv?t-y DEPARTMENT OF PUBLIC WORKS. In conformance 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 4 of 8 C-16 June 11, 2014 Local Assistance Procedures Manual Exhibit 12-H Sample Bid DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager: • is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any Federal agency; • has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federal agency within the past 3 years; • does not have a proposed debarment pending; and • has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Page 5 of S C-17 June It, 2014 Local Assistance Procedures Manual NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS Exhibit 12-H Sample Bid The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure, The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. Page 6 of 8 C-18 June 11, 2014 Local Assistance Procedures Manual Exhibit 12-H A) 4 Sample Bid DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE 1,01313Y1NU AC I IVI IIES YURSUAN 1 1U s 1 U.s.U, ls.� 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: ® a. contract ® a. bid/offer/application ®a. initial b. grant b. initial award b. material change c. cooperative agreement c. post -award d. loan For Material Change Only: e. loan guarantee year quarter f. loan insurance date of last report 4. Name and Address 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 6. Federal Department/Agency: S. Federal Action Number, if known: 10. a. Name and Address of Lobby Entity (If individual, last name, first name, MI) 11. 12. 14. 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. 10a) (last name, first name, MI) (attach Continuation Sheet(s) if necessary) Amount of Payment (check all that apply) 13. Type of Payment (check all that apply) $ ® actual El planned a. retainer b. one-time fee Form of Payment (check all that apply): c. commission a. cash d. contingent fee b. in -kind; specify: nature e deferred value f. other, specify Brief Description of Services Performed or to be performed and Date(s) of Service, including offrcer(s), empioyee(s), or member(s) contacted, for Payment Indicated in Item It: (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 Signature: reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required Print Name: 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 faits to file the required Title: disclosure shall be subject to a civil penalty of not tens than $10,000 and not more than $100,000 for each such failure. Telephone No.: Date: Federal Use Only: Stand—f Fn Authorized for Local Rcproduction Standard Form - LLL Page 7 of S C-19 June11,2014 Local Assistance Procedures Manual Exhibit 12-H Sample Bid 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 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. 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. Check all boxes that apply. If other, specify nature. 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) employees) 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-Insmfions Rev. 0e-04-90aENDIF» Page 8 of 8 C-20 June 11, 2014 Local Assistance Procedures Manual EX IT 15-G Local Agency Bidder DBE Commitment (Construction Contracts) E7]ffrBrr 15-G LOCAL AGENCY BIDDER DBE COUNT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCALAGENCY: City of Huntington Beach LOCATION: A PROJECT DISCRIPTION:l-4kC 6TIZE T '5fC-YCLt. %rCE1t2^4C�7S ff /JO�yti:Cr✓sl1 i jltl j TOTAL CONTRACT AMOUNT: $ z-S C,) _ co BID DAT& % Z4 / 2Gli LF BIDDER'SNAMS: Cal% �C��-rrz a C-7,Ci�7 CONTRACT DBE GOAL.: it's NTRACT ITPM NO. OF WORK AND DESCRIPTION ERVICES TO BE ONTLiACTED OR MATERIALS ridd.r BE CBRT NO. EXPIRATION DATE OF EACH DBE (Most be certified on the date bidsBE opencd - include DBE address DOLLARAMOUNT E PROVIDED (or contracted if the d phone number) is aDBE) 00, liC sw- 9�ift5•rr C `�+�� � Et; 0 For Local Agency to Complete: Total Claimed DBE s dQ; e-`�j Local Agency Contrad Nrmher. CC -14 G B Participation Federal -aid Project Number. CIS 5181(179) j Federal Share: Contract Award Date: aa� Local Agency certifies that an DBE certifications have been verified and n Sipatm of Bidder information is complete and accurate, Date (Aron Code) Tel. No. Print Name Signature Date /'40--1 Person to Contact (Please Type -Print) Local Agency Representab- (Area Code) Telephone Number. Local Agency Bidder DBE Con=kwmt (Cowftcrim Contractg) . (Rat' 4t26/09) Distribution: (1) Copy -Fait or scan a copy to the Calfraos District Local Assistance Engineer (DLA E) wfWn30 days of contract execution. Failure to scud a copy to the DLAE within 30 days of contract execution may result in d"bligation of fiends for this project (2) Copy -Include in award pacinge to Caltrans District Local Assistance (3) Original' Local agency files OB 12-04 C-21 Page I5-1 June 29, 2012 CALIFORNIA UNIFIED CERTIFICATIONPROGRAM f. DISADVANTAGED BUSINESS ENTERPRISE CERTIFICATE STATEWIDE STRIPES, INC P.O. T30X 900287 S SAN DIEGO, CA 92090 Owner. DAVID A. BRILHANTF Business Structure- CORPORATION This certificate acknowledges that said firm is approved by the California Unified Certification Program a Disadvantaged Husiness Enterprise (DBE) as defined by the US. Department of Transportation (DOT) CFR 49 Part 26, as inay be amended, for the following NAICS codes: NAICS Gadefs) * Indicates primary NAICS code * 23X320 Painting and Wall Covering Contractors, Work Category Code(s) C'9854 PAINTING STRUCTURES l'itensus C32 Parking and Highway Improvement Contractor C33 Painting anti Decorating Contractor CERTIFYING AGENCY: lJCP Firm Number: 32232 DEPARTMENTOFTRANSPORTATION 3 1823 14TH STRE11, MS 79 /111, - , " '' j" P(� SACRAENTO, CA 95814 0000 _M�, P MAugu 122, 2008 (916) 324-1700 C U Fl`,Of 'Pt C F R, It is CUUT'g policy and objective to Promote and maintain a level playing field for DRFs in California an Federal -aid contracts. We ensure nondiscrimination in the award and administration of U.S. DOT assisted contracts based on the requirements of 44 CPR Parts 21 and 26. EXHIBIT 15-G Local Assistance Procedures Manual Local Agency Bidder DBE Commitment (Construction Contracts) INSTRUCTIONS - LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) PLEASE NOTE: 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 DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE 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, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project 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-G 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 agenciesshould 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 15-2 June 29, 2012 C-22 OB 12-04 Local Assistance Procedures Manual Exhibit 15-H DBE Information - Good Faith Effort ExHmn 15-H DBE INFORMATION —GOOD FAITH EFFORTS DBE WORMATION - GOOD FAITH EFFORTS Federal -aid Project No. CML 5181(179) Bid Opening Date The City of Huntington Beach established a Disadvantaged Business Enterprise (DBE) goal of 11.00 % 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 DBE Commitment" form indicates that the bidder has met the DBE 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 DBE firm was not certified at bid opening, or the bidder made a mathematical error. Submittal of only the "Local Agency Bidder DBE 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 DBE Commitment" of the Special Provisions: A. The names and dates of each publication in which a request for DBE 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 DBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the DBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): OB 12-04 Names of DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation C-23 Page 15-1 June 29, 2012 Exhibit 15-H DBE Information -Good Faith Effort Local Assistance Procedures Manual C. The items of work which the bidder made available to DBE 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 DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items M Of (y/N) Contract A,47r-- %44 S AJU SrGNS. PC S7 D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each DBE if the selected firm is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: A.60r3E. See- Names,addresses and phone numbers of firms selected for the work above: E. Efforts made to assist interested DBEs 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 DBEs: Page 2 June 29, 2012 C-24 OB 12-04 Local Assistance Procedures Manual Exhibit 15-H DBE Information - Good Faith Effort F. Efforts made to assist interested DBEs in obtaining necessary equipment, supplies, materials or related assistance or services, excluding supplies and equipment the DBE subcontractor purchases or leases from the prime contractor or its affiliate: AlIxf G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using DBE 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 Or z2 - M1.)1s7ZA-:" 6&as e Gets Sc 4%�!o H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): ti 6 NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. Page 3 OB 12-04 C-25 June 29, 2012 Traffic Control Engineering Engineering Services Kuan, David 2687 Saturn Street Brea, CA 92821 (714) 447-6077 Contact Telephone & Email 11/19/2014 10:06 DBE 2.txt ,,,�Z� .- G�-� �itv' � cam✓ !� r3i�.. "A Signs Portal Design of Signs Robles, David A.,��,c��rR ��- 11367 Relax Lane Pacoima, CA 91331 (213) 880-8112 Contact Telephone 11/19/2014 10:56 Sav-On-Signs, Inc. Sign Manufacturing Kelleher, Jane 3929 E. Anaheim St. Long Beach, CA 90804 (562) 961-3414 J" C Contact Telephone & Email COUL1��,.7- 11/19/2014 13 : 35 n/%T-�; AL.. Full Traffic Maintenance, Inc. Traffic control & Sign manufacturing Salgado, Samuel 1. _ 217 Lewis Court Corona, CA 92882 (951) 520-9990 F1%LEA f�yS Contact Telephone & Email 11/19/2014 14 : 30 Page 1 d� SUPER SEAL & STRIPE, INC Traffic signs BRENDA HAMPTON-ORTIZ 310 A STREET FILLMORE, CA 93015 (805) 524-7345 Contact i/ `zf Telephone & email 11/20/2014 15:45 Untitled Pc S 1Z � Get r <:),r- (bFF—r CC < /A-) AK),jjar STATEWIDE STRIPES, INC Traffic signs & Control DAVID BRILHANTE 7320 MISSION GORGE ROAD SAN DIEGO, CA 92120 (858) 560 6887 �r/Z� S,�/•C� �`"�%`� Contact Telephone & email 11/21/2014 14:25 A CONE ZONE, INC Traffic Signs & control I ELAINE NORLAND 160 N. JOY STREET {! Corona, CA 92879 (951) 734 9535 Contact Telephone & email 11/20/2014 16:05 Page 1 Local Assistance Procedures Manual Exhibit 12-B Bidder's List of Subcontractors (DBE and Non -DBE) EXHIBIT 12-B 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. Firm Name/ Phone/ Annual Gross Description of Portion of Work to be Performed p Loc�lA�encti IIse Address/ Fax Receipts, Cerifiesi=ABE� Ci , State, ZIP Name hone Ilion a /y.+ I _ - itiL� SSG �c>v'i ❑ < $5 million ❑ $10 million - 2�a �Gy';� T, S �r1 �•Cr.��QNO .............._._._........._..... _ Y ist 1)BE # r Address C,C>Cd'rG Fax❑ ?> $ (P', < $15 millio' > $15 million _ _.._.. _-.__.-..._.._. _._ ;'A , &0 F'vim City State ZIP iWC? cfz/�,C: - Name Phone ❑ < $ l million ---------_.-._.-....._ - __........----'--- -- � rOn .. ❑ < $5 million ----- NO _ ❑ <$10 million _........_ _. _ . _._. _ __. _ ._...__.._...._. _ I� rstCBE# Address.._......__.......... Fax ❑ < $15 million > $15 million --- ....._._.--- __---------------- _._......_.-----._.--- __ ._ _._._ _.._.............__-- _ ....__.............__ ......_.___..._._......_ __e z oixs 14 7 xn" City State ZIP Name Phone ❑ <$1 million _._. _._ r { EYES El < $5 million _ --...... 511771 O < $10 million ------------- .......... ..---------------------- _._._._._. _ ---- -- E S list ?B Fax< $15 million $15 million __....._... ......__......- _ - - .............----...._.. _-1itt1 wOrs City State ZIP �❑--> ❑ < $1 million .e Name Phone ---......_......-_......_......----•-._. — --- _.__.._.... , ❑ < $5 million----------------------- < $ 10 million _ =l l'Ea Irst DI # A e of Frrxp Yrs ANO ddress Fax ❑< El> $$15 million $15 million City State ZIP Distribution: 1) Original - Local Agency File rage i or z. DLA-OB 13-06 C-26 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-B Bidder's List of Subcontractors (DBE and Non -DBE) EXIiIBIT 12-B 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. Photocopy this form for additional firms. Firm Name/ Phone/ i oe, "Qe�neV Use Oniv,� Address/ Fax Annual Gross Receipts Description of Portion of Work to be Performed (Ct�rttied DBE?) Ci , State, ZIP Name Phone ❑ <$1 million __._._ _ - ---------- ❑ < $5 million ❑ < $10 million _...................... _ -.--. ._.....,._...._._ _ _.._...._.___.. _ _.__._.- ....__.............___-........ _............-............. - 1 YES first fli3 Address Faz < $15 million El> $15 million _.._ _,.- _—_._................................ __.._........... .....___...._.... R �' °#� City State ZIP p,� �" PQ al <$1 million Name Phone ^❑�'£$ ❑ < $5 million ❑ < $10 million _........... ... _............._.._......._ ...--.----- -- -- ....... Address Fax < $15 million > $15 million -- City State ZIP §�. ......... ----- ..............._ .... _ ----........_............ - . Name Phone ❑ <$1 million 3S ❑ ❑ < $5 million < $10 million -------------- __.. _._....._..__._...----...._- __._._._._._.__ IY hstLE ¥ Address pax ❑ ❑ < $15 million ? $15 tntihon °A t? �f } City State ZIP Name Phone ❑ < $1 million _.. " ❑1�f0 ❑ ❑ < $5 million < $10 million _.... _......._.__ .-Y l?st l?E Address < $15 million---------------- ❑ > $15 million _._._...._.--___Fax ------------ N i'rs Aeofit(WE City State ZIP Distribution: 1) Original — Local Agency File Page 2 of 2 - DLA-OB 13-06 August 12, 2013 C-27 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 For Lake Street Bicycle Treatments and Downtown Parking Clegg. CC-1468 CML-5181(179) November 14, 2014 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1. The Federal Labor Rates contained in Appendix H — Part 2 of the Project Specifications for the Lake Street Bicycle Treatments and Downtown Bicycle Parking - CC1468 CML-5181(179) shall be replaced with the attached FEDERAL LABOR RATES DATED November 14, 2014. The Federal labor rates dated November 14, 2014 shall be the Federal labor rates in effect for the above named project. This is to acknowledge receipt and review of Addendum Number One, dated May 9, 2014. 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 Darren Sam at (714) 536-5431. 4X19 INSCO INSURANCE SERVICES, INC. 1n5C%1C® Underwriting Manager for: Developers Surety and Indemnity Company Indemnity Company of California 17780 Fitch, Suite 200 • Irvine, California 92614 • (949) 263-3300 BID BOND BOND NO. KNOW ALL MEN BY THESE PRESENTS, That we, Creative Home DBA CHI Construction as Principal, and Developers Surety and Indemnity Company authorized to transact a general surety business in the State of California bound unto City of Huntington Beach in the full and just sum of Ten Percent of Amount Bid N/A corporation as Surety, are held and firmly called the Obligee) Dollars, ($10% of Bid ) for the payment whereof in lawful money of the United States, we bind ourselves, our heirs, administrators, executors, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the said PRINCIPAL has submitted the accompanying bid for Lake Street Bicycle Treatments 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, or in the event of the failure of the Principal to enter such Contract, 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 19th day of November 2014 YEAR Creative me-DBA CHI Construction Developers Surety and Indemnity Company Sur 7 By: Principal Cyntaa J. Young torney-in act 10-1198 (Bid Bond) (REV. 1/01) CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT State of California SS. County of San Bernardino On November 19, 2014 before me, Laurie B. Druck, Notary Public Name and Title of Officer (e.g., "Jane Doe, Notary Public") Personally appeared Cynthia J. Young Name(s) of Signer(s) LAURIE B. ORUCK Commission # 1982312 a =m &}; Notary Public -California z z : „.�t�•, a Z 'tom:., San Bernardino County My Comm. Expires Jul 14, 2016 who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her authorized capacity, and that by her signature on the instrument the person, or the entity upon behalf of which the person 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. a-L __Ovgw_�, 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: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Number of Pages: O Individual O Corporate Officer Title O Partner — O Limited O General Top atlhuTbhere O Attorney -in -Fact O Trustee O Guardian or Conservator Other. - Signer is Representing: POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box 19725. IRVINE. CA 92623 (949) 263-3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA. do each hereby make. constitute and appoint: "'Cynthia J. Young, Jay P. Freeman, Laurie B. Druck, Pamela McCarthy, jointly or severally*** as their true and lawful Attorneys) -in -Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of surety- ship giving and granting unto said Attorneys) -in -Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attorney(s)-in-Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA. effective as of January 1st, 2008. RESOLVED, that a combination of any two of the Chairman of the Board, the President. Executive Vice -President. Senior Vice -President or any Vice President of the corporations be, and that each of them hereby is, authorized to execute this Power of Attorney, qualifying the attomey(s) named in the Power of Attorney to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship, and that the Secretary or any Assistant Secretary of either of the corporations be. and each of them hereby is. authorized to attest the execution of any such Power of Attorney: RESOLVED. FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond. undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective officers and attested by their respective Secretary or Assistant Secretary this November 21, 2013, By�f� 4Z_� _.. fYAN0 tFANY Daniel Young, Senior Vice -President °�� """`i Oti 9 J.•G��POAgrl pPPo�. T. By/OCT. 5 10 : r5 : `z 1967 93 Mark J. Lansdon, Vice President 1 6 State of California County of Orange On ...... November 21. 2013 before me, .. ... Date personally appeared 04 aiZll ., ,�' •1��. IFC -. Place Notary Seal Above .. Antonio Alvaiatlo Notary Public_ Here Insert Name and Title of the Officer oung and Mark J. LansdOn Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) isiare subscribed to the within instrument and acknowledged to me that helshelthey 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 __�__—� CERTIFICATE Antonio Alvarado, Notary Public The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETY AND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore.. that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth in the Power of Attorney are in force as of the date of this Certificate. This Certificate is executed in the City of Irvine, California. this t� l� day of Cassie J. Berrisfor , sistant Secretary ID-1380(Rev.11'13) CHI Construction "SEALED BID" for LAKE STREET BICYCLE TREATMENTS And DOWNTOWN BICYCLE PARKING ice" CC 1.469�—CML 5181 (174) In the CITY OF HUNTINGTON BEACH - DO NOT OPEN WITH REGULAR MAIL Focal Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language FHWA-1273 — Revised May 1, 2012 REQUIRED CONTRACT PROVISIONS FEDERAL -AID. CONSTRUCTION CONTRACTS I. General IL Nondiscrimination III. Nonsegregated Facilities IV. Davis -Bacon and Related Act Provisions V. Contract Work Hours and Safety Standards Act Provisions VI. Subletting or Assigning the Confract VII. Safety:;Accident Prevention VIII. False Statements Conceming. Highway Projects IX. Implementation of Clean.Air Act snd Federal WaterPoilution: Control Act X. Compliance with Govemmentwide Suspension and Debarment Requirements- A. Certification Regarding Use of Contract Funds for Lobbying ATTACHMENTS. A. Employment and Materials Preference for Appalachian Development Highway System or Appalachian Local, Access Road Contracts (included in Appalachian contracts only) I. GENERAL. 1. Form FHWA-1273 must be physically incorporated in each construction contract funded under Title 23 (excluding emergency contracts solely intended for debris removal). The contractor (or subcontractor) must insert this form in each subcontract and further require its inclusion in all lower tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services). The applicable requirements of Form FHWA-1273 are incorporated by reference for work done under any purchase order, rental agreement or agreement for other services. The prime contractor shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider:. Form FHWA-1273 must be included in all Federal -aid design -build contracts, in all subcontracts and in lower tier subcontracts (excluding subcontracts: for design services, purchase orders,rental agreements and other agreements for supplies or services). The design -builder shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Contracting agencies may reference Form FHWA-1273 in bid proposal or request for proposal documents, however, the Form FHWA-1273 must. be physically incorporated (not referenced) in,all contracts, subcontracts and lower -tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services related to a construction contract). 2. Subject to the applicability criteria noted in the following sections, 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. 3. A breach of any of the stipulations contained in these Required Contract Provisions: may be sufficient grounds for withholding of progress payments;, withholding of final payment; termination of the contract,. suspension / debarment or any other action determined to be appropriate by the contracting agency and FHWA, 4. Selection of Labor. During the performance: of this contract, the contractor shall not use convict labor for any purpose within the limits of a construction projectona Federal -aid highway unless it is labor performed by convicts who are. on parole, supervised release, or probation. The term Federal -aid highway, does not include roadways functionally classified as local roads or rural minor collectors. II., NONDISCRIMINATION The provisions of this section, related to 23 CFR.Part:230 are applicable, to All Federal-aidconstruction contracts and to all related construction subcontracts of $10,000 ormore. The provisions of23'CFR Part 230;are not applicable to material supply, engineering;:or architectural service contracts. In addition, the contractor and all subcontractors must comply with the following policies: Executive Order 11246, 41 CFR 60;;29 CFR 1625 1627, Title 23 USC Section 140, the Rehabilitation Act of1973, as amended (29.USC794), Title VI of the Civil Rights Act of'1964,. as amended, and related regulations including 49 CFR. Parts 21, 26 and 27; and 23 CFR Parts:200, 230, and 633. The contractor and all subcontractors must comply with: the requirements of the Equal Opportunity Clause in 4.1. CFR 60-1.4(b) and,. for all construction contracts exceeding $10,000, the Standard Federal Equal.Employment Opportunity Construction Contract Specifications in 41 CFR 60-4.3. Note: The U.S. Department of Labor has exclusive authority to determine compliance with Executive Order 11246 and the policies of the Secretary of Labor including 41 CFR 60,.and 29 CFR 1625-162T The contracting agency and the FHWA have the authority and the responsibility to. ensure compliance with Title 23 USC Section 140, the'Rehabllitation Act of 1973, as amended (29 USC 794), and Title VI of the Civil Rights Act of 1964,.as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. The following. provision is adopted from 23 CFR 230, Appendix A, with appropriate.revisions to conform to the U.S. Department of Labor (US DOL) and FHWA requirements. 1. Equal. Employment Opportunity: Equal employment opportunity (EEO) requirements notto discriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, riles, regulations (28 CFR 35, 29 CFR 1630, 29 CFR 162571627, 41 CFR 60 and 49 CFR 27) and orders of the Secretary of Labor as modified by the provisions prescribed herein,.and imposed 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 provisions of the Americans with Disabilities Act of 1990 (42 U.&C. 12.101 et seq.) set forth.under 26 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 contracting agencyand the Federal Govemment to ensure that it has made every good faith effort to provide equal opportunity with respect to all of its terms and conditions of employment and in their review.of activities under the contract. b. The contractor Will accept as its 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 advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre -apprenticeship, and/or on - the job training." 2. EEO Officer: The contractor will designate and make known to the contracting officers an EEO Officer who will have the responsibility for and must be capable of effectively administering and promoting an active EEO program and who must be assigned adequate authority and responsibility to do so Page 8 of 22 DLA-013 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language 3. Dissemination of Policy: All members of the contractor's staff who are authorized to hire, supervises promote, and discharge employees, or who recommend such action, or who are substantially involved in such action, will be made fully cognizant of, and wjll 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 supervisoryand 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 reviewed 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 minorities and women. 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 implement such policy will be brought to the attention of employees 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 advertisements will be placed in publications having a large circulation among minorities and women in the area from which the project workforce 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 minorities and women. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such identified sources procedures whereby minority and women applicants may be referred to the contractor for employment consideration. b. In the event the contractorhas a valid bargaining agreement providing for exclusive hiring hall referrals, the contractor is expected to observe the provisions of that agreement to the extent that the system meets the contractor's compliance with EEO contract provisions. Where implementation of such an agreement has the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Federal nondiscrimination provisions. c. The contractor will encourage its present employees to refer minorities and women as applicants for employment. Information and procedures_ with regard to referring such applicants will be, discussed with employees. 5. 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 insure 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 indicatesthat 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 its 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 mayaffect 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 their avenues of appeal. 6: Training and Promotion: a. The contractor will assist in locating, qualifying, and increasing the skills of minorities and women who are applicants for employment or current employees. Such efforts should be aimed at developing full journey level status employees in the type of trade :or job classification involved. 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, i.e., apprenticeship, and on- the-job training programs for the geographical area of contract performance. In the event a special provision for training is provided under this contract, this subparagraph will be superseded as indicated in the special, provision. The contracting agency may reserve training positions for persons who receive_ welfare assistance in accordance with 23 U.S.C. 140(a}. c. The contractor will advise employees and applicants for employment of available training programs and entrance requirements for each. ci. The contractor will periodically review the training and promotion potential of employees who are minorities and women and will encourage eligible employees to apply for such training and promotion. 7; Unions: If the contractor relies in whole or in part upon unions as a source of employees, the contractor will use good faith efforts to obtain the cooperation of such unions. to increase opportunities for minorities and women. 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 good faith efforts to develop, in cooperation with the unions, joint training programs aimed toward qualifying more minorities and. women for membership in the unions and increasing the. skills of minorities and women so that they may qualify for higher paying employment, b. The contractor will use good faith efforts to incorporate an EEO clause intoeach 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 it 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 contracting agency Page 9 of22 DLA-OB 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language 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 reasonable flow of 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 minorities and women. The failure of a union to provide sufficient referrals (even though it is obligated to provide exclusive. referrals under the terms of a collective bargaining agreement) does:not' relieve the contractor from the requirements of this paragraph. In the.event the union referral practice prevents the contractor from meeting the obligations pursuant to Executive Order 1,1246, as amended, and these special provisions, such contractor shall immediately notify the contracting agency. 8. Reasonable Accommodation for Applicants / Employees With Disabilities: The contractor must be familiar With the requirements for and comply with the Americans with Disabilities Act: and all rules and regulations established there under. Employers must provide reasonable accommodation in all employment activities unless to do so would cause an undue hardship.. 9. Selection of Subcontractors, Procurement of Materials 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. The contractor shall take all necessary and reasonable steps to ensure nondiscrimination in the administration of this contract. a. The contractor shall notify.all potential subcontractors and suppliers and lessors of their EEO obligations under this contract. b. The contractor will use good faith efforts to ensure subcontractor compliance. with their EEO obligations. 10. Assurance Required by 49 CFR 26.13(b): a. The requirements of 49 CFR Part 26 and the State DOT's U.S. DOT -approved DBE program are incorporated by reference. b. The contractor 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 49 CFR Part 26 in the award and administration of 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 contracting agency deems appropriate. 11. Records and Reports: The contractor shall keep such records as necessary to document compliance with the EEO requirements.. Such records shall be retained for a period of three years following the date of the final payment to the contractor for all contract work and shall be available at reasonable times and places for inspection by authorized representatives of the contracting agency and the FHWA. a. The records kept by the contractor shall document the following: (1) The number and work hours 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 opportunities for minorities and women; and (3) The progress -and efforts being made in locating, hiring, training, qualifying, and upgrading minorities and women; b. The contractors and subcontractors will submit an annual report to the contracting agency each July 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. The staffing data should represent the project work force on board in all or any part ofthe last payroll period preceding the end of July, If on-the-job training is being required by special provision, the contractor will be required to collect and report. training data. The employment data should reflect the work force on board during all or any part of the last payroll period preceding the. end of July. III. NONSEGREGATED FACILITIES This provision is applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The contractor must ensure that facilities provided for employees are provided in such a manner that segregation.on the basis of race,. color, religion, sex, or national origin cannot result. The contractor may neither require such segregated use by written or oral policies nor tolerate such use by employee custom. The contractor's obligation extends further to ensure that its employees are not assigned to perform their services at any location, under the contractor's control, where the facilities are segregated. The term "facilities" includes waiting rooms, work areas, restaurants and other eating areas, time clocks, restrooms, washrooms, locker rooms, and other storage or dressing areas, parking lots, drinking fountains; recreation or entertainment areas, transportation, and housing provided for employees. The contractor shall provide separate or single -user restrooms and necessary dressing or sleeping areas to assure privacy between sexes. 1V. DAVIS-BACON AND RELATED ACT PROVISIONS This section is applicable to all Federal -aid construction projects exceeding.$2,000 and to all related subcontracts and lower -tier subcontracts (regardless of subcontract size). The requirements apply to all projects located within the right-of-way of a roadway that is functionally classified as Federal -aid ,highway, This excludes roadways functionally classified as local roads or rural minor collectors, which are exempt. Contracting agencies_ may elect to apply these requirements to other projects. The following provisions are from the U.S., Department of Labor regulations in 29 CFR 5.5 "Contract provisions and related matters" with minor revisions to conform to the FHWA-1273 format and FHWA program requirements. 1. Minimum wages a. All laborers and mechanics 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 issued by the Secretary of Labor under the Copeland Act (29 CFR part 3)), the full amount of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment computed at rates not less than those contained in the wage determinationof the Secretary of Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics. Page 10 of 22 DLA-OB 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language Contributions made or costs reasonably anticipated for bona fide fringe benefits under section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics.are considered wages paid to such laborers or mechanics, subject to the provisions of paragraph 1.d. of this section; also, regular contributions made or 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 determination for the classification of work actually performed, without:regard to skill, except as provided in 29 CFR 5.5(a)(4).'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. The wage determination (including any additional classification and wage rates conformed under paragraph 1.b. of this section) and the Davis -Bacon poster (WH-1321) 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. b. (1) The contracting officer shall require that any class of laborers or mechanics, including helPers, which is not listed in the wage determination and which is to be employed under the contract shall be classified in conformance with the wage determination. The contracting officer shall approve an additional classification and wage rate and fringe benefits therefore only when the, following criteria have been:met: (i) The work;to be performed by the classification requested is not performed by a classification in the wage determination; and (ii) The classification is utilized in the area by the construction industry; and (iii) The proposed wage rate, including any bona fide fringe. benefits; bears a reasonable relationship to the wage. rates contained in the wage determination. (2) If the contractor and.the laborers and.mechanicsto be employed in the classification (if known), 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 Administrator of the Wage and Hour Division, Employment Standards Administration, U.S, Department of Labor, Washington, DC 20210. The 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. (3) In the event the contractor, the laborers or mechanics to be employed in the 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. The Wage and Hour 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. (4) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs 1.b.(2) or 1.b.(3) of this section, shall be paid to ail workers performing work in the classification under this contract from the first day on which work. is performed in the classification. c. Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate; the contractor shall either pay the, benefit as stated inthe wage determination or shall pay another bona fide fringe benefit or an. hourly cash equivalent thereof. d. If the contractor does not make payments to a trustee or other third person, the contractor may consider as part of the:wa9es, of any laborer or mechanic 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. 2. Withholding The contracting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor, withhold or cause to be withheld from the contractor 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, so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics; including apprentices, trainees, and helpers, employed by contractor or any suboontractorthe 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 contracting agency may, after 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. 3. Payrolls and basic records a. Payrolls and basic records relating thereto shall be maintained by the contractor during the,course of the work. and preserved for a; period of three years thereafter for all laborers and mechanics working at the site. of the work. Such records shall contain the name, address, and social:security number of each such worker, his or her correct classification, hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the _types described. in section 1(b)(2)(B) of the Davis -Bacon Act), daily.and weekly number of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv) that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under aplan or program described in section 1(b)(2)(B) of the Davis -Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits is enforceable; that: the plan or program is financially responsible, and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or actual cost incurred in providing such benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs, the; registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. Page 11 of 22 DLA-®B.13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language b. (1) The contractor shall submit weekly for each week in which any contract work is performed a copy of all payrolls to the contracting agency. The payrolls. submitted shall set out accurately and completely all of the information required to be maintained under 29 CFR 5.5(a)(3)(i), except that full social security numbers and home addresses shall not be included on weekly transmittals. Instead the payrolls shall only need to include an individually identifying number for each employee ( e.g. , the last four digits of the employee's social security number). The required weekly payroll information may be submitted in any form desired. Optional Form WH-347 is available for this purpose from the Wage and Hour Division Web site 'at hftp:ltwww:dol.gov/esalwhd/formstwh347instr.htm or its successor site. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the full social security number_ and current address of each covered worker, and shall provide them upon request to the contracting agency for transmission to the State DOT, the FHWA or the Wage and Hour Division. of the Department of Labor for purposes of an investigation or audit of compliance with prevailing wage requirements. It is not a violation of this.section for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for its own records; without weekly submission to the contracting agency.. (2) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (I) That the payroll for the payroll period contains the information required to be provided under §5.5 (a)(3)(ii) of Regulations, 29 CFR part 5, the appropriate information is being maintained under §5.5 (a)(3)(i) of Regulations, 29 CFR part 5, and that such information is correct and complete; (ii) That each 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 permissible deductions as set forth in Regulations, 29 CFR part 3; (iii) That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or cash equivalents for the classification of work performed, as specified in the applicable wage determination incorporated into the contract. (3) 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 3.b.(2) of this section. (4) The falsification of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under section 1001 of title 18 and section 231 of title 31 of the United States Code. c. The contractor or subcontractor shall make the records required under paragraph 3.a. of this section available for inspection, copying, or' transcription by authorized representatives of the contracting agency, the State DOT, the FHWA, or the Department of Labor, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records or to make them available, the FHWA may, after written notice to the contractor, the contracting agency or the State DOT, take such action as may be; necessary 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 5.12, 4. Apprentices and trainees a. Apprentices (programs of the USDOL). 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 U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or if a person is employed in his or 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 Office of Apprenticeship Training, Employer and Labor Services or State Apprenticeship Agency (where appropriate) to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices to journeymen 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 worker 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 on 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 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's hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. 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 journeymen hourly rate specified in the applicable wage determination. 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 determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved. b. Trainees (programs of the USDOL). 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 U.S. Department of Labor, Employment and. Training Administration Page 12 of 22 DLA-OB 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration: Every trainee must be paid at not less than the rate specified in the approved program for the trainee's level of progress, expressed as a percentage of the journeyman 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 journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices. 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 paid 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. In the event the Employment and Training Administration withdraws approval of a training program, the contractor 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. Equal employment opportunity. The utilization of apprentices, trainees and journeymen under this part shall:be in conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR part 30. d. 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 IV. The straight time hourly wage rates for apprentices and trainees under such programs will be established by the particular programs. The ratio of apprentices and trainees to journeymen shall not be greaterthan permitted by the terms of the particular program. 5. Compliance with Copeland Act requirements. The,contractor shall comply with the requirements:of 29 CFR part 3, which are incorporated by reference, in this contract. 6. Subcontracts. The contractor or subcontractor shall insert Form FHWA-1273 in any subcontracts and also require the subcontractors to include Form FHWA-1273 in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR 5.5. 7. Contract termination: debarment. A breach of the contract clauses in 29 CFR 5.5 may be grounds for termination of the contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR 5.12. 8. Compliance with Davis -Bacon and Related Act requirements. All rulings and interpretations of the Davis -Bacon and Related Acts contained in 29 CFR parts 1; 3; and 5 are herein incorporated, by reference in this contract. 9. Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall. not be subject to the general disputes clause of this contract. Such disputes shall be resolved in accordance with the procedures of the Department of Labor set forth in 29 CFR parts 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 U.S. Department of Labor, or the employees or their representatives. 10. Certification of eligibility. a. By entering into this contract; the contractor certifies that neither it (nor he or she) nor any person or firm who has an interest in the contractor's firm is a person or firm ineligible to be awarded: Government contracts by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). b. No part of this contract shall be subcontractedto any person or firm ineligible for award of a Government contract by -virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). c. The penalty for making false statements, is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. V. CONTRACT WORK HOURS.AND SAFETY STANDARDS ACT The following clauses.apply to any Federal -aid construction contract in an amount in excess of $10.0,000 and subject to the overtime provisions of the Contract Work Hours and Safety Standards Act. These clauses shall be inserted in addition to the clauses required by 29 CFR 5.5(a) or 29 CFR 4.6 As used in this paragraph, the terms laborers and mechanics include watchmen and guards. 1.Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek: 2. Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (1.) of this section, the contractor and any subcontractor responsible therefor shall be liable for the 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 or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (1.) of this section, in the sum of $10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (1.) of this section. 3. Withholding for unpaid wages and liquidated damages. The FHWA or the contacting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor 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 Page 13 of 22 IDLA-OB 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-0 Required Federal -aid Contract Language prime. contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determine_ d 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 (2.) of this section.. 4. Subcontracts._ The contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (1.) through (4.) of this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The primecontractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (1_) through (4.) of this section, VI. SUBLETTING OR ASSIGNING THE CONTRACT This provision is applicable to. all Federal -aid construction contrails on the National Highway System. 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 contracting agency. 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 635.116). a. The term "perform work with its own organization" refers to workers employed or leased 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 or lower tier subcontractor, agents of the prime contractor, or any other assignees. The tern may include payments for the costs of hiring leased employees from an employee leasing firm meeting all relevant Federal and State regulatory requirements: Leased employees may only be included in this term if the prime contractor meets all of the -following conditions:. (1) the prime contractor maintains control over the supervision of the day-to-day activities of the leased employees; (2) the prime contractor remains responsible for the quality of the work of the leased employees; (3) the prime contractor retains all power to accept or exclude individual employees from work on the project; and (4) the prime contractor remains ultimately responsible for the payment of predetermined minimum wages, the submission of payrolls, statements of compliance and all other Federal regulatory requirements. 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 or propose on the contract as awhole and in general are to be limited to minor components of the overall contract. 2. The contract amount upon which the requirements set forth in paragraph (1) of Section VI is computed includes the cost of material and manufactured products which are to be purchased or produced by the contractor under the contract provisions. 3. The contractor shall furnish (a) a competent superintendent or supervisor who is employed by the firm, has full authority 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 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 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 contracting agency has assured that each subcontract is evidenced in writing and that it contains all pertinent provisions and requirements of the prime contract. 5. The 30% self -performance requirement of paragraph (1) is not. .applicable to design -build contracts; however, contracting agencies may establish their own self -performance requirements.. VII. SAFETY: ACCIDENT PREVENTION This provision is.applicable to all Federal -aid construction contracts. and, to all related subcontracts. 1, In the performance of this contrail 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 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 protectproperty in connection with the performance of the work covered by the contract. 2. 1t is a condition of this contract, and shall be made a condition of each subcontract, which the contractor enters into pursuant 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. 3704). 3. Pursuant to 29 CFR 1926.3, it is a condition of this contract that the Secretary of Labor or authorized representative thereof,. shalt 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.3704). Vill. FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. In order to assure high quality and, durable construction in conformity with approved plans and specifications and a high degree of 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 misrepresentation with respect to any facts related to the project is a violation of Federal law.. To prevent any misunderstanding regarding the seriousness of these and similar acts, Form FHWA-1022 shall be posted on each Federal -aid highway project (23 CFR 635) in one or more places Page 14 of 22 DLA-OB 13-06 August 12, 2013 Local Assistance,Procedures Manual Exhibit 12-G Required Federal -aid Contract ]Language where it is readily available to all persons concerned with the project: 18 U.S.C. 1020 reads as follows: 'Whoever, being an officer, agent, or employee of the United States, or of any State or Territory, orwhoever, whether a person, association, firm; or corporation, knowingly makes any false statement, .false representation, or false report as.to the character,. quality, quantity, or cost of the material.used orto be used, or the quantity or quality of the work performed or to be performed, or the costthereof in connection with the submission of plans, maps, specifications, contracts, oncosts of construction on any highway or related project submitted for approval `to the Secretary of Transportation; or. Whoever knowingly makes any false statement, false representation, false report or false claim with respect to the character, quality, quantity, or cost of any work performed or to be performed, 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 representation 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 Stat. 355), as amended, and supplemented; Shall be fined under this title or imprisoned not morethan. years or both." IX. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. By submission of this'bid/proposalor the execution of this contract; or subcontract, as appropriate, the bidder, proposer, Federal -aid construction contractor, or subcontractor, as appropriate; will be. deemed to have stipulated as follows: 1. That any person who is or will be utilized in the performance of this contract is not prohibited from receiving an award due to a. violation of Section 508,of the Clean Water Act or Section 306 of the Clean Air Act. 2. That the contractor agrees to include or cause to be included the requirements of paragraph (1) of this Section X in every subcontract, and further agrees to take such action as the contracting agency may direct as a means of enforcing such requirements- X. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION This provision is applicable to all Federal -aid construction contracts, design -build contracts, subcontracts, lower -tier subcontracts, purchase orders; lease agreements_, consultant contracts. or any other covered transaction requiring FHWA approval or that is estimated.to cost $25,000 or more — as defined in 2 CFR Parts 180 and 1200. 1. Instructions for Certification — First Tier Participants: a. By signing and submitting this proposal, the prospective first tier 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 first tierparticipant 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 first tierparticipant to furnish a certification or an explanation shall disqualify such a person,from participation in this transaction. c. The certification in this clause is a material representation of fact upon which reliance was placed when the contracting agency determined to enter into this transaction. If it is later determined that the prospective participant knowingly rendered an.erroneous: certification, in addition. to: other remedies available to the Federal Government, the.contracting agency may terminate this transaction for cause of default. d. The prospective.first tier participant shall provide immediate written notice to the.contracting agency to whom this proposal is submitted if any time.the prospective first tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. e. The terms "covered transaction, `"'debarred,", %uspended," "ineligible," "participant," "person, "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200.. "First Tier Covered Transactions" refers to. any covered transaction between a granteeorsubgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction. (such as subcontracts)_. "First Tier: Participant." refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a.First. Tier Participant or other Lower Tier Participants. (such as subcontractors and suppliers). f. The prospective.first tier participant agrees by submitting this proposal that, should the proposed covered. transaction be. entered into, it shall not knowingly enterinto 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 entering into this transaction. g. The prospective first tier participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary. Exclusion -Lower Tier Covered Transactions," provided by the department or contracting agency, entering into, this covered transaction, .without modification, ,in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. h. 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, suspended, ineligible, or voluntarily excluded from the covered. transaction, unless it knows that the certification is erroneous, A participant is responsible. for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in.covered transactions: To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant.may, but is not required to, check the Excluded Parties List System,website (htt�s://wnvt�:egls.gov/), which is compiled by the General. Services Administration. i. Nothing contained in the foregoing shall be construed to.require the establishment of a system of records in. order to render in good faith the certification required by this clause. The knowledge and Page 15 of 22 DLA-OB 13-06 August 12, 2013 Local Assistance Procedures Manual. Exhibit 12-G Required. Federal -aid Contract Language information of the prospective 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 (0 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, in or voluntarily excluded from participation.in this transaction, in addition to other remedies available to the Federal Government, the,department or agency may terminate this transaction for cause or default. 2. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - First: Tier. Participants: a. The prospective first tier participant certifies to the best of its knowledge and belief, that it and its principals: (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactionsby any Federal department or agency; (2) Have not within a three=yearperiod 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; (3) 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 (a)(2) of this certification; and (4) Have not % ithin a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. b. Where the prospective participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. 2:. Instructions for Certification. = Lower Tier Participants: (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200) 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," "participant, "person, "principal," and "voluntarily excluded," as used in this clause, are defined in CFR Parts 180 and 1200. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. ".First Tier Covered Transactions" refers to any covered transaction between a grantee orsubgrantee.of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). ".First Tier, Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds.(such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants,(such as subcontractors and suppliers). e. The prospective lowertier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, itshall not knowingly enter into any lowectiercovered transaction with a person who is debarred, suspended, declared ineligible, or voluntarilyexcluded 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 exceeding,the $253000 threshold. 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, suspended, ineligible, or voluntarily excluded from the, covered transaction, unless.it knows that the certification is erroneous. A participant is responsible for ensuring that its principals are, not suspended, debarred; or otherwise, ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each, participant may, but is not required to, check. the Excluded Parties List System website Ihttps://« iw:epls•eovLl, which is com_ piled by the General Services Administration: h: 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 normall y 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 department 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 Participants: 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 participating; in covered transactions by any Federal department or agency. Page 16 of 22 DLA-01313-06. August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language: 2. Where the prospective lower tier participant is unable to certify to any the statements in this certification, such prospective participant shall attach an explanation to this proposal. XI. CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING This provision is 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 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 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, grant,. loan, or cooperative agreement, the undersigned shall. complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 2. This certification is a material representation, of fact upon which reliance was placed when this transaction was made or entered into: Submissionof 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 be subject to a civil penalty of not less than $10,000.and not more than $100,000 for each such failure. 3. The prospective participant also agrees by submitting its bid or proposal that the participant shalt require that the language of this certification be included in alt lower tier subcontracts, which exceed $100,000. and that all such recipients shall certify and disclose accordingly. Page 17 of 22 DLA-OB 13-06 August 12; 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language 12. FEAL LE AND IMIIONORITY GOALS To comply with SectionlI, "Nondiscrimination," of "Required Contract'Provisions Federal -Aid Construction Contracts;" the following are goals for female:and minority utilization goals for Federal -aid construction contracts and subcontracts that exceed $10,000: The_nationwide goal for female utilization is 6.9 percent. The goals for minority utilization [45 Fed Reg 65984'(10/3/1980)] are as follows: MINORITY UTILIZATION GOALS, Goal Economic Area (Percent Redding CA:. 174 Non-SMSA (Standard Metropolitan Statistical Area) Counties: 6.8 CA Lassen; CA Modoc; CA Plumas; CA Shasta; CA Siskiyou;, CA Tehama Eureka, CA 175 Non-SMSA Counties: 6.6 CA Del Norte; CA Humboldt; CA Trinity 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 176 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 Sacramento, CA: SMSA Counties: 6920 Sacramento, CA 16.1 177 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 Stockton -Modesto, CA: SMSA_ Counties, 5170 Modesto, CA 12.3 178 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 Tuolumne Page:18 of 22 DLA-OB 13-06 August 12, 2013 Local. Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language 179 Fresno -Bakersfield, CA SMSA Counties: 0.680 Bakersfield, CA CA Kern 2840 Fresno, CA CA Fresno Non-SMSA Counties: CA Kings; CA Madera; CA Tulare _. 19.1, 261.1 23.6 Los Angeles, CA: SMSA Counties: 0360 Anaheim -Santa Ana -Garden Grove, CA CA Orange 4480 Los Angeles -Long Beach, CA 28.3 CA Los Angeles 180 6000 Oxnard -Simi Valley -Ventura, CA 21.5 CA Ventura 6780 Riverside -San Bernardino -Ontario, 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 San Diego, .CA: SMSA Counties 181 7320 San Diego, CA 16.9 CA San Diego Non-SMSA Counties 18:2. CA Imperial 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. 13. FEDERAL TRAINEE PIiOGR" For the Federal training program, the number of trainees or apprentices is 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 1 st year of apprenticeship or training. Distribute the number of apprentices or trainees among the work classifications on the basis of your needs and, the availability of journeymen in the various classifications within a reasonable recruitment area. Before starting work, submit to the City/County of Page 1.9 of 22 DLA-OD 13-06 August 12, 2013. LocalAssistance Procedures. Manual Exhibit 12-G Required Federal -aid Contract Language 1. Number of apprentices or trainees to be trained for each classification. 2. Training program to be used 3. Training starting date for each classification Obtain the City/County's of approval for this submitted: information before you start work. The City/County of credits you for each apprentice or trainee you employ on the work who is currently enrolled or becomes enrolled in an, approved program. The primary objective of this section is to train and upgrade minorities and women toward journeymen status,. Make every effort to enroll.minority and women apprentices or trainees, such as conducting systematic.and direct recruitment through public and private sources likely to yield minority and women. apprentices or trainees, to the. extent they are available within a reasonable recruitment area. Show that you have made the efforts. In making these efforts, do not discriminate. against any applicant for training. Do not employ as an apprentice or trainee an employee: 1. In any classification in which the: employee has successfully completed a training course leading to journeyman status or in which the employee has been employed. as a journeyman 2. Who is not registered in a program approved by the US Department of Labors Bureau of Apprenticeship and Training. Ask the employee . f the employee has successfully completed a training course leading to journeyman status or has been: employed as a journeyman. Your records must show the employee's answers! to the questions. In your training program, establish the minimum length and training type for each classification. The City/County of and FHWA approves a program if one of the following :is met, 1. It is calculated to: ® Meet the your equal employment opportunity responsibilities Qualify the average apprentice or trainee for journeyman status in the classification involved by the end of the training. period 2. It is registered with the.U.S. Department of Labor, Bureau of Apprenticeship and Training, and it is administered in a way consistent with the equal employment responsibilities of Federal -aid highway construction contracts. Obtain the State's approval for your training program before you ,start work involving the classification covered by the program. . Provide training in the construction crafts, not in clerk -typist or secretarial -type positions. Training is allowed in lower level management positions such as office engineers; estimators, and timekeepers if the training is oriented toward construction applications: Training is allowed. in the laborer classification if significant and meaningful training is provided. and, approved. by the division office. Off -site trairung.is allowed if the training is an integral part of an approved: training program and does not make up a significant part of the overall training. The City/County of reimburses you 80 cents per hour of training given an employee on this, contract: under an approved training program: 1. For on -site training 2. For off -site training if the apprentice or trainee is currently employed. on a Federal -aid project and you do at least one of the following: Contribute to the cost of the training ® Provide the instruction to the apprentice or trainee Pay the apprentice's or trainee's wages during theoff-site training period 3. If you comply this section. Page 20 of 22 DLA-OB 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language Each apprentice or trainee must:; 1. Begin training on the project: as soon as feasible after the start of work involving the apprentice's or trainee's skill 2. Remain on the project as long as training opportunities exist in the apprentice's or trainee's work classification or until the apprentice or trainee has completed the training program Furnish the apprentice or trainee: 1. Copy of the program you will comply with in providing the training 2. Certification showing the type and length of training satisfactorily completed 14. TITLE VIASSURf1NCES During the performance of this Agreement, the contractor, for itself, its assignees and successors in interest (hereinafter collectively referred. to as CONTRACTOR) agrees as follows-. (1) Compliance with Regulations: CONTRACTOR shall comply with the regulations relative to nondiscrimination in federally assisted programs of the Department of Transportation; Title 49, 'Code of Federal Regulations; Part 2.1, as they maybe amended from time to time, (hereinafter referred to as the REGULATIONS), which are herein incorporated by reference and made a part of this agreement., (2) Nondiscrimination: CONTRACTOR, with regard to the work performed by it during the AGREEMENT; shall not discriminate on the grounds of race,. color, sex, national origin, religion, age; or disability in the selection and retention of sub -applicants, including procurements of materials and leases of equipment. CONTRACTOR shall not participate either directly or indirectly in the discrimination prohibited by Section 21.5 of the Regulations; including employment practices when the agreement covers a program set. forth in Appendix B of the Regulations._ (3) Solicitations for Sub -agreements; Including Procurements of Materials and Equipment: In all solicitations either by competitive bidding or negotiation made by CONTRACTOR for work to be performed under.a Sub -agreement, including procurements of materials or leases of equipment, each potential sub -applicant or supplier shall be notified by CONTRACTOR of the CONTRACTOR'S obligations under this Agreement and the Regulations relative to nondiscrimination on the grounds of race, color, or national origin. (4) Information and Reports: CONTRACTOR- shall provide all information and reports required by the Regulations, or directives issued pursuant thereto, and shall permit access to its books, records, accounts, other sources of information, and its facilities as may be determined by the California Department of Transportation or FHWA to be pertinent to ascertain compliance with.such Regulations or directives. Where any information required of CONTRACTOR is in the exclusive -possession of another who fails or refuses to furnish this information, CONTRACTOR shall so certify to the. California Department of Transportation or the FHWA as appropriate,_ and shall set forth what efforts CONTRACTOR has made to obtain the information (5) Sanctions for Noncompliance In the event of CONTRACTOR's noncompliance with the nondiscrimination provisions of this agreement, the California Department of Transportation shall. impose such agreement sanctions as it or the FHWA may determine to be appropriate, including, but. not limited to: (a) withholding of payments to CONTRACTOR under the Agreement within a reasonable period of time, not to exceed 90 days; and/or (b) cancellation, termination or suspension of the Agreement, in whole or in part. (6) Incorporation of Provisions: CONTRACTOR shall includetheprovisions of paragraphs (1) through (6) in every sub -agreement, including procurements of materials. and leases of equipment, unless, exempt by the Regulations, or directives. issued pursuant thereto. Page 21 of 22 DLA-OB 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language CONTRACTOR shall take such action with respect.to any sub -agreement or procurement as the California Department of Transportation or F1 WA may direct as a means of enforcing such provisions. including sanctions for noncompliance, provided, however, that,, in the event CONTRACTOR becomes' involved in, or is threatened. with, litigation with a sub -applicant or supplier as a result of such direction, CONTRACTOR may request the California Department of Transportation enter into such: litigation. to protect the interests of the State, and, in addition, CONTRACTOR may request the United States to enter into such litigation to protect the interests of the United States. MAINTAIN RECORDS AND SUBMIT REPORTS. DOCUMENTING YOUR PERFORMANCE UNDER THIS SECTION Page 22 of 22 DLA-OB 13-06 August 12, 2013 RECEIVED BY: (Name) (Date) TO: FROM: DATE: SUBJECT: CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office after signing/dating CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION City Treasurer City Cler _ 3�ij Bond Acceptance have received the bonds for l i17LI CAPITAL PROJECTS (Includes CC's and MSC's) Performance Bond No. Payment Bond (Labor and Materials) Bond No. Warranty or Maintenance Bond No. TRACT AND DEVELOPMENT Faithful Performance Bond No. Labor and Material Bond No. Guarantee and Warranty Bond No. Monument Bond No. Franchise Bond No. Letter of Credit Bond No. Other Re: Tract No. CC No. U MSC No. Other No. g:/forms/bond transmittal to treasurer (Company Name) 3 Approved / —04 (Council Approval Date) Agenda Item No. `7`/` City Clerk Vault No. SIRE System ID No.�S�C�6 Executed Four Counterparts Bond No. 756634P Premium: $520.00 PERFORMANCE BOND Premium is for contract term and is subject to adjustment based on final contract price KNOW ALL PERSONS BY THESE PRESENTS: WHEREAS, Cityof Huntington Beach (hereinafter referred to as "City") has, by written agreement dated , 20_, entered into a contract with Creative Home DBA CHI Construction 701 E. Ball Road #101, Anaheim. CA .2805 (name and address of Contractor) (hereinafter referred to as "Principal"), for performance of the work described as follows: Lake Street Bicvcle Treatments (Project Title) WHEREAS, said contract, and all documents referenced therein (hereinafter collectively "Contract"), are incorporated herein by this reference made a part hereof as though set forth herein in full. WHEREAS, said Principal is required under the terms of the Contract to furnish a bond guaranteeing the prompt, full and faithful performance of said Contract. NOW THEREFORE, we, the undersigned, as Principal, and Developers Surety and Indemnity Company 17771 Cowan, Ste. 100, Irvine, CA 92614 (name and address of Surety) (a duly admitted surety insurer under the laws of the State of California and hereinafter referred to as "Surety"), as Surety, are held and firmly bound unto City in the penal sum of Twentv Thousand Eight Hundred Eight and No/100 Dollars ($ 20,808.00 ), this amount being not less than one hundred percent of the price set forth in the Contract, in lawful money of the United States, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT if the Principal shall promptly, fully and faithfully perform each and all of the covenants, obligations and things to be done and performed by the Principal in strict accordance with the terms of the Contract as said contract may be altered, amended or modified from time to time; and if the Principal shall indemnify and save harmless City and all of City's officers, agents and employees (hereinafter collectively referred to as "Obligees") from any and all losses, liability and damages, claims, judgments, stop notices, fees and costs of every description, whether imposed by law or in equity, which may be incurred by the Obligees by reason of the failure or default on the part of the Principal in the performance of any or all of the terms or the obligations of the Contract, including all alterations, amendments and modifications thereto, and any warranties or guarantees required thereunder; then this obligation shall be void; otherwise, it shall be and shall remain in full force and effect. Surety stipulates and agrees, for value received, that no adjustment of the time or price in the Contract or any alteration, change, deletion, addition or other modification to the Contract, or the work to be performed thereunder, shall in any way affect, limit, restrict, impair or release the obligations of the Surety under this Bond. Surety waives notice of any adjustment of contract time or contract price, and 277591.1 PERFORMANCE BOND Page 1 of 2 Bond No. 756634P any other alteration, change, deletion, addition or other modification to the Contract, or the work to be performed thereunder, and agrees to automatically adjust the penal sum of this Bond to reflect such adjustments, alterations, changes, deletions, additions or other modifications. Surety agrees to provide written confirmation of such adjustments•in the penal sum to City on not less than a quarterly basis. Surety also waives the provisions of Civil Code §§ 2845 and 2849. The obligations of this Bond shall survive the completion of the work described in the Contract as to all obligations and liabilities of the Principal which survive completion of the work. IN WITNESS WHEREOF, each party represents and warrants that this instrument has been duly executed by Principal and Surety, on the date set forth below, that the name of each corporate party being affixed hereto is such party's proper legal name and that the individuals signing this instrument have been duly authorized pursuant to the authority of its governing body. Surety, by execution of this bond, waives any defense which Surety has or may have by reason of any failure of the Principal to execute or properly execute this bond. Dated: February 18, 2015 ATTEST Creative Home DBA CHI Construction (Corporate Seal) (Principal Name) By: Name:_ Title: i9J24rS'l a ATTEST Developers Surety and Indemnity Company (Corporate Seal) (Surety Name) By: Name: (Signature of Attorney -in -Fact for S rety) (Attach Attorney -in -Fact Certificate) (800 1782-1546 (Area Code & Telephone Number of Surety) APPROVED AS TO FORM: CITY _E.kIUNTINGTON BEACH aYeAnn cifer Mc ath '14164 ity Attorney Note: This bond must be executed in duplicate and dated, aff signatures must be notarized, and evidence of the authority of any person signing as attome)o,h-fact must be attached. 277591.1 PERFORMANCE BOND Page 2 of 2 CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ` SS. County of San Bernardino /) On February 18, 2015 before me personally appeared Cynthia J. Young LAURIE B. DRUCK Commission # 1982312 Notary Public California D Z :�._� Z 'r, San Bernardino County ' My Comm. Expires Jul 14, 2016 Name and Title of Officer (e.g., "Jane Doe, Notary Public") Name(s) of Signers) who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her authorized capacity, and that by her signature on the instrument the person, or the entity upon behalf of which the person 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. � 8 e 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: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: O Individual O Corporate Officer Title O Partner -- O Limited O General O Attorney -in -Fact O Trustee O Guardian or Conservator Other: Signer is Representing: Number of Pages: Top of thumb here No. 6695 STATE OF CALIFORNIA ]DEPARTMENT OF INSURANCE SAN FRANCISCO Certificate of Authority THIS 1S TO CERTIFY, That, pursuant to lire Insurance Corte of the State of California, Developers Surety and lndenutity Company of West Des Moines, Iowa, organized under the lrnvr of Iowa, subject to ibr Arricles of Incorporation or other fundamental organiZtuional dot.uments, is hereby authorized to transact within this State, subje n to all pro vi,rimis of this Certificate, the following classes of insurance, Surety a,r such rla.rses are now or may heretrfter be defined in the Insurance Laws of the State of California. THIS CERTIFICATE is expressly conditioned upon tite !colder hereofnow and hereafter bring in full compliance with all, and not in violation ofany, ofthe applicable laws and lawful requirements made wider authority of the laws of the State of Cal fortia as long ar .rurlr laws or requirements tire in ejjecl and applicable, and as such laws and retlrurements now (ire, or nary hrrea)ler be rlronged orantended, 1N WITNESS WHEREOF, effective as ofthe 30th day of August, 199.9, 1 have heretauo set my hand atul caused my official sea( to he affued this 30th day ofAugurt, 1999. Fee S2833.00 Ree. No, Chuck Quackenbush hcrurunce C'ornmf.riro,, Filed 3/3/99 Bp Victoria S. Sidbur)+ Drrynnp Certification 1, the unrlersigrrerl Insurance C.ommisslourr of the Slate r, fCalifornia, tlo hereby cart j+that 1 hove. compared the above coP), of Certlfrcahr u/'AWhority with the drrplirate oforiginal now orr,frle in nry ojTjt`e,, clod thou the same is a frill, true, and correel transcript thereof, and of the whole ofsctirj rluplit:utr., a nd said Ccrttftcatc olAttthork)' is' now in f r1(1orre and eIrcct. IN WITNESS WHEREOF, / htive heremito set my hru)d and cattred my olTcittl seal to be affrxed this 21st day of October. 2005. John Gorrimenrlr lu.u,rn m:c ravena icnicr llv Dui b )A,_ +.. 1Peudiae D ,,Imlrea POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box 19725, IRVINE, CA 92623 (949) 263-3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each hereby make, constitute and appoint: ***Cynthia J. Young, Jay P. Freeman, Laurie B. Druck, Pamela McCarthy, jointly or severally*** as their true and lawful Attorney(s)-in-Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of surety- ship giving and granting unto said Attomey(s)-in-Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attomey(s)-in-Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2008. RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice -President, Senior Vice -President or any Vice President of the corporations be, and that each of them hereby is, authorized to execute this Power of Attorney, qualifying the attorney(s) named in the Power of Attorney to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of either of the corporations be, and each of them hereby is, authorized to. attest the execution of any such Power of Attorney; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective officers and attested by their respective Secretary or Assistant Secretary this November 21, 2013. By; ANfl'�a; OitpANyoF Cl Daniel Young, Senior Vice President ,. pp ��Fy -,�,r �p O�PO9 _V By: Mark J. Lansdon, Vice -President State of California County of Orange On November 21, 2013 before me, Date OCT. �. 1936 r$, Antonio Alvarado. Notary Pu Here Insert Name and Title of the Officer personally appeared Daniel Young and Mark J. Lansdon Name(s) of Signer(s) ! ar:�`r • 1 � 5K v _ W NotaryPlace •. - 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 CERTIFICATE Antonio Alvarado, Notary Public The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETY AND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth in the Power of Attorney are in force as of the date of this Certificate. `{�y of r— This Certificate is executed in the City of Irvine, California, this J& ma':�LCadG�t e� l ��S By: &"' - . Cassie J. Berrisfo ssistant Secretary ID-1380(Rev.11/13) Executed Four Counterparts Bond No. 756634P Premium included in charge for PAYMENT EON® Performance Bond (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS, the City of Huntington Beach (hereinafter referred to as "City") has awarded to Creative Home DBA CHI Construction 701 E. Ball Road #101, Anaheim. CA 92805 (name and address of Contractor) (hereinafter referred to as "Principal"), a contract ("Contract") for the work described as follows: Lake Street Bicycle Treatments (project title) WHEREAS, Principal is required under the terms of the Contract and the California Civil Code to secure the payment of claims of laborers, mechanics, materialmen, and other persons as provided by law. NOW THEREFORE, we, the undersigned Principal, and Developers Surety and Indemnity Company 17771 Cowan Ste 100, Irvine, CA 92614 (name and address of Surety) (a duly admitted surety insurer under the laws of the State of California and hereinafter referred to as "Surety"), as Surety, are held and firmly bound unto City in the penal sum of Twenty Thousand Eiqht Hundred Eipht and No/100 dollars, ($ 20,808.00 ), this amount being not less than one hundred percent (100%) of the total price set forth in the Contract, in lawful money of the United States of America, for the payment of which sum, well and truly to be made, we bind ourselves, and each of our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the Principal, his, her, or its heirs, executors, administrators, successors or assigns, or subcontractors shall fail to pay any of the persons named in Section 3181 of the California Civil Code ("Claimants") for all labor, materials or services used or reasonably required for use in performance of the work described in the Contract, or any amounts due under the Unemployment Insurance Code with respect to work or labor performed by any such Claimant, or prevailing wages due and penalties incurred pursuant to Sections 1774, 1775, 1813 or 1815 of the Labor Code, or any amounts required to be deducted, withheld and paid over to the Employment Development Department from the wages of employees of the Principal and Subcontractors pursuant to Section 13020 of the Unemployment Insurance Code with respect to the work or labor performed under the Contract, Surety will pay for the same, in an amount not exceeding the penal sum specified in this bond; otherwise, this obligation shall be null and void. This bond shall inure to the benefit of any of the persons named in Section 3181 of the California Civil Code so as to give a right of action to such persons or their assigns. In case any action is brought upon this bond, Surety further agrees to pay all court costs and a reasonable attorney's fee in an amount fixed by the court. Surety stipulates and agrees, for value received, that no change, extension of time, alteration, addition or modification to the terms of the Contract, or any contract document or any work to be performed thereunder, whether made after notice or not, shall in any way affect, impair or release the obligations of Surety under this bond. Surety hereby waives notice of any such change, 7.77589.1 PAYMENT BOND Page 1 of 2 Bond No. 756634P extension of time, alteration, addition, or modification to the terms of the Contract, the contract documents or the work thereunder. Surety also waives the provisions of California Civil Code §§ 2845 and 2849. IN WITNESS WHEROF, each party represents and warrants that this instrument has been duly executed by Principal and Surety, on the date set forth below, that the name of each corporate party being affixed hereto is such parry's proper legal name and that the individuals signing this instrument have been duly authorized pursuant to the authority of its governing body. Surety, by execution of this bond, waives any defense which Surety has or may have by reason of any failure of the Principal to execute or properly execute this bond. Dated: February 18, 2015 ATTEST (Corporate Seal) ATTEST (Corporate Seal) (Attach Attorney -in -Fact Certificate) Creative Home DBA CHI Construction (Principal Name) By: Name: Its: Developers Surety and Indemnity Company 1 (Surety Name) By: Name: ' nt�JVni - - (Signature of Attomey-in-Fact for urety) (= 782-1548 (Area Code & Telephone Number of Surety) APPROVED AS TO FORM: CITY OF HUNTINGTON BEACH ByJennifer M Mc rath Attorney s Note: This bond must be executed in duplicate and dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney -in -fact must be attached. 277589.1 PAYMENT BOND Page 2 of 2 CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ` ss. County of San Bernardino /) On February 18, 2015 before me personally appeared Cynthia J. Young Name and Title of Officer (e.g., "Jane Doe, Notary Public") Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her authorized capacity, and that by her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. LAURIE B. 'DR I certify under PENALTY OF PERJURY under the laws of _ Commission # 1982312 z the State of California that the foregoing paragraph is -� Notary Public - California z Z D true and correct. San Bernardino County My Comm. Expires Jul 14, 2016 WITNESS my hand and official seal. 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: Document Date: Number of Pages: Signers) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: 0 Individual O Corporate Officer Title 0 Partner -- O Limited 0 General 0 Attorney -in -Fact O Trustee 0 Guardian or Conservator Other: Signer is Representing: Top of thumb here No. 8895 STATE OF CALIFORNIA DEPARTMENT OF INSURANCE SAN FRANCISCO Certificate of Authority THiS 1S TO CERTIFY, 771111, purmant to the Insurance Code of the State of California, Developers Surety and Indentrtity Canrparry of West Des Moines, Iowa, organized under the lmvr of Iowa, subject to its Arrirles of Incorporation or othtrrfundmnerual nrgarti�allorttrl dncumentr, is hereby authorized to transact within Ibis' Siale, subject to all previsions of this Certificate, the fallowing eiatsses' of insurance: Surety its• such rlasses are now or may beret fter be definer/ in the Ituwrance Laws of the State of Cal prnia. THIS CERTIFICATE 1s expressly catditioned upon the holder hereof now and hereaj}erbeing in All compliance with all, and not in violation of any, of the applicable laws and lawful requirements trade ender authority of the laws of'the State of Califanda as long as surh laws or requirements arc in effect and applicable, and as such laws and rer/ttirements now tire, or may hereafl er he changed or antended, IN WITNESS WHEREOF, efective as of the 30th day of Auglar, 199.9, 1 have hereunto set my hand and carried my official seal to he affixed this 30th day of August, 1999. Fee $2833,00 Ree. No. Chuck Quackcnbuxh ni rurvarr C mwrusia—r Filed 313/99 By Pirtoria S. Sidburn+ Ortn�ry Cerfureatiotr 1, the undersigned lnsurtunce C'onnrrrissivrrrr of the STarr c'+f Cali/nu•nia, do herehv certify that 1 htive cnnrpared the above cant, ofCertificnle gfAtilhority wilt the duplicate nforigivat nowon file in ory office, crud drat the sutiic is tu,fitll, true, and curre0l trurrscrrpt thereof, and ofthe whole ofaaid dup/icur, and said Cerrifrcnre ofAnthoriuy is taw in ldl Torre and effect. iN WITNESS WHEREOF, 1 have hereunto sec my !rand and canned ii y oTcaal seal to bo affixed this 21st day of Oclober, 2005, Johe Garronendi Gl� ((n-m mw ruwn in.rsiuer nry 7w�" b 14 h�'U— prudinrc D "Intlrea POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box 19725, IRVINE, CA 92623 (949) 263-3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each hereby make, constitute and appoint: ***Cynthia J. Young, Jay P. Freeman, Laurie B. Druck, Pamela McCarthy, jointly or severally*** as their true and lawful Attorney(s)-in-Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of surety- ship giving and granting unto said Attorney(s)-in-Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attorney(s)-in-Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2008. RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice -President, Senior Vice -President or any Vice President of the corporations be, and that each of them hereby is, authorized to execute this Power of Attorney, qualifying the attorney(s) named in the Power of Attorney to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of either of the corporations be, and:each of them hereby is, authorized to attest the execution of any such Power of Attorney; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective officers and attested by their respective Secretary orAssistant Secretary this November 21, 2013. �1 Daniel Young, Senior Vice -President ., c5 Q� •. y -^ �Cv Op P 0 yq� 0 OCT = z OCT. 5 By: G w'' 1936 ' = ups 1967 Mark J. Lansdon, Vice -President y� -., ti: C> �, 2 State of California County of Orange On November21, 2013 before me, Antonio Alvarado Notary Public Date Here Insert Name and Title of the Officer personally appeared Daniel Young and Mark J. Lansdon 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/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 AN'T4ldIC?ALVARAIXi which the person(s) acted, executed the instrument. COMM 42033M NARY PU" C#tLFOR I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is 3: OMN" CO LWYY true and correct. sty caW liras , 20171 WITNESS my hand and official seal. Place Notary Seal Above Signature Antonio Alvarado, Notary Public CERTIFICATE The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETYAND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth in the Power of Attorney are in force as of the date of this Certificate. This Certificate is executed in the City of Irvine, California, this,j � d of By: Cassie J. Berrisfo ssistant Secretary ID-1380(Rev.11113) CREAT08 OP ID: M2 .4C`4cwR'1jW. CERTIFICATE OF LIABILITY INSURANCE � ATE 03/09/2015Y) 03/09/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Hunter Insurance Services, Inc Agency Lic# OD94594 1950 Cordell Ct. Ste 101 El Cajon, CA 92020 CONTACT NAME: Miriam E. Rothe a/c, No Et : 888-815-7639 A/C No): 619-465-1926 E-MAIL miriam@hunteronline.com ADDRESS: Miriam E. Rothey INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Colony Insurance Company 39993 INSURED Creative Home DBA: CHI Construction 701 E. Ball Rd. #101 INSURER B : Infinity Select Insurance Co. INSURER C : State Compensation Ins. Fund 35076 INSURER D : Anaheim, CA 92805 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,00 CLAIMS -MADE NOCCUR X 101GL000159900 10/28/2014 10/28/2015 DAMAGE TO RENTEIT_ PREMISES Ea occurrence $ 50,00 MED EXP (Any one person) $ 5100 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 PRO LOC JECT X 1,000,00POLICY $ OTHER: AUTOMOBILE LIABILITY COEa aMBINED SINGLE LIMITccident $ 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO 504610064057001 09/25/2014 09/25/2015 ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED AUTOS X NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 19605692015 01/18/2015 01/18/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is requiredlJAC City of Huntington Beach its officers, elected or appointed officials, APPROVED employees, agents, and volunteers as Additional Insured, per attached endorsement. By: M; eomeY Get CERTIFICATE HOLDER CANCELLATION HUNTING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Huntington Beach CA AUTHORIZED REPRESENTATIVE 2000 Main Street Huntington Beach, CA 92648 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Oraanization(s): I Location(s) Of Covered Operations City of Huntington Beach, its officers, elected or appointed officials, employees, agents, and volunteers City of Huntington Beach CA 2000 Main Street Huntington Beach, CA 92648 Information required to complete this Schedule, if not shown above, will shown in the Declarations. It is further agreed that this insurance shall be Primary and Non -Contributory but only in the event of a Named Insured's sole negligence. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, mainte- nance or repairs) to be performed by or on be- half of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG20370704 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided, under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera - Or Organization(s): I tions City of Huntington Beach, its officers, elected or appointed officials, employees, agents, and volunteers City of Huntington Beach CA 2000 Main Street Huntington Beach, CA 92648 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. It is further agreed that this insurance shall be Primary and Non -Contributory but only in the event of a Named Insured's sole negligence. Section 11 — Who Is An Insuredis amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 Certification of Compliance with Prevailing Wage Laws To: City of Huntington Beach Department of Public Works 2000 Main Street/P.O. Box 190 Huntington Beach, CA 92648 Re: Certification of Compliance with Prevailing Wage Laws Contract: Project: The undersigned contractor on the above -referenced project ("Project") hereby 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 pursuant to the minimum wage and bona fide fringe benefit -requirements 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 United States Department of Labor. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed this day of , 20_, at (Type Contractor Name) By: Name: [Type Name] Title: [Type Title] California. Si-s o3- ab - Mp 247542.1 CONTRACTOR'S CERTIFICATE I, , state and certify that: (Name of Declarant) 1. is the general contractor to the City of Huntington Beach ("City") on Contract No. (the "Contract") for the construction of the public work of improvement entitled: (the "Project") 2. All work to be performed pursuant to the Contract has been completed in accordance with the Contract Documents (as such term is defined in the Contract). 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 "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 that are the subject of a Notice to Withhold filed pursuant to the Civil Code of the State of California (list all disputed claims; if none, write "NONE"): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed at APPROVED AS TO FORM By: Name: [Type Name] Title: [Type Title] on this - day of , 20 (Signature of Declarant) 2459141 Certification of Compliance with 'Title VH of the Civil Rights Act and Equal Employment Opportunity Act of 1972 To: City of Huntington Beach Department of Public Works 2000 Main Street/P.O. Box 190 Huntington Beach, CA 92648 Re: Certification of Compliance with Title VII of the Civil Rights Act and Equal Employment Opportunity Act of 1972 Contract: Project: The undersigned contractor on the above -referenced project (`Project") hereby certifies that it has complied with Title VII of the Civil Rights Act, the Equal Opportunity Act of 1972 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 has not maintained any segregated facilities at its establishments on the basis of race, creed, color, sex, national origin, age or disability (with the exception of access for the disabled). I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct_ Executed this day of , 20,, at , California. (Type Contractor Name) By: Name: [Type Name] Title: [Type Title] R �",�— W'YA� ORNEY IL) 3--�f6-up 245911 1 City ®f Huntington Beach 2000 Main Street e Huntington Beach, CA 92648 (714) 536-5227 ® www.huntingtonbeachca.gov Office of the City Clerk Joan L. Flynn, City Clerk March 20, 2015 CHI Construction 701 E. Ball Road #101 Anaheim, CA 92805 Re: Lake Street Bicycle Treatments & Downtown Bicycle Parking — CC-1468 The City Council awarded the bid to your company for the above referenced project. Enclosed is a copy of the executed contract with the City of Huntington Beach. A Certification of Compliance with Title VII of the Civil Rights Act, Certification of Compliance with Prevailing Wage Laws and Contractor's Certificate form must be returned to this office after the proiect is completed but prior to the release of retention funds. In addition, the following item must also be on file, with this office before the City can release any retention funds: A warranty bond guaranteeing the final amount of work and materials for one year. If your performance bond does not include specific wording for a one-year warranty, then a rider or separate bond must be submitted. Should you have any questions or concerns regarding the enclosures or items that must be on file in this office prior to release of retention funds, please call the Public Works Department at 536-5517. JF:pe Enclosures: Copy of Contract including Proposal Copies of insurance/bonds Contractor's Certificate Certificate of Compliances Bid Bond (original) Sister Cities: Anjo, Japan ® Waitakere, New Zealand / RECEIVED BY: r ' (Name) +✓ I l� (Date) TO: FROM: DATE: SUBJECT City Treasurer City Clerk Bond Acceptance I have received the bonds for CAPITAL PROJECTS (Includes CC's and MSC's) Performance Bond No. Payment Bond (Labor and Materials) Bond No. Warranty or Maintenance Bond No. TRACT AND DEVELOPMENT Faithful Performance Bond No. Labor and Material Bond No. Guarantee and Warranty Bond No. Monument Bond No. Franchise Bond No. Letter of Credit Bond No. Other Re: Tract No. CC No. MSC No. Other No. gAorms/bond transmittal to treasurer CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office after signing/dating (Company Name) Approved -,- (Council Approval //Date) Agenda Item No. �` City Clerk Vault No. r 5D SIRE System ID No. Dept. ID PW 15-001 Page 1 of 2 Meeting Date: 1/20/2015 CITY OF HUNTINGTON REACH REQUEST FOR. CITY COUNCIL ACTION MEETING DATE: 1/20/2015 SUBMITTED TO: Honorable Mayor and City Council Members SUBMITTED BY: Fred A. Wilson, City Manager PREPARED BY: Travis K. Hopkins, PE, Director of Public Works SUBJECT: Accept bid and authorize execution of a construction contract with CHI Construction, Inc. in the amount of $20,808 for the Lake Street Bicycle Treatments and Downtown Bicycle Parking Project, CC-1468 Statement of Issue: On November 24, 2014, bids were publicly opened for the Lake Street Bicycle Treatments and Downtown Bicycle Parking project, CC-1468. Staff requests that the City Council award the contract to CHI Construction, Inc., the lowest responsive and responsible bidder. Financial Impact: Funding is through the Bicycle Corridor Improvement Program for a reimbursement amount of $37,030. The Local Match of $5,500 is budgeted in the Air Quality Management District Subvention fund, Account No. 20185201. Recommended Action: A) Accept the lowest responsive and responsible bid submitted by CHI Construction, Inc. in the amount of $20,808; and B) Authorize the Mayor and City Clerk to execute a construction contract in a form approved by the City Attorney Alternative Action(s): Reject all bids, and provide staff with alternative action. Analysis: In April 2012, staff submitted an application for the 2012 Bicycle Corridor Improvement Program call for projects. The Bicycle Corridor Improvement Program is a Federal Congestion and Air Quality funded program authorized under the Intermodal Surface Transportation Efficiency Act. The Orange County Transportation Authority (OCTA) is responsible for selecting the projects within Orange County and working with the California Department of Transportation in program administration. Based on recommendations from the Bicycle Advisory Committee, the application requested funding for bicycle related treatments on Lake Street between Pecan Avenue and Orange Avenue, along with installation of bike racks in locations near downtown. In August 2012, the OCTA Board approved funding of up to $37,030 for the project, with the City's Local Match of $5,500. The project enhances bicycle sighs and markings, shown in Attachment 2, in this section through the use of sharrow markings: "share the road" and "bikes may use full lane" signs. The section of Item 4. - I HIS -26- Dept. ID PW 15-001 Page 2 of 2 Meeting Date: 1/20/2015 Lake Street south of Pecan Avenue narrows significantly due to the lack of street width. Additionally, bike racks will be installed with this project in four locations downtown with a capacity of 156 bikes. One location will install 98 bike racks under the pier. Two existing on -street parking spaces on Main Street will be converted to bike parking areas accommodating 24 spaces at one location and 18 spaces at the other. The other location is on Orange Avenue next to Jax bike shop, where space for 19 bikes will be provided. Bids were opened publically on November 24, 2014, and are listed in ascending order: BIDDER'S NAME BID AMOUNT CORRECTED BID CHI Construction Inc. $20,808.00 Correct as bid PTM General Engineering Services Inc. $21,012.00 Correct as bid Sterndahl Enterprises Inc. $35,000.00 Correct as bid The lowest responsive and responsible bidder was determined to be CHI Construction, Inc. The experience and reference checks of CHI Construction, Inc. provided acceptable responses from past agency clients. The engineer's estimate for the bid items was $20,000. The total estimated cost for this project is $42,030 which includes the City's direct purchase of the bike racks to be installed. Direct purchase provides the benefit of reduced costs to the City due to elimination of contractor mark-ups, typically in excess of 20 percent for these items. Public Works Commission Action: None required. The project is not included in the threshold for a CIP project. The project was informational item on October 15, 2014. CIP since the project doest not meet the funding presented to Public Works Commission as an Environmental Status: The project is categorically exempt from CEQA per Article 19, Section 15301. Strategic Plan Goal: Improve the City's infrastructure Attachment(s): 1. Location Map 2. Lake Street Bicycle Treatments HB -27- Item 4. - 2 4-T 'I B0 1OLSA AVE]. < 0 Ln J J7 I Mc FADDEN AVE. EDINGER AVE. < Ln Ln NTS > 0 0 OHEIL < 0 fl� ui < cr- AVE. M ry- m 5- Z o Fmn D!f < �;: z Ld Ln 0 < WARNER ui . ... . ..... AVE. I SLATER I JAVE. u 405 AVE. PACIFIC ELLIS AVE. GARFIELDJ� AVE. J �-1 ru) :10<t (n F (YOIRKTOWN AVE. F� ZO PROJECT LOCA110N ADAMS AVE. F— Ln fr I D INDIANAPOLIS AVE. < z 0 Ir < 0 0 cr- M TLANTA < Z AVE. U) D 7—-ca < z uj HAM M LTON AVE. BANNING A jr7 PROJECT LOCATION MAP CITY OF HUNTINGTON BEACH PUBLIC WORKS LAKE STREET BICYCLE TREATMENTS & DOWNTOWN BICYCLE PARKING, CC-1468 ATTACHMENT 1 Item 4. - 3 HB -28- A i i' SYMBOL OW (NOT TO C"" w i l STD. PLAN 4w l R GENERAL NOTES. EM WTH Lam' 42' KUST BE 117VIDED C36` VITH AL LF E IMEERA TYPICAL .. , A ROAD i.. INSTALLATION LAKE STREET BICYCLE TREATMENTS DOWNTOWN BICYCLE PARKING, C —1468 ATTACHMENT FIB -29- Item 4. - 4 ulAJ Engineer's Estimate: $0 d� BLO LIST BIDDER'S-NAAM - RAM TOTAL BID "OUNT- 1. C�vj oo 4. $ 5. $ 6. $ 7. $ �. $ 9. $ 10. $ 11. $ 12. $ 13. $ 14. $ 2014 NOV 24 PM 2: 00 CITY CLERK CITY OF HUNTINGTON BEACH < > woz-1 C.) c-i Lai rrj rn rn to SECTION A NOTICE INVITING SEALED BIDS for the construction of LAKE STREET BICYCLE TREATMENTS And DOWNTOWN BICYCLE PARKING CC No. CC 1468 — CML 5181 (179) in the CITY OF HUNTINGTON BEACH PUBLIC NOTICE IS HEREBY GIVEN that the CITY OF HUNTINGTON BEACH, as AGENCY, invites sealed bids for the above stated projects and will receive such bids in the office of the City Clerk, Second Floor, 2000 Main Street, Huntington Beach, California 92648, up to the hour of 2:00 PM on November 24, 2014. Bids will be publicly open in the Council Chambers unless otherwise posted. Copies of the Plans, Specifications, and contract documents are available from the Office of the Director of Public Works, 2000 Main Street, Huntington Beach, CA 92648, upon payment of a $15.00 nonrefundable fee if picked up, or payment of a 25.00 nonrefundable fee if sent by UPS ground delivery (bidder shall pay additional costs for special delivery). This is a Davis -Bacon project and the Federal Regulations will be enforced. Any contract entered into pursuant to this notice will incorporate the provisions of the Federal Labor Standards, which are on file at the office of the Director of Public Works, 2000 Main Street, Huntington Beach. CA 92648. The AGENCY will deduct 5% retention from all progress payments. The Contractor may substitute an escrow holder surety of equal value to the retention in accordance with the provisions of the Public Contract Code, Section 10263. The Contractor shall be beneficial owner of the surety and shall receive any interest thereon. The AGENCY hereby affirmatively ensures that minority business enterprises will be afforded full opportunity to submit bids in response to this notice and will not be discriminated against on the basis of race, color, national origin, ancestry, sex, or religion in any consideration leading to the award of contract. No bid shall be considered unless it is prepared on the approved Proposal forms in conformance with the Instructions to Bidders as determined by the AGENCY. The bid must be accompanied by a certified check, cashier's check, or bidder's bond made payable to the AGENCY for an amount no less than 10% of the amount bid. The successful bidder shall be licensed in accordance with provisions of the Business and Professions Code and shall possess a State Contractor's License Class A at the time of contract award. The successful Contractor and his subcontractors will be required to possess business licenses from the AGENCY. All extension of unit prices will be subject to verification by the AGENCY. In case of a variation between the unit price and the extension, the unit price will govern. Project Description: The project consists primarily of installing bicycle racks and signing and striping improvements in the downtown area. 0 The contract shall allow the Contractor 10 working days to complete the contract. ® The engineer's estimate of probable construction cost for the work included in the basis of award is $20,000. The Project Disadvantage Business Enterprises (DBE) goal is 11%. The AGENCY reserves the right to reject any or all bids, to waive any irregularity and to take all bids under advisement for a maximum period of 60 days. BY ORDER of the CITY COUNCIL of the CITY OF HUNTINGTON BEACH, CALIFORNIA, the 2nd day of September 2014, by Resolution No. 2014-69. Attest: Joan L. Flynn CITY CLERK OF THE CITY OF HUNTINGTON BEACH CITY OF HUNTINGTON 2000 Main Street P.O. Box 190 Huntington Beach, CA LETTER OF TRANSMITTAL Attention: Joan L. Flynn To: City Clerk's Office 2000 Main Street Huntington Beach, CA 92648 BEACH 92648 Fax (714) 374-1573 Date: October 27, 2014 Project/C.C. No.: C.C. No. 1468 Regarding: Lake Street Bicycle Treatments ❑ 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 Pages, Description 1 1 1 Notice Inviting Sealed Bids for CC-1468, Lake Street Bicycle Treatments and Downtown Bicycle Parking. 2 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: Please find attached the Notice Inviting Sealed Bids for advertisement on 10/30/14, 11/6/14 & 11/13/14. The bid opening is scheduled for 11/24/14. Please contact me at 374-1619 with any questions you may have. cc: fileCC-1468 By: "D S 1 o%23jl,* Darren Sam, Senior Traffic Engineer M, E Di I A Order ID: 2796561 GROSS PRICE *: $793.00 PACKAGE NAME: Legal-11-1131- mr%fil-ac Product(s): Huntington Beach Independent, hbindependent.com, CApublicnotice.com—HBI AdSize(s): 3 Column, Run Date(s): Thursday, October 30, 2014, Thursday, November 06, 2014, Thursday, November 13, 2014 Color Spec. B/W Preview C,C T I Q N-: !A NO T 'NV F,LTUA! Wdl' S E A L 'E D Di, :: LAKSTRE,Ei�:61'r�' LETR,E:ATMENTS DOWNTOWN B1CYCLCPARX:Ill, G DC Na �,, C6 i 48 4.j 87 ( 1 79) fn �hLl dTV"QF,IjUNT I N , GTO:N BEAC I H E:]SLL ',t tilkifY"& HON"TNOON liiACH� as �!PL AL JCN&lt HEfl1E5Y4JVI.--& aN: 14d oft@ 'in. 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T, N chhi Printed: 10/27/2014 4:28:53 PM Page 2 of 2 * Agency Commission not included UNSUCCESSFUL BIDS CC-1468 Lake Street Bicycle Treatments and Downtown Bicycle Parking City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Joan L. Flynn, City Clerk March 23, 2015 PTM General Engineering Services, Inc. 5942 Acorn St. Riverside, CA 92504 RE: Lake Street Bicycle Treatments & Downtown Bicycle Parking — CC-1468 Enclosed please find your original bid bond for CC-1468. Sincerely, Joan L. Flynn, CIVIC City Clerk JF:pe Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand Iif i5�y,id, 2�{ ��a'4filpVr24 fr, PTM General Engineering Services Inc. S942'Acorn St. Riverside, CA 92504 (951)1710-1000 City of Huntington beach ATTN: City Clerk 2000 Main St. Huntington Beach, CA 92648 714.536.5431 . .Bid Date: November 24tn Bid T'i'me� 2 PM Bid, N®; CM 5181(179) Bid Description: Lake Street Bicycle Treatments and Downtown Bicycle Parking BID ENCLOSED - DO NOT OPEN WITH REGULAR MAIL SECTION C PROPOSAL. for the construction of LAKE STREET BICYCLE TREATMENTS And DOWNTOWN BICYCLE PARKING CC No. CC 1468 — CML 51.81 (179) in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE. COUNCIL OF IrIUNTINGTON 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 rile 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 10 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 AC;FNCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contact 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 and 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 RIGI-IT TO DE1,ETE ANY ITEM I -ROM 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 of 10%total bid in the amount which said amount is not less than I0% 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 for % ", as the case may be) Any standard Surety Bid Bond form is acceptable. Bidder shall signify receipt of all Addenda here, if any: C-z Pro'ect Bid Schedule Lake Street Bicycle Treatments and Downtown Bicycle Parking CC- l 468 Federal Project Number-5181(1. 79) .F a ... .. 1...' : .. ter Mobilization. U. t� ?LiIdEFi� .. . ' AYrlount{ $/O D _ ._ Per L.S. $ T OIJ 2 1 L.S. Furnish Project Traffic Control. Per L.S. $%ip0 c9 $ �� o — 3 1 L.S. Furnish and Install Traffic Striping and Signing. $_ �,�00 "- $__.._ f%ti CO? Per L.S. 4 L.S. Install City Furnished Peak Bicycle Racks (I56 Total Bicycle Slots) Using City Furnished Tamper Resistant Mounting Hardware, $ 1 ,;2,Yll $ 12SI2- '—' Per L.S. Total Amount Bid in Figures: $ �' '0 I �-- Total Amount Bid in Words: r� l;-2.I 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. Bid Name and Address of Subcontractor state Class Dollar % of Item(s) License Amount Contract Number By submission of this proposal, the Bidder certifies: 1. That lie 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 BIDDEN AND SUBMITTED WITH BID I declare under penalty of perjury under the taws of the State of California that the foregoing is true and correct and that this declaration is executed on 1 t.24.14 at Riverside Ca Date City .State Elizabeth H. Mendoza de McRae , being first duly sworn, deposes and says that he or she is President/CFO of PTM General Engineering Services, 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. PTM General Engineering Services, Inc. r tie of Bidder_ Eli etfi H. Mendoza de McRae resident/CFO Signature of Bidder 5942 Acorn St. Riverside, CA 92504 Address of Bidder 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 Lake Street Bicycle Treatments and Downtown Bicycle Parking, (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, Califomia Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to he 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: 11.24.2014 C-5 PTM General Engineering Services, Inc. Conti., ar By Elizabeth H. Mendoza de McRae President/CFO "f itic DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 10162, 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? 0 Yes 0 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 oftlik qucstionnaire. 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 perfonnance of the work of this contract. Date: 11.24.2014 C-7 PTM General Engineering Services, Inc. Cont for (C By Elizabeth H. Mendoza de McRae President/CFO Title 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, State Zip e51 710 1000 Telephone Number 891265 Class A State Contractor's License No. and Class 01 • >p011 Original Date Issued 02.28.15 Expiration Date The work site was inspected by Brian Mendoza of our office on 1 1.24 2014. The following are persons, firms, and corporations having a principal interest in this proposal: Elizabeth H. Mendoza de McRae, President/CFO Brian Mendoza, 'Vice 11restderiV'Secietiny C-8 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. Signature of Bidder Elizabeth H. Mendoza de McRae President/CFO Printed or Typed Signature Subscribed and sworn to before me this 24 day of November 1201 4 NOTARY PUBLIC C-9 NOTARY SEAL n". '.til.. State of California County of ORANGE Y� On /Y -vU& betore me, Philip Vega, Notary -public 0ste Hate Insan Name Er)d Taio o i o of car personally appeared ELIZABETH H. MENDOZA de McRAE amo s o(gnor(,c) who proved to me on the basis of satisfactory evidence to be the person(4) whose names) is/gre subscribed to the within Instrument and acknowled to me that hel��Wt executed the same in hid /�� /61r authorized YOM LA capaa/(�), and that by hid/hiet//t4r sicgnatA(s) on the 088 to IFORNIA oinstrument the person(), or the entity upon behalf of UN7y which the person(g) acted, executed the Instrument. 31,2016 I certify under PF.NALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my h n n lclal seal. Signature Plana Notary Seal Aoovs AV (ilgnan,ra oI Notnty Publlc ---- OPTIONAL Though the information below is not required by law, It may prove valuable to persons retying on the document and could prevent fraudulent removal and reattachMent of this torm to another document, Description of Attached Document Tltle or Type of Document; Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Individual ❑ Corporate Officer—Title(s): 0 Partner — L Limited ❑ General ❑ Attorney in Fact Top of thumb nets F1. Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Offleer -- Title(s): f ❑ Partner ---- ❑ Limited ❑ General ❑ Attorney in Fact C.)-Trustee R_ Guardian or Conservator D Other: Signer Is Representing: RIGMK'THUMBPRINT MIGNER P32007 Netlonel Mowry Aaacdatlorr 9360 DO Soto Avo„ P,0,6ox 2902 •C4atewarill,CA 91313.2402•www,NallonelNolnryorg [tam 05907 Roordar.Call Yoll-Frea1.800.878.8927 Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work. Bidders are encouraged to submit supplemental relevant project history in addition to the projects listed herein. Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past five years: City of Newport Beach 3300 Newport Blvd., Newport beach, CA 91730 Name and Address of Public Agency Name and Telephone No. of Project Manager: Brad Sommers 949.644.3326 $547,050.00 Traffic Signal 11.2012 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: 2. CalTrans 1727 30th St., Sacramento, CA 95816 Name and Address of Public Agency Name and Telephone No. oPProject Manager: Danh Thai 949.279.8803 $354,453.00 Upgrade Traffic Signals 11.2012 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: of Rosemead 8838 E. Valley Blvd. Rosemead, CA 91770 Name and Address of Public Agency Naive and Telephone No. of Proicct Manager: Sean Sullivan 626.569.2189 $655,045.00 Safe Routes to School 1.2013 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: C-t 0 Bidder's Critical Staff Listed below are the names of the bidders proposed Construction Project Manager, and Superintendent. For each of these critical positions, please list at least three projects for which the critical staff has performed similar work within the last five years. These projects do not have to be under the employment of the bidder of this project. Bidders are encouraged submit supplemental relevant project history in addition to the projects listed herein. Brian Mendoza Name of proposed Project Manager Tclephone No. of proposed Project Manager: _ 951.722.5755 Traffic Signal Rehabilitation $547,050 _ Traffic Signal _ 11.2012 Project Name & Contract Amount "Type of Work _ Date Completed Upgrade Traffiic Signals $354,453 Traffic Signal 11.2012 Project Name & Contract Amount Type of Work Date Completed Hellman/San Gabriel Intersection Improvements $482,024.00 Traffic Signal 1.2013 Project Name & Contract Amount Type of Work Date Completed 2. Brian Mendoza Name of proposed Superintendent Telephone No. of proposed Superintendent: 951.722.5755 Traffic Signal Rehabilitation $547,050 Traffic Signal 11.2012 Project Name & Contract Amount Type of Work Date Completed Upgrade Traffiic Signals $354,453 Traffic Signal 11.2012 Project Name & Contract Amount Type of Work Date Completed Hellman/San Gabriel Intersection Improvements $482,024 Traffic Signal 1.2013 Project Name & Contract Amount "Type of Work Date Completed C-1 t (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 1969; 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, In.c Contact Person: Elizabeth H. Mendoza de c ae Contact Phone: 951.710.1000 -- Signed: Date: 11.24.2014 *Note: The above certification is required by the Dcpartntent 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 ** We will meet project requirements. Currently we need no new labor. However if we do, we will have pre requirements. C-12 Local Assistance Procedures Manual Exhibit 1241 Sample Bid -4LS BIDDERS Iz,YECU77ON ON THE SIGNATURE PORTION OF T/U,i' PROPosAl SII�tLI. ALSO CpNS7TTU7E' A,v E'.VDORSEATENT ,l ArD EXECUT IOiV OF' THOS'!' C'I;RT/k IC:I H HICHARE A PART OF' TIIIS I'ROPOSiIL) TION,S EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder PTM General Engineering Services, Inc. proposed subcontractor — hereby certities that he has x_x a previous contract or subcontract subject to the equal oppohas not __ ,participated in 11246, .snd that, where required, he has rtunity clauses, as required by Executive Orders 10925, 11114, or 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 (4 ) 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 arc exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generatty only contracts or subcontracts Of $ [ 0,000 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 1 of 8 C-13 June 11, 2014 Local Assistance Procedures Manual Exhibit 12-f1 Sam le Bid PUBLIC CONTRACT CODE PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1995), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has _,,,_ , has not - xx 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 works contract, as defined in Public Contract Code Section 1101. with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The terns "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 it check -mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal 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 101.62 QUESTIONNAIRE in conformance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire: Was 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 front bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation? Yes No xx If the answer is yes, explain the circumstances in the following space. Page 2 of 8 C-14 .June 11, 2014 Locol Assistance Procedures Manual Exhibit 1241 Sam le Bid PUBLIC CONTRACT CODE 10232 STATEMENT In conformance with public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable 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 Contra(Aor s failure to comply with an order of a federal court which orders the Contractor to comply with an order of the National Labor Relations Board. Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal 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. Page 3 of 8 C-1$-June 11,2014 Local Assistance Procedures Manual Exhibit 12-11I Sample Bid 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 conformance 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 clement 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 hay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or shant 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 Atidavit. Bidders are cautioned that making a false certification stay subject the certifier to criminal prosecution. Nitge 4 of 8 C-.I b .June 11, 2014 Local Assistance Procedures Manual Exhibit 12-H Sample Bid DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE Or FEDERAL REGULATIONS, FART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager: • is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any Federal agency; • has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federal agency within the past 3 years; • does not have a proposed debarment pending; and • has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility, For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action, Motes: Providing talse 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 5of8 C-17 .1unc 11, 2014 Local Astsistaaee Procedures Manual Exhibit 12-n Sample Bid NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, belief, that: to the best of his or her knowledge and (1) No Federal appropriated funds have been paid or will be paid, by or on behaifof 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 Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the staking of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 3 I, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 For each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language Of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. - Page 6of8 C-18 -)line 11, 2014 N/A = Not Applicable Local Assistance Procedures Manual OF COMPLETE THIS FORM TO D SCL�OSr Lp138YIINCCr AcTi TIES ING P R.SUAN 1. Type of F d Exhibit 12-11 Sample Bid e eraAction: 2. Status of , a. Federal Action: ,v �r t� a't' 1352 contract N/A b. grant a. 3- Report Type: bid/offer/application M b. c. caoperativc agreement d. loan C. a� initial initial a4vard b natcrial change Post -award N/A 1v/Ar e,loan guarantee f. loan insurance For Material Change only: Name and ,Address of Reporting Entity year quarter4• date of last report ® Prime Subawardee `- % if Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Tier—, ifknosvn N/A N/A ('ongressional District, ifknown 6• Federal Dcpartment/A enc g Congressional District, ifkrrot+n y- 7, Federal Program Name/Description: N/A N/A S. Federal Action Number, ifknown: CFDA Number, if upplicable _ - 9. Award Amount, ifknotvn: N/A N/A It). A. Name and Address oft.abbyEntity (If individual, last name, first name, MI ) b. Performing Services {including it'Individuals address adJrtss ifditterent from No. !Qa) N/A (last name, first name, MI) N/A (attach Continuation Shect(s) if necessary) It- Amount of Payment (check all that apply) N/A 13. Type of srten( (check check all (hat apply) �P y nP y) S ❑ actual planned a. retainer 12, Form of Payment {check all that apply): y): b. one-time fee N/A ®pP a. cash N/A c. cormnission d. contingent r'ec h. in -kind; specify: nature a deferred value f. other, specify__- 14. Brief Description of Sea ices Performed or to _._.__ be performed and Date(s) of Service, including offrccr•(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11: N/A (attach Continuation Shcet(s) illteccssan) 15. Continuation Sheet(s) attached: Yes ® No ® 16. Information requested through this form is authorized by 'title 31 U S.C..' eclion 1352. This disclosure of lobbying Signature: reliance was placed by the tier above when his transaction -----_.____...... _._.__..._._._.._.—__..._ _ ....._._ was made or entered into. This disclosure is required print Name: Elizabeth H. Mendoza de McRa pursuant to 31 U.S.C. 1352. 'this information will be reported to Congress semiannually and will be available for president/CFO public inspection. Any person who fails W file the required Title: disclosure shall be subject to a civil penalty of not less than S10,000 and not more than S100,W0 for each such failure. Telephone No,:. 951.710.1000-- Date: 11.24.1 Authorized for I.ocal Repmduction Federal Use Only: Standard form - 111. Statdwd ronn LI.I. It — Page 7 of 8 C-ly ,tune 11, 2014 Local Assistance Procedures Manual Exhibit 12-II Sample Bid INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardec 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. ]'he filing of a form is required for such payment or agrcerncrit 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 uniployce 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 thls 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. Inclutic ('ongressionaf District i I' 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. S. 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 of loan commitment. include at least one organization level below agency name, if known. For example, Department on'ransportation, United States Coast Guard. T. Enter the Federal program name or description rot the covered Federal action (item 1). If known, enter the tiAl Catalog of Federal Domestic Assistance (CFDA) number for grants, eooperative agreements, loans and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identification in item I (e.g- Request for Proposal (RFP) number. Invitation for Bid (IT'B) number, grant announcement number, the contract grant. or loan award number, the application/proposal control numf•cr assigacd 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 ofthe award/loan commitments for the prune enfii}• identificd in item 4 or S. 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 intfuenced the covered Federal action. (b) Lnter the full names orthe individual(s) performing service-, inil incude full address ifs different from 10 (a). Bitter 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, eater the cumulaiive amount of payment made or planned to be made. 12. Check the appropriate box. Check all boxes that apply. If payment is made through an in -kind cantrihuiion, spceiti the nature and value of the in -kind payment. 13. Check the appropriate box. Check all boxes that apply. If other, speeiti' nature. 14, Provide a specific and detailed description critic services that the Iobb} ist has performed or gill he expected to perform and the date(s) of any services rendered. Include all preparatory and related uctivity not just tittle spent in actual contact with Federal officials. Identify the Federal officer(s) or employce(s) contacted or the officcr(s) ernploycc(,) or Mcniber(s) of Congress that were contacted. 15, Check whether or not a continuation sheet(s) is attached. 16. The certifying offeial shall sign and date the form. print his/her name title and telephone nurnher. 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 [lie data needed, and completing and rcviC%0ig the collection of information, Send comments regarding the burden estimate cur any other aNpcct of this collection of information, including suggestions for reducing this burden, to thu Office of Manugentent and Budget. Paperwork Reduction Project (0348-0040), Washington, D.C. 20503. 5F LLLeu t-til . H,, tk:. 3 x)..F.Nn1Fh Page 8 of 8 C-20 ,tune 11, 2014 Local AssiatancoProcedures Manual EXRMrr 15-G "I Ageacy Bidder DBE Commitment (Construction Contracts) Exmff 25-G LOCAL. ACBNCY BYADRR DBE COMMrrMMNT (CoxslituenoN CONrV ACTS) NOT$: PLEASE EtEM'TO WSTR RUCTIONS ON TUX REVERSIC SIDE of TERS FORM LACALA0EXr,Y: City of Huntington Beach LOCATION: PRo18C'TnIzRimou. Lake Street Bicylce Treatments and Downtown Bicycle e Paring TOTAL COWMAC.R AMOUNT. f BroI?A[$ 11.24.14 l31DDERrSNAI :_PT General Engineering Services Inc. cwmACT m ooAL• 11 N7RAC: C ITEM NO. TEM OF WORK. AND PI•-�N R S RVICBS'f0 E$ OON7RAC, ED OR MAT MUMS EO BE PROVIDED (or ec atranted if the iddcr is a DBii) Mr. Ct1iT NO. EDa%A'i1UN DATS ARM OF BACK DBg7*�AMOUNT (Must be crutitied on tho detc bids aro opmod - include DBE address mod phone awubao -- For Local Agency to Complete: Lncai Ag=ay Contract Nambgr. _-2C -14 6 8 Frdend-aid L}oj M%vziber. CML 5181 (179) Federal simm: Cvatraet Awed Dak: Local Agency certifies that all DBE eertiSgliom have been vmiflad and infbrmation is complete end accurate. Pria Name siyaanan -� Dai- - -�- Local Ageaoy Reluueutmiva Wva Code)'rekphom Number. _ ...__._ Total Claimcd D6E participation °fo Si6RIntatf of Bidder _11.24.14 951.710.1000 _ El zIeth H. Mendo�Caaif c ae President/CFO _ person to Contact _ leasa (? Typa or Print) 1-1 Ageaep bidder 538E Cemwibacm (Coadro firm C�atncn) . (Itav 67bN9) Dlstributton: (I) Copy - Vax or stun a copy to the Calhaas District 1=4 Assistance Pngineea (I)I kn within 30 days of con:mct exc tttfon Yailtae to sead a copy to the DI.AE within 30 days of cm&pft execution may result in deobligotion of funds fo: this pro)cct (2) Copy-Inchrdc in award pacSmp to Caffim Disuict Loud Anistanco (3) Original - Lccel agency filed OB 324id C-21 Page 15-1 June 29, 2012 EXHIBIT 15-G Local Assistance rrocedures Manual Local eae Bidder DBE Commitment (Construction Contracts) INSTRUCTIONS - LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) ALL BIDDERS: PLEASE NOTE: 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 DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE 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, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project 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 Clainied DBF 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 tine 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-G trust 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 accuratc before signing and filing. Page 15-2 June 29, 2012 C:-22 011 12-04 Local Assistance Procedures Manual Exhibit 15-H DBE Information - Good Faith Effort EXHIBIT 15-H DBE INFORMATION —GOOD FAITH EFFORTS DBE INFOI211IATION - GOOD FAITH[ EFFORTS Federal -aid Project No. CML 5181(179) Sid Opening Date 11.24.14 The Gity of Huntington Beach established a Disadvantaged Business Enterprise (DBE) goal of 11.00 % 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 DBE Commitment" form indicates that the bidder has met the DBE goal. 'Ibis 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 DBE firm was not certified at bid opening, or the bidder made a mathematical error. Submittal of only the "Local Agency Bidder DBE 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 DBE Commitment" of the Special Provisions: A. The names and dates of each publication in which a request for DBE participation f'or this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications Goals Met Dates of Advertisement B. The names and dates of written notices sent to certified DBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the DBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of DBE.,; Solicited Date of Initial Follow Up Methods and Dates Solicitation Met Page 15-1 OB 12-U4 Juoc 29, 2012 C-23 Exhibit 1541 Local Assistance Procedures Manual DBE Information -Good Faith Effort C. The items of work which the bidder made available to DBE firins 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 DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items ($) Of (YM) Contract Goals Met D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each DBE if the selected firm is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: Goals Met Names, addresses and phone numbers of firms selected for the work above: Goals Met E. Efforts made to assist interested DBEs 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 DBEs: Goals Met Page 2 June 29, 2012 C-24 OB 12-04 Local Awbtance Procedures Manual Exhibit 15-H nuir Inf-*i.... n--A F. Efforts made to assist interested DBEs in obtaining necessary equipment, supplies, materials or related assistance or services, excluding supplies and equipment the DBE 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 DBE 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 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 PAVER IF NECESSARY. Page 3 OB 12-04 C-25 .tune 29, 2012 Local Assistance Procedures Manual Exhibit 12-B Bidder's List ofSnbcontractors (DBE and Non -DBE) EXHIBIT 12-B 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 44, 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 Tams. Firm Name/ Address! City, State, ZIP Phone/ Fax Annual Gross Receipts Description of Portion of Work to be Performed _. r.-.: _ _-. __�•. t •� T "- Phone ❑ <$1 million ❑ < $5 million <S10million - I Address Fax El <SI S million -` •1=� - '��"�' Cif} State ZIP El > S15 million Name i Phone <SI million...:. ---- — ----�. ❑ <S5 million -------- --- Um Address < Sl O mil lion Fax ❑ <St5 million j City State ZIP > SIS million Vane Phone :Iddr¢ss Far Cirti .Prate !lP ❑ < S I million - .... �1 < $5 million ' ❑ < SI0 minion < 515 million =: > $15 million edfrnr Phone \_ ame :Iddress i Far j 0A State 71P <$1 million <$5 million 0 < SIO million 1 }'7rShsr DBE # ❑ <S15 million >$ISmillion A Di,itribntiws i I Original - Local Agency File Page I of 2 D1.A-013 13-06 C-26 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-B Bidder's List of Subcontractors (DBE and Non -DBE) EMBBIT 12-B BIDDER'S LIST OF SUBCONTRACTORS (DBE AND NoN-DBE PART n 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. Photocopy this form for additional firms. - Firm Namel Address/ Ci , State, ZIP Phone/ Fax Annual Gross Receipts Description of Portion of Work to be Performed ame Phone �j million, < $5 million < $10 million I ddress Wp h Fnr i <$15 million C, State ZIP > $15 million j^ M. ha#n i Phone ! o! %(v'� <$1 million <$5 million _ Zd-dress i� • �vX �� � CMAStale ZIP OL <$10 million T Fa-(, < $15 million > $15 million C f .name Phone ❑ <$I million , .._.. <SSmillion ----_ —ET= iddress Car; Srare 71P EJ < $10 million --i -- ------ I - Ear < S 15 million > $15 million A ypp :15 .Vane Phan ❑ <$I million ❑ <$5 million _.._..— _ = - Address I <$10million------------ .._-..._.— ......... ...__._-_--- _-_.___.__—__--_-----...__ 1, . Fur ❑ <$15 million Cary Sfare ZIP Lj > $15 million - Dktributi-m t j Original -- Local AgencyFile Dl,a-Oi3 13-06 Page 2 of 2 August 12, 2013 C-27 EXHIBIT "B" FHWA-1273 REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language FHWA-1273 — Revised May 1, 2012 REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS 1. General II, Nondiscrimination III. Nonsegregated Facilities IV. Davis -Bacon and Related Act Provisions V. Contract Work Hours and Safety Standards Act Provisions Vl. Subletting or Assigning the Contract VII. Safety: Accident Prevention Vill. False Statements Concerning Highway Projects IX. Implementation of Clean Air Act and Federal Water Pollution Control Act X. Compliance with Governmentwide Suspension and Debarment Requirements XI. Certification Regarding Use of Contract Funds for lobbying ATTACHMENTS A. Employment and Materials Preference for Appalachian Development Highway System or Appalachian Local Access Road Contracts (included in Appalachian contracts only) L GENERAL 1. Form FHWA-1273 must be physically incorporated in each construction contract funded under Title 23 (excluding emergency contracts solely intended for debris removal). The contractor (or subcontractor) must insert this form In each subcontract and further require its Inclusion in all lower tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services). The applicable requirements of Form FHWA-1273 are incorporated by reference for work done under any purchase orde r, rental agreement or agreement for other services. The prime contractor shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Form FHWA-1273 must be Included in all Fedefal-aid design -build contracts, in all subcontracts and in lower tier subcontracts (excluding subcontracts for design services, purchase orders, rental agreements and other agreements for supplies or services). The design -builder shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Contracting agencies may reference Form FHWA-1273 in bid proposal or request for proposal documents, however, the Form FHWA-1273 must be physically incorporated (not referenced) in all contracts, subcontracts and lower -tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services related to a construction contract), 2. Subject to the applicability criteria noted in the following sections, 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. 3. A breach of any of the Stipulations contained in these Required Contract Provisions maybe sufficient grounds for withholding of progress payments, withholding of final payment, termination of the contract, suspension i debarment or any other action determined to be appropriate by the contracting agency and FHWA. 4, Selection of Labor. During the performance of this contract, the contractor shall not use convict labor for any purpose within the limits of a construction project on a Federal -aid highway unless it is labor performed by convicts who are on parole, supervised release, or probation. The term Federal -aid highway does not include roadways functionally classified as local roads or rural minor collectors. DLA-013 13-06 If. NONDISCRIMINATION The provisions of this section related to 23 CFR Part 230 are applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The provisions of 23 CFR Part 230 are not applicable to malerial supply, engineering, or architectural service contracts. In addition, the contractor and all subcontractors must comply with the following policies: Executive Order 11246, 41 CFR 60. 29 CFR 1625- 1627, Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633, The contractor and all subcontractors must comply with: the requirements of the Equal Opportunity Clause in 41 CFR 60-1.4(b) and, for all construction contracts exceeding $10,000, the Standard Federal Equal Employment Opportunity Construction Contract Specifications in 41 CFR 60-4.3. Note: The U.S. Department of Labor has exclusive authority to determine compliance with Executive Order 11246 and the policies of the Secretary of Labor including 41 CFR 60, and 29 CFR 1625-1627. The contracting agency and the FHWA have the authority and the responsibility to ensure compliance with Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), and Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 233, and 633. The following provision is adopted from 23 CFR 230, Appendix A, with appropriate revisions to conform to the U.S. Department of Labor (US DOL) and FHWA requirements. 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, 29 CFR 1625.1627, 41 CFR 60 and 49 CFR 27) and orders of the Secretary of Labor as modified by the provisions prescribed herein, and imposed 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 provisions of the Americans with 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 contracting agency and the Federal Government to ensure that it has made every good faith effort to provide equal opportunity with respect to all of its terms and conditions of employment and in (heir review of activities under the contract. b. The contractor will accept as its 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 advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre -apprenticeship, and/or on- the-job training." 2. EEO Officer: The contractor will designate and make known to the contracting officers an EEO Officer who will have the responsibility for and must be capable of effectively administering and promoting an active EEO program and who must be assigned adequate authority and responsibility to do so Page 8 of 22 August 1.2, 2013 Local Assistance Procedures Manual Exhibit 12-G 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 then once every six months, at which time the contractor's EEO polity and its Implementation will be reviewed and explained. The meetings will be conducted by the EEO Officer. b. AN 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. AN 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 minorities and women. 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 implement such policy will be brought to the attention of employees 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 advertisements will be placed in publications having a large circulation among minorities and women 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 minorities and women. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such identified sources procedures whereby minority and women 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, the contractor is expected to observe the provisions of that agreement to the extent that the system meets the contractor's compliance with EEO contract provisions. Where implementation of such an agreement has the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Federal nondiscrimination provisions. c. The contractor will encourage its present employees to refer minorities and women as applicants for employment. Information and procedures with regard to referring such 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 insure that working conditions and employee Facilities do not Indicate discriminatory treatment of project site personnel. Required Federal -aid Contract Language 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 its 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 their avenues of appeal. 6. Training and promotion: a. The contractor will assist in locating, qualifying, and increasing the skills of minorities and women who are applicants for employment or current employees. Such efforts should be aimed at developing full journey level status employees in the type of trade or job classification involved. 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, i.e., apprenticeship, and on- the-job training programs for the geographical area of contract performance. In the event a special provision for training is provided under this contract, this subparagraph will be superseded as indicated in the special provision. The contracting agency may reserve training positions for persons who receive welfare assistance in accordance with 23 U.S.C. 140(a). c. The contractor will advise employees and applicants for employment of available training programs and entrance requirements for each. d. The contractor will periodically review the training and promotion potential of employees who are minorities and women and will encourage eligible employees to apply for such training and promotion. T. Unions: It the contractor relies in whole or in part upon unions as a source of employees, the contractor will use good faith efforts to obtain the cooperation of such unions to increase opportunities for minorities and women. 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 good faith efforts to develop, in cooperation with the unions, joint training programs aimed toward qualifying more minorities and women for membership in the unions and increasing the skills of minorities and women so that they may qualify for higher paying employment. b. The contractor will use good faith 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 contracting agency Page 9 of 22 ALA-OB 13-06 August 12, 2013 Local Assistance ;Procedures Manual Exhibit 12-G 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 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 qualtfiable minorities and women. The failure of a union to provide sufficient referrals (even though it Is obligated to provide exclusive referrals under the terms of a collective bargaining agreement) does not relieve the contractor from the requirements of this paragraph. in the event the union referral practice prevents the contractor from meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, such contractor shalt immediately notify the contracting agency. B. Reasonable Accommodation for Applicants f Employees with Disabilities: The contractor must be familiar with the requirements for and comply with the Americans with Disabilities Act and all rules end regulations established there under. Employers must provide reasonable accommodation in all employment activities unless to do so would cause an undue hardship. 9. Selection of Subcontractors, procurement of Materials 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. The contractor shall take all necessary and reasonable steps to ensure nondiscrimination in the administration of this contract. a. The contractor shalt notify all potential subcontractors and suppliers and lessors of their EEO obligations under this contract. b. The contractor will use good faith efforts to ensure subcontractor compliance with their EEO obligations. 10. Assurance Required by 49 CFR 26.13(b) a. The requirements of 49 CFR Part 25 and the State DOT's U.S. DOT -approved DBE program are incorporated by reference. b. The contractor or subcontractor shalt 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 49 CFR Part 26 in the award and administration of 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 contracting agency deems appropriate. 11. Records and Reports: The contractor shall keep such records as necessary to document compliance with the EEO requirements Such records shallbe retained for a period of three years following the date of the final payment to the contractor for all contract work and shall be available at reasonable times and places for inspection by authorized representatives of the contracting agency and the FHWA. a. The records kept by the contractor shall document the following: (1) The number and work hours 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 opportunities for minorities and women: and Required Federal -aid Contract Language (3) The progress and efforts being made in locating, hiring, training, qualifying, and upgrading minorities and women; b. The contractors and subcontractors will submit an annual report to the contracting agency each July 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 19rlttili Ac13 .J • The staffing data should represent the project work force on board in all or any part of the last payroll period preceding the end of July. If on -the Job training Is being required by special provision, the contractor will be required to collect and report training data. The employment data should reflect the work force on board during all or any part of the last payroll period preceding the end of July. Ill. NONSEGREGATED FACILITIES This provision is applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The contractor must ensure that facilities provided for employees are provided in such a manner that segregation on the basis of race, color, religion, sex, or national origin cannot result. The contractor may neither require such segregated use by written or oral policies nor tolerate such use by employee custom. The contractors obligation extends further to ensure that its employees are not assigned to perform their services at any location, under the contractors control, where the facilities are segregated. The term "facilities" includes waiting rooms, work areas, restaurants and other eating areas, time clocks, restrooms, washrooms, locker rooms, and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing provided for employees. The contractor shall provide separate or single -user restrooms and necessary dressing or sleeping areas to assure privacy between sexes. 1V. DAVIS-BACON AND RELATED ACT PROVISIONS This section is applicable to all Federal -aid construction projects exceeding $2.000 and to all related subcontracts and iower4ler subcontracts (regardless of subcontract size). The requirements apply to all projects located within the right-of-way of a roadway that is functionally classified as Federal -aid hlghway. This excludes roadways functionally classified as local roads or rural minor collectors, which are exempt. Contracting agencies may elect to apply these requirements to other projects. The following provisions are from the U.S. Department of Labor regulations in 29 CFR 5.5 "Contract provisions and related matters' with minor revisions to conform to the FHWA-1273 format and FHWA program requirements. 1. Minimum wages a. All laborers and mechanics 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 issued by the Secretary of Labor under the Copeland Act (29 CFR part 3)), the full amount of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment computed at rates not less than those contained in the wage determination of the Secretary of Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics. Page 10 of 22 DLA-0R 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Contributions made or costs reasonably anticipated for bona fide fringe benefits under section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of paragraph 1.d. of this section; also, 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 determination for the clessification of work actually performed, without regard to skill, except as provided In 29 CFR 5.5(a)(4). 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 employers payroll records accurately set forth the time spent in each classification in which work is performed. The wage determination (including any additional classification and wage rates conformed under paragraph 1.b. of this section) and the Davis -Bacon poster (WH-1321) 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. b. (1) The contracting officer shall require that any class of laborers or mechanics, including helpers, which is not listed in the wage determination and which is to be employed under the contract shall be classified in conformance with the wage determination. The contracting officer shall approve an additional classification and wage rate and fringe benefits therefore only when the following criteria have been met: (i) The work to be performed by the classification requested is not performed by a classification in the wage determination: and (if) The classification is utlized in the area by the construction industry; and (III) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (2) If the contractor and the laborers and mechanics to be employed in the classification (if known), 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 conlracting officer to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor, Washington, DC 20210. The 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. (31 In the event the contractor, the laborers or mechanics to be employed in the 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. The Wage and Hour 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. Required Federal -aid Contract Language (4) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs 1.b.(2) or t.b.(3) of this section, shall be paid to all workers performing work in the classification under this contract from the first day on which work is performed in the classification. c. Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate, the contractor shall either pay the benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. d. If the contractor does not make payments to a trustee or other third person, the contractor may consider as part of the wages of any laborer or mechanic 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. 2. Withholding The contracting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor, withhold or cause to be withheld from the contractor 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, so 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 contracting agency may, after 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. 3. Payrolls and basic records a. Payrolls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all laborers and mechanics working at the site of the work. Such records shall contain the name, address, and social security number of each such worker, his or her correct classification, hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in section 1(b)(2)(B) of the Davis -Bacon Act), daily and weekly number of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1)(ty) that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in section 1(b)(2)(B) of the Davis -Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred in providing such benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs, the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. Page 11 of 22 BLA-013 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G b. (1) The contractor shall submit weekly for each week In which any contract work is performed a copy of all payrolls to the contracting agency. The payrolls submitted shall set out accurately and completely all of the information required to be maintained under 29 CFR 5.5(a)(3)(i), except that full social security numbers and home addresses shall not be included on weekly transmittals. Instead the payrolls shall only need to include an individually identifying number for each employee ( e.g. , the last four digits of the employee's social security number). The required weekly payroll information may be submitted in any form desired. Optional Form WH-347 is available for this purpose from the Wage and Hour Division Web she at http:/Mww.dol.goviesahvhdffoffnsAAoh347instr.htm or Its successor site. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the full social security number and current address of each covered worker, and shall provide them upon request to the contracting agency for transmission to the State DOT, the FHWA or the Wage and Hour Division of the Department of tabor for purposes of an Investigation or audit of compliance with prevailing wage requirements. It is not a violation of this section for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for its own records, without weekly submission to the contracting agency.. (2) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (i) That the payroll for the payroll period contains the information required to be provided under §5.5 (a)(3)(6) of Regulations, 29 CFR part 5, the appropriate information is being maintained under §5.5 (a)(3)(i) of Regulations. 29 CFR part 5, and that such information is correct and complete; (ii) That each 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 indirectty from the full wages earned, other than permissible deductions as set forth in Regulations, 29 CFR part 3; (iii) That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or cash equivalents for the classification of work performed, as specified in the applicable wage determination incorporated into the contract. (3) The weekly submission of a property 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 3.b.(2) of this section. (4) The falsification of any of the above cerUfications may subject the contractor or subcontractor to ctvil or criminal prosecution under section 1001 of title 18 and section 231 of title 31 of the United States Code. c. The contractor or subcontractor shall make the records required under paragraph 3.a. of this section available for inspection, copying, or transcription by authorized representatives of the contracttng agency, the State DOT, the FHWA, or the Department of Labor, and shall permit such representatives to interview employees during working hours on the job. if the contractor or subcontractor fails to submit the required records or to make them available, the FHWA may, after written notice to the contractor, the Required Federal -aid Contract Language contracting agency or the State DOT, take such action as may be necessary 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 5.12. 4. Apprentices and trainees a. Apprentices (programs of the LISDOL). 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 U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or if a person is employed in his or 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 Office of Apprenticeship Training, Employer and Labor Services or a State Apprenticeship Agency (where appropriate) to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices to journeymen 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 worker 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 on 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 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's hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. 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 journeymen hourly rate specified in the applicable wage determination. 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 determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved. b. Trainees (programs of the USDOL). 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 uniess they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by format certification by the U.S. Department of Labor, Employment and Training Administration. Page 12 of 22 ALA-nB 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified in the approved program for the trainee's level of progress, expressed as a percentage of the joumeyman hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the tralnee 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 journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices. 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 paid 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. In the event the Employment and Training Administration withdraws approval of a training program, the contractor 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. Equal employment opportunity. The utilization of apprentices, trainees and journeymen under this part shall be in conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR part 30. d. 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 IV. The straight time hourly wage rates for apprentices and trainees under such programs will 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. S. Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR part 3, which are incorporated by reference in this contract. 6. Subcontracts. The contractor or subcontractor shall insert Form FHWA-1273 in any subcontracts and also require the subcontractors to include Form FHWA-1273 in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with aft the contract clauses in 29 CFR 5.5. 7. Contract termination: debarment A breach of the contract clauses in 29 CFR 5.5 may be grounds for termination of the contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR 5.12. 8. Compliance with Davis -Bacon and Related Act requirements. Ali rulings and interpretations of the Davis -Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in this contract. Required Federal -aid Contract Language 9. Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall not be subject to the general disputes clause of this contract Such disputes shall be resolved in accordance with the procedures of the Department of Labor set forth in 29 CFR parts 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 U.S. Department of Labor, or the employees or their representatives. 10. Certification of eligibility. a. By entering into this contract, the contractor certifies that neither it (nor he or she) nor any person or firm who has an interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). b. No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). c. The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. V. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT The following clauses apply to any Federal -aid construction contract in an amount in excess of $100,000 and subject to the overtime provisions of the Contract Work Hours and Safely Standards Act. These clauses shall be inserted in addition to the clauses required by 29 CFR 5.5(a) or 29 CFR 4.6. As used in this paragraph, the terms laborers and mechanics include watchmen and guards. 1. Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek, 2. Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (1.) of this section, the contractor and any subcontractor responsible therefor shall be liable for the 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 Disirict or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (1.) of this section, in the sum of $10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (1 ) of this section. 3. Withholding for unpaid wages and liquidated damages. The FHWA or the contacting agency shalt upon its own action or upon written request of an authorized representative of the Department of Labor 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 Page 13 of 22 DLA-pB 13-06 August 12, 20t3 Local Assistance Procedures Manual 12- Required Federal -aid Contract Lan# ua G Prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by he 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 (2) of this section. 4. Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (1.) through (4.) of this section and also a Clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shah be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth In paragraphs (I.) through (4) of this section. VI, SUBLETTING OR ASSIGNING THE CONTRACT This provision is applicable to all Federal -aid construction contracts on the National Highway System. 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 contracting agency. 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 635.116). a. The term "perform work with its own organization" refers to workers employed or leased 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 or lower tier subcontractor, agents of the prime contractor, or any other assignees, The term may include payments for the costs of hiring leased employees from an employee leasing firm meeting all relevant Federal and State regulatory requirements. Leased employees may only be included in this term if the prime contractor meets all of the following conditions: ) the Prime laintains control over the supervision of theday to -day activities esoff the leased employees; (2) the prime contractor remains responsible for the quality of the work of the leased employees; (3) the prime contractor retains all power to accept or exclude individual employees from work on the project; and (4) the prime contractor remains ultimately responsible for the payment of predetermined minimum wages, the submission of payrolls, statements of compliance and all other Federal regulatory requirements. b. "Specialty items" shad be construed to be limited to work that requires highly specialized knowledge, abilities, or equipment not Ordinarily available in the type ofcontracting organizations qualified and expected to bid or propose on the contract as a whole and In general are to be limited to minor components of the overall contract. 2. The contract amount upon which the requirements set forth in paragraph (1) of Section Vi IS computed includes the cost of material and manufactured products which are to be purchased or produced by the contractor under the contract provisions. 3. The contractor shall furnish (a) a competent superintendent or supervisor who is employed by the firm, has full authority to direct performance of the work In accordance with the contract $ ge 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 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 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 contracting agency has assured that each subcontract is evidenced in writing and that it contains all pertinent provisions and requirements of the prime contract. 5. The 30% self -performance requirement of paragraph (1) is not applicable to design -build contracts; however, contracting agencies may establish their own setf-performance requirements. ViI. SAFETY; ACCIDENT PREVENTION This provision is applicable to all Federai-aid construction contracts and to all related subcontracts. 1. 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 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 condition of each subcontract, which the contractor enters into pursuant to this contract, that the contractor and any subcontractor shaif 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.3704). 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 J.S.C.3704). Vill. FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. In order to assure high quality and durable construction in conformity with approved plans and specifications and a high degree of 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 misrepresentation with respect to any facts related to the project is a violation of Federal law. To prevent any misunderstanding regarding the seriousness of these and similar acts, Form FHWA-1022 shall be posted on each Federal -aid highway project (23 CFR 635) in one or more places DLA-OB 13-06 Page 14 of 22 Augus( 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Langus e where it is readily available to all persons concerned with the project: 18 U.S.C. 1020 reads as follows: 'Whoever, being an officer, agent, or employee of the United States, or of any State or Territory, or whoever, whether a person, association, firm, 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 performed, or the cost thereof in connection with the submission of plans, maps, specifications, 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 representation, false report or false claim with respect to the character, quality, quantity, or cost of any work performed or to be performed, 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 representation 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 Stat, 355). as amended and Supplemented; Shall be fined under this title or imprisoned not more than 5 years or both.' IX. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. By submission of this bid/proposal or the execution of this contract, or subcontract, as appropriate, the bidder, proposer, Federal -aid construction contractor, or subcontractor, as appropriate, will be deemed to have stipulated as follows: 1. That any person who is or will be utilized in the performance of this contract is not prohibited from receiving an award due to a violation of Section 508 of the Clean Water Act or Section 306 of the Clean Air Act. 2. That the contractor agrees to include or cause to be included the requirements of paragraph (1) of this Section X in every subcontract, and further agrees to take such action as the contracting agency may direct as a means of enforcing such requirements. X. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION This provision is applicable to all Federal -aid construction contracts, design -build contracts, subcontracts, lower -tier subcontracts, purchase orders, lease agreements, consultant contracts or any other covered transaction requiring FHWA approval or that is estimated to cost $25,000 or more — as defined in 2 CFR Paris 180 and 1200, 1. Instructions for Certification — First Tier Participants: a. By signing and submitting this proposal, the prospective first tier participant is providing the certification set out below. DI. A-013 .i 3-06 g 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 first tier 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 first tier participant to furnish a certification or an explanation shall disqualify such a person from participation in this transaction. c. The certification in this clause is a material representation of fact upon which reliance was placed when the contracting agenty determined to enter into this transaction. If it is later determined that the prospective participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the contracting agency may terminate this transaction for cause of default. d. rospective first tier written notice otice to he contracting a greincy to whom pant shall r immediateovide this p os posai submitted if any time the prospective first tier 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," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CPR Parts 180 and 1200. "First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a Participant (such as the prime or general contract). "Lower Tier Covered Transactions' refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). 'Lower Tier Participant" refers any Participant who has entered into a Covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). I. The prospective first 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 entering into this transaction. g. The prospective first tier participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions," provided by the department or contracting agency, entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. h, 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, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification Is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (ilUps:;hvww_zhls,g w/), which is compiled by the General Services Administration. I. Nothing contained in the foregoing shall be construed to require the establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and Page 15 of 22 August t2, 2013 Local Assistance Procedures Manual Exhibit 12-G information of the prospective 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 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 department or agency may terminate this transaction for cause or default. 2. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — First Tier Participants: a. The prospective first tier participant certifies to the best of its knowledge and belief, that it and its principals: (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency; (2) Have not within a three-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; (3) 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 (a)(2) of this certification; and . (d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. b. Where the prospective participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. 2. Instructions for Certification - Lower Tier Participants: (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200) 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,* "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 Required Federal -aid Contract Language and 1200. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. "First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a Frst Tier Covered Transaction (such as subcontracts). "First Tier Participant' refers to the participant who has entered into a covered transaction With a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). 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 vAh which this transaction originated. f. The prospective tower 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 exceeding the $25,000 threshold. 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, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous, A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verity the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (httns:ll�s�y.cp,lagv�(), which is compiled by the General Services Administration. In. 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. 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 department or agency with which this transaction originated may pursue available remedies, including suspension andlor debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower Tier Participants: 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 participating in covered transactions by any Federal department or agency. Page 16 of 22 DT,A-Oi3 13-06 August 12, 2013 Local Assistance Procedures Manual Exhibit 12-G Required Federal -aid Contract Language 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shalt attach an explanation to this proposal. XI. CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING This provision is 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 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. 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, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 2. This certification is a material representation of fad 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 31 U.S.C. 1352. 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. 3. The prospective participant also agrees by submitting its bid or proposal that the participant 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. Page 17 of 22 DLA-Oil 13-06 August 12, 2013 Brian Mendoza P.O. Box 7745 Riverside, CA 92513-7745 Email: brian@ptni-eng.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 Iuc./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, street lighting, 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 SKILLS • Capable of operating heavy equipment such as skip loaders, cranes, and backhoes; • Hands-on experience with hand tools and power tools; i 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. 0 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. LANGUAGES • English (Native) • Spanish (Fluent) 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 407-1224U4 (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 CONUNUED 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)473-7331. 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 #ST0131(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 CERTIFICATE OF CORPORATE RESOLUTION 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 9?° day of % , �7 (year). A TRUE RECORD ATTEST (Corporate Seal) ( 12, Brian Mendoza Secretary/Clerk Vice President/Secretary 53 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 jo Lake Street Bicycle Treatments and Downtown Parking Clegg CC-1468 CM L-5181(179 ) November 14, 2914 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1. The Federal Labor Rates contained in Appendix H - Part 2 of the Project Specifications for the Lake Street Bicycle Treatments and Downtown Bicycle Parking - CC1468 CML-5181(179) shall be replaced with the attached FEDERAL LABOR RATES DATED November 14, 2D14. The Federal labor rates dated November 14, 2014 shall be the Federal labor rates in effect for the above named project. This is to a'POeag'Ptes.eipt and review of Addendum Number dated May 9, 2014, 4P 2� tl Company oRN 5oa By gga E, cA g2 RIVERg�p Date - All bidders must acknowledge the receipt of this Addendum vrith your bid proposal. Should you have any questions regarding this Addendum, please call Darren Sam at (714) 536-5431. Page I of 26 General Decision Number! CA140035 111/07/2014 CA35 Superseded General Decision Number: CA20130035 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 Publication Date 0 01/03/2014 1 01/10/2014 2 01/24/2014 3 02/21/2014 4 03/07/2014 5 03/14/2014 6 04/25/2014 7 05/09/2014 8 05/23/2014 9 06/06/2014 10 06/13/2014 11 06/20/2014 12 07/04/2014 13 07/11/2014 14 07/18/2014 15 07/25/2014 16 08/01/2014 17 08/08/2014 18 08/22/2014 19 10/17/2014 20 11/07/2014 ASBE0005-002 06/30/2014 Rates Fringes Asbestos Workers/insulator (includes the application of all insulating materials, protective coverings, coatings, and finishes to all types of mechanical systems) ..... $ 35.44 19.36 Fire Stop Technician (Application of Firestopping Materials for wall openings and penetrations in walls, floors, ceilings and curtain walls) ........................... $ 24.34 16.09 ASBE0005-004 06/24/2013 Rates Fringes littp://N7,�-%,.wdol.gov/tvdol/scafiles/davisbacon/CA'15,dvb9v=19 I 1/14/201.4 Page 2 of 26 Asbestos Removal worker/hazardous material handler (includes preparation, wetting, stripping, removal, scrapping, vacuuming, bagging and disposing of all insulation materials from mechanical systems, whether they contain asbestos or not) ....$ I6-95 I0.33 ° oncA0004-0I0 ns/oz/zoz« Rates Fringes *The *age scale for prevailing wage projects performed in Blythe, China lake, Death Valley, Fort Irwin, Twenty -Mine Palms, Needles and l-zs corridor (Barstow to the Nevada State Lino) will be Three Dollars <$3.00> above the standard Guo Bernardino/Riverside County hourly wage rate ------------------ _______________ __ ______________________ 8RCAOOl8-nVA 06/01/2014 Rates Fringes ' MARBLE FINISHER .................. $ 28.45 Il .3$ TILE FINISHER ............ ........ $ 23.78 9.84 TILE LAYER ....................... $ 35.14 14.33 ________________ ___________ ________ _______ nRCa0018-010 09/01/2013 Rates Fringes TERRAZZO FINISHER ................ $ 26.59 I0.34 TERRAZZO WORKER/SETTER ........... $ 32.63 I1.I3 __ _________________________________________ CARPV000-on1 07/01/2010 Rates Fringes CARPENTER (1) Carpenter, Cabinet Installer, zoevlatipo Installer, Hardwood Floor Worker and acoustical installer ................... $ 37.35 11.08 (u) Millwright. . .. ... . . . ....$ 37.e5 11.08 (3) piIedrivezmen/oorrick Bargeman, Bridge or Dock Carpenter, Heavy Framer, Rock Bargeman or 000vmao, RookoIiugez, ahingIer (commezoial)................ $ 37.48 11.08 (4) Pneumatic Nailer, Power StapIer............... $ 37.e0 11.08 Page 3 of 26 (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). $0.13 per hour additional. ---------------------------------------------------------------- CARP0409-005 07/01/2010 Rates Fringes Drywall DRYWALL INSTALLER/LATHER....$ 37.35 11.06 STOCKER/SCRAPPER ............ $ 10-00 6.67 --------------------------------------------------------------- CARP0409-008 08/01/2010 Rates Fringes Modular Furniture Installer ...... $ 17.00 7.41 ---------------------------------------------------------------- ELEC00-11-002 05/26/2014 COMMUNICATIONS AND SYSTEMS WORK Rates Fringes Communications System Installer ................. _$ 28.30 12.43 Technician ............. .... $ 30.10 12.48 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. bttp://www.wdol.gov/Nvdol/scafiles/daN,isbacoi-dCA35.dvb?v=l 9 11/14/2014 Page 4 of 26 ---------------------------------------------------------------- * ELEC0441-001 09/01/2014 Rates Fringes CABLE SPLICER .................... $ 43,56 15.76 ELECTRICIAN ...................... $ 41,64 15.70 ---------------------------------------------------------------- * ELEC0441-003 05/26/2014 COMMUNICATIONS & SYSTEMS WORK (excludes any work on intelligent Transportation Systems or CCTV highway systems) Rates Fringes Communications System Installer ................... $ 29.09 11.60 Technician .................. $ 30-89 11.66 SCOPE OF WORK The work covered shall include the 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 http://w�-ww,Nvdol.gov./wdol/scafilesidavisbacoi-i/CA35.dvb'?v—I 9 11/14/2014 Page 5 of 26 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. 2. Fire Alarms -Open Wire Systems; installed by the Technician. ELEC0441-004 02/24/2014 Rates Fringes ELECTRICIAN (TRANSPORTATION SYSTEMS, TRAFFIC SIGNALS STREET LIGHTING) Cable Splicer/Fiber Optic Splicer ..................... $ 41.74 15.20 Electrician ................. $ 41.14 15.18 Technician .................. $ 30.86 14.88 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. http://w�,vw.wdol.gov/wdol/scafiles/davisbacon,/C;A35.dvb?v=l9 9 11/14/2014 Page 6 of 26 -------------------------------------------- I -------------------- F-LEC1245-001 06/01/2013 Rates Fringes LINE CONSTRUCTION (1) Lineman; Cable splicer-$ 50.30 15.00 (2) Equipment specialist (operates crawler tractors, commercial motor vehicles, backhoes, trenchers, cranes (50 tons and below), overhead & underground distribution line equipment). .......... $ 40.17 14.56 (3) Groundman ............... $ 30.73 13.48 (4) Powderman... ........ ... $ 44.91 13.46 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 ---------------------------------------------------------------- BLEV0018-001 01/01/2014 Rates Fringes ELEVATOR MECHANIC ........ - ...... $ 49,03 26.785 FOOTNOTE PAID VACATION. Employer. contributes 8%- of regular hourly rate as vacation pay credit for employees with more than 5 years of service, and 6% 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. ------------------------------------------------ - --------------- ENGIO012-003 07/07/2014 Rates Fringes OPERATOR: Power Equipment (All other Work) GROUP 1 ................ -.$ 39.05 22.25 GROUP 2 ............... .... $ 39.83 22.25 GROUP 3 .................. 40,12 22.25 GROUP 4 .................. 41.61 22.25 GROUP 5 .... ......... .$ 41.86 22.25 GROUP 6 ............... --$ 41.83 22.25 GROUP 5 ....I ...... 11.1--$ 41,94 22.25 GROUP 9 ................... $ 42.19 22.25 GROUP 10- ..... ........... $ 42,06 22.25 GROUP 11....................$ 42.31 22.25 GROUP 42.23 22.25 GROUP 13 ................... $ 42.33 22.25 GROUP 14 ....... ............ $ 42.36 22.25 GROUP 15 .................... $ 42.44 22.25 GROUP 16 ........ ... --...$ 42.56 22.25 GROUP 17 ....... ............ $ 42,73 22.25 hup:/Iw,,vw.wdol.gov/wdol/scafiles/daN,isbacon/CA3�;.dvb?v-l9 11/14/2014 Page 7 of 26 GROUP 18 .................... $ 42.83 22.25 GROUP 19 ................... .$ 42.94 22.25 GROUP 20 .................... $ 43.06 22.25 GROUP 21 .................... $ 43,23 22.25 GROUP 22 .............. ..... $ 43.33 22.25 GROUP 23 ................. _$ 43.44 22.25 GROUP 24 .................... $ 43.56 22.25 GROUP 25 ..... ............ 43.73 22.25 OPERATOR: Power Equipment (Cranes, Piledriving Hoisting) GROUP I ................ $ 40.40 22.25 GROUP 2 .................... $ 41.18 22.25 GROUP 3 ................... $ 41,47 22.25 GROUP 4 .................... $ 41.61 22.25 GROUP 5 ...... ............. $ 41.83 22,25 GROUP 6 ................... $ 41.94 22.25 GROUP 7 .................... $ 42.06 22.25 GROUP 8 .................... $ 42.23 22.25 GROUP 9 .................... $ 42.40 22.25 GROUP 10 .................... $ 43.40 22.25 GROUP 11 .................... $ 44.40 22.25 GROUP 12 .................... $ 45.40 22.25 GROUP 13 .................... $ 46.40 22.25 OPERATOR: Power Equipment (Tunnel Work) GROUP I ..... .............. $ 40.90 22.25 GROUP 2 .......... __ ...... $ 41.68 22.25 GROUP 3 ...... ............. $ 41.97 22.25 GROUP 4 ........ ........... $ 42.11 22.25 GROUP 5 ....... ........... .$ 42.33 22.25 GROUP 6 .................... $ 42.44 22.25 GROUP 7 .............. ..... $ 42,56 22.25 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 AFB, 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 CROUP 2: Asphalt -rubber plant operator (nurse tank operator); Concrete mixer operator -skip type; Conveyor operator; hitp://ww-w.wdol.goN,/wdol/scafiles-/davisbacon/CA35.dvb?v=19 11/14/2014 Page 8 of 26 Fireman; Forklift operator (includes loed, lull or similar types over 5 tons; Hydrostatic pump operator; oiler crusher (asphalt or concrete plant); Petromat laydowa 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 dra9type attachments); Helicopter radioman (ground); Stationary pipe wrapping and cleaning maciine 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 301 maximum); Equipment greaser (grease truck); Guard rail post driver operator; Highline cableway signalman; 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 (use LO 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, bucket or auger types (Calweld 100 bucket or similar types - Watson 1000 auger or similar types - Texoma 130, 500 or 600 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 tunriel 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 yde, struck); self-propelled tar pipe lining 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 (I drum); Ultra high pressure waterjet cutting tool system operator; Vacuum blasting machine operator http://w-",w,NAidol.go\,/wdol/scaftles/davisbacon,/CA35.dvb?v=l 9 11/14/22014 Page 9 of 26 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 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 anit); 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 yds. struck); Rubber tired earth moving littp://,,vww.wdol.gov/wdol/scafiles/daN7isbacon./C A3 -5.dvb`?v= l 9 11 /14/2014 Page 10 of 26 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 1751 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 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 So yds. struck) GROUP 17: Rubber -tired earth -moving equipment operator, operating equipment with push-pull system (multiple engine, Euclid, Caterpillar and similar, over So 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 1-ittp://www.wdol.gov/wdol/scafiles/davisbacon/CA35.dvb?v=19 11/14/2014 Page 11 of 26 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) 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 So 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 So cu. yds. struck) CRANES, PILEDRIVING, AND HOISTING, EQUIPMENT CLASSIFICATIONS GROUP I., Engineer oiler; Fork lift operator (includes loed, lull or similar types) GROUP 2: Truck crane oiler GROUP 3: A -frame or winch truck operator; Ross carrier operator (jobsite) http://Nv-,vw.Nvdol.gov/wdol/scafiles/davisbacon/CA3 5.dvb?v=l 9 11/14/2014 Page 12 of 26 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) 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 So tons mrc); Highline cableway operator; Hoist operator, stiff legs, Guy derrick or similar type (over 25 tons up to and including so 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) http:/,/www.wdol.gov/wdol/`scafiles/davisbacon/CA3-4.dvb?v=l 9 11/14/2014 Page 13 of 26 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 operator; Heading shield operator; Heavy-duty repaiTperson; 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 SE corner of Section 34, T24S, R40E, MDM, Continue 10 along the Inyo and Kern County boundary until the intersection with Tulare County, at that point which is the SW corner of the SE quarter of Section 32, T24S, R37Et MDM. Continue W along the Kern and Tulare County boundary, until that point which is the NW corner of T25S, R322, MDM. Continue S following R32E lines to the NW corner of T31S, R32E, MDM. Continue W to the NIKI corner of T318, R31E, MDM. Continue S to the SW corner of T32S, R31E, MDM. Continue w to SW corner of SE quarter of Section 34, T32S, R30E, MDM. Continue s to SW corner of T11N, R17W, SBM. continue E along hitp-1/w,ArN,v.wdol.gov/,A,dol/scafiles/davisbacon/CA3�.dvb?v=I 9 11/14/2014 Page 14 of 26 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, RlE, SSM, Continue S along west boundary of RlE, SMB to Riverside County line at the SW corner of TIS, RlE, SBM. Continue E along south boundary of Tls, SBM (Riverside County Line) to SW corner of TIS, RIOE, SBM. Continue S along west boundary of RIOE, SBM to Imperial County line at the SW corner of T8S, RIOE, 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, T17Nt R14E, SBM $1.00 additional per hour for portions of SAN LUIS OBISPO, KERN, SANTA BARBARA & VENTURA as defined below: 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 E to SW corner of T30S, R17E, MDM. Continue S to SW corner of T31S, R17E, MDM. Continue E to SW corner of T31S, R18E, 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 T8N, 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 MDM]. Continue North along the East side of R21E, MDM 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. $2.00 additional per hour for INYO and MONO Counties and the Northern portion of SAN BERNARDINO County as defined below: That area within the following Boundary; Begin at the intersection of the northern boundary of Mono county and the California state line at the point which is the center of http://w-AN-w,wdol.gov/wdol/scafiles/da-,,isbacon/CA35,dvb?v=19 11/14/2014 Page 15 of 26 Section 17, T10N, R22E, Mt. Diablo Meridian, Continue S then SE along the entire western boundary of Mono County, until it reaches Inyo County at the point which is the NE corner of the Western half of the NW quarter of Section 2, T8S, R29E, MDM. Continue SSE along the entire western boundary of Inyo County, until the intersection with Kern County at the point which is the SW corner of the SE 1/4 of Section 32, T24S, R37E, MDM. Continue E along the Inyo and Kern County boundary until the intersection with San Bernardino County at that point which is the SE corner of section 34, T24S, R40E, MDM, Continue E along the Inyo and San Bernardino County boundary until the point which is the NE corner of the Western half of the NN quarter of Section 6, T25S, R42E, MDM. Continue S to that point which is the SW corner of the NW quarter of Section 6, T27S, R42E, MDM. Continue E in a straight line to the California and Nevada state border at the point which is the NW corner of Section 1, T17N, R14E, San Bernardino Meridian, Then continue NW along the state line to the starting point, which is the center of Section 18, TION, R22E, MDM. REMAINING AREA NOT DEFINED ABOVE RELIEVES BASE RATE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ENGIO012-004 08/01/2014 Rates Fringes OPERATOR: Power Equipment (DREDGING) (1) Leverman ............. _$ 48.60 22.40 (2) Dredge dozer ............ $ 42.63 22.40 (3) Deckmate .............. '.$ 42,52 22,40 (4) Winch operator (stern winch on dredge) ............ $ 41.97 22.40 (5) Fireman -oiler, Deckhand, Bargeman, Leveehand ................... $ 41.43 22,40 (6) Barge Mate.. ............ $ 42.04 22.40 IRON0377-002 07/01/2014 Rates Fringes Ironworkers: Fence Erector ............... $ 26.58 17,74 Ornamental, Reinforcing and Structural .............. $ 33.50 26.74 PREMIUM PAY: $6.00 additional per hour at the following locations; China Lake Naval Test Station, Chocolate Mountains Naval Reserve-Niland, Edwards AFE, 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 htip://www.wdol.gov/wdol/scafiles/da,visbacon/CA35.dvb?v=19 11/14/2014 Page 16 of 26 $4.00 additional per hour at the following locations: Army Defense Language Institute - Monterey, Fallon Air Base, Naval Post 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 LAB00300-005 01/01/2014 Rates Fringes Asbestos Removal Laborer ......... $ 28.00 15.25 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. ------ I ---------------------------------------------------------- LABO0345-001 07/01/2014 Rates Fringes LABORER (GUNITE) GROUP 1 ..... ............... $ 34.79 17.92 GROUP 2 ..................... $ 33.84 17.92 GROUP 3 ...... .............. $ 30.30 17.92 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 751-011 above base level and which work must be performed in whole or in part more than 751-011 above base level, that work performed above the 751-011 level shall be compensated for at 35 cents per hour above the applicable classification wage rate. GUNITE LABORER CLASSIFICATIONS GROUP 1: Rodmen, Nozzlemen GROUP 2: Gunmen GROUP 3: Reboundmen ---------------------------------------------------------------- http-.//Nk,�vw.wdol.gov/-,vdol/scafiles/davisbacon/CA35.dvb?v=19 11/14/2014 Page 17 of 26 LABOO652-001 07/01/2014 Rates Fringes LABORER (TUNNEL) GROUP 1 ..................... $ 35.74 16.48 GROUP 2 ..................... $ 36.06 16.48 GROUP 3 ..................... $ 36.52 16.48 GROUP 4 ..................... $ 37.21 16,48 LABORER GROUP 1 ..................... $ 30-19 16.48 GROUP 2 ..................... $ 30.74 16.48 GROUP 3 ..................... $ 31,29 16.48 GROUP 4 ..................... $ 32.84 16.48 GROUP 5 ............ ........ $ 33.19 16.48 LABORER CLASSIFICATIONS GROUP i-,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 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 http-//w�,vw.wd.ol.gov/wdol/scafiles/davisbacoti/CA')5.dvb?v=19 11/14/2014 Page 18 of 26 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 ncluding 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, Clacker 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 --ubular 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 oipe 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 TUNNEL LABORER CLASSIFICATIONS GROUP 1: Batch plant laborer; Changehouse person; Dump person; Dump person (outside); Swamper (brake person and switch person on tunnel work); Tunnel materials handling person; Nipper; Pot tender, using mastic or other materials (for example, but not by way of limitation, shotcrete, etc.) GROUP 2: Chucktender, cabletender; Loading and unloading agitator cars; Vibrator person, jack hammer, pneumatic tools (except driller); Bull gang mucker, track person; Concrete crew, including rodder and spreader GROUP 3: Blaster, driller, powder person; Chemical grout jet person; Cherry picker person; Grout gun person; Grout mixer http:lhvw;,v.wdol.govlu,dol/ scafilesldavisbacon/CA35,dvb?v=19 11 /14/2014 Page 19 of 26 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 Douse); 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 --------------------------- I ------------------------------------ LABOO652-003 07/01/2014 Rates Fringes Brick Tender .................. —$ 29.12 15.78 LABO1.3.84-001 ,07/01/2014 Rates Fringes Laborers: (HORIZONTAL DIRECTIONAL DRILLING) (1) Drilling Crew Laborer ... $ 31.65 13.33 (2) Vehicle operator/Hauler.$ 31.82 13.33 (3) Horizontal Directional Drill operator .............. $ 33.67 13,33 (4) Electronic Tracking Locator ..................... $ 35.67 13,33 Laborers: (STRIPING/SLURRY SEAL) GROUP J. .............. 32.56 16.28 GROUP 2 ..................... $ 33.86 16.28 GROUP 3 ..................... $ 35.87 16.28 GROUP 4 ............ ........ $ 37.61 16.28 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 littp://www.,,Ardol.gov/wdol/`seafiles/davisbacon/C,A35,dvb?v--1 9 1 t / 14/2014 Page 2Onf26 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 cuotruI/ operation of all related machinery and equipment _______________________________________ zABOz4z*-onz 08/07/2013 Rates Fringes LABORER PLASTER CLEAN-UP LABORER .... $ 27.45 16.36 Work on a swing stage scaffold: $1'00 per hour additional. --'------------'-'--'--------'-------'--'---'-'----------------- PAI0VOss-oOI 07/01/2014 Rates Fringes Painters: (Including Lead Abatement) (1) Repaint (excludes San Diego County) .... ........... $ 26.89 13.28 REPAINT of any previously painted etzucture. Exceptions: work involving the aerospace industry, breweries, commercial recreational facilities, hotels which operate commercial establishments as part of hotel service, and sports facilities. ________________________________ ________ ^ gAIN0036-008 10/0I/20I* Rates Fringes DRYWALL FINISHER/TAPER ........... $ 35.18 15.91 ___________________ _ __ ________________ 9AINnO36-015 06/0I/2014 Rates Fringes GLAZIER .......................... $ 37.95 22.69 FOOTNOTE: Additional $1.25 per hour for wozk in a roador, from the third (3zd) floor and up Additional $1.25 per hour for *nzk on the outside of the building from a swing stage or any suspended contrivance, from the ground up ----------------------'---------------- --- PAI0z247-oO2 01/0I/2014 Bates Fringes httnxYnmvm'.m^]ol-ishuoon/CA35.dvb7v=|9 11/14/2014 Page 21 of 26 Snrr FLOOR LAYER ................. $ 29.85 I2.56 ______________________________________ PLA3O2O0-8O9 08/06/281* Rates Fringes PLASTERER ........................ $ 37.43 13.28 __---__-_--_-----_ --_ _-___-----______ _--- PL&SVSOO-0O2 07/07/20I4 Rates Fringes CEmomr omASna/cnmcREzE FINISHER ... $ 31.85 19.55 ------------- --- -------- - ------ ----- ---''--'-------'---- ezaJM0nlG-Vn1 07/01/201* Rates Fringes pzUMBER/ezeEFZTzEn plumber and Pipeflttez All other work except work on new additions and remodeling of bars, restaurant, stores and commercial buildings not to exceed 5,000 sq. ft. of floor space and work on strip malls, light commercial, tenant improvement and remodel work ....................... $ e4.71 20.36 Work ONLY on new additions and remodeling of bars, restaurant, stores and commercial buildings not to exceed s'uuu sq. ft. of floor space ................. $ 43.33 19.38 Work ONLY on strip malls, light commercial, tenant improvement and remodel PLlM0345-001 07/01/2014 Rates Fringes PLUMBER Landscape/Irrigation ritter.$ 29.27 19.75 Sewer & Storm Drain Work .... $ 33.24 17.I3 ------------------ ----------- -- ------------------- -- -- - RQOFO0y8-no2 08/01/2014 Rates Fringes FOOTNOTE: Pitch prem±um: work on which employees are exposed to pitch fumes or required to handle pitch, pitch base or pitch impregnated products, or any material onuta±oiug onaI tar pitch, the entire roofing crew shall receive $1.75 per htto:/h^nArw.nvdolgov/wdol/scafiles/davisbacon/CA'I 11/14/2014 Page 22 of 26 hour "pitch premium" pay. ---------------------------------------------------------------- SFCA0669-008 07/01/2013 DOES NOT INCLUDE SAN CLEMENTE ISLAND, THE CITY OF SANTA ANA, AND THAT PART OF ORANGE COUNTY WITHIN 25 MILES OF THE CITY LIMITS OF LOS ANGELES: Rates Fringes SPRINKLER FITTER .................$ 34.19 19.37 ---------------------------------------------------------------- SFCA0709-003 01/01/2014 SAN CLEMENTE ISLAND, THE CITY OF SANTA ANA, AND THAT PART OF ORANGE COUNTY WITHIN 25 MILES BEYOND THE CITY LIMITS OF LOS ANGELES: Rates Fringes SPRINKLER FITTER (Fire) ..........$ 40.61 24.02 ---------------------------------------------------------------- SHEE0105-003 07/01/2014 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 ........................$ 40.79 23.75 (2) Industrial work including air pollution control systems, noise abatement, hand rails, guard rails, excluding aritechtural sheet metal work, excluding A-C, heating, ventilating systems for human comfort ... $ 40.79 23.75 ---------------------------------------------------------------- TEAM0011-002 07/01/2014 Rates Fringes TRUCK DRIVER GROUP 1....................$ 27.99 24.14 GROUP 2....................$ 28.14 24.14 GROUP 3........ ............ $ 28.27 24.14 GROUP 4....................$ 28.46 24.14 GROUP 5.......... .......... $ 28.49 24.14 GROUP 6............. ....... $ 28.52 24.14 GROUP 7....................$ 28.77 24.14 http://www.wdol.gov/wdol/scafiles/davisbacon/CA3 -4.dvb?v=19 11 /1412014 Page 23 of 26 GROUP 8 .............. ... $ 29,02 24.14 GROUP 9 ................... .$ 29.22 24.14 GROUP 10 ......... .......... $ 29.52 24.14 GROUP 11 ................ 30.02 24.14 GROUP 12 ................ 30.45 24.14 WORK ON ALL MILITARY BASES: PREMIUM PAY: $3.00 per hour additional. [29 palms Marine Base, Camp Roberts, China Lake, Edwards AFB, El Centro Naval Facility, Fort Irwin, Marine Corps Logistics Base at Nebo & Yermo, Mountain Warfare Training Center, Bridgeport, Point Arguello, Point Conception, Vandenberg AFB] TRUCK DRIVERS CLASSIFICATIONS GROUP 1: Truck driver GROUP 2: Driver of vehicle or combination of vehicles - 2 axles; Traffic control pilot car excluding moving heavy equipment permit load; Truck mounted broom GROUP 3: Driver of vehicle or combination of vehicles - 3 axles; Boot person; Cement mason distribution truck; Fuel truck driver; Water truck - 2 axle; Dump truck, less than 16 yds, water level; Erosion control driver GROUP 4: Driver of transit mix truck, under 3 yds.; Dumperete truck, less than 6-1/2 yds, water level GROUP 5: Water truck, 3 or more axles; Truck greaser and tire person ($o.5o 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 GROUP 7: A Frame, Swedish crane or similar; Forklift driver; R058 carrier driver. GROUP 8: Dump truck, 25 yds. to 49 yds. water level; Truck repair person; Water pull - single engine; Welder GROUP 9: Truck repair person/welder; Low bed driver, 9 axles or over GROUP 10: Dump truck - 50 yds. or more water level; Water pull - single engine with attachment GROUP 11; Water pull - twin engine; Water pull - twin engine with attachments; Winch truck driver - $1.25 additional when operating winch or similar, special attachments GROUP 12; Boom Truck 17K and above http://w�Nw.wdol.gov/wdoltscafiles/davisbacon/CA35.dvb?v=l9 11/14/2014 Page 24 of 26 WELDERS - Receive rate prescribed for craft performing operation to which welding is incidental. Unlisted classifications needed for work not included within the scope of the classifications listed may be added after award only as provided in the labor standards contract clauses (29CFR 5.5 (a) (1) (ii)). The body of each wage determination lists the classification and wage rates that have been found to be prevailing for the cited type(s) of construction in the area covered by the wage determination. The classifications are listed in alphabetical order of "identifiers" that indicate whether the particular rate is union or non -union. Union Identifiers An identifier enclosed in dotted lines beginning with characters other than "SUIT denotes that the union classification and rate have found to be prevailing for that classification. Example: PLUM0198-005 07/01/2011. The first four letters , PLUM, indicate the international union and the four -digit number, 0198, that follows indicates the local union number or district council number where applicable , i.e., Plumbers Local 0198, The next number, 005 in the example, is an internal number used in processing the wage determination. The date, 07/01/2011, following these characters is the effective date of the most current negotiated rate/collective bargaining agreement which would be July 1, 2011 in the above example. Union prevailing wage rates will be updated to reflect any changes in the collective bargaining agreements governing the rates. 0000/9999; weighted union wage rates will be published annually each January. Non -Union identifiers Classifications listed under an "SUIT identifier were derived from survey data by computing average rates and are not union rates; however, the data used in computing these rates may include both union and non -union data. Example: SULA2004-007 5/13/2010. SU indicates the rates are not union majority rates, LA indicates the State of Louisiana; 2004 is the year of the survey; and 007 is an internal number used in producing the http://ww•rv.NWdol.gov/wdol/scafiles/davisbacon./CA35.dvb?v=19 11/14/2014 Page 25 of 26 wage determination. A 1993 or later date, 5/13/2010, indicates the classifications and rates under that identifier were issued as a General Wage Determination on that date. Survey wage rates will remain in effect and will not change until a new survey is conducted. WAGE DETERMINATION APPEALS PROCESS i_) Has there been an initial. decision in the matter? This can be: * an existing published wage determination * a survey underlying a wage determination * a Wage and Hour Division letter setting forth a position on a wage determination matter * a conformance (additional classification and rate) ruling On survey related matters, initial contact, including requests for summaries of surveys, should be with the Wage and Hour Regional Office for the area in which the survey was conducted because those Regional Offices have responsibility for the Davis -Bacon survey program. If the response from this initial contact is not satisfactory, then the process described in 2.) and 3.) should be followed. With regard to any other matter not yet ripe for the formal process described here, initial contact should be with the Branch of, Construction Wage Determinations. Write to: 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 CPR Part 1.8 and 29 CPR 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 http://wtivw.wdol..gov/wool/scafiles/da-,'isba.con`/C 15.dvb?v=l9 11/14/2014 Page 26 of 26 200 Constitution Avenue, N.W. Washington, DC 20210 4.) All decisions by the Administrative Review Board are final. END OF GENERAL DECISION http://w-ww.wdol.gov/wdol/scafiles/davisbac,on/CA3 5.dvb?N =19 I I /14/2014 BID BOND KNOW ALL BY THESE PRESENTS, That we, PTM GENERAL ENGINEERING SERVICES INC. of 5942 ACORN STREET, RIVERSIDE, CA 92504 (hereinafter called the Principal), as Principal, and INTERNATIONAL FIDELITY INSURANCE COMPANY (hereinafter called the Surety), as Surety are held and Fu-mly bound unto CITY OF HUNTINGTON BEACH (hereinafter called die Obligee) in the penal sum of 10% OF TOTAL BID AMOUNT Dollars (S 10% ) for the payment of which the Principal and the Surety bind themselves, their hairs, 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 LAKE STREET BICYCLE IMPROVEMENTS AND DOWNTOWN BICYCLE PARKING 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 Obligce for the Faithful performance of the said Contract, then this obligation shall be void; otherwise to remain in full force and effect. Signed and sealed this 24TH day of NOVEMBER 1 2014 PTM GE EGINEERING SERVICES INC.(Seal) Principal Witness f2'za a en oza de c aeritle PRESIDENT/CFO Witness INTERNATIONAL FIDELITY INSURANCE COMPANY 3VEGA Attorney -in -Fact Gr I State of California Couniy of ORANGE On before me, Philip Vega, Notary -public Data Hare Inssri Name end Two at i o officer personally appeared ELIZABETH H. MENDOZA de McRAE Imo : ❑ gnor(,c) who proved to me on the basis of satlsfactory evidence to he the person(4) whose names) is/gre subscrlbed to the PHILtP VEGA within Instrument and acknowled99 to me that COMM. # f9770M co he(��1��tf�i�� executed the same in hid/h� l�t�elr authorized NOTARY ANGELES cCALIFORNIA capactty(� s), and that by hIdNei/Meir signatA(s) on the ^�c a�esOUNTy lnnnv31zo1s instrument the person(g), or the entity upon behalf of which the'person(�) acted, executed the Instrument. I certify under PFNALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correot- WITNESS my ha and o ' al seal. Plans Signature Notary Saal Above 6lpnatara of Notary Public ----� OPTIONAL Though the information below is not required by law, it may prove veivable to persons relying on the doourttent snd could prevent fraudulent removal and redtteohment 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 Name: ❑ individual ❑ Corporate Officer Title(s): _ ❑ Partner --- L] Limped ❑ General ❑ Attorney in Fact 1-1 Trustoa ❑ Guardian or Conservator ❑ Other: Signer. Is Representing RIGWTTHUMSPHINT, Top of tliumb nato Number of Pages: Signer's Nama: ❑ Individual ❑ Corporate Offlcer -- Title(s): ❑ Partner- EJ Limited ❑ General ❑ Attorney in Fact CPTrustee Q Guardian or Conservator ❑ dther: Signer Is Representing: RIOWTHUMBPM7 OFSIGNER- P]2007 National Noiary Aseociatiori• 9350 Do Sala Avo„ P,O,Box 2402 -Charewattll, CA 01313.2402• wvrw,NallonalNalary019 Ilem h5907 Roordar.Call Yoll-Free 1.800.878.8027 rwise ANCt::. ;ANCE. HENYi CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § i189 State of California County of Los Angeles On SEP 18 2014 before me, Monica Blaisdell, Notary Public Date Here Insert Name and Title of the Officer personally appeared Philip E. Vega Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the personj< whose nameNj is/ar-o- subscribed to the within instrument and acknowledged to me that he/s'Wtki�y executed the same in MONICA BLAISDELL his r authorized ca aci Commission # 194708345 /� thid P ty(p and that by z his/hgr/thtiic- signatureX on the instrument the a --® Notary Public - California z z Orange County personK, or the entity upon behalf of which the M Comm. Expires Mar 26, 20t6 personacted, 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: Place Notary Seal Above Slonafute. of Notau,Public a City Of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Joan L. Flynn, City Clerk March 23, 2015 Sterndahl Enterprises, Inc. 11861 Branford St. Sun Valley, CA 91352-1032 RE: Lake Street Bicycle Treatments & Downtown Bicycle Parking — CC-1468 Enclosed please find your original bid bond for CC-1468. Sincerely, Joan L. Flynn, CMC City Clerk JF:pe enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand RECEIVED 2014 NOV 24 AM 10, 59 C -LERK ITY CITY OF HUNTINGTON BEACH for the construction of LAKE STREET BICYCLE TREATMENTS And DOWNTOWN BICYCLE PARING CC No. CC 1468 — CML 5181(179) 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 10 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 and 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 '�tiillZ <s -I)o rJ D /P/,D in the amount of I 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 for_% ", as the case may be) Any standard Surety Bid Bond form is acceptable. Bidder shall signify receipt of all Addenda here, if any: Addenda No. Date Received.:.:: Bidder's Si nature:' / C-2 Project Bid Schedule Lake Street Bicycle Treatments and Downtown Bicycle Parking CC-1468 Federal Project Number- 5181(179) 1 II 1 L.S. II Mobilization. 11 Per L.S. 2 1 L.S. Furnish Project Traffic Control. Per L. S. 3 1 L.S. Furnish and Install Traffic Striping and Signing. Per L.S. 4 L. S. Install City Furnished Peak Bicycle Racks (156 Total Bicycle Slots) Using City Furnished Tamper Resistant Mounting Hardware. Per L.S. Total Amount Bid in Figures: $ Total Amount Bid in Words: C-2.1 $ 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. Bid Name andAddress o 5'ubconfractor State Class Dollar of Iiem(s). License Amount Contract Number 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 1 BE EXECUTED BY BIDDER AN1 SUBMITTED WITH BID I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on I I-1 -6 , at Chi Date City State 6 2 iEi ,'r)Ar , being first duly sworn, deposes and says that he or she is y,uc- of ��e�P+ ),nek�— &TcRRt�g 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. Name of Bidder 1 Signature of Bidder Address of Bidder 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 Fake Street Bicycle Treatments and Downtown Bicycle Parking, (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: I t-1 t -H C-5 C Contractor L 2 1� By Title In accordance with Government Code Section 10162, 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 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: C-7 Title BIDDER certifies that the following information is true and correct: t Bidder Name I�R-AN`;--o Business Address City, State Zip Telephone Number A C- L State Contractor's License No. and Class l Original Date Issued q Expiration Date The work site was inspected by D. of our office on H-I F , 201 t . The following are persons, firms, and corporations having a principal interest in this proposal: C-s 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. XI Company Name Signature of Bidder )Et-100 1Z- I,, - Printed or Typed Signature Subscribed and sworn to before me this /M ay of �Q-V' , 2014. NOTARY PUBLIC C-9 NOTARY SEAL Commission #E 2025425 Notary Public - California Los Angeles County Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work. Bidders are encouraged to submit supplemental relevant project history in addition to the projects listed herein. Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past five years: 1. C tl-� 6.� U, Xj--, &7-- Name and Address of Public Agency Name and Telephone No. of Project Manager: U4WC Contract Amount Type of Work Date Completed Provide additional project description to show similar work: rR,ow, -r tAwAwu 1 7(4O-Ou((t i Q-01 Qic i S 2.Cr- Name`and Address of Public Agency Name and Telephone No. of Project Manager: � �lt.li �w Y Contr Amount Type of Work PrnVirlP arldit„innal project description to show Sim;] ar xxrorlS: C).tJ•-�;L`-- TP-I�f-�<L. p�L1+��T�> i).i�v; ���L4�c� AJ frs /-/�c"1/�t� 3. CJTJ Or Named and Address of Public Agency Date Completed Utt Rom. !r zG � NMAR",. Name and Telephone No. of Project Manager: L(. / `lm Contract Amount Type of Work Provide additional project description to show similar work: m4g4A./ J C-10 �-c1i 3 Date Completed Bidder's Critical Staff Listed below are the names of the bidders proposed Construction Project Manager, and Superintendent. For each of these critical positions, please list at least three projects for which the critical staff has performed similar work within the last five years. These projects do not have to be under the employment of the bidder of this project. Bidders are encouraged submit supplemental relevant project history in addition to the projects listed herein. Name of proposed Project Manager Telephone No. of proposed Project Manager:l C(-t-(/ `) LO`y A j,. A,,- J I H OA N.41 Project Name & Contract Amount Type of Work Date Completed L x — iy�AiZ�c�►.f, ��hfi°� `�I � �a"> r.wly-" Ww- o4 (M i Project Name & Contract Amount Type of Work Date Completed q 0sfir/,,-J Project Name & Contract Amount Type of Work N Date Completed 2. ) TEV-t�:- 1 1� Name of proposed Superintendent Telephone No. of proposed Superintendent: ANY n y -Ko, tl f—MrL-I ltv ) d 613 Project Name & Contract Amount Type of Work Date Completed NZiCw-,rJ /c -B P�V O\ � Iry oE iMfrmy-0 4 Project Name & Contract Amount Type of Worlc Date Completed Project Name & Contract Amount Type of Work C-11 Date Completed (For federally funded projects, use this following page) 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: 5� cW� U� Av Contact Person: VE:04,) (�- voniact I I1U1I Signed. Date: N_ *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-12 Local Assistance Procedures Manual Exhibit 12-H Sample Bid (THE BIDDER'S EXECUTION ON THE SIGATATURE 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 J f i�� �►� ' 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 o,her pe,,.od specified by the Federal Highway F dm;-- stration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. t Page 1 of 8 C-13 June 11, 2014 Local Assistance Procedures Manual Exhibit 12-H Sample Bid PUBLIC CONTRACT CODE PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Slats. 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 works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the 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 checkmark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal 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 a safety regulation? Yes No If the answer is yes; PXnlain fhe r_,irgitmatanres in tha fnllnwino c11aca explain __.a _p_--. Page 2 of 8 C-14 .Tune 11, 2014 Local Assistance Procedures Manual Exhibit 12-H Sample Sid PUBLIC CONTRACT CODE 10232 STATEMENT In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealabie 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 to comply with an order of the National Labor Relations Board. Note; The above Statement and Questionnaire are part of the Proposal. Signing this Proposal 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. Page 3 of 8 C-15 June 11, 2014 Local Assistance Procedures Manual Exhibit 12-H Sample Bid Noncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY / COUNTY of 6�&�tk DEPARTMENT OF PUBLIC WORKS. In conformance 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 euccivate a C6ifusiVc 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 4 of 8 C-16 June11,2014 Local Assistance Procedures Manual Exhibit 12-H Sample Bid DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager: • is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any Federal agency; • has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federal agency within the past 3 years; • does not have a proposed debarment pending; and • has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily rcSiiiL iri dcniai o1 awau, but v1'lll UG 1.G11JIdGrGd 111 LLGlei llltillllg 171LLLLCi' 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 5 of 8 C-17 June 11, 2014 Local Assistance Procedures Manual Exhibit 12-H Sample Bid NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. Page 6 of 8 C-18 June 11, 2014 Local Assistance Procedures Manual ! v Exhibit 12-H Sample Bid DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYINU ACTIVITIES PUKSUAN 1 1 U 31 U.S.C. 13�2 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: ® a. contract ® a. bid/offer/application ®a. initial b, grant b. initial award b. material change c. cooperative agreement c. post -award d. loan For Material Change Only: e. loan guarantee year quarter f. loan insurance date of last report 4. Name and Address 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 6. Federal Department/Agency: 8. Federal Action Number, if known: 10. a. Name and Address of Lobby Entity (If individual, last name, first name, MI) Congressional District, if known 7. Federal Program Name/Description: CFDA Number, if applicable 9. Award Amount, if ]mown: b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI) (attach Continuation Sheet(s) if necessary) 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. Form of Payment (check all that apply): c. commission a. cash d. coniingeni fee b. in -kind; specify: nature a deferred value LJ f. other, specify 14. Brief Description of Services Performed or to be performed and Dates) 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 ® No 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying Signature: reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required print Name: pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for Title: 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. Telephone No.: Date: Authorized for Local Reproduction Federal Use Only: Standard Form - LLL Form LLL Rev, Page 7 of 8 C-19 June 11, 2014 Local Assistance Procedures Manual Exhibit 12-H Sample Bid 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 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. 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. Check all boxes that apply. If other, specify nature. 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-LLI.Amtrucflom Rev.06-04-904ENDSFA Page 8 of 8 C-20 June 11, 2014 Local Assistance Procedures Manual E70$3IT 15-G Local Agency Bidder DBE Commitment (Construction Contracts) EXMBrr 15-G LOCAL AGENCY BIDDER DBE COMM TAONT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON'. HE REVERSE SIDE OF T13I5 FORM LOCALAGWCT: City of Huntington Beach LOCATION: h,1"f,("CTN-6 j d�C- Ak k PROIEGTD�r.EUMMON: RIL�Ic C� T61k JCS 1i1�G- TOTAL CONTRACT AMOUNT: $ BID DATE: BIDDEWSNAME: CONTRACT DBE GOAL- 11s. ONTRACT NO. OF WORK AND DESCRIPTION OR SERVICES TO BE SUBCONTRACTED ORMATRRLUS O BE PROVIDED (or contacted if the bidder is a DBE) DBE CERT NO. AND EXPIRATION DATE OF EACH DBE be certified on the date bidsBE ned - include DBE address rdrph-ouenumber) DOLLARAMOM il1�h` } fN i 17�i �iL (o —( cl1 VPJ A P,49 C_o , 14 l �?� • c r? 4;9 -13d -c>Si3 For Local Agency to Complete: Local Agency ConttaetNumber. CC-1468 Federal -aid PrgectNumbec CML 5181(179) PedP.vl Chow• Contract Award Date: Local Agency certi5es that all DBE certifications have been verified and information is complett; and acaaate. Print Name Sigaamra Date Local Agency Representative (Area Code) Telephone Number: 1 Total Claimed DBE Participation �3,3 . F Signature of Bidder Datc (Area Code) Tel. No. or'w t Person to Contact (Please TypeorPrint) Local Ageaep BidderDBB ConmAmnd (Coastact= Contaets) . (Rev 6%109) 1 i Distribution (I) Cady —Fax or scan. a copy to the Caltraos District Local Assistance Engineer (DLAE) withk 30 days of contact execution. Failure to send a copy to the DLAE witbin 30 days of eantract exec&oamay result in de -obligation of tends for this prujat (2) Copy —Include in awardpackage to Catirmrs District Local Assistance (3) Original — Local agency files Page 15-1 OB 12-04 June 29, 2012 C-21 EXHIBIT 15-G Local Assistance Procedures Manual Local Agency Bidder DBE Commitment (Construction Contracts) INSTRUCTIONS - LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) FA WN I.1.'.M PLEASE NOTE: 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 DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE 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, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project 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-G 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. Focal 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 15-2 June 29, 2012 C-22 OB 12-04 Local Assistance Procedures Manual Exhibit 15-H DBE Information - Good Faith Effort EXImIT 15-H DBE INFORMATION —GOOD FAITH EFFORTS DBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. CML 5181(179) Bid Opening Date ( I _)4 1`a The City of Huntington Beach established a Disadvantaged Business Enterprise (DBE) goal of 11.00 % 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 DBE Commitment" form indicates that the bidder has met the DBE 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 DBE firm was not certified at bid opening, or the bidder made a mathematical error. Submittal of only the "Local Agency Bidder DBE 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 DBE Commitment" of the Special Provisions: A. The names and dates of each publication in which a request for DBE 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 DBEs soliciting bids for this proj ect and the dates and methods used for following up initial solicitations to determine with certainty whether the DBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation Page 15-1 OB 12-04 June 29, 2012 C-23 Exhibit 15-H Local Assistance Procedures Manual DBE Information -Good Faith Effort C. The items of work which the bidder made available to DBE 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 DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE 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 DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each DBE if the selected firm is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: Names, addresses and phone numbers of firms selected for the work above: U15^ to, (A-- E. Efforts made to assist interested DBEs 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 DBEs: Page 2 June 29, 2012 C-24 OB 12-04 Local Assistance Procedures Manual Exhibit 15-D DBE Information - Good Faith Effort F. Efforts made to assist interested DBEs in obtaining necessary equipment, supplies, materials or related assistance or services, excluding supplies and equipment the DBE 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 DBE 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 3 OB 12-04 C-25 June 29, 2012 Local Assistance Procedures Manual Exhibit 12-B Bidder's List of Subcontractors (DBE and Non -DBE) EXHIBIT 12-B 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. Firm Name/ Phone/ Local Agency Use- Address/ Fax Annual Gross Description of Portion of Work to be Performed Ci ,State, ZIP Receipts CerttfitdDBE? '. Name Phone ❑ < $1 million T2-id LOr F11 . — r 3 on < $10 million _ _: i .._......._. NO I❑fYFSS- first DBE #, Address h l Siy Fax _ ❑ ❑ < $15 million > $15 million _.._. ._.._....... _.-__-.....-... _.... -- City State ZIP _ j l �3? _��F`i Name Phone ❑ < $1 million --------- _------- --- ❑xE3 ❑ < $5 million --........_.-- -------- ------------- ' ❑N� ❑ < $10 million - -._..... _ _. 1i1 IISt b�' i Address Fax ❑ ❑ < $15 million > $15 million Abe of 1?trrd (Yrs City State ZIP �. .� Name Phone ❑ < $1 million -------- ❑YES ,: ❑ < $5 million - ._._.... - - .......------------ ❑ {_`.. r # t ❑ <$10 million'EStkstDl3E# - -- _ .....-...__....__..._..._ _. .--------- _ Address Fax <$15 million ---------- ❑ > $15 million _ .__ ..._-. ....._..._...... _......._--....---- - At3tt�firtct',(Xrs ; ZIP City State - Name Phone ❑ <$1 million ❑ 1 �i' ;� 4 1U :V ❑ < $5 million ❑NQ ❑ < $10 million _ ... ................_ . -................. ..------ ----- _............. ...... .......DYES �rsf DBE #k Address Fax ❑ < $15 milli(n" City State ZIP ❑ > $15 million A e of kttm Yrs y Distribution: 1) Original - Local Agency File Local Assistance Procedures Manual Exhibit 12-B Bidder's List of Subcontractors (DBE and Non -DBE) EXFIIBIT 12-B BIDDER'S LIST OF SUBCONTRACTORS (DBE AND NON -DBE) PART II 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. Photocopy this form for additional firms. Firm Name/ Phone/ Zoeal Ag�nc� 1Jse O.... Address/ Fax Annual Gross Receipts Description of Portion of Work to be Performed rayP(G��Yiedt�BE }y Ci State, ZIP , ; Name Phone ❑ <$1 million _ _ ........__...._._._ ❑ _ < $5 million _. _.._............_._.... ❑Nl7 ` , �"� �'" ❑ < $10 million - ---- I YESlist`DBE# Address Fax ❑ ❑ < $15 million-................. > $15 million ...... .. -------------------- .... ......._.._.....__ _.....MMI 6 Y Ag of rs ) R City State ZIP mom Name Phone ❑ < $1 million --------- ................................❑❑YES i ❑ < $5 million million _ -...._....._......._. _. NO 1tK I i'ES Cis CBE # 4 Address❑<$10 ` Age u�i (Xrs)� Fax ❑ ❑ <$15 million > $15 million ......— City State ZIP Name Phone ❑ < $1 million hl ❑ ❑ < $5 million < $10 million _ _ _ 1'YES list DBE # a W Address Fax ❑ < $15 million .aq ❑ > $15 million __-..-._._.---- ---- .....------_ - ......._....-- -- -----------------— _ _ Abe tfliirm (Yrs } City State ZIP }^��F�i1d�F'4.'��al'�7 11�� Name Phone ❑ <$1 million --_. ___.._.._._._._._._._ _._.__.._._..._.._.....--____-- ❑ < $5 million _.._..__....._..._..__-- ❑O ❑ <$10 millionY�Siis1D�$E,# _...._..... ......-_.._.._......_..._.. -_-._._._ _ ..._ - Address Fax ❑ < $15 million __-- _____ --------- ----- - - __.... --- --- - -----------•---... ----_.__._.---- t ❑ > $15 million -- ._....._........._.._ ..-... _...._._.__._._...._ - - _ City State ZIP Distribution: 1) Original - Local Agency Pile Page 2 of 2 DLA-OB 13-06 August 12, 2013 C-27 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 For Lake Street Bicycle Treatments and Downtown Parking Clegg CC-1468 CIVIL-5181(179) November 14, 2014 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1. The Federal Labor Rates contained in Appendix H — Part 2 of the Project Specifications for the Lake Street Bicycle Treatments and Downtown Bicycle Parking - CC1468 CML-5181(179) shall be replaced with the attached FEDERAL LABOR RATES DATED November 14, 2014. The Federal labor rates dated November 14, 2014 shall be the Federal labor rates in effect for the above named project. This is to acknowledge receipt and review of Addendum Number One, dated May 9, 2014 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 Darren Sam at (714) 536-5431. THE AMERICAN INSTITUTE OF ARCHITECTS AIA Document A310 Bid Bond BOND # 2014117 KNOW ALL MEN BY THESE PRESENTS, that we STERNDAHL ENTERPRISES, INC. 11861 Branford Street Sun Valley, CA 91352-1032 (Here insert full name ,and address or legal title of Contractor) as Principal, hereinafter called the Principal, and U.S. SPECIALTY INSURANCE COMPANY 625 The City Drive South, Ste. 130 Orange, CA 92868 (Here insert full name ,and address or legal title of Surety) a corporation duly organized under the laws of the State of TX as Surety, hereinafter called the Surety, are held and firmly bound unto CITY OF HUNTINGTON BEACH 2000 Main Street Huntington Beach, CA 92648 (Here insert full name ,and address or legal title of Owner) as Obligee, hereinafter called the Obligee, in the sum of Ten Percent of Amount Bid ------------------------------------------ Dollars ($ 10.00% ), 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 BID BOND (Here insert full name, address and description of project) 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 material 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 7th day of November, 2014 STERdbAHL ENTERPRISES INC. Z&,Princ,p_�Zj (Seal) (Title) (Seal) Yung T/Uullick, AIA DOCUMENT A310 BID B%ND AIA ® FEBRUARY 1970 ED THE AMERIG INSTITUTE OF ARCHITECTS, 1735 N.Y. AVE., N.W. WASHINGTON, D.C. 20006 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT STATE OF GA UFORWA County Of ORANGE On NOVEA5ER 7, 22014 kipfqro'me. JLNNIFEIR C. AINAYA, NOTARY PUBLIC Ho-reRate:77-7'�-,. � Na me anal Title of the (Ricer peWnaliy re appea 0 YUNG T. NIULLICK vdip tc imppri tV e.. basis of ��Vsf4ctory pyidence to whose nameW i-s/are sub'spribed to the i it.Ti;j ;nett Fitt? nj: and aCk ad to me that he/she/they . nowledgc Wed the same in his AW*ff,,4W authorized capacity(ies), anthat s! W setrurnent the OF r, Fs �JENNir-ER C. ANAYA d tht bhi �ye hftdbe� signatureon the in pqrson�.4-or the COMM. # 1974168 X ants - I- , e entity upon behalf of which the pierson�41 d , i�c - LIFORNIA X ,. , ox uted the instr iment 0 NOTARY PUBLIC -CA U) the 'n s" 'men" ORANGE COUNTY I certify under PENALT OF PEIRJLJRY tinder the laws of t To Qj My COMM, EXP. MAY 2,2016 'r _j the of California at t foreg oing paragraph is true qrtc�l correct. Witness, rny, hand nd Aoffff al e Signal We six) OPT Thmugh the into,"Ma-Uon Ooiovj 4n0i r )'y kppv. it may prove valuabip- to persons relying on the document Old qq provent m4ijilvior' r5�mp-,,pl pf?q ;,-.-4qqq w �ne ct this forma to an th r doourt,a t, Veacrlpfion of Arhv;hO Popument Title of Type of ,,t,pp t 'j, P1Q! VR#_0 ollr-.Imcd oy C- loc ' iivioua-1 LJ In Fact TfLlSt.ep Quarciiafi QV cQf1sar%e4-,,,r i T r t�tt�rza t yr ., pr nPort,n#r-- E,-JjLirpi�w [General . - 4 oeene .l - = - PO`VER OF ATTOkNEV - AMERICAN CONTRACTORS INDEMNITY COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company, a California corporation, United States Surety mpa a Maryland corporation and U iS IL III Specialty Insurance otn 6 exas corporation = (collectrveLy, the Corn-anres }, do=by these present's make, constitute and appoint: - _ James W. Moren,I�Y1mg T. IMulhck or Jennifer 45—manaya lanoMission Viejo, California its true and lawful Attomey(s)-in-fact, each in their separate capacity if more than one is named above, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings_ or__other'instruments or contracts of suretyship todude riders, amendments; rand„ consents of surety, pxonding t"_on& penalty does notexceed--**—*teenMillion**I*I;�fil��lll'i�l�llll�il• Ili'�il IIIIII�,IIIIVII �I''I�il. Dollars (S=ISOQOD000 �)� This Power of Atforne shall ex ire withoutfurt e ctran on Decetnbe"P& 1120D1&I'I ° — y _ ul IIThislllllypyier o ,1 orney is gr nte�c undemand=_lam authority of the following resolutions adopted by the Boards of Directors of the" Companies: Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attomey(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: I III'; Wrney- in Fact may, be given full power and authority for and, m the name of and on behalf afthe may � exez e -acknowledge and deliver any;and all bonds recomzances contracts, agreements or indemm ° =g _ gre ty: and other conditional or obligatory vrsdeakf includu`rgn}nd al] consents for :the release of retained peceenta estindlor final estimates on engineering an constructilon!, on"Itra'cts, and any and�LnyticeandEocttments=carieeling or termmmgatthe Company s hability —thereunder, and any such instruments so ezecutedlbyany such°Attomey-in-Fact shall be bin trtgupori_%-is Company as if signed by the President'and-sealed and effected by the Corporate Secretary. Be it R solved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any cer ifcWte relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached - I II il�illi.. II IIII! ICI IN -WITNESS WHEREOF, The Companies. have causedhs instrument tolpelstglnedlla d 1�eilrl co orate seals to biereto- affixed, this loth day -of -December, 2012. 6r rol _ = _ AMERICAN CONTRACTORS INDEMNITY COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY C Co,7•-7r,,orate Seals _ `i' o�a'l4pCTOAB��''c SUR�T�a�s- O W. •+.F` Daure P.W-g0dar, V ce President State of California 4,1 N p, * r „„ County of Los Angeles SS: ' III I'll it �ll�l IIII iII I I!Illli- Arnerican ConirDcfors ndemnlit Corneae aneessa Wrr t, a notary public, person Illy ap ellaredlbamel P. Aguilarr 3 %T=— 76 derr o y — R t_ S tes=Surety Company.,ancjl WITS. ��g ,alty iiiArance Compan w�io�oved tame on the basis of satisfactory evidence to be the person whose name is subscribe' o to the within instrument and acknoredgedito, me that he executed the same in his authorized capacity, and that by his signature on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I a ertrfyurrderPNALTY OF PERJURY'utrder �tli'e law'Is, 111s;. of the State of_{rfotraoing paragraph is true and correct WITNEsriy hand and official seal ill"' K Mom_ ,M = = Cpmmit;ron � t9t6= Signature (Seal) to Lae "gow CNN Comm. E ....Dec 6. M,_ 2016 I, Jeannre,Lee, Assistant Secretary of American—Contradors Indemnity Company, Unttpeld,IlStatFIl,;,ISurety Company and U S ;S_pe ialt = Insurance Company, do hereby ceifithat the as)v: foregoing is alt°,I, lellilanlli cloirect';Ilcop of a Power of Atmeyeex�ateb_ said Companies, which is still m u11 force ante c =fu erYrrore, the reso utronsl;afi;theljB' 'aia, �bf Directors, se ou the owes Attorney are in full force and effect �'I', uyl, — ,� i In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Los Angeles, California this 7th day of November , 2014 7�T CT,a��9 )la.` NSA ,9vo0''. ,,��� qE. ........ .Fp`., ,o``.a . Bond No: '�; `.�z_. =q o_ 'y + °•3= Jeannie Lee sistant Secretary Agency�,No. 7715 . SFPTIS t999'+j