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HomeMy WebLinkAboutAlfaro Communications Construction, Inc. - 2017-11-20RECEIVED % (Name)' t (Date) LD CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office after signing/dating CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION TO: City Treasurer FROM: City Clerk DATE: lam!1 D SUBJECT: 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. g:/forms/bond transmittal to treasurer ,nw_l" IT),-L4--,( L;qtst_- (Company Name) Approved l/ l ?.D /-WI -7 (Council Approval Date) Agenda Item No. City Clerk Vault No. Yob. k5o SIRE System ID No. 3,05'19 RECEIVED BY: (Name) CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office after signing/dating (Date) CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION TO: City Treasurer FROM: City Clerk DATE: IQ/%i SUBJECT: 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. g:/forms/bond transmittal to treasurer (Company Name) LAME' 0660ig Approved Agenda Item No. City Clerk Vault No (Council Approval Date) 6a uo o. So SIRE System ID No. 3,0 93 oi, CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION DATE: 10/3/2018 TO: THOSE LISTED HEREON FROM: Joseph Fuentes, Contract Administrator SUBJECT: Retention Release Payment - PO #23563-OJ Supplier #308794 Co. #995 Traffic Signal Modifications, Project # CC1465 Contractor's Name: Alfaro Communications Address: 620 S. Bradfield Ave City, State and Zip Code: Compton, CA 90713 Phone Number: (310) 669-8949 City Business License Number: A298971 Notice of Completion (Date by City Clerk): 8/29/2018 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. a - Z(2 Date Travis I certify that there are no outstanding invoices on file. io15(10 Date ins, Director of Public Works �h4 Joyce Zacks, [ 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. lelrl2als, Date , City Clerk Attachments 1. Notice of Completion 2. Maintenance Bond 3. Certificate of Compliance with Prevailing Wage Laws 4. Contractor's Certificate 5. Certificate of Compliance with Title VI I of the Civil Rights Act and Equal Employment Opportunity Act of 1972 6. Consent for Release letter from the Surety Company Document-5 844793-Page-1 Page 1 of 1 PLEASE COMPLETE THIS INFORMATION RECORDING REQUESTED BY: WHEN RECORDED MAIL TO: CITY OF HUNTINGTON BEACH PUBLIC WORKS DEPARTMENT Attn:Joseph Fuentes P.O. Box 190 — 2000 Main Street Huntington Beach, CA 92648 Recorded in Official Records, Orange County Hugh Nguyen, Clerk-Recorder [[ i ��� III III [!I it IIII lI �I�lII91 ��f II NO FEE * S R D 0 1 0 3 1 4 2 0 3 8 2018000314958 9:56 am 08128/18 63 406 NI 1 0.00 0.00 0.00 0.00 0.00 0.00 0.000.000.00 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 Alfaro Communications, who was the company thereon for doing the following work to -wit: Traffic Signal Modifications, Project# CC1465 That said work was completed 0812212018 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 08/22/2018, per City Council.Resolution No. 2003-70 adopted October 6, 2001 That upon said contract Endurance Assurance Corp, was surety for the bond given by the said company as required by law. This document is solely for the official business of the City of Huntington Beach, as contemplated under Government Code Section 27383 and should be recorded free of charge, a2 4121,1,� Direrctor of rks or City Engineer Date City of Huntington Beach, California STATE OF CALIFORNIA) County of Orange ) ss: City of Huntington Beach ) I, the undersigned, say: I am an Agent of the City of Huntington Beach, owner in fee, in the foregoing NOTICE OF COMPLETION. I have read said NOTICE OF COMPLETION and know the contents thereof, the same is true of my knowledge. I declare under penalty of perjury that the foregoing is true and correct, and that said NOTICE OF COMPLETION was duly and regularly ordered to be recorded in the Office of the County Recorder of Orange County. This document is solely the official business of the City of r r of P li o ks or City Engineer Date Huntington Beach, as contemplated under Government City of Huntington Beach, California code section 27383 and should be recorded free of char e. THIS PAGE IS ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION (Additional recording fee applies) about:blank 8/28/2018 Bond No. EACX157000018 Premium listed Performance Bond Executed in Duplicate MAINTENANCE BOND KNOW ALL PERSONS BY THESE PRESENTS: That Alfaro Communications Construction, Inc. (contractors name) 15614 S. Altantic Ave., Compton CA 90221 (contractor's street address, city and state and zip code) as Principal (hereinafter called Contractor), and: Endurance Assurance Corporation (surety's name) 1221 Avenue of the Americas New York NY 10020 (surety's street address, city and state and zip code) a corporation org�nized and existing under the laws of the State of Delaware with its principal office in the City of New York as Surety (hereinafter called Surety), are held firmly bound unto CITY OF HUNTINGTON BEACH as Obligee (hereinafter called Owner), in the amount of Thirty Six Thousand Eight Hundred Forty Six & 15/100 Dollars ($ 36,846.15 ), 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, 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 November 20 , 20 17 entered into a contract with Owner for the Traffic Si nal Modifications at the Intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street an ac a den Avenue; Project No. CC 1465 in accordance with drawings and specifications prepared by reference made a part hereof (hereinafter referred to as the Contract); and 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 Contractor's 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 August 22 , 2018, 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 follovuing Owner's 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. 15-1584%1!8138 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 defaults) 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 tire 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 ovmer named herein or the successors of Owner. Signed and sealed this 22nd day of August Principal Raised Corporate Seal [MUST BE AFFIXED] Principal Raised Corporate Seal [MUST BE AFFIXED] NOTES: Acknowledgments must be completed and returned as hart of the bond. Raised Corporate Seals are mandatory. Please attach Power of Attorney. 15-A584/110138 20 18 Alfaro Communicatigns Construction, Inc. (C mractor Name) By.. (Seal) 64), Piw _1 (Title) Endurance Assurance Corporation e) By: l (Seat) Yung T. N,b/Hick, Attorney-i Fact APPR ED AS T0-FORI\ By., Michael E. Gates, City Attorney r ..- CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County of Oran On August 22, 2018 before me, Date personally appeared IRENE LUONG z NotaryPublic-California z Orange County Commission � 2207169 My Comm. Expires Jul 27, 202 i Place Notary Seal Above Irene Luong , Notary Public, Insert Name of Notary exactly as it appears on the official seal Yung T. Mullick 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 fore goy{ ragraph is true and correct. Witness my hand a Signature OPTIONAL Signature of Notary Public\/rend\Luong 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 the 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 ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer—Title(s): ❑ Partner ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: ENDURANCE ASSURANCE CORPORATION 157 POWER OF ATTORNEY 4,jww all Men 6y these Present, that ENDURANCE ASSURANCE CORPORATION, a Delaware corporation (the "Corporation"), with offices at 4 Manhattanville Road, 3rd Floor, Purchase, NY 10577, has made, constituted and appointed and by these presents, does make, constitute and appoint YUNG T. MULLICK, JAMES W. MOILAN EN its true and lawful Attorney(s)-in-fact, aI,MISSION VIEJO in the Stale of CA and each of them to have full power to acl without the other or others, to make, execute and deliver on its behalf, as surety or co-suretybonds and -undertakings given for any and all purposes, also to execute and deliver on its behalf as aforesaid renewals, extensions, agreements, waivers, consents or stipulations relating to suchlbonds or undertakings provided, however, that no single bond or undertaking so made. executed and delivered shall obligate the Corporation for any portion of the penal sum lhcreof in axoess_�of tha sum of TEN, MIL;CION Dollars ($10,000,000). Such bonds and undertakings for said purposes; when duly executed by said altorney(s)-in-fact, shall be binding upon the Corporation as fully and to the same extent as if signed by the President of the Corporation under its corporate seal attested by its Corporate Secretary. This appointment is made undetand by authority, of certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on the 9th of January, 2014, a copy of which appears below under3He heading entitled "Certificate". This Power of Aiarney is signed land sea] ed"by facsimile under and by authority of the following resolution adopted by the Board of Directors of the Corporation by unanimous written consent on January 9 2014`and said resdlUtiart not since been revoked, amended or repealed: RESOLVED, that in granting powers of attorney pursuant to certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2014, the signature of such directors and officers and the seal of the Corporation may be affixed to any such power of attorney or any certificate relating thereto by facsimile , and any such power of attorney or certificate bearing such facsimile signature or seal shall be valid and binding upon the Corporation in the future with respect to any bond or undertaking to which it is attached. IN WITNESS WHEREOF, the Corporation has caused these presents to be duly signed and its corporate seal to be hereunto affixed and attested this 23rd day of June, 2017 at Purchase, New York. (Corporate Seal) ENDURANCE ��ASSURANCE CORPORATION J ATTEST %��-� 8y aY.t1Y) ` l - C/ MARIANNE L. WILBERT, SENIOR VICE PRESIDENT SHARON L. SIMS, SENIOR VICE PRESIDENT STATE OF NEW YORK ss: PURCHASE COUNTY OF WESTCHESTER On the 23rd day of June, 2017 before me personally came SHARON L. SIMS, SENIOR VICE PRESIDENT to me known, who being by me duly sworn, did depose and say that (s)he resides in SCOTCH PLAINS, NEW JERSEY that (s)he is a SENIOR VICE PRESIDENT of ENDURANCE ASSURANCE CORPORATION, the Corporation described in and which executed the above instrument; that (s)he knows the seal of said Corporation, that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said Corporation, and that (s)he signed his (her) name thereto by like order. (Notarial Seat) NICHOLAS JAMES BENENATI, Notary Public - My Commission Expires - 12/07/2019 CERTIFICATE STATE OF'NEW YORK," ss: PURCHASE COUNTY OF WESTCHESTER I, CHRISTOPHER DONELAN the PRESIDENT of ENDURANCE ASSURANCE CORPORATION, a Delaware Corporation (the "Corporation"), hereby certify: 1. That the original power of attorney of which the foregoing is a copy was duly executed on behalf of the Corporation and has not since been revoked, amended or modified; that the undersigned has compared the foregoing copy thereof with the original power of attorney, and that the same is a true and correct copy of the original power of attorney and of the whole thereof; 2. The following are resolutions which were adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2014 and said resolutions have not since been revoked, amended or modified: 'RESOLVED, that each of the individuals named below is authorized to make, execute, seal and deliver for and on behalf of the Corporation any and all bonds, undertakings or obligations in surety or co -surety with others: CHRISTOPHER DONELAN, SHARON L. SIMS, MARIANNE L. WILBERT And be it further ;• RESOLVED tha, alp o(the individuals named above is authorized to appoint attorneys -in -fact for the purpose of making, executing, sealing and delivering bonds, undertakings or obligations in surety orco surety for and on behalf of.the.Corporatiorc 3. The undersigned further certifies that the above resolutions are true and correct copies of the resolutions as so recorded and of the whole thereof. IN WITNESS WHFREOF I have, hereunto set m,yhand and affixed the corporate seal this 22nd _ day of August 20 18 (Corporate Seal) r CHRISTOPHER DONELAN, PRESIDENT Any reproductions are void. Primary Surety Claims Submission: suretybondclaims@@sompo-ir Isom Surely Claims Hotline: 877-676-7575 Mailing Address: Surety Claims Department, 750 Third Avenue - 10m Floor, New York, NY 10017 CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of nVI�XI�,S ) OnZ�A 13" U 12(E before me,CiRol i-&.Eanta"Otriq Cod -Ito, (here insert name and title of the officer) personally appeared 0 who proved tome on the basis of satisfactory evidence to be the person(j whose name(61 is/aye subscribed to the within instrument and acknowledged to me that he/sbe/t#ey- executed the same in his/hi r the r authorized capacity(te§), and that by his/-h r/tom signature{sron the instrument the persono, or the entity upon behalf of which the persons 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. ICindi Esmeralda Santamaria Castillo Comm. #2200339 z b Notary Public • California o Z Los Angeles County Signature M Comm, Expires June 5, 2021 (Seal) Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document titled/for the purpose of containing pages, and dated The signer(s) capacity or authority is/are as: ❑ Individual(s) ❑ cottrporate OFact Cor orate Officers) Title(s) ❑ Guardian/Conservator ❑ Partner - Limited/General ❑ Trustee(s) ❑ Other: representing: Name(s) of Person(s) or Entity(les) Signer is Representing Method of Signer Identification Proved to me on the basis of satisfactory evidence: 0 form(s) of identification 0 credible witness(es) Notarial event is detailed in notaryjournal on: Page # Entry # Notary contact: 3Z�3- Other ❑ AdditionalSigner(s) ❑ Signer(s)Thumbprint(s) 0 Copyright 2007-2016 Notary Rotary, Inc. PO Box 41400, Des Moines, IA 50311-0507. All Rights Reserved, Item Number 101772. Please contact your Authorized Reseller to purchase copies of this form. Certification of Compliance with Prevailing Wage Laws "To: City of Huntington Beach Department of Public Works 2000 Main Street/P.O. Box 190 luntington Beach, CA 92648 Re: Certification of Compliance with Prevailing Wage Laws Contract: CC-1465 Project: Traffic Signal Modifications at Gothard and Talbert,Gothard and Heil, and Springdale and McFadden 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. n Executed this _ day of 20 1 at % California. n . _ .4 n_ / (Co)ttractor APPROVED�,�SJO FORM By:-- Mitzhael E. Gates Ctity Attorney CONTRACTOR'S CERTIFICATE 1 Hugo Alfaro state and certify that: (Natne of Declarant) Alfaro Communications Construction Inc is the general contractor to the City of Huntington Beach ("City") on Contract No CC-1465 (the "Contract") for the construction of the public work of improvement entitled: Traffic Signal Modifications at Gothard and Talbert, Gothard and Heil, Springdale and McFadden (the "Project"). 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 als 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"): None 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. 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 t APPROVED AS T - ORM X Michael,-E. Gates C itv ,Attorney 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: Certification of Compliance with Title VII of the Civil Rights Act and Equal Employment Opportunity Act of 1972 Contract: CC-1465 Project: Traffic Signal Modifications at Gothard and Talbert,Gothard and Heil, and Springdale and McFadden 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; 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 c day of , 20 , at California. (Contractor Nan2e.) By: APPROVED Miclxael E. Gates City Attorney 5� UNCONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT NOTICE TO CLAIMANT: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. Identifying Information Name of Claimant: G&C Equipment Corporation Name of Customer: Alfaro Job Location: city of Huntington Beach Owner: Traffic Signal Modifications Unconditional Waiver and Release This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for all labor and service provided, and equipment and material delivered, to the customer on this job. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written change order that has been fully executed by the parties prior to the date that this document is • signed by the claimant, are waived and released by this document, unless listed as an Exception below. The claimant has been paid in full. Exceptions This document does not affect any of the following: Disputed claims for extras in the amount of: $ • 1/2014 CONTRACTOR'S RECYCLABLE MATERIAL TRACKING SHEET (FOR NON -HAZARDOUS MATERIAL) PLEASE TYPE OR PRINT LEGIBLY IN INK CONTRACTOR I COLLECTOR INFORMATION Business Name: Alfaro communications Construction,Inc Address: 15614 S. Atlantic Avenue,Compton, CA 90221 Phone: 310-669-8949 Fax: 310-693-5343 Contact Name: Hugo Alfaro Quarter Reporting: 3rd Source Location Recycling Permit # Type of Material Tonnage Removed Destination/Disposition City of Stanton PCC 30 Ewles Materials City of Stanton AC 10 Ewles Materials I i i I j THIS FORM SHALL BE SUBMITTED QUARTERLY FOR EACH PERMIT ISSUED. Reports are due by the last day of the month following quarter end (15' Qtr.=April 30, 2"d Qtr.=July 31, 3'd Qtr.=October 31, 4th Qtr.=January 31). Please call (714) 374-5321 with questions. Please attach copy of weight ticket(s) from certified recycler and return completed form via mail or fax to: CITY OF HUNTINGTON BEACH DEPT. OF PUBLIC WORKS ATTN: RECYCLING COORDINATOR DEPT. OF PUBLIC WORKS - MAINTENANCE DIV. 2000 MAIN ST. HUNTINGTON BEACH, CA 92648 FAX: (714) 375-5099 Document-5 844793 -Page-1 Page 1 of 1 PLEASE COMPLETE THIS INFORMATION RECORDING REQUESTED BY: WHEN RECORDED MAIL TO: CITY OF HUNTINGTON BEACH PUBLIC WORKS DEPARTMENT Attn: Joseph Fuentes P.O. Box 190 — 2000 Main Street Huntington Beach, CA 92648 Recorded in Official Records, Orange County Hugh Nguyen, Clerk -Recorder 1� � 11] II 11111111111 11111111111II NO FEE *$ R 0 0 1 0 3 1 4 2 0 3 $ * 2018000314958 9:56 am 08/28/18 63 406 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.000.000.00 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 Alfaro Communications, who was the company thereon for doing the following work to -wit: Traffic Signal Modifications, Project # CC1465 That said work was completed 08/22/2018 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 08/22/2018, per City Council Resolution No. 2003-70 adopted October 6, 2003. That upon said contract Endurance Assurance Corp, was surety for the bond given by the said company as required by law. This document is solely for the official business of the City of Huntington Beach, as contemplated under Government Code Section 27383 and should be recorded free of charge. 4%27zy6R Dir for of rks or City Engineer ate City of Huntington Beach, California STATE OF CALIFORNIA) County of Orange ) ss: City of Huntington Beach ) I, the undersigned, say: I am an Agent of the City of Huntington Beach, owner in fee, in the foregoing NOTICE OF COMPLETION. I have read said NOTICE OF COMPLETION and know the contents thereof; the same is true of my knowledge. I declare under penalty of perjury that the foregoing is true and correct, and that said NOTICE OF COMPLETION was duly and regularly ordered to be recorded in the Office of the County Recorder of Orange County. Z4, Ali 0 This document is solely the official business of the City of it r of P li orks or City Engineer Date Huntington Beach, as contemplated under Government City of Huntington Beach, California code section 27383 and should be recorded free of charge. THIS PAGE IS ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION (Additional recording fee applies) about:blank 8/28/2018 RECEIVED BY: CITY CLERK RECEIPT COPY Return DUPLICATE to ✓h�'� City Clerk's Office (Name) after signing/dating i . (Date) CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION &-* U TO: City Treasurer FROM: City Clerk , I DATE: / /c)-�! 1 SUBJECT: 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. /L/40�,CT MSC No. Other No. g:/forms/bond transmittal to treasurer (Company Name) FACk / c / z a0, 0 r. 12 r= rV /s-oiJv o/ f5 Approved 111,2_ I 0 (Council Approval Date) Agenda Item No. City Clerk Vault No. �Q f� . 4DL; SIRE System ID No. 3052,53 FEDERALLY FUNDED CONSTRUCTION CONTRACT BETWEEN THE CiTY OF HUNTiNGTON BEACH AND Alfaro Communications Construction, Inc. FOR The Traffic Signal Modification Project, CC-1465 THIS AGREEMENT ("Agreement") made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of Califo►7iia, hereinafter referred to as "CITY," and Alfaro Communications Construction, Inc. , a California Corporation , hereinafter referred to as "CONTRACTOR." WHEREAS, CITY has solicited bids for a public works proiect, hereinafter referred to as "PROJECT," more fully described as traffic modifications at Gothard and Talbert Gothard and Neil, and Springdale and McFadden, 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 SFF:17-i73?f15RU97rC,il"f runs-f'etleral Contr1act 6/17 of the elements, from any unforeseen difficulties which may arise or be encountered in the prosecution 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; SPf:17-57',21158097lC,il"I-rans-federal Contract 6 17 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: D. The edition of Standard .Sj)ecificafions .ibr Public H/orks 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 as specified in the particular Plans, Specifications, Special Provisions and Addenda applicable to the Project, E. Bid documents including the Notice inviting Bids, the Special Instructions to Bidders, the CONTRACTOR's proposal, (attached as Exhibit "A"), and, the Federal Requirements from FH WA 1273 (attached as Exhibit "B" ), and 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 3 SI=F:I7-*�7;2/1 ';8097"CaI"IYans-Federal Contract 6/17 adjust the discrepancy without the decision of DPW, save only at its own risk and expense. 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 Three Hundred Twenty -Six Thousand Dollars (S 326,000.00 ), 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 sixty ( 60 ) consecutive working days from the day the Notice to Proceed is issued by CITY, 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 4 SFF:11Contract6/1 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 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. SIFT 7-57,_/151?f1�J7rCal'I rans-Federal Comrai1 6/17 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 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 ( I ) 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 detective item or 6 SFF:17-5732/IContract 0l17 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 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, damaue 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 ) per each calendar 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 7 SFF:17-57 ,2/1 s,90)7,Cal'Trans-Feclerat Contract 6;1 7 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 darnares 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 stlbcontractors due to such causes. CONTRACTOR shall, within fifteen (15) days from the beginning of any such delay (unless CITY shall grant a further period of time), notify CITY 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 CiTY 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 8 SF17:17-5732l1 Contract & I7 other contractors or subcontractors, will be allowed and an extension of time for completion shall be the sole remedy of CONTRACTOR. 12. DEMANDS FOR ADDITIONAL TiME OR MONEY A. Definitions. (1) "Change Order" means a document signed by the CONTRACTOR and CITY which authorizes an addition, deletion or revision in the work, or an adjustment in the Compensation under Section 3, or the Completion Time specified at Section 4 (2) "Demand" means a written demand for a Change. Order by the CONTRACTOR for any of the followin:.*: (a) A time extension; (b) Payment of money or damages arising from work done by, or on behalf of, the CONTRACTOR pursuant to this Agreement and payment of which is not expressly permitted pursuant to Section 3 of this Agreement; (c) Payment of an amount the CITY disputes; (d) Any disputes and other matters relating to the acceptability of the work performed or the interpretation of the Contract Documents; (e) A request for a time extension or additional payment based upon differing site conditions, such as subsurface or latent physical conditions at the job site differing materially from those indicated in this Agreement or the Contract Documents, or unknown physical 9 SFF:17->732/158097'Cal'IYans-I'ecieral Contract 617 conditions at the job site, of an unusual nature, differing materially from those ordinarily encountered and generally recognized as inherent to work of the PROJECT- or (f) A request for a time extension or additional payment based upon acts of neglect by CITY or due to fires, floods, labor disputes, epidemics, abnormal weather conditions or acts of God. B. A Demand for a time extension or payment of money or damages may only be granted by a Change Order. C. No Change Order may be granted except where the Contractor has submitted a Demand to the DPW (or its written designee). All Demands shall be submitted promptly, but in no event later than thirty (30) days after the occurrence of the event giving rise to the Demand. The Demand shall be in writing and include all docurnents necessary to substantiate the Demand. The DPW shall act on the Demand within fifteen (15) days after receipt, including by requesting, additional information from the CONTRACTOR to determine whether to approve the Change Order the Demand seeks. The DPW shall act on the Demand within fifteen (15) days after receipt of the additional information or within a period of time no greater than the time the CONTRACTOR took to produce the additional information requested, whichever is greater. D. Notwithstanding the thirty (30) days to submit a Demand under Subparagraph C, in the case of differing or unknown site conditions, immediately upon encountering the conditions, CONTRACTOR shall notify the DPW in writing of the conditions, so that the DPW may promptly investigate the conditions. E. If the CONTRACTOR disputes the DPW's written response on the Demand; or the DPW fails to respond within the time prescribed, the CONTRACTOR may so notify the DPNV. in writingu, either within fifteen (15) days of receipt of the DPW's response or in SFF:17-573211>3U97'Cal'frans-Federal Contract 6/17 within fifteen (15) days of the DPW's failure to respond within the time prescribed, respectively, and request an informal conference to meet and confer for settlement of the Demand. Upon the CONTRACTOR's request, the DPW shall schedule a meet and confer conference within thirty (30) days to seek to resolve. F. CiTY and CONTRACTOR shall execute appropriate Change Orders covering changes to the time or price by executing the Change Order by mutual agreement. If the CITY and CONTRACTOR are unable to reach a mutual agreement, then the City Engineer shall issue a written decision on the claim within a reasonable time. G. Following the meet and confer conference, if the Demand remains in dispute; the CONTRACTOR may file a claim with the CITY as provided in Chapter I (commencing with Section 900) and Chapter 2 (commencing with Section 910) of Part 3 of Division 3.6 of Title i of the Government Code. For purposes of those provisions, the running of the period of time within which a claim must be filed shall be tolled from the time the time the CONTRACTOR submits his or her Demand until the Demand is denied as a result of the meet and confer process, including any period of time utilized by the meet and confer process. 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 SFF:17-57a?ll Contract 6 1 7 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 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 findinas 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. When CONTRACTOR has, in the judlnment of DPW, faithfully executed fifty percent (50%) or more of the value of the work as determined from the bid schedule, and if DPW finds that satisfactory progress has been and is being made, CONTRACTOR may be paid such sum as will bring the payments of each month up to one hundred percent (100%) of the value of the work completed since the commencement of the PROJECT, as determined in its sole discretion by DPW, less all previous payments and less all previous retained amounts. 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 12 SIT: 17-5732I15ti097/Carl"rans-Federal Contract 6/1 7 DPW, affirming that the work for which payment is demanded has been perfornied 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 an 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 witliheld by CITY to ensure performance under the terms of this Agreement. 16. AFFIDAVITS OF SATISFACTION OF CLAIMS After the completion of the work contemplated by this Agreement, CONTRACTOR shall file with CITY its affidavit statinu 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 13 SFF:17-5732/1 Contract Gi 17 against any and all claims, damages, losses, expenses, judgments, demands; defense costs, and consequential damaV(e 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 neglig=ence, or willful misconduct of the CiTY, its officers, elected or appointed officials, employees, agents, and 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. 14 S1,17:I 7-,�73211 Contract 6117 CONTRACTOR shall furnish to CITY a certificate of waiver of subrogation raider 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 defend, hold harmless and indemnify CiTY, CONTRACTOR shall obtain and furnish to CiTY, a policy of general public liability insurance, including motor vehicle coverage coverings 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 limit bodily injury and property damage, including products/completed operations liability and blanket contractual liability, of One Million Dollars (51,000,000) 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 (S i ,000,000) for this PROJECT. This policy shall name CITY, its officers, elected or appointed officials, employees, agents, and volunteers as (the "Additionally Insured Parties") 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 CONTRACTOR's insurance shall be primary and non-contributory with any other valid and collectible insurance or self-insurance available to the Additionally Insured Parties. Any available insurance proceeds in excess of the minimum coverage amount specified herein shall be available to the Additionally Insured Parties. All coverage available to CONTRACTOR shall also be available to the Additionally insured Parties. Under no circumstances shall said above -mentioned insurance contain a self -insured retention 15 SFF_17-57i211';8097lCall-rents-Federal Contract 6.'17 without the express written consent of CiTY,- however, an insurance policy "deductible" of 55,000.00 is permitted. CONTRACTOR shall be responsible for causing all Subcontractors to maintain the same types and limits of insurance coverage as that required of CONTRACTOR by this Agreement. 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-. ! . 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 fitlly completed and accepted by CITY. The requirement for carrying the foregoing insurance coverages shall not derogate fi-om 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 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 CONTRACTOR's insurance policies, naming CITY, its officers, elected 16 SFF:17-i732/15S097iCafl'rans-Federal Comract 6/1 7 and appointed officials, employees, agents and volunteers as Additional insureds, to the City Attorney for approval prior to any payment hereunder. 22. DISADVANTAGED BUSINESS ENTERPRISES. CONTRACTOR shall not discriminate on the basis of race, color, national origin, or sex in the performance of this Agreement. CONTRACTOR shall carry out applicable requirements of Part 26 of Title 49 of the Code of Federal Reuulations in the award and administration of this Agreement, which has received funding assistance from the United States Department of Transportation. Failure by CONTRACTOR to carry out these requirements is a material breach of this Agreement, which may result in the termination of this Agreement or such other remedy as the CITY deems appropriate. 23. 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 with 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 twenty-five dollars (S25) for each calendar day or portion thereof for each \vorker paid (either by 17 SFF:1 7-5732/I COMNI.t 6.!1 7 CONTRACTOR or any of its subcontractors) less than the prevailing wage rate established for that particular craft or type of work. 24. CALIFORNIA EIGHT -HOUR LAW A. California Labor Code, Sections 1810 erseq, 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 tuwenty-five dollars (S25) 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. 25. 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. Ho SFFA 7-57,2115, 097 C,il'l"rans-Federal Contract 6/1 7 26. EMPLOYMENT OF APPRENTICES Section 1777.5 of the California Labor Code, regarding the employment of apprentices is applicable to this PROJECT. 27. PAYROLL RECORDS CONTRACTOR agrees to keep accurate payroll record showings the name, address, social security number, work classification, straiaht time and overtime hours % orked 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. 28. FEDERAL PARTICIPATION Because the United States of America is providing funding for the PROJECT, CONTRACTOR shall comply with the following Federal Statutes and Regulations: A. Attached at Exhibit "B" is FHWA Form 1273, which describes required Federal contract provisions which CONTRACTOR shall perform. Additionally, CONTRACTOR shall incorporate Fonn 1273 into each of CONTRACTOR's subcontracts for the PROJECT, and further require each subcontractor to incorporate Form 1273 in any lower tier subcontract or purchase order. B. Pursuant to the Federal Cargo Preference Act (46 CFR Part 381), the CONTRACTOR agrees: 19 SF17:17-5712/1 iy097,`Ca1Trans-Federal Comtraci 6/1 -1 (1) To utilize privately owned United States -flag commercial vessels to ship at least 50 percent of the gross tonnage (computed separately for dry bulk carriers, dry cargo liners, and tankers) involved, whenever shipping any equipment, material, or commodities pursuant to this Agreement, to the extent such vessels are available at fair and reasonable rates for United States -flag commercial vessels. (2) To furnish within 20 days following the date of loading for shipments originating within the United States or within 30 working days followln�g, the date of loading for shipments originating outside the United States, a legible copy of a rated, `on -board' commercial ocean bill -of -lading in English for each shipment of cargo described in paragraph (B) (1) of this Section to both the Contracting Officer (through the prime contractor in the case of subcontractor bills -of -lading) and to the Division of National Cargo, Office of Market Development, Maritime Administration, Washington, DC 20590. CONTRACTOR shall incorporate Section 28(13) of this Agreement into each subcontract, and further require each subcontractor to incorporate Section 27(13) of this Agreement in in any lower tier subcontract or purchase order. C. Pursuant to the Buy America Act, CONTRACTOR agrees: (1) Furnish steel and iron materials to be incorporated in the PROJECT that was melted and manufactured in the United States except: a. Foreign pig iron and processed, pelletized, and reduced iron ore may be used in the domestic production of the steel and iron materials b. If the total combined cost of the materials does not exceed the greater of 0.1 percent of the total bid or 52,500, materials produced outside the United States may be used if authorized 20 SFF:17-5732/1 Contract 6/1 7 (2) Furnish steel and iron materials to be incorporated into the work with certificates of compliance and certified mill test reports. Mill test reports must indicate where the steel and iron were melted and manufactured. (3) To incorporate Section 28(C) of this Agreement into each subcontract and further require each subcontractor to incorporate Section 28(C) into any lower tier subcontract or purchase order. D. Pursuant to Section 402 of the Vietnam Era Veterans Readjustment Act of 1974 (38 USC Section 219 ei seg.), CONTRACTOR agrees: (1) To prohibit job discrimination and require affirmative action to comply and advance in employment to (1) qualified Vietnam veterans during the first four (4) years after their discharge, and (2) qualified disabled veterans throughout their working life if they have a thirty percent (30%) or more disability. (2) To incorporate Section 28(D) of this Agreement into each subcontract and further require each subcontractor to incorporate Section 28(C) into any lower tier subcontract or purchase order. 29. 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. 21 SFF:17-5732/IContract 6!17 B. The CONTRACTOR agrees to comply with all of the requirements of Section 306 of the Clean Air Act and section 509 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 aurees to include or cause to be included the requirements of paragraph (a) thorough (d) of this section in every nonexempt subcontract, and fiu-ther agrees to take such action as the Government may direct as a means of enforcing such requirements. 30. 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. 31. 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 SFF_ f 7-5732tf SSUJTC- ti'l cans-l'eclerol Contract 6f17 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 to a termination for convenience under Section 32 and any damages shall be assessed as set forth in Section 32. 32. 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 oblivation to CONTRACTOR. 33. 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. 23 SFF 17-5732115SW9'/Cartrrms-Federal Contract 6117 34. 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. 35. 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 Aureement in violation of the California Government Code. 36. 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. 37. NOTICES Any notices, certificates, or other communications hereunder shall be given either by personal delivery to CONTRACTOR's agent (as designated in Section I hereinabove) or to C ITY 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: 24 SFF:17-"�732f1'a()97,'C:al'I-rans-Federal Contract 6.'17 TO CITY: City of Huntington Beach ATTN: Joseph Fuentes 2000 Main Street Huntington Beach, CA 92648 38. SECTION HEADINGS TO CONTRACTOR: Alfaro Communications Construction, Inc. ATTN: Mavra !\Martinez 620 S. Bradfield Avenue Compton, CA, 90221 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. 39. 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. 40. 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. 25 SFI':17->732;'1'8097:'C;il'Irans-Federal Contract 6%17 41. 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 its own attor-ney's fees and the prevailing party shall not be entitled to recover its attorney's fees from the nonprevailing party. 42. 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 steal I 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. 43. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 26 SFF:17-57 32/I Contract 6/17 44. 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 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. 45. 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. 46. 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 ei seq. 47. SIGNATORIES Each undersigpied 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. 48. 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 27 SFF:17-57 i2/1 Contract 6117 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 parry's behalf, which are not embodied in this Agreement, and that that party has not executed this Agreement in reliance on any representation, 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 / 2 — 20 �� (CemQICkeu�4L � M CITY OF HUNTINGTON BEACH, a municipal corporation of tk State of California Mayor prmt name 0 Lew r ITS: (circle are) Chairma Presiden Vice President 69v — City Clerk —.I6 t�24rlg La print name ITS: (circleonec Secretary - Treasurer 28 INaIV-01NOW-\,4b7 APPROVED AS SFF:17-5712/158097/Carrrans•Federal Contract 6117 EXHIBIT A (Contractor's Proposal) ?T] SFF:17-5732115M7/Carr mts-Federal Contract 617 _K41,6,T SECTION C PROPOSAL for the construction of Traffic Signal Modifications from At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue And Springdale Street and McFadden Avenue CC No.1465 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 §Qworking days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find Bid Bond in the amount of 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. C-2 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE BID ITEMS Item Description Quantity Unit Unit Cost Total Cost No. Mobilization 1 LS $ -RZ) (Extension) 1 $ VO , z Furnish Project Traffic Control 1 LS $g,'� $ 3 Furnish and Install Traffic Striping and Signing 1 LS i l�i $��,LZ1QfG 4 Preparation of W PCP and installation and of Maintenance of 1 LS $ �do $b'�i BMP's per the approved WPCP. Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case A and Typical Section at New Curb Ramps 5 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 2 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, rr//G $JT, $ retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case B and Typical Section at New Curb Ramps 6 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 1 EA appurtenances, curb and gutter, depressed curb, sidewalk,/�� $ C $ truncated, domes, retaining curb, slot pave, etc.) i Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case C and Typical Section at New Curb Ramps 7 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 5 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.). Excludes the, Northeast Gothard Street Heil Avenue. $ Gib comer of and ,— Construct Curb Ramps, Truncated Domes, Sidewalk, Curb and Gutter and Railing at the Northeast Corner of Gothard 8 Street and Heil Avenue and per Detail on Sheet 5. (Item 1 LS includes all appurtenances, curb and gutter, depressed curb, sidewalk, railings, truncated domes, retaining curb, slot pave, �r 46)o $ etc.) Construct Curb, Access Ramps and Concrete Sidewalk on the Raised Island at the Southwest quadrant of the Intersection of 9 Springdale Street and McFadden Avenue. See the Details on 1 LS Sheet 5. (Item includes all appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, $ [ / $ slot pave, etc.) 4T �T 10 Modify Traffic Signal at Gothard Street and Talbert Avenue. 1 LS 1_.,_ Item includes all work in plans not included in other items. $,4 =1=Wi,�pj� $ 11 Modify Traffic Signal at Gothard Street and Heil Avenue. 1 LS $ $ Item includes all work in plans not included in other items. 12 Modify Traffic Signal at Springdale Street and McFadden Ave. Item 1 LS $ includes all work in plans not included in other items. C-2.1 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE Item Description Quantity Unit Unit Cost Total Cost No. (Extension) TOTAL BID AMOUNT $ 2 TOTAL BID AMOUNT IN WORDS: Note: Refer to Section 9, Measure and Payment. All extensions of unit prices will be subject to verification by Owner. In case verification is required between the unit price and the extension, the unit price will govern. The Owner reserves the right to reject any or all proposals and bid items. The City will provide the traffic signal equipment, as listed in the pole schedules, (also includes anchor bolts) to the contractor. The contractor is to pick up the materials, with its own labor, at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 536-5530. C-z.z 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 or $10,000, whichever is greater, and the portion of the work to be done by such subcontractor. Bid Items) Name and Address o% Subcontractor State License Number Class D/B PWC Registration Dollar Amount %o Contract i01'If n— A ,{� _I /o 0 3� 4— �7 "�,, �7 � . e ye, f�, G � � 6,-le 4873' M)f QcdV. Ji 0 2 Gai c A—e(oL4-,L— By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2 That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID 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 8/12/2017 at Cew toff , CA Date City State Marra Martinez being first duly sworn, deposes and says that he or she is V. President of Alfaro Communications Construction,lnc the party malting 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. Alfaro Communications Construction,lnc Name of Bidder 610 S. Bradfield Avenue, Compton, CA 90221 Address of Bidder C4 UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue, (1)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: 8a2/2017 Communications Construction,lnc. Contractor Ma ra Martinez By V. President Title C-5 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 YdNo 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: 812212017 Alfaro Communications Construction,lnc Contractor Ma ra Martinez By V. Preasident Title C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Communications Construedon,Inc Name 620 S. Bradrield Avenue Business Address State Zip ( 310 ) 669-8949 huro.accinQmaiLcom Telephone Number Email Address 912 72 7. Class: A.C-7 State Contractor's License No. and Class Original Date Issued The work site was inspected by .lamal Daail of our office on 811512017 , 201 The following are persons, firms, and corporations having a principal interest in this proposal: Affaro Communications Construction,Inc Hugo Alfaro : President, Treasurer Mayra Martinez: V. President,Secretary The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. or C-8 NOTARY CERTIFICATE Subscribed and sworn to before me thisj5?day of N IQ 11& , 2011 . 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 6P` I Tu V1 I6n I County of ( OAAW-41 � 1Sr 2bl 1 before ni/l �� II E. �G rm r 1V onth, Day, and Year Insert Name and Title of Notary personally appeared Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be 9KIPersonW whose named i�aresubscribed to the within instrument and aclmowled ed to me that sh th y executed the same in ' /hey�titeii authorized capacity(ieo, and that by la a dmir signatureW on the instrument the personj}, 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 m hand and official seal. Cindi Esmeralda Santamaria Castillo y Comm. #2200339 z a Notary Public - California o Z Los Angeles County M Comm. Ez fires June 5, 2021 Signature �r\� �/ Signature of Notary Public (PLACE NOTARY SEAL ABOVE) C-9 Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work, specifically referencing the construction of {Describe specific work and experience necessary for project. For example, "Sanitary sewer line installation of at least of 1.000 of 8-inch and greater in public right-of- way. Sanitary sewer lift stations of similar size. project work within public streets, an area containing high ground water and pipeline construction in high ground water regions with trench depths of 8-feet to the invert."). 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: Name and Address of Public Agency Name and Telephone No. of Project Manager: Please see attached Contract Amount Type of Work Date Completed Provide additional project description to show similar work: 2. _ Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed Provide additional project description to show similar work: 3. _ Name and Address of Public Agency Name and Telephone No. of Project Manager: Amount Type of Work Date Completed Provide additional project description to show similar work: C-10 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. L d%M--/ D,-O i`. Name of proposed Project Manager Telephone No. of proposed Project Manager: 7/i Z40- 9 2-I-" - oT 4T f87.9 q f" %,%, $/ /4/l - - Project Name & Contract Amount Type of Work Date Completed / " 7/ e- !! (//T/I -- Project Name & Contradt Amount Type of Work Date Completed 'roj ct Name & Contract Amount( Type of Work D 2. A,�-o d-cm f Name of proposed Superintendent Telephone No. of proposed Superintendent: 776 0- /M- C'a I-k--- o -�- gTyuo -i z7yJ'k 4). ,l f It t l ry Project Name & Contract Amount Type of Work Date Completed Project Name & Contract Amount Type of Work C0.(14/aw b p_O' Project Name & Contract Amount Type of Work C-11 Date Completed s-11-14 � Date Completed IN ■ ■ @ a a ■ 7 ra \ | !/f I !k)!& \�k\! mf /)�ti k\ ;k$k|k) /\�}k k �§)�|,�! !i�\2;$ )� ;_)0m !! k � LA Ew/ �/ ad k) )�k at a ! }\ ! - a 7 ƒ{ . ! Z■ !| � - ! me !! ` !\® - . �-• �®` �( CONTRACTOR REGISTRATION WITH CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS (DIR) CERTIFICATE Pursuant to SB 854 (citing Labor Code Section 1771.1(a)), passed by the California State Senate on June 20, 2014, established a new public works Contractor Registration Program, which requires all contractors and subcontractors bidding and performing work on Public Works Projects to register on an annual basis (each July 1 through June 30 state fiscal year) with the California Department of Industrial Relations (DIR). Currently the annual non-refundable registration fee for Contractors is $300. Each contractor to whom a public works contract has been awarded shall sign the following certificate. DIR FACT SHEET on SB 854 http://www.dir.ca.gov/DLSE/PublicWorks/SB854FactSheet_6.30.14.pdf DIR's Contractor Registration Link — Call (844) 522-6734 https://efiling.dir.ca.gov/PWCR/ActionServlet?action=displayPWCRegistrationForm DIR's Contractor Registration searchable database: https://efiling.dir.ca.gov/PWCR/Search.action I am aware and will comply with the provisions of Labor Code Section 1771.1(a) which states: "A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5. It is not a violation of this section for an unregistered contractor to submit a bid that is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the contractor is registered to perform public work pursuant to Section 1725.5 at the time the contract is awarded." I furthermore will comply by providing proof of registration with DIR as the primary contractor, as well as for ALL subcontractors at the time of submitting the bid. Date: 8-22-1017 PWC Registration #: 100042376 Aljaro Communications Construction,Inc Contractor Marra Martine;: By V. President Title C-12 6/2612017 California Department of Industrial Relations -Contact DIR _ila;a ai t;.]IrituUiy I'CCI Ir. �,f,ty c Health Hoe-rd1, Public Works Public Works Contractor (PWC) Registration Search Public Works Contractor (PWC) Registration Search This is a listing of current and active PWC registrations pursuant to Division 2, Part 7, Chapter 1 (commencing with section 1720 of the California Labor Code.) Enter at least one search criteria to display active registered public works contractors) matching your selections. Registration Year: Next Fiscal Year. 2017/11 vj PWC Registration 1000042378 Number: Contractor Legal Name: example: ABC COMPANY exam le: 123458 License Number: Contractor License Lookup County: Select County search Rasol Search Results One registered contractor found. 1 Details Legal Name View ALFARO COMMUNICATIONS CONSTRUCTION INC. About DIR Who we are DIR Divisions, Boards & Commissions Contact DIR Export as: Excel I PDF Registration County City Registration Expiration Number Date Date 1000042376 LOS ANGELES COMPTON 06/07/2017 06/30/2018 Work with Us Jobs at DIR Licensing, registrations, certifications & permits Learn More Acceso at idioma Frequently Asked Questions Site Map v2.20160101 https://efi ling.di r.ca.gav/PW CR/Search.wtion 1/1 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): IVI Will ensure that 10% of all new hires as a result of this project shall meet all requirements 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: Altaro Communications Construction,lnc Contact Person: V1 &92.'D Contact Phone: Signed: Date: h2 (/ 2 *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). C-13 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION CO w. N. L. -, car *. , S C-0"A t c�P. o 1•, � The bidder , proposed subcontractor 6,'10fj� F.4 ,hereby certifies that he has . ...............has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. C-14 PUBLIC CONTRACT CO DE 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 L-6" CoVwVI.HnIC Ji C-A has _, has not been convicted Cp %-4v%,d� a. - i n L 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. IK1 WIC ►M�„�I,r.� 22,E =1 Name Date 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? D ED--� Yes No _ If the answer is yes, explain the circumstances in the following space. C-15 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. ure — Print Name Date C-16 onco 11 usion Xfffflavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY of Huntington Beach 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 Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Name Date C-17 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 detennination 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. YGt r �ar�� k�-c�� F Z 2 t Name Date C-18 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. C-19 DISCLOSURE OF LOBBYING ACTIVITIES 11.. Type of Federal Action: 2.Status of Federal Action: 3. Report Type: q-� a. contract ®a. bid/offer/application F a. initial b. grant b. initial award b. material chanee 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. 41sSubawardee, Enter Name and Address of Prime: 2v__me �Subawardee At f`1-_° (u'.,yt.,Nn; La-viorvf Cx5 Tier 62o A s` ,ifknown �'�+�m j' V ;W AC-ri toe - Corn. a V-0 vs r C'10� CA 01-1. \ Congressional District, if known 6. Federal DepartmentlAgency: N\fA 8. Federal Action Number, if known: NkA 10. a. Name and Address of Lobby Entity (If individual, last name, firstname, MI) N kY�'\ Congressional District, if known 7. Federal Program Name/Descripdon: N \ it CFDA Number, if -applicable 9. Award Amount, if known: N\lN- b. Individuals Performing Services (including address if different from No. I Oa) (last time, first time, MI) (attach Continuation Sheet(s) if necessary) H. Amount of Payment (check all that apply) 13. Type of Payment (check all thatapply) $ planned a. retainer b. one-time fee 12. Form of Payment (check all that apply): a commission Ha. cash d. contingentfee b. in -kind: specify: nature_ a deferred N k 0� value_ �f other, specify N 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if necessary) 15. Continuation Sheet(s) attached: Yes No 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying Sienature: reliance was placed by the tier above when his transaction ,��1//���.�� 1y was made or entered into. This disclosure is required Print Name. I • "^mot 'Iy e_; pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for publicinspp ection. Anv erson who fails to file the reauhed Title: y l �/1 CA- r yrp 31 IX-t✓�. disclosure shall be subject to a civil penalty of not less than S 10,000 and not more than $100,000 for each such failure. Telephone No.: Date: R — 2.1 1 _P6 - 6 { 9 — Authorized for Local Reproduction Federal Use Only: e q'1 Of Standard Form - LLL C-20 o„. fit, 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 orplanned 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, specifynature. 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-UL,]..n. ar.oaoa-s EN WYF C-21 Local Assistance Procedures Manual Exhibit 15-G Construction Contract DBE Commitment 1441 � EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT 1. Local Agency: City of Huntington Beach 2. Contract DBE Goal: 10.00% 3. Project Description: Traffic Signal Modifications at Gothard SUTalbert/Av, Gothard St/Heil Av. Sorinodale St/McFadden 4. Project Location: Gothard St(TalberUAv, Gothard St/Heil Av, Springdale St/McFadden Av. 5. Bidder's Name: ALA, �' v,,. ,,. CnV.",,,rS co^t. Prime Certified DBE: ❑ 7. Bid Amount: Occ f r� 8. Total Dollar Amount for ALL Subcontractors: i� �n 9. Total Number of ALL Subcontractors: _ 10. Bid Item Number 11. Description of Work, Service, or Materials Supplied 12. DBE Certification Number DBE Contact Information certified (Must be certrfi'7ed on the date bids are opened) 14. DBE Dollar Amount ter 101- / 9g �,1 // iy � a.r C�✓`/"' 3 1 I (o `- 1C CPC ee` i''J_. 2% 3`T" t 01110 Local Agency to Complete this Section 21. Local Agency Contract Number.CC-1465 22. Federal -Aid Project Number: HSIPL-5181(178) 23. Bid Opening Date: 15. TOTAL CLAIMED DBE PARTICIPATION 5 f 24. Contract Award Date: IMPORTANT: Identify all DBE firms being claimed for credit, regardless of tier. Names of the First Tier DBE Subcontractors and their respective item(s) of work listed above must be consistent, Local Agency certifies that all DBE certifications are valid and information on this forth is complete and accurate. where applicable with the names and items of the work in the "Subcontractor List" submitted with your bid. Written confirmation of each listed DBE islequired. 25. Local Agency Representative's Signature 26. Date 16. P pa Signal�` � 17. Date 27. Local Agency Representative's Name 28. Phonr "rA IylN^1 tnc'- 31 g_ 1Gq_ 18. Pre-pareTra7 19. Phone VLce-r�aLcQew'� 29. Local Agency Representative's Title 1 20. Preparer's Title DISTRIBUTION: 1. Original - Local Agency 2. Copy - Cahrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract execution may result in de -obligation of federal funds on contract. Include additional copy with award package. ADA Notice: For individuals with sensory disabilities, this document is available in aftemate formats. For information call (916) 65"410 or TDD (916) 654. 3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814, Page 1 of 2 zq- C-22 Local Assistance Procedures Manual Exhibit 15-H DBE Information - Good Faith Effort EXHIBIT 15-H DBE INFORMATION —GOOD FAITH EFFORTS DBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. HSIPL-5181 (178)_Bid Opening Date The established a Disadvantaged Business Enterprise (DBE) goal of 10.00% 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 S a1�Or G 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 DBEs Solicited Date of Initial Follow Up Methods and Dates C-23 Local Assistance Procedures Manual Exhibit 15-H 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 ($) Of (Y/N) Contract Please see attached 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: Please see attached Names, addresses and phone numbers of firms selected for the work above: Please see attached 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: Ph'aw, Srr u!/orh"at C-24 Local Assistance Procedures Manual Exhibit 15-11 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: Please see attached 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 Please see attached 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. C-25 m L O 'E O 'E E E T I O 'E O 'E .Q E E I 0 'E 0 'E E E '' I C 0 'E C 0 'E g = E C I C 0 C== 0 'E S T I O 'E O— ' G E E E E E E E E O .. N ono ry �n .r vio N rl in ti 'yNo�n N N 'i rl ,. wto �-1 'I N N '1 '1 in N C V V y V LL V V y V O V V y V LL V V V v O V V v V O V V V V LL o a J W Z N dE T t 3 A z v 9 3 z a g O `o a O 2 w w m EU Ova Q�— p f0 U i b � C_ tk a 7 0 ? A l v v v v z z z z' z v `o N lo#-AIADocument A31 d �M —201d CONTRACTOR: rA'arne, le;zol slaw and ucldt'<s.SJ ALFARO COMMUNICATIONS CONSTRUCTION, INC. 620 S. BRADFIELD AVE COMP [ON, CA 90221 Bid Bond No: N/A SURETY: (A`umc. legged staters and principal place Of busirres.si ENDURANCE ASSURANCE CORPORATION 4 MANHATTANVILLE ROAD PURCHASE, NY 1OS77 OWNER: 1rlpnre. lcEal srnhxs �ntr! aci<L rsc/ City of Huntington Beach 2000 Main Street, Huntington Beach, CA 92648 BOND AMOUNT: (10°!o)Ten percent of the attached bid amount This document has Important legal consequences. Consultation with an attorney is encouraged with respect to its completion or modification Any singular reference to Contractor, Surety. Owner or other party shall be considered plural where applicable PROJECT: (A'ame, locutic»> or address. f1ne( Prcyecr rrzrnrbe;-, i. anyi Traffic Signal Modications at the Intersections of Gotard Street and Protect Number. if any: 1465 Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue The Conn acuw and Surety are hound to the Owiwr in the announr set forth ahove, for the payment of which the Cownsctoi and Surci:v hind lhem.selves, their heirs, executors, administrators, succassors and assigns. joindy and `;ereratly, as providcd herein. The conditions ofthis Bond are such that if tlic Owlier accepis the bid o(the Contractor within rile time specified in the bid documents, or within such time Period as may be arrrced to b% the Chsnerand Contractor, and the Contractor zither ( I ) elvers into a contract with the thv ner in accordance yv-ttb the terms of Bach bid, and gives Stich bored or bonds as nia)• be spc:cilied in the bidding or Contract F)ocurients, wilt a suruty admitted in the jurisdiction of the Prujcct and athuwi,e acceptable to the ()Wrier- for the faith(ul performance uhsuch Contract and for the prompt payment of labor and matet-ial furnished in the prosecution thereof; or 1,2) pays to the 0tvtxr die diflcrence, not. to exceed the ;tlncimt of this Bond, belwettin the amount specifird in said bid and such larger amount for which the Ott ncr may in good faith contrael ttith another party to perfurni die vlork coverrcl by said hid, lhrn this obli,-mien shnU be null and void, otherwisc to remain in full force and efTcet. The Surely hereby v aivcs any notice of an agrccntvnt between the O)� ner and Contractor to extend tha Brie in which the 0%vnei may accept tho bid. Waiver of uoticc by the Suruty shall not apply to tally extcnsiolt excecdinr, sixt (00) dtiys iit the aggregate beyond the time for acceptance ofbids specified in the bid documnitti, and the Ovvncr and Contractor shall obtain the Suretv's consent i'Rr an exlension beyond sixty (00) davls. if this Bond it. issued in connection with a subcontractor's bid to a CQtnCCaCfol, the; term Contractor iu this Bond shall be deemed 14) be Subcontractor and the term Owner shalf he deemed 11) he CuntrActor_ When this Bond ha been titrnished to comply � ith ra statutory or other legal requireinent in the location cif the Project, ant provision in this Bond conilien111= vn ith said stattuc)ry Or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other te�-,al requiretncut shall be deemed inct1rp0ratrd herein. Whet) �o furnished, the intent is that this Bond shall be construed as a snauitory bond alto not as a common lave bond. Signed and reined this 7th cloy of August, 2017 ALFAROCO'l�UNIIJATIONS CONSTRUCTION, INC. if'rincip t [Seal) (FD'hrress �� l 1Ti;lej /5 ENDURAN E ASCORP-ORATION, (yeah f' E IrenLuon Fr (Tine) Yung T. M,ul k, Attorney -in -Fact 1 AfA Document A310^ — 2010. Copyright" 19ri3. 1970 and 2010 by The Amer:ran Institute: Architects. All rights reserved. WARNr".VG: The; AW Init. Darur.;rnt,S r.,•ac;ed a' J.S Co'• ri itt L<e,a and :r.teznabcnal Frcn ies. tina;;thorzecr et.:rnductu.n or as'ri h?�tiAt+',f -n'a AiA'' ¢ r r�Y t# ; i^ E"rr:rt3,'-ran:, or any {;crtio;: a`tf, ,nay esuit re scve{e crril anew c-minat per,30ien, and wril toe pro;-1 ed to ;ire maxi>-n:era ex',ent p�ossih4e eihder the la:=r. This t document was created cn 01i27,'2012 0723:12 under the Ierrns of AIA Do �ments-on-Demand- onla, no 2006397483 . and is not for ,esale This docuaeent is !ici I)sed by The American ins6lufe of Architects'or one-time use only, and may not be reproduced niter eo ils com❑letion. -- A notary public or other officer completing this certificate verifies only the identity of the individual who signed the docurrient to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County of Orange On August7 2017 ____R Ka ah��__N�aryPub|ic Date n��Na�������������������u���e� personally appeared Yung T. MuUick ____�__ __ NOTARY PUBLICZAUFORNIA CA ORANGE COUNTY W My Comm, EXPJUNE 13,2019 who proved to me on the basis of satisfactory evidence to be the whose name(o) is/are subscribed to the within instrument and acknowledged tmethat he/she8he exeoutedthe same inhio/hentheirauthorized oapooity(iee), and that by his/her/their signature(s) on the instrument the pemon(n), or the entity upon behalf of which the person(a) acted, executed the instrument, | certify underPENALTY OFPERJURY Linder the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand fficial seal. Signature :No -P , Uy n R K i Place Notary Seal Above I( Zatur No ry PU C Though the information below is not required by law, it may prove valuable on the document and could prevent fraudulent removal and reattachment of the form to another document. Description of Attached Document Title or Type of Document Docunnent Date: Signel Other Than Named Abovei Capauity(ies)Claimed bySigner(a) Number ofPages: ` Signer's Name: � Signer's Name: � [] individual [] Individual � � L] Corporate Officer --Td|e(s) [] Corporate Officer --Title(e): '|� O partoet OUmited General O Partner OUmited E­ General �� 7 xttnmeymFact [] Attorney inFact ! CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of ) On l� �U t-1 before me10 ,C l i�l�� l 1, �4� I�iC (here insert name and title of the officer) personally appeared Q 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 �t ndi Esmeralda Santamaria Castillo Los Angeles aComm. #2200339 z Notary Public • California 1 My Comm. Expires June 5, 2021 (Seal) Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document titled/for the purpose of E) Id containing pages, and dated 1�20 The signer(s) capacity or authority is/are as: ❑ Individual(s) ❑ ttorney-in-Fact Corporate Officer(s) Title(s) ❑ Guardian/Conservator ❑ Partner - Limited/General ❑ Trustee(s) ❑ Other: representing: Name(s) of Person(s) or Entity(ies) Signer is Representing Method of Signer Identification Proved to me on the basis of satisfactory evidence, O form(s) of identification O credible witness (es) Notarial event is detailed in notary journal on: Page # Entry # r Notarycontact62-2o Other ❑ AdditionalSigner(s) ❑ Signer(s)Thumbprint(s) Q Copyright 2007-2016 Notary Rotary, Inc. PO Box 41400, Des Moines, IA 50311-0507 All Rights Reserved Item Number 101772 Please contact your Authorized Reseller to purchase copies of this form. ENDURANCE ASSURANCE CORPORATION 157 POWER OF ATTORNEY X ww adWen 6y these Resent, that ENDURANCE ASSURANCE CORPORATION, a Delaware corporation (the "Corporation"), with offices at 4 Manhattanvdle Road, 3rd Floor, Purchase, NY 10577, has made, constituted and appointed and by these presents, does make, constitute and appoint YUNG T. MULLICK, JAMES W. MOILANEN its true and lawful Attorneys)-m-fact, at;MISSIQN VIEJO in the Stale of CA and each of them to have full power to act without the other or others, to make, execute and deliver on its behalf, as surety or co -surety, bond's and undertakings,given for any and all purposes, also to execute and deliver on its behalf as aforesaid renewals, extensions, agreements, waivers, consents or stipulations relating to such�bonds or undertakrngsprovided, however, that no single bond or undertaking so made, executed and delivered shall obligate the Corporation for any portion of the penal sum thereofln_eX ssofthe„sumof,iENMILLIONDollars ($10,000,000). M Such t o,rids and undertakings for said purposes, when duly executed by said attorney(s)-in-fact, shall be binding upon the Corporation as fully and to the same extent as if signed by the Presidant of the Corporation under its`borporate seal attested by its Corporate Secretary. This a ointrlent is n pp m�deiindei4and by authority of certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on the 9th of January, 2014, a copy of which appears belovvGjer=the heading entitled "Certificate" Tors Power ohAtlorrey is signed and sealed by facsimile under and by authority of the following resolution adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2614;andsad resolgtii has not since been revoked, amended or repealed RESOLVED, that in granting powers of attorney pursuant to certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2014, the signature of such directors and officers and the seal of the Corporation may be affixed to any such power of attorney or any certificate relating thereto by facsimile, and any such power of attorney or certificate bearing such facsimile signature or seal shall be valid and binding upon the Corporation in the future with respect to any bond or undertaking to which it is attached IN WITNESS WHEREOF, the Corporation has caused these presents to be duly signed and its corporate seal to be hereunto affixed and attested this 23rd day of June, 2017 at Purchase, New York (Corporate Seal) ENDURANCE ASSURANCE CORPORATION ATTEST � c J lLa[a x-A SZ �tl By ad4.{.AY# "7toit�R1 MARIANNE L WILBERT, SENIOR VICE PRESIDENT SHARON L SIMS, SENIOR VICE PRESIDENT STATF OF NEW YORK ss PURCHASE COUNTY OF WESTCHESTER On the 23rd day of June, 2017 before me personally came SHARON L. SIMS, SENIOR VICE PRESIDENT to me known, who being by me duly sworn, did depose and say that (s)he resides in SCOTCH PLAINS'NEW JERSEY that (s)he is a SENIOR VICE PRESIDENT of ENDURANCE ASSURANCE CORPORATION, the Corporation described in and which executed the above instrument; that (s)he knows the seal of said Corporation, that the seal affixed to said instrument is such corporate seal, that it was so affixed by order of the Board of Directors of said Corporation, and that (s)he signed his (her) name thereto by like order (NotarrelSeal)� NICHOLAS JAMES BENENATI, Notary Public - My Commission Expires 12/07/2019 _ CERTIFICATE STATEOF`NEWAYORK ":u` ss PURCHASE COUNTY OF WESTCHESTER I, CHRISTOPHER DONELAN the PRESIDENT of ENDURANCE ASSURANCE CORPORATION, a Delaware Corporation (the "Corporation"), hereby certify 1 That the original power of attorney of which the foregoing is a copy was duly executed on behalf of the Corporation and has not since been revoked, amended or modified, that the undersigned has compared the foregoing copy thereof with the original power of attorney, and that the same is a true and correct copy of the original power of attorney and of the whole thereof, 2 The following are resolutions which were adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2014 and said resolutions have not since been revoked, amended or modified "RESOLVED, that each of the individuals named below is authorized to make, execute, seal and deliver for and on behalf of the Corporation any and all bonds, undertakings or obligations in surety or co -surety with others CHRISTOPHER DONELAN, SHARON L SIMS, MARIANNE L. WILBERT And be It further RESOLVED,lthat each<oi,the individuals named above is authorized to appoint attorneys -in -fact for the purpose of making, executing, sealing and delivering bonds, undertakings or obligations in .s•, .� surety or_co-surety_foF aa nd on behalt,of the,Corporation " 3 Thkevndersigned further certifies thatlheve aboresolutions are true and correct copies of the resolutions as so recorded and of the whole thereof. � 4: IN WITNESS WHE.Rtdt I xhave hereunto setmy hand and affixed the corporate seal this 7th day of August 20 17 (Corporate ,9ea!' — ;:_ r� �YL CHRISTOPHER DONELAN, PRESIDENT Any reproductions are void Primary Surety Claims Submission, suretybondclaims@@sompo-mil com Surety Claims Hotline 877 676 7575 Mailing Address Surety Claims Department, 750 Third Avenue - 10th Floor, New York, NY 10017 No. 5082-3 STATE OF CALIFORNIA DEPARTMENT OF INSURANCE SAN FRANC'ISCO Amended Certificate ®f Authority THIS IS TO CERTIFY that, pursuant to the Insurance Code of the State of California. Endurance Assurance Corporation of Delaware, organized under the laws of Delaware, subject to its Articles of Incorporation or other f emlawerual organizational documents, is herebl; authorized to transact ivithin this State, sttbiect to all provisions ofthis Certificate, the,foliowing classes of insurance: Fire, Marine, Surety, Disability, Plate Glass, Liability, Workers' Compensation, Common Carrier Liability, Boiler and Nfachinery, Burglary, Credit, Sprinkler, Team and Vehicle, Automobile, Aircraft, and Miscellaneous as such classes are now or ma.), hereafter be dcflned in the Insurance Laws of the State o�t"California, THIS CER iFICATE is expressly conditioned upon the holder hereofnow and hereafter being in full conipliartce with all, and not in violation of any, ofthe applicable laws and lawftti requirements made under authority of the laws of the State ofCalifornia as long as such laws or requirements are in effect crud applicable, and as such lass and requirements now are, or may hereafter be changed or amended. 1N WITNESS WHEREOF, e{fective as of the 23"' day gfAugctst. 2010, I have hereunto set my hand and caused my official seal to be affixed this 23rd dory ofAugust. 2016. Dave Jones 14swame Commissioner By Carol Frair for Joel Laucher C;nef Leputy NOTICE: Qualification with the Secretary of Siate must be accompiished as required by the Califortr.a Corporations Code promptly after issuance oftliis Certificate ofAuti;ority. Failure to do so will be a violation ofinsurance Code section 7Q t andwill be n-ounds foi- 1 cvokilill this Certificate of Authori(y pursuant to the covenants made in the application therefoi and the conditions contained herein. 'City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE For Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue — CC 1465 HSIPL5181 (178) August 11, 2017 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES. The Federal Labor Rates contained in Appendix I of the specifications for the: Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue - CC1465 HSIPL5181(178) shall be replaced with the following attached documents: The Federal Labor Rates dated August 4, 2017 shall be the labor rates in effect for the subject project. 2) PAGE C-1 — SECTION 3 — PROPOSAL The following sentence shall be inserted at the end of the first paragraph. The undersigned acknowledges that the issuance of Notice to Proceed will occur approximately three months after the award of contract to allow procurement time for the city furnished equipment. This is to acknowledge receipt and review of Addendum Number One, dated August 11, 2017. L , Cl- r� '(� ; t c Vv�.,c1 i I ki t G iNiv►� n m C ny Name By / - J q Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F. Janusz at (714) 536-5431. EXHIBIT B (Required Contract Provision For All Federal Aid Construction Contracts FHWA 1273) 30 SFF:17-5732/15ltU97iCaffrcut,-Federal Contract 6,117 'eXhibil- 8 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment A ATTACHMENT A SECTION 14. FEDERAL REQUIREMENTS FOR FEDERAL -AID CONSTRUCTION PROJECTS GENERAL. —The work herein proposed will be financed in whole or in part with Federal funds, and therefore all of the statutes, rules and regulations promulgated by the Federal Gov - eminent and applicable to work financed in whole or in part with Federal funds will apply to such work. The "Required Contract Provisions, Federal -Aid Construction Contracts, "Form FHWA 1273, are included in this Section 14. Whenever in said required contract provisions references are made to "SHA contracting officer," "SHA resident engineer," or "authorized representative of the SHA," such references shall be construed to mean "Engineer" as defined in Section 1-1.18 of the Standard Specifications. PERFORMANCE OF PREVIOUS CONTRACT. —In ad- dition to the provisions in Section II, "Nondiscrimination," and Section VII, "Subletting or Assigning the Contract," of the re- quircd contract provisions, the Contractor shall comply with the following: The bidder shall execute the CERTIFICATION WITH RE- GARD TO THE PERFORNIANCE OF PREVIOUS CON- TRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND THE FILING OF REQUIRED REPORTS located in the proposal. No request for subletting or assigning any portion of the contract in excess of $10,000 will be considered under the provisions of Section VII of the required contract provisions unless such request is accompanied by the CERTIFICATION referred to above, executed by the proposed subcontractor. NON -COLLUSION PROVISION. —The provisions in this section are applicable to all contracts except contracts for Federal Aid Secondary projects. Title 23, United States Code, Section 112, requires as a condi- tion precedent to approval by the Federal Highway Administrator of the contract for this work that each bidder file a sworn statement executed by, or on behalf of, the person, firm, association, or corporation to whom such contract is to be awarded, certifying that such person, firm, association, or corporation has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with the submitted bid. A form to make the non -collusion affidavit statement required by Section 112 as a certification under penalty of perjury rather than as a sworn statement as permitted by 28, USC, Sec. 1746, is included in the proposal. PARTICIPATION BY DISADVANTAGED BUSINESS EN- TERPRISES IN SUBCONTRACTING. —Part 26, Title 49. Code of Federal Regulations applies to this Federal -aid project. Pertinent sections of said Code are incorporated in part or in its entirety within other sections of these special provisions. Schedule B—Information for Determining Joint Venture Eli- gibility FRA (This form need not be filled in if all joint venture firms are DBE owned.) 1. Name of joint venture 2. Address of joint venture 3_ Phone number of joint venture 4. Identify the firms which comprise the joint venture. (The DBE partner must complete Schedule A.) a. Describe the role of the DBE firm in the joint venture. b. Describe very briefly the experience and business qualifications of each non -DBE joint venturer: 5. Nature of the joint venture's husiness 6. Provide a copy of the joint venture agreement. 7. What is the claimed percentage of DBE ownership? 8. Ownership of joint venture: (This need not he filled in if described in the joint venture agreement, provided by question 6.). Revised 3-95 08-07-95 Page 12-9 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment A PS&E Checklist Instructions a. Profit and loss sharing. b. Capital contributions, including equipment. c. Other applicable ownership interests. 9. Control of and participation in this contract. Identify by name, race, sex, and "firm" those individuals (and their titles) who are responsible for day-to-day management and policy decision making, including, but not limited to, those with prime responsibility for: a. Financial decisions b. Management decisions, such as: 1. Estimating 2. Marketing and sales 3. Hiring and firing of management personnel 4. Purchasing of major items or supplies c. Supervision of field operations Note. —If, after filing this Schedule B and before the comple- tion of the joint venture's work on the contract covered by this regulation, there is any significant change in the information submitted, the joint venture must inform the grantee, either di- rectly or through the prime contractor if the joint venture is a subcontractor. Affidavit "The undersigned swear that the foregoing statements are cor- rect and include all material information necessary to identify and explain the terms and operation of our joint venture and the intended participation by each joint venturer in the undertaking. Further, the undersigned covenant and agree to provide to grantee current, complete and accurate information regarding ac- tual joint venture work and the payment therefor and any pro- posed changes in any of the joint venture arrangements and to permit the audit and examination of the books, records and files of the joint venture, or those of each joint venturer relevant to the joint venture, by authorized representatives of the grantee or the Federal funding agency. Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initiating action under Federal or State laws concerning false statements." Revised 3-95 08-07-95 .............................................................................................. Name of Firm Name of Firm ................................................................................................ Signature Signature ................................................................................................. Name Name .................................. ........ .......................................................... Title Title ................................................................................................. Date Date Date State of County of On this day of , 19 _, before me appeared (Name) to me personally known, who, being duly sworn, did execute the foregoing affi- davit, and did state that he or she was properly authorized by (Name of firm) to execute the affidavit and did so as his or her free act and deed. Notary Public Commission expires [Seal] Date Statc of County of On this day of 19 _, before me appeared (Name) _ to me personally known, who, being duly sworn, did execute the foregoing affidavit, and did state that he or she was properly authorized by (Name of firm) to execute the affidavit and did so as his or her free act and deed. Notary Public Commission expires [Seal] FR-2 Page 12-10 June 29, 2012 OB 12-04 Local Assistance Procedures Manual PS&E Checklist Instructions EXHIBIT 12-E Attachment B ATTACHMENT B REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS (Exclusive of Appalachian Contracts) Page I. General....................................................................... 3 II. Nondiscrimination..................................................... 3 III. Nonsegregated Facilities ............................................ 5 IV. Payment of Predetermined Minimum Wage ......._....- 6 V. Statements and Payrolls ............................................. 8 VI. Record of Materials, Supplies, and Labor .................. 9 VII. Subletting or Assigning the Contract ......................... 9 VIII. Safety: Accident Prevention ...................................... 10 IX. False Statements Concerning Highway Project .......... 10 X. Implementation of Clean Air Act and Federal Water Pollution Control Act .................................................. 10 XI. Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion ...................... I I XII. Certification Regarding Use of Contract Funds for Lobbying............................... ......... __ .................. 12 ATTACHMENTS A. Employment Preference for Appalachian Contracts (included in Appalachian contracts only) L GENERAL 1. These contract provisions shall apply to all work performed on the contract by the contractor's own organization and with the assistance of workers under the contractor's immediate superintendence and to all work performed on the contract by piecework, station work, or by subcontract. 2. Except as otherwise provided for in each section, the con- tractor shall insert in each subcontract all of the stipulations contained in these Required Contract Provisions, and further re- quire their inclusion in any lower tier subcontract or purchase order that may in turn be made. The Required Contract Provisions shall not be incorporated by reference in any case. The prime contractor shalt be responsible for compliance by any subcontractor or lower tier subcontractor with these Required Contract Provisions. 3. A breach of any of the stipulations contained in these Re- quired Contract Provisions shall be sufficient grounds for termi- nation of the contract. 4. A breach of the following clauses of the Required Contract Provisions may also be grounds for debarment as provided in 29 CFR 5.12: Section I, paragraph 2; Section IV, paragraphs I, 2, 3, 4, and 7, Section V, paragraphs I and 2a through 2g. 5. Disputes arising out of the labor standards provisions of Section IV (except paragraph 5) and Section V of these Required Contract Provisions shall not be subject to the general disputes clause of this contract. Such disputes shall be resolved in accor- dance with the procedures of the U.S. Department of Labor (DOL) as set forth in 29 CFR 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, the DOL, or the contractor's employees or their representatives. FR-3 6. Selection of Labor: During the performance of this contract, the contractor shall not: a. discriminate against labor from any other State, possession, or territory of the United States (except for employment preference for Appalachian contracts, when applicable, as specified in Attachment A), or b. employ convict labor for any purpose within the limits of the project unless it is labor performed by convicts who are on parole, supervised release, or probation. II. NONDISCRIMINATION (Applicable to all Federal -aid construction contracts and to all related subcontracts of $10,000 or more.) I. Equal Employment Opportunity: Equal employment opportunity (EEO) requirements not to discriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, rules, regulations (28 CFR 35, 29 CFR 1630, and 41 CFR 60) and orders of the Secretary of Labor as modified by the provisions prescribed herein, and im- posed pursuant to 23 U.S.C. 140 shall constitute the EEO and specific affirmative action standards for the contractor's project activities under this contract. The Equal Opportunity Construction Contract Specifications set forth under 41 CFR 60-4.3 and the provisions of the American Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) set forth under 28 CFR 35 and 29 CFR 1630 are incorporated by reference in this contract. In the execution of this contract, the contractor agrees to comply with the following minimum specific requirement activities of EEO: a. The contractor will work with the State highway agency (SHA) and the Federal Government in carrying out EEO obli- gations and in their review of his/her activities under the con- tract- b. The contractor will accept as his operating policy the following statement: It is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age or disability. Such action shall include: ensploynient, upgrading, demotion, or transfer; recruitment or recruitment ad- vertising,, layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprentice- ship, preapprenticeship, andlor on-the-job training." 2. EEO Officer: The contractor will designate and make known to the SHA contracting officers an EEO Officer who will have the responsibility for and must be capable of effectively Page 12-1 l OB 12-04 June 29, 2012 EXHIBIT 12-E Attachment B administering and promoting an active contractor program of EEO and who must be assigned adequate authority and responsibility to do so. 3. Dissemination of Policy: All members of the contractor's staff who are authorized to hire, supervise, promote, and discharge employees, or who recommend such action, or who are substantially involved in such action, will be made fully cognizant of, and will implement, the contractor's EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above agreement will be met, the following actions will be taken as a minimum: a Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and then not less often than once every six months, at which time the contractor's EEO policy and its implementation will be re- viewed and explained. The meetings will be conducted by the EEO Officer. b. All new supervisory or personnel office employees will be given a thorough indoctrination by the EEO Officer, covering all major aspects of the contractor's EEO obligations within thirty days following their reporting for duty with the contractor. c. All personnel who are engaged in direct recruitment for the project will be instructed by the EEO Officer in the contractor's procedures for locating and hiring minority group employees. d. Notices and posters setting forth the contractor's EEO policy will be placed in areas readily accessible to employees, applicants for employment and potential employees. e. The contractor's EEO policy and the procedures to im- plement such policy will be brought to the attention of em- ployees by means of meetings, employee handbooks, or other appropriate means. 4. Recruitment: When advertising for employees, the contractor will include in all advertisements for employees the notation: "An Equal Opportunity Employer." All such adver- tisements will be placed in publications having a large circulation among minority groups in the area from which the project work force would normally be derived. a- The contractor will, unless precluded by a valid bargaining agreement, conduct systematic and direct recruitment through public and private employee referral sources likely to yield qualified minority group applicants. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such identified sources procedures whereby minority group applicants may be referred to the contractor for employment consideration. b. In the event the contractor has a valid bargaining agreement providing for exclusive hiring hall referrals, he is expected to observe the provisions of that agreement to the extent that the system permits the contractor's compliance with EEO contract provisions. ("The DOI, has held that where implementation of such agreements have the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Executive Order 11246, as amended.) c. The contractor will encourage his present employees to Form 1273 — Revised 3-95 OM7-95 Local Assistance Procedures Manual PS&E Checklist Instructions Form 1273 — Revised 3-95 OM7-95 refer minority group applicants for employment. Information and procedures with regard to referring minority group 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: FR-4 a_'Ihe contractor will conduct periodic inspections of project sites to ensure that working conditions and employee facilities do not indicate discriminatory treatment of project site personnel. b. The contractor will periodically evaluate the spread of wages paid within each classification to determine any evidence of discriminatory wage practices. c. The contractor will periodically review selected personnel actions in depth to determine whether there is evidence of discrimination. Where evidence is found, the contractor will promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all affected persons. d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor in connection with his obligations under this contract will attempt to resolve such complaints, and will take appropriate corrective action within a reasonable time. If the investigation indicates that the discrimination may affect persons other than the complainant, such corrective action shall include such other persons. Upon completion of each investigation, the contractor will inform every complainant of all of his avenues of appeal. 6. Training and Promotion: a The contractor will assist in locating, qualifying, and increasing the skills of minority group and women employees, and applicants for employment. b. Consistent with the contractor's work force requirements and as permissible under Federal and State regulations, the contractor shall make full use of training programs, i.e., apprenticeship, and on-the-job training programs for the ge- ographical area of contract performance. Where feasible, 25 percent of apprentices or trainees in each occupation shall be in their first year of apprenticeship or training. In the event a special provision for training is provided under this contract, this subparagraph will be superseded as indicated in the special provision. c. The contractor will advise employees and applicants for employment of available training programs and entrance re- quiremcnts for each. d. The contractor will periodically review the training and promotion potential of minority group and women employees and will encourage eligible employees to apply for such training and promotion. Page 12-12 June 29, 2012 OB 12-04 EXHIBIT 12-E Attachment B 7. Unions: If the contractor relies in whole or in part upon unions as a source of employees, the contractor will use his/her best efforts to obtain the cooperation of such unions to increase opportunities for minority groups and women within the unions, and to effect referrals by such unions of minority and female employees. Actions by the contractor either directly or through a contractor's association acting as agent will include the procedures set forth below: a The contractor will use best efforts to develop, in coop- eration with the unions, joint training programs aimed toward qualifying more minority group members and women for membership in the unions and increasing the skills of minority group employees and women so that they may qualify for higher paying employment. b. The contractor will use best efforts to incorporate an EEO clause into each union agreement to the end that such union will be contractually bound to refer applicants without regard to their race, color, religion, sex, national origin, age or disability. c. The contractor is to obtain information as to the referral practices and policies of the labor union except that to the extent such information is within the exclusive possession of the labor union and such labor union refuses to furnish such information to the contractor, the contractor shall so certify to the SHA and shall set forth what efforts have been made to obtain such information. d. In the event the union is unable to provide the contractor with a reasonable flow of minority and women referrals within the time limit set forth in the collective bargaining agreement, the contractor will, through independent recruitment efforts, fill the employment vacancies without regard to race, color, religion, sex, national origin, age or disability; making full efforts to obtain qualified and/or qualifiable minority group persons and women. (The DOL has held that it shall be no excuse that the union with which the contractor has a collective bargaining agreement providing for exclusive referral failed to refer minority employees.) In the event the union referral prac- tice prevents the contractor from meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, such contractor shall immediately notify the SHA. 8. Selection of Subcontractors, Procurement of Materials ad n 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 ]cases of equipment. a The contractor shall notify all potential subcontractors and suppliers of his/her EEO obligations under this contract. b. Disadvantaged business enterprises (DBE,), as defined in 49 CFR 26, shall have equal opportunity to compete for and perform subcontracts which the contractor enters into pursuant to this contract. The contractor will use his best efforts to solicit bids from and to utilize DBE subcontractors or subcontractors with meaningful minority group and female representation among their employees. Contractors shall obtain lists of DBE construction firms from SHA personnel. c. The contractor will use his best efforts to ensure subcon- tractor compliance with their EEO obligations. 9. Records and Reports: The contractor shall keep such Local Assistance Procedures Manual PS&E Checklist Instructions records as necessary to document compliance with the EEO requirements. Such records shall be retained for a period of three years following completion of the contract work and shall be available at reasonable times and places for inspection by au- thorized representatives of the SIIA and the FHWA. a The records kept by the contractor shall document the following_ (1) The number of minority and non -minority group members and women employed in each work classification on the project; (2) The progress and efforts being made in cooperation with unions, when applicable, to increase employment op- portunities for minorities and women; (3) "The progress and efforts being made in locating, hiring, training, qualifying, and upgrading minority and female employees; and (4) The progress and efforts being made in securing the services of DBE subcontractors or subcontractors with meaningful minority and female representation among their employees. b. The contractors will submit an annual report to the SHA each 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. If on-the-job training is being required by special provision, the contractor will be required to collect and report training data - III NONSEGREGATED FACILTI'IES (Applicable to all Federal -aid construction contracts and to all related subcontracts of $10,000 or more.) FR-S a By submission of this bid, the execution of this contract or subcontract, or the consummation of this material supply agreement or purchase order, as appropriate, the bidder, Federal - aid construction contractor, subcontractor, material supplier, or vendor, as appropriate, certifies that the firm does not maintain or provide for its employees any segregated facilities at any of its establishments, and that the firm does not permit its employees to perform their services at any location, under its control, where segregated facilities are maintained. The firm agrees that a breach of this certification is a violation of the EEO provisions of this contract. The firm further certifies that no employee will be denied access to adequate facilities on the basis of sex or disability. b. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms, and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive, or are, in fact, seg- regated on the basis of race, color, religion, national origin, age or disability, because of habit, local custom, or otherwise. The only exception will be for the disabled when the demands for accessibility override (e.g. disabled parking). Form 1273 -- Revised 3-95 08-07-95 Page 12-13 OB 12-04 June 29, 2012 EXHIBIT 12-E Attachment B c. "rhe contractor agrees that it has obtained or will obtain identical certification from proposed subcontractors or material suppliers prior to award of subcontracts or consummation of material supply agreements of $10,000 or more and that it will retain such certifications in its files. IV. PAYMENT OF PREDETERMINED MINIMUM WAGE (Applicable to all Federal -aid construction contracts exceeding $2,000 and to all related subcontracts, except for projects located on roadways classified as local roads or rural minor collectors, which are exempt.) 1. General: a_ All mechanics and laborers employed or working upon the site of the work will be paid unconditionally and not less often than once a week and without subsequent deduction or rebate on any account [except such payroll deductions as are permitted by regulations (29 CFR 3)] issued by the Secretary of Labor under the Copeland Act (40 U.S.C. 276c) the full amounts of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment. The payment shall be computed at wage rates not less than those contained in the wage determination of the Secretary of Labor (hereinafter "the wage determination") which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the contractor or its subcontractors and such laborers and mechanics. The wage determination (including any additional classifications and wage rates conformed under paragraph 2 of this Section IV and the DOL poster (WH-1321) or Form FI-IWA-1495) shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. For the purpose of this Section, contributions made or costs reasonably anticipated for bona fide fringe benefits under Section 1(b)(2) of the Davis -Bacon Act (40 U.S.C. 276a) on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of Section 1V, paragraph 3b, hereof. Also, for the purpose of this Section, regular contributions made or costs incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs, which cover the particular weekly period, are deemed to be constructively made or incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage deter- mination for the classification of work actually performed, without regard to skill, except as provided in paragraphs 4 and 5 of this Section IV. b. Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein, provided, that the employer's payroll records accurately set forth the time spent in each classification in which work is performed. c. All rulings and interpretations of the Davis -Bacon Act and related acts contained in 29 CFR 1, 3, and 5 are herein incorporated by reference in this contract. Form I273 -- ReNised 3-95 08-07-95 FR-6 Local Assistance Procedures Manual PS&E Checklist Instructions 2. Classification: a. The SHA contracting officer shall require that any class of laborers or mechanics employed under the contract, which is not listed in the wage determination, shall be classified in conformance with the wage determination. b. The contracting officer shall approve an additional classification, wage rate and fringe benefits only when the following criteria have been met: (1) the work to be performed by the additional classifi- cation requested is not performed by a classification in the wage determination; (2) the additional classification is utilized in the area by the construction industry; (3) the proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination; and (4) with respect to helpers, when such a classification prevails in the area in which the work is performed. c. If the contractor or subcontractors, as appropriate, the laborers and mechanics (if known) to be employed in the addi- tional classification or their representatives, and the contracting officer agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate), a report of the action taken shall be sent by the contracting officer to the DOL, Administrator of the Wage and Hour Division, Employment Standards Administration, Washington, D.C. 20210. The Wage and Hour Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30-day period that additional time is necessary. d. In the event the contractor or subcontractors, as appro- priate, the laborers or mechanics to be employed in the addi- tional classification or their representatives, and the contracting officer do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions, including the views of all interested parties and the recommendation of the contracting officer, to the Wage and Hour Administrator for determination. Said Administrator, or an authorized representative, will issue a determination within 30 days of receipt and so advise the contracting officer or will notify, the contracting officer within the 30-day period that additional time is necessary e. The wage rate (including fringe benefits where appropriate) determined pursuant to paragraph 2c or 2d of this Section IV shall be paid to all workers performing work in the additional classification from the first day on which work is performed in the classification. 3. Payment of Fringe Benefits: a_ Whenever the minimum wage rate prescribed in the con- tract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate, the contractor or subcontractors, as appropriate, shall either pay the benefit Page 12-14 June 29, 2012 OB 12-04 Local Assistance Procedures Manual PS&E Checklist Instructions as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly case equivalent thereof. b. If the contractor or subcontractor, as appropriate, does not make payments to a trustee or other third person, he/she may consider as a 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. 4. Apprentices and Trainees (Programs of the U.S. DOL) and Helpers: a. Apprentices: (1) Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the DOL, Employment and Training Administration, Bureau of Apprenticeship and Training, or with a State apprenticeship agency recognized by the Bureau, or if a person is employed in his/her first 90 days of probationary employment as an apprentice in such an apprenticeship program, who is not individually registered in the program, but who has been certified by the Bureau of Apprenticeship and Training or a State apprenticeship agency (where appropriate) to be eligible for probationary employment as an apprentice. (2) The allowable ratio of apprentices to journeyman -level employees on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any employee listed on a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rate listed in the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shalll be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor or subcontractor is performing construction on a project in a locality other than that in which its program is registered, the ratios and wage rates (expressed in percentages of the journeyman -level hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. (3) Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's level of progress, expressed as a percentage of the journeyman - level hourly rate specified in the applicable wage 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 most be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator for the Wage and Hour Division determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. FR-7 EXHIBIT 12-E Attachment B (4) In the event the Bureau of Apprenticeship and Training, or a State apprenticeship agency recognized by the Bureau, withdraws approval of an apprenticeship program, the contractor or subcontractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the comparable work performed by regular employees until an acceptable program is approved. b. Trainees: (I) Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by formal certification by the DOL. Employment and Training Administration. (2) The ratio of trainees to journeyman -level employees on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Any employee listed on the payroll at a trainee rate who is not registered and participating in a training plan approved by the Employment and Training Administration shall be 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. (3) Every trainee must be paid at not less than the rate specified in the approved program for his/her level of progress, expressed as a percentage of the journeyman -level hourly rate specified in the applicable wage determination. 'Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding journeyman -level wage rate on the wage determination which provides for less than full fringe benefits for apprentices, in which case such trainees shall re- ceive the same fringe benefits as apprentices. (4) In the event the Employment and Training Adminis- tration withdraws approval of a training program, the con- tractor or subcontractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. c. Helpers: Helpers will be permitted to work on a project if the helper classification is specified and defined on the applicable wage determination or is approved pursuant to the conformance procedure set forth in Section IV.2. Any worker listed on a payroll at a helper wage rate, who is not a helper under an approved definition, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. Form 1273 — Revised 3-95 D8-07-95 Page 12-15 OB 12-04 June 29, 2012 EXHIBIT 12-E Attachment B 5. 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. 6. Withholding: The SHA shall upon its own action or upon written request of an authorized representative of the DOL withhold, or cause to be withheld, from the contractor or subcontractor under this contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to Davis -Bacon prevailing wage requirements which is held by the same prime contractor, as much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees, and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, including any apprentice, trainee, or helper, employed or working on the site of the work, all or part of the wages required by the contract the SHA contracting officer may, 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. 7. Overtime Requirements: No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers, mechanics, watchmen, or guards (including apprentices, trainees, and helpers described in paragraphs 4 and 5 above) shall require or permit any laborer, mechanic, watchman, or guard in any workweek in which he/she is employed on such work, to work in excess of 40 hours in such workweek unless such laborer, mechanic, watchman, or guard receives compensation at a rate not less than one -and -one-half times his/her basic rate of pay for all hours worked in excess of 40 hours in such workweek. 8. Violation: Liability for Unpaid Wages; Liquidated Damages_ In the event of any violation of the clause set forth in paragraph 7 above, the contractor and any subcontractor responsible thereof shall be liable to the affected employee for his/her unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory) for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer, mechanic, watchman, or guard employed in violation of the clause set forth in paragraph 7, in the sum of $10 for each calendar day on which such employee was required or permitted to work in excess of the standard work week of 40 hours without payment of the overtime wages required by the clause set forth in paragraph 7. Foam 1273 — Revised 3-95 08-07-95 FRA Page 12-16 June 29, 2012 Local Assistance Procedures Manual PS&E Checklist Instructions 9. Withholding for Unpaid Wages and Liquidated Damages: The SHA shall upon its own action or upon written request of any authorized representative of the DOL withhold, or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph 8 above. V. STATEMENTS AND PAYROLLS (Applicable to all Federal -aid construction contracts exceeding $2,000 and to all related subcontracts, except for projects located on roadways classified as local roads or rural collectors, which are exempt.) 1. Compliance with Copeland Regulations (29 CFR 3): The contractor shall comply with the Copeland Regulations of the Secretary of Labor which are herein incorporated by reference. 2. Payrolls and Payroll Records: a Payrolls and basic records relating thereto shall be maintained by the contractor and each subcontractor during the course of the work and preserved for a period of 3 years from the date of completion of the contract for all laborers, mechanics, apprentices, trainees, watchmen, helpers, and guards working at the site of the work. b. The payroll records shall contain the name, social security number, and address of each such employee; his or her correct classification; hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalent thereof the types described in Section I(b)(2)(B) of the Davis Bacon Act); daily and weekly number of hours worked; deductions made; and actual wages paid. In addition, for Appalachian contracts, the payroll records shall contain a notation indicating whether the employee does, or does not, normally reside in the labor area as defined in Attachment A, paragraph 1. Whenever the Secretary of Labor, pursuant to Sec- tion IV, paragraph 3b, has found that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in Section I(b)(2)(B) of the Davis Bacon Act the contractor and each subcontractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, that the plan or program has been communicated in writing to the laborers or mechanics affected, and show the cost anticipated or the actual cost incurred in providing benefits. Contractors or subcontractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprentices and trainees, and ratios and wage ratr nrr r;her1 in tha annlirahl.• nrnar Local Assistance Procedures Manual PS&E Checklist Instructions c. Each contractor and subcontractor shall furnish, each week in which any contract work is performed, to the SHA resident engineer a payroll of wages paid each of its employees (including apprentices, trainees, and helpers, described in Section IV, paragraphs 4 and 5, and watchmen and guards en- gaged on work during the preceding weekly payroll period). The payroll submitted shall set out accurately and completely all of the information required to be maintained under paragraph 2b of this Section V. This information may be submitted in any form desired. Optional Form WH-347 is available for this purpose and may be purchased from the Superintendent of Documents (Federal stock number 029-005-0014-1), U.S. Government Printing Office, Washington, D.C. 20402. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. d. Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or sub- contractor or his/her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (1)that the payroll for the payroll period contains the information required to be maintained under paragraph 2b of this Section V and that such information is correct and complete: (2) that such laborer or mechanic (including each helper, apprentice, and trainee) employed on the contract daring 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 the Regulations, 29 CFR 3; (3) that each laborer or mechanic has been paid not less that the applicable wage rate and fringe benefits or cash equivalent for the classification of worked performed, as specified in the applicable wage determination incorporated into the contract. e. The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH-347 shall satisfy the requirement for submission of the "Statement of Compliance" required by paragraph 2d of this Section V. f. The falsification of any of the above certifications may subject the contractor to civil or criminal prosecution under 18 U.S.C. 1001 and 31 U.S.C. 231. g. The contractor or subcontractor shall make the records re- quired under paragraph 2b of this Section V available for in- spection, copying, or transcription by authorized representatives of the SI- A, the FHWA, or the DOL, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the re- quired records or to make them available, the SHA, the FHWA, the DOL, or all may, after written notice to the contractor, sponsor, applicant, or owner, take such actions as may be nec- essary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available EXHIBIT 12-E Attachment B may be grounds for debarment action pursuant to 29 CFR 5.12. VI. RECORD OF MATERIALS, SUPPLIES, AND LABOR 1. On all Fedcral-aid contracts on the National Highway System, except those which provide solely for the installation of protective devices at railroad grade crossings, those which are constructed on a force account or direct labor basis; highway beautification contracts, and contracts for which the total final construction cost for roadway and bridge is less than $1,000,000 (23 CFR 635); the contractor shall: a. Become familiar with the list of specific materials and supplies contained in Form FHWA-47, "Statement of Materials and Labor Used by Contractor of Highway Construction Involving Federal Funds," prior to the commencement of work under this contract. b. Maintain a record of the total cost of all materials and supplies purchased for and incorporated in the work, and also of the quantities of those specific materials and supplies listed on Form FHWA-47, and in the units shown on Form FHWA-47. c. Furnish, upon the completion of the contract, to the SI-IA resident engineer on Form FHWA-47 together with the data required in paragraph lb relative to materials and supplies, a final labor summary of all contract work indicating the total hours worked and the total amount earned. 2. At the prime contractor's option, either a single report covering all contract work or separate reports for the contractor and for each subcontract shall be submitted. VH. SUBLETTING OR ASSIGNING THE CONTRACT I. The contractor shall perform with its own organization contract work amounting to not less than 30 percent (or a greater percentage if specified elsewhere in the contract) of the total original contract price, excluding any specialty items designated by the State. Specialty items may be performed by subcontract and the amount of any such specialty items performed may be deducted from the total original contract price before computing the amount of work required to be performed by the contractor's own organization (23 CFR 635). FR-9 a. "Its own organization" shall be construed to include only workers employed and paid directly by the prime contractor and equipment owned or rented by the prime contractor, with or without operators. Such term does not include employees or equipment of a subcontractor, assignee, or agent of the prime contractor. b. "Specialty Items" shall be construed to be limited to work that requires highly specialized knowledge, abilities, or equipment not ordinarily available in the type of contracting organizations qualified and expected to bid on the contract as a whole and in general are to be limited to minor components of the overall contract. Form 1273 — Revised 3-95 08-07-95 Page 12-17 OB 12-04 June 29, 2012 EXHI.BIT 12-E Attachment B 2. The contract amount upon which the requirements set forth in paragraph I of Section VII 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 SHA contracting officer determines is necessary to assure the performance of the contract. 4. No portion of the contract shall be sublet- assigned or otherwise disposed of except with the written consent of the SHA contracting officer, or authorized representative, and such consent when given shall not be construed to relieve the contractor of any responsibility for the fulfillment of the contract. Written consent will be given only after the SHA has assured that each subcontract is evidenced in writing and that it contains all pertinent provisions and requirements of the prime contract. VIII. SAFETY: ACCIDENT PREVENTION 1. In the performance of this contract the contractor shall comply with all applicable Federal, State, and local laws goveming safety, health, and sanitation (23 CFR 635). The contractor shall provide all safeguards, safety devices and protective equipment and take any other needed actions as it determines, or as the SHA contracting officer may determine, to be reasonably necessary to protect the life and health of employees on the job and the safety of the public and to protect property in connection with the performance of the work covered by the contract. 2. It is a condition of this contract, and shall be made a con- dition of each subcontract, which the contractor enters into pur- suant to this contract that the contractor and any subcontractor shall not permit any employee, in performance of the contract, to work in surroundings or under conditions which are unsanitary, hazardous or dangerous to his/her health or safety, as determined under construction safety and health standards (29 CFR 1926) promulgated by the Secretary of Labor, in accordance with Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 333). 3. Pursuant to 29 CFR 1926.3, it is a condition of this contract that the Secretary of Labor or authorized representative thereof, shall have right of entry to any site of contract performance to inspect or investigate the matter of compliance with the construction safety and health standards and to carry out the duties of the Secretary under Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 333). M. FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS In order to assure high quality and durable construction in conformity with approved plans and specifications and a high degree 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 mis- representation with respect to any facts related to the project is a violation of Federal law. To prevent any misunderstanding re - Form 1273 — Revised 3-95 08-07-95 Local Assistance Procedures Manual PS&E Checklist Instructions garding the seriousness of these and similar acts, the following notice shall be posted on each Federal -aid highway project (23 CFR 635) in one or more places where it is readily available to all persons concerned with the project: NOTICE TO ALL PERSONNEL ENGAGED ON FEDERAIs-AID HIGHWAY PROJECTS 18 U.S.C. 1020 reads as follows: "g'hoever being an officer, agent, or employee of the United States, or any State or Territory, or whoever, whether a person, association, firm, or corporation, knowingly maker 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 ary highway or related project submitted for approval to the Secretary of Transportation; or Whoever knowingly makes any false statement, false repre- sentation, false report or false claim with respect to the character, quality, quantity, or cost of any work performed or to be per- formed. or materials furnished or to be furnished, in connection with the construction of any highway or related project approved by the Secretary of Transportation: rn- Whoever knowingly makes anv false statement or false repre- sentation as to material fact in any statement, certificate, or report submitted pursuant to provisions of the Federal -aid Roads Act approved July 1, 1916, (39 Sint. 355), as amended and sup- plemented; Shall be fined not more that $10,000 or imprisoned not more than 5 years or both. " X. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROI. ACT (Applicable to all Federal -aid construction contracts and to all related subcontracts of $100,000 or more.) By submission of this bid or the execution of this contract, or subcontract as appropriate, the bidder, Federal -aid construction contractor, or subcontractor, as appropriate, will be deemed to have stipulated as follows: 1. That any facility that is or will be utilized in the performance of this contract, unless such contract is exempt under the Clean Air Act as amended (42 U.S.C. 1857 et seq., as amended by Pub. L. 91-604), and under the Federal Water Pollution Control Act as amended (33 U.S.C. 1251 et seq., as amended by Pub. L. 92-500), Executive Order 11738, and regulations in implementation thereof (40 CFR 15) is not listed, on the date of contract award, on the U-S. Environmental Protection Agency (EPA) List of Violating Facilities pursuant to 40 CFR 15.20. 2. That the firm agrees to comply and remain in compliance with all the requirements of Section 114 of the Clean Air Act and Section 308 of the Federal Water Pollution Control Act and all regulations and guidelines listed thereunder. 3. That the firm shall promptly notify the SHA of the receipt of any communication from the Director, Office of Federal Activities, EPA, indicating that a facility that is or will be utilized FR-10 Page 12-18 .June 29, 2012 013 12-04 Local Assistance Procedures Manual PS&E Checklist Instructions for the contract is under consideration to be listed on the EPA List of Violating Facilities. 4. That the firm agrees to include or cause to be included the requirements of paragraph 1 through 4 of this Section X in every nonexempt subcontract, and further agrees to take such action as the government may direct as a means of enforcing such re- quirements. XI. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION 1. Instructions for Certification - Primary Covered Transactions_ (Applicable to all Federal -aid contracts - 49 CFR 29) a. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. b. The inability of a person to provide the certification set out below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to fitmish 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 department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause of default. d. The prospective primary participant shall provide im- mediate written notice to the department or agency to whom this proposal is submitted if any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. e. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause; have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is submitted for assistance in obtaining a copy of those regulations. E The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower 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. FR-I 1 EXHIBIT 12-E Attachment B g. The prospective primary 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 Transaction," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. h. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower 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 may decide the method and frequency by which it determines the el- igibility of its principals. Each participant may, but is not required to; check the nonproeurement portion of the "Lists of Parties Excluded From Federal Procurement or Nonprocurement Programs" (Nonprocurement List) which is compiled by the General Services Administration. i. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. j. Except for transactions authorized under paragraph f of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the de- partment or agency may terminate this transaction for cause or default. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion —Primary Covered Transactions 1. The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; b. Have not within a 3-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records. making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph 1 b of this certification; and Form 1273 — Revised 3-95 08-07-95 Page 12-19 013 12-04 June 29, 2012 EXHIBIT 12-E Attachment B d. Have not within a 3-year period preceding this ap- plication/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. 2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. 2. Instructions for Certification - Lower Tier Covered Transactions: (Applicable to all subcontracts, purchase orders and other lower tier transactions of $25,000 or more - 49 CFR 29) a By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. e. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended," "ineligible," "primary covered transaction," "participant," "person." "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. c. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. f. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. g. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the el- igibility of its principals. Each participant may, but is not Form 1273 — Revised 3-95 08-07-95 Local Assistance Procedures Manual PS&E Checklist Instructions required to, check the Nonprocurement List. h. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in 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 e of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the de- partment or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. XII. CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING (Applicable to all Federal -aid construction contracts and to all related subcontracts which exceed $100,000 - 49 CPR 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, FR42 Page 12-20 June 29, 2012 OB 12-04 Local Assistance Procedures Manual PS&E Checklist Instructions 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 en- tered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall EXHIBIT 12-E Attachment B 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 his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such recipients shall certify and disclose accordingly. Minority Utilization Goals Economic Area Goal (Percent) 174 Redding CA: Non-SMSA Counties: 6.8 CA Lassen; CA Modoc; CA Plumas; CA Shasta; CA Siskiyou; CA Tehama 175 Eureka, CA Non-SMSA Counties: 6.6 CA Del Norte; CA Humboldt; CA Trinity 176 San Francisco -Oakland -San Jose, CA: SMSA Counties: 7120 Salinas -Seaside -Monterey, CA 28.9 CA Monterey 7360 San Francisco -Oakland 25.6 CA Alameda; CA Contra Costa; CA Marin; CA San Francisco; CA San Mateo 7400 San Jose, CA CA Santa Clara, CA 19.6 7485 Santa Cruz, CA CA Santa Cruz 14.9 7500 Santa Rosa CA Sonoma 9.1 8720 Vallejo -Fairfield -Napa, CA CA Napa; CA Solano 17.1 Non-SMSA Counties: CA Lake; CA Mendocino; CA San Benito 23.2 177 Sacramento, CA: SMSA Counties: 6920 Sacramento, CA 16.1 CA Placer; CA Sacramento; CA Yolo Non-SMSA Counties 14.3 CA Butte; CA Colusa; CA El Dorado; CA Glenn; CA Nevada; CA Sierra; CA Sutter; CA Yuba 178 Stockton -Modesto, CA: SMSA Counties: 5170 Modesto, CA 12.3 CA Stanislaus 8120 Stockton, CA 24.3 CA San Joaquin Non-SMSA Counties 19.8 CA Alpine; CA Amador; CA Calaveras; CA Mariposa; CA Merced; CA Toulumne FR-13 Page 12-21 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions 179 Fresno -Bakersfield, CA SMSA Counties: 0680 Bakersfield, CA CA Kern 2840 Fresno, CA CA Fresno Non-SMSA Counties: CA Kings; CA Madera; CA Tulare 19.1 26.1 23.6 180 Los Angeles, CA: SMSA Counties: 0360 Anaheim -Santa Ana -Garden Grove, CA 11.9 CA Orange 4480 Los Angeles -Long Beach, CA 28.3 CA Los Angeles 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 181 San Diego, CA: SMSA Counties 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. Training This section applies if a number of trainees or apprentices is specified in the special provisions. As part of your equal opportunity affirmative action program, provide on-the-job training to develop full journeymen in the types of trades or job classifications involved. You have primary responsibility for meeting this training requirement. If you subcontract a contract park 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 l st year of apprenticeship or training. FR-14 Page 12-22 June 29, 2012 OB 12-04 Local Assistance Procedures Manual PS&E Checklist Instructions EXHIBIT 12-E Attachment B 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 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 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 joumeymcn. 2. Who is not registered in a program approved by the US Department of Labor, Bureau of Apprenticeship and Training. Ask the employee if 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: 1.1. Meet your equal employment opportunity responsibilities. 1.2. 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. FR-15 Page 12-23 OB 12-04 June 29, 2012 EXHIBIT 12-E Attachment B Local Assistance Procedures Manual PS&E Checklist Instructions 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 training 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. 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: 2.1. Contribute to the cost of the training. 2.2. Provide the instruction to the apprentice or trainee. 2.3. Pay the apprentice's or trainee's wages during the off -site training period. 3. if you comply with this section. 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. Maintain records and submit reports documenting your performance under this section. FR-16 Page 12-24 June 29, 2012 OB 12-04 -j AC( � D T11MM/DD/YYYY) �i CERTIFICATE OF LIABILITY INSURANCE iv5/2017 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELY 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. HIM certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED Provisions or be endorsed. If SUBROGATION IS WAIVED, subject to Me term, and condition, of the polhy, certain Policies may require an endorwnMt.AAMemmt on this certificate does net center rights to the certificate holder infieuof such <ndorsemends). PRODUCER CONTACT NAME: Aymme Melia FARMERSINSURANCE PHONE FAX LORENA GUTIERREZ (A/C, NO. EXT): (562) 445-4690 (A/C No): (562) 446-4096 8141 2nd ST STE 215 E4ML DOWNEY, CA 90241 ADDRESS: IgUtierrezl@famKTrsagent.com INSURER(S)AFTORDINGCOVERAGE Nw* INSURED Alfaro Communications Construction Inc. 15614 S. Atlantic Ave Compton. CA 90221 INSURERA: INSURERS: INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TOCERTIFY THATTHE POLICIES OFINSUPA14CE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEASOVE FOR THE POLICY PERIOD INDICATED. NOT WITHSTANOINGANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOAULTHE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IIMR TYPEOFINSURANCE A„fp fWVU POLICY NUMBER POLICY EFF (MM/DD/YYYY) PoUICYE%P (MM/DD/YYYY) LIMBS COMMERCIAL GENERAL LIAMUTY EACHOCCURRENCE 3 CLAIMS -MADE ❑ OCCUR DAMAGETORENTED PREMISES (Ea Occurrence) $ MEDEXP(Myonepersur) S PERSONAL&ADVINJURY f GEN'L AGGREGATE UMITAPPLIES PER: GENERAL AGGREGATE f POLICY O PROJECT ❑ LOC PRODUCTS-COMP/OPAGG f OTHER: $ AUTOMOBILE IIAMIRY COMBINED SINGLE LIMB (EaaccidenU f 1000 BODILYINJURY(Perperson) S ANYAUTO A �YEDAUTOS SCHEDULED AUTOS Y Y 506684088 08/252017 08/25,2018 BODILY INJURY (Pen accident)$ PROPERTY DAMAGE (Per accident) f HIREDAUTOS NON -OWNED ONLY AUTOS ONLY f UMBRELLALIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESSUAS CLAWIS-MADE DED RETENTIONS f WORKERSCOMPENSATION ANDEMPLOYERS'LWBIUTY ANY PROPRIETOR/PARTNER/ YIN EXECUTIVE'(cO E OFFICER/MEMBER EXCLUDED?(Mandisoryin NH) N/A 6Y V LE'GF p,�PYOtA14 e GN PER STATUTE OTHER S E.L. FACHACGDENT S EL DISEASE -EA EMPLOYEE E.L DISEASE -POLICY UMII 3 lives. describe under -DESCRIPTION OF OPERAHONSbelow OF T.j(lN� DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101. Additional Berri Schedule, maybeactached if mare space is required) *30 day notice of cancellation, 10 day notice of cancellation in the event of nonpayment of premium RE: Traffic Signal Modifications, Project if CC1465 The City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers are named as Additional Insured regarding the General Liability policy per (am CG 20 10 04 13 and CG 20 37 04 13. Primary and Non -Contributory wording applies in regards to the General Liability per form CG 20 0104 13. CERTIFICATEHOLDER CANCELLATION ty0 unbngto^ SHOULOANY OF THE AB E SCRIBE ICIES BE CELLED BEFORE THE EXPIRATION 2000 Main St DATE THEREOF. NOTICE L EDE A DANCE WITH THE POLICY PROWSIONS. Huntington Beach, CA 92648 1 AUTHORIZED REPRESE I I v J ACORD 25(2016/03) 31-1769 11.15 The ACORD name and logo are registered CORPORATION. All Rights Reserved M POLICY NUMBER: 606684033 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. DESIGNATED INSURE® This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM +MOTOR CARRIER COVERAGE FORNI TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Countersigned BW(, 12/05/2017 Named Insured:ALFARO COMMUNICATIONS d Representative) SCHEDULE Name of Person(s) or Organization(s): City of Huntington Beach (If.no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section If of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page i of 1 ❑ A c> �® CERTIFICATE OF LIABILITY INSURANCE DATE DDIYY lVV/R 12/2 12�21/2017 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: Nick Roumi Radius Insurance Services 135 S State College Blvd., #200 C No:(888) 908-0704 WC. No Ext: (800) 400-7283 (AC, E-MAIL nick@radiusins.com ADDRESS: Brea CA 92821 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Arch Insurance Company 11150 INSURED (310) 669-8949 INSURERS: Evanston Insurance Company 35378 Alfaro Communications Construction Inc. INSURER C : INSURERD: 620 S. Bradfield Ave. INSURER E: Compton CA 90221 INSURER F : COVERAGES CFRTIFICATF NUMRFR' Cert ID 2505 REVISION NLIAARER- 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 WIT`I RESPECT T^ ;^1HICH THIS CERTIFICATE MAY "E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU3JECT TO .111L THE TERMS, EXCLUSIGNS AND C DNDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF;NSURANCE ADDL SUER POLICY NUM BER POLICY EFF MMIDDNYYY POLICY EXP 'Mh1IDDNYYY LIMITS B X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 1. 000, 000 CLAIMS -MADE X OCCUR Y Y 3C21407 10/09/2017 10/09/2018 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) _ $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER, GENER.�L AGGREGATE $ 2,000,000 GEN'L POLICY FX JET E LOC PRODUCTS - COUP/GP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per peron) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (P�r accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMA:,E Per accident $ B X UMBRELLA LIAB X OCCUR MKLV5EUL100667 10/09/2017 10/09/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA ZATICI2540400 11/26/2017 11/26/2018 PER OTH- X STATUTE ER E L EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 $ DESCRIPTION OF OPERAT: )NS I LOCATIONS I VEHICLES (ACORD 10', Additional Remarks Schedule, may be attached if more space is required) •30 day notice o:i cancellation, 10 day no,:.ce of cancellation in the event of nonpayment of pre7t!_um RE: Traffic Sign,-.1 Modifications, Project t'CC1455 The City of Huntington Beach, its of.ficere elected or appointed officials, employees, a5�ents a:,d volunteers are named as Additional Insured regarding the Ger_eral Lia`ili.ty policy per form C3 2: 10 04 13 ant- CG 20 37 04 13. Primary and Nor-Gontri:Dutoiy wording applies in regards to the Genera'. Liabilit,- per fc:-,n CG 20 01 0"_ 13. L,LK 111-ILd1: t-tiVL, tK UANL:tLLAI IUN City of .=tirg' .. Beach 2000 Main Strec': Huntington Beach CA 92648 SHOULD AN`.' OF -HE ABOVE L E1"RIBED POL!';ES BE CP.NCELLED BEFORE THE EXPIRATION DATE TKc:tEOF, HOT!C c WI-L BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVIS!GNS. AUTHORIZED tREPRESENTATIVE ©1988-2015 ACGR7 —30RPOF'jTION. All rights reserved. ACORD 25 (201610;: The ACOPND name and logo are registered marks of ACORD Page 1 of 1 POLICY NUMBER: 3C21407 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations City of Huntington Beach, its officer, elected or Traffic Signal Modifications, Project #CC1465 appointed officials, employees, agents and volunteers 2000 Main St Huntington Beach, CA 92648 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by: provide for such additional insured. 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) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page,1 of 2 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page :)f 2 © Insurance Services Office, Inc., 2012 CG 20 9G 04 i3 POLICY NUMBER: 3021407 COMMERCIAL GENERAL LIABILITY CG 20 3' 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations City of Huntington Beach, its officer, elected or appointed officials, employees, agents and volunteers 2000 Main St Huntington Beach, CA 92648 Traffic Signal Modifications, Project #CC1465 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" 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". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04.13 © Insurance Services Office, Inc., 2012 Page 1 of 2 3. With respect to the insurance afforded to these add;::;onal insureds, the following is added to Sec':'on III — Limits Cf Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page ' 3f 2 G ISO Prcperties, Inc., 2004 c 20 37 7 C4 ❑ COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 3C21407 RKEV EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT - PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL G-7NERAL LIABILITY COVERAGE FORM PRODUCTS/COM'LETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE ADDITIONAL INSURED City of Huntington 3each, its officer, elected or appointed officials, employees, agents and volunteers 2000 Main St Huntinaton Beach, CA 92648 n: Traffic Signal Modifications, Project #CC1465 Owner of Traffic Signal Modifications, Project #_-C1465 Please refer to each coverage form to determine which terms are defined. Words shown in quotations on this endorsement may -r may not be defined in all coverage forms. SECTION II - WHO IS AN INSURED is amended to include as an Additional Insured the person(s) or entity(s) show,i in the Schedule above, but only as respects negligent acts or omissions of the Named Insured and only for "o currences", "claims" c coverage not otherwise excluded by this insurance. Where no coverac � applies to the Named Insured, no coverage or defense applies to the Additional Insured Eiiown in "he Schedule above. No coverage applies to the Additional insured scheduled above for any "bodily injury", "personal and advertising injury", or "property damage" to any "employee" of the Named Insured or to any obligation of the Additional Insured to indemnify an- other because of camages arising out of such injury. t. Subject to the ab4,,e, when coverage, applies to the Additional Insured(s) listed above, it shall be primary insurance as respects any "claim", loss, or liability arising out of the Named Insured's operations as covered by this insurance. If cov- erage applies under this policy, any other insurance maintained by the Additional Insured(s) as a Named Insured shalt be excess and non-contributory to the coverage provided by this insurance. Io �J All ether terms and c:,iditions remain unchanged. MEGL 0010 03 11 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission. CONTRACTOR'S SWORN STATEMENT AND WARRANTY REGARDING CONTINUING INSURANCE OBLIGATIONS FROM: Alfaro Communications Construction,Inc PROJECT. 1'raffhc Signal Modifications (Contractor Name) Project # CC 1465 620 S. Bradfield Avenue (Street Address) Compton, CA 90221 (C tyr State and Zip) TO CITY OF HUNTINGTON BEACH DECLARATION Attached hereto Is a bve and correct copy of the omen Certificate of Insurance and Additonal Iravred Endorsement Cis 2010 1185, which Cerdlldte comptles with the kmtrance requirements of the Contact by and between the City of Huntington Beach ("Qtyl and the above -named Contractor ('Contractor) for the above -described project ('Pro)ecn. I declare under penalty of pepuy mow the laws of the State of California that the above "Went is true and correct S fined an 12/7/2017 2o_ at Brea, CA (Dal) (City, Sbte) signed by insurance agent for Contractor = h Lam— �)� (Simon a of kdA" Who Is Mating Declaration) WARRANTY (bntrector heeby warrants and agrees to tnaatain Products and Completed Operation lnsurence in comptence with the Insurance requkements of the Contract for the Project Said insurance shall be maintained through and trM the aykatlon of all Irwrar Iles provided by Contractor. Said r suana "A contain Additional IrstRed Endorsement CG 2010 1185, naming ON as an additional Insared. Conbactor shall srppy to City, on at least an annual basis, a Certificate of 1mrance and the aforanwlhBoned 6htlorseme t evidencing continued coverage which meets the Contract requirements. Signed on 20_, at (Date) CONTRACTOR: Name: . kii,r� o (:ommunications Constmaion.Inc Ely Name: Ma MaNnez rna t �h2 �pM11;o. �JCfrOUh'11 CF�\t^ City of Huntington Beach Business License 714 536-5267 FAX 714 536-5934 Lori Ann Farrell Harrison Chief Financial Officer ALFARO COMMUNICATIONS CONSTRUCTION INC 620 SOUTH BRADFIELD AVENUE COMPTON CA 90221 Dear Business Owner: P.O. Box 190 Huntington Beach, CA 92648 Thank you for your payment. Attached is your City of Huntington Beach Business License. Please note that approximately one month prior to the license expiration date, you will be mailed a renewal notice for the coming year. If for any reason your renewal notice does not arrive, you are still responsible to renew and pay your business license amount prior to the expiration date. You will incur penalties if this payment is not received by the expiration date. Please post the business license in public view. If you do not transact business from a fixed location within the city, you must carry this license with you at all times. Your business vehicle should also carry this license, and the license plate number of the vehicle(s), if applicable, should match the one on the business license. Please notify Business License if there are any changes of ownership, address, business name, business vehicle, or type of business conducted. Additionally, please notify the city if you discontinue your business. If your business is operated in a commercial, retail, or industrial location, you will need to contact the Planning and Building Department regarding the requirement for a Certificate of Occupancy. For additional questions or information on this matter call 714-536-5271. The Planning and Building Department is located on the 3rd floor of City Hall. There are many resources available to our licensed business people. We have listed a few that might be of interest and assistance to you. City of Huntington Beach Economic Development Department - 714-536-5582 Huntington Beach Chamber of Commerce - 714-536-8888 Huntington Beach SCORE (Service Corps of Retired Executives) - 714-550-7369 Fictitious Business Name Information - 714-834-2889 State Board of Equalization (seller's permit information) - 949-440-3473 If you have any questions, please call a Business License representative at 714-536-5267. City Of Huntington Beach Business License Business Name / Service Address ALFARO COMMUNICATIONS CONSTRUCTION INC License Type Contractor Owner I Corporation ALFARO COMMUNICATIONS CONSTRUCTION THIS LICENSE IS ONLY FOR THE BUSINESS AND TYPE SHOWN. IT IS FOR THE PERSON TO WHOM ISSUEDAND IS NON -TRANSFERABLE. RENEWAL IS DUE ON OR BEFORE THE EXPIRATION DATE. POST IN PUBLIC VIEW License Number A298971 Effective Date 04/01/2017 Expiration Date 03/31/2018 Amount Paid $190.75 SIC 1522 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 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. f CC No. / LAO,15 MSC No. Other No. g:/forms/bond transmittal to treasurer (Company Name) CACX l57 ,06 0v i2 011z - V IS-76)6 tJ 0 l Approved / // & f 7 (Council Approval Date) Agenda Item No. City Clerk Vault No. r-D SIRE System ID No. 065,73 U � r✓J ��L BOND NO. EACX157000018 PREMIUM $4,694.00 IS SUBJECT TO CHANGE BASED ON THE FINAL CONTRACT AMOUNT. BOND EXECUTED IN DUPLICATE PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS: WHEREAS, City of Huntington Beach (hereafter referred to as "City") has, by written agreement dated November 20 20 17, entered into a contract with Alfaro Communications Construction, Inc. 620 S Bradfield Ave, Compton, CA 90221 (name and address of Contractor) (hereinafter referred to as "Principal"), for performance of the work described as follows: Traffic Signal Modifications at the Intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and MacFadden Avenue; Project No. CC1465 (Project Title) WHEREAS, said contract, and all documents referenced therein (hereinafter collectively "Contract"), are incorporated herein by this reference made a part hereof as though set forth herein in full; and Said Principal is required under the terms of the Contract to furnish a bond guaranteeing the prompt, full and faithful performance of said Contract, by a duly admitted surety insurer under the laws of the State of California (hereinafter referred to as "Surety"); and Surety is certified and listed in the U.S. Department of the Treasury Circular 570, and has provided proof of sufficient bonding limitations as shown in said circular to provide bonds in the amount required by said Contract; and Surety has provided financial strength ratings from reputable companies, such as from A.M. Best, Moody's, or Standard & Poor's, to validate that Surety has positive ratings of being secure or Stable; and Surety is registered and listed with the California Department of Insurance, NOW, THEREFORE, we, the undersigned, as Principal, and Endurance Assurance Corporation 4 Manhattanville Road, Purchase, NY 10577 (name and address of Surety) as Surety, are held and firmly bound unto City in the penal sum of three hundred and twenty-six thousand and 00/100 Dollars ($ 326,000.00 ), 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") fromany 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 or contract price, and any other alteration, change, deletion, addition or other modification to the Contract, or the work to be performed thereunder, and agrees 15-4584/117174 Bond No. EACX157000018 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: December 6, 2017 ATTEST Alfaro Communications Construction, Inc. (Corporate Seal) (Principal Name By: Na V%,0- L— Title: V1 CX- ' rP-j t ATTEST Endurance Assurance Corporation (Corporate Seal) (Attach Attorney -in -Fact Certificate) Name) By: Name: Yung T u Atto Fact (Sign r f Attorney-in-F t for Surety) (Area CAd� &Telephone Number for Surety) APPROVED AS TO F l ? By: Michael E. Gates, City Attomey s 1 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. PERFORMANCE BOND Page 2 of 15-4584/117174 CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ) County of On �2� I �� before -ir-A��. F (here Insert name and title of the officer) personally appeared E�Q � l��t 1'' l re-2 who proved to me on the basis of satisfactory evidence to be the personfS') whose nameX is/atesubscribed to the within instrument and acknowledged to me that -He/shetthey executed the same in-his/her/t-be+f- authorized capacity(ies), and that by-#a+s/her/thu r signatureJs) on the instrument the personO, or the entity upon behalf of which the persorjk-) 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. QMX ndiEsmeraldaSantamariaCastilloComm. #2200339 z 0:Notary Public - CaliforniaLos Angeles County Signature (� �� Comm. Expires June 5, 2021 ea Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document titled/for the purpose of containing pages, and dated The signer(s) capacity or authority is/are as: ❑ Individual(s) ❑ Attorney -in -Fact Corporate Officer(s) Title(s) ❑ Guardian/Conservator ❑ Partner - Limited/General ❑ Trustee(s) ❑ Other: representing: Name(s) of Person(s) or Entity(les) Signer is Representing 2wjM Method of Signer Identification Proved to me on the basis of satisfactory evidence: 0 form(s) of identification 0 credible witness(es) Notarial event is detailed in notary journal on: Page # Entry # Notary contact: Other ❑ AdditionalSigner(s) ❑ Slgner(s)Thu mbprint(s) O Copyright 2007-2016 Notary Rotary, Inc PO Box 41400, Des Moines, IA 50311-0507. All Rights Reserved. Item Number 101772. Please contact your Authorized Reseller to purchase copies of this form CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County of Orange On December 6, 2017 Date before me, Jessica Dayog , Notary Public, Insert Name of Notary exactly as it appears on the official seal personally appeared Yung T. Mullick JESSICA DAYOG Notary Public - California r Orange County >_ Commission # 2204914 My Comm. Expires Jul 14, 2021 Place Notary Seal Above Name(s) of 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 off i I seal. Signature Signature of No ary lic Jess ca D yog 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 the 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 ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: Top of thumb here Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer—Title(s): _ El Partner ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: ENDURANCE ASSURANCE CORPORATION 157 POWER OF ATTORNEY Xnow affWen 6y these Tment, that ENDURANCE ASSURANCE CORPORATION, a Delaware corporation (the'Corporationl, with offices at 4 Manhattanville Road, 3rd Floor, Purchase, NY 10577, has made, constituted and appointed and by these presents, does make, constitute and appoint YUNG T. MULLICK, JAMES W. MOILANEN its true and lawful Attomey(s)-in-fact,atMISSION, VIEJO in the State of CA and each of them to have full power to act without the other or others, to make, execute and deliver on its behalf, as surety or co -surety; bond§ d,1undertatfakings V%P for any and all purposes, also to execute and deliver on its behalf as aforesaid renewals, extensions, agreements, waivers, consents or stipulations relating tosu h�Lnncfs'- u T`r�3k" pmvaded, however, that no single bond or undertaking so made, executed and delivered shall obligate the Corporation for any portion of the penal sum thereofln eXkss,ofil q%1 �T•EN M ION Dollars ($10,000,000). =., Such b,Q`rids-and undertakings for s610 purposes duly executed by said attomey(s)-in-fact, shall be binding upon the Corporation as fully and to the same extent as if signed by the Presidgffi of the Cor)pration under its�seal attested by its Corporate Secretary. This appointmentis ma "Y�ndL I by authp ty of certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on the 9ih of January, 2014, a copy of e ¢ which appears beh)Z inns heading en6j§d'Certficate". dx This Power of Aftorney is signed and sealed by facsimile under and by authority of the following resolution adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2014 cifsaid resdi,'%+has not since been revoked, amended or repealed: RESOLVED, that in granting poinersof attomey pursuant to certain resolutions adopted by the Board of Directors of the Corporation by unanunous written consent on January 9, 2014, the signature of such directors and officers and the seal of the Corporation may be affixed to any such power of attorney or any certificate relating thereto by facsimile , and any such power of attorney or certificate bearing such facsimile signature or seal shall be valid and binding upon the Corporation in the future with respect to any bond or undertaking to which it is attached. IN WITNESS WHEREOF, the Corporation has caused these presents to be duly signed and its corporate seal to be hereunto affixed and attested this 23rd day of June, 2017 at Purchase, New York. (Corporate Seal) �—j(�� J ENDURANCE ASSURANCE CORPORATION ATTEST ,_lea By MARIANNE L. WILBERT, SENIOR VICE PRESIDENT SHARON L. SIMS, SENIOR VICE PRESIDENT STATE OF NEW YORK ss: PURCHASE COUNTY OF WESTCHESTER On the 23rd day of June, 2017 before me personally came SHARON L. SIMS, SENIOR VICE PRESIDENT to me known, who being by me duly swum, did depose and say that (s)he resides in SCOTCH PLAINS"NEW JERSEY that (s)he is a SENIOR VICE PRESIDENT of ENDURANCE ASSURANCE CORPORATION, the Corporation described in and which executed the above instrument;that (s)hokil& tFe seal of -said Corporation; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said Corporation, a`nd tha�s)h2s lg eb�his (he'r),name thereto by like order. (Notarial Sea, ;dad. NICHOLAS JAMES BENENATI, Notary Public - My Commission Expires " s� ` � � - - �• 12107/2019 CERTIFICATE STATE OFNEW YORE( ss: PURCHASE COUNTY OF WESTCHESTER ' 1, CHRISTOPHER DONELAN the PRESIDENT of ENDURANCE ASSURANCE CORPORATION a Delaware Corporation (the'Corporabon' , hereby certify: 1. That the original power of attorney of which the foregoing is a copy was duty executed on behalf of the Corporation and has not since been revoked, amended or modified; that the undersigned has compared the foregoing copy thereof with the original power of attorney, and that the same is a true and correct copy of the original power of attorney and of the whole thereof; 2. The following are resolutions which were adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2014 and said resolutions have not since been revoked, amended or modified: "RESOLVED, that each of the individuals named below is authorized to make, execute, seal and deliver for and on behalf of the Corporation any and all bonds, undertakings or obligations in surety or co -surety with others: CHRISTOPHER DONELAN, SHARON L. SIMS, MARIANNE L. WILBERT And be it furthe RESOLVEditateati�aoi lfteIrnlroldual named above is authorized to appoint attorneys -in -fact for the purpose of making, executing, sealing and delivering bonds, undertakings or obligations in suretv`orcv-sureiv fbr and or"befiefPof It e£oroorafion." r 3. Tqe undersigned er certifies QIthe move resolutions are true and correct copies of the resolutions as so recorded and of the whole thereof. IN WITNESS WHE fahen:unto semy1hand and affixed the corporate seal this 6th day of , 20 17 . .,r• (Corporate Sea CHRISTOPHER DONELAN, PRESIDENT Any reproductions am void. Primary Surety Claims Submission. mretybwdclaims@@sompc inll.can Surety Claims Hotline: 877-676-7575 Mailing Address: Surety Claims Department, 750 Third Avenue-101h Floor, New York, NY 10017 BOND NO. EACX157000018 PREMIUM LISTED ON PERFORMANCE BOND. BOND EXECUTED IN DUPLICATE PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS: WHEREAS, City of Huntington Beach (hereafter referred to as "City") has awarded to Alfaro Communications Construction, Inc. 620 S Bradfield Ave, Compton, CA 90221 (name and address of Contractor) (hereinafter referred to as "Principal'), a contract ("Contract') for the work described as follows: Traffic Signal Modifications at the Intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and MacFadden Avenue; Project No. CC1465 (Project Title) WHEREAS, Principal is required under the terms of the Contract and the California Civil Code to furnish a bond to secure the payment of claims of laborers, mechanics, materialmen, and other persons as provided by law, by a duly admitted surety insurer under the laws of the State of California (hereinafter referred to as "Surety"); and Surety is certified and listed in the U.S. Department of the Treasury Circular 570, and has provided proof of sufficient bonding limitation, as shown in said circular 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 or 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. NOW THEREFORE, we, the undersigned Principal, and Endurance Assurance Corporation 4 Manhattanville Road, Purchase, NY 10577 (name and address of Surety) as Surety, are held and firmly bound unto City in the penal sum of three hundred and twenty-six thousand and 001100 dollars ($ 326,000.00 ), 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. Page 1 of 2 1545841117357 PAYMENT BOND 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, 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 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: December 6, 2017 ATTEST Alfaro Communications Construction, Inc. (Corporate Seal) (Principal Name) By:. Name. \ / — Title: V ?(2 s l &Aev-{\ ATTEST Endurance Assurance Corporation (Corporate Seal) rety Name) By: Name: Tung 7. Mullick, orney-in- ct (Srof Attorney -in -Fact for urety) (Attach Attorney -in -Fact Certificate) 415 500- (Area de & Telephone Number for Surety) APPROVED AS By: E. Gates, -City Attorney 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. Page 2 of 2 15A5541117357 PAYMENT BOND CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of \—C �2 On :I I �--O � � before me,�� n � � , �J�►�i OlYl� I� f� �I ��r here insert name and title of the officer) personally appeared�t,� who proved to me on the basis of satisfactory evidence to be the personA whose name( is/&Fc-subscribed to the within instrument and acknowledged to me that-ire/she/tiny executed the same in H'J/her/tl°& authorized capacity(ies), and that bytriVher/t-he F signature,(S) on the instrument the personA, or the entity upon behalf of which the personKacted, 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. Cindi Esmeralda Sarrtamaria Castillo Q4. Comm. #2200339 ZNotary Public • California � Signature r�-. Los Angeles County ° M Co ires June 5, 2021 Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document titled/for the purpose of containing pages, and dated The signer(s) capacity or authority is/are as: dorporateOfficer(s) dividual(s) ttorney-in-Fact 1' �` :Pc c> t--' 1 Title(s) ❑ Guardian/Conservator ❑ Partner - Limited/General ❑ Trustee(s) ❑ Other: representing: Name(s) of Person(s) or Entity(ies) Signer is Representing Method of Signer Identification Proved to me on the basis of satisfactory evidence: O form(s) of identification O credible witness(es) Notarial event is detailed in notary journal on: Page # Entry # Notary contact: LA Other ❑ AdditionalSigner(s) ❑ signer(s)Thumbprint(s) m Copyright 2007-2016 Notary Rotary, Inc PO Box 41400, Des Moines, IA 50311 -0507. All Rights Reserved. Item Number 101772 Please contact your Authorized Reseller to purchase copies of this form CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County of Orange On December 6, 2017 before me, Jessica Dayog , Notary Public, Date Insert Name of Notary exactly as it appears on the official seal personally appeared Yung T. Mullick Name(s) of 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) JESSICADAYOG EZ 7otaryPubliC-Calif0r1­ acted, executed the instrument. • ;t '? orange County I certify under PENALTY OF PERJURY under the laws of 14 Commission Expires ,2 My Comm. Expires Jul 14, 2021 the State of California that the foregoing paragraph is true g g p g p and correct. Witness my hand and off n Signature Place Notary Seal Above Signature of Notary ub' a Mica Da og 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 the 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 ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer—Title(s): — ❑ Partner ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: ENDURANCE ASSURANCE CORPORATION 157 POWER OF ATTORNEY 4 lww aff9Kee by these Present, that ENDURANCE ASSURANCE CORPORATION, a Delaware corporation (the "Corporafion7, with offices at 4 Manhattanville Road, 3rd Floor, Purchase, NY 10577, has made, constituted and appointed and by these presents, does make, constitute and appoint YUNG T. MULLICK, JAMES W. MOILANEN its true and lawful Attomey(s}in-fact,at;MISSIO(J VIEJO in the State of CA and each of them to have full power to act without the other or others, to make, execute and deliver on its behalf, as surety or co -surety; bonds"apod t tLeaking�peo for any and all purposes, also to execute and deliver on its behalf as aforesaid renewals, extensions, agreements, waivers, consents or stipulations relating tosLff Etlbnds or under§ings:provided, however, that no single bond or undertaking so made, executed and delivered shall obligate the Corporation for any portion of the penal sum the reo(3rg,@ uA 'ithgst rigf EN`ML"i1pNDouars($10,000,000). Such bonds and undertakings for as �1 s'_when duly executed by said attomey(s)-in-fact, shall be binding upon the Corporation as fully and to the same extent as if signed by the Presio of the Cc ion under is orpo seal attested by its Corporate Secretary. This appontme t is man dand by authogty'of certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on the 9th of January, 2014, a copy of which appearsbelow d r "iP heading entitled'Certificate. This Power of�'ney is signed and sealed by facsimile under and by authority of the following resolution adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2014'.;d%aid resot�b_a+'has not since been revoked, amended or repealed R n, n, RESOLVED, that in grantmgpbi, rs of attorney pursuant to certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2014, the signature of such directors and officers and the seal of the Corporation may be affixed to any such poser of attorney or any certificate relating thereto by facsimile , and any such power of attorney or certificate bearing such facsimile signature or seal shall be valid and binding upon the Corporation in the future with respect to any bond or undertaking to which it is attached. IN WITNESS WHEREOF, the Corporation has caused these presents to be duly signed and its corporate seal to be hereunto affixed and attested this 23rd day of June, 2017 at Purchase, New York. (Corporate Seal)1 J( ENDURANCE ASSURANCE CORPORATION a[� ATTEST��/Quo�a,I.St��„�1 By MARIANNE L WILBERT, SENIOR VICE PRESIDENT SHARON L. SIMS, SENIOR VICE PRESIDENT STATE OF NEW YORK ss: PURCHASE COUNTY OF WESTCHESTER On the 23rd day of June 2017 2017 before me personally came SHARON L SIMS, SENIOR VICE PRESIDENT to me known, who being by me duly swom, did depose and say that (s)he resides in SCOTCH PLAINS`NEW JERSEY that (s)he is a SENIOR VICE PRESIDENT of ENDURANCE ASSURANCE CORPORATION, the Corporation described in and which executed the above instrument;4hat (s)hek6xnv5.t& seal ofsaid Corporation; that the seal affixed to said instrument is such corporate seal; that t was so affixed by order of the Board of Directors of said Corporation and that (s h&signePt $'(hef),name thereto by like order. (Notarial a�, 'y 0 L 1 IN a k_ Y—K NICHOLAS JAMES BENENATI, Notary Public - My Commission Expires 42iGTia''C43 12/07/2019 CERTIFICATE STATE OF'NEWYOf3FC! ; *. `` ss: PURCHASE COUNTY OF WESTGHESTER I, CHRISTOPHER DONELAN the PRESIDENT of ENDURANCE ASSURANCE CORPORATION, a Delaware Corporation (the 'Corporation"), hereby certify: 1. That the original power of attorney of which the foregoing is a copy was duly executed on behalf of the Corporation and has not since been revoked, amended or modified; that the undersigned has compared the foregoing copy thereof with the original power of attorney, and that the same is a true and correct copy of the original power of attorney and of the whole thereof; 2. The following are resolutions which were adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2014 and said resolutions have not since been revoked, amended or modified: "RESOLVED, that each of the individuals named below is authorized to make, execute, seal and deliver for and on behalf of the Corporation any and all bonds, undertakings or obligations in surety or co -surety, with others: CHRISTOPHER DONELAN, SHARON L. SIMS, MARIANNE L. WILBERT And be h furtfie[ � n..,:. RESOL+iECINAP ' V @i4 iduals partied above is authorized to appoint attorneys -in -fact for the purpose of making, executing, sealing and delivering bonds, undertakings or obligatons in suretv�-or.'txi ssur6bbfb� and on beheffof theCAoration' 3. TI ersigned I certifies th4the � tove resolutions are true and correctcopies opies of the resolutions as so recorded and of the whole thereof. IN WITNESS WHE kAag hereunto s my'hand and affixed the corporate seal this 6th day of t> mb, 20 17 . (Corporate Seams CHRISTOPHER DONELAN, PRESIDENT Any reproductions are void Primary Surety Claims Submission: suretybondclaims@@sompo-in8.com Surety Claims Hotline: 877-676-7575 Mailing Address: Surety Claims Department, 750 Third Avenue —10th Floor, New York, NY 10017 12/1512017 Surety Bonds - Certified Companies Admitted Reinsurers Sureties Listing Department of the Treasury's Listing of Certified Companies • Certified Companies • Certified Reinsurer Companies • Footnotes • Notes • States Insurance Departments • Supplemental Chanaes to Circular 570 Download the complete listing of Certified Companies M (146 KB) EIEI�IQIEIFIaIli III!IKImI!IN121EIQIRIaI!IUIYIWIXIYI? A Updated July 1, 2017 ACCREDITED SURETY AND CASUALTY COMPANY, INC. (NAIC #26379) BUSINESS ADDRESS: PO Box 140855, Orlando, FL 32814. PHONE: (407) 629-2131, UNDERWRITING LIMITATION b/: $2,307,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Florida. ACE American Insurance Company (NAIC #22667) BUSINESS ADDRESS: 436 Walnut Street P.O. Box 1000, Philadelphia, PA 19106. PHONE: (215) 640-1000. UNDERWRITING LIMITATION b/: $281,237,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Pennsylvania. ACE Property and Casualty Insurance Company (NAIC #20699) BUSINESS ADDRESS: 436 WALNUT STREET, P.O. Box 1000, Philadelphia, PA 19106. PHONE: (215) 640- 1000. UNDERWRITING LIMITATION b/: $215,758,000. SURETY LICENSES 01: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Pennsylvania. Forms ACSTAR INSURANCE COMPANY (NAIC #22950) BUSINESS ADDRESS: 30 SOUTH ROAD, FARMINGTON, CT 06032. PHONE: (860) 415-8400. Regulations & Guidance UNDERWRITING LIMITATION b/: $2,712,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ................................. .............. ............ ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Illinois. Correspondence _. Aegis Security Insurance Company (NAIC #33898) Contacts BUSINESS ADDRESS: P.O. Box 3153, Harrisburg, PA 17105. PHONE: (717) 657-9671. UNDERWRITING LIMITATION b/: $5,554,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Pennsylvania. ALL AMERICA INSURANCE COMPANY (NAIC #20222) BUSINESS ADDRESS: P.O. BOX 351, VAN WERT, OH 45891 - 0351. PHONE: (419) 238-1010. UNDERWRITING LIMITATION b/: $15,262,000. SURETY LICENSES c,V: AZ, AR, CA, CO, CT, GA, ID, IL, IN, Tra sate https://www.fiscal.treasury.gov/fsreports/ref/suretyBnd/c570_a-z.htm#e 1/23 12/15/2017 Surety Bonds - Certified Companies Cooperativa de Seguros Multiples de Puerto Rico (NAIC #18163) BUSINESS ADDRESS: PO BOX 363846, SAN JUAN, PR 00936 - 3846. PHONE: (787) 622-3575 x-2512. UNDERWRITING LIMITATION bl: $14,833,000. SURETY LICENSES c,f/: PR. INCORPORATED IN: Puerto Rico. CorePointe Insurance Company (NAIC #10499) BUSINESS ADDRESS: 401 South Old Woodward Avenue, Suite 300, Birmingham, MI 48009. PHONE: (800) 782-9164. UNDERWRITING LIMITATION b/: $5,590,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Michigan. CUMIS INSURANCE SOCIETY, INC. (NAIC #10847) BUSINESS ADDRESS: P. 0. Box 1084, Madison, WI 53701. PHONE: (608) 238-5851. UNDERWRITING LIMITATION b/: $81,622,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Iowa. CUMIS Specialty Insurance Company, Inc. (NAIC #12758) BUSINESS ADDRESS: Post Office Box 1084, Madison, WI 53701. PHONE: (608) 238-5851. UNDERWRITING LIMITATION b/: $5,302,000. SURETY LICENSES c,f/: AL, CA, CT, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, MD, MA, MI, MN, MO, NE, NV, NJ, NY, NC, OH, OK, OR, PA, SC, SD, TX, UT, VA, WA, WI, WY. INCORPORATED IN: Iowa. t-- Back To Too e Developers Surety and Indemnity Company (NAIC #12718)2 BUSINESS ADDRESS: P.O. BOX 19725, IRVINE, CA 92623 - 9725. PHONE: (949) 263-3300. UNDERWRITING LIMITATION b/: $8,184,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: California. t_- Back To Top ELECTRIC INSURANCE COMPANY (NAIC #21261)° Employers Insurance Company of Wausau (NAIC #21458) BUSINESS ADDRESS: 175 Berkeley Street, Boston, MA 02116. PHONE: (617) 357-9500. UNDERWRITING LIMITATION b/: $144,808,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Wisconsin. Employers Mutual Casualty Company (NAIC #21415) BUSINESS ADDRESS: P. O. BOX 712, DES MOINES, IA 50306 - 0712. PHONE: (515) 280-2511. UNDERWRITING LIMITATION b/: $137,856,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Iowa. Endurance American Insurance Company (NAIC #10641) BUSINESS ADDRESS: 4 MANHATTANVILLE ROAD, PURCHASE, NY 10577. PHONE: (914) 468-8000. UNDERWRITING LIMITATION b/: $28,308,000. SURETY LICENSES c,f/: AL, AK, AZ, CO, DE, DC, GA, HI, ID, IL, IN, IA, KS, KY, LA, MD, MA, MI, MS, MO, MT, NE, NV, NH, NJ, NM, NY, ND, OH, OK, OR, PA, Rl, SC, SD, TN, TX, UT, VT, WA, WV, WI, WY. INCORPORATED IN: Delaware. Endurance Reinsurance Corporation (NAIC #11551)§ Endurance Assurance Corporation (NAIC #11551) BUSINESS ADDRESS: 4 MANHATTANVILLE ROAD, PURCHASE, NY 10577. PHONE: (914) 468-8000. UNDERWRITING LIMITATION b/: $50,373,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WY. INCORPORATED IN: Delaware. Erie Insurance Company (NAIC #26263) BUSINESS ADDRESS: 100 ERIE INSURANCE PLACE, ERIE, PA 16530, PHONE: (814) 870-2000. UNDERWRITING LIMITATION b/: $35,371,000. SURETY LICENSES c,f/: DC, IL, IN, KY, MD, MN, NY, NC, OH, PA, TN, VA, WV, WI. INCORPORATED IN: Pennsylvania. Euler Hennes North America Insurance Company (NAIC #20516) BUSINESS ADDRESS: 800 Red Brook Blvd. Owings Mills, MD 21117. PHONE: (410) 753-0718. UNDERWRITING LIMITATION b/: $14,807,000. SURETY LICENSES c,f/: AL, AK, AZ, CA, CO, DE, DC, GA, HI, ID, IL, IN, IA, KS, KY, LA, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, PA, RI, SC, SD, TN, TX, UT, VT, VA, WI, WY. INCORPORATED IN: Maryland. ��Translate� hftps://www.fiscal.treasury.gov/fsrepa-ts/ref/suretyBndtc570_a-z.htm#e 7/23 Endurance Assurance Corporation (?) A.M. Best #: 012559 NAIC M 11551 FEIN M 352293075 Administrative Office View Addifional Address Inforrnatior. 4 Manhattanville Road Purchase, IVY 10577 United States Web: wtiv.errdurartc;�.i rn Phone: 914-468-8000 Fax:914-997-0331 Assigned to"�"'�"'�' a� insurance companies BEST that have, in our A. or opinion, a superior ability to meet their ongoing insurance obligations, Based on A.M. Best's analysis, 02641 - SO atPO Holdings. Inc; is the AMB Ultimate Parent and identifies the topmost entity of the corporate structure. View a list of operating insurance entities in this structure. Financial Strength Rating View Definition Rating: Affiliation Code: Financial Size Category Outlook: Action: Effective Date: Initial Rating Date: A+ (Superior) g (Group) XV ($2 Billion or greater) Stable Affirmed July 14, 2017 December 23, 2002 Long -Term Issuer Credit Rating View Definition Long -Term: aa- Outlook: Stable Action: Affirmed Effective Date: July 14, 2017 Initial Rating Date: November 24, 2004 u Denotes t.trder E2 v c:. Bests Ra;jinx Best's Credit Rating Analyst Rating Issued by: A.M. Best Rating Services, Inc. Financial Analyst: Victoria Ohorodnyk Director: Greg Reisner Disclosure Information Disclosure Information Form', View A.M. Best's Rating Disclosure _�orrn A.M. Best Affirms Credit Ratings of Sompo Press Release; Japan Nipponkoa Insurance Inc. and Its Subsidiaries July 14, 2017 A.M. Best has provided ratings & analysis on this company since 2002. Powered by A.M. Best's Global Insurance Database Page 1 of 3 Financial Strength Rating 1 Lang -Term Issuer Credit Rating i Effective Date Rating Effective Date Rating 7/14/2017 A+ 7/14/2017 aa- 3/28/2017 A+ 3/28/2017 aa- 10/5/2016 Au 10/5/2016 a u 5/12/2016 A 5/12/2016 a 5/28/2015 A 5/28/2015 a 5/6/2014 A 5/6/2014 a 4/10/2013 I A 4/10/2013 a ---' Be.,Xs Credit Report - Where applicable, includes Best's Financial Strength Rating and rationale along with comprehensive analytical commentary, detailed business overview and key financial data. Report Revision Date: 7/25/2017 (represents the latest significant change). '- Historical Reports are available in Best's Credit Report Archive. View additional news, reports and products for this company. Date r Jay _..._-_-_ ..... ... _... __.._................................................. ............... ............................ _..... ..... .... ....._........ _.._._.............. _.............. _... .......... ........................ ........................................................................ .,.... .... _............ ... _...... _..................................... _._..............._................. .......................... Jul 14, 2017 A.M. Best Affirms Credit Ratings of Sompo Japan Nipponkoa Insurance Inc. and Its Subsidiaries Mar 28, 2017 A.M. Best Removes From Under Review and Upgrades Credit Ratings of Endurance Specialty Holdings Ltd. and Its Subsidiaries Oct OS, 2016 A.M. Best Places Credit Ratings of Endurance Specialty Holdings, Ltd. and Its Subs. Under Review With Positive Implications May 12, 2016 A.M. Best Affirms Ratings of Endurance Specialty Holdings Ltd. and Its Subsidiaries May 28, 2015 A.M. Best Affirms Ratings of Endurance Specialty Holdings Ltd. and Its Subsidiaries Mar 31, 201S A.M. Best Comments on the Ratings of Endurance Specialty Holdings, Ltd. and Its Subsidiaries May 06, 2014 A.M. Best Affirms Ratings of Endurance Specialty Holdings, Ltd. and Its Subsidiaries Apr 10, 2013 A.M. Best Affirms Ratings of Endurance Specialty Holdings, Ltd. and Its Subsidiaries Mar 05, 2012 A.M. Best Affirms Ratings of Endurance Specialty Holdings, Ltd. and Its Subsidiaries Feb 25, 2011 A.M. Best Affirms Ratings of Endurance Specialty Holdings, Ltd and Its Subsidiaries 3 1 j 2 3, Is PI Page size 10 21 stems in :3 pages European Union Disclosures A.M. Best - Europe Rating Services Limited (AMBERS), a subsidiary of A.M. Best Rating Services. Inc., is an External Credit Assessment Institution (ECAI) in the European Union (EU). Therefore. Credit Ratings issued and endorsed by AMBERS may be used for regulatory purposes in the EU as per Directive 2006/48IEC. Australian Disclosures A.M. Best Asia -Pacific Limited (AMBAP), Australian Registered Body Number (ARBN No.150375287), is a limited liability company incorporated and domiciled in Hong Kong. AMBAP is Powered by A.M. Best's Global Insurance Database Page 2 oj3 a wholesale Australian Financial Services (AFS) Licence holder (AFS No. 411055) under the Corporations Act 2001. Credit Ratings emanating from AMBAP are not intended for and must not be distributed to any person in Australia other than a wholesale client as defined in Chapter 7 of the Corporations Act. AMBAP does not authorize its Credit Ratings to be disseminated by a third -party in a manner that could reasonably be regarded as being intended to influence a retail client in making a decision in relation to a particular product or class of financial product. AMBAP Credit Ratings are intended for wholesale clients only, as defined. Credit Ratings determined and disseminated by AMBAP are the opinion of AMBAP only and not any specific credit analyst. 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Best's Global Insurance Database Page 3 oj3 12/15/2017 Company Profile COMPANY PROFILE Company Profile Company Search Company Information Company Search Results ENDURANCE ASSURANCE CORPORATION Company 4 MANHATTANVILLE ROAD, 3RD FLOOR Information NEW YORK, NY 10577 Old Company Names Old Company Names Effective Date Agent for Service Reference ENDURANCE REINSURANCE COMPANY OF AMERICA 01/30/2008 Information ENDURANCE REINSURANCE CORPORATION OF AMERICA 08/23/2016 NAIC Group List ENDURANCE REINSURANCE CORPORATION OF AMERICA DBA 12J30J2009 Lines of Business ENDURANCE WORKERS' COMPENSATION INSURANCE COMPANY Workers' Compensation Agent For Service Complaint and Request for Request forAction/Appeals Vivian Imperial 818 WEST SEVENTH STREET Contact Information SUITE LOS ANGEGELES CA 90017 Financial Statements PDF's Annual Statements Reference Information Quarterly,.,,,,,„ ..,...,,,,,<;,...,.... NAIC #: 11551 Statements f Company Complaint California Company ID 5082-3 Company _....._. ______......_._.__.._. ..__.: Performance & Date Authorized in California: 01/30/2008 Comparison Data i — --- --- Company License Status: UNLIMITED -NORMAL Enforcement Action _.....__ _.._.......... ..._..._....._;.__...._. __._...„ Composite Company Type: ___ ;Property & Casualty Complaints Studies State of Domicile: D,= WARE Additional Info-„ Find A Company back to top Representative In Your Area View Financial Disclaimer NAIC Group List NAIC Group #: 3219 Sompo Grp Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. AIRCRAFT AUTOMOBILE BOILER AND MACHINERY BURGLARY COMMON CARRIER LIABILITY CREDIT DISABILITY FIRE LIABILITY https //interactive.web.insurance.ca.gov/companyprofile/companyprofile?event=companyProfile&doFunction=getCompanyProfile&eid=107243 1/2 12/15/2017 Company Profile back to top J 2008 California Department of Insurance MARINE MISCELLANEOUS PLATE GLASS SPRINKLER SURETY TEAM AND VEHICLE WORKERS' COMPENSATION https://i nteractive.web.i nsurance.ca.gov/com panyprofile/com panyprofile?event=com panyProf I e&doFuncti on=getCom panyProf I e&eid=107243 2/2 RECEIVED AUG 22 pt, 1: 04 CITY CLERK NUt�illVGTON SEA li u c 0 4a 4a E E cn 0 u 0 L- m M jp vi q rq r 0 4a 0. E 0 LL. u Z) m (D m Lu Lu 0 0 0 Lu 0 LL 0 CL 4- 0 cl) cl) > 0 cl) m cl) X m c cl) > 0 *z m cl) z 0 z 0 m cl) z m cl) L— D Mo (A LL ui 0 m m L— 0 F- (D cc 0 0 i LL 0 z 0 u F- V) z 75 O O O uj -j F- u LLI X LL 0 LLI LL 0 uj X 0 I= LLI -j LLI 0 City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Robin Estanislau, City Clerk January 24, 2018 Alfaro Communications Construction, Inc. Attn: Maria Martinez 620 S. Bradfield Avenue Compton, CA 90221 Re: Traffic Signal Modifications — CC-1465 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 project 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. Sincerely, 4441L., �&4vhj� Robin Estanislau, CIVIC City Clerk RE:ds Enclosures: Copy of Contract including Proposal Copies of insurance/bonds Bid Bond (original) Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand Dept. ID PW 17-057 Page 1 of 3 Meeting Date: 11/20/2017 4�'10 Y� 7 --0 CITY OF HUNTINGTON BEACH REQUEST FOR. CITY COUNCIL ACTION MEETING DATE: 11/20/2017 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: Award and authorize the execution of a construction contract with Alfaro Communications Construction, Inc. in the amount of $326,000 for the traffic signal modifications at three intersections, CC-1465; authorize appropriations and ur to 15% in change orders Statement of Issue: On August 22, 2017, bids were opened for the traffic signal modifications at the intersections of Gothard Street and Heil Avenue, Gothard Street and Talbert Avenue and at Springdale Street and McFadden Avenue. City Council action is requested to award the contract to Alfaro Communications Construction, Inc., the lowest responsive and responsible bidder. Financial Impact: Appropriations in the amount of $468,000 to federal Highway Safety Improvement Program (HSIP) grant Account No. 99585002.82700 and $82,000 to Proposition 42 Account No. 21990420.82700 are requested for a total of $550,000. This project was originally approved in the FY 16-17 Capital Improvement Program (CIP). The $326,000 is for the construction contract, plus additional funds of $175,100 will be used for city -furnished equipment purchases and costs not reimbursable through the grant program, and a 15 percent contingency of $48,900, result in total costs of $550,000. Recommended Action: A) Accept the lowest responsive and responsible bid submitted by Alfaro Communications Construction, Inc. in the amount of $326,000; and, B) Appropriate $82,000 of undesignated Proposition 42 funds to Proposition 42 project account 21990420.82700; and, C) Appropriate $468,000 to federal Highway Safety Improvement Program Account No. 99585002.82700; and, D) Authorize the Mayor and City Clerk to execute a construction contract in a form approved by the City Attorney; and, E) Authorize the Director of Public Works to execute change orders not to exceed a total of 15 percent of the contract construction costs or $48,900. Alternative Action(s): Reject all bids and provide staff with alternative direction. Item 6. - 1 1413 -32- Dept. ID PW 17-057 Page 2 of 3 Meeting Date: 11/20/2017 Analysis The City applied for grant funding for traffic signal modifications at three intersections under the federal Highway Safety Improvement Program (HSIP). These intersections were identified for the installation of left turn arrows based on their recent collision history. The grant was approved and engineering and construction funds were subsequently approved. The project was included in the FY 2016/17 Capital Improvement Program and is also identified in the FY 2017/18 Capital Improvement program as a continuing project. The continuing funds for the project are not available at this time due to the timing of the award of the contract. Therefore, rather than request these funds be carried over from last year, which is the typical practice, it is requested that the funds be appropriated with the award of the contract. At the intersection of Gothard Street and Heil Avenue, left turn arrows will be installed in all four directions. At the intersection of Gothard Street and Talbert Avenue, left turn arrows will be installed in the north -south direction. For the intersection of Springdale Street and McFadden Avenue, left turn arrows will be installed in all four directions. A complete set of plans and specifications are available for review at the Public Works counter during normal business hours. Bids were opened on August 22, 2017, and are listed in ascending order: Bidder Submitted Bid 1 Alfaro Communications Construction, Inc. $326,000.00 2 PTM General Engineering Service, Inc. $372,872.00 3 Steiny Electric Company $376,880.00 4 Sturgeon Electric California, LLC $380,410.00 5 California Professional Engineering, Inc. $397,888.00 6 Elecnor Belco Electric , Inc. $404,943.00 7 Comet Electric $434,195.00 8 Aldridge Electric, Inc. $470,361.30 9 DBX, Inc. $490,306.00 The engineer's estimate for the bid items was $560,000. The total estimated cost of this project is $550,000 which includes the City's direct purchase of all major equipment which is estimated at approximately $120,000. This practice ensures consistency of equipment among the traffic signals and street lighting maintained by the City. Direct purchase also provides the added benefit of reduced costs to the City due to elimination of contractor mark-ups, typically in excess of 20 percent on this type of equipment. Federal grant funds totaling total approximately $468,000 are anticipated to be received with $82,000 of undesignated Proposition 42 funds requested to provide the required grant matching funds and to fund the items ineligible for federal reimbursement These ineligible items include some of the construction administration tasks such as material testing and monitoring for labor compliance. Staff is requesting that the Director of Public Works be given authorization to approve change orders on this project up to 15 percent of the construction cost rather than the standard 10 percent. The request equates approximately to the typical 10 percent contingency based on the total of the construction contract and the materials purchased by the City. This authorization will provide the added flexibility needed to complete a typical construction project yet still be consistent with the intent of the 10 percent limit. HB _33_ Item 6. - 2 Dept. ID PW 17-057 Page 3 of 3 Meeting Date: 11/20/2017 Public Works Commission Action: The Public Works commission recommended this project on March 15, 2017, by a vote of 6-0-1 (Nguyen absent).. Environmental Status: This project is categorically exempt pursuant to the California Environmental Quality Act, Section 15303 (c). Strategic Plan Goal: Enhance and maintain infrastructure Attachment(s): 1. Project Location Map. Item 6. - 3 HB -34- M CITY OF HUNTINGTON BEACH * PUBLIC WORKS * TRAFFIC ENGINEERING no VICINITY MAP ATTACHMENT 100 GOTHARD & HEIL, GOTHARD & TALBERT, SPRINGDALE & McFADDEN 1 HB -35- Item 6. - 4 CITY OF HUNTINGTON BEACH PROJECT NAME: Gothard Signals & Springdale -McFadden CC#: CC1465 BID OPENING DATE: 8/22/2017 TIME & LOCATION: 2:00:00 PM Council Chamber ENGINEER'S ESTIMATE: $670,000.00 BIDS SUBMITTED (AS READ AT OPENING) BIDDER'S NAME FINAL APPARENT BID RANK AMOUNT Aegis ITS Alfaro Communications 6 -- California Professional Engineering : r..r.� Comet Electric / Y1,5 D BX bz Dpalectric Elecnor�Belco Electric / _f IE General Engineering PTM General Engineenng Services 5 /7 R & H Industries (dba, Best Electric) Select Electric Sturgeon Electric California i-ly VT Electric PTS_07102015_Version_15_CC 1465.xlsx RECEIVED 2017 AUG 22 PM 2., 00 ::fT Y CLERIC CITY OF HUNTINGTON BEACH, 0 U-) LAJ C] I C.3 cv Ln � USA 22201 7 w � C= s c -< no -7 /iL /i7 71Z7 Mp 8 / 3 //; eho //7 NOTICE INVITING SEALED BIDS for the construction of Traffic Signal Modifications At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue And Springdale Street and McFadden Avenue CC No. 1465 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 August 22, 2017. Bids will be publicly opened 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 $20.00 nonrefundable fee if picked up, or payment of a $30.00 nonrefundable fee if sent by UPS ground delivery (bidder shall pay additional costs for special delivery). Plans, Specifications, and contract documents can be downloaded free on AGENCY website at: http://www.huntini�tonbeachca.gov/government/departments/public works/Bids/ Open website, then click on "Current Advertised Projects" tab. 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 the bid opening. 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 modifying three traffic signals to add left turn phasing and constructing ADA compliant ramps. The contract shall allow the Contractor 60 working days to complete the contract. The Project Disadvantage Business Enterprises (DBE) goal is 10.00% 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 6th day of September 2016, by Resolution No. 2016-58. Attest: /s/ Robin Estanislau 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: Robin Estanislau To: City Clerk's Office 2000 Main Street Huntington Beach, CA 92648 BEACH 92648 Fax (714) 374-1573 Date: July 12 2017 Project/C.C. No.: C.C. No, 1465 Regarding: Traffic Signal Modifications ❑ We are sending you: ❑ Hy Mail ❑ Hy 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 # I Copies J Pages- 'Description 1 1 1 Notice Inviting Seated Bids for CC-1465, Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue. 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: Per Resolution 2016-58 (adopted on September 6 h, 2016), the City Council authorized the advertisement of the above Traffic Signal Modifications, Project CC-1465. Please find attached the Notice Inviting Sealed Bids for advertisement on 7/27/17, 8/3/17 & 8/10/17. The bid opening is scheduled for 8/22/17. Please contact me at 374-1628 with any questions you may have. cc: fileCC-1464 By: William F. Janusz,Orincipal Civil En ' er Esparza, Patty From: David Ward [daward@scng.com] Sent: Thursday, July 13, 2017 10:11 AM To: Esparza, Patty Cc: Escutia, Jim; Janusz, Bill; Estanislau, Robin Subject: Re: Legal ad for the HB Wave - CC-1465 Hello again Patty. Your notice is all set. Ad410980429 Run Date 7/27, 8/3, 8/10 Cost $864.00 PROOF NOTICE INVITING SEALED BIDS for the construction of Traffic Signal Modlf Ications At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Hall Avenue And Sprl n9dalle Street and McFadden Avenue CC No. 146S in the CITY OF 14UNTI NGTON BEACH PUBLIC NOTICE IS HEREBY GIVEN that the CITY OF HUN- TINGTON BEACH, as AGENCY. 'invites sealed bids for the above stated proiects and will receive such bids in the off -ice of the City Clerk, Second Floor, 2000 Main Street, Huntington Beach, California 92648, up to the hour of 2:00 PM on August 22, 2017. Bids will be publicly opened in the Council Chambers unless otherwise posted. Copies of the Plans Specifications, and contract documents are available from the Olf1ce of the Director of Public Works, 2000 Main Street, Huntington Beach, CA 92640, upon payment of a $20.00 nonrefundable fee if picked urr or payment of a $30.00 nonrefundable fee if sent by UPS ground delivery (bidder shall pay additional costs for special delivery). Plans, Specifications, and contract documents can be downloaded free on AGENCY website at; h ftp . 1/www. hunti ji 9ton beZaove rn men t6depa rtme nts� publi,worksalidsd thel, ,c_ Open website, Ick on 'Current Advertised Proiects'tab. This is a Davis- Bacon protect and the Federal Regulations will be en- forced. Any contract entered into pursuant to this notice will in -corpo- rate the provisions of the Federal Labor Standards, which are on tile at the office of the Director of Public Works, 2000 Main Street, Hun- tington Beach, CA 92648, The AGENCY wil I 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 Con- tract 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 re- sponse to this notice and will not be discriminated against on the ba- sis 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 Pro- posal forms in conformance with the Instructions to Bidders as deter- mined by the AGENCY. The bid must be accompanied by a certified check, cashier's check, or bidder's bond made payable to the AGEN- Cv for an amount no less than 10% of the amount bid. The successful bidder shal I 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 the bid opening. The successful Contractor and his subcontractors will be required to possess business licenses from the AGENCY. All extension of unit prices will be subiect to verifica- tion by the AGENCY. In case of a variation between the unit price and the extension, the unitpricewill govern. Prolect DescriPtiGn: The protect consists prlmarlly of modi- ling three traffic signals to add left turn phasing and coni- s s rutting ADA compliant rumps. The contract shall allow the Contractor 60 working days to complete the contract. The Proiect Disadvantage Business Enterprises (DBE) goal is 10.00% The AGENCY reserves the right to reiect any or all bids, to WU"]Ve any irregularity and to take all bids under advisement for a maxi- mum period of 60 days. BY ORDER of the CITv COUNCIL of the CITY OF HUNTINGTON BEACH, ALITORNIA, the lath day of September 2, by Resolu- tion No. 2016-59- Attest: IV Robin Estanislau CITY CLERKOF THE CITY OF HUNTINGTON BEACH Publish. The Huntington Beach Wave July 27, Aug 3,10,201710980429 David Ward Legal Advertising Rep 2190 S. Towne Centre PI. Anaheim, CA 92806 714-796-6764 daward@scng.com PLEASE NOTE THE E-MAIL ADDRESS HAS CHANGED F On Thu, Jul 13, 2017 at 9:59 AM, David Ward <dawardnscn com> wrote: Hello Patty. I trust your day is going well. I'm going to assume the start date is 7/27 (I just want to double check since the notice says 7/2). Thank you. David Ward Legal Advertising Rep 2190 S. Towne Centre PI Anaheim, CA 92806 714-796-6764 daward@scng.com PLEASE NOTE THE E-MAIL ADDRESS HAS CHANGED On Wed, Jul 12, 2017 at 11:23 AM, Esparza, Patty <PEsparzansurfcity-hb.or > wrote: Hi David: Attached is a legal ad for the HB Wave that needs to be published 3 weeks in a row beginning: 7/2/2017, 8/3/2017 and 8/10/2017. 3 Please confirm when time permits — thanks! Patty Esyarza, CAW Assistant City Clerk City o[Dunio�tonBeach 2000 Main Street Huntington Beach, CA 92648 UNSUCCESSFUL BIDS CC-1465 Traffic Signal Modifications Gothard St. & Talbert St/ Gothard St. & Heil Ave/ Springdale St. & McFadden Ave. City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Robin Estanislau, City Clerk January 31, 2018 Aldridge Electric, Inc. 844 E. Rockland Road Libertyville, IL 60048 RE: Traffic Signal Modifications at Gothard St.& Talbert Ave./Gothard St. & Heil Ave./Springdale St. & McFadden Ave. — CC-1465 Enclosed please find your original bid bond for CC-1465. Sincerely, Robin Estanislau, CIVIC City Clerk RE:ds Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand SECTION C PROPOSAL for the construction of Traffic Signal Modifications from At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue And Springdale Street and McFadden Avenue CC No. 1465 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 60 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find a bid bond for ten percent of amount bid 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 1 August 11, 2017 �er�e R. Huebner, CFO oQ Q C-2 CORPORATE SEAL 1957 !2FCAW ARE 'City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE For Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue — CC 1465 HSIPL5181(178) August 11, 2017 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES. The Federal Labor Rates contained in Appendix t of the specifications for the: Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue - CC1465 HSIPL5181(178) shall be replaced with the following attached documents: The Federal Labor Rates dated August 4, 2017 shall be the labor rates in effect for the subject project. 2) PAGE C-1 — SECTION 3 — PROPOSAL The following sentence shall be inserted at the end of the first paragraph: The undersigned acknowledges that the issuance of Notice to Proceed will occur approximately three months after the award of contract to allow procurement time for the city furnished equipment. This is to acknowledge receipt and review of Addendum Number One, dated August 11, 2017. Aldridge Electric, Inc. Company Name August 22, 2017 Date CORPORATE SEAL By Gene R. Huebner, CFO 1957 All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F. Janusz at (714) 536-5431. eeCAW Pt SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFA.DDEN AVENUE BID ITEMS 2 Furnish Project Traffic Control 1 LS $10,884.70 $ 10,884.70 3 Furnish and Install Traffic Striping and Signing 1 LS $12,862.00 $ 12,862.00 4 Preparation of WPCP and installation and of Maintenance of 1 LS 8,870.70 $ 8,870.70 $ BMP's per the approved WPCP. Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case A and Typical Section at New Curb Ramps 5 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 2 EA appurtenances, curb and gutter, depressed curb, sidewalk, $13,382.70 $ 26,765.40 truncated domes, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case B and Typical Section at New Curb Ramps 6 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 1 EA appurtenances, curb and gutter, depressed curb, sidewalk, $16,169.10 $ 16,169.10 truncated, domes, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case C and Typical Section at New Curb Ramps 7 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 5 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.). Excludes the $11,572.40 $ 57,862.00 Northeast corner of Gothard Street and Heil Avenue. Construct Curb Ramps, Truncated Domes, Sidewalk, Curb and Gutter and Railing at the Northeast Corner of Gothard 8 Street and Heil Avenue and per Detail on Sheet 5. (Item 1 LS includes all appurtenances, curb and gutter, depressed curb, sidewalk, railings, truncated domes, retaining curb, slot pave, $ 17,567.8 $ 17,567.80 etc.) Construct Curb, Access Ramps and Concrete Sidewalk on the Raised Island at the Southwest quadrant of the Intersection of 9 Springdale Street and McFadden Avenue. See the Details on 1 LS Sheet 5. (Item includes all appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, 25265.3 , $ 25,265.30 $ slot pave, etc.) 10 Modify Traffic Signal at Gothard Street and Talbert Avenue. Item includes all work in plans not included in other items. 1 LS $163,099.3 $ 163,099.30 11 Modify Traffic Signal at Gothard Street and Heil Avenue. Item includes all work in plans not included in other items. 1 LS $52,054.70 $ 52,054.70 12 Modify Traffic Signal at Springdale Street and McFadden Ave. 1 LS $ 72,449.60 $ 72,449.60 Item includes all work in plans not included in other items. C-2.1 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-51.81(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HELL AVENUE AND SPRI.NGDALE STREET AT MCFADDEN AVENUE M"y,.-��r� ItemDescr�pt�on.a 1 'a rt h s.Quant�tyUn�t UnitGost �TotalGost TOTAL BID AMOUNT $ 470,361.30 TOTAL BID AMOUNT IN WORDS: Four hundred seventy thousand, three hundred sixty one dollars and thirty cents Note: Refer to Section 9, Measure and Payment. All extensions of unit prices will be subject to verification by Owner. In case verification is required between the unit price and the extension, the unit price will govern. The Owner reserves the right to reject any or all proposals and bid items. The City will provide the traffic signal equipment, as listed in the pole schedules, (also includes anchor bolts) to the contractor. The contractor is to pick up the materials, with its own labor, at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 536-5530. C-2.2 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 or $10,000, whichever is greater, and the portion of the work to be done by such subcontractor. Bid Items) Name and Address of Subcontractor State License Number Class DIR PWC Registration # Dollar Amount % of Contract Directional Drilling DC Directional Drilling 6955 Capistrano Way Riverside, CA 92504 995044 D09 1000014902 $7,000.0 1% Median Ncse, Sidewalk, Ramps Her - on Uonstruction bervices 58 S. Hollenbeck Ave., Covina, CA 91723 Inc. 945955 C12 1000012689 $126,707. 0 27% Signing/ Striping Cat Tracking Inc. 2950 Rubidoux Blvd Riverside, CA 92509 991122 C32 1000011750 $10,900. 0 2% By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID 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 8/22/17, at Libertyville IL Date City State Gene R. Huebner being first duly sworn, deposes and says that he or she is CFO of Aldridge Electric, 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. Aldridge Electric, Inc. ?� ELECT Name of Bidder DCORPORATE ene R. Huebner, CFO gnature of Bidder 844 E. Rockland Road, Libertyville, IL 60048 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 Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue, (I)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Aldridge Electric, Inc. Contractor CORPORATE Z e, SEAL � � Q"� ,�i Gene R. Huebner 1957 By �F�AW ARE Date: August 22, 2017 CFO Title C-5 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 ® No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. Date: August 22, 2017 Aldridge Electric, Inc. Contractor CORPORATE SEAL ���ine R. Huebner 1957 B �OELAW PAS CFO Title C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Aldridge Electric, Inc. Bidder Name 844 E. Rockland Road Business Address Libertyville IL 60048 City, State Zip ( 847 ) 680-5200 kgottschlich@aldridgegroup.com Telephone Number Email Address 855841 C10 A State Contractor's License No. and Class 03/17/2005 Original Date Issued 03/31 /2019 Expiration Date The work site was inspected by Todd Simmons of our office on August 14 , 2017. The following are persons, firms, and corporations having a principal interest in this proposal: Thomas G. McLinden, President Timothy Bradley, Executive Vice President 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. Aldridge Electric, Inc. Company Name Sl(nature of Bidder Gene R. Huebner, CFO Printed or Typed Signature C-8 CORPORATE SEAL NOTARY CERTIFICATE Subscribed and sworn to before me this22ndday of August , 2017 . 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 Illinois County of Lake On August 22, 2017 before me, Nancy L. Schroeder Month, Day, and Year Insert Name and Title of Notary personally appeared Gene R. Huebner, CFO 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. =@Notary L. SCHROEDER ICIAL SEAt lic - State of Illinois mission Expires mber 16, 2020 Signature IlKa'rt� Signature of Notary Public (PLACE NOTARY SEAL ABOVE) C-9 Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work, specifically referencing the construction of {Describe specific work and experience necessary for project. For example, "Sanitary sewer line installation of at least of 1,000 of 8-inch and greater in public right-of- way. Sanitary sewer lift stations of similar size, proiect work within public streets, an area containing high ground water and pipeline construction in high ground water regions with trench depths of 8-feet to the invert."}. 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: Freeway Lighting Partners (FLP) / Michigan Department of Transportation Name and Address of Public Agency Name and Telephone No. of Project Manager: Charlie Stein 517-373-7339 $40,000,000.00 MDOT Metro Freeway Lighting 10/01/17 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Design/build improvements to the existing freeway and tunnel lighting systems in the Detroit Metro Region 2. Chicago Department of Transportation Name and Address of Public Agency Name and Telephone No. of Project Manager: Otto Letamendi 312.742.3913 $8,500,000.00 Arterial & Viaduct Roadway Lighting Improvement 3/18/17 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Removal of existing light poles, HSPV luminaires & aerial cables, replace with new aluminum light poles & LED fixtures fed through underground conduit system. Illinois State Toll Highway Authority Name and Address of Public Agency Name and Telephone No. of Project Manager: Jim Laskero (630) 816-6336 $3,100,000.00 Temp Lighting & Advnaced ITS 06/01 /13 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Installation of (175) 70 ft. Temp Wood Poles with 15 ft. Mast Arms and 750 watt Luminaries, (28) Camera/RTMS units with Wireless and Solar Panels C-10 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. Patrick Foley Name of proposed Project Manager Telephone No. of proposed Project Manager: 847-321-5956 Elgin O'Hare 1-14-4642 Installation of ITS and lighting duct packages, light poles, sign foundations and structures, and ground -mounted signs. 11/17/17 Project Name & Contract Amount Type of Work Date Completed IL-53 Interchange Installed plaza buildings, new lighting, an ITS system, and ITS/Lighting ductbank. 08/31/17 Project Name & Contract Amount Type of Work Date Completed EOWA Roadway and Bridge Construction Includes the removal and installation of all electrical items and sign -age. 03/01/16 Project Name & Contract Amount Type of Work Date Completed 2. Roy Cheaney Name of proposed Superintendent Telephone No. of proposed Superintendent: 847-946-0044 City of Culver City- CCTV Gap Closure $3,000,000 ITS Improvements Project Name & Contract Amount Type of Work City of Los Angeles- My Figueroa $3,500,000 Traffic Signal Improvements Project Name & Contract Amount Type of Work Project Name & Contract Amount Type of Work C-11 July 2017 Date Completed To Be Completed in Fall 2017 Date Completed Date Completed CONTRACTOR REGISTRATION WITH CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS (DIR) CERTIFICATE Pursuant to SB 854 (citing Labor Code Section 1771.1(a)), passed by the California State Senate on June 20, 2014, established a new public works Contractor Registration Program, which requires all contractors and subcontractors bidding and performing work on Public Works Projects to register on an annual basis (each July 1 through June 30 state fiscal year) with the California Department of Industrial Relations (DIR). Currently the annual non-refundable registration fee for Contractors is $300. Each contractor to whom a public works contract has been awarded shall sign the following certificate. DIR FACT SHEET on SB 854 http://www.dir.ca.gov/DLSE/PublicWorks/SB854FactSheet 6.30.14.pdf DIR's Contractor Registration Link — Call (844) 522-6734 https://efiling. dir.ca. gov/PWCR/ActionServlet?action=displayPWCRegistrationFonn DIR's Contractor Registration searchable database: https://efiling.dir.ca.gov/PWCR/Search.action I am aware and will comply with the provisions of Labor Code Section 1771.1(a) which states: "A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5. It is not a violation of this section for an unregistered contractor to submit a bid that is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the contractor is registered to perform public work pursuant to Section 1725.5 at the time the contract is awarded." I furthermore will comply by providing proof of registration with DIR as the primary contractor, as well as for ALL subcontractors at the time of submitting the bid. Aldridge Electric, Inc. Contractor CORPORATE Z SEAL 1957 "gene R. Huebner 0ELAW PRE CFO Title Date: August 22, 2017 PWC Registration #: 1000009777 C-12 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 requirements 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: Aldridqe Electric, Inc. Contact Person: Gene R. Huebner Contact Phone: Signed Date: 847-680-5200 © CORPORATE 2 SEAL n 1957 / August 22, 2017 PFLAIN Fj *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-13 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION Aldridge Electric, Inc. The bidder , proposed subcontractor , hereby certifies that he has X . ...............has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has 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. C-14 PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder — has_, has not X been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public 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. Signature Gene R. Huebner, CFO August 22, 2017 Print Name PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE Date Cj CORPORATE SEAL 1957 °F-LAMIP 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? F] Yes No If the answer is yes, explain the circumstances in the following space. C-15 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. Signature _--Gene R. Huebner, CFO Aul Print Name C-16 ust 22, 2017 ' CORPORATE 2' fP� SEAL � Date \ 1957 / PEIAW NP5 Noncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY of Huntington Beach DEPARTMENT OF PUBLIC WORKS. In 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 Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. FAQ Signature �_— Gene R. Huebner, CFO August 22, 2017 Print Name C-17 Date E11 CORPORATE SEAL n 1957 �FZA W ARti 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. ene R. Huebner, CFO August 22, 2017 Signature Print Name Date C-18 CORPORATE SEAL 1957 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. C-19 DISCLOSURE OF LOBBYING ACTIVITIES CUM PLi- I IIS lUI 1. Type of Federal Action: a. contract b. grant c. cooperative agreement d. loan e. loan guarantee f, loan insurance 2. Status of Federal Action: Ela. bid/offer/application b. initial award c. post -award 4. Name and Address of Reporting Entity 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) 3. Report Type: Ca. initial b. material change For Material Change Only: year quarter_ date of last report 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Congressional District, if known 7. Federal Program Name/Description: CFDA Number, if applicable 9. Award Amount, if known: b. Individuals Performing Services (including address if different from No. I Oa) (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) $ I I actual planned a. retainer b. one-time fee 12. Form of Payment (check all that apply): c. commission Ha.cash d. contingent fee b. in -kind; specify: nature e deferred value f. other, specify 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if necessary) 15. Continuation Sheet(s) attached: YesEl No El 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty ofnot less than $10,000 and not more than $100,000 for each such failure. Federal Use Signature: Print Name: Telephone No.: —Date: Authorized for Local Reproduction Standard Form - LLL C-20 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-LLL-Instructions Re 06-04-%ENDIF» C-21 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presents, That Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called "the CNA Companies"), are duly organized and existing insurance companies having their principal offices in the City of Chicago, and State of' Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint William P Weible, Harriet R Reilly, William Cahill, Kimberly Sawicki, Karen A Ryan, Kimberly R Holmes, Deborah A Campbell, Leigh Ann Francis, Ann Marie Waters, Christine Eitel, Richard A Freebourn Jr, Individually of Lisle, IL, their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Boards of Directors of the insurance companies. In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 16th day of May, 2017. GASUgtly 1tASUR * ANY 0A_ rub 4 C� ~y` � � 2 OORPOAAre Di + O G`qa �NCOAPOagT � Q c Oro Z > O A JULY 11, y �U SEAL < y 1902a� 1897 HARli • Continental Casualty Company National Fire Insurance Company of Hartford American Cas alty Company of Reading, Pennsylvania Paul T. Bruflat Vice President State of South Dakota, County of Minnehaha, ss: On this 16th day of May, 2017, before me personally came Paul T. Bruflat to me known, who, being by me duly sworn, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is a Vice President of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that he knows the seals of said insurance companies; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance companies. J. MOHR ------ NOTARYPUBLIC SEf:L `o3 SOUTH DANOTA `v My Commission Expires June 23, 2021 J. Mohr Notary Public CERTIFICATE I, D. Johnson, Assistant Secretary of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in for e. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this v`�4/✓�� day ofUsi GAS Ugtly %14SUI?4* `��FANY 0A_ ((� n F� � C� Ay 2 CORPOAAre O; '4 O tyw \HCORPOB 4 arOro Z Z > O D JULY 11, Ov SEAL < aZ r=� 1902 a* 1897 MAR1f b • Continental Casualty Company National Fire Insurance Company of Hartford American Casualty Company of Reading, Pennsylvania D. Johnson Assistant Secretary Form F6853-4/2012 Authorizing By -Laws and Resolutions ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company at a meeting held on May 12, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents. agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of Continental Casualty Company. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25'h day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the `Authorized Officers") to execute various policies, bonds, undertakings and other obligatory instruments of like nature, and Whereas, from time to time, the signature of' the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company." ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of National fire Insurance Company of Hartford. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 251h day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers") to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of' the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively. "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company." ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of American Casualty Company of Reading, Pennsylvania. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 251h day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers") to execute various policies, bonds, undertakings and other obligatory instruments of like nature: and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, `Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company." THE AMERICAN INSTITUTE OF ARCHITECTS AIA Document A310 Bid Bond KNOW ALL MEN BY THESE PRESENTS, THAT WE Aldridge Electric Inc 844E Rockland Road Libertyville IL 60048 as Principal, hereinafter called the Principal, and Continental Casualty Company 333 S. Wabash Ave Chicago IL 60604 a corporation duly organized under the laws of the State of IL as Surety, hereinafter called the Surety, are held and firmly bound unto City of Huntington Beach 2000 Main Street Huntington Beach, CA 92648 as Obligee, hereinafter called the Obligee, in the sum of Ten Percent of Amount Bid Dollars ($ 10% ), for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for CC No. 1465 Traffic Signal Modifications, at the intersections of Gothard St. and Talbert Ave., Gothard St. and Heil Ave. and Springdale St. and McFadden Ave. NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and materials furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this 22nd ��`�}�`,� (Witness) Ann Marie Waters ess) day of August 1 2017 Aldridge Electric, Inc. (Principal) Continental Casualty Compa / (Surety) C606WATE SEAL (Seal) Kirnbe6 R. Holmes (Title) AIA DOCUMENT A310 s BID BOND o AIA • FEBRUARY 1970 ED. • THE AMERICAN INSTITUTE Or ARCHITECTS,173-9, N.Y. AVE., N.W., WASHINGTON, D.C. 20006 G-23208-13 ss. STATE OF Illinois COUNTY OF DuPage I, Christine Eitel Notary Public of DuPage County, in the State of Illinois , do hereby certify that Kimberly R. Holmes Attorney -in -Fact, of the Continental Casualty Company who is personally known to me to be the same person whose name subscribed to the foregoing instrument, appeared before me this day in person, and is acknowledged that he signed, sealed and delivered said instrument, for and on behalf of the Continental Casualty Company for the uses and purposes therein set forth. Given under my hand and notarial seal at my office in the City of Lisle in said County, this 22nd day of August A.D., 2017 Notary Public Christine Eitel My Commission expires: May 26, 2020 "OFFIC=EITEL CHRISNOTARY PUBLIMY COMMISSIO EACH ;E OF THE CITY CLERK, SECOND FLOOR MAIN STREET I•INGTON BEACH, CALIFORNIA 92648 BID ENCLOSED TRAFFIC SIGNAL MODIFICATIONS AT THE INTERSECTIONS OF 1THARD STREET AND TALBERT AVENUE, GOTHARD tEET AND HEIL AVENUE, AND SPRINGDALE STREET AND MCFADDEN AVENUE CC NO. 1465 BID DATE: AUGUST 22, 2017 AT 2:00 P.M. VATTED BY: ALDRIDGE ELECTRIC, INC. 844 E. ROCKLAN D ROAD LIBERTYVILLE, IL 60048 City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Robin Estanislau, City Clerk February 2, 2018 Elecnor Belco Electric, Inc. 14320 Albers Way Chino, CA 91710 RE: Traffic Signal Modifications at Gothard St. & Talbert Ave./Gothard St. & Heil Ave./Springdale St. & McFadden Ave. — CC-1465 Enclosed please find your original bid bond for CC-1465. Sincerely, Robin Estanislau, CIVIC City Clerk RE:ds Enclosure Sister Cities. Anjo, Japan ♦ Waitakere, New Zealand WCO Ulec10C. SECTION C PROPOSAL for the construction of Traffic Signal Modifications from At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue And Springdale Street and McFadden Avenue CC No. 1465 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 60 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-t If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find (,�' o 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. Da a Received Bidder's Signature C-2 `City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE For Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue — CC 1465 HSIPL5181 (178) August 11, 2017 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES. The Federal Labor Rates contained in Appendix I of the specifications for the: Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue - CC1465 HSIPL5181(178) shall be replaced with the following attached documents: The Federal Labor Rates dated August 4, 2017 shall be the labor rates in effect for the subject project. 2) PAGE C-1 — SECTION 3 — PROPOSAL The following sentence shall be inserted at the end of the first paragraph: The undersigned acknowledges that the issuance of Notice to Proceed will occur approximately three months after the award of contract to allow procurement time for the city furnished equipment. This is to acknowledge receipt and review of Addendum Number One, dated August 11, 2017. E3"c tctyl C - W"-./ A ,)cA)n Company Name a a.1,v?,i I Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F_ Janusz at (714) 536-5431. SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE BID ITEMS Item t ".ro', Description �` Quantity Unit tCost h �,' TotalCosf 0.1 (Exten's�on) 1 Mobilization 1 LS [, 2 Furnish Project Traffic Control 1 LS 3 Furnish and Install Traffic Striping and Signing 1 LS 4 Preparation of WPCP and installation and of Maintenance of BMP's the WPCP. 1 LS per approved ,0iG.(1► Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case A and Typical Section at New Curb Ramps 5 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 2 EA appurtenances, curb and gutter, depressed curb, sidewalk, PD truncated domes, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case B and Typical Section at New Curb Ramps 6 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 1 EA appurtenances, curb and gutter, depressed curb, sidewalk, domes, $ ��`��� $ �,4�•� truncated, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case C and Typical Section at New Curb Ramps 7 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 5 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc ). Excludes the Northeast Gothard Street Heil Avenue. $ q' ��� $ 41. `K5. corner of and Construct Curb Ramps, Truncated Domes, Sidewalk, Curb and Gutter and Railing at the Northeast Corner of Gothard 8 Street and Heil Avenue and per Detail on Sheet 5. (Item 1 LS includes all appurtenances, curb and gutter, depressed curb, sidewalk, railings, truncated domes, retaining curb, slot pave, $ 2a ` x) $ 2�}r >8;• etc.) Construct Curb, Access Ramps and Concrete Sidewalk on the Raised Island at the Southwest quadrant of the Intersection of 9 Springdale Street and McFadden Avenue. See the Details on 1 LS Sheet 5. (Item includes all appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.) $2zi,565 0 6S5.0 j 10 Modify Traffic Signal at Gothard Street and Talbert Avenue. Item includes all work in plans not included in other items. 1 LS 11 Modify Traffic Signal at Gothard Street and Heil Avenue. Item includes all work in plans not included in other items. 1 LS $ I22,73I 33) .OD 12 Modify Traffic Signal at Springdale Street and McFadden Ave 1 LS $ ��,3,� Item includes all work in plans not included in other items. C-2.1 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE Item-. ' De'sci iption Qdantity Unit Unit Cost Tota11 Cost.'' ,. No.. (Ext6'sion)' TOTAL BID AMOUNT TOTAL BID AMOUNT IN WORDS: Note: Refer to Section 9, Measure and Payment. All extensions of unit prices will be subject to verification by Owner. In case verification is required between the unit price and the extension, the unit price will govern. The Owner reserves the right to reject any or all proposals and bid items. The City will provide the traffic signal equipment, as listed in the pole schedules, (also includes anchor bolts) to the contractor. The contractor is to pick up the materials, with its own labor, at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 536-5530. C-2.2 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 or $ l 0,000, whichever is greater, and the portion of the work to be done by such subcontractor. Bid Item(s) Name and Address of Subcontractor State License Number Class DIR PWC Registration # Dollar Amount % of Contract roam bC6 ad! 10 ?Ar�r,:�L T�-Ai G<c 1.004'> t.F-�CK G �cc r,JU P ' ��'ZC75lrT PYM371 � � 13 7 3o 3. 3 X C4r l Eck. ��,��, , )u�. 1I ?IVi65ru6 A .�3 c-g Cl2 2.7 �31 By submission of this proposal, the Bidder certifies: I. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID 1 declare under penalty of perjury under the laws .���f-�the State of California that the foregoing is true and correct and that this declaration is executed on " , at C IMUP , CA }nr i Date City State bein first duly sworn, {�d,,eposes and says that he or she is of.� mor M(O�&(Y Qr)C_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. l�CZI'1 Wtc _ Name of Bidder SIgna)ure o Bidder J 1 way ci n1� Address of Bidder C-4 ALL- PURPOSE I — t I ,E OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the Individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of uM*rwA County ofi�eC��dtn� On kC before me, 0� I --r (Here insert name and title of the officer) personally appeared Y w� who proved to me on the basis of satisfa tory evidence to be the person(s) whose name(s)Is re subscribed to the within instrument and acknowledged to me that the/they executed the same in Is er/their authorized capacity(), and that by ails er/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. OLIVIA CHEA� WI y and d official seal Commission No.2107474 NOTARY PUBLIC-CALIFORNIA 9 SAN BERNARDINO COUNTY My Comm. Expxes APRIL 18, 2019 Notary Public Sig ature (Notary Public Seal) %�!`� i'� ;%.i �,• 'c�+�%.: �, �i- ,�: ', fit, DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) Corpora e Offi,c r (Title) ❑ Partner(s) ❑ Attomey-in-Fact ❑ Trustee(s) ❑ Other INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, f needed, should be completed and attached to the document Acknotwedgents from other states may be completed for documents being sent to that state so long as the wording does not require the Cal forma notary to violate California notary law • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public) c Print the name(s) of document signer(s) who personally appear at the time of notarization a Indicate the correct singular or plural forms by crossing off incorrect forms (i e he/she/they, is /are ) or circling the correct forms Failure to correctly indicate this information may lead to rejection of document recording • The notary seal impression must be clear and photographically reproducible Impression must not cover text or lines If seal impression smudges. re -seal if a sufficient area permits, otherwise complete a different acknowledgment form e Signature of the notary public must match the signature on file with the office of the county clerk Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document Indicate title or type of attached document, number of pages and date r� Indicate the capacity claimed by the signer If the claimed capacity is a corporate officer, indicate the title (i e. CEO, CFO, Secretary) • Securely attach this document to the signed document with a staple UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue, (I)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: $ o Contractor Title C-s 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 XNo 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: 0 �(bVl ;L"lleowr -Wco Contractor Title C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: `60Cu `-�eft(Hc Bidder Name Bu iness Address C�wu CA q � -� I, �. o City, State Zip Telephone Number Email State Contractor's License No. and Class Original Datg Issued Expiration Date The work site was inspected by i-U\?'� of our office on , 201 The following are persons, firms, and corporations having a principal interest in this proposal: v -e QSC �'1 -�0 IfVV CXec.U1c �de� - i�ewlu ruc� 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. v\en� WAW Compan),� ame Sihnahare of B Printed or TypeAignature C-8 NOTARY CERTIFICATE Subscribed and sworn to before me this —CP y of , 2011. 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 uhr %a ) County of f-ewAk On ��� �� X before me, fDyMa �, . ��% � Y1��O� Month, Day, and Year Insert Name and Title of Notary personally appeared Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person whose name��s%are subscribed to the within instrument and acknowledged to me that she/they executed the slime in hi er/their authorized capacity( i and that b hi her/their signatureXn the instrument the person or the entity upon behalf of which the person�cted, 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. ;�,: OLIVIA CHEA .<!' Commission No.2107474 Z NOTARY PUBLIC-CALIFORNIA n Z SAN BERNARDINO COUNTY . ° My Comm Expires APRIL 18, 2019 �. y. Signature a)(5�1 Signature of Notary Public (PLACE NOTARY SEAL ABOVE) C-9 Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work, specifically referencing the construction of {Describe specific work and experience necessary for project. For example, "Sanitary sewer line installation of at least of 1,000 of 8-inch and greater in public right-of- way. Sanitary sewer lift stations of similar size, project work within public streets, an area containing high ground water and pipeline construction in high ground water regions with trench depths of 8-feet to the invert."}. 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: Name and Address of Public Agency Name and Telephone No. of Project Manager:�� Ii� 121 , Contract Amount c Type of ork Date completed 2. c�� Lk eai c� C. �r�lw�ftiy. cAi�cle, Name and Address of Public Agency Name and Telephone No. of Project Manager: �,oyo-, v}C� a� 4,nn -* J Contract Amount Type of Wor Provide additional project description to show similar work: [�1 r liii�h[� Date Completed 3. �yui'1), t; l;G�(l�P�.Y CSC ��Ala�l c ltic;�r�' Ifemar �Iilb Name and Address of Public\Aaencv Name and Telephone No. of Project Manager: ftp A" 1 o C A 117VA C Sl id" lei I S geCe+W Contract Amount Type of Work Date Completed Provide additional ro. c ,desc�i tion o show similar work: cif r✓ 6F c� C~ vv c L C-10 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. 1UM CE1a1.�v) Name of proposed Project Manager Telephone No. of proposed Project Manager: --i yao c YEA 2-0 Project Name & Contract Amount Type of Work Date Completed tIMONNA Project Name & Contract Amount Type of Work Date Completed Project Name & Contract Amount Type of Work Date Compld ed Name of proposed Superintendent Telephone No. of proposed Superintendent:-'�LL� vXkNll�wvv � A I CK � log - � #tic S�lrc�l �� w�v Project Name & Contract Amount Type of Work Date Completed Project Name & Contract Amount Type of Work vl(� Vt Project Name & Contract Amount Type of Work C-t 1 r Date Completed Date Comp CONTRACTOR REGISTRATION WITH CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS (DIR) CERTIFICATE Pursuant to SB 854 (citing Labor Code Section 1771.1(a)), passed by the California State Senate on June 20, 2014, established a new public works Contractor Registration Program, which requires all contractors and subcontractors bidding and performing work on Public Works Projects to register on an annual basis (each July 1 through June 30 state fiscal year) with the California Department of Industrial Relations (DIR). Currently the annual non-refundable registration fee for Contractors is $300. Each contractor to whom a public works contract has been awarded shall sign the following certificate. DIR FACT SHEET on SB 854 http://www.dir.ca.gov/DLSE/PublicWorks/SB854FactSheet-6.30.14.pdf DIR's Contractor Registration Link — Call (844) 522-6734 https:HefiI ing.dir.ca.gov/P WCR/ActionServlet?action=displayPWC RegistrationForm DIR's Contractor Registration searchable database: https:HefiIing.dir.ca.gov/PWCR/Search.action 1 am aware and will comply with the provisions of Labor Code Section 177 ] . ] (a) which states: "A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5. It is not a violation of this section for an unregistered contractor to submit a bid that is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the contractor is registered to perform public work pursuant to Section 1725.5 at the time the contract is awarded." I furthermore will comply by providing proof of registration with DIR as the primary contractor, as well as for ALL subcontractors at the time of submitting the bid. Date: n PWC Registration 4: lua� � r 5e1io OeMacg ( . Contractor Title C-12 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 requirements of Section 3 ofCFR 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:��('ICCi- Contact Person: Contact Phone:" !��J Signed: Dater 1 *Note: The above cer�fication 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-13 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder%, proposed subcontractor hereby certifies that he has >( . ...............has not participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 1 1 114, 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. C-14 PUBLIC CONTRACT C O D E 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 erjury 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 prosecutA. Signature/ X Print Name J Date PUBLIC CONTRXT CODE SEtAWIaN 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? D ZI Yes No If the answer is yes, explain the circumstances in the following space. C-15 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. Signature I ) Print Name Date C-16 Noncollusion >l av>l (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY of Huntington Beach 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 Non -collusion Aflidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. CPO Print Name Date C-17 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. NoN IC-7 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. 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. C-19 DISCLOSURE OF LOBBYING ACTIVITIES UUMI'LL I L I II IJ f UKM I U LWA-LUJL LUBB Y INU AU 11V I I ILJ VUKJUAN I I U 3I U JA: l3JL 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: Ra. contract Fla. bid/offer/application C a. initial b. erant b. initial award b. material ehanae e. cooperative agreement c. post -award d. loan \Nae tee ce ddress of Reporting Entity El Subawardec Tier if known Congressional Distric if known 6. Federal Department/Age 8. Federal Action Number, if known: 10. a. Name and Address of Lobby Entity (If individual, last name, first name, MI) For Material Change Only: year quarter date of last report 5. If Reporting Entity in No. 4 is Subaw rdee, Enter Name and Address of Prim Congressional xName/Descrip t, if known 7. Federal Progra CFDA N ber, if applicable 9. Awar Amount, if known: Individuals Performing Services (including address if different from No. IOa) (last name, first name, MI) /hk attach ontinuation Sheet(s) if necessary) 11. Amount of(check all tha pply) 13. 'type of Payme t (check all that apply) S ctual planned a. retainerb. one-time fcc 12. Form of Pk that apply): c. commission8 a. d. contingent fcc-kind; specify: nature e deferredvalue f. other, specify 14. Brief Descices Performed or to be performed and Date(s) of Service, including officer(s), r member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if necessary) 1/5.-Ctinuation Sheet(s) attached: Yes L1 No Fj 1ation 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 Nam AY) pursuant to 31 US C 1352 'this information will be JJ reported to Congress semiannually and will be available for '`, *6A09 public inspection Any person who fails to file the required Title: v disclosure shall be subject to a civil penalty of not less than - �J S10,000 and not more than $100,000 for each such failure. Telephone No.: Date: (,.-- VZ_17_ Federal Use C-20 Authorized for Local Reproduction Standard Form - LLI. 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 tiling pursuant to title 31 U.S.C. section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered Federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. l . Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered Federal action. 2. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardce, 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 I ). 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 I (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 officcr(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-LIA-Instructions Rev 06-04-90«ENDIF» C-21 Local Assistance Procedures Manual Exhibit 15-G Construction Contract DBE Commitment EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT 1. Local Agency: City of Huntington Beach 2. Contract DBE Goal: 10.00% 3. Project Description: Traffic Signal Modifications at Gothard St/Talbert/Av, Gothard St/Heil Av, Springdale St/McFadden 4. Project Location: Gothard St/Talbert/Av, Gothard St/Heil Av, Springdale St/McFadden Av. 5. Bidder's Name: !EAmr-WkVaA-fins , 6. Prime Certified DBE: ❑ 7. Bid Amount: 8 Total Dollar Amount for ALL Subcontractors. 9. Total Number of ALL Subcontractors: 10. Bid Item 11. Description of Work, Service, or Materials 12. DBE Certification 13. DBE Contact Information 14. DBE Dollar Number Supplied Number (Must be certified on the date bids are opened) Amount 1�-12 r1CCC11�\�plr�s �o rNA'C ,, ��2' 2T,�co. 00 6.VIN CA 2k �,s lanes- 3003 r L_L � �.3 Z3b.oc ,VA t{64tit , / °x Local:Agencyyto Comjilete t_his.Sec_ tion $ �� `T, CD 21. Local Agency Contract Number.CC-1465 15. TOTAL CLAIMED DBE PARTICIPATION 22. Federal -Aid Project Number HSIPL-5181(178) 23. Bid Opening Date: P 24. Contract Award Date: IMPORTANT: Identify all DBE fines being claimed for credit, regardless of tier. Names of the First Tier DBE Subcontractors and their respective item(s) of work listed above must be consistent, where applicable with the names and items of the work in the Local Agency certifies that all DBE certifications are valid and information on "Subcontractar List" submitted with your bid. Written confirmation of this form is complete and accurate. erteDrequired.25. Local AgencyRepresentative's Signature 26. Date gnat a 17. Date 9uqqq3— �27. Local Agency Representative's Name 28.Phone ame 19. Phone �1 CL WP�i� 29. Local Agency Representative's Title 20. Preparer's Title DISTRIBUTION: 1. Original — Local Agency 2. Copy — Caltrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract execution may result in de -obligation of federal funds on contract. Include additional copy with award package. ADA Notice: For individuals with sensory disabilities, this document is available in alternate formats For information call (916) 654-6410 or TDD (916) 654- 3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814 Page I of 2 C-22 Local Assistance Procedures Exhibit 12-B Bidder's List of Subcontractors (DBE and NON -DBE) Exhibit 12-B Bidder's List of subcontractor (DBE and Non -DBE) Pa rt 1 As of March 1. 2015 Contractors [and sub -contractors] wishing to bid on public works contracts shall be registered with the State Division of Industrial Relations and ccitilied to bid on Public Works contracts. Please: register at: https:llefiIing.dir.ca.gov/PWCRIActionServlet?act{on=displayPWCRegistrationForm In accordance with Title 49, Section 26.11 of the Code of Federal Regulations, and Section 4104 of the Public ContractCode of the State of California, as amended, the following information is required for each sub -contractor who will perform work amounting to more than one half of one ttercent (0.5%) of the Total Base Bid or $10,000 (whichever is greater). Photocopy this form for additional firms, Subcontractor Name and Location Line item & Description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor License Number DBE (YIN) DBE Cert Number Annual Gross Receipts DIR Reg Number Name: � A ti {r&J ►"ai'i{ALT KD 1 1 � j r 2 {��i✓7'.3 <$1 million c smillion City, State: [,A <$10 million <$15 million of Firm:_Qyrs. Name: — '�, ` i t 1 e r �fG' e51 million <$5 millionA City, State: rr �IXf5iP C� 14` iJt✓ ! l i <$10 million <$15 million ge of Firm; yrs. Name; <$1 million t$5 million El City, State: E$10 million <$15 million e of Firm:lyrs. Name:_-- ,�' L.L.• j }# f 'C F + ]) IGI f L L n j+ j J C , 3 65 2`! �� ^s 1 million c$5 million El City, state: /NLj 79 a$10 million <$15 million Age of Firm: rs. Name' c$1 million <$5 million City, State: c$10 million Lj c$15 million Age of Firrn:_yrs. Name: c$1 million <$5 million City, State: <$10 million <$15 million Age of Firm:_yrs. Distribution: 1) Original -Local Agency File 2) Copy-DLAE wI Award Package Page 26 of 2 Local Assistance Procedures Exhibit 12-B Bidder's List of subcontractors (DBE and NON -ODE) I - B Bidder's List of subcontractor (DBE and Non -DBE) Fart 2 In accordance with Title 49, Section 26 of the Code of Federal Regulations, the Bidder shall list all subcontractor who provide a quote or bid but were not selected to participate as a subcontractor on this project. Photocopy this form for additional firms. Subcontractor Name and Location Line Item & Description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor License Number DBE (Y/N) DBE Cert Number Annual Gross Receipts AIR Reg Number Name: 7 i L �(�'� $�1� f ^�� �i 7ZcV 1 <$1 million <S5 million City, State: A r�� l.J t ! <$10 million <$15 million A e of l irm: yrs. Na e: t tl j ' - CtC IQ lriL ] 5 (. �k"hL LOP pj p �t tp � Cf - 1 million <$5 million City, State: .f f,,,'}`-l� 1� �1' f {74�1 �yl C? lion <$1S million Age of Firm: a rs. Name: <$1 million 5 million City, State:. <$10million <$15 million Age of Firm:_yrs. Name; <$1 million < 5 million City, State: <$10 million <$15 million Age of Firm;_yrs. Name: < 1 million < 5 million City, State: <$10 million <$15 million Age of Firm:-yrs. Name: <$1 million e 5 million City, State: <$10 million <$15 million A e of firm; Yrs, Distribution: 1) Original -Local Agency File 21 Copy-DLAE w/ Award Package Page 27 of 2 Bond Number Bid Bond Oblicee: Cite of Huntinaton Beach ZL,RICEI AMERICAN LNSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KN10`N ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by Michael P. Bond, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Stacy Rivera , its true and lawful agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as it act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH .AMERICAN INSURANCE COMPANY at its office in New York, New York_, the regularly elected officers of the COLONIAL AMERICAN' CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V. Section 8, of the By -Laws of said Companies, and is now in force. IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his./her names and affixed the Comorate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 22❑d day of July, A.D. 2015. o By: Michael P. Bond Vice President Br: Eric D. Barnes secretan, State of Maryland County of Baltimore ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND 04? cg low 'P4 OEtOs,i Ytnt �� a On this 22nd day of July, A.D. 2015, before the subscriber, a Notary Public of the State of Marvland, duly commissioned and qualified, Michael P. Bond, Vice President and Eric D. Barnes, Secretary of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowiedeed the execution of same, and being by me duly sworn, deposeth and saifn, that he/she is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. Constance A. Dunn. Notary Public '`)� My Commission Expires: July 9, 2019 +nt"``� EXTRACT FROfPt BY -LAMS OF THE COMPANIES "Article V, Section 8, Attornevs-i-:-Fact. The Chief Executive Officer, the President, or any Execu.ive Vice. President or Vice President may, by written instrument under the attested corporate seal, appoint attorneys -in -fact with Lufhoriry to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney -in -fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any 'Lime." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of the By -Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the I Sth day of December 1998, RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney ... Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the Sth day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seats of the said Companies, this 2nd day of Atiaust 201 *� CEppf� pliIKS(r, _ �7 SEAL I4W ? ' V 766g /a i sam a Gerald F. Haley, Vice President TO REPORT A CLAIM WITH REGARD TO A SURETA' BOND, PLEASE SLiBMIT ALL REQIiI=RED INFORMATION TO: Zurich American Insurance Co. Attn: Surety Claims 1299 Zurich Way Schaumburg, IL 60196-1056 AIA Document 310 - 2010 Bid Bond CONTRACTOR CName, legal status and address): SURETY (Name, legal status and principal place of business): Elecnor Belco Electric, Inc. Fidelity and Deposit Company of Maryland 14320 Albers Way 1299 Zurich Way, 5th Floor Chino, CA 91710 Schaumburg, IL 60196-1056 OWNER (Name, legal status and address): City of Huntington Beach 2000 Main Street Huntington Beach, CA 92648 Bond Amount: 10% Ten Percent of Amount Bid PROJECT: (Name, location or address, and Project number, if any): Traffic Signal Modifications at the intersections of Gothard Street and TalbertAvenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue; CC No. 1465 The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters in to a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed by the Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this ,Bond shall be construed as a statutory bond and not as a common law bond. Signed and sealed this 2nd day of August 2017 Elecnnorr Belco/Electric, Inc. (Witness) (Seal) (Prin�ipal) t (Seal) 11EPO��� Fideli mpany of Maryland (Witness) Donna Planeta ,, Z 0 urety) .fir f� By: I>14Q itle) Stacy Riv Attorney -in -Fact Language conforms to AIA Document A310 Bid Bond BID7000IZZ031 if ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of I*Mw County ofa, An R%'nyy� lino } On U u before me, �JC�a I fttaQ �tti C ere insert name and title of Me o cer) personally appeared �,)= `( M who proved to me on the basis of satisfactory evidence to be the person(s) whose name(a) Is re subscribed to the within instrument and acknowledged to me that (ii�the/they executed the same in lger/their authorized capacity(ies), and that by (Ewer/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. »» OLIVIA CHEA WIT S m hand rid official seal 5k:: .%r�\�: Commission No.2107474 Zl'° NOTARY PUBLIC-CALIFORNIA SAN BERNARDINO COUNTY My Comm. Expires APRIL 18, 2019 Nota lic Nr6ature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or descrption of attached document continued) Number of Pages Document Date CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attomey-in-Fact ❑ Trustee(s) ❑ Other )f:15';�rsiv4,,,!`lotary'_lasses INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, f needed, should be completed and attached to the document. Acknolwedgents from other states may be completed for documents being sent to that state so long as the hording does not require the California notary to violate California notary law. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e he/she/they; is /afe ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photograptucally reproducible Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document { Indicate title or type of attached document, number of pages and date ri Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i e. CEO, CFO, Secretary) • Securely attach this document to the signed document with a staple. ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. Connecticut State of County of Hartford ) On 8/2/2017 before me, Joshua Sanford, Notary Public (insert name and title of the officer) personally appeared Stacy Rivera 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. Signatu (Sea[) JOSHUA SANFORD NOTARY PUBLIC -173©58 MY COMMISSION EXPIRES DEC. 31, 2021 . belco elemor group 14370 Albers Way Chino, CA 91710 909-993-5470 / 909-993-5476 City of Huntington Beach 2000 Main Street Huntington Beach, CA 92548 RECEIVED 2017 AUG 22 PH I= 55 MY CLERK CITY OF HUNTINGTON BEACH PROJECT NAME: Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue CC No. 1465 BID DATE: August 22, 2017 BID TIME: 2:00PM *SEALED BID. DO NOT OPEN WITH REGULAR MAIL* City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Robin Estanislau, City Clerk January 31, 2018 California Professional Engineering, Inc. 929 Otterbein Ave. Unit E La Puente, CA 91748 RE: Traffic Signal Modifications at Gothard St.& Talbert Ave./Gothard St. & Heil Ave./Springdale St. & McFadden Ave. — CC-1465 Enclosed please find your original bid bond for CC-1465. Sincerely, Robin Estanislau, CIVIC City Clerk RE:ds Enclosure Sister Cities. Anjo, Japan ♦ Waitakere, New Zealand I SECTION C PROPOSAL for the construction of Traffic Signal Modifications from At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue And Springdale Street and McFadden Avenue CC No. 1465 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 60 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications.. Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find Bidder's Bond for 10% 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: / n Addenda No. Date Received 's Si ure / 1 8/22/2017 I/ I C-z SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE BID ITEMS Item Description;`., Quantity Unit Unit Cost Total Cost. -. No. (Extension)- 1 Mobilization 1 LS 2 Furnish Project Traffic Control 1 LS $ Q, CSi30 $ q- 00 O 3 Furnish and Install Traffic Striping and Signing 1 LS 4 Preparation of WPCP and installation and of Maintenance of 1 LS BMP's per the approved WPCP. Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case A and Typical Section at New Curb Ramps 5 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 2 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc) $ ID, I ZO Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case B and Typical Section at New Curb Ramps 6 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 1 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated, domes, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case C and Typical Section at New Curb Ramps 7 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 5 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.) Excludes the Northeast corner of Gothard Street and Heil Avenue. $ I Oi I �,O $ s;-0, 6 0 b Construct Curb Ramps, Truncated Domes, Sidewalk, Curb and Gutter and Railing at the Northeast Corner of Gothard 8 Street and Heil Avenue and per Detail on Sheet 5. (Item 1 LS includes all appurtenances, curb and gutter, depressed curb, sidewalk, railings, truncated domes, retaining curb, slot pave, etc.) Construct Curb, Access Ramps and Concrete Sidewalk on the Raised Island at the Southwest quadrant of the Intersection of 9 Springdale Street and McFadden Avenue. See the Details on 1 LS Sheet 5. (Item includes all appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.) US-b $ IT oS(> 10 Modify Traffic Signal at Gothard Street and Talbert Avenue. Item includes in included in items. 1 LS $��_r'1_. $ ZU�i �� all work plans not other 11 Modify Traffic Signal at Gothard Street and Heil Avenue. Item includes all work in plans not included in other items. 1 LS $ I%0, 6 '6 $ I i A 7`� 12 Modify Traffic Signal at Springdale Street and McFadden Ave. Item includes all work in plans not included in other items. 1 LS $ �3%. $ �2, { 3 Z C-2.1 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE Item Description Unit, .= Unit"Cost.` :,�`� Total.Co§t No. ,Ouantity (Extension) TOTAL BID AMOUNT 0t Note. Refer to Section 9, Measure and Payment. All extensions of unit prices will be subject to verification by Owner. In case verification is required between the unit price and the extension, the unit price will govern. The Owner reserves the right to reject any or all proposals and bid items. The City will provide the traffic signal equipment, as listed in the pole schedules, (also includes anchor bolts) to the contractor. The contractor is to pick up the materials, with its own labor, at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 536-5530. C-2.2 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 or $10,000, whichever is greater, and the portion of the work to be done by such subcontractor. Bid Item(s) Name and Address of Subcontractor State License Number Class DIR PWC Registration # Dollar Amount % of Contract Suger iON . k6LY��� 5 CyefeSS S� . eYPress, CA- I o6 So 776 Sob C-311 C —57-t c I 1000006 7 1 S, —J Lj P (, 2 A�vaw�ay2 133 i 5 ( "^Q540A V�-Ao\jMQ CR-q,231Z o 9, C41 JpooD5-o7?_f, 470 z% S-1 Ca.w 64,01S t cbn, c� 2�s t °l 2670?5 X i C—LZ la boo 1 PS ( f2 R 60 3 By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID 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 8/22/17 , at La Puente CA Date City State Van Nguyen being first duly sworn, deposes and says that he or she is President of California Professional Engineering, 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. California Professional Engineering, Inc. Name of Bid Signature of Bidder 929 Otterbein Avenue, Unit E, La Puente, CA 91748 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 Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue, (1)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person ivho, 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: 8/22/2017 California Professional Engineering, Inc. Contracto►\ By President Title C-5 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 IdNo If the answer is yes, explain the circumstances in the space provided. n/a 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: 8/22/2017 California Professional Engineering, Inc. Contractor /*,—� President Title C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: California Professional Engineering, Inc. Bidder Name 929 Otterbein Avenue, Unit E Business Address La Puente CA 91748 City; State Zip ( 626 ) 810 1338 van@cpengineeringinc.com Telephone Number Email Address 793907 A, C-10 State Contractor's License No. and Class 04/16/2001 0 1ina10 ate Issued /20 Expiration Date The work site was inspected by Van Nguyen of our office on August 18 . 201 7 The following are persons. firms, and corporations having a principal interest in this proposal: Van Nguyen of California Professional Engineering, Inc. President, Secretary, I reasurer 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. California Professional Engineerii Company Name Signature of Bidder Van Nguyen Printed or Typed Signature C-8 NOTARY CERTIFICATE Subscribed and sworn to before me this day of , 201_ 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 ) County of ) Oil Month, Day, and Year personally appeared before rne. Insert Name and Title of Notary Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose narne(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 Signature of Notary Public C-9 (PLACE NOTARY SEAL ABOVE) *PLEASE SEE ATTACHED.* dState of California �+ Los Angeles SS' 4 ♦ County of 4 6 22nd August 17 4 Subscribed and sworn to (or affirmed) before me on this day of 20 , by 4 Van Nguyen proved to me on the basis of satisfactory evidence p ♦ 0 4 to be the person(si who appeared before me. ♦ ♦ 0 2042313 4 U� ='�»3� 9 'f ..",JiR PU3LIG-CAUFORNIA ♦ \' 41T Los A.1GE(ES COONTY 0 MY Coale, EXP SEP 21, 2017 � NOTARY'S SIGNATURE ♦ A notary public or other office completing this certificate verifies only the identity of the individual who signed the document ♦ to which this certificate is attached. and not the truthfulness. accuracv. or validity of that document. ♦ PLACE. NOTARY SEAL IN ABOVE SPACE OPTIONAL. INFORMATION b � ♦ The information below is optional. However, it may prove valuable and could prevent fraudulent attachment O ♦ of this form to an unauthorized document. 6 ♦ CAPACITY CLAIMED BY SIGNER (PRINCIPAL,) DESCRIPTION OF ATTACHED DOCUMENT � ❑ INDIVTDUAI_ Q CORPORATE OFFICER President Secretary- Treasurer, Manager TITLE OR TYPE OF DOCUMENT � ❑ PARTNER(S) 'IITLE(s) Q a❑ ATTORNEY -IN -FACT 4 d ❑ TRUSTEE(S) NUMBER OF PAGES ❑ GUARDIAN/CONSERVATOR 0 ® ❑ OTHER: DATF OF DOCUMENT A ♦ 0 0 � OTHER 0 ABSENT SIGNER (PRINCIPAL) IS REPRESENTING: RIGHT 0 NAAME OF PERSON1s)ORENTIMJESI THUMBPRINT OF California Professional Engineering, Inc. _ SIGNER d 0 0 4 4 0 0 � 4 � �t9v8®6a0�E?®IV, ICP ell Oaoo6>C+-k9-�0�dG►d4�o®od'd®®IV, ®®mO O45%41P01& ao®A0,0 10ii200s NOT:ARYBONDS.StiPPLILSANDPORNISATHTTP:/iWWV1'.A'ALLEY-SIF.i?RA('ONI )2C,(i5-200RVALLEI SIF.RRAINSliI2AN('F. Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work, specifically referencing the construction of {Describe specific work and experience necessary for project. For example, "Sanitary sewer line installation of at least of 1,000 of 8-inch and greater in public right-of- way. Sanitary sewer lift stations of similar size, project work within public streets, an area containing high ground water and pipeline construction in high ground water regions with trench depths of 8-feet to the invert."}. 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: Please see attached. Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Please see attached. Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Please see attached. Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed Provide additional project description to show similar work: C-10 929 Otterbein Ave., Unit E La Puente, CA 91748 Ph: (626) 810-1338 Fax: (626) 810-1322 www.cpengineeringinc.com Cal'ifomia Professional Engineering, Inc: - Traffic Signal -Job References PMECTS: Traffic Signal Improvements at Pasadena Ave & Walnut St Amount: $110,684.96 Owner: City of Pasadena Owner Address: 100 N. Garfield Ave Pasadena, CA 91109 Project Manager: John Ramey Contact Phone #: (626) 744-6912 Fax #: (626) 396-7986 Status: Completed Approximate Start/End Dates: August 2015-Jan 2016 Description of Supplies, Equipment, or Services Provided: Installation of Conduit, Pull Boxes, Loop Detectors and Bicycle Loop Detectors, Traffic Signal & Poles, Cabinet & Controller. Traffic Signal Modification Raitt Street at Adams Street Amount: $707,855.63 Owner: City of Santa Ana Owner Address: 20 Civic Center Plaza Santa Ana, CA 92701 Project Manager: Edward Torres Contact Phone #: (714) 647-5029 Fax #: (714) 647-5622 Status: Completed Approximate Start/End Dates: April 2015-Aug 2015 Description of Supplies, Equipment, or Services Provided: Installation of Conduit, Pull Boxes, Communication Equipment, Loop Detectors, Fiber Optic, Cable, Preemption System, Cabinet & Controller, Access Ramps, and Striping & Markings. Lincoln Avenue and Westchester Drive Traffic Signal System Improvement Project Amount: $227,460.00 Owner: City of Anaheim Page 1 of 4 Document L asl Updrued 415/2016 Owner Address: 200 South Anaheim Blvd Anaheim, CA 92805 Project Manager: Robert Palaeologus Contact Phone #: 714-765-5285 Status: Completed Approximate Start/End Dates: September 2014 — November 2014 Description of Supplies, Equipment, or Services Provided: Installation of Conduit, Pullboxes, Traffic Signal, Poles, Illuminated Street Name Signs, HPS Luminaires, Loop Detectors, LED Countdowns, Cabinet & Controller, Access Ramps, Median Nose, Striping & Markings. Traffic Signal Modification at Euclid Street & County Hills Drive Amount: $109,942.80 Owner: City of La Habra Owner Address: 201 East La Habra Blvd La Habra, CA 90633 Project Manager: Sam Makar Contact Phone #:.562-383-41.58 Status: Completed Approximate Start/End Dates: June 2014 —August 2014 Description of Supplies, Equipment, or Services Provided: Installation of Conduit, Pullboxes, Traffic Signal, Poles, Illuminated Street Name Signs Relocation, Signals, Pedestrian Push Buttons, Cabinet Modification, LED Flashing Beacons. San Gabriel Blvd, et. al TSM0010049 Amount: $1,463,453.23 Owner: County of Los Angeles Department of Public Works Owner Address: 900 South Fremont Ave Alhambra, CA 91803 Project Manager: Abigail Flores Contact Phone #: (626) 458-3157 Status: Completed Approximate Start/End Dates: Jan 2013 — March 2014 Description of Supplies, Equipment, or Services Provided: Installation of Conduit, Pullboxes, Traffic Signal, Interconnect Cable, Communication Equipment, Loop Detectors and Bicycle Loops, Fiber Optic, Reflective Street Name Signs, Illuminated Street Name Signs Relocation, Curb Ramps and Preemption System. Tustin Street & Palm Avenue Left Turn Signal Modification Amount: $179,527.00 Owner: City of Orange Owner Address: 300 East Chapman Ave Orange, CA 92866 Project Manager: Medel Vanes Contact Phone #: (714) 744-5535 Fax #: (714) 744-5573 Page 2 of 4 Docnwenl Las! Upcluled 41V20/6 Status: Completed Approximate Start/End Dates: Nov 2013-Jan 2014 Description of Supplies, Equipment, or Services Provided: Modify Traffic Signal at One Intersection along with Traffic Control, LED Illuminated Street Name Signs, Install New Cabinet, Safety Lighting, Loops, Vehicle Pre-emption System, Sidewalk Access Ramps & Traffic Signal Heads. Woodruff/Washburn Traffic Signal Amount: $156,697.58 Owner: City of Downey Owner Address: 11111 Brookshire Ave Downey, CA 90241 Project Manager: Keith Hoey Contact Phone #: (562) 622-5898 Fax #: (562) 904-7296 Status: Completed Approximate Start/End Dates: Apr 2013-Aug 2013 Description of Supplies, Equipment, or Services Provided: Upgrading Traffic Signal at Intersection, Trenching, Conduit Runs, and Installation of LED Safety Lighting. Traffic Signal Modification at Brookhurst Amount: $237,213.67 Owner: City of Huntington Beach Owner Address: 2000 Main Street Huntington Beach, CA 92648 Project Manager: John Griffin Contact Phone #: (714)375-5011 Fax #: (714) 374-1648 Status: Completed Approximate Start/End Dates: March 2011-Sept 2011 Description of Supplies, Equipment, or Services Provided: Modify Traffic Signal at Multiple Intersections along with Traffic Control, Installation of Curb Ramps & Traffic Signal Heads, and Monument Preservations. Traffic Signal System Upgrade Phase V-VIII Amount: $292,175.99 Owner: City of Santa Ana Owner Address: 20 Civic Center Plaza Santa Ana, CA 92701 Project Manager: William Albright Contact Phone #: (714) 647-5029 Fax #: (714) 647-5622 Status: Completed Approximate Start/End Dates: Jan 2011-Aug 2011 Description of Supplies, Equipment, or Services Provided: Installation of Conduit, Pullboxes, Traffic Signal, Interconnect Cable, Communication Equipment, Page 3 of 4 Document Lust Updates! 41512016 Loop Detectors and Bicycle Loops, Fiber Optic, Cable, Signal Heads, CCTV System, and Preemption System. Traffic Signal at Various Locations HSIPL 5331(017) & HSIPL 5331(010) Amount: $507,840.79 Owner: City of La Puente Owner Address: 15900 East Main Street La Puente, CA 91744 Project Manager: Jason Brown, Willdan Contact Phone #: (562) 908-6222 Status: Completed Approximate Start/End Dates: June 2012 — March 2013 Description of Supplies, Equipment, or Services Provided: Installation of Conduit, Pullboxes, Traffic Signal, Loop Detectors and Bicycle Loops, Curb Ramps and Preemption System. 201h Street & Cherry Ave Traffic Signal Amount: $247,540.60 Owner: City of Signal Hill Owner Address: 2175 Cherry Ave Signal Hill, CA 90755 Project Manager: Natalie Avila, RKA Group Contact Phone #: (909) 594-9702 Fax #: (909) 594-2658 Status: Completed Approximate Start/End Dates: Feb 2013 — Sept 2013 Description of Supplies, Equipment, or Services Provided: Installation of Conduit, Pullboxes, Traffic Signal, Interconnect Cable, Communication Equipment, Loop Detectors and Bicycle Loops, Fiber Optic, Curb Ramps and Preemption System. Page 4 of 4 Documew Laav Updcaed 41512016 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. l , Diem Chu, Project Manager Name of proposed Project Manager Telephone No. of proposed Project Manager: 626 810 1338 x 102 Clty of Santa Ana Raitt St/Adams St $707,855.63 Traffic Signal Installation August 2015 Project Name & Contract Amount Type of Work Date Completed LA County - San Gabriel Blvd Traffic Signal Modifications $2.2 Million July 2017 Project Name & Contract Amount Type of Work Date Completed LA County - Aviation Blvd Traffic Signal Modifications $1.3 Million August 2017 Project Name & Contract Amount Type of Work Date Completed 2 Van Nguyen, Superintendent Name of proposed Superintendent Telephone No. of proposed Superintendent: 626 810 1338 x 103 Clty of Santa Ana Raitt St/Adams St $707,855.63 Traffic Signal Installation August 2015 Project Name & Contract Amount Type of Work Date Completed LA County - San Gabriel Blvd Traffic Signal Modifications $1.2 Million July 2017 Project Name & Contract Amount Type of Work Date Completed LA County - Aviation Blvd Traffic Signal Modifications $1.3 Million August 2017 Project Name & Contract Amount Type of Work Date Completed G11 CONTRACTOR REGISTRATION WITH CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS (DIR) CERTIFICATE Pursuant to SB 854 (citing Labor Code Section 1771.1(a)), passed by the California State Senate on June 20, 2014, established a new public works Contractor Registration Program, which requires all contractors and subcontractors bidding and performing work on Public Works Projects to register on an annual basis (each July 1 through June 30 state fiscal year) with the California Department of industrial Relations (DIR). Currently the annual non-refundable registration fee for Contractors is $300. Each contractor to whom a public works contract has been awarded shall sign the following certificate. DIR FACT SHEET on SB 854 http://www.dir.ca.gov/DLSE/PublicWorks/SB854FactSheet_6.30.14.pdf DIR's Contractor Registration Link — Call (844) 522-6734 https://efiling.dir.ca.gov/PWCR/ActionServlet?action=displayPWCRegistrationForm DiR's Contractor Registration searchable database: https://efiling.dir.ca.gov/PWCR/Searcii.action I am aware and will comply with the provisions of Labor Code Section 1771.1(a) which states: "A contractor or subcontractor shall not be qualited to bid on, be listed in a bid proposal.. subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5. it is not a violation of' this section for an unregistered contractor to submit a bid that is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the contractor is registered to perform public work pursuant to Section 1725.5 at the time the contract is awarded." i furthermore will comply by providing proof of registration with DiR as the primary contractor, as well as for ALL subcontractors at the time of submitting the bid. Date: 8/22/2017 PWC Registration #: 1000001980 California Professional Engineering, Inc. Contractor n / President Title C-12 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): VN Will ensure that 10% of all new hires as a result of this project shall meet all requirements 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: California Professional Engineering, Inc. Contact Person: Van Nguyen Contact Phone: 626 810 1338 Signed: Date: 8/22/2017 *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-13 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION California Professional Engineering, Inc. The bidder proposed subcontractor hereby certifies that he has ...............has not participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 1 1 114, 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. C-14 PUBLIC CONTRACT C O D E 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 p jury 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 oft is tatement. Bidders are cautioned that making a false certification may subject the certifier to criminal prose it Van Nguyen 8/22/2017 Sint ure Print Name Date 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? 7 Yes No If the answer is yes, explain the circumstances in the following space. C-15 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. f Van Nguyen 8/22/2017 Signature Print Name Date C-16 Noncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code,Section 7106) To the CITE' of Huntington Beach 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 Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Van Nguyen 8/22/2017 Signature II Print Name Date C-17 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. n/a 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. Van Nguyen 8/22/2017 Signature I/ Print Name Date C-18 NONLOBBVING 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. C-19 DISCLOSURE OF LOBBYING ACTIVITIES K A UUMI'LL IL I1-1IS I'UKM IU llIJULUDL LULSIiYIINIi A(- I IVII ILJ 1'tJKMJAIN I IU J I U NA- IJDG 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: F]b a. contract Fla. bid/offer/application F a. initial . eranl b. initial award b. material chance 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 Subaivardee, Enter Name and Address of Prime: El Primc Subawardee 'I'icr . if'known Congressional District, if'known 6. Federal Department/Agency: 8. Federal action Number, it known: 10. a. Name and Address of Lobby Entity (If individual, last name, first name. MI) Congressional District, ifknown 7. Federal Program Name/Description: CFDA Number, il'applicable 9. Award Amount, if known: b. Individuals Performing Services (including address ifdifficrent from No. I0a) (last name. first name. MI) (attach Continuation Sheet(s) ifnecessary) II. .amount of Payment ((check all that apply) 13. "Type of Payment (check all that apply) S I I actual planned a. retainer b. one-time fee 12. Form of Payment (check all that apply): c. commission a. cash d. contingent fee b. in -kind; specify: nature e delerred value _ f: other. specity 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including oflicer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 1 l: (attach Continuation Shcct(s) ifncccssarv) 15. Continuation Sheet(s) attached: Yes El No 9 16. Information requested through this form Is authorized by 'title 31 U S C Section 1352. '['his disclosure of lobbying reliance was placed by the tier above when his transaction %+as made or entered into '['his disclosure is required pursuant to 31 U S C 1352 ']']iis information will be reported to Congress ,emlannualhv and will be available for public inspection Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10.000 and not more than $100,000 for each such faik ire Federal Use Only: Signature: V 1'rint Name: Van Nguyen Title, President Telephone No.: —Date: Authorized for Local Reproduction Standard Dorm - 1,11, C-20 INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES "this disclosure form shall he completed by the reporting entity. whether suhawardee 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. Identifv1 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. Identifv the status ofthe covered Federal action. 3. Identifv the appropriate classification of this report. Willis 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 suhmitted 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 he a prime or subaward recipient. Identify the tier of the subawardee. e.g., the first suhawardee of the prime is the first tier. Suhawards include but are not limited to subcontracts, suhgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Suhawardee" then enter the full name. address. city, state and zip code of the prime Federal recipient. Include Congressional District. if known. 6. Fnter 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. Lnter 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. I?nter the most appropriate Federal identifying number available for the Federal action identification in item I (e.g., Rcqucst for Proposal (RIP) 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.. "RIP-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 lobby' 2 entity engaged by the reporting entity identified in item 4 to influenced the covered Federal action. (h) 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). 1 I . Enter the amount of compensation paid or reasonably expected to he paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will he 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 lohbyist has performed or will he 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 employce(s) contacted or the officer(s) employce(s) or Memher(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. 16. The ccrti tying 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. sr-1,r.L [muuoons a,, o6-a-9o«EINDrr» C-21 Local Assistance Procedures Manual Exhibit 15-G Construction Contract DBE Commitment I EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT 1 Local Agency: City of Huntington Beach 2. Contract DBE Goal: 10.00% 3. Project Description: Traffic Signal Modifications at Gothard St/Talbert/Av, Gothard St/Heil Av, Springdale St/McFadden 4. Project Location: Gothard SUTalbert/Av, Gothard St/Heil Av, Springdale St/McFadden Av. 5. Bidder's Name: California Professional Engineering, Inc. 6. Prime Certified DBE: VF 7. Bid Amount: 1q -7 8. Total Dollar Amount for ALL Subcontractors: 4 I `b f 9. Total Number of ALL Subcontractors: 10. Bid Item 11. Description of Work, Service, or Materials . 12DBE Certification 13. DBE Contact Information 14. DBE Dollar Number Supplied Number (Must be certified on the date bids are opened) Amount U 2,,/o, (� Lu���9YV15'F �w�eSs�ua` 1�)AS(_VaV,-k5 #,C r ,f 7 r4A) cc� w� W 27 dZR o I�erbeik Rom, (� ue� CA IIN 1502 Agency to Complete this Section ZS() 0 21. Local Agency Contract Number:CC-1465 15. TOTAL CLAIMED DBE PARTICIPATION 22. Federal -Aid Project Number: HSIPL-5181(178) 23. Bid Opening Date: {�3 24. Contract Award Date: IMPORTANT: Identify all DBE firms being claimed for credit, regardless of tier. Names of the First Tier DBE Subcontractors and their respective item(s) of work listed above must be consistent, Local Agency certifies that all DBE certifications are valid and information on where applicable ith the names d items of the work in the "Subcontractor Lis ubmltted with your bid. Written confirmation of this form is complete and accurate. each listed D$E is resul I 8/22/2017 25. Local Agency Representative's Signature 26. Date 16. Preparer' S ature 17. Date Van Nguyen 626 8101338 27. Local Agency Representative's Name 28. Phone 18. Preparer's Name 19. Phone President 29 Local Agency Representative's Title 20. Preparer's Title DISTRIBUTION: 1. Original — Local Agency 2. Copy — Caltrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract execution may result in de -obligation of federal funds on contract. Include additional copy with award package. ADA Notice: For individuals with sensory disabilities, this document is available in alternate formats For information call (916) 654-6410 or TDD (916) 654- 3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. Page I of 2 jully1j 2015 C-22 Local Assistance Procedures Manual Exhibit 15-H DBE Information - Good Faith Effort EXHIBIT 15-H DBE INFORMATION —GOOD FAITH EFFORTS DBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. HSIPL-5181 (178) Bid Opening Date 8/22/2017 The established a Disadvantaged Business Enterprise (DBE) goal of 10.00% 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 e are 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 DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation *We are DBE* C-23 Local Assistance Procedures Manual Exhibit 15-H 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 ($) Of (Y/N) Contract *We are DBE* 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: *We are DBE* Names, addresses and phone numbers of firms selected for the work above: *We are DBE* 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: *We are DBE* C-24 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: *We are DBE* 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 *We are DBE* H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): *We are DBE* NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. C-25 Local Assistance Procedures Exhibit 12-B Bidder's List of Subcontractors (DBE and NON -DBE) Exhibit 12-B Bidder's List of subcontractor (DBE and Non -DBE) Part 1 As of March I, 2015 Contractors {anti sub -contractors} wishing to bid on public works contracts shall be registered with the State Division of Industrial Relations and certified to bid on Public Works contracts. Please register at: https:/lefiIing.dir.ca.gov/PWCR/ActionSeMet?action=displayMCRegistrationForm In accordance with Title 49, Section 26.11 of the Code of Federal Regulations, and Section 4104 of the Public Contract Code of the State of California, as amended, the following infortnation is required for each sub -contractor who will perform work amounting to more than one half of one Dercent (0.5%) of the Total Base [aid or $1 0,000 (whichever is greater). Photocopy this form for additional firms. Subcontractor Name and Location tine Item & description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor License Number ORE tY/O DBE Cert Number Annual Gross Receipts DIR Reg Number Name: V S rSf�f of 4 [° r7 �i 0 i <51 million c 5 million City, State: c��'f'�SjI C Pr- f UOU0 4 I�1 `f, t$10 million c$15 million .vf Firm: I yrs. Name: 4i i4 Ji G +�A pti>L11G1h } Utz Q if +^+� 1 `�p l�LfaiL A 4 �7 f 6! �� q �` a 2 `T a$1 million El ¢$5 million City, State. J V .`G °{Ili�lP CA obbt) ¢$10 million c$15 million —4ge of Firm: °I yrs. Name: ff vi l i+V IvytQ x "; k` - <$1 million ¢$5 millionAAk City, State: Q {" 01 I U (}b t} b (uSrAgI <$10 million <$15 million e of Firm:(&yrs. Name: <$1 million <$5 million City, State: =$10 million =$15 million Age of Firm: yrs. Name: t. * .? LJ <$1 million <$5 million City, State: :$10 million e$15 million Age_ of Firm:yrs. Name:'.Li<$1 million <$5 million City, State: �$10 million c$15 million Age of Firm: rs. Distribution: 1) original -Local Agency File 2) Copy -DIRE w/ Award Package Page 26 of 2 Local Assistance Procedures Exhibit 12-B Bidder's List of Subcontractors (DBE and NON -DBE) - B Bidder's List of subcontractor (DBE and Non -DBE) Part 2 In accordance with Title 49, Section 26 of the Code of Federal Regulations. the Bidder shall list all subcontractor who provide a quote or bid but were not selected to participate as a subcontractor on this project. Photocopy this form for additional firms. Subcontractor Name and Location Line Item & Description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor License Number DBE (Y/N) DBE Cert Number Annual Gross Receipts DIR Reg Number Name: a l �3'9 2, 11 j 1' <$1 million [ 5 million City, State: V1 [$10 million <$15 million Age of Firm:-layrs. Name: `�� 1 2�tc66� p 7 �' f `j Z U a i� =;r " ;, a �` <$1 million <$5 million City, State: LU�rtMA 1#0060 ' < 10 million <$15 million Age of Firm:? 1 yrs. Name: :' <$1 million <$5 million City, State: < 10 million <$15 million Age of Firm! _yrs_ Name: <$1 million < 5 million City, State:_ <$10 million <$15 million Age of Firm:ryrs. Name-, a-, F t•, <$1 million <S5 million City, State: <$10 million <$15 million Age of Firm:_yrs. Name: Er ,. ,ti : •_``' ! <$1 million <$5 million City, state: <$10 million <$15 million Age of Firm: rs. Distribution: 1) Original -Local Agency File 2) Copy-DLAE w/ Award Package Page 27 of 2 Local Assistance Procedures Manual Exhibit 17-F Final Report -Utilization of Disadvantaged Business Enterprises (DBE) and First -Tier Subcontractors EXHIBIT 17-F FINAL REPORT -UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES (DBE) AND FIRST -TIER SUBCONTRACTORS 1. L4cal Agency Contract Number 2. F fal;fjisi E�q�rtlNumber 3 "l `�ur�ington Beach d. Contract Completion Date 5, Contractor/Consuttant California Professional Engineering, Inc. 6. Business Address 929 Ctterbein Avenue, Unit E, La Puente, CA 91748 7. Final Contract Amount 8. Contract I Number 9. Description of Work, Service, or Materials Supplied pp 1©. Company Name and Business Address 11. DBE Certification Number 12. Contract Payments 13. Date Worts Completed 14. Date of Final Payment Non -DBE DBE I 15. ORIGINAL DBE COMMITMENT AMOUNT 16. TOTAL List all first -tier subcontractorslsubconsultants and DBEs regardless of tier whether or not the firms were originally listed for goal credit If actual DBE utilization (or item of work) was different than that approved at the time of award, provide comments on an additional paste. Ly't actual amount paid to each entity If no subcontractors+subconsultants were used on the contract, indicate on t}teform. I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT 17. Contr c r/Consultant Re e's Signature 18. Contractor/Consultant Representative's Name Van Nguyen 19. Phone 217. Date 626 8101338 8/22/2017 I CERTIFY THAT THE CONTRACTING RECORDS AND ON -SITE PERFORMANCE OF THE DBE(S) HAS BEEN MONITORED 21, Local Agency Representative's SYgnature 22. Local Agency Representatives Name 23. Phone 24. Date DISTRIBUTION: OnginW — Local Agency. Copy — Caltrans District Local Assistance Engineer. Include with Final Report of Expenditures ADA NOTICE: For individuals with sensory disabilities, this document is available in alternate formats For information. call (916) 445-1233, Local Assistance Procedures Manual TTY 711, or write to Records and Forms Management- 1120 N Street MS-89, Sacramento. CA 95814 C-28 A V ALLIED WORLD INSURANCE COMPANY i, A IL L I E M 30 S. 171h St, Suite 1600 OIRLD Philadelphia, PA 19103 USA POWER OF ATTORNEY Issue Date: June 22, 2017 No. 32826-A1622 Single Transaction Limit: $10,000,000 KNOW ALL MEN BY THESE PRESENTS: Allied World Insurance Company, a New Hampshire corporation (the ".Company') does hereby appoint NAME(s): lames W. Moilanen Yung T. Mullick Christine Hoang Stephanie Hoang FIRM:' The Bond Exchange & Insurance Agency'24800 Chrisanta'Drive Suite 160,Mission Viejo, CA 92691 Its true and lawful Attomey(s)-in-Fact, with full authority to execute on its behalf bonds, undertakings, recognizances and other contracts of indemnity and writings obligatory, in the nature thereof, issued in the course of its business, and to bind the Company thereby. This Power of Attorney shall remain in full force and effect for one year from the issued date above -referenced and shall expire on close of business of the first anniversary of such Issue Date. IN WITNESS WHEREOF, ALLIED WORLD INSURANCE COMPANY has caused these presents to be executed by the officer named below, Who is duly authorized and empowered to execute on the Company's• behalf. This 22nd day of June, 2017 COM ZN-A _, ilnis OrKNKSYLat7,MI CI f ,, K� D l` Nclvypt4� _Ni tr"Wph4 PIMA, vm f ^ Mt mzAsawt��=;,r''fk' Name: Robert E. Staples Title: Senior Vice President - Surety, State of Pennsylvania ) County.of Philadelphia )ss. i f1 On this 22nd day of tune, 2017, before me came the above -named officer of ALLIED-y-- WORLD INSURANCE COMPANY, to me.personally known to be the individual and officer described herein, and acknowledged that he executed the foregoing Notary instrument and affixed the seals of said corporation thereto by authority of his My Commission Expires: 08/05/2018 office. CERTIFICATE Excerpt of Resolution adopted by the Board of Directors of the ALLIED WORLD INSURANCE COMPANY (the "Corporation"), on December 31, 2012: RESOLVED, that the proper officers of the Corporation, the head of the surety business line for the Corporation and their appointed designees (each an "Authorized Officer" and collectively, the "Authorized Officers") be, and each hereby is, authorized to appoint one or more Attomeys-in-Fact to represent and act for and on behalf of the Corporation in the transaction of the Company's surety business to execute (under the common seal of the Corporation, if appropriate) bonds, undertakings, recognizances and other contracts of indemnity and writings obligatory in the nature thereof. RESOLVED, that in connection with the Corporation's transaction of surety business, the signatures and attestations of the Authorized Officers and the seal of the Corporation 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 or facsimile seal shall be valid and binding upon the Corporation when so affixed with respect to any bond, undertaking, recognizance or other contract of indemnity or writing obligatory in the nature thereof. RESOLVED, that in connection with the Corporation's transaction of surety business, the facsimile or mechanically reproduced signature of any Authorized Officer, whether made heretofore or hereafter, wherever appearing upon a copy of any Power of Attomey of the Corporation, with signatures affixed as next above noted, shall be valid and binding upon the Corporation with the same force and effect as though manually affixed. RESOLVED, that in connection with the Corporation's transaction of surety business, any such Attomey-in-Fact delivering a secretarial or other certification that the foregoing resolutions still be in effect may insert in such certification the date thereof, said date to be not later than the date of delivery thereof by such Attomey-in-Fact. RESOLVED, that the Authorized Officers be, and each hereby is, authorized to execute (under the common seal of the Corporation, if appropriate), make,'file and deliver in the name and on behalf of the Corporation any and all consents, certificates, agreements, amendments, supplements, instruments and other documents whatsoever, and do any and all other things whatsoever in connection with the Corporation's transaction of surety business, as such 'Authorized Officer shallin his or her, absolute discretion deem or determine appropriate and any of the foregoing resolutions, the transactions contemplated thereby and any ancillary matters thereto and/or to carry out the purposes and intent thereof; such deeming or determination to be conclusively evidenced by any such execution or the taking of any such action by such Authorized Officer. I, Daniel zharkovky, Secretary of the ALLIED WORLD INSURANCE COMPANY, do hereby certify that the foregoing excerpts of Resolution adopted by the Board of Directors of this corporation, and the Power of Attomey issued pursuant thereto, are true and correct, and that both the Resolution and the Power of Attomey are in full force and effect IN WITNESS WHEREOF, I have hereunto set my hand and affixed the facsimile seal of the corporation, this Ll day of Daniel Zharkovky; AVP, Assistant General Counsel SUR 00046 00(05/2016) It v No. 3186-4 STATE OF CALIFO"IA DEPARTMENT OF INSURANCE SAN FRANCISCO Amended Certificate of Authority TIIIS IS TO CERTIFY that, pursuant to the Insurance Code of the State of California, Allied World Insurance Company of Xeiv Hampshire, organized under the laws of New Hampshire, .subject to its Articles oflncorporation or other fundamental organizational documents, is hereby authorized to transact within this State, subject to all provisions of this Certificate, the,following classes of insurance: Fire, Marine, Surety, Plate Class, Liability, Workers' Compensation, Common Carrier Liability, Boiler and Machinery, Burglary, Credit, Sprinkler, Team and Vehicle, Automobile, Aircraft, and Miseellaneous as such classes are now or pray hereafter be defined in the Insurunce Lairs of the State of California. THIS CERTIFICATE is expressly conditioned upon the holder hereof now and hereafter being in full compliance with all, and not in violation of any, ofthe applicable lotus and lcniful requirements made under authority of the Icnrs of the .State of California as long as such laws or reytrirentents are in effect and applicable, and a.s such laws and requirements now are, or may hereafter be changed or amended IN WITNESS %V14ERF.OF, effective as c#fthe 22" day, ofMay, 2013, 1 have hereunto set by hand and caused my official seal to be affixed this 22t'd dory of,Vay, 2013. Dave Jones tnsui ance Comevissionrr By, Susan J. Stapp for Nettie Hoge Chiej' [napui v NOTICE.: Qualification with the Secretary of State must be acconrplishzd as required by the California Corporations Code promptly after issuance of dais Certificate of Authority. Failure to do so will be a vioiation orinsurance Code section 701 and will be grounds for revokuig this Certificate of Anthority pursuant to the covenants made in the application therefor and the conditions contained herein. A `City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 For Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue — CC 1465 HS1PL5181 (178) August 11, 2017 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES. The Federal Labor Rates contained in Appendix I of the specifications for the: Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue - CC1465 HSIPL5181(178) shall be replaced with the following attached documents: The Federal Labor Rates dated August 4, 2017 shall be the labor rates in effect for the subject project. 2) PAGE C-1 — SECTION 3 — PROPOSAL The following sentence shall be inserted at the end of the first paragraph: The undersigned acknowledges that the issuance of Notice to Proceed will occur approximately three months after the award of contract to allow procurement time for the city furnished equipment. This is to acknowledge receipt and review of Addendum Nun 0 o e s • ompany ame Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F. Janusz at (714) 536-5431. SAIADocument A310TM — 2010 CONTRACTOR: (:VOIne, legyraslellits "reel ociclres.0 CALIFORNIA PROFESSIONAL ENGINEERING, INC. 929 Otterbein Avenue, Suite E La Puente, CA 91718 Bid Bond No: N/A SURETY: tAlurne, lie eliltas rind hrirtr;pol place of Lusirteas) ALLIED WORLD INSURANCE COMPANY S50 SOUTH HOPE STREET, SUITE 1825 This document has important legal Los Angeles, CA 90071 consequences. Consultation with OWNER: an attorney is encouraged with respect to its completion or (r'•�urne. lcZc7l,clu(ttS <rtrr.(adcb'estj modification City of Huntington Beach 2000 Main St., Any singular reference to Huntington Beach, CA 92648 Contractor, Surety, Owner or BOND AMOUNT: o other party shall be considered (10 /o)Ten percent of the attached bid amount plural where applicable. PROJECT: (iVani ', hoculiorl or cd(h'ess, utrci n11111her, Traffic Signal Modifications at the Intersection Street and Talbert Pruicct Number, il'anc: CC-1465 Avenue, Gothard Street and Heil Avenue, and Springdale Street and McFadden Avenue The Contractor and Surety are hound to the! O«ner in the amount set tbrth above, for the payment of'yvhich the Contractor and sure;" hind themselves, their heirs, cxeenlors, administrators, suce.ssclrs and assigns,jointly and tievetally. as_proyided hereiri. The Conditions ot'this Fiord are such Chat il'the Caner ,acccpt� the bid of the C'on[ractur within the time :yeciflcd in the hid documents. Or \l ithiu $Ue11 time period as may he al_roed to by the Owner and C ontraictut', and the Contractor either ( 1 ) enters into a comtract a iih the Ua ncr in accordance n Rh the (cols ol`.;och bid, and -ives such bond or bonds as nwy he specified in the bidding of C olilract lhtcumenis, "vitll:l surely admitted in file -iurisdielicn of the. Project and othem ise aeeeptahlc 11 the Owner, fur I.he f>tiihCul ticrFucmanee of such Contract and for the prompt pnynwni ut' labor and material furnished in Lhc prosecution thercof: t!r (2) pays to the 0,, ocr the difIcrence, not to exceed the amount ol'thiS Bond. betWeen the amount specified in ;aid hid and such larger arnount for which th. Owner mby in good faith contract N-vith another early to perform the ti�ork. covered by said bid, flten this obligation shall be null and void- other`,cise to I-Cn!ailt in full tprCC and effcet. The Surly hereby waives any notice of al! s@ruen;ellt beuyC n the (h nee and Contractor to extend the [role i11 v, hick the O s err arty accept the bid. tiifaiaer o! notice by the Succly shall not appiv to ally extension exceecline Sixty (60) days in the -,g`r -egate beyond the time for acccptuncc of bills spccified in the hid ducurllcnts, and the 0micr and Contractor shall obtain the Surctv's consent for an cxtcn.cion bevr,nd sixt'v (60) days. Ifihis Bond i; issued in co rtcction with it subcontractor's bid to a Contractor, the term Contractor in this Bond shall he deemed to be Suhcomroctor and (he term Owncr shall he deemed to he Connector. When this Bond hxs been lunlished to cnnlph; a ith .a swolu)n or usher legatl requirement in the location of the Projecr. Lilly 1110r1niun m this Bond conllicurl; xcilli said statotelry or I al reyutroment shall be deemed deleted hcrefrum and pmvisirms Coll forlilill _ to such siattttOn or tither legal requirement shall be dcclned incorporated herein. %Vheu ;o furnished, the intent Is that fhis t30nd shall be construed as a suututory bond and not as it common law bond. Si.-ned and scaled this 14th day of August, 2017 CALIFOR IA O SST�T il'riur,;p (I � f6Ylness•� �,� --- ---- _ `.... _....._g (b17(rress) Ire Lu ALLIED WORLD INSURANCE COM (Title)�jetTg T. Mullick, Attorney -in - INC. GS'e<t/j 12esldwt lseal/ flit AIA Document A�10TM — 2010, Copyright c- 1963. 1970 and 2010 by Tho merican Institute of Architects. All rights reserved. WARMING: Titts AIAs rO„tu^. i; r,i i5 C?t:!g:r, teal 'd ;:i.5 ri;nyri. �hi i-as: and !rternb.rorcti iiUaTaes. 0n2;:?1hOri7r:d rn; redo^tiwi or c!fsC,=b utinn of ibis At::� or any pry:tip, o' it. "nay' ;esutt fo se'e.r cFrii ar,d c!;roinai and wi;l be p;ess aca:ced , I'*:e ms^.;mf:rr+. extent pessinte cinder th;� law.lhi; dorurnent was treated on 01!2712012 07'23,12 undal the terms of AIA Documents-on-Damand" order no 2006597463, and ;s not roi iaseie This d0,vmenl is Iir ensed by The Amencan Institute of Architects !or une-time use only, and may riot be rrproducerl prior to ils comr;ietion. LY41 -) ALL-PURPOSE ACKNOWLEDGMENT State of California County of Los Angeles On August 22, 2017 DAIS , before me, personally appeared Van Nguyen SS. Diem Chu , Notary Public, who proved to me on the basis of satisfactory evidence to be the personW whose name( isj',4xq subscribed to the within instrument and acknowledged to me that he%A-rolikizy executed the same in hisAN3Mheir authorized capacity(ii2n), and that by his/k&rAheir, signature(&) on the instrument the person(j4, or the entity upon behalf of which the person(4 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. _�,��••\. DIEM CHU � •� l l!/ ;I�y�f �i==/ NOi1tRY PUBLIC-CALIFORNIA Ul �";�n, � LOS ANGEL'c5 COUtITY �_ a� iVIY' COMh4 EzP CEP. 21, 2017E NOTARY'S SIGNATURE A notary public or other office completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracv, or validitv of that document. PT_ACE NOTARY SEAL IN ABOVE SPACE ,, , , ,. , ,, any - `a.:-.. r _,:�.q 494,�w g.. -kv The information below is optional. However, it may prove valuable and could prevent fraudulent attachinent of this form to an unauthorized document. CAPACITY CLAINIED BY SIGNER (PRINCIPAL) DESCRIPTION OFATTACHED DOCUMENT ❑ INDIVIDUAL ® CORPORATE OFFICER President, Secretary- Treasurer, Manager ❑ PARTNER(S) TITLE(S) ❑ ATTORNEYAN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: SIGNER (PRINCIPAL) IS REPRESENTING: NAME OF PERSON(S) OR FN I I 'Y(IES) California Professional Engineering, Inc. TITLE OR TYPE OF DOCUMENT NUMBER OF DATE OF DOCUMENT RIGHT THUMBPRINT OF SIGNER OTHER APA1,2012 NOTARYBONDS, SUPPLIES AND FORMS AT C'2005-2005%,ALLF)-SIEIZRAINSt1RANCE CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County of Orange On August 14, 2017 before me, Jessica Dayog , Notary Public, Date Insert Name of Notary exactly as it appears on the official seal personally appeared Yung T. Mullick Name(s) of Signer(s) JESSICA DAYOG NotaryPublic- California Z Orange County r Commission # 2204914 My Comm. Expires Jul 14, 2021 Place Notary Seal Above 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 o i ial e Signature Signature of N tyy P blic Je0a Dayog 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 the 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 ❑ Limited ❑ General Attorney in Fact Trustee Guardian or Conservator ❑ Other: Signer is Representing: Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer—Title(s): _ ❑ Partner ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: From: California Professional Engineering, Inc. 929 Qtterbein Ave, Unit E La PuEnte, CA 91748 (676) 810-1338 RECEIVE© 2017 AUG 22 PH 1: 47 CITY CLERK CITY OF HUNTINGTON BEACH � r 10�1 C;y OO NOT OPEN WITH REGULAR MAIL. "Sealed Bid" For Traffic Signal Modifications at the intersections of Gothard St and Talbert Ave, Gothard St and Heil Ave and Springdale and McFadden Ave In the City of Huntington Beach - 00 NOT OPEN WITH REGULAR MAIL DELIVER TO THE OFFICE OF THE CITY CLERK, 20DO MAIN STREET, SECOND FLOOR Project CC No.:1465 2000 Main Street Huntington Beach, CA 92648 City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Robin Estanislau, City Clerk January 31, 2018 Comet Electric 21625 Prairie Street Chatsworth, CA 91311 RE: Traffic Signal Modifications at Gothard St.& Talbert Ave./Gothard St. & Heil Ave./Springdale St. & McFadden Ave. — CC-1465 Enclosed please find your original bid bond for CC-1465. Sincerely, Robin Estanislau, CIVIC City Clerk RE:ds Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand SECTION C PROPOSAL for the construction of Traffic Signal Modifications from At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue And Springdale Street and McFadden Avenue CC No. 1465 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 60 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find Bidder's Bond for 10% 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 Bi er's Si ' ature 1 8/21/2017 A Sam tiaitman President C-2 `City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE For Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Sprinqdale Street and McFadden Avenue — CC 1465 HSIPL5181(178) August 11, 2017 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES. The Federal Labor Rates contained in Appendix I of the specifications for the: Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue - CC1465 HSIPL5181(178) shall be replaced with the following attached documents: The Federal Labor Rates dated August 4, 2017 shall be the labor rates in effect for the subject project. 2) PAGE C-1 — SECTION 3 — PROPOSAL The following sentence shall be inserted at the end of the first paragraph: The undersigned acknowledges that the issuance of Notice to Proceed will occur approximately three months after the award of contract to allow procurement time for the city fumished equipment. This is to acknowledge receipt and review of Addendum Number One, dated August 1 ,2 17. Comet Electric, Inc. Company Name By am Saitman, silent August 21, 2017 Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F. Janusz at (714) 536-5431. SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE BID ITEMS Item , , Description Quantity, . Unit Unit Co"st, Total .Cost No: (Eztension) 1 Mobilization 1 LS S. 7 $ Z 2 Furnish Project Traffic Control 1 LS $ % (c 6� $ ��. ,� �/ C:— 3 Furnish and Install Traffic Striping and Signing 1 LS $ � $ ., %P9�/ �— 4 Preparation of WPCP and installation and of Maintenance of BMP's per the approved WPCP. 1 LS $= _ $=— Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case A and Typical Section at New Curb Ramps 5 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 2 EA appurtenances, curb and gutter, depressed curb, sidewalk, $ k3sa — $ Z-) truncated domes, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case B and Typical Section at New Curb Ramps 6 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 1 EA appurtenances, curb and gutter, depressed curb, sidewalk, $ �� $ truncated, domes, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case C and Typical Section at New Curb Ramps 7 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 5 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.). Excludes the $ Northeast corner of Gothard Street and Heil Avenue. Cr's Construct Curb Ramps, Truncated Domes, Sidewalk, Curb and Gutter and Railing at the Northeast Corner of Gothard 8 Street and Heil Avenue and per Detail on Sheet 5. (Item 1 LS includes all appurtenances, curb and gutter, depressed curb, sidewalk, railings, truncated domes, retaining curb, slot pave, etc.) $ uy $ L Construct Curb, Access Ramps and Concrete Sidewalk on the Raised Island at the Southwest quadrant of the Intersection of 9 Springdale Street and McFadden Avenue. See the Details on 1 LS Sheet 5. (Item includes all appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.) 10 Modify Traffic Signal at Gothard Street and Talbert Avenue. Item includes in included in items. 1 LS c,ti $ Ic I o_ $ yj[ 11(_ all work plans not other ' 11 Modify Traffic Signal at Gothard Street and Heil Avenue. Item includes in included in items. 1 LS a, $) Z - 3 Cal $ G� all work plans not other 12 Modify Traffic Signal at Springdale Street and McFadden Ave. Item includes in included 1 LS ci $ Apr - $ 3S j all work plans not in other items. J C-2.1 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE Item Description Quantity Unit - Umt Cost Total Cost No '-(Extension) TOTAL BID AMOUNT TOTAL BID AMOUNT IN WORDS: Note: Refer to Section 9, Measure and Payment. All extensions of unit prices will be subject to verification by Owner. In case verification is required between the unit price and the extension, the unit price will govern. The Owner reserves the right to reject any or all proposals and bid items. The City will provide the traffic signal equipment, as listed in the pole schedules, (also includes anchor bolts) to the contractor. The contractor is to pick up the materials, with its own labor, at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 536-5530. C-2.2 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 or $10,000, whichever is greater, and the portion of the work to be done by such subcontractor. Bid Name and Address of State Class DIR PWC Dollar % of Item(s) Subcontractor License Registration # Amount Contract Number Smithson Electric, Inc 10 / 11 1938 E. Katella Ave Orange, Ca. 92867 614518 C-10 1000001610 $9,250.00 2% (714)997-9556 Cat Tracking Inc 2950 Rubidoux Blvd A, B, 3 Riverside, Ca. 92509 991122 C-8,12, 1000011750 $14,700.00 (951) 682-1491 32,31 3% Her -Con Construction 5/6/7/8/9 A 758 S. Hollenbeck Ave Covina, Ca. 91723 94595 A, C 8 1000012689 $126,706.95 30% (626)339-7000 By submission of this proposal, the Bidder certifies: That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID 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 8/21/17, at Chatsworth , -CA Date City State Adam Saitman being first duly sworn, deposes and says that he or she is President of Comet Electric, 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. Adam Saitman, President Name of Bidder Signature of Bidder 21625 Prairie St. Chatsworth, CA 91311 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 Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue, (I)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: 8/21/2017 Comet Electric, Inc. Contractor By Adam Saitman, President Title C-5 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 ® No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. Date: 8/21/2017 Comet Electric, Inc. Contractor By Adam Saitman, President Title C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Comet Electric, Inc. Bidder Name 21625 Prairie St. Business Address Chatsworth CA 91311 City, State Zip ( 818 ) 340-0965 info@CometElectric.com Telephone Number Email Address 681827 A, B, C-10 State Contractor's License No. and Class December 9, 1993 Original Date Issued December 31, 2017 Expiration Date The work site was inspected by Steve Brown of our office on August 18 , 2017. The following are persons, firms, and corporations having a principal interest in this proposal: 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. Comet Electric, Inc. 3ignaLure of tsiuuer Adam Saitman, President Printed or Typed Signature C-8 NOTARY CERTIFICATE Subscribed and sworn to before me this day of , 201L . 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 0 o-y n,.1 w ) County of On �d \ I >'DkM before me, Arn0!N9C,- 12— ever , Mb -jy Month, Day, and Year Insert Name and Title of Notary personally appeared 6:-ec---N 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. AMANDA R. STOVER Notary Public - California i Los Angeles County Z Commission # 2178933 M Comm. Ex fires Feb 1, 2021 Signature _ Signature of Notary Public (PLACE NOTARY SEAL ABOVE) C-9 Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work, specifically referencing the construction of {Describe specific work and experience necessary for project. For example, "Sanitary sewer line installation of at least of 1,000 of 8-inch and greater in public right-of- way. Sanitary sewer lift stations of similar size, project work within public streets, an area containing high ground water and pipeline construction in high ground water regions with trench depths of 8-feet to the invert."}. 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: 2. 3 ** See attached** Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed Provide additional project description to show similar work: C-10 Comet Electric Completed Project Compet Electric, Inc - Completed projects Job fies jy t%n Customer Contact Contact Phone Owner Owner Address City zip Total Moulton Pa rkway Widening Griffith Company Bill Grider 562-929-1128 Orange County Dept Public Works 11S2 E. Fruit Street Santa Ana CA 92701 643,741 LED Cobrahead Streetli ht City of Arcadia Dave McVey 626-256.6664 Ci of Arcadia 11900 Goldring Road Arcadia CA 91C06 382,464 LA Lorenzo-Sl nal Mod/Upgrade G. H. Palmer G. H. Palmer 213.346.9796 Palmer/Flower St. Properties 11740 San Vicente Blvd. Los Angeles CA 90049 1,271,156 PCH/Del Prado Streetscape Los Angeles Engineering Las Angeles Engineering 626-454.5222 Brave ark Property LLC 33282 Golden Lantern Street Dana Point CA 92629 1,D99,DD0 Bob Hope Airport MCCARTHY Rob Ragland 949-851-8383 Burbank -Glendale -Pasadena Airport Transit Authority Burbank CA 91505 743,542 MATSU - Street Lighting OL DEVELOPMENT O.L. Development 918-783.9800 Avalon Bay Communities 4440 Von Barman Newport Beach CA 92660 139,729 McBean Pkwy Bridge Widening SECURITY PAVING COMPANY Security Paving Compan , InC. 818-362-9200 City of Santa Clarita 23920 Valencia Blvd. Santa Clarita CA 913552196 199,730 Brand & Wilson Holland Construction, Inc. Holland Construction 562.285.3000 120 W. Wilson Avenue Apartments, L.P. 1111 Main Street Vancouver WA 98660 173,643 Orange & Wilson Holland Construction, Inc. Holland Construction, Inc. 562-285.3000 120 W. Wilson Avenue Apartments, L.P. 1111 Main Street Vancouver WA 98660 152,860 Spring hill Suites Marriott RD Olson Development R.D. Olson Development 949.271-IIOD 549 San Fernando, SPE, LLC, 2955 Main Street, 3rd Floor Irvine CA 92614 2,997 Da Vinci G. H. Palmer GH Palmer 213-346.9796 Palmer Temple Street Properties LLC 924 West Sunset Blvd. Los An eles CA 9OD12 323,060 Da Vinci • LADWP/Traffic Cont G. H. Palmer GH Palmer 213.346-9796 Matt Construction 924 West Sunset Blvd. Los Angeles CA 9OD12 220,220 Mercedes- Benz W. Coast Campus Norm Wilson & Sons, Inc. Norm Wilson & Sons 562-634-7933 Superior Courts of California 1 Mercedes Drive Montvale NJ 07645 131,569 Hollywood 959 J.M. Snyder JH Snyder 213-365-1783 Snyder 959 Seward, LLC. 5757 Wilshire Blvd. Los Angeles CA 90036 9,551 MW Wayside Energy Storage Sys Kinetic Traction Systems, Inc. Kinetic Traction Systems, Inc. 818-812.9629 L.A. Metro T ransit Au th ority One Gateway Plaza Los Angeles CA 90012 182,417 Chatsworth Commerce Center Norm Wilson & Sons, Inc. Norm Wilson & Sons, Inc. 562.634.7933 OMP Desoto Industrial, LLC. 19300 Ham}Itan Avenue Gardena CA 90248 39,490 David G. Millen School AN Construction ANM Construction & Engineering 661-729-6200 .. Palmdale School District 39131 SOth Street East Palmdale CA 93550 492,629 Div 13 Bus Maintenance MCCARTHY Michael Flick 949.8S1.8383 L.A. County Metropolitan TrarmAuth One Gateway Plaza Los Angeles CA 190012 1 487,520 Emerson MS Redevelopment SJ AMOROSO CONSTRUCTION CO Amoroso Construction 714-433.2326 Los Angeles Unified School District 333 S. Beaudry Avenue Los Angeles CA 90017 1 50,569 Westside Ad U ti lity Relocatio STEVE BUBALO CONSTRUCTION CO Steve Bubalo Construction 6265747570 Los Angeles County Metro Transit Auth. 0 Los Angeles CA 90012 88,000 NBC Universal Underground NBC Universal NBC Universal 818-777-9968 NBC Universal 0 0 0 0 12,800 Expo 2 Joint Venture Skanska-Rados Expo Skanska-Rados 1V 951.684.5360 Expo Metro Line Construction Auth. 707 Wilshire Blvd. Los Angeles CA 90017 1,082,574 NOS Rehab Units 3 Spiniello Companies S p iniello Companies 909-629-1000 City of Los An eles 1149 S. Broadwa , 6th floor Los Angeles CA 9DO15 30,029 LAX WAMA - LADWP Duct Bank Ex Griffith Company • Griffith Company 5622667065 Los Angeles World Airport 7301 World Way West, Sth Floor Los Angeles CA 9DD45 1 128,738 DaVinci SL & Traffic Signal G. H. Palmer GH Palmer 213.346.9796 Palmer Temple Street Properties LLC 924 West Sunset Blvd. Los Angeles CA 9DO12 384,540 DaVinci - BSL Street Light In G. H. Palmer Jennifer Uncourt 2133469796 Palmer Temple Street Properties LLC 924 West Sunset Blvd, Los An eles CA 90012 318,022 VBU EXPO - Culver City Plaza Skanska-Rados Expo Skanska/Rados JV 9513686411 Expo Metro Line Construction Auth. 707 Wilshire Blvd. Los Angeles CA 9OD17 153,10D Irvine Spectrum Center Griffith Company Griffith Company 5629291128 The Irvine Company 111 Innovation Irvine CA 926170000 89,292 El Monte Gateway KPRS Construction Services Inc K P R S Construction Services Inc 7146720800 Grapevine Advisors, LLC. 15301 Ventura Blvd. Sherman Oaks CA 91403 382,190 Valencia@1Si5 Wilshire T/S Mod Astani Construction Inc. Astani Construction 310-273-2999 Wilshire Valencia Partners, LLC 433 N. Camden Dr. Beverly Hills CA 90212 10,308 Howard Hughes A is Sites 1 & 2 WE O'NEIL W.E. O'Neil 310.643-6541 Equity Residential 4835 E. Cactus Road Suite 20D Scottsdale AZ 85254 69,243 US 101 Improvements Universal Powell Constructors Powell Constructors 9093568880 NBC Universal Media, LLC. ATTN: SOURCING DEPARTMENT Universal City CA 91608 1,641,563 Village at USC - LADWP Permit Hathaway Dinwiddie Hathaway Dinwiddle 2132360500 University of S. California Campus Dev. &Fac. Mana emen Las Angeles CA 90007 1,391,170 POLA - John S. Gibson CA RASMUSSEN INC C.A. Rasmussen, Inc. 661-367.9040 Port of Los Angeles 425 South Palos Verdes Street San Pedro CA 90731 1,768,446 NBC Universal Hollywood Drive Griffith Company Griffith Company 562.864-8970 NBC Universal 100 Universal City Plaza Universal City CA 91608 3,304,072 Blossom Plaza Benchmark Contractors, Inc. Benchmark Contractors, Inc, 3105669357 Forest City Blossom, LP 949 S. Hope Street Los Angeles CA 90015 26,625 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. Louis Perez Name of proposed Project Manager Telephone No. of proposed Project Manager: (818) 280-5703 ** See attached** Project Name & Contract Amount Type of Work Date Completed Project Name & Contract Amount Type of Work Date Completed Project Name & Contract Amount Type of Work Date Completed 2. Doua Turner Name of proposed Superintendent Telephone No. of proposed Superintendent: (818) 262-9926 **See attached** Project Name & Contract Amount Type of Work Date Completed Project Name & Contract Amount Type of Work Project Name & Contract Amount Type of Work C-11 Date Completed Date Completed Comet Electric Completed Project Compet Electric, Inc - Completed projects Job Description Customer Confect Confect Phone owneY Owner Address [l ZIP Total Moulton Parkway Widening Griffith Company BilI Grider 562.929.1128 Orange County Dept Public Works 1152 E. Fruit Street Santa Ana CA 92701 643,741 LED Co bra head Streetlight City of Arcadia Dave McVey 626-256-6664 City of Arcadia 11800 Goldrin Road Arcadia CA 91006 382,464 LA Lorenzo -Signal Mod/U rade G. H. Palmer G. H. Palmer 213-346-9796 Palmer/Flower St. Properties 11740 San Vicente Blvd. Los Angeles_ CA_ 90049 1,271,156 PCH/Del Prado Streetscape Los Angeles Engineering Los Angeles Engineering 626-454-5222 Bravepark Property LLC 33282 Golden Lantern Street Dana Point CA 92629 1,099,000 Sob Hope Airport MCCARTHY Rob Ragland 949-851.8383 Burbank -Glendale -Pasadena Airport Transit Authority Burbank CA 191505 743,542 MATSU - Street Lighting OL DEVELOPMENT O.L. Development 818-783-9800 Avalon Bay Communities 4440 Von Karman Newport Beach CA 92660 139,729 McBean Pkwy Bridge Widening SECURITY PAVING COMPANY Security Paving Company, Inc. 818362.920D City of Santa Clarita 23920 Valencia Blvd, Santa Clarita CA 91355219E 199,730 Brand & Wilson Holland Construction, Inc. Holland Construction 562-285-3000 120 W. Wilson Avenue Apartments, L.P. 1111 Main Street Vancouver WA 98660 173,643 Orange & Wilson Holland Construction, Inc. Holland Construction, Inc. 562-285-3000 120 W. Wilson Avenue Apartments, L.P. 1111 Main Street Vancouver WA 98660 152,860 Springhill Suites Marriott RD Olson Development R.D. Olson Development 949-271-1100 549 San Fernando, SPE, LLC. 2955 Main Street, 3rd Floor Irvine CA 192614 2,997 Da Vinci G. H. Palmer GH Palmer 213-346-9796 Palmer Temple Street Properties LLC 924 West Sunset Blvd. Los Angeles CA 90012 323,060 Da Vinci - LADWP/Traffic Cont G. H. Palmer GH Palmer 213-346-9796 Matt Construction 924 West Sunset Blvd. Los Angeles CA 90012 220,220 Mercedes- Benz W. Coast Campus Norm Wilson & Sons, Inc. Norm Wilson & Sons 562-634-7933 Superior Courts of California 1 Mercedes Drive Montvale NJ 07645 131,568 Hollywood 959 1.H. Sn der JH Snyder 213-365-1783 Snyder 959 Seward, LLC. 5757 Wilshire Blvd. Los Angeles CA 90036 9,551 MW Wayside Energy Storage Sys Kinetic Traction Systems, Inc. Kinetic Traction Systems, Inc. 818-812-9629 L.A. Metro Transit Authority One Gateway Plaza Los Angeles CA 190012 182,417 Chatsworth Commerce Center Norm Wilson & Sons, Inc. Norm Wilson & Sons, Inc. 562-634-7933 OMP DeSoto Industrial, LLC. 19300 Hamilton Avenue Gardena CA 90248 39,490 David G. Millen School ANM Construction ANM Construction & Engineering 661-729-6200 Palmdale School District 39131 10th Street East Palmdale CA 93550 492,629 Div 13 Bus Maintenance MCCARTHY Michael Flick 949-851-8383 L.A. County Metropolitan Trans-Auth One Gateway Plaza Los Angeles CA 90012 487,520 Emerson MS Redevelopment Si AMOROSO CONSTRUCTION CO Amoroso Construction 714-433-2326 Los Angeles Unified School District 333 S. Beau dry Avenue Los Angeles CA 90017 50,569 Westside Adv Utility Relocatio STEVE HUBALO CONSTRUCTION CD Steve Bubalo Construction 6265747570 Los Angeles County Metro Transit Auth. 0 Los Angeles CA 190012 68,000 NBC Universal Underground NBC Universal NBC Universal 918-777-9968 NBC Universal 0 0 0 0 12,800 Expo 2 Joint Venture Skanska-Rados Expo Skanska-Rados JV 951-684-5360 Expo Metro Line Construction Auth. 707 Wilshire Blvd. Los Angeles CA 90017 1,082,574 NOS Rehab Units 3 Spinielio Companies Spiniello Companies 909-629-1000 City of Los Angeles 1149 5. Broadway, 6th floor Los Angeles CA 90015 30,029 LAX WAMA- LADWP Duct Bank Ex Griffith Company Griffith Company5622667065 Los Angeles World Airport 7301 World Way West, Sth FloorLos Angeles CA 90045 128,738 DaVinci SL & Traffic Signal G. H. Palmer GH Palmer 213-346-9796 Palmer Temple Street Properties LLC 924 West Sunset Blvd, Los Angeles CA 90012 384,540 DaVincl - BSL Street Lighting G. H. Palmer Jennifer Lincourt 2133469796 Palmer Temple Street Properties LLC 924 West Sunset Blvd. Los Angeles CA 90012 318,022 VBU EXPO - Culver City Plaza Skanska-Rados Expo Skanska/Rados 1V 9513686411 Expo Metro Line Construction Auth. 707 Wilshire Blvd. Los Angeles CA 190017 153,100 Irvine Spectrum Center Griffith Cam pan Griffith Company S629291128 The Irvine Company 1111 nnovati on Irvine CA 926170000 89,292 El Monte Gateway KPRS Construction Services Inc KPRS Construction Services fnc 7146720800 Grapevine Advisors, LLC. 15301 Ventura Blvd. Sherman Oaks CA 91403 392,180 Valencia @1515 Wilshire T/S Mod Astani Construction Inc. Astani Construction 310-273.2999 Wilshire Valencia Partners, LLC 433 N. Camden Or Beverl Hills CA 90212 1 10,308 Howard Hughes Apts Sites 1 & 2 WE O`N€IL W.E. O'Neil 310-643-6541 Equity Residential 4835 E. Cactus Road Suite 200 Scottsdale At 85254 69,243 US 101 Improvements Unlversal Powell Constructors Powell Constructors 9093568880 NBC Universal Media, LLC, ATTW SOURCING DEPARTMENT Universal City CA 91608 1,641,563 Village at USC - LADWP Permit Hathaway Dinwiddie Hathaway Dinwlddie 2132360500 University of S. California Campus Dev. &Fat. Managemen Los Angeles CA 90D07 1391,170 POLA - John S. Gibson CA RASMUSSEN INC C.A. Rasmussen, Inc. 661-367-9040 Port of Los Angeles 425 South Palos Verdes Street San Pedro CA 90731 1,768,446 NBC Universal Hollywood Drive Griffith Company Griffith Company 562-864-8970 NBC Universal 100 Universal Ci uy Plaza I Universal City CA 916M 3,304,072 Blossom Plaza Benchmark Contractors, Inc. Benchmark Contractors, Inc. 3105669357 I Forest City Blossom, LP I Los AnLeles CA 90015 26,625 CONTRACTOR REGISTRATION WITH CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS (DIR) CERTIFICATE Pursuant to SB 854 (citing Labor Code Section 1771.1(a)), passed by the California State Senate on June 20, 2014, established a new public works Contractor Registration Program, which requires all contractors and subcontractors bidding and performing work on Public Works Projects to register on an annual basis (each July 1 through June 30 state fiscal year) with the California Department of Industrial Relations (DIR). Currently the annual non-refundable registration fee for Contractors is $300. Each contractor to whom a public works contract has been awarded shall sign the following certificate. DIR FACT SHEET on SB 854 http://www.dir.ca.gov/DLSE/PublicWorks/SB854FactSheet 6.30.14.pdf DIR's Contractor Registration Link — Call (844) 522-6734 https://efiling.dir.ca.gov/PWCR/ActionServlet?action=displayPWCRegistrationForm DIR's Contractor Registration searchable database: https://efiIing.dir.ca.gov/PWCR/Search.action I am aware and will comply with the provisions of Labor Code Section 1771.1(a) which states: "A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5. It is not a violation of this section for an unregistered contractor to submit a bid that is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the contractor is registered to perform public work pursuant to Section 1725.5 at the time the contract is awarded." 1 furthermore will comply by providing proof of registration with DIR as the primary contractor, as well as for ALL subcontractors at the time of submitting the bid. Date: 8/21/2017 PWC Registration #: 1000005922 Comet Electric. Inc. Contractor By Adam Saitman, President Title C-12 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 requirements 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: Comet Electric, Inc. Contact Person: Adam Saitman, President Contact Phone: 818 340-0965 Signed: _ Date: 8/21/2017 v *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-13 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder, proposed subcontractor hereby certifies that he has X ...............has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has 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. C-14 PUBLIC CONTRACT C O D E PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has_, has not X been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public 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 Statem��'idders are cautioned that making a false certification may subject the certifier to criminal prosecution. �� dam Saitman President 8/21/2017 Signatur -,�, Print Name Date 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? L] a Yes No If the answer is yes, explain the circumstances in the following space. C-15 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. Signature Print Name Date C-16 Aoncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY of Huntinston Beach 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 Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. '111� Adam Saitman President 8 21 2 Signature Print Name Date C-17 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. Adam Saitman, President 8/21/201 Signature Print Name Date C-18 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. C-19 DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTMTIES PURSUANT TO 31 U.S.C. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: Pa. contract Fla. bid/offer/application C a. initial b. erant b. initial award b. material chance c. cooperative agreement c. post -award d. loan For Material Change e. loan guarantee yea/Sawai f. loan insurance dat 4. Name and Address of Reporting Entity 5. If Reporting Entity in NoEnter Name and Address El 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 Dis ict, if known eral 7. FedProgr Name/Description: CFDA her, if applicable 9. Awar mount, if known: nly: 'Individuals Performing Services (including address if different from No. I Oa) (last name, first name, MI) /ka ttach Conti ation Sheet(s) if necessary) 11. Amount of Payment (at appl 13. Type of Payment (check all that apply) S I ned a. retainer b. one-time fee 12. Form of Payment (chply): c. commission 8 a. cash d. contingent fee b.ecify: nature e deferred value f. other, specify14. Brief Description of rformed or to be performed and Date(s) of Service, including officer(s),employee(ser(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if necessary) ®rted tinuati Sheet(s) attached: Yes No ation quested through this form is authorized by 1 U C. Section 1352. This disclosure of lobbying Signature: as placed by the tier above when his transaction de or entered into. This disclosure is required print Name: t to 31 U.S C. 1352. This information will be d to Congress semiannually and will be available for inspection. Any person who fails to file the required Title: ure shall be subject to a civil penalty of not less than 0 and not more than $100,000 for each such failure. Telephone No.: —Date: Authorized for Local Reproduction Federal Use Only: Standard Form - LLL C-20 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 I (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-LLL-instructions Rev 06-04-90«ENDIF» I C-21 Local Assistance Procedures Manual Exhibit 15-G Construction Contract DBE Commitment EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT 1. Local Agency: City of Huntington Beach 2. Contract DBE Goal: 10.00% 3. Project Description: Traffic Signal Modifications at Gothard St/Talbert/Av, Gothard St/Heil Av, Springdale St/McFadden 4. Project Location: Gothard St/Talbert/Av, Gothard St/Heil Av, Springdale St/McFadden Av. 5. Bidder's Name: Comet Electric, Inc. 6. Prime Certified DBE: ❑ 7. Bid Amount: 8. Total Dollar Amount for ALL Subcontractors: 9. Total Number of ALL Subcontractors: 10. Bid Item Number 11. Description of Work, Service, or Materials Supplied . 12DBE Certification Number 13. DBE Contact Information (Must be certified on the date bids are opened) 14. DBE Dollar Amount 5"� A' CtuiL '�1� 'Jl 1 e-CD,� L6.15t'4.vc co,►ts ?S$ 6. Aolle►s6ax ku� C U IYL& 0,41- 4 t-r z t2�p,7010 q5 Local Agency to Complete this Sect�ony Q $ 12-(o70(p. 21. Local Agency Contract Number:CC-1465 15. TOTAL CLAIMED DBE PARTICIPATION 30 22. Federal -Aid Project Number: HSIPL-5181(178) 23. Bid Opening Date: 24. Contract Award Date: IMPORTANT: Identify all DBE firms being claimed for credit, regardless of tier. Names of the First Tier DBE Subcontractors and their respective item(s) of work listed above must be consistent, where applicable with th ames and items of the work in the Local Agency certifies that all DBE certifications are valid and information on this form is complete and accurate. "Subcontractor List" mltted with your bid. Written confirmation of each Ast BE.i r uire 8/21/2017 25. Local Agency Representative's Signature 26. Date 16`Preparer's Signatwe) 17. Date Adam Saitman (818)340-0965 27. Local Agency Representative's Name 28. Phone 18. Preparer's Name 19. Phone President 29. Local Agency Representative's Title 20. Preparer's Title DISTRIBUTION: 1. Original - Local Agency 2. Copy - Caltrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract execution may result in de -obligation of federal funds on contract. Include additional copy with award package. ADA Notice: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654- 3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. Page 1 of 2 C-22 2917 AUG 22 PSI 1: 30 fi. City of Huntington 'Beach City Clerk's Office 2nd Floor 2000 Main Street Huntington Beach, CA 92648 SEALED BID DOCUMENTS ENCLOSED jtq City of Huntington Beach Traffic SignaI ,difications Gothard Street and Talbert mue, Gothard Street and Heil Avenue and ingdale Street and McFadden Avenue No. 1465 Date: Tuesday, August 22, 2017 at 2:00 PM CITY CLERK CITY OF f1UNTINGTON EEAc#j City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Robin Estanislau, City Clerk February 2, 2018 DBX, Incorporated 42024 Avendia Alvarado, Suite A Temecula, CA 92590 RE: Traffic Signal Modifications at Gothard St. & Talbert Ave./Gothard St. & Heil Ave./Springdale St. & McFadden Ave. — CC-1465 Enclosed please find your original bid bond for CC-1465. Sincerely, Robin Estanislau, CIVIC City Clerk RE:ds Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand SECTION C PROPOSAL for the construction of Traffic Signal Modifications from At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue And Springdale Street and McFadden Avenue CC No. 1465 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 60 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find \3� d.de�'s 3�G� 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 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MMCFADDEN AVENUE BID ITEMS Item Description Quantity Unit Unit Cost Total Cost No. _ (Extension)' 1 Mobilization 1 LS $l�j(�,t� $ co 2 Furnish Project Traffic Control 1 LS $`12.500.00 $ 1 Z 500. 00 3 Furnish and Install Traffic Striping and Signing 1 LS $I(o0 $ IC>C), `UO 4 Preparation of WPCP and installation and of Maintenance of BMP's per the approved WPCP. 1 LS $'jSCsJ.�O $ 35aJ•(� Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case A and Typical Section at New Curb Ramps 5 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 2 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.) $)ZOA). 00 $Zy(Xw,00 Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case B and Typical Section at New Curb Ramps 6 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 1 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated, domes, retaining curb, slot pave, etc.) $ i oou o $N 0001W Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case C and Typical Section at New Curb Ramps 7 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 5 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.). Excludes the Northeast corner of Gothard Street and Heil Avenue. 9ALjo.w $ UO,(� Construct Curb Ramps, Truncated Domes, Sidewalk, Curb and Gutter and Railing at the Northeast Corner of Gothard 8 Street and Heil Avenue and per Detail on Sheet 5. (Item 1 LS includes all appurtenances, curb and gutter, depressed curb, sidewalk, railings, truncated domes, retaining curb, slot pave, etc.) $15 ), $ I5TUX)- ) Construct Curb, Access Ramps and Concrete Sidewalk on the Raised Island at the Southwest quadrant of the Intersection of 9 Springdale Street and McFadden Avenue. See the Details on 1 LS Sheet 5. (Item includes all appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.) $2000,00 �7 $ ZZ(JW,oi3 10 Modify Traffic Signal at Gothard Street and Talbert Avenue. Item includes all work in plans not included in other items. 1 LS_ $ 11 Modify Traffic Signal at Gothard Street and Heil Avenue. Item includes all work in plans not included in other items. 1 LS $ $ I Z ? qo, oO 12 Modify Traffic Signal at Springdale Street and McFadden Ave. Item includes in included in items. 1 LS $l95 Llo. 1 $ -1ci 5Z(,•(Z all work plans not other C-2.l SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) COTHARD STREET AT TALBERT AVENUE, COTHARD STREET AT HEIL AVENUE AND SPRINCDALE STREET AT MCEADDEN AVENUE Item No. Description' Quantity Unit - Unit Cost Total Cost (Extension) TOTAL BID AMOUNT $ �90 30LDI Q() TOTAL BID AMOUNT IN WORDS: t �I I' IIISM Note: Refer to Section 9, Measure and Payment. All extensions of unit prices will be subject to verification by Owner. In case verification is required between the unit price and the extension, the unit price will govern. The Owner reserves the right to reject any or all proposals and bid items. The City will provide the traffic signal equipment, as listed in the pole schedules, (also includes anchor bolts) to the contractor. The contractor is to pick up the materials, with its own labor, at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 536-5530. C-2.2 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 or $10,000, whichever is greater, and the portion of the work to be done by such subcontractor. Bid Name and Address of State Class DIR PWC Dollar % of Item(s) Subcontractor License Registration # Amount Contract Number Zl P 1�rr - CS:. rJr,srr...v-i on �1 S 16 Is, VYv\ 1 e n t�'c_IL 1 lJ 2 q �irJ �`J� �1�� ��D 5 PLO 1 l3tc •� S 3:9 CuV�r\a,C GI-1Z3 CW r n S i) reO a VA 1- - c or\Var�o) CoCl \l�o"L cjOsS'l� CLoI / D0`1 lJ000357iy t,� ,� 1 'L (X P C>emn- rt C-, Z Mo-rLirv,)s S'J%-L C",C'`c'sS 51 - rj'llo'7J1� C;'5l C-te%l ��11.01701�t110 1S$3l.Cv Cycwcss, Ci) C� ob"3� p3,y S m i�-1'1SOr\ `i- lac tri c �n C . I ►�P> Cy-unye, Cry 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 EN 'City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE For Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue — CC 1465 HSIPL5181(178) August 11, 2017 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES. The Federal Labor Rates contained in Appendix l of the specifications for the: Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue - CC1465 HSIPL5181(178) shall be replaced with the following attached documents: The Federal Labor Rates dated August 4, 2017 shall be the labor rates in effect for the subject project. 2) PAGE C-1 — SECTION 3 — PROPOSAL The following sentence shall be inserted at the end of the first paragraph: The undersigned acknowledges that the issuance of Notice to Proceed will occur approximately three months after the award of contract to allow procurement time for the city furnished equipment. This is to acknowledge receipt and review of Addendum Number One, dated August 11, 2017. Inc _, e. Company Name thy ,i� 12� 1-I Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F. Janusz at (714) 536-5431. NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND 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 b '-I, at T�t`teGulci , �t,�\ �rnt 0 Date City State 0.mes C . being first duly sworn, deposes and says that he or she is Pr�S C\eni )Sec:rektun1 I Treasw-e, of (�& x Tnc 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. 'SD6)s, :S:n c- Name of Bidder gnature of Bidder LA Z, o2_Lt A ve n'.61, Al va✓^adA Is i A i--e ,4 T-emeCulo CA gZSGo Address of Bidder C-4 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 �':i'°�2�>M�°v"t3':,?�;;^,"z�'?�'�:�>;t',�'is'si4a�`:�i`���i=.S�a"k'•*•fi��i,�: ,�i°�s . �v>; t -w>�. ""`?>',K�j".,V:.�"�".itt;;:;;°emu:,:-s;+�F='. ^bi..` "4,'f' cV?'<' A notary public or other officer completing this certificate verifies onlythe 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 l County of Riverside J} On August 21, 2017 before me, Date personally appeared James C. Perry Phyllissa Martz, Notary Public Here Insert Name and Title of the Officer Nome(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. PHYLLISSA MARTZ Notary Public . California i Riverside County Z Commission # 2159844 D M Comm. Ex ires Au 11, 2020 Place Notary Seal and/or Stomp Above 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 1��►WJ Signature of Notary Public Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: ©2017 National Notary Association Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue, (1)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. )L) 6 & -1 nC- Contractor i�es-16 Sic urn, 1 es v Title C-5 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 YIN 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: 1912 � \ \-7 D hX :, Contractor L, B �('e.5.S-ec.rr}una I Fy-eas�-�� Title C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: ni3X Bidder Name C4ZOZI-4 Ayen; do, A\ varahz . S i-A �e A Business Address -Tcm-r-- CkAa CC)- GtzSCl City, State Zip (GSI ) 2g10- gGOq c1bxjic,Qhufrna,l-conm Telephone Number Email Address 2H054-1 A -4-C-\i�) State Contractor's License No. and Class Original Date Issued -i►3�\ICi Expiration Date The work site was inspected by S of our office on 1 q , 201-7. The following are persons, firms, and corporations having a principal interest in this proposal: Zarne--, C, Per r\-, 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. �h3 C- Cornaanv Name of Bidder Printed or Typed Si C-8 W-011 NOTARY CERTIFICATE Subscribed and sworn to before me this 2l day of A uq uSr , 201-7 . 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 e (Ly, CDC n,k o. ) County of �L,yeX'S; a e ) On g 1 Z 1 1 1 -1 before me, ffia(y, S 5 U I w-*z M no h Day, and Year Insert Name and Title of Notary personally appeared i ) 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 PHYLLISSA MARTZ Notary Public - California nERiverside County Z Commission # 2159844 D m Comm. Ex Tres Au 11, 2020 Signature of 1�otary Public (PLACE NOTARY SEAL ABOVE) C-9 Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work, specifically referencing the construction of {Describe specific work and experience necessary for project. For example, "Sanitary sewer line installation of at least of 1,000 of 8-inch and greater in public right-of- way. Sanitary sewer lift stations of similar size, project work within public streets, an area containing high ground water and pipeline construction in high ground water regions with trench depths of 8-feet to the invert."}. 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: C; V14c CyCtcil�l a Si5 S;-1,4k S ., Coa-Chel\a Name and Address of Public Agency Name and Telephone No. of Project Manager: —1 i,,u_sy\.cc1Zl Z i 3501 1 8 y. 2 o Iry l i; c s� anca s Contract Amount Type c f Work Iz1201l�. Date Completed Provide additional project description to show similar work: r(� ShSta9A C�kL6-i, Sbs- O�6t 175-CaeCT i CV mlidi 1, ex+st-NM, c S,s O'D , CF' q2-5�� Name and Address of Public Agency Name and Telephone No. of Project Manager: Svu- ci Si-g55-ugo6 �nv.a �►�_ Contract Amount Type of Work Date Completed Provide additional project description to show similar work: -10 s!-cw n-f--w �;- Q c mn 1 1-e . % mew,! ern f f41 S �- i 62�_i A n k <- o -r-f-Ps C-%I)\ ni ne Pa S X 01Q nl re Ph I ms, CA q'1171 Name and Address o Public Agency Name and Telephone No. of Project Manager: R.;c:.hcrcl PeAk-se,) Contract Amount Type of Work Date Completed Provide additional project description to show similar work: r.� C-10 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: q Oq- lZ l yuZ-1 6e✓no--d-ir\-,-- $333.QzU,-I5 311(a)11 TJ Project Name & Contract Amount Type of Work Date Completed szoc,Lon. OL3 WO'N,S'tcpeA Project Name & Contract Amount Type of Work UJIQ 115 Date Completed GL_TV , Q CL-P COA iYa S -11, 10Qo-L1 cn-ee, 1yI Z3� 1 y Project Name & Contract Amount Type of Work Date Completed 2. S eSSQ y ern und.e z Name of proposed Superintendent Telephone No. of proposed Superintendent: AS\ - SS t — l q gp CcCA 1YCt," S `5 q;3 -1 Z m e ><1 �h nc, \ ,, h nc� le ► (—i Project Name & Contract Amount Type of Work v Date Completed n S�r.W Gay JFluVevr`e 31►,vgg,�5 A-Y- na.a , J�ZCo�1la Project Name & Contract Amount Type of Work Date Completed -ThousuncL 00� S �3gN Zy�.�y e 1�ns� o� tzs 011-1 z ill L7 Project Name & Contract Amount Type of Work i1-iQs Date Completed C-ti CONTRACTOR REGISTRATION WITH CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS (DIR) CERTIFICATE Pursuant to SB 854 (citing Labor Code Section 1771.1(a)), passed by the California State Senate on June 20, 2014, established a new public works Contractor Registration Program, which requires all contractors and subcontractors bidding and performing work on Public Works Projects to register on an annual basis (each July 1 through June 30 state fiscal year) with the California Department of Industrial Relations (DIR). Currently the annual non-refundable registration fee for Contractors is $300. Each contractor to whom a public works contract has been awarded shall sign the following certificate. DIR FACT SHEET on SB 854 http://www.dir.ca.gov/DLSE/PublicWorks/SB854FactSheet_6.30.14.pdf DIR's Contractor Registration Link — Call (844) 522-6734 https://efiI1ng.dir.ca.gov/PWCR/ActionServlet?action=displayPWCRegistrationForm DIR's Contractor Registration searchable database: https://efiling.dir.ca.gov/PWCR/Search.action I am aware and will comply with the provisions of Labor Code Section 1771.1(a) which states: "A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5. It is not a violation of this section for an unregistered contractor to submit a bid that is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the contractor is registered to perform public work pursuant to Section 1725.5 at the time the contract is awarded." I furthermore will comply by providing proof of registration with DIR as the primary contractor, as well as for ALL subcontractors at the time of submitting the bid. Date: SJ2 1 1-1 PWC Registration #: I vOOW NZ yZ- DUX, Inc Contractor pr-�s dent-( Se u-c�� f Tr1ea S W-e*, Title C-12 Legal Name Registration Number County I city Registration date I Expiration Date DBX, INC. 1000004242 RIVERSIDE TEMECULA ®5/01P2017 b5Y=018 Legal Name ReglstraWn Number County CRY Registration Date Expiration Date HER•CON CONSTRtJCTION SERVICES. INC. 1000012689 LOS ANGELES COVINA 06f2612017 061301'2018 LBpi Name I Registration Number County I Registration Date Expiration [late M. J. DIRECTIONAL, INC. 100DO35774 SAN BERNARDWO I ONTARIO 06116/2017 06/30/2018 Legal Name Registration Number County City Registration Date Expiration Date SUPERIOR PAVEMENT MARKINGS 1000001476 ORANGE CYPRESS 06i2312017 O6'3012018 Legal Name Registration Number County City Registration Dale Expiration gate smrrHSON ELECTRIC, INC 1000001510 ORANGE ORANGE 06123/2017 06/3012018 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): V Will ensure that 10% of all new hires as a result of this project shall meet all requirements 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: n 6x, _Tr, Contact Person: J (DIme S C . P--P,-r Contact Phone: J t-z.ciu-gUpci Signed: ,�pp Date:�Z,�4—t *Note: The above certification is required by the Department of Housing and Urban Development (24 CFR 135 and Subtitle A et al) and must be submitted by the bidders and proposed sub -contractors only in connection with contracts and subcontracts which are subject to Section 3 of the 1968 Housing and Urban Development Act, as amended in 1992 (HUD). Previous non-compliance with Section 3 could result in disqualification. C-1 3 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION L)iax, Tric- The bidder-Zproposed subcontractor , hereby certifies that he has . ...............has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. C-14 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder , proposed subcontractor "er CL-X1 C ),s uc� (,n hereby certifies that he has ✓ . ...............has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. C-14 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder , proposed subcontractor M6 `Ji rccl-�k�,nc—k —T� hereby certifies that he has \,**"- . ...............has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. C-14 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder , proposed subcontractor hereby certifies that he has ✓ . ...............has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. C-14 k, t EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder , proposed subcontractor Sfn , A'hs 'z�,, ccle _A( .mac 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, 1 1114, 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. C-14 PUBLIC CONTRACT C O D E 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. ?lute: 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 prosNution. I L b aCQrtlS-, r 7-11 Signature Print Name Date 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 o law or a safety regulation? Yes No If the answer is yes, explain the circumstances in the following space. C-15 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. C . Ner-r-u R I Zt Signature Print Name Date C-16 Noncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY of Huntington Beach DEPARTMENT OF PUBLIC WORKS. In conformance with Title 23 United States Code Section 1 12 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 shah: bid. Mote: The above Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. J coM-eS C, P1 Print Name C-17 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. 'i he above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Signature Print Name 1.JDate C-18 w. 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. C-19 iA DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U S C. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract Fla. bid/offer/application F a. initial b. erant b. initial award b. material chanee C. cooperative agreement c. post -award d. loan e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity Prime Subawardee Tier if known Congressional District, if known 6. Federal Department/Agency: 8. Federal Action Number, if known: 10. a. Name and Address ofJ.16bby Entity (If individual, last n e, first name, MI) 11. A ount of Payment (check all that apply) 13. Type of Payment (check all that a pply) 1 (attach Continuation Sheet(s) if necessary) 15. Continuation Sheet(s) attached: Yes - No For Material Change Only: yearTquarter_ date of last report lY 5. If Reporting Entity in,o. 4 is Subawardee, Enter Name and Address of Prime: Congressional District, if known Federal Program Name/Description: CFDA Number, if applicable 9. Award Amount, if known: b. Individuals Performing Services (including address if different from No. I Oa) (last name, first name, MI) 2. 14. Form of Payment (check all that apply): c. commission Brief Description of Services Performed or to be performed and Dates) of Service, including (attach Continuation Sheet(s) if necessary) actual � planned a. retainer b. one-time fee a. cash d. contingent fee b. in -kind; specify: nature e deferred value _ f. other, specify officcr(s), employec(s), or member(s) contacted, for Payment Indicated in Item 11: 16. Information requested through this form is authorized by Title 31 U S C. Section 1352. This disclosure of lobbying reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 U S C. 1352 This information will be reported to Congress semiannually aed �ni!I be available for public inspection. Any person who izjls to file the iequued disclosure shall be subject to a civil penalty of not less than $ I Q000 and not more than $ I OO,Ov^0 for each such fad ure. Federal Use Only: Signature: Print N Title: PCCS;�t- dAl Sec�'�1"�-i I T7'PLPSU_1' asp-cl�oa Telephone No.:_Date: %\ �ki Authorized for Local Reproduction Standard Form - LLL C-20 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 tiling pursuant to title 31 U.S.C. section 1352. The tiling 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 tiling the report in Item 4 checks "Subawardee" then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-00 L" 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered Federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (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-LLL-Instructions Rev 06-04-')NENDIF» C-2I Local Assistance Procedures Manual Exhibit 15-G Construction Contract DBE Commitment EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT 1. Local Agency: City of Huntington Beach 2. Contract DBE Goal: 10.00% 3. Project Description: Traffic Signal Modifications at Gothard St/Talbert/Av, Gothard St/Heil Av, Springdale St/McFadden 4. Project Location: Gothard St/Talbert/Av, Gothard St/Heil Av, Springdale St/McFadden Av. 5. Bidder's Name: �i�k. T', ( 6. Prime Certified DBE: ❑ 7. Bid Amount: A_`L,l 8. Total Dollar Amount for ALL Subcontractors: I51 S`4 i 05 9. Total Number of ALL Subcontractors: J 10. Bid Item Number 11. Description of Work, Service, or Materials Supplied Su PP . 12DBE Certification Number 13. DBE Contact Information (Must be certified on the date bids are opened) 14. DBE Dollar Amount -ZL pi O W n 'h-a '1 L ILLY`&T'%i) , AGG-CSS ra..,pccA�,c A,3-C) 34Z 1 1-+.C�'• '(,i�,tl ( n: &u Li-! i, 1 S�-eroi L;cs �S$ S,�a�t\•a, e�1�,�ue �I �v, CA C'4 1-17,3 \2��o�.q'6 �•t C\ ConSrriL1- Cr-ury-1 S toll° 33C -7o.IJ Local Agency to Complete this Section $ I Lln�Otc.45 21. Local Agency Contract Number:CC-1465 15. TOTAL CLAIMED DBE PARTICIPATION 22. Federal -Aid Project Number: HSIPL-5181(178) 23. Bid Opening Date: 24. Contract Award Date: IMPORTANT: Identify all DBE firms being claimed for credit, regardless of tier. Names of the First Tier DBE Subcontractors and their respective item(s) of work listed above must be consistent, where applicable with the names and items of the work in the Local Agency certifies that all DBE certifications are valid and information on this form is complete and accurate. "Subcontractor List" submitted with your bid. Written confirmation of ea sted DBE is re r d. 25. Local Agency Representative's Signature 26. Date g12-1�►1 . Preparer's Signature 17. Date 27. Local A Agency Representative's Name 28. Phone 9 Y P j0.meS C ,04-ri q CGS'1191. CK-A 18. Preparer's Name 19. Phone 29. Local Agency Representative's Title PreS '� d•a-*-Seu� - m PaS ou-ea' 20. Preparer's Title DISTRIBUTION: 1. Original - Local Agency 2. Copy - Caltrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract execution may result in de -obligation of federal funds on contract. Include additional copy with award package. ADA Notice: For individuals with sensory disabilities, this document is available in alternate formats For information caii (916) 654-6410 or TDD (916) 654- 3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814 Page 1 of 2 C-22 flfp,.— On COHSTPUCTIon stpyl(fs Inc. CS1945955 7`8 S. i10LLLFi1bfCN fiVE, "'OVI t1, (fl 91725 Phone: (626) 339-7000 Certified - DBE/MBE Contractor E-mail: hercon7774511@aol.com DIR # 1000012689 SCCA Member Date: 18/17/2017 ATTN: ICharles TO: DBX, Inc. HSIPL-5181 City of Huntington Beach LUSION SHEET) ATTACHED. MEM DESCRIPTION QUANTITY UNIT UNIT $ COST 5 Construct Access Ramp per Caltrans Standard A88A case A 2 ea $ 11,341.28 $ 22,682.56 6 Construct Curb Access Ramp per Caltrans A88A case B 1 ea $ 13,702.61 $ 13,702.61 7 Construct Curb Access Ramp per Caltrans A88A case C 5 ea $ 9,807.10 $ 49,035.50 8 Construct Curb RampsN/E corner Gothard/Heil 1 I/S $ 14,888.00 $ 14,888.00 9 Construct Ramp/Sidwalk on IslandSM Springdale/McFadden 1 I/S $ 21,411.28 $ 21,411.28 A Traffic Control for Hercon work only 1 I/S $ 4,987.00 $ 4,987.00 Please Review Notes Below Note: Price is based on 1-move see sheet 2 for add mob. Costs. We have excluded all BMP's,SWWP's,Footing Removals,All Overexcavating,Cut and Cap and Relocating of all Existing Utilities,Locating and Pot Holing for any and all utilities, All Weekend and Night work,Fees,Pennits,Licenses,All Survey and Staking.Shop Drwngs, Badging,All sgnage and striping,Traffic control plans, Engineering,Water source and permit, Message boards,sign postings,Light Source and Towers,Street sweeping,All Badging , ,Washouts,Dumpsters,Rubberized Asphalt,Handling all Hazardous materials. Hercon will require temp. toilets for its work forces furnished by others Grand Total $ 126,706.95 Note /lteluJe� �it/i tkis p�0p0sa! please fi;zd aMwhed short 2 # 2 - Hcr-Colt G'cas&&Woa 94,wi es. /ne, 8&*d4l+d,F"Aw1on8 1p,144 all tarns and eold% lm It pa Aare not reeelrea'sAme 2 ot2 Please eontaet 00' -0#1�i prlov- 0t aeerptanee &0 338-7000 we Flack To Query Form Search Returned 1 Records Query Criteria Firm/DBA Name: HER -CON Firm Type: DBE Firm ID 36281 Firm/DBA Name HER -CON CONSTRUCTION SERVICES, INC. Address Line1 758 S. HOLLENBECK AVENUE Address Line2 City COVINA State CA Zip Code1 91723 Zip Code2 Mailing Address Line1 Mailing Address Line2 Mailing City Mailing State Mailing Zip Code1 Mailing Zip Code2 Certification Type DBE Entail hercon7774511 @aol.com Contact Name JOSEPH HERNANDEZ Area Code ( 626 ) Phone Number 339-7000 Extension Alt Area Code ( ) Alt Phone Number Extension Fax Area Code ( 626 ) Fax Phone Number 331-3638 Agency Name DEPARTMENT OF TRANSPORTATION Counties 19; 30; 33; 36; Districts 07; 08; 12; DBE NAICS 236220; 237110; 237120; 237130; 237990; ACDBE NAICS Mon Aug 21 12:52:38 PDT 2017 C7500 MISC IRON & STEEL FRAME, COVER & GRATE; C1901 ROADWAY EXCAVATION; C3901 ASPHALT Work Codes CONCRETE; C6500 REINFORCED CONCRETE PIPE; C8851 Lead Compliance; C9810 SMALL STRUCTURES; C1601 CLEARING & GRUBBING; C0651 CONCRETE & CEMENT SUPPLIER; C9801 BUILDING CONSTRUCTION; C5100 CONCRETE STRUCTURE; C5105 MINOR CONCRETE STRUCTURE; C7301 CONCRETE CURB & SIDEWALK - MISC; Licenses A General Engineering Contractor; C08 Concrete Contractor; Trucks Gender M Ethnicity HISPANIC Firm Type DBE Back To Query Form ,/ Local Assistance Procedures Manual Exhibit 15-H DBE Information - Good Faith Effort EXHIBIT 15-H DBE INFORMATION —GOOD FAITH EFFORTS DBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. HSIPL-5181 (178) Bid Opening Date The established a Disadvantaged Business Enterprise (DBE) goal of 10.00% 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.): Names of DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation C-23 ./` Local Assistance Procedures Manual Exhibit 15-H 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 N 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: 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: C-24 Local Assistance Procedures Manual Exhibit I5-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: 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. C-25 Local Assistance Procedures Exhibit 12-B Bidder's List of Subcontractors (DBE and NON-DSE) Exhibit 12-B Bidder's List of subcontractor (DBE and Nan -DBE) Part I As of March 1, 2015 Contractors (and sub -contractors) wishing to bid on public works contracts shall be registered with the State Division of Industrial Relations and certified to bid on Public Works contracts. Please register at: https://efiling.dir.ca.gov1PWCR1ActionServlet?action=dis plaYMCRegistration Form In accordance with Title 44, Section 26.11 of the Cade of Federal Regulations, and Section 4104 of the Public Contract Code of the State of California, as amended, the following information is required for each sub -contractor who will perform work amounting to more than one half of one percent (0.5%) of the Total Base Bid or $10,000 (whichever is Greater). Photocopy this form for additional firms. Subcontractor Name and Location Line Item & Description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor License Number DBE (Y/N) DBE Cert Number Annual Gross Receipts DIR Reg Number Name: 14 ev' C on c-S'Sry -% osee-v��� _ 2Cpi Q,-Pn IWO '- n%tr%.'-e 5-consSti"�.wi-4c-cssr°oHp . tQ,,sS,u} j}c or s rm,r� 1_c�n3��h rs 4 Q �t 4-7. u3 `z2.� SZ . Sk r�y�T ,2. Lo i yyC Vc'. 3q °le Q`( q-1 cy� c'i9-h! 9 ei-h; yscl=a5 � jip Zg t r$1 million <$5 million City, State: `r,V�oo,(r4 I�jVw42.'�a i r$10 million <$15 million of Firm:_yrs. Name: q-COAWWA-rorr-p1 2.1-+it.Z�' r$imillion r$5 million City, State: r$10 million <$15 million ge of Firm:_yrs. Name: tvNa of rc-Ui by'+;-) t,CQ? &I {i1+,llerlr� rl w l] 3� r$1 million <$5 million City, State: on�W,-i sCt1 �`y��rr7•—tJ <$10 million <$15 million e of Firm:_yrs. Name: ir i-s r�r) C6°w <$1 million L..ic$5 million City, State: Si Go Ity.�jl�}-�0 <$10 million r$15million Age of Firm:_yrs. Name: _ 5m�Ai-t5�n C1CC_Y�L i t7te) Sn s 3 �1Q7 S 32_g5• 3_-, q V5, t5u 'l`� Lk 1L151 Y ri r$1 million <$5 million City, State: U( Cl f '�. U <$lo million 0} )Ow i l.al 0 <$15 million Age of Firm:_yrs. Name: LJ <$1 million <$5 million City, State: <$10 million r$15 million Age of Firm:_yrs. Distribution: 1) Original -Local Agency 'File 2) Copy-DLAE w/Award Package Page 26 of 2 Local Assistance Procedures Exhibit i 2-B Bidder's List of Subcontractors (DBE and NON -DBE) I-B Bidder's List of subcontractor (D BE and. Non -DBE) Part 2 In accordance with Title 49- Section 26 of the Code of Federal Regulations, the Bidder shall list all subcontractor who provide a quote or bid but were not selected to participate as a subcontractor on this project. Photocopy this form for additional firms. Subcontractor Name and Location Line item & Description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor License Number DBE (Y/N) DBE Cert Number Annual Gross Receipts DIR Reg Number Name: �-� L� <$1 million 5 million City, State: <$10 million <$15 million Age of Firm-_yrs- Name: <$1 million <$5 million City, State: < 1D million, <$15 million Age of Firm:_yrs. Name: <$1 million <$5 million City, State: <$10 million <$15 million Age of Firm:_yrs. Name: <$1 million <$5 mullion City, State: <$10 million <$15 million Age of Firm:_yrs. Name: <$1 million < 5 million City, State: <j10 million <$15 million Age of Firm: yrs. Name: <$1 million <$5 million City, State: <$10 million <$15 million Age of firm: yrs. Distribution: 1) Original -Local Agency File 2) Copy-DLAE w/ Award Package Page 27 of 2 Local Assistance Procedures Manual Exhibit 17-f Final Report -Utilization of Disadvantaged Business Enterprises (DBE) and First -Tier Subcontractors EXHIBIT 17-F FINAL REPORT -UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES (DBE) AND FIRST -TIER SUBCONTRACTORS 1. Local Agency Contract Number 2, Federal -Aid Project Number 3. Local Agency 4. Contract Completion Date 5. Contractor/Consultant 6. Business Address 7, Final Contract Amount 8 Contract Item Number 9. Description of Work, Service, or Materials Supplied 10. Company Name and Business Address 11. DBE Certification Number 12. Contract Payments 13. Date Work Completed 14. Date of Final Payment Non -DBE DBE 15. ORIGINAL DBE COMMITMENT AMOUNT 15.TOTAL List all first -tier subcontractorstsubconsultants and DBEs regardless of trey whether or not the firms were originally listed for goal credit. If actual DBE utilization (or item of work) was different than that approved at the time of award. crovide comments on an additional oaae List actual amount ❑aid to each entity. If no subcontractorslsubconsultants were used on the contract, indicate on the form I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT 17. Contractor/Consultant Representative's Signature 18. Contractor/Consultant Representative's Name 19, Phone 20. Date I CERTIFY THAT THE CONTRACTING RECORDS AND ON -SITE PERFORMANCE OF THE DBE[S) HAS BEEN MONITORED 21, Local Agency Representative's Signature 22. Local Agency Representative's Name 23. Phone 24. Date DISTRIBILMON: Original - Local Agency, Copy - Caltrans District Local Assistance Engineer. Include with Final Report of Expenditures ADA NOTICE: For Individuals with sensory disabilities, this document is available in alternate formats For information, call (916) 445-1233, Local Assistance Procedures Manual TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. C-28 THE The Guarantee Company of North America USA GUARANTEETM POWER OF ATTORNEY Southfield, Michigan KNOW ALL BY THESE PRESENTS: That THE GUARANTEE COMPANY OF NORTH AMERICA USA, a corporation organized and existing under the laws of the State of Michigan, having its principal office in Southfield, Michigan, does hereby constitute and appoint David L. Culbertson, Charles L. Flake, Richard A. Coon, Spencer Flake Culbertson Insurance Services, Inc. its true and lawful altorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise. The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at the principal office. The Power of Attorney is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By -Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 3151 day of December, 2003. The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority: 1, To appoint Attomey(s)-in-fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof; and 2. To revoke, at any time, any such Attorney -in -fact and revoke the authority given, except as provided below 3. In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. 4. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner — Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting duly called and held on the 6th day of December 2011, of which the following is a true excerpt: RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, contracts of indemnity and other writings obligatory in the nature thereof, and such signature and seal when so used shall have the same force and effect as though manually affixed. ,+* IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and its corporate seal to be affixed by its authorized officer, this 23rd day of February, 2012. THE GUARANTEE COMPANY OF NORTH AMERICA USA yO"H AYEa`�r STATE OF MICHIGAN Stephen C. Ruschak, President & COO Randall Musselman, Secretary County of Oakland On this 23rd day of February, 2012 before me came the individuals who executed the preceding instrument, to me personally known, and being by me duly sworn, said that each is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of Cynthia A. Takal Notary Public, State of Michigan County of Oakland w My Commission Expires February 27, 2018 Acting in Oakland County IN WITNESS WHEREOF, I have hereunto set my hand at The Guarantee Company of North America USA offices the day and year above written. I, Randall Musselman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect. p TErC% IN WITNESS WHEREOF, I have thereunto set my hand and attached the seal of said Company thisl4th day of August , 2017 S`�1AMER`tP Randall Musselman, Secretary The Guarantee Company of North America USA +, 1800 Sutter Street, Suite 735, Concord, CA 94520 BID BOND BOND NO. 8-g Premium: Nil KNOW ALL MEN BY THESE PRESENTS, That we, DBX, Incorporated as Principal, and The Guarantee Company of North America USA, a corporation duly organized under the laws of the State of Michigan, as Surety, are held and firmly bound unto City of Huntington Beach as Obligee, in the sum of Ten Percent of Amount bid ($ 10% ) Dollars for the payment of which Principal and Surety bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally. WHEREAS, Principal has submitted a bid for Traffic Signal Modification at Intersections of Gothard Street and Talbert Ave., G�othard Street and Heil Ave., Springdale Street and McFadden Ave. CC No. 1465 NOW, THEREFORE, if the Obligee accepts the bid of the Principal and the Principal enters into a Contract with the Obligee for the Project; or, if the Principal pays the Obligee the amount of this Bond or the difference between Principal's bid and the next lowest bid for the Project, whichever is less: this obligation is null and void, otherwise to remain in full force and effect. Signed and seated thi$;4th day of August 2017 X, Incor orated BY: (Witness) P mcipal ITS: The Guaran a ny of North rica USA BY: (Witness) Charles L. ke, Attorney -In -Fact CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Riverside On August 21, 2017 before me, Phyllissa Martz, Notary Public Date Here Insert Name and Title of the Officer personally appeared James C. Perry Nome(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. PHYLLISSA MARTZ Notary Public - California -.s Riverside County z z Commission 8 2159844 M Comm. Ex iris Aug11, 2020 Place Notary Seal and/or Stomp Above 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 Ow � L "IJIMA: ISI natur of Notary Public g e ry Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: ©2017 National Notary Association Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County of Orange On 8-14-17 Date before me, Lexie Sherwood personally appeared Charles L. Flake LEXIE SHERVIPOOD sr;g��M COMM. # 2203287 1 , Notary Public, Insert Name of Notary exactly as it appears on the official seal ) 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 capaclt'y(les), 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 �! Lt _,we -- Place Notary Seal Above Signature of Notary Public exie bherwood 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 the 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 ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer Title(s): ❑ Partner ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: ORIGIN ID:HMTA (951) 296-9909 LISA MARTZ SHIP DATE: 21AUG17 ACTWGT: 1.00 LB DBX INC CAD: 39536181INET3920 42024 AVENIDA ALVARADO SUITE A TEMECULA CA 92590 BILL SENDER UNITED STATES US TO CITY CLERK'S OFFICE CITY OF HUNTINGTON BEACH 2000 MAIN STREET 2ND FLOOR HUNTINGTON BEACH CA 92648 (714) 536-5431 REF. INV PO- DEPT: FecFra. FEI 11111 ............. ....... p k I I TUE - 22 AUG 10:30A 0 0# 7700 7475 4051 PRIORITY OVERNIGHT WZ APVA lill 111111111 92648 II wu, SNA II ullllllllltl 0 0 -0 0 T1 CD Cl_ m x m x -0 cn en cr, 27 -o' -0 cn ET - p L._` 42024 Avenida Aiv aaado Suite A Temecula, CA 92590 License NO. 240547 C- 1 0 & A DIR No. 1000004242 CITY OF HUNTINGTON BEACH CITY CLERK'S OFFICE — 2ND FLOOR 2000 MAIN STREET HUNTINGTON BEACH, CA 92648 "SEALED BID" For the construction of: TRAFFIC SIGNAL MODIFICATIONS At the intersections of Dthard St. and Talbert Ave., Gothard St. and Heil Ave, and Springdale St. and McFadden Ave. Bid Date: August 22, 2017 @ 2:00 prin **DO NOT OPEN WITH REGULAR MAIL** City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Robin Estanislau, City Clerk January 31, 2018 PTM General Engineering Services, Inc. 5942 Acorn St. Riverside, CA 92504 RE: Traffic Signal Modifications at Gothard St.& Talbert Ave./Gothard St. & Heil Ave./Springdale St. & McFadden Ave. — CC-1465 Enclosed please find your original bid bond for,CC-1465. Sincerely, Robin Estanislau, CIVIC City Clerk RE:ds Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand blijcr: PTM Gcncral E_nginccring 5cn iccs, Inc. 5 99-2 Acorn 5t. RivcrslJc, CA )2509- 9 51.710. i 000 City of Huntington bcack Att: City ClcrL 2000 Main 5t 2"' rloor Huntington bcach Ca, 102648 (719-) 536-5227 T imc of 51ci: 2:00Fm Datc of 51J: TucsJay August 22, 201 7 FroJcct No: 1- 151PL 51 s 1 ;178) CC 19-65 Dcsc: GotharJ 5t & j alkcrt Avc Gothari 5t & Hcil Avc & 5rringJalc 5t & McraJJcn Avenue. Traffic Signal Modifications. F)iD E-NCL05E-D - DO NOT OPE-N WITH RE-GULAK MAID SECTION B INSTRUCTIONS TO BIDDERS 1. Proposal Forms Bids shall be submitted in writing on the Proposal forms provided by the AGENCY. All information requested therein must be clearly and legibly set forth in the manner and form indicated. The AGENCY may reject any proposal not meeting these requirements. The bid shall be filed with the City Clerk, Second Floor City Hall, 2000 Main Street, Huntington Beach, California, which shall be endorsed with the Project Title and CC Number as it appears on the Notice Inviting Sealed Bids. The sealed envelopes will be publicly opened and read at the time and place stated in the Notice Inviting Bids. Bidders or their authorized agents are invited to be present at the opening. Unauthorized conditions, limitations, or provisions attached to a proposal will render it informal and may cause its rejection. The complete proposal forms shall be without interlineations, alterations or erasures. Alternative proposals will not be considered unless requested. No oral, telegraphic, or telephonic proposals or modifications will be considered. The proposal may be withdrawn upon request by the bidder without prejudice to himself prior to, but not after the time fixed for opening of bids, provided that the request is in writing, that it has been executed by the bidder or his duly authorized representative, and that it is filed with the AGENCY. 2. Proposal Guarantee ® Proposals must be accompanied by a proposal guarantee consisting of a certified or cashier's check or bid bond payable to the AGENCY in the amount not less than 10% of the total amount named in the proposal. Any proposal not accompanied by such a guarantee will not be considered. Said check or bond shall be made payable to the AGENCY, and shall be given as a guarantee that the bidder, if awarded the Work, will enter into a contract within 10 working days after the award and will furnish the necessary bonds as hereinafter provided. In the case of refusal or failure to enter into said contract, the check or bond, as the case may be, shall be forfeited to the AGENCY. 3. Proposal Signature If the proposal is made by an individual, it shall be signed and his full name with his address shall be given; if it is made by a firm, it shall be signed with the co partnership name by a member of the firm who shall sign his own name and the name and address of each member shall be given; and if it is made by a corporation, the name of the corporation shall be signed by its duly authorized officer or officers attested by the corporate seal, and the names and titles of all officers of the corporation shall be given. s-t 4. Delivery Of Proposal Proposals shall be enclosed in a sealed envelope plainly marked on the outside: "SEALED BID" for Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue in the CITY OF HUNTINGTON BEACH - DO NOT OPEN WITH REGULAR MAIL DELIVER TO THE OFFICE OF THE CITY CLERK, 2000 MAIN STREET, SECOND FLOOR Proposals may be mailed or delivered by messenger. However, it is the bidder's responsibility alone to ensure delivery of the proposal to the Office of the City Clerk prior to the bid -opening hour stipulated in the Notice Inviting Sealed Bids. Late proposals will not be considered. 5. Return Of Proposal Guarantees The proposal guarantees of the second and third lowest bidders will be held until the awarded bidder has properly executed all contract documents. Within 10 working days after the award of contract, the remaining proposal guarantees accompanying all other proposals will become null and void and returned to the unsuccessful bidders. Adlk 6. Taxes No mention shall be made in the proposal of Sales Tax, Use Tax or any other tax, as all amounts bid will be deemed and held to include any such taxes which may be applicable. 7. Disqualification Of Bidders In the event that any bidder acting as a prime contractor has an interest in more than one proposal, all such proposals will be rejected and the bidder will be disqualified. This restriction does not apply to subcontractors or suppliers who may submit quotations to more than one bidder, and while doing so, may also submit a formal proposal as a prime contractor. 8. Contractor's License Requirement This project requires the Contractor to possess a valid State of California contractor's license of the proper classification in accordance with the provisions of Public Contract Code Section 10164. All traffic signal electrical work must be performed by a traffic signal contractor who possesses a C-10 Electrical Contractors License. 9. References B-2 SECTION C PROPOSAL for the construction of Traffic Signal Modifications from At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue And Springdale Street and McFadden Avenue CC No. 1465 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 10 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 60 working days, starting from the date of the Notice to Proceed. Ll BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security is 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 10 % of Total Bid Bond 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 s C-2 • SECTION C 11 PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE BID ITEMS haw "S 011-11-10 A 1 1 Mobilization 1 LS 2 Furnish Project Traffic Control 1 LS 3 Furnish and Install Traffic Striping and Signing 1 LS $1913Q 3q i! 4 Preparation of WPCP and installation and of Maintenance of BMP's per the approved WPCP. 1 LS $ Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case A and Typical Section at New Curb Ramps 5 Adjacent to AC Paving Detail on Sheet 5. (item includes all 2 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case B and Typical Section at New Curb Ramps 6 Adjacent to AC Paving Detail on Sheet 5. (item includes all 1 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated, domes, retaining curb, slot pave, etc.) $ g, �fs. JtZ (4,-776. Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case C and Typical Section at New Curb Ramps 7 Adjacent to AC Paving Detail on Sheet 5. (item includes all 5 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.). Excludes the Northeast corner of Gothard Street and Heil Avenue. $q Construct Curb Ramps, Truncated Domes, Sidewalk, Curb and Gutter and Railing at the Northeast Corner of Gothard a Street and Heil Avenue and per Detail on Sheet 5. (item 1 LS includes all appurtenances, curb and gutter, depressed curb, sidewalk, railings, truncated domes, retaining curb, slot pave, etc.) Construct Curb, Access Ramps and Concrete Sidewalk on the Raised Island at the Southwest quadrant of the Intersection of 9 Springdale Street and McFadden Avenue. See the Details on 1 LS Sheet 5. (item includes all appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.) C[1aoo-oj 10 Modify Traffic Signal at Gothard Street and Talbert Avenue. Item includes all work in plans not included in other items. 1 LS 11 Modify Traffic Signal at Gothard Street and Heil Avenue. 1 LS Item includes all work in plans not included in other items. 12 Modify Traffic Signal at Springdale Street and McFadden Ave. Item includes in included in items. 1 LS 'SC all work plans not other C-2.1 OF ROM 0-06 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE TOTAL BID AMOUNT TOTAL BID AMOUNT IN WORDS: Note: Refer to Section 9, Measure and Payment. N All extensions of unit prices will be subject to verification by Owner. In case verification is required between the unit price and the extension, the unit price will govern. The Owner reserves the right to reject any or all proposals and bid items. 0 The City will provide the traffic signal equipment, as listed in the pole schedules, (also includes anchor bolts) to the contractor. The contractor is to pick up the materials, with its own labor, at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 536-5530. C-2.2 L 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 or $10,000, whichever is greater, and the portion of the work to be done by such subcontractor. Bid Item(s) Name and Address of Subcontractor State License Number Class DIR PWC Registration # Dollar Amount % of Contract Cl _T. E.,IILe'e",n d- 3ssks VOCKS+ • 3e.-v' d I t'F 4 $ 22 3 44 10c0oy3o61r 985oa ode 2y 44 1o^ii 6-1106zle 4411W 16e32 00-4a{-1 ddj,At-e crt�vn �rPvZ ,Ci �b i0000C��1 103y0 By submission of this proposal, the Bidder certifies: That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID 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 08.21.17 , 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. 11, PTM General Engineering Services Inc Name Bidder Elizabeth H. Mendoza de McRae President/CFO Si f Bidder 5942 Acorn St Riverside Ca, 92504 Address of Bidder C7 C-4 UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue, (1)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person' is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: August 21, 2017 U PTM General Engineering Services, Inc i Contractor lizabeth H. Mendoza de McRae By President/CFO Title C-5 DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 10162, the Bidder shall complete, under penalty perjury, of e ' 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 U No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 • COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. Date: August 21, 2017 PTXGeneral President/CFO Title C-7 Elizabeth H. Mendoza de McRae BIDDER'S INFORMATION Aah BIDDER certifies that the following information is true and correct: Wo PTM General Engineering Services, Inc Bidder Name 5942 Acorn St Business Address Riverside Ca 92504 City, State zip (951 ) 710.1000 elizabeth@ptm-eng.com Telephone Number Email Address 891265 Class A;C10 State Contractor's License No. and Class 02.20.2007 Original Date Issued 02.28.2019 Expiration Date The work site was inspected by Brian Mendoza of our office on Riverside 2017 . The following are persons, firms, and corporations having a principal interest in this proposal: Elizabeth H. Mendoza de McRae President/CFO Brian Mendoza Secretary/Vice President 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 G& Company Sign Inc Elizabeth H. Mendoza de McRae President/CFO Printed or Typed Signature 9 C-8 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ) County of LOS A'NNGELES ) On f_(• / ? before me, PHILIP VEGA, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared ELIZABETH H. MENDOZA de McRAE 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. PHILIP VE6q� COMM. # 2152121 /<� eo NOTARY PUBL!CCALIFORNIA U! °a,Rr LOSANOElES COUNTY Signature MY COtt EXP, MAY 31, 2020 .. Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: ©2014 National Notary Association - www.NationalNotary.org - 1-800-US NOTARY (1-800-876-6827) Item #5907 NOTARY CERTIFICATE Subscribed and sworn to before me this _ day of , 201_ 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 ) County of ) On Month, Day, and Year personally appeared before me, Insert Name and Title of Notary 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 isauthorized 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 Signature of Notary Public (PLACE NOTARY SEAL ABOVE) Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work, specifically referencing the construction of {Describe specific work and experience necessary for project. For example, "Sanitary sewer line installation of at least of 1,000 of 8-inch and greater in public right of way. Sanitary sewer Iift stations of similar size Proiect work within public streets an area containing high ground water and Pipeline construction in high ground water regions with trench depths of 8-feet to the invert.111. 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 Pico Rivera 6615 Passon Blvd Pico Rivera Ca, 90660 Name and Address of Public Agency Name and Telephone No. of Project Manager: Mr. Jose Loera 562.801.4350 $1,937,510.68 Traffic Signal Safety Improvements April 2015 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: 2. City of Irvine One Civic Center Drive Irvine Ca, 92623Aft Name and Address of Public Agency Name and Telephone No. of Project Manager: Mr. Darrel Hartman 949.724.6000 $424,023.00 Northbound On -Ramp Traffic Signal Improment. July 2015 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: City of Pomona 505 S. Garey Avenue Pomona Ca, 91769 Name and Address of Public Agency Name and Telephone No. of Project Manager: Mr. Ron Chan 909.620.2261 $571,209.00 Traffic Modification on Lexington December 2014 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: I] C-10 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 Telephone No. of proposed Project Manager: 951.722.5755 City of Pico Rivera $1,937,510.68 TS Improvements April 2015 Project Name & Contract Amount Type of Work Date Completed City of Irvine $424,023.00 TS Improvements July 2015 Project Name & Contract Amount Type of Work Date Completed City of Pomona S571,209.00 TS Modidifcation December 2014 Project Name & Contract Amount Type of Work Date Completed 2. Brian Mendoza Name of proposed Superintendent Telephone No. of proposed Superintendent: 951.722.5755 City of Pico Rivera $1,937,510.68 TS Improvements April 2015 Project Name & Contract Amount Type of Work Date Completed City of Irvine $424,023.00 TS Improvements July 2015 Project Name & Contract Amount Type of Work Date Completed City of Pomona $571,209.00 TS Modidifcation December 2014 Project Name & Contract Amount Type of Work Date Completed C-11 CONTRACTOR REGISTRATION WITH CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS (DIR) CERTIFICATE Pursuant to SB 854 (citing Labor Code Section 1771.1(a)), passed by the California State Senate on June 20, 2014, established a new public works Contractor Registration Program, which requires all contractors and subcontractors bidding and performing work on Public Works Projects to register on an annual basis (each July 1 through June 30 state fiscal year) with the California Department of Industrial Relations (DIR). Currently the annual non-refundable registration fee for Contractors is $300. Each contractor to whom a public works contract has been awarded shall sign the following certificate. DIR FACT SHEET on SB 854 http://www.dir.ca.gov/DLSE/PublicWorks/SB854FactSheet 6.30.14.pdf DIR's Contractor Registration Link — Call (844) 522-6734 https://efiling. dir.ca. gov/PWCR/ActionServlet?action--displayPWCRegistrationForm DIR's Contractor Registration searchable database: https: //efiling. dir. ca. gov/PWCR/ S earch. acti on I am aware and will comply with the provisions of Labor Code Section 1771.1(a) which states: "A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5. It is not a violation of this section for an • unregistered contractor to submit a bid that is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the contractor is registered to perform public work pursuant to Section 1725.5 at the time the contract is awarded." I furthermore will comply by providing proof of registration with DIR as the primary contractor, as well as for ALL subcontractors at the time of submitting the bid. Date: August 21, 2017 PWC Registration #: 1000001433 Inc Contractor Elizabeth H. Mendoza de McRae By President/CFO Title C-12 • 0 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 requirements of Section 3 of CFR Part 135 of the HUD Act of 1968; or 4 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. 0 Contractor: PTM General Engineering Services, Inc C7 Contact Person: Elizabeth H. Mendoza de McRae Contact Phone: 951.710.1000 Signed: Date: August 21, 2017 *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-13 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder , proposed subcontractor hereby certifies that he has X . ...............has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has 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 S10,000 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. * PTM General Engineering Services, Inc C-14 El PUBLIC CONTRACT C O D E PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has_, has not X been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public 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 o e Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this S to ent. Bidders are caytioned that making a false certification may subject the certifier to criminal prosecutioni. 7 H. Mendoza de McRae Aut?ust 21, 2017 Print Name Date 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. C-15 * PTM General Engineering Services, Inc 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. 0 beth H. Mendoza de McRae August 21, 2017 Print Name Date C-16 L� 0 Noncolluslon >< avi (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY of Huntington Beach 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 Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion ther of shall also constitute signature of this Non -collusion Affidavit. Bidders a e cautioned that 'making a false certification may subject the certifier to criminal prosecution. Elizabeth H. Mendoza de McRae Print Name C-17 ust 21, 2017 Date DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 0 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 certific 'on is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute ature of this Certification. eth H. Mendoza de McRae Au Signature Print Name C-18 ist 21, 2017 Date E. 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. C-19 N/A=Not Applicable DISCLOSURE OF LOBBYING ACTIVITIES TO 31 I. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract N/A a bid/offer/application C a. initial N/A b. erant b. initial award N/A b. material chanee 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, Prime Subawardee Enter Name and Address of Prime: N/A N/A Tier if known Congressional District, if known 6. Federal Department/Agency: N/A 8. Federal Action Number, if known: N/A 10. a. Name and Address of Lobby Entity (If individual, last name, first name, MI) N/A Congressional District, if known 7. Federal Program Name/Description: N/A CFDA Number, if applicable 9. Award Amount, if known: N/A b. Individuals Performing Services (including address if different from No. I Oa) (last name, first name, MI) N/A (attach Continuation Sheet(s) if necessary) 11. Amount of Payment (check all that apply) 13. Type of Payment (check all that apply) $ N/A n actual 0 planned a. retainer b. one-time fee N/A 12. Form of Payment (check all that apply): c. commission Ha. cash d. contingent fee N/A b. in -kind; specify: nature e deferred value _ f, other, specify 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer/(As), employee(s), or member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if ne 15. Continuation Sheet(s) attached: Yes No Q 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure oflohbying reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty ofnot less than S 10,000 and not more than S 100,000 for each such failure. Federal Use Only: Signature: 1 Print Name: Elizabeth H. Mendoza de McRae President/CFO Telephone No.:_Date: August 21, 2017 951.710.1000Authorized for Local Reproduction Standard Form - LLL C-20 Ll 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-t <.L-1mt�am­ Rc 060490�,ENDLF» C-21 Local Assistance procedures Manual Exhibit I S-G Construction Contract DBE Commitment ExHIBIT 15-G CONSTRUCTION CONTRACT DB E' COyiMITINIENT 1. Locai Agency: City of Huntington Beach 2 Contract DBE Goal: 10.DO% 3. Project Description: Traffic Signal Modifications at Gothard St%Talbei JAv. Gothard St/Heil Av. Sprinodale SUMcFadden 4 Project Location: Gothard SUTalbetlAv. Gothard SYHeil Av. Springdale St/McFadden Av. 5. Bidders Name:PTM General Engineering Svcs, Inch. Prime Certified DBE: ❑ 7. Bid Amount: 372872.00 8. Total Dollar Amount for ALL Subcontractors: 1 08840.00 9. Total Number of ALL Subcontractors: 2 10, Bid Item 11. Description of 1� ork, Service, or t haterials 12. DBE Certification 13. DBE Contact Information 14. DBE Dollar Number Supplied Number (Idiust be certified on the date bids are opened) Amount Ptn. 10 Ptn. of electrical install. 1176 Global Road Sealing Inc. 10340.00 -11 10832 Dorothy Ave. Garden Grove, CA 92843 I I 714. 93.0845 I Ptn. 10- Ptn. of material. 37133 L teforms 531195.00 12 13841 Roswell Ave. #A Chino, CA 91710 909. 80.8123 x o= tocal Agencyfo Complete tfii__s 42257.0 21. Local Agency Contract Number.CC-1455 45. TOTAL CLAIMED DBE PARTICIPATION 22. Federal -Aid Project Number: HSIPL-5181(178) 23. Bid Opening Date: 11.3 24. Contract Award Date: IMPORTA Identify all DBE firms being claimed for credit, regardless of�ier. Names of the First Tier DBE Subcontractors and their respe fve items) of work listed above must be consistent. where app ble wish the names and items of the work in the Local Agency certifies that all DBE certifications are valid and information on "Subcon r List" submitted with your bid. Written confirmation of this form is complete and accurate. each lis ed kB required. 08.28.17 25. Local Agency Representative's Signature 26. Date 16(Preparer's Signature 17. Date Elizabeth H. Mendoza de McRae 951.722.5678 27. Local Agency Representative's Name 28. Phone 18. Preparer's Name 19. Phone President/CFO 29. Local Agency Representative's Title 20, Preparer's Title DISTRIBUTION 1. Original -Local Agency 2. Copy - Caltrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract execution may result in de -obligation of federal funds on contract. Include additional copy with award package. ADA Notice: For individuals with sensory disabilities, this aociment is available in alternate formats. For iniorm,atior call (816) 654-6410 or TDD (916) 654- 3330 or write Records and Forms Management 1120 N Street, MS-89, Sacramenio, C4 95814. Page 1 of 2 C-2 2 FORM S eR� Ave Una S 214= a g s, » as c2 n —L C�m 33 Date: Auoulst2%2017 T:: eTv GenaalEn/n bng Ser $ 3c Smw: § Eab«h QR Ate Do c Elizabeth-EGc ngee%. F §c 951.710.1006 se: Date Ef 0822/2017 Dqm/m:CC145te&PSSyg2gGdhaey.at7al oMae Heil t and Sptngdale x vcFadden A e. J ETV: Geae pleased 0qu«ethe %§ «g 3� cep i� \ Se T, 2 •�Description U/v Qt y UnE Price Eytension \\ t\ § x a s . 4 .' % 1,275M J P' J se 5 2.50 s Isc 00 Rv:s 3z » S 9 2200 § 7:Eoo Block 9q: . 5 s 1 5. DO f 2372m .- a G _ 2 S25.00 3 az.00 Rem rT =5 y� _ s 2 osE oo $ 1,050.00 m Pill Box S $ 425.00 $ 4,250.00 J PVC zF 450 $ 2.52 S 2!25.m J PVC s 0 > 350 } 2 c>3 n J 7500 : 275 S 13,125.00 w 3 ze&. sz J zoG z tso 5 600.00 Ke». :\c J 403 z 250 § 1,002 00 Se«. :ac s 1400 S « 2s S %zsC 00 >o+ Si_ . s :75. 2 \45ceo w, \ m 3 eb -, T v 25 w - Gneq a s z 4 .00 s 2:2coa x PVC J 100 : 250 s 2513.130 SIyEs w: w 7 575.00 S 4,025.00 r \:&' :c J :a: S 1.50 : soc 00 w 1e 14 ::z J 200 : 2.5e % s00.00 \ 2 J w 2 t za sG s 2:sEm :\ mr 2E y 2 : ?Gsc o0 t 210E o: :3 ,:22C) 0 Includes shipping GLOBAL ROA SEALING NC l�Nnion s,ignat ryes, U�3BE and, M,�E. certified CT# 031176E C- SBE#, 2001305 10832 Dorothy ave, Garden Grove ,Ca 92843. LIC #757584 Ph: (714) 893-0845 FAX (714)893-0945 DIR #: 1000007714 Subcontract Quotation Traffic Signal Modification at Gothard St/Talbert, Gothard st/Heil ave, Springdale Project: st/ Mcfadden ave Location: City of Huntington Beach Bid Date/Time: 48-22-17 (d� 2pm Item Description Quantity Unit Price Extensdon Traffic loops 44 235.00 10,340.00 PRICES ARE GOOD FOR 45 DAYS FROM THE DATE OF THIS PROPOSAL INCLUSIONS: - Sawcut and install traffic loops per plan - splice loops to existing DLCs - Traffic control - One mobilization. Additional move in at $1500 EXCLUSIONS: - Insurance premium in excess of $2 million, bonding not available at this time utility permits and fees, inspection fee, - traffic control Plan, sign posting of any kinds, weekend work - notify resident, and any items not specifically included under inclusion section. conrete and asphalt restoration Estimator: Tri La L ) Two weeks notice required for scheduling Local Assistance Procedures Manual Exhibit 15-I3 DBE Information - Good Faith Effort ExHIBIT 15-H DBE INFORMATION —GOOD FAITH EFFORTS DBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. HSIPL-5181 (178) Bid Opening Date August 22, 2017 The established a Disadvantaged Business Enterprise (DBE) goal of 10.00% 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-ifthe "Local Agency Bidder DBE Conulvtinent" form indicates that the bidder has met the DBE goal. This will protect the bidder's eligibility for award of the contract if the administerina agency detennines that the bidder failed to meet the goal for various reasons, e.a., 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 Went directlyy to dbe. Dates of Advertisement B. The names and dates of written notices sent to certified DBEs solicitina bids for this project and the dates and methods used for following up initial solicitations to determine with certainty «�hether 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 Went directly to dbe. C _3 Local Assistance Procedures Manual Exhibit 15-H 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 fins. Items of lYoik Bidder Normally Breakdown of Amount Percentage Performs Item Items ($) Of (Y;T) Contract Went directly to dbe. 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 front the fuels mvol-vtd), 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: Went directly to dbe. Haines, addresses and phone numbers of firms selected for the work above: Went directly to dbe. Global oa elaing Inc. 10832 Dorothy Ave. Garden Grove, CA 92843 714.893.0845 dbe 31176 osweAve. #A Chino, e 37133 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 uvas proN ided to DBEs: Went directly to dbe. C-2 4 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: Went directly to dbe G. The names of agencies, organizations or groups contacted to provide assistance in contactin(z, 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 Went directly to dbe H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): Went directly to dbe NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. C-25 Local-%.ssislance Procedures Exhibit. +_-13 EilIIFfC6''C 1,isttif{1)BF.anti NO N-1)13F) Exhibit 12-B Bidder's List of subcontractor (DBE and Non -DBE) Part i As of' March 1, 2015 Contractors (and sub-contmetors) wishing, to bid till [Mbllc works conliacts ahall lie registered with the State Division of Ind List ri al RelatioTIN all d certified to bid oil Public Woiks contracls. Plea.w registcl- al: Ilttl)5 �leflliill;.rllr.c�r.l r_'y�PlVi fi'L�1c_lIrpIlser) le0actioji — li [}I� �F'Ul�t f r � sfi" rtic�oa# r��'rn In accordance wills Title 49, Section 26.11 of the Cock of Federal Regulitions, and Section 4104 cif the PLIWiC {,[7111t 10 COde Of- the 5tille Of Califtlrnia, as amended, the 1011tllLring Hillol'mation is required floc each sub -contractor who will 11CIT01-111 F OOC t111101.111tl114,' 10 11101-C tllilll 011C hclll ofone nereent (0.5';�W) ol'the Total Base Rid or S 10,000 (whichever is greater). Photocopy this fol•111 for additlollaf firms. Subcontractor Name and Locatton Line Item & Description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor Lieense Number DBE (YIN) DBE Cert Number - Annual Grass Receipts DIR Reg Number Name: I.E. General Engineering Ptn. #2, 4-9 Ptn. concrete work. 98500-00 25% 1 1000043058 015380 No $ +, ; CS,j, ntiflltlon c;5+nilliaii -$16rn111init City, State: Beaumont. CA c$15 million of Finn: S. Name: GlQbaLRQa;Laejahnu Ptn.10.11 Ptn_ electrical install. 10340.00 dbe 31176 2,75 757584 y s 3p Ipy k _ _ <$I million <$59ariliiaia City, State: Garaden Gove, CA 000D07714 <510 million <$15 million ge of Firrwifvrs. Nance: , - � iir ;;a•-•rs-., ,_ <$1 million <$5 rnillinn City, State c$10million <$15 r3rikliory Ageof Firm: yrs. Nance: r ihT c$i rnillioll <$5 million City, State: �$io million =$la nciIIion Age of Firin:_yrs. Name: ,iaf : _4_. _~ h <51 million <$5 million City, State: <$10 million <$15 mIllion Age of Hi nt:-____,yrs. Name: +. i„i _ . r - c$1 million <$5 million Oky, State: ' 57.0 mrdliair j15 million Age of Firm yrs. Distribution: 1) Original -Local Agency File 2) Cupy•OLAE w/ Award Parkage. C-26 1'agc 26 of 2 Local Assistance. Procedures Exhibit 12-B Birlticr's List of Srtbcrlttl racleli s (DRU ant! NON -DBE) - B Bidder's L i s t o f subcontractor (D B E a n (l N u n- D B E) Part Z ]n acconhnce with Title 49, Section 26 of the Codc of ederal Regttlatinns, iltc f3ic(cicr shall list al Si117C[)nti'ilet{1r kTJlltl p4'C1V1[]l a quote of bid but were aot selected to parlicipate as a SUbcontractor on this project. Photocopy nits form for additional ttfn -is. Subcontractor Name and Location Line item & Description Subcontract Amount Percentage of Did Item Sub- contracted Contractor License Number DOE IV/N) DBE Cert Number Annual Gross Receipts DIR Reg Number Name: Sterndahl Ent. - ---- Ptn. #3 Ptn. stripe. 34000.00 �fSfe��n`ttr $i l Gj 21823 _ __ _- ..�_ 0 x tl �U k �' 1 M <$I million _.._W - <$5million City, Stater Sun Valley, CA <510 million - Age of Firrrl:_,5±yrs. Name: CTI Ptn. #3 Ptn. stripe la 10900.00 j 9 �f' +�p7Y �ft7+la y� �{ Sys• 1122 No��; yf Itr a 'i 7,�' 3rr"4fi' c' ry siiM <$1 million -$s million 4 1l] enilll City, state: y, Riverside, r5fC1@, CA — '00006/ 5 -$SS million Age of Firmrs. Name.' Superior Pavement Ptn. ##3 Ptn. Stripe 16787.00 4c-f k(CA � �� 776306 No ; xkl <$I million x c$5 million, City, state; Cypress, CA 10 t�0OL91�° �1i1_nnillion <$15 million Age of Firrn: yrs. I LEI Ptn. #3 Ptn. Stripe 17980.00 noldla 823802 NO 7 �^ is ' `'; i r+'k� �. 1 million millions City, State: Azusa, CA �� 5 _ <$10 million <$1.5 millipp Age of Firm: yrs- Ptn. 2,4-8 Ptn. concrete work. 126800.00 4,R11f3'&k' `r'� 20016 p Ij '# � � `�'� `� i" Ir � i k° x 3 3 t51 million c�5 mlllio City, State: Corona, Ca e ©'n` � x <$10 mifliorl $ milliorrs' -5 Age of Nance: All American Asphalt Ptn. 5-9 Ptn. concrete work. 124900.00� .Stc fj 267073 No ' 5 `z 4, <$1 rsrillign_ c$5 million City, State: Corona, Ca c$10 million x <$15 million A e of FirmJO yrs. J�e Disbibutiuw 1) 0?iginal-Lacal Agency File 2) Capy-DLAE w,IAward Package C-27 5 �r Page 27 of 2 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 ail 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 fire covered Federal action. 3. Identify the appropriate classification of :his report. If this is a follow-up report caused by a material change to the information previoush, reported, enter the year and quarter in which the change occurred. Enter the date of the last, previouslysubmitted report by this reporting entity for this covered Federal action, 4. Enter the full name, address. ciry, 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 "Subav ardee" then enter the full name, address, ch,, state and zip code of theprime 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 a\k�ard number; the application/proposal control number assigned by the Federal agency). Include prefixes. e.g.. "REP-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 awarddoan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter- the full nanne. 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 Frame, 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 pa}rznent 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 officcr(s) or employce(s) contacted or the officer(s) employee(,) or Members) 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 bis.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 iAanagerment and Budget, Paperwork Reduction Project (0348-0046), -Washinmon. D.C. 20503. sr-1-L -r,—coons ace. un-o�-�DuavDtru C-2I Local Assistance Procedures Manual EMT_CBIT 15-G Local Agency Bidder DBE Commitment (Construction Contracts) Da= I5-G LOCAL AGENcy BIDDER DBE CORDIZTMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON TI31 REVERSE SIDE OF TIIIS FORAT LocALAGENCY: City of Huntington Beach LocATIOLr: Huntington Beach, CA Traffic Signal Modifications at Gothard St/Talbert Ave, Gothard St. /Heil Ave.; PRO.irCTEir8 .TP 014—, Sorinadale/McFadden TOTAL CONTRACT ANOLTNT: S 372872.00 BIDDATE: August 22. 2017 BFDDER'SNAAT-P: PTM General Engineering Services, Inc. CON`LTUCT DBE GOAL., 10% �-OIS'IRACT rrEwl NO. 1,4 OF WORK AND DESCRIPTION �R SERVgCES TO BE SUBCONTRACTED OR W,-ITEERTAIS O BE?RO-YDED (or contracted if the bidder is a DBE) , BE CERT NO. 1ND Euilz kTIOIvT G DA TE N.42YfE OF EACa--I DBE (Must be terrified on the date bids am opened - include DBE address and phone number) OLL.AR A1viOblTI' DBF Ptn 10-11 Ptn of electrical install 371176 G obal Road & Sealing Inc 1034000 Gard n Grove Ca 92843 714 T93 0845 1 Ptn 10-12 Ptn of material 37133 Ly —� eforms 5 195 00 hin —swermye ,,A 909.650 8123 For Local Agency to Complete: Local Agency ContrastIdumbtr. Federal -aid Projcct?Sumb=-.. Federal Share: Total Claimed DBE Participation $ 4225700 113 % Caniract Award Date: Locimil Agency cerc flies that all DBE certi-ricabons have been verified and k6ormationis complete and accurate. Print Name Sipature Date Local Agency Representative (Area Code) Telephone ?Sumba: I �ignat= ofgidd 08 28 2017 951 7225678 Date (.ATer, Codej Tel. No. Elizabeth H Mendoza de McRae 951 722 5678 Person to Contact (Please Type or Print) Lncu; Agency Bidder DRE Con4-ucts) _ iFiev 626/09) Distribution: (1) Copy - Fax or scan a copy to the Cahrans Disiric Local Assistance Enzmee: (DLAE) within 30 dams of contract execution. Failure to send a copy to the DL.AE within 30 days of rrantract execution may rzgult in de -obligation of f mds for this prcjey_ (2 ) Copy - Include in award packa5. to Calt;am s District Local A ssistanec (3) Original - T-ocal meaty riles Page 15-1 OB 12-04 June 24, 2012 Local Assistance Procedures Manual Exhibit 15-H DBE information - Good Faith Effort EXIT 15-H DBE INFORMATION --GOOD FAITH EF FoRT's DBE INFORMATION - GOOD FAITH. EFFORTS Federal -aid Project No. HSIPL-5181(1787) Bid Opening Date 082217 Huntington Beach/C C The (City/County or) established a Disadvantaged Business Enterprise (DBE) go l of 10 % for this project. 'Ile information prodded 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 fum 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 Cozunutment" of the Special Provisions: A. The names and dates of each publication in w1uch a request for DBE participation for this project teas placed by the bidder (please attach copies of advertisements or proofs of publication): Publications Went directly to dbe. Dates of Advertisement B. 'Tbe. names and dates of iwitten ;notices sent to certified DBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to deterudne with certainty whether the DBEs were interested (please attach copies of solicitations, telephone records, fax confu-mations, etc_): Names of DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation Went directly to dbe Page 15-1 O;B 12-04 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 farms including, Where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its ovTn forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation v,,as made available to DBE fuzes. Items of VV'ork Bidder Normally Breakdown. of Amount Percentage Performs Item Items M Of t YlNl Contract Went directly to dbe 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 svork (please attach copies of quotes from the firms involved), and the price difference. for each DBE if the selected firm is not a DBE: ?games, addresses and phone numbers of rejected DBEs and the reasons for -le bidder's rejection of the DBEs: Went directly to dbe Names, addresses and phone na-nbers of firms selected for the work- above: Went directly to dbe Globarl Road & Sealing Inc. 10832 Dorothy Ave Garden Grove, CA 92843 714 893 0845 dbe 371176 Lyteforms 13841 Roswell Ave #A Chino, CA 91710 909 680 8123 dbe 37133 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: Went directly to dbe Page 15-2 June 19, 2012 OB 12-04 Locai Assistance Procedures Manual Exhibit 15-1I 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: Went directly to doe G. The names of agencies, organizations or groups contacted to provide assistance in contacting, rccrui.ting and using DBE fines (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page dovmload, etc.): Name of Agency/DT anization MethodfDate of Contact Results Went direclty to doe H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): Went directly to doe NOTE: USE ADDMONAL SHEETS OF P.APER7F NECESSARY. Page 15-3 OB 12-04 3une 29, 2012 Lociil Assistance PrErcedures $'[:inual E`f1-11BIT Milder's List of Subcoutrartors (D-BE and Non BIDDER'S LIST OF SUBCONTRACTORS (DBE and NON•DBE)- PART The bidder shad] list all slabconU actors (bath DBE and umi-L)DE) iaa accordance witli Sectiori 2-1.054 of the Standard Specifications and per Title 49, Sectiou 2ti.11 of the Cod of Federal ltegtilatiolm. This listing is }required hi addition to listing DBE Subcolztractois else` here ill the proposal. 111lutucapy this forin t`nr additional firins. Firm Name/ Adddi m /Y c �7�) .• City:. State, ZL • Phpsie/. t ax Annual... Gi ass:: [) }.4p�.fit}t4 Descr-ilitimi of Poi-tion ofWoi lc to be Performeci : �4�� � `�lrr x� syt # ' ' a�7i+ � ��' lq::; Y 95 �_ Y 1 ; i }?`41iP. `F •.xf� kr l �_f [ Ed7 I.E. Genera �— "---� 35565 Stockton St. Fliorir- 951.775.661 $1 mifflon P#n. of concrete work. t f i ' B l �_� � t ;zx _ 1f YES Plat DRE g: .ii 1R. ' ; r, 9r... ❑ c $5 Iniiilvn -Z S l o miif l on _..—,.— -.._� Pax - _ 951.696.3749 -G .,;is nTulzl,u 7 —-.-.----------..._• �' 1s million Age of 9�a, r rs.� ; eaumont, CA 92223 Xome Global Road Sealing i horrG 714.893.084 Ip 'j - SI million Ptn. of electrical install. _ i sy �� 'k ®r 7 „ - $s luilli- _ Addrtsg 10832 Dorothy St, { <i101xsillion — _ if YES lia DBE A[ 31176 [ — l 714.893.0945 milliflii C'i +�Swee 7f1, tCarden Grove, CA 92843 _0<b15 E ` 515 niillivn DBE 31176 Age of Firm (Yrs.) �:,�x;:lT;;;i :,�-; Name .address — phone C $1 Tuil li0I1 t—eMF.�C �}'§'�Fi='"����F�s ��l r •4d}'��k ❑<$9 million � < $10 million yYES iis: DRE 9: _ rye {] $15 n�liliaa- W C;iysirafe ZIF ❑ `$13 million '-- Arc of AT= (Yrs.) !lcrrlo Pl rrrra [ it million ------- •—• -� rya Fuil� a ; I a �rtts, +y�h�T nra rt t,�' t r rri E' �` rr_ .,:^[- ,rl {, Li✓ } Sf 4i �... .i.r .� ; El< $S ruilCva _... �.�._�—._...., &frexs �4 [� r 0 miilivn Fax < $15 million L..f 7 S 15 I1TIl Iit) 11 1�{1K..l •W1'Af' c lr , Slate Ziff �. a vi fI''icY r7 . lhslrilrntion: 1) Original - Local Agenry File LPP QC-06 Page 1 -111 NDvember 14.1206 6 EXHIBIT 12-G Bidder's .List of Sijbc€ ixtract4rS BE Ptid Non -DBE Lomil Assistance Procedures Mahnal BIDDER'S LIST OF SUBCONTRACTORS (OBE and NON -DBE)- PART It Iho bidder shall last all suhcolAraclors who prmided a quote or bid but were not selcuLed to participate as a subcontractor on this project This is required for corupl wice 1-;11r* da R-N'- )r .,r[l,r, C-'. �.I r.-rT�nrir.rnl Pl-fr•,rr-, ih;c r - r ,• .,Millr,,,nl Fi-- )�rrntNnrilel Adds ess/- . , ilk ' �? AfE'ZIP'RCCG"Il}t3' � 1, —��xl,.ij,�� Gross"Des4rd hnjx rrf �'nrtlun of Work to be Perf€;i'rnerl r a 'Fi Nrrv. _ �,�f�q� j■.} ( GYr���-iGf �� Phone r, �+. r ��5. �d Y• � ��5 mili1013 _ �___W_>�_.-____�_.__..+�— �— ^.__ -..-...--_._�...i�'�i�-a��}�G�.�ir��"�u�:i L y,1F ts�a ;.r3+�T� YES [is rDBE 0: rlf,� i�, ��';�y rani _ Address❑�SlQmillion �_..�-_.._-_�...�.._- © r/� f✓ ri r°ai �!A' Spy. Gil < S15 million [.'4 Tfafe ZIP 1�# C j%4 {+ CCi -his ©]$15nxi9inlj i�t{�y}}�r � tr C c M3�+ k` ri Name Phore // {p7)) !`.(j $1 millk11 �/ P- "€" 47 -� gb,, d ' u4 �rJ l�4.k�rk [ -$5millioFl 0,aIvrill liiori A ddre.s. LL �n ,(� d �1 Jr�i (!l!t^i Fr.z p 0 : 8 t 5 taillion Gi,sraan L)I x]f.�r?�'li%`�Iifss`rJ `- 1 J > $l5 mill an Jy /%�f,/� y�� "[-SiC vr'€ f .-yl�, i� �yy [ ' �%. f r 1 `�5 �-�.1 i •"�/ ----` _----'---- -------'- fj �"'[Y 1.;,}i(1� .�;tkF'„la ��i. tjYES Ave DBE #: kr�J.•d m1]llall []r$10miilinke 0 <S15 LnMia;z EJ5 $15 mdlieil }`➢'Lti:;: �14 - , r!`.jrfrS .]~ � ,V,P1 .,9 l�� _. --- Fax N gig �� H(`rf�Y�P�'mr� cli. ciij�a[r ZIP.._. ,4•-L� Name I million�k , Al, F S lkiAdYF: ' e St Q million .�.— YF'S ilS1 DBE �1go�h¢� St � [?',, 3Jlstri4uliou: 1) Qrigind -- Local Agcnoy File Page 12-112 November 14, 2006 LPP 0 46 EXHIBIT 12-G Bidder's List of Subcontractors (DBE slid N Local Assistawe Procedures Manual BIDDER'$ LIST OF SUBCONTRACTORS (DBE and NUN -DBE)- PART 11 The budder shall list nil subcontractors who, provided a quote or bid but were not selected to Participate as a subcoilttactor on this projecl. This is required for cotnphance Tide 49. Section 26 of the Code of reriernl Re Phutocvrav this foxln fur addii.ioual ilrnls. w ..� til�t"�l&aj1C� Ari�lressl City; State; ZIP �i10%4�i° Fax f�uf]Ua� .: Gz vss" lieceipts`r�t�r'ril_Y � '. Descr ilit�nn of Pnrtavn 6F i'Vark to lea perfv� ky§�e'i���`',IeRP�"tvi��•`�"1},.ij�i N Cam•-�y7l� Phone �y ,// [•� �� s[ M C _ W � 5 d million ❑'$Snaillion — if �j yj c r �Q _._..__r C �F .„. ' i,.._-.I {w��5'1 Y `l�l�ry l`s:;e fi'. a= PSrM3 c� v .L. 4+ii �p � t• < rtpi,:i Xddres — I f ��0 fp�y J, !e� t tl4 million Q jj 1�Q Ary �ffl �/} �� T — -- ,fp�•SlisrDl XP.. 1 ui lQ� ll �/�C% �� [ .$15 million > $15 pnill'pon �;;'t'f=� (,If Srata ZIP � GGy?'Y�.�r� i."mot. �u�stT #4 , `� 'y .i_•i Nn [/�j �.g .yam A,I— //��v W� Non e �j/ f I:! !" .gam• �/ 74' ��1 rnollian ®'`�$ I17IlllOn y ���/ ��f �/-�q ,,J r `r.G+f" K.' �Y -�! -- 1;F1�^�*��f 4�' � r x!1�t .- J�S,;�ln :=LF'r''�•.tiA,� �i. ,�y,� •: ;1'�''1.�: tyir.•' _C:� r� .a ri-_t. `n t a""'" Ad 7. Ax [jjS19111111ion IfiPSlistDBEW: r 4.- ,i�{j�}�.. ..Lrll is .,4 -.�}j} `�� . Pax ���� ❑ = $ E5 widlioo G'i Stake ZIP ��r S15 rniltic ll tt ` Name -� 1'&else $1 nllllion ' � — ����1111"•• �; - L �� :i Y• i !n' S 1311111e`}[i E1- 310 million Addrrss� � rP! ' 1 - ��L �' I • �' Lr Sl : t DBE #: Fax ! ❑ < 515 rnillsolt --- - --- -- _ py��.°�ay� t }'� v •p�i,"`t�P°'+tsP„ ". ey Ci fareZp'P__�Y f//f/j '�+ :: "Y Pace ®•4e Name. Phone ❑F $i million - — SL j Qa$14mi11ion Andress - dfYE31istDB '#: G'ityS'rare GIP $i 5 rn 1 oil i� n y Ulstdbultoa:1) Origin 9— Loon! Agency File Page I2-112 Noveruller 14, 2006 UP 0 Local Assistance Procedures Manual Exhibit 15-G Construction Contract DBE Commitment EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT 0 1. Local Agency: City of Huntington Beach 2. Contract DBE Goal: 10.00% 3. Project Description: Traffic Signal Modifications at Gothard St/Talbert/Av, Gothard St/Heil Av, Springdale St/McFadden 4. Project Location: Gothard St/Talbert/Av. Gothard St/Heil Av, Springdale St/McFadden Av. 5. Bidder's Name: PTM General Engineering Services, Inc 6. Prime Certified DBE: 17 7. Bid Amount: 8. Total Dollar Amount for ALL Subcontractors: 9. Total Number of ALL Subcontractors: _ 10. Bid Item Number 11. Description of Work, Service, or Materials Supplied Certification 12. DBE Number 13. DBE Contact Information (Must be certified on the date bids are opened) 14. DBE Dollar Amount �is SerytiDii �: a 21. Local Agency Contract Number:CC-1465 22_ Federal -Aid Project Number. HSIPL-5181(178) 15. TOTAL CLAIMED DBE PARTICIPATION 23. Bid Opening Dale: 24. Contract Award Date: IMPORTANT: Identify all DBE firms being claimed for credit, regardless of tier. Names of the First Tier DBE Subcontractors and s their re cove it of work listed above must be consistent, Local Agency certifies that all DBE certifications are valid and information on this form is complete and accurate. where 'cable with the names and items of the work in the "Subcont c r List" submitted with your bid. Written confirmation of each list D quired. 25. Local Agency Representative's Signature 26. Date te August 21, 2017 16. reparer's Signature 17. Date 27. Local Agency Representative's Name 28. Phone Elizabeth H. Mendoza de McRae 951.710.1000 18. Preparer's Name 19. Phone 29. Local Agency Representative's Title President/CFO20. Preparer's Title DISTRIBUTION: 1. Original - Local Agency 2. Copy - Caltrans District Local Assistance Engineer (DLAE) Failure to submit to DLAE within 30 days of contract execution may result in de -obligation of federal funds on contract. Include additional copy with award package. ADA Notice: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654- 3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. Page 1 of 2 C-22 Local Assistance Procedures Manual Exhibit 15-H ® DBE Information - Good Faith Effort EXHIBIT 15-H DBE INFORMATION —GOOD FAITH EFFORTS DBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. HSIPL-5181 (178) Bid Opening Date August 22, 2017 The established a Disadvantaged Business Enterprise (DBE) goal of 10.00% 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 Went Directly to DBE 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 DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation Went Directly to DBE C-23 Local Assistance Procedures Manual Exhibit 15-H 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 ($) Of (Y/N) Contract Went Directiv to DBE 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: Went Directly to DBE Names, addresses and phone numbers of firms selected for the work above: Went Directly to DBE 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: Went Directly to DBE C-24 Ll 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: Went Directly to DBE 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 Went Directly to DBE H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): Went Directly to DBE NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. C-25 LoAssistance Procedures Exhibit* Bidder's List of Snbcontractors (DBE and NUN -DBE) Exhibit 12-B Bidder's List of subcontractor (DBE and Non -DBE) Part 1 As of March 1, 2015 Contractors (and sub -contractors) wishing to hid on public works contracts shall be registered with the State Division of Industrial Relations and certified to bid on Public Works contracts. Please register at: https://efiling.dir.ca.gov/PWCR,ActionServlet?action=displayPWCRepistrationForm In accordance with Title 49, Section 26.11 of the Code of Federal Regulations, and Section 4104 of the Public Contract Code of the State of California, as amended, the following information is required for each sub -contractor who will perform work amounting, to more than one half of one percent (0.5%) of the Total Base Bid or $10,000 (whichever is mreater). Photocopy this form for additional firms. Subcontractor Name and Location Line item & Description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor License Number DBE (Y/N) D8E Cart Number Annual Gross Receipts DIR Re Number Name: { 2, 4 _ CY [ rr y .[ ItJarr't—t �^"`� S O / D c$1 million million �$10 million �$15mill ion of F1rm:_L_yrs. tate: city, S G N fo G6 x City, State: D f I 1 0 j g Q r7 75 � t� -` r� [$1 million [$5 million [$1i] million c$15 million ge of Arrn�5_yrs. Name: <$1 million r$5 million City, State: [$14 million [$15 million e of rtrm:_yrs. Name: . a 1 million <$5 million City, State: [$10 million [$15 million Age of Firm:,yrs. Name: rDLJ c 1 million c$s million City, State: [ ip million LJ 4$15 million Age of Firm Name: F r [$1 million <$5 million City, Y 10 million LJ -�$15 million Age of Firm: rs. Distribution: 1) Original -Local Agency File 2) Copy-DLAE w/ Award Package Page 26 of 2 49 9 1 Local Assistance Procedures Exhibit I2-B Bidder's List of Subcontractors (DBE and NON-DRE) t - B Bidder's List of subcontractor (DBE and Non -DBE) Part 2 In accordance with `l"itle 49, Section 26 of the Code of Federal Regulations, the Bidder shall list all subcontractor who provide a quote or hid but were not selected to participate as a subcontractor on this project. Photocopy this form for additional firms. Subcontractor Name and Location Line Item & Description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor License Number DBE (Y/N) DBE Cert Number Annual Gross Receipts DIR Reg Number Na sty, state: 1 / <$1 million <S5 million <$10million <$15 million Age of Firm:_yrs. Nawe. F < 1 million r 5 million City, Stater <$10 million <$15 million Age of Firm:_yrs, Name: y !rr,7 <$1 million c 5 million City, State: 1� < lO million <$15 million Age of Firm : r$_ Name: 12 AS ` �1 �1 �! <$1 million c 5 million C' , State: <$10 million <$15 million Age of Firm--yrs. Na e: _ 3 e 1 million c City, State <$10 million <$15 million Age of Firm:_yrs. Na (�' i l < 1 million < 5 million City, tate: L c$10 million <$15 millicxr Age of Firm: rs. Distribution: 1) Original -Local Agency File 2) Copy -DIRE w/ Award Package CY17r"V r eW .3/,)"/,& Page 27 of 2 Local AAMce Procedures Manual MW of Repo rt-Uti[ixaR of Disadvarkta rSu Ezh-F ExHiar 17-F FINAL REPORT -UTILIZATION OFDISADVANTACED BUSINFSS ENTFRPRISES (DBE)AND FIRST -TIER SUBCONTRACTORS 1. Local Agency Contract Number 2. Federal -Aid Project Number 3. Local Agency 4- Contract Completion Date 5. Contractor/Consultant w 6. Business Address 7. Final CanlractAmount 8. Contract Item Number 9. Description of Work, Service, or Materials Supplied 1 t7 Company Name and Business Address 11. D13E Certification Number 12. Contract Payments 13. Date Work Completed 14. Date of Final Payment Non -DBE DBE 15. ORIGINAL DBE COMMITMENT AMOUNT 16.TOTAL List all hrsl-uer subconlractors/suhcemuftards and DBEs regardless of tier whether or nol the firms were originally listed for goal credit. If actual DBE utilizatlon for iiem of work) was different than Thal approved at (tie time of a ward, provide comments on an additional a . List actual amount pald to each entity, It no subcontractorsfsubconsullants were used on the contract indicate on the form. I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT 17. ConfractorfConsultant Representative's Signature 18. ConlractorfConsultanl Representative's Name 19. Phone 20. Date I CERTIFY THAT THE CONTRACTING RECORDS AND ON -SITE PERFORMANCE OF THE DBE(S)HAS BEEN MONrrORED 21. Load Agency Representative's Signature 22, Local Agency Representative's Name 23. Phone 24. Date DISTRIBUTION: Original - Local Agency, Copy - CaNrans Oisldct Local Assistance Engineer. Include with Final Report of Expenditures ADA NOTICE: For individuals with sensory disabilities, this document is available in allernete formats. For Information, call (916) 446-1233, Local Assistance Procedures Manua$ TTY 711, or write to Records and Forms Management, 1124 N Street, RS-89, Sacramento, CA 95814. C-28 APPENDIX-] FEDERAL & STATE REQUIREMENTS FOR FEDERAL -AID CONSTRUCTION PROJECTS 11 IMPORTANT DISCLAIMER THE ATTACHED WAGE RATES ARE FOR REFERENCE ONLY. THE CONTRACTOR IS SOLELY RESPONSIBLE FOR PAYING THE ACTUAL AND CURRENT WAGES REQUIRED BY THE LAWS APPLICABLE FOR THIS PROJECT r U El ►'I Local Assistance Procedures Manual EX MIT 12-E PS&E Checklist Instructions Attachment A ATTACHMENT A SECTION 14. FEDERAL REQUIREMENTS FOR FEDERAL -AID CONSTRUCTION PROJECTS GENERAL. —The work herein proposed will be financed in whole or in part with Federal funds, and therefore all of the statutes, rules and regulations promulgated by the Federal Gov- emment and applicable to work financed in whole or in part with Federal funds will apply to such work. The "Required Contract Provisions, Federal -Aid Construction Contracts, "Form FHWA 1273, are included in this Section 14. Whenever in said required contract provisions references are made to "SH . contracting officer," 'ISM resident engineer," or "authorized representative of the SHA," such references shall be construed to mean "Engineer" as defined in Section 1-1.18 of the Standard Specifications. PERFORMANCE OF PREVIOUS CONTRACT. In ad- dition to the provisions in Section II, "Nondiscrimination," and Section VII, "Subletting or Assigning the Contract," of the re- quired contract provisions, the Contractor shall comply with the following: The bidder shall execute the CERTIFICATION WITH RE- GARD TO THE PERFORMANCE OF PREVIOUS CON- TRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND THE FILING OF REQUIRED REPORTS located in the proposal. No request for subletting or assigning any portion of the contract in excess of S10,000 will be considered under the provisions of Section VII of the required contract provisions unless such request is accompanied by the CERTIFICATION referred to above, executed by the proposed subcontractor. NON -COLLUSION PROVISION. —The provisions in this section are applicable to aII contracts except contracts for Federal Aid Secondary projects. Title 23, United States Code, Section 112, requires as a condi- tion precedent to approval by the Federal Highway Administrator of the contract for this work that each bidder file a sworn statement executed by, or on behalf of the person, firm, association, or corporation to whom such contract is to be awarded, certifying that such person, firm, association, or corporation has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with the submitted bid. A form to make the non -collusion affidavit statement required by Section 112 as a certification under penalty of perjury rather than as a sworn statement as permitted by 28, USC, Sec. 1746, is included in the proposal. PARTICIPATION BY DISADVANTAGED BUSINESS EN- TERPRISES IN SUBCONTRACTING. —Part 26, Title 49, Code of Federal Regulations applies to this Federal -aid project. Pertinent sections of said Code are incorporated in part or in its entirety within other sections of these special provisions. Schedule B—Information for Determining Joint Venture Eli- gibility OB I2-04 (This form need not be filled in if all joint venture firms are DBE owned.) 1. Name ofjoint venture 2. Address of joint venture 3. Phone number of joint venture 4. Identify the firms which comprise the joint venture. (The DBE partner must complete Schedule A.) a_ Describe the role of the DBE firm in the joint venture. b. Describe very briefly the experience and business qualifications of each non -DBE joint venturer: 5. Nature of the joint venture's business 6. Provide a copy of the joint venture agreement. 7. What is the claimed percentage of DBE ownership? 8. Ownership of joint venture: (This need not be filled in if described in the joint venture agreement, provided by question 6.)_ Not Applicable Since We are not Bidding as Joint Venture. Revised 3-95 0"7-95 Page 12-9 June 29, 2012 EXMB[T 12-E Local Assistance Procedures Manual Attachment A PS&E Checklist Instructions a. Profit and loss sharing. b. Capital contributions, including equipment c, Other applicable ownership interests. 9. Control of and participation in this contract Identify by name, race, sex, and "firm" those individuals (and their titles) who are responsible for day -today management and policy decision making, including, but not limited to, those with prime responsibility for. a Financial decisions b. Management decisions, such as: 1. Estimating 2. Marketing and sales 3. Hiring and firing of management personnel _ 4. Purchasing of major items or supplies c. Supervision of field operations Note. —It after filing this Schedule B and before the comple- tion of the joint venture's work on the contract covered by this regulation, there is any significant change in the information submitted, the joint venture must inform the grantee, either di- rectly or through the prime contractor if the joint venture is a subcontractor. Affidavit "The undersigned swear that the foregoing statements are cor- rect and include all material information necessary to identify and explain the terms and operation of our joint venture and the intended participation by each joint venturer in the undertaking. Further, the undersigned covenant and agree to provide to grantee current, complete and accurate information regarding ac- tual joint venture work and the payment therefor and any pro- posed changes in any of the joint venture arrangements and to permit the audit and examination of the books, records and files of the joint venture, or those of each joint venturer relevant to the joint venture, by authorized representatives of the grantee or the Federal finding agency. Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initialing action under Federal or State laws concerting false statements." Rcvind 3-95 0"7-45 Page 12-10 June 29, 2012 ..................................................................................... .... Name of Firm Name of Firm ............................................................................ ............... _...... Signature Signature ............................................................ I ............... .... Name Name ......................i...-...........................................Titl....... Titleee ................................ _............-.................................. Date Date Date State of _ County of On this _ day of 19 , before me appeared (Name) to me personally known, who, being duly sworn, did execute the foregoing affi- davit, and did state that he or she was properly authorized by (Name of firm) to execute the affidavit and did so as his or her free act and deed. Notary Public Commission expires [seal] Date State of County of On this _ day of 19 , before me appeared (Name) to me personally known, who, being duly sworn, did execute the foregoing affidavit, and did stale that he or she was properly authorized by (Name of firm) to execute the affidavit and did so as his or her free act and deed. Notary Public Commission expires [Seal] FR-2 Not Applicable Since We are not Bidding as Joint Venture. OR 12-04 Ell C 7 :1 Local Assistance Procedures Manual PS&E Checklist Instructions EXI1IBIT 12-E Attachment B A,TTACHMENT B REQUIRED CONTRACT PROVISIONS FEDERAL -.AID CONSTRUCTION CONTRACTS (Exclusive of Appalachian Contracts) Page I. General....................................................................... 3 II. Nondiscrimination...................................................- 3 III. Nonsegregated Facilities ............................................ 5 IV. Payment of Predetermined Mmimum Wage .............. 6 V. Statements and Payrolls ............................................. 8 VI. Record of Matrrials, Supplies, and Labor .................. 9 VII. Subletting or Assigning the Contract ......................... 9 VIII. Safety: Accident Prevention ...................................... 10 IX. False Statements Concerning Highway Project .......... 10 X. Implementation of Clean Air Act and Federal Water Pollution Control Act ................................................. 10 XL Certification Regarding Debannent, Suspension, Ineligibility, and Voluntary Exclusion ...................... I XII. Certification Regarding Use of Contract Funds for Lobbying..... ............ ........... ............. __.............. ........ 12 ATTACHMENTS A Employment Preference for Appalachian Contracts (included in Appalachian contracts only) ice+ AZLBAttl" 1. These contract provisions shall apply to all work performed on the contract by the contractor's own organization and with the assistance of workers under the contractor's immediate superintendence and to all work performed on the contract by piecework, station work, or by subcontract 2. Except as otherwise provided for in each section, the con- tractor shall insert in each subcontract all of the stipulations contained in these Required Contract Provisions, and further re- quire their inclusion in any lower tier subcontract or purchase order that may in turn be made. The Required Contract Provisions shall not be incorporated by reference in any case. The prime contractor shalt be responsible for compliance ,by any subcontractor or lower tier subcontractor with these Required Contract Provisions. 3. A breach of any of the stipulations contained in these Re- quired Contract Provisions shall be sufficient grounds for termi- nation of the contract. 4. A breach of the following clauses of the Required Contract Provisions may also be grounds for debarment as provided in 29 CFR 5.12: Section I, paragraph 2; Section IV, paragraphs 1, 2, 3, 4, and 7; Section V, paragraphs I and 2a through 2g. 5. Disputes arising out of the labor standards provisions of Section IV (except paragraph 5) and Section V of these Required Contract Provisions shall not be subject to the general disputes clause of this contract Such disputes shall be resolved in accor- dance with the procedures of the U.S. Department of Labor (DOL) as set forth in 29 CFR 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, the DOL, or the contractor's employees or their representatives. FR-3 6. Selection of Labor: During the performance of this contract, the contractor shall not: a. discriminate against labor from any other State, possession, or territory of the United States (except for employment preference for Appalachian contracts, when applicable, as specified in Attachment A), or b. employ convict labor for any purpose within the limits of the project unless it is labor performed by convicts who are on parole, supervised release, or probation. H. NONDIISCRU41NATION (Applicable to all Federal -aid construction contracts and to all related subcontracts of $10,000 or more.) L 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 CFR35, 29 CFR 1630, and 41 CFR 60) and orders of the Secretary of Labor as modified by the provisions prescribed herein, and im- posed pursuant to 23 U.S.C. 140 shall constitute the EEO and specific affirmative action standards for the contractor's project activities under this contract The Equal Opportunity Construction Contract Specifications set forth under 41 CFR 60-4.3 and the provisions of the American Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) set forth under 28 CFR 35 and 29 CFR 1630 are incorporated by reference in this contract In the execution of this contract, the contractor agrees to comply with the following minimum specific requirement activities of EEO: a. The contractor will work with the State highway agency (SHA) and the Federal Government in carrying out EEO obli- gations and in their review of hislher activities under the con- tract b. The contractor will accept as his operating policy the following statement: "It is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age or disability. Such action shall include: employment upgrading, demotion, or transfer; recruitment or recruitment ad- vertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprentice- ship, preapprenticeship, and/or on-the-job training. " 2. EEO Officer: The contractor will designate and make known to the SHA contracting officers an EEO Officer who will have the responsibility for and must be capable of effectively Page 12.-11 OB 12-04 June 29, Z012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions administering and promoting an active contractor program of EEO and who must be assigned adequate authority and responsibility to do so. 3. Dissemination of Policy: All members of the contractor's staff who are authorized to hire, supervise, promote, and discharge employees, or who recommend such action, or who are substantially involved in such action, will be made fully cognizant o1 and will implement, the contractor's EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment To ensure that the above agreement will be met, the following actions will be taken as a minimum: a. Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and then not less often than once every six months, at which time the contractor's EEO policy and its implementation will be re- viewed and explained. The meetings will be conducted by the EEO Officer. b. All new supervisory or personnel office employees will be given a thorough indoctrination by the EEO Officer, covering all major aspects of the contractor's EEO obligations within thirty days following their reporting for duty with the contractor. c. All personnel who are engaged in direct recruitment for the project will be instructed by the EEO Officer in the contractor's procedures for locating and hiring minority group employees. d. Notices and posters setting forth the contractor's EEO policy will be placed in areas readily accessible to employees, applicants for employment and potential employees. e. The contractor's EEO policy and the procedures to im- plement such policy will be brought to the attention of em- ployees by means of meetings, employee handbooks, or other appropriate means. 4. Recruitment: When advertising for employees, the contractor will include in all advertisements for employees the notation: "An Equal Opportunity Employer." All such adver- tisements will be placed in publications having a large circulation among minority groups in the area from which the project work force would normally be derived. a The contractor will, unless precluded by a valid bargaining agreement, conduct systematic and direct recruitment through public and private employee referral sources likely to yield qualified minority group applicants. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such identified sources procedures whereby minority group applicants may be referred to the contractor for employment consideration. b. In the event the contractor has a valid bargaining agreement providing for exclusive hiring hall referrals, he is expected to observe the provisions of that agreement to the extent that the system permits the contractor's compliance with EEO contract provisions. (line DOL has held that where implementation of such agreements have the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Executive Order 11246, as amended.) c. The contractor will encourage his present employees to Form 1273 — Revised 3-95 0"7-95 k'R Page 12-12 Form 1273 — Revised 3-95 09-07-95 refer minority group applicants for employment Information and procedures with regard to referring minority group 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, IayofL and termination, shalt be taken without regard to race, color, religion, sex, national origin, age or disability. The following procedures shall be followed: a The contractor will conduct periodic inspections of project sites to ensure that working conditions and employee facilities do not indicate discriminatory treatment of project site personnel. b. The contractor will periodically evaluate the spread of wages paid within each classification to determine any evidence of discriminatory wage practices. c. The contractor will periodically review selected personnel actions in depth to determine whether there is evidence of discrimination. Where evidence is found, the contractor will promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all affected persons. d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor in connection with his obligations tinder this contract, will attempt to resolve such complaints, and will take appropriate corrective action within a reasonable time. If the investigation indicates that the discrimination may affect persons other than the complainant, such corrective action shall include such other persons. Upon completion of each investigation, the contractor will inform every complainant of all of his avenues of appeal 6. Training and Promotion: a. The contractor will assist in locating, qualifying, and increasing the skills of minority group and women employees, and applicants for employment b. Consistent with the contractor's work force requirements and as permissible under Federal and State regulations, the contractor shall make full use of training programs, i.e., apprenticeship, and on-the-job training programs for the ge- ographical area of contract performance. Where feasible, 25 percent of apprentices or trainees in each occupation shall be in their fast year of apprenticeship or training. In the event a special provision for training is provided under this contract, this subparagraph will be superseded as indicated in the special provision. c. The contractor will advise employees and applicants for employment of available training programs and entrance re- quircments for each. d. The contractor will periodically review the training and promotion potential of minority group and women employees and will encourage eligible employees to apply for such training and promotion. June 29, 2012 OB 12-04 11 11 El EXIIIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions 7. Unions: If the contractor relies in whole or in part upon unions as a source of employees, the contractor will use his/her best efforts to obtain the cooperation of such unions to increase opportunities for minority groups and women within the unions, and to effect referrals by such unions of minority and female employees. Actions by the contractor either directly or through a contractor's association acting as agent will include the procedures set forth below: a. The contractor will use best efforts to develop, in coop- eration with the unions, joint training programs aimed toward qualifying more minority group members and women for membership in the unions and increasing the skills of minority group employees and women so that they may qualify for higher paying employment. b. The contractor will use best efforts to incorporate an EEO clause into each union agreement to the end that such union will be contractually bound to refer applicants without regard to their race, color, religion, sex, national origin, age or disability. c. The contractor is to obtain information as to the referral practices and policies of the Iabor union except that to the extent such information is within the exclusive possession of the Iabor union and such labor union refuses to furnish such information to the contractor, the contractor shall so certify to the SHA and shall set forth what efforts have been made to obtain such information. d. In the event the union is unable to provide the contractor with a reasonable flow of minority and women referrals within the time limit set forth in the collective bargaining agreement, the contractor will, through independent recruitment efforts, fill the employment vacancies without regard to race, color, religion, sex, national origin, age or disability; making full efforts to obtain qualified and/or qualifiable minority group persons and women. (The DOL has held that it shall be no excuse that the union with which the contractor has a collective bargaining agreement providing for exclusive referral failed to refer minority employees.) In the event the union referral prac- tice prevents the contractor from meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, such contractor shall immediately notify the SHA. 8. 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 Ieases of equipment a The contractor shall notify all potential subcontractors and suppliers of his/her EEO obligations under this contract. b. Disadvantaged business enterprises (DBE), as defined in 49 CFI, 26, shall have equal opportunity to compete for and perform subcontracts which the contractor enters into pursuant to this contract The contractor will use his best efforts to solicit bids from and to utilize DBE subcontractors or subcontractors with meaningful minority group and female representation among their employees. Contractors shall obtain lists of DBE construction firms from SHA personnel. c. The contractor will use his best efforts to ensure subcon- tractor compliance with their EEO obligations. 9. Records and Reports: The contractor shall keep such OB 12-04 records as necessary to document compliance with the EF,O requirements. Such records shall be retained for a period of three years following completion of the contract work and shall be available at reasonable times and places for inspection by au- thorized representatives of the S13A and the FHWA. a. The records kept by the contractor shall document the following: (1) The number of minority and non -minority group members and women employed in each work classification on the project; (2) The progress and efforts being made in cooperation with unions, when applicable, to increase employment op- portunities for minorities and women; (3) The progress and efforts being made in locating, hiring training, qualifying, and upgrading minority and female employees; and (4) The progress and efforts being made in securing the services of DBE subcontractors or subcontractors with meaningful minority and female representation among their employees. b. The contractors will submit an annual report to the SHA each 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. If on-the-job training is being required by special provision, the contractor will be required to collect and report training data - III NONSEGREGATED FACILITIES (Applicable to all Federal -aid construction contracts and to all related subcontracts of S I0,000 or more.) a. By submission of this bid, the execution of this contract or subcontract, or the consummation of this material supply agreement or purchase order, as appropriate, the bidder, FederaI- aid construction contractor, subcontractor, material supplier, or vendor, as appropriate, certifes that the firm does not maintain or provide for its employees any segregated facilities at any of its establishments, and that the firnr does not permit its employees to perform their services at any location, under its control, where segregated facilities are maintained The firm agrees that a breach of this certification is a violation of the EEO provisions of this contract The firm further certifies that no employee will be denied access to adequate facilities on the basis of sex or disability. b. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restroomt and washrooms, restaurants and other eating areas, time clocks, locker rooms, and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive, or are, in fact, seg- regated on the basis of race, color, religion, national origin, agc or disability, because of habit, local custom, or otherwise. The only exception will be for the disabled when the demands for accessibility override (e.g. disabled parking). Foffi 1273—Reviard 3-95 08-07-95 Page 12-13 June 29, Z012 EXELIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions a The contractor agrees that it has obtained or will obtain identical certification from proposed subcontractors or material suppliers prior to award of subcontracts or consura nation of material supply agreements of $10,000 or more and that it will retain such certifications in its files. IV. PAYMENT OF PREDETERMINED MINIMUM WAGE (Applicable to all Federal -aid construction contracts exceeding $2,000 and to all related subcontracts, except for projects located on roadways classed as local roads or rural minor collectors, which are exempt) 1. General: a All mechanics and laborers employed or working upon the site of the work will be paid unconditionally and not less often than once a week and without subsequent deduction or rebate on any account [except such payroll deductions as are permitted by regulations (29 CFR 3)] issued by the Secretary of Labor under the Copeland Act (40 U.S.C. 276c) the full amounts of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment. The payment shall be computed at wage rates not less than those contained in the wage determination of the Secretary of Labor (hereinafter "the wage determination") which is attached bereto and made a part hereof; regardless of any contractual relationship which may be alleged to exist between the contractor or its subcontractors and such laborers and mechanics. The wage determination (including any additional classifications and wage rates conformed under paragraph 2 of this Section N and the DOL poster (WH-1321) or Form FHWA-1495) shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. For the purpose of this Section, contributions made or costs reasonably anticipated for bona fide fringe benefits under Section 1(b)(2) of the Davis -Bacon Act (40 U.S.C. 276a) on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of Section IV, paragraph 3b, hereof Also, for the purpose of this Section, regular contributions made or costs incurred for more than a weekly period (but not less often than quarterly') under plans, funds, or programs, which cover the particular weekly period, are deemed to be constructively made or incurred during such weekly period_ Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage deter- mination for the classification of work actually performed, without regard to skill, except as provided in paragraphs 4 and 5 of this Section IV. b. Laborers or mechanics performing work in more than one classification may be compensated at the rate speed 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 wbich work is performed_ c. All rulings and interpretations of the Davis -Bacon Act and related acts contained in 29 CFR 1, 3, and 5 arc herein incorporated by reference in this contract Form 1273 — Revised 3.95 UM7-95 rage U-14 June 29, 2012 r�� 2. Classification. a. The SHA contracting officer shall require that any class of laborers or mechanics employed under the contract, which is not listed in the wage determination, shall be classified in conformance with the wage determination. b. The contracting officer shall approve an additional classification, wage rate and fringe benefits only when the following criteria have been met: (1) the work to be performed by the additional classifi- cation requested is not performed by a classification in the wage determination; (2) the additional classification is utilized in the area by the construction industry; (3) the proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination; and (4) with respect to helpers, when such a classification prevails in the area in which the work is performed. c.If the contractor or subcontractors, as appropriate, the laborers and mechanics (if known) to be employed in the addi- tional classification or their representatives, and the contracting officer agree on the classification and wage rats (including the amount designated for fringe benefits where appropriate), a report of the action taken shall be seat by the contracting officer to the DOL, Administrator of the Wage and Hour Division, Employment Standards Administration, Washington, D.C. 20210_ The Wage and Hour Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30-day period that additional time is necessary. d. In the event the contractor or subcontractors, as appro- priate, the laborers or mechanics to be employed in the addi- tional classification or their representatives, and the contracting officer do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions, including the views of all interested parties and the recommendation of the contracting officer, to the Wage and Hour Administrator for determination- Said Administrator, or an authorized representative, will issue a determination within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30-day period that additional time is necessary e. The wage rate (including fringe benefits where appropriate) determined pursuant to paragraph 2c or 2d of this Section IV shall be paid to all workers performing work in the additional classification from the first day on which work is performed in the classification. 3. Payment of Fringe Benefits: a. Whenever the minimum wage rate prescribed in the con- tract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate, the contractor or subcontractors, as appropriate, shall either pay the benefit OB 12-04 C7 Local Assistance Procedures Manual PS&E Checklist Instructions MW as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly case equivalent thereof b. If the contractor or subcontractor, as appropriate, does not make payments to a trustee or other third person, he/she may consider as a 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 aappplicable standards of the Davis -Bacon Act have been meL 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 11 4. Apprentices and Trainees (Programs of the U.S. DOL) and Helpers: a. Apprentices: (1) Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the DOL, Employment and Training Administration, Bureau of Apprenticeship and Training, or with a State apprenticeship agency recognized by the Bureau, or if a person is employed in his/her first 90 days of probationary employment as an apprentice in such an apprenticeship program, who is not individually registered in the program, but who has been certified by the Bureau of Apprenticeship and Training or a State apprenticeship agency (where appropriate) to be eligible for probationary employment as an apprentice. (2) The allowable ratio of apprentices to joumeyman-level employees on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program Any employee listed on a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rate listed in the wage determination for the classification of work actually performed_ in addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor or subcontractor is performing construction on a project in a locality other than that in which its program is registered, the ratios and wage rates (expressed in percentages of the journeyman -level hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. (3) Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's level of progress, expressed as a percentage of the journeyrnan- level hourly rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with the provisions ofthe apprenticeship program If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator for the Wage and Hour Division determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determiriation. EXHIBIT 12-E Attachment B (4) In the event the Bureau of Apprenticeship and Training, or a State apprenticeship agency recognized by the Bureau, withdraws approval of an apprenticeship program, the contractor or subcontractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the comparable work performed by regular employees until an acceptable program is approved. b. Trainees: (1) Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by formal certification by the DOL, Employment and Training Administration. (2) The ratio of trainees to journeyman -level employees on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Any employee Iisted on the payroll at a trainee rate who is not registered and participating in a training plan approved by the Employment and Tmming 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. (3) Every trainee must be paid at not less than the rate specified in the approved program for his/her level of progress, expressed as a percentage of the journeyman -level hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding joumeyman-level wage rate on the wage determination which provides for less than :full fringe benefits for apprentices, in which case such trainees shall re- ceive the same fringe benefits as apprentices. (4) In the event the Employment and Training Adminis- tration withdraws approval of a training program, the con- tractor or subcontractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. c. Helpers: Helpers will be permitted to work on a project if the helper classification is specified and defined on the applicable wage determination or is approved pursuant to the conformance procedure set forth in Section TJ.2. Any worker listed on a payroll at a helper wage rate, who is not a helper under an approved definition, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. Form 1273 — Reused 3.95 OM7-95 Page 12-15 OB 12-04 Jane 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions 5. 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. 6. Withholding: The SHA shall upon its own action or upon written request of an authorized representative of the DOL withhold, or cause to be withheld, from the contractor or subcontractor under this contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to Davis -Bacon prevailing wage requirements which is held by the same prime contractor, as much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees, and bclpers, employed by the contractor or any subcontractor the full amount of wages required by the contract In the event of failure to pay any laborer or mechanic, including any apprentice, trainee, or helper, employed or working on the site of the work, all or part of the wages required by the contract, the SHA contracting officer may, after written notice to the contractor, take such action as may be accessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. 7. Overtime Requirements: No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers, mechanics, watchmen, or guards (including apprentices, trainees, and helpers described in paragraphs 4 and 5 above) shall require or permit any laborer, mechanic, watchman, a in any workweek in which he/she is employed on such work guard in excess of 40 hours in such workweek unless such laborer, mechanic, watchman, or guard receives compensation at a rate not less than one -and -one-half times his/her basic rate of pay for all hours worked in excess of 40 hours in such workweek 8. Violation: Liability for Unpaid Wages; Liquidated Damages: In the event of any violation of the clause set forth in paragraph 7 above, the contractor and any subcontractor responsible thereof shall be liable to the affected employee for his/her unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory) fbr liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer, mechanic, watchman, or guard employed in violation of the clause set forth in paragra h 7, in the sum of $10 for each calendar day on which such employee was required or permitted to work in excess of the standard work week of 40 hours without payment of the overtime wages required by the clause set forth in paragraph 7. Form 1273--Rsvised 3-95 D8-07-95 Page 12.-16 June 29, 2012 9. Withholding for Unpaid Wages and Liquidated Damages: The SHA shall upon its own action or upon written request of any authorized representative of the DOL withhold, or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph 8 above. STATEMENTS AND PAYROLLS (Applicable to all Federal -aid construction contrails exceeding $2,000 mid to all related subcontracts, except for projects located on roadways classified as local roads or rural collectors, which are exempt.) 1. Compliance with Copeland Regulations (Z9 CFR 3). The contractor shall comply with the Copeland Regulations of the Secretary of Labor which are herein incorporated by reference. 2. Payrolls and Payroll Records; a Payrolls and basic records relating thereto shall be maintained by the contractor and each subcontractor during the course of the work and preserved for a period of 3 years from the date of completion of the contract for all laborers, mechanics, apprentices, trainees, watchmen, helpers, and guards working at the site of the work- b. The payroll records shall contain the name, social security number, and address of each such employee; his or her correct classification-, hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalent thereof the types described in Section I (b)(2)(B) of the Davis Bacon Act); daily and weekly number of hours worked; deductions made; and actual wages paid. In addition, for Appalachian contracts, the payroll records shall contain a notation indicating whether the employee does, or does not, nonnally reside in the labor area as defined in Attachment A, paragraph 1. Wbcnevcr the Secretary of Labor, pursuant to Sec- tion IV, paragraph 3b, has found that the wages of any laborer or mechanic include the amount of any 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 and each subcontractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, that the plan or program has been communicated in writing to the laborers or mechanics affected, and show the cost anticipated or the actual cost incurred in providing benefits. Contractors or subcontractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprentices and trainees, and ratios and wage rates prescribed in the applicable programs. OB 12-04 n Ll Local Assistance Procedures Manual VG]L BIT 12-E PS&E Checklist Instructions Attachment B c. Each contractor and subcontractor shall furnish, each week may be grounds for debarment action pursuant to 29 CFR 5.12, in which any contract work is performed, to the SHA resident engineer a payroll of wages paid each of its employees VL RECORD OF MATERIALS, SUPPLIES, AND (including apprentices, trainees, and helpers, described in LABOR Section IV, paragraphs 4 and 5, and watchmen and guards en- gaged on work during the preceding weekly payroll period). The payroll submitted shall set out accurately and completely all 1.On all Federal -aid contracts on the National Highway System, of the information required to be maintained under paragraph 2b 'in except those which provide solely for the installation of protective devices at railroad grade crossings, those which are constructed on of this Section V. This information may be submitted any desired Optional Form WH-347 is available for this a force account or direct labor basis, highway beautification purpose and may be purchased from the Superintendent of contracts, and contracts for which the total final construction cost for roadway and bridge is less than $1,000,000 (23 CFR 635); the Documents (Federal stock number 029-005-0014-1), U.S. contractor all: Government Printing Office, Washington, D.C. 20402. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. a Become familiar with the list of specific materials and li lain d ' F FIiWA-47 "S f E d. Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or sub- contractor or his/her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (1) that the payroll for the payroll period contains the information required to be maintained under paragraph 2b of this Section V and that such information is correct and complete; (2) that such laborer or mechanic (including each belper, 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 the Regulations, 29 CFR 3; (3) that each laborer or mechanic has been paid not less that the applicable wage rate and fringe benefits or cash equivalent for the classification of worked performed, as specified in the applicable wage determination incorporated into the contract. e. The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH-347 shall satisfy the requirement for submission of the "Statement of Compliance" required by paragraph 2d of this Section V. f 'Ile falsification of any of the above certifications may subject the contractor to civil or criminal prosecution under 18 U.S.C. 1001 and 31 U.S.C. 231. g. The contractor or subcontractor shall make the records re- quired under paragraph 2b of this Section V available for in- spection, copying, or transcription by authorized representatives of the SHA, the FHWA, or the DOL, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the re- quired records or to make them available, the SHA, the FHWA, the DOI, or all may, after written notice to the contractor, sponsor, applicant, or owner, take such actions as may be nec- essary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available OB 12-04 supp es con e m orto tatMOIL o Matenals and Labor Used by Contractor of Highway Construction Involving Federal Funds," prior to the commencement of work under this contract. b. Maintain a record of the total cost of all materials and supplies purchased for and incorporated in the work, and also of the quantities of those specific materials and supplies listed on Form FHWA-47, and in the units shown on Form FHWA-47. c. Furnish, upon the completion of the contract, to the SHA resident engineer on Form FHWA-47 together with the data required in paragraph lb relative to materials and supplies, a final labor summary of ail contract work indicating the total hours worked and the total amount earned. 2. At the prime contractor's option, either a single report covering all contract work or separate reports for the contractor and for each subcontract shall be submitted. VII. SUBLETTING OR ASSIGNING THE CONTRACT 1. The contractor shall perform with its own organization contract work amounting to not less than 30 percent (or a greater percentage if specified elsewhere in the contract) of the total original contract price, excluding any specialty items designated by the State. Specialty items may be performed by subcontract and the amount of any such specialty items performed may be deducted from the total original contract price before computing the amount of work required to be performed by the contractor's own orgarrization (23 CFR 635). a "Its own organization" shall be construed to include only workers employed and paid directly by the prime contractor and equipment owned or rented by the prime contractor, with or without operators. Such term does not include employees or equipment of a subcontractor, assignee, or agent of the prime contractor. b. "Specialty Items" shall be construed to be limited to work that requires highly specialized knowledge, abilities, or equipment not ordinarily available in the type of contracting organizations qualified and expected to bid on the contract as a whole and in general are to be limited to minor components of the overall contract. Form 1273 —Revised 3-95 0"7-95 Page 12-17 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist instructions 2. The contract amount upon which the requirements set forth in paragraph 1 of Section VII 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 SHA contracting officer determines is necessary to assure the. perfo manec of the contract 4. No portion of the contract shall be sublet, assigned or otherwise disposed of except with the written consent of the SHA contracting officer, or authorized representative, and such consent when given shall not be construed to relieve the contractor of any responsibility for the fulfcllment of the contract Written consent. will be given only after the SHA has assured that each subcontract is evidenced in writing and that it contains all pertinent provisions and requirements ofthe prime contract V1IL SAFETY: ACCIDENT PREVENTION 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 SHA contracting officer may determine, to be reasonably necessary to protect the life and health of employees on the job and the safety of the public and to protect property in connection with the performance of the work covered by the contract 2. It is a condition of this contract, and shall be made a con- dition of each subcontract, which the eoniractor enters into pur- suant to this contract, that the contractor and any subcontractor shall not permit any employee, in performance of the contract to work in surroundings or under conditions which are unsanitary, hazardous or dangerous to his/her health or safety, as determined under construction safety and health standards (29 CFR 1926) promulgated by the Secretary of Labor, in accordance with Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 333). 3. Pursuant to 29 CFR 19263, it is a condition of this contract that the Secretary of Labor or authorized representative thereof shall have right of entry to any site of contract performance to inspect or investigate the matter of compliance with the construction safety and health standards and to carry out the duties of the Secretary under Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 333). DL FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS In order to assure high quality and durable construction in conformity with approved plans and specifications and a high degree of reliability on statements and representations made by engineers, contractors, suppliers, and workers on Fcdmal4d highway projects, it is essential that all persons concerned with the project perform their fimctions as carefully, thoroughly, and honestly as possible. Willful falsification, distortion, or mis- representation with respect to any facts related to the project is a violation of Federal law. To prevent any ra6tmdcrstanding re- Parm U73 —Revised 3-95 0"7-95 Page 12-18 .Tune 29, 2012 garding the seriousness of these and similar acts, the following notice shall be posted on each Federal -aid highway project (23 CFR 635) in one or more places where it is readily available to all persons concerned with the project: NOTICE TO ALL PERSONNEL ENGAGED ON FEDERAL -All) HIGHWAY PROJECTS 18 U.S.C. 1020 reeds as follows: "Whoever being an offer, agent, or employee of the United States, or 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 ofplans, 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 repre- sentation, false report or false claim with respect to the character, fuality, quantity, or cost of any work performed or to be per- ormed, or materials furnished or to be furnished, in connection with the constriction of any highway or related project approved by the Secretary of Transportation: or Whoever knowingly makes arry false statement or false repre- sentation as to material fact in any statement, certificate, or report submitted pursuant to provisions of the Federal -aid Roads Act approved July 1, 1916, (39 Slat. 355), as amended and sup- plemented,• Shall be fined not more that $10,000 or imprisoned not more than S years or both. " X. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT (Applicable to all Federal -aid construction contracts and to all related subcontracts of $100,000 or more.) By submission of this bid or the execution of this contract, or subcontract, as appropriate, the bidder, Federal -aid construction contractor, or subcontractor, as appropriate, will be deemed to have stipulated as follows: 1. That any facility that is or will be utilized in the performance of this contract, unless such contract is exempt under the Clean Air Act; as amended (42 U.S.C. 1857 et seq, as amended by Pub. L. 91-604), and under the Federal Water Pollution Control Act, as amended (33 U.S.C. 1251 ct seq., as amended by Pub. L. 92-500), Executive Order 11738, and regulations in implementation thereof (40 CFR 15) is not listed, on the date of contract award, on the U.S. Environmental Protection Agency (EPA) List of Violating Facilities pursuant to 40 CFR 15.20. 2. That the firm agrees to comply and remain in compliance with all the requirements of Section 114 of the Clean Air Act and Section 308 of the Federal Water Pollution Control Act and all regulations and guidelines listed thereunder. 3. That the firm shall promptly notify the SHA of the receipt of any communication from the Director, Office of Federal Activities, EPA, indicating that a facility that is or will be utilized OB 12-04 Cs Local Assistance Procedures Manual EXI3IBTT 12-E PS&E Checklist Instructions Attachment B MW for the contract is under consideration to be listed on the EPA List of Violating Facilities. �7 4. That the fern agrees to include or cause to be included the requirements of paragraph 1 through 4 of this Section X in every nonexempt subcontract, and further agrees to take such action as the government may direct as a means of enforcing such re- quirements. XL CERTMCATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION L Instructions for Certification - Primary Covered Transactions: (Applicable to all Federal -aid contracts - 49 CFR 29) . By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. b. The inability of a person to provide the certification set out below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to 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 department or agency determined to enter into this transaction If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Govemment the department or agency may terminate this transaction far cause of default d. The prospective primary participant shall provide im- mediate written notice to the department or agency to whom this proposal is submitted if any time the prospective primary participant teams that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. e. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is submitted for assistance in obtaining a copy of those regulations. f The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower 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 primary 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 Transaction," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. h. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower 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 may decide the method and frequency by which it determines the el- igibility of its principals. Each participant may, but is not required to, check the nonprocurement portion of the "Lists of Parties Excluded From Federal Procurement or Nonprocurement Programs" (Nonprocurement List) which is compiled by the General Services Administration. L Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause, The knowledge and information of participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. j. Except for transactions authorized under paragraph f of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the de- partment or agency may terminate this transaction for cause or default Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Primary Covered Transactions 1. The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals: a. Are not presently debarred, suspended, proposed for debarment declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; b. Have not within a 3-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph I of this certification; and Foam 1273 —Revised 3-95 0"7-95 Page 12-19 OR 12-04 June 29, 2012 EXIDEBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions d Have not within a 3-year period preceding this ap- plication/proposal had one or more public transactions (Federal, State or local) terminated for cause or default 2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. ***** 2. Instructions for Certification - Lower Tier Covered Transactions: (Applicable to all subcontracts, purchase orders and other lower tier transactions of S25,0M or more - 49 CFR 29) a. By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. c. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended," "ineligible," "primary covered transaction "participant," "person," "principal," "proposal," and "voluntarily excluded as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. e. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. f. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exchusion-Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. g. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it detemrines the el- igibility of its principals. Each participant may, but is not Form 1273 — Revised 3-95 0847-95 Page 12-20 June 29, 2012 required to, check the Nonprocurement List b. 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 de- partment or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions I. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements m this certification, such prospective participant shall attach an explanation to this proposal. * * * * %IL CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING (Applicable to all Federal -aid construction contracts and to all related subcontracts which exceed $100,000 - 49 CFR 20) I. 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 fiords other than Federal appropriated funds have been paid or will be2aid to any person for influencing or attempting to influence an oracw 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, OB 12-04 11 C E Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B grant, loan, or cooperative agreement, the undersigned shall be subject to a civil penalty of not less than $10,000 and not more complete and submit Standard Form-LLL, 'Disclosure Form to than $100,000 for each such failure. 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 en- tered into. Submission of this certification is a prerequisite for malting or entering into this transaction imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall 3. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such recipients shall certify and disclose accordingly. Minority Utilization Goals Economic Area Goal (Percent) 174 Redding CA: Non-SMSA Counties: 6.8 CA Lassen; CA Modoc; CA Plumas; CA Shasta; CA Siskiyou; CA Tehama 175 Eureka, CA Non-SMSA Counties: 6.6 CA Del Norte; CA Humboldt; CA Trinity 176 San Francisco -Oakland -San Jose, CA: SMSA Counties: 7120 Salinas -Seaside -Monterey, CA 28.9 CA Monterey 7360 San Francisco -Oakland 25.6 CA Alameda; CA Contra Costa; CA Marin; CA San Francisco; CA San Mateo 7400 San Jose, CA CA Santa Clara, CA 19.6 7485 Santa Cruz, CA CA Santa Cruz 14.9 7500 Santa Rosa CA Sonoma 9.1 8720 Vallejo -Fairfield -Napa, CA CA Napa; CA Solano 17.1 Non-SMSA Counties: CA Lake; CA Mendocino; CA San Benito 23.2 177 Sacramento, CA: SMSA Counties: 6920 Sacramento, CA 16.1 CA Placer, CA Sacramento; CA Yolo Non-SMSA Counties 14.3 CA Butte; CA Colusa; CA El Dorado; CA Glenn; CA Nevada; CA Sierra; CA Sutter, CA Yuba 178 Stockton -Modesto, CA: SMSA Counties: 5170 Modesto, CA 12.3 CA Stanislaus 8120 Stockton, CA 24.3 CA San Joaquin Nan-SMSA Counties 1918 CA Alpine; CA Amador; CA Calaveras; CA Mariposa; CA Merced; CA Toulumne OB 12-04 Page 12-21 June 29, 2012 EXHIBIT 12-E Attachment B Local Assistance Procedures Manual PS&E Checklist Instructions 179 Fresno -Bakersfield, CA SMSA Counties: 0680 Bakersfield, CA CA Kem 2840 Fresno, CA CA Fresno Non-SMSA Counties: CA Kings; CA Madera; CA Tulare 19.1 26.1 23.6 180 Los Angeles, CA: SMSA Counties: 0360 Anabeim-Santa Ana-Crarden Grove, CA 11.9 CA Orange 4480 Los Angeles -Long Beach, CA 25.3 CA Los Angeles 6000 Oxnard -Simi Valley -Ventura, CA 21.5 CA Ventura 6780 Riverside -San Bemandino-Ontario, CA 19.0 CA Riverside; CA San Bernardino 7480 Santa Barbara -Samoa Maria -Lompoc, CA 19.7 CA Santa Barbara Non-SMSA Counties 24.6 CA Ingo; CA Mono; CA San Luis Obispo 181 San Diego, CA: SMSA Counties 7320 San Diego, CA 16.9 CA San Diego Non-SMSA Counties 18.2 CA biperial For each July during which work is performed under the contract, you and each non -material -supplier subcontractor with a subcontract of $10,000 or more must complete Form FHWA PR-1391 (Appendix C to 23 CFR 230). Submit the forms by August 15. Training This section applies if a number of trainees or apprentices is specified in the special provisions. As part of your equal opportunity affirmative action program, provide on-the-job training to develop full journeymen in the types of trades or job classifications involved. You have primary responsibility for meeting this training requirement. If you subcontract a contract part, determine how many trainees or apprentices are to be trained by the subcontractor. Include these training requirements in your subcontract. Where feasible, 25 percent of apprentices or trainees in each occupation must be in their 1st year of apprenticeship or training. - -14 Adak Page 12-22 _ .Tune 29, 2012 OB 12-04 HB= Huntington Beach C Local Assistance Procedures Mannal PS&E Checklist Instructions EX Mrr 12-L Attachment B 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 HB I. 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 of HB approval for this submitted information before you start work. The City/County of HB 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 Labor, Bureau of Apprenticeship and Training. Ask the employee if the employee has successfully completed a training course leading to j ourneyman 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 HB and FHWA approves a program if one of the following is met: 1. It is calculated to: 1.1. Meet your equal employment opportunity responsibilities. 1.2. 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. Page 12-23 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions HB= Huntington Beach Provide training in the construction crafts, not in clerk -typist or secretariat -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 training 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 HB 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: 2.1. Contribute to the cast of the training. 2.2. Provide the instruction to the apprentice or trainee. 2.3. Pay the apprentice's or trainee's wages during the off -site training period. 3. If you comply with this section. 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 Iong 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 within providing the training. 2. Certification showing the type and length of training satisfactorily completed. Maintain records and submit reports documenting your performance under this section. TR--16 Page 12-24 June 29, 2012 OB 12-04 C n 11 Local Assistance Procedures Manual EXI3TBTr 12-E PS&E Checklist Instructions Attachment C (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE ANENDORSEMENT AND EX =70N OF THOSE CERTIFICATIONS WHICHAREA PART OF THIS PROPOSAL) ATTAaDaNT C EQUAL EMPLOYMENT OPPORTIINTTY CERTIFICATION The bidder PTM General Engineering Services, Inc proposed subcontractor 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.) E. 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. OR L2-04 Page 12-25 June 29, 2012 Local Assistance Procedures Manua[ Ps&E Checklist Instructions ATTACHMENT D NoNcoLLusm AFFmAvu (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY / COUNTY of Huntington Beach/OC DEP.4R.TMBNT OF PUBLIC WORKS. EXHIBIT 12-E Attachment D In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of; any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. OB 12-04 Page 12-27 June 29, 2012 1-1 Local Assistance Procedures Manual EX MIT 12-E PS&E Checklist Instructions Attachment E ATTAmm:EENT E DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, and manager: • Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; • Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past 3 years; • Does not have a proposed debarment pending, and • 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. OB 12-04 Page 12-29 Tune 29, 2012 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment F ATTAcickmNT F NONLOBB'YING CERTIFICATION FOR FEDERAL -AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U-S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify and disclose accordingly. is OB 12-04 Page 12-31 June 29, 2012 N/A= Not Applicable C] 2 Local Assistance Procedures Manual V rr 12-E PS&E Checklist Instructions Attachment G �A S COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVrMS PURSUANT TO 31 U.S.C. 1352 1. Type of Federal Action: N/A a. contract b. grant c. cooperative agreement d. loan e. loan guarantee f loan insurance 2. States of Federal Action: N/A a. bid/offer/application b. initial award c. post -award 4. Name and Address of Reporting Entity Prime Subawardee N/A Tier , if known Congressional District, if known b. Federal Department/Agency: N/A 8. Federal Action Number, if known: N/A 3. Reporf Type: E] a initial N/A b. material change For Material Change Only: year_ quarter date of last renort 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: N/A Congressional District, ifknawn 7. Federal Program Name/Description: N/A CFDA Number, if applicable 9. Award Amount, if known: N/A 10. a. Name and Address of Lobby Entity b. Individuals Performing Services (including (If individual, last name, first name, MI) address if different from No. i0a) N/A (last name, first name, MI) N/A (attach Continuation Shect(s) if necessary) 11. Amount of Payment (check all that apply) 13. Type of Payment (check all that apply) g N/A actual planned a. retainer b, one-time fee N/A 12. Form of Payment (check all that apply): C. commission cash d. contingent fee ea. b. in -land; specify: natare N/A e deterred value Lj f other, specify 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or members) contacted, for Payment Indicated in Item 11: N/A (attach Continuation Sheet(s) if necessary) 15. Continuation Sheet(s) attached: Yes No 16. lnfou nmon requested through this form is w1horized by Title 31 U_S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above whoa bis transaction was made or entered into. This disclosure is required pursuant to 31 Print Name: Elizabeth H. Mendoza de McRae U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection" Any Trtic: President/CFO person who && to file the required disclosure shad be subject to a civil penalty of not less than S 10,000 and not more than 1100,000 for each such failure. Telephone No.: 951, 710,1000 Date: 08.21.2017 Authorized for Local Reproduction Federal Use Only: Standard Form - LLL OB 12-04 Rr,.na.rd Porn, tSI. Page 12-33 June 29, 2012 E3CMrr 12-E Local Assistance Procedures Manual Attachment G PS&E Checklist Instructions INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient, at the initiation or receipt of covered federal action or a material change to previous filing pursuant to title 31 U.S.C. Section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered federal action. 2. Identify the status of the covered federal action. 3. Identify the appropriate classification of this report If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred_ Enter the date of the last, previously submitted report by this reporting entity for this covered federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the fast tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, State and zip code of the prime federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard- 7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate federal identifying number available for the federal action identification in item 1 (e_g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the federal agency). Include prefixes, e.g., "RFP-DE-90-00 L" 9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter the federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (Ml). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10)_ Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in -kind contribution, specify the nature and value ofthe in -kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. Page 12-34 is June 29, 2012 OR 12-04 0 Local Assistance Procedures Manual EX11MTT 12-E PS&E Checklist Instructions Attachment G 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with federal officials. identify the federal officer(s) or employees) contacted or the officers) employee(s) or Member(s) of Congress that were contacted. 15_ Check whether or not a continuation sbeet(s) is attached. 16. The certifying official shall sign and date the farm, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information_ Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. SF-LLL-Instructions Rev.06-04-90(041)T» Page 12-35 OB 12-04 June 29, 2012 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment H ATTACHMENT H SECTION 2. PROPOSAL REQuuwxEA'Ts AND CONDITIONS 0 2-1.01 GENERAL The bidder's attention is directed to the provisions in Section 2, "Proposal Requirements and Conditions," of the Standard Specifications and these special provisions for the requirements and conditions which the bidder must observe in the preparation of and the submission of the bid. The bidder's bond shall conform to the bond form in the Bid book for the proj ect and shall be properly filled out and executed_ The bidder's bond form included in that book may be used. In conformance with Public Contract Code Section 7106, a Noncollusion Affidavit is included in the Bid book. Signing the Bid book shall also constitute signature of the Noncollusion Affidavit. The Contractor, sub -recipient or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of Title 49 CFR (Code of Federal Regulations), Part 26 in the award and administration of US DOT -assisted contracts. Failure by the Contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy, as the recipient deems appropriate. Each subcontract signed by the bidder must include this assurance. Failure of the bidder to fulfill the requirements of the Special Provisions for submittals required to be furnished after bid opening, including but not limited to escrowed bid documents, where applicable, may subject the bidder to a determination of the bidder's responsibility in the event it is the apparent low bidder on a future public works contracts. 2-1.015—FEDERAL LOBBYING RESTRICTIONS. —Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower -tier sub -recipient of a Federal -aid contract to pay for any person for influencing or attempting to influence a Federal agency or Congress in connection with the awarding of any Federal -aid contract, the making of any Federal grant or loan, or the entering into of any cooperative agreement. If any funds other than Federal funds have been paid for the same purposes in connection with this Federal -aid contract, the recipient shall submit an executed certification and, if required, submit a completed disclosure form as part of the bid documents. A certification for Federal -aid contracts regarding payment of funds to lobby Congress or a Federal agency is included in the Bid book. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Bid book. Signing the Bid book shall constitute signature of the Certification. The above referenced certification and disclosure of lobbying activities shall be included in each subcontract and any lower -tier contracts exceeding $100,000. All disclosure forms, but not certifications, shall be forwarded from tier to tier until received by the Engineer. The Contractor, subcontractors and any lower -tier contractors shall file a disclosure form at the end of each calendar quarter in which there occurs any event that requires disclosure or that materially affects the accuracy of the information contained in any disclosure form previously filed by the Contractor, subcontractors and any lower -tier contractors. An event that materially affects the accuracy of the information reported includes: Page 12-37 OB 12-04 June 29, 2012 C EXHIBIT 12-E Local Assistance Procedures Mannal Attachment A PS&E Checklist Instructions (1) A cumulative increase if $25,000 or more in the amount paid or expected to be paid for influencing or attempting to influence a covered federal action; or (2) A change in the persou(s) or individual(s) influencing or attempting to influence a covered federal action; or (3) A change in the officer(s), employees(s), or member(s) contacted to influence or attempt to influence a covered Federal Action. 2-1.02 DISADVANTAGED BUSINESS ENTERPRISE (DBE). —This project is subject to Title 49 CFR 26.13(b): The Contractor, sub -recipient or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The Contractor shall carry out applicable requirements of 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 recipient deems appropriate. Take necessary and reasonable steps to ensure that DBEs have opportunity to participate in the contract (49 CFR 26). ® To ensure there is equal participation of the DBE groups specified in 49 CFR 26.5, the Agency specifies a goal ® for Disadvantaged Business Enterprises (DBEs). DBE is a firm that meets the definition of DBE. 11 Make work available to DBEs and select work parts consistent with available DBE subcontractors and suppliers. Meet the DBE goal shown in the Notice to Bidders or demonstrate that you made adequate good faith efforts to meet this goal. It is your responsibility to verify that the DBE firm is certified as DBE at date of bid opening. For a list of DBEs certified by the California Unified Certification Program, go to: bttp://www.det.ca.gov/bgtbQtfind certified.htm All DBE participation will count toward the California Department of Transportation's federally mandated statewide overall DBE goal. Page 12-38 June 29, 2012 OR 12-04 Local Assistance Procedures Manual EXAIBIT 12-E PS&E Checklist Instructions Attachment I Credit for materials or supplies you purchase from DBEs counts towards the goal in the following manner: 1. 100 percent counts if the materials or supplies are obtained from a DBE manufacturer. 2, 60 percent counts if the materials or supplies are obtained from a DBE regular dealer. 3. Only fees, commissions, and charges for assistance in the procurement and delivery of materials or supplies count if obtained from a DBE that is neither a manufacturer, nor a regular dealer. 49 CFR 26.55 defines "manufacturer" and "regular dealer." You receive credit towards the goal if you employ a DBE trucking company that performs a commercially useful function as defined in 49 CFR 26.55. DBE Commitment Submittal Submit DBE information on the Local Agency Bidder DBE Commitment (Construction Contracts), Exhibit 15-G form, included in the Bid book. If the form is not submitted with the bid, remove the form from the Bid book before submitting your bid. If the DBE Commitment form is not submitted with the bid, the apparent low bidder, the 2nd low bidder, and the 3rd low bidder must complete and submit the DBE Commitment form to the Agency. DBE Commitment form must be received by the Agency no later than 4:00 p.m, on the 4th business day after bid opening. Other bidders do not need to submit the DBE Commitment form unless the Agency requests it. If the Agency requests you to submit a DBE Commitment form, submit the completed form within 4 business days of the request. Submit written confirmation from each DBE stating that it is participating in the contract Include confirmation with the DBE Commitment form. A copy of a DBE's quote will serve as written confirmation that the DBE is participating in the contract. If you do not submit the DBE Commitment form within the specified time, the Agency finds your bid nonresponsive. Good Faith Efforts Submittal If you have not met the DBE goal, complete and submit the DBE Information - Good Faith Efforts, Exhibit 15-H form with the bid showing that you made adequate good faith efforts to meet the goal. Only good faith efforts directed towards obtaining participation by DBEs will be considered. If good faith efforts documentation is not submitted with the bid, it must be received by the Agency no later than 4:00 p.m. on the 4th business day after bid opening. If your DBE Commitment form shows that you have met the DBE goal or if you are required to submit the DBE Commitment form, you must also submit good faith efforts documentation within the specified time to protect your eligibility for award of the contract in the event the Agency finds that the DBE goal has not been met Page 12-39 OR 12-04 June 29, 2012 EXMIT 12-E Attachment I Local Assistance Procedures Manual PS&E Checklist Instructions Good faith efforts documentation must include the following information and supporting documents, as necessary. L Items of work you have made available to DBE firms. Identify those items of work you might otherwise perform with its own forces and those items that have been broken down into economically feasible units to facilitate DBE participation. For each item listed, show the dollar value and percentage of the total contract. It is your responsibility to demonstrate that sufficient work to meet the goal was made available to DBE firms. 2. Names of certified DBEs and dates on which they were solicited to bid on the project_ Include the items of work offered. Describe the methods used for following up initial solicitations to determine with certainty if the DBEs were interested, and the dates of the follow-up. Attach supporting documents such as copies of letters, memos, facsimiles sent, telephone logs, telephone billing statements, and other evidence of solicitation. You are reminded to solicit certified DBEs through all reasonable and available means and provide sufficient time to allow DBEs to respond. 3. Name of selected firm and its status as a DBE for each item of work made available. Include name, address, and telephone number of each DBE that provided a quote and their price quote. If the firm selected for the item is not a DBE, provide the reasons for the selection. 4. Name and date of each publication in which you requested DBE participation for the project. Attach copies of the published advertisements. S. Names of agencies and dates on which they were contacted to provide assistance in contacting, recruiting, and using DBE firms. If the agencies were contacted in writing, provide copies of supporting documents. 6. List of efforts made to provide interested DBEs with adequate information about the plans, specifications, and requirements of the contract to assist them in responding to a solicitation. If you have provided information, identify the name of the DBE assisted, the nature of the information provided, and date of contact. Provide copies of supporting documents, as appropriate. 7. List of efforts made to assist interested DBEs in obtaining bonding, lines of credit, insurance, necessary equipment, supplies, and materials, excluding supplies and equipment that the DBE subcontractor purchases or leases from the prime contractor or its affiliate. If such assistance is provided by you, identify the name of the DBE assisted, nature of the assistance offered, and date. Provide copies of supporting documents, as appropriate. 8. Any additional data to support demonstration of good faith efforts. The agency may consider DBE commitments of the 2"d and 3'd bidders when determining whether the low bidder made good faith efforts to meet the goal. Page 12-40 June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment I ATTACHMENT I SECTION 3. AwARD AND EXECUTION OF CONTRACT The bidder's attention is directed to the provisions in Section 3, "Award and Execution of Contract," of the Standard Specifications and these special provisions for the requirements and conditions concerning award and execution of contract. Bid protests are to be delivered to the following address: lAgency to provide information] The award of the contract, if it be awarded, will be to the lowest responsible bidder whose bid complies with all the requirements prescribed. The contract shall be executed by the successful bidder and shall be returned together with the contract bonds, to the Agency so that it is received within 10 days, not including Saturdays, Sundays and legal holidays, after the bidder has received the contract for execution. Failure to do so shall be just cause for forfeiture of the proposal guaranty. The executed contract documents shall be delivered to the following address: lAeency to provide detailed information if this paragraph is usedl SECTION 4. BEGINNING OF WORK, TIME OF COMPLETION AND LIQUIDATED DAMAGES Attention is directed to the provisions in Section 8-1.03, `Beginning of Work" in Section 8-1.06 "Time of Completion," and in Section 8-1.07, "Liquidated Damages," of the Standard Specifications and these special Is provisions. The Contractor shall begin work within 15 calendar days after the contract has been approved by the attorney appointed and authorized to represent the City/County of Huntington Beach/OC This work shall be diligently prosecuted to completion before the expiration of WORKING DAYS beginning on the 15 calendar day after approval of the contract. (INSERT AMOUNT OF LIQUIDATED DAMAGES) The Contractor shall pay to the City/County of HB/OC the sum of $ 500.00 per day, for each and every calendar day's delay in finishing the work in excess of the number of working days prescribed above. Page 12-41 OB 12-04 June 29, 2012 E E3IMIT 12-E Attachment I Liquidated Damages Local Assistance Procedures Manual PS&E Checklist Instructions Liquidated Damages are based on the estimated cost of field construction engineering. In special cases, liquidated damages greater than the estimated field construction engineering cost may be specified, provided detailed reasons are given to support the greater amount. In every case, show the calculations that support the recommended rate. Liquidated damages are not to be used as disincentives to encourage timely completion. Use the following formula for highway construction projects to avoid excessive liquidated damages: L% (See Table below ) x Engineer's Estimate+ RE Office Expenses * = Liq Dam/calendar day Working Days ** * Resident Engineer office expenses over the life of the contract should be added unless the cost is already included in the Engineer's Estimate. * * Working days used to calculate liquidated damages should not include water pollution establishment or plant establishment days. LIQUIDATED DAMAGES TABLE (L%) Project Ve Project Estimate Resurfacing*/Rehab New Highway Realignment/ Widening Landscaping Soundwall Others Over $30 million 10 % 10 % 13% 15% 15% 15 % $10million to $30 million 10% 12% 15% 15% 15% 15% $5 million to $10 million 10 % 15 % 15% $750k to $5 million 15% 15% 15% 18 % 18 % 15 Less Than $750k 15 % 1 20 % 20 % 18 % 20 % 15% * Resurfacing projects include AC Surfacing, seal coats, slurry seals, and so on. The calculated liquidated damages sbould be rounded up in $100 increments to determine the amount to be specified_ Page 12-42 June 29, 2012 OB 12-04 ATTACHMENT J SUBCONTRACTOR AND DBE REcORiDs Required for ALL construction contracts administered under the Cattrans Standard Specifications 5-1._ SUBCONTRACTOR AND DBE RECORDS Use each DBE subcontractor as listed on the List of Subcontractors form and the Local Agency Bidder DBE Commitment (Construction Contracts), Exhibit 15-G, forms unless you receive authorization for a substitution. The Agency requests the Contractor to: 1. Notify the Engineer of any changes to its anticipated DBE participation 2. Provide this notification before starting the affected work Maintain records including: 1. Name and business address of each 1st -tier subcontractor 2. Name and business address of each DBE subcontractor, DBE vendor, and DBE trucking company, regardless of tier 3. Date of payment and total amount paid to each business Ifyou are a DBE contractor, include the date of work performed by your own forces and the corresponding value of the work_ Before the 15th of each month, submit a Monthly DBE Trucking Verification form. If a DBE is decertified before completing its work, the DBE must notify you in writing of the decertification date, If a business becomes a certified DBE before completing its work, the business must notify you in writing of the certification date. Submit the notifications. On work completion, complete a Disadvantaged Business Enterprises (DBE) Certification Status Change, Exhibit 17-0, form. Submit the form within 30 days of contract acceptance_ Upon work completion, complete a Final Report — Utilization of Disadvantaged Business Enterprises (DBE), Fast -Tier Subcontractors, Exhibit 17-F, form. Submit it within 90 days of contract acceptance. The Agency withholds $10,000 until the form is submitted. The Agency releases the withhold upon submission of the completed form. Page 12-44 Jane 29, 2012 OB 12-04 11 F7 ATTACEWNT K PERFORMANCE OF SUBCONTRACTORS 5-1._ PERFORMANCE OF SUBCONTRACTORS DBEs must perform work or supply materials as listed in the Local Agency Bidder DBE Commitment (Construction Contracts), Exhibit 15-G, included in the Bid. Do not terminate or substitute a listed DBE for convenience and perform the work with your own forces or obtain materials from other sources without authorization from the Agency. The Agency authorizes a request to use other forces or sources of materials if it shows any of the following justifications: 1. Listed DBE fails or refuses to execute a written contract based on plans and specifications for the project.. 2. You stipulated that a bond is a condition of executing the subcontract and the listed DBE fails to meet your bond requirements. 3. Work requires a contractor's license and listed DBE does not have a valid license under Contractors License Law. 4. Listed DBE fails or refuses to perform the work or furnish the listed materials. 5. Listed DBE's work is unsatisfactory and not in compliance with the contract. 6. Listed DBE is ineligible to work on the project because of suspension or debarment 7. Listed DBE becomes bankrupt or insolvent. & Listed DBE voluntarily withdraws with written notice from the Contract 9. Listed DBE is ineligible to receive credit for the type of work required. 10. Listed DBE owner dies or becomes disabled resulting in the inability to perform the work on the Contract. 11. Agency determines other documented good cause. Notify the original DBE of your intent to use other forces or material sources and provide the reasons. Provide the DBE with 5 days to respond to your notice and advise you and the Agency of the reasons why the use of other forces or sources of materials should not occur. Your request to use other forces or material sources must include: 1. 1 or more of the reasons listed in the preceding paragraph 2. Notices from you to the DBE regarding the request 3. Notices from the DBEs to you regarding the request If a listed DBE is terminated, make good faith efforts to find another DBE to substitute for the original DBE. The substitute DBE must perform at least the same amount of work as the original DBE under the contract to the extent needed to meet the DBE goal. The substitute DBE must be certified as a DBE at the time of request for substitution. Unless the Agency authorizes (1) a request to use other forces or sources of materials or (2) a good faith effort for a substitution of a terminated DBE, the Agency does not pay for work listed on the Local Agency Bidder DBE Commitment (Construction Contracts), Exhibit 15-G, form unless it is performed or supplied by the listed DBE or an authorized substitute. Page 12-46 June 29, 2012 OB 12-04 Local Assistance Procedures Manual EDIT 12-E PS&E Checklist Instructions Attachment L AM ATTACHMENT L SUBCONTRACTING 5-1._ SUBCONTRACTING No subcontract releases the Contractor from the contract or relieves the Contractor of their responsibility for a subcontractor's work. If the Contractor violates Pub Cont Code § 4100 et seq., the City/County of Huntington BeauMy exercise the remedies provided under Pub Coat Code § 4110. The City/County o$Iuntinton Beacinay refer the violation to the Contractors State License Board as provided under Pub Cont Code § 4111. The Contractor shall perform work equaling at least 30 percent of the value of the original total bid with the Contractor's own employees and equipment, owned or rented, with or without operators_ Each subcontract must comply with the contract. Each subcontractor must have an active and valid State contractor's license with a classification appropriate for the work to be performed (Bus & Prof Code, § 7000 et seq.). Submit copies of subcontracts upon request by the Engineer. Before subcontracted work starts, submit a Subcontracting Request form. Do not use a debarred contractor; a current list of debarred contractors is available at the Department of Industrial Relations web site at: Lttp:/Iwww.dir.ca.gov/dlse/debar.html Upon request by the Engineer, immediately remove and not again use a subcontractor who fails to prosecute the work satisfactorily. Each subcontract and any lower -tier subcontract that may in turn be made shall include the "Required Contract Provisions Federal -Aid Construction Contracts" in Section 14 of these special provisions. Noncompliance shall be corrected. Payment for subcontracted work involved will be withheld from progress payments due or to become due, until correction is made_ Failure to comply may result in termination of the contract. 5-1.` PROMPT PROGRESS PAYMENT TO SUBCONTRACTORS A prime contractor or subcontractor shall pay any subcontractor not later than 10 days of receipt of each progress payment in accordance with the provision in Section 7108.5 of the California Business and Professions Code concerning prompt payment to subcontractors_ The 10 days is applicable unless a longer period is agreed to in writing. Any delay or postponement of payment over 30 days may take place only for good cause and with the agency's prior written approval. Any violation of Section 7108.5 shall subject the violating contractor or subcontractor to the penalties, sanctions and other remedies of that section. This requirement shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the contractor or subcontractor in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance, or noncompliance by a subcontractor. 11 Page 1249 OB 12-04 June 29, 2012 11 EXHIBIT 12-E Local Assistance Procedures Manual Attachment L PS&1E Checklist Instructions 5-1._ PROMPT PAYMENT OF FUNDS WITHHELD TO SUBCONTRACTORS The local agency must include one of the following three provisions (if using Caltrans Standard Specification, modify or delete paragraphs 9-1.06 and 9-1.065) to ensure prompt and full payment of any retainage from the prime contractor, or subcontractor to a subcontractor. (EITFIER) No retainage will be withheld by the agency from progress payments due the prime contractor. Retainage by the prime contractor or subcontractors is prohibited and no retainage will be held by the prime contractor from progress due subcontractors. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the California Business and Professions Code. This requirement shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcontractor, in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance or noncompliance by a subcontractor. (OR) No retainage will be held by the agency from progress payments due the prime contractor. Any retainage held by the prime contractors or subcontractors from progress payments due subcontractors shall be promptly paid in full to subcontractors within 30 days after the subcontractor's work is satisfactorily completed. Federal law (49 CFR 26.29) requires that any delay or postponement of payment over the 30 days may take place only for good cause and with the agency's prior written approval. Any violation of this provision shall subject the violating prune contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code. These requirements shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcontractor, in the event of a dispute involving Iate payment or nonpayment by the prime contractor, deficient subcontract performance or noncompliance by a subcontractor. (OR) The agency shall hold retainage from the prime contractor and shall make prompt and regular incremental acceptances of portions, as determined by the agency, of the contract work and pay retainage to the prime contractor based on these acceptances. The prime contractor or subcontractor shall return all monies withheld in retention from a subcontractor within 30 days after receiving payment for work satisfactorily completed and accepted including incremental acceptances of portions of the contract work by the agency. Federal law (49 CFR 26.29) requires that any delay or postponement of payment over 30 days may take place only for good cause and with the agency's prior written approval. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code. These requirements shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcontractor, in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance or noncompliance by a subcontractor. Page 12-50 June 29, 2012 OB 12-04 Local Assistance Procedures Manual PS&E Checklist Instructions EXEaBIT 12-E Attachment L 5-1. FEDERAL REQUIREMENTS (AMERICAN RECOVERY AND REINVESTMENT ACT) Under the American Recovery and Reinvestment Act (ARRA) of 2009, 9 USC § 902: SEC. 902. ACCESS OR GOVERIN74ENT ACCOUNTABILITY OFFICE. (a) ACCESS. —Each contract awarded using funds made available in this Act shall provide that the Comptroller General and his representatives are authorized: (1) to examine any records of the contractor or any of its subcontractors, or any State or local agency administering such contract, that directly pertain to, and involve transactions relating to, the contract or subcontract; and (2) to interview any officer or employee of the contractor or any of its subcontractors, or of any State or local government agency administering the contract, regarding such transactions. (b) RELATIONSHIP TO EXISTING AUTHORITY. —Nothing in this section shall be interpreted to limit or restrict in any way any existing authority of the Comptroller General. Under ARRA of 2009, 9 USC § 1515(a): SEC. 1515. ACCESS OF OFFICES OF INSPECTOR GENERAL TO CERTAIN RECORDS AND EMPLOYEES. (a) ACCESS. —With respect to each contract or grant awarded using covered funds, any representative of an appropriate inspector general appointed under section 3 or 8G of the Inspector General Act of 1978 (5 U.S.C. App.), is authorized: (1) to examine any records of the contractor or grantee, any of its subcontractors or subgrantees, or any State or local agency administering such contract, that pertain to, and involve transactions relating to, the contract, subcontract, grant, or subgrant; and (2) to interview any officer or employee of the contractor, grantee, subgrantee, or agency regarding such transactions. (b) RELATIONSHIP TO EXISTING AUTHORTIY.—Nothing in this section shall be interpreted to limit or restrict in any way any existing authority of an inspector general. Immediately notify the Engineer if you have been contacted by the U. S. Comptroller, Inspector General, or their representatives. Used in projects with ARRA Federal -aid fiords. Used in projects with American Recovery and Reinvestment Act Federal -aid funds. 5-1. — MONTHLY EMPLOYMENT REPORT (AMERICAN RECOVERY AND REINVESTMENT ACT) For the purpose of complying with the American Recovery and Reinvestment Act of 2009, submit a completed Monthly Employment Report form by the fifth of each month for the previous month. For the form, go to: http://www.dotca og v/hq/construc/forms/cem1204.pdf If you fail to submit a complete and accurate report, the Department withholds 2 percent of the monthly progress estimate. The Department does not withhold more than $10,000 or less than $1,000. The Department releases the withhold upon submission of the completed form. Page 12-51 OR 12-04 June 29, 2012 E EX "rr 12-E Local Assistance Procedures Manual Attachment L PS&E Checklist Instructions Used in projects with American Recovery and Reinvestment Act Federal -aid funds 3-1.02 DATA UNNERSAL NUMBERING SYSTEM (D-U-N S) NUMBER For the purpose of complying with the American Recovery and Reinvestment Act of 2009, the successful bidder must provide the Department a D-U N-S number. Complete and sign the Data Universal Numbering System (D-U-N-S) Number form included in the contract documents. This form must be submitted with the executed contract. If your company does not have a D-U N-S number, you can obtain one by contacting Dun & Bradstreet at: hU:/Idnb.com/us/ If you fail to submit this information with the executed contract, the City/County ofHuntington B .gAill not approve the contract. Page 12-52 .Tune 29, 2012 OB 12-04 Local Assistance Procedures Manual EXWRIT 12-E PS&E Checklist Instructions Attachment M ATrAcmdENT M Buy Aiv micA RFQumEMENTS 5-1.— BUY AMERICA REQUIREMENTS. — Attention is directed to the `Buy America" requirements of the Title 23 United States Code, Section 313 and the regulations adopted pursuant thereto. In accordance with said law and regulations, all manufacturing processes for steel and iron materials furnished for incorporation into the work on this project shall occur in the United States; with the exception that pig iron and processed, pelletized and reduced iron ore manufactured outside of the United States may be used in the domestic manufacturing process for such steel and iron materials. The application of coatings, such as epoxy coating, galvanizing painting, and any other coating that protects or enhances the value of such steel or iron materials shall be considered a manufacturing process subject to the "Buy America" requirements. A Certificate of Compliance, conforming to the provisions in Section 6-1.07, Certificates of Compliance, of the Standard Specifications, shall be furnished for steel and iron materials. The certificates, in addition to certifying that the materials comply with the specifications, shall also specifically certify that all manufacturing processes for the materials occurred in the United States, except for the exceptions allowed herein_ The requirements imposed by said law and regulations do not prevent a minimal use of foreign steel and iron materials if the total combined cost of such materials used does not exceed one -tenth of one percent (0.1%) of the total contract cost or $2,500, whichever is greater. The Contractor shall furnish the Engineer acceptable documentation of the quantity and value of any foreign steel and iron prior to incorporating such materials into the work d C7 Page 12-53 OB 12-04 June 29, 2012 9 Local Assistance Procedures Manual EXHIBIT 15-G Local Agency Bidder DBE Commitment (Construction Contracts) EXHIBIT 15-G LOCAL AGENCY BIDDER DBE COMDHTMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF TffiS FORM LOCALAGENCY: Huntington Beach LoeATwN: Huntington Beach PRoJE i5 scRirmN: Traffic Signal Modifications, TOTAL CONTRACT AMOUNT: S BIDDATE: August 21, 2017 BIDDwsNAME: PTM General Engineering Services, Inc CONTRACT DBE GOAL: 10% CONTRACT MFMNO. OF WORK AND DESCRIPTION OR SERVICES TO BE SUBCONTRACTED OR MATERIALS O BE PROVIDED (or contracted if the bidder is a DBE) DBE CERT NO. AND EY PIRATION DATE NAME OF EACH DBE (Must be certified on the date bids am opened - include DBE address and phone number) DOLLARAMOUNT BE For Local Agency to Complete: Local Agency Contract Number: Federal -aid Project Number. Federal Sham: Total Claimed DBE Participation i $ % Contract Award Date: Local Agency certifies that all DBE certifications have been verified and information is complete and accurate. Print Name Sim Date Local Agency Representative (Area Code) Telephone Number. 1 Sign 1 e ofAiddcr August 21, 2017 951.710.1000 Date (Area Code) Tel No. Elizabeth H. Mendoza de McRae Penton to Contact (Please Type or Print) Local Agency Bidder DBE Commuocat (Coostroction Contracts) . (Rev 61261D9) Distribution: (1) Copy — Fax or scan a copy to the Caltrans Dishsct Local Assistance Engineer (DIAE) within 30 days of contract execution. Failure to send a copy to the DLAB within 30 days of contract =cut= may result in de -obligation of funds for this projecL (2) Copy — Include in award paol®ge to Caltram District Local Assistance 0 (3) Original —Local agency fizz Page 15-1 013 12-04 June 29, 2012 EXHBIT IS-G Local Assistance Procedures Manua[ Local Agency Bidder DBE Commitment (Construction Contracts) INSTRUCTIONS - LOCAL AGENCY BIDDER DBE COMN MAENT (CONSTRUCTION CONTRACTS) PLEASE NOTE: This information may be submitted with your bid. U 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). RVTORTANT: 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 f lmished 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 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 OB I2-04 Local Assistance Procedures Manual Exhibit 15-11: DBE Information - Good Faith Effort EXHMIT 15-11 DBE INFORMATION --GOOD FAITH EIVORTS DBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. HSIPL 5181 (178) Bid Opening Date August 21, 2017 The (City/County of) HB established a Disadvantaged Business Enterprise (DBE) goal of 10 % 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 Went Directly to DBE 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 DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation Went Directly to DBE Page 15-1 OB 12-04 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 ($) Of (YIN) 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 DB Went Directly to DBE Names, addresses and phone numbers of firms selected for the work above: Went Directly to DBE 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: Went Directly to DBE Page 15-2 June 29, 2012 OB 12-04 �J 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: Went Directly to DBE 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 Went Directly to DBE H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): Went Directly to DBE NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. Page 15-3 OR 12-04 June 29, 2012 Local Assistance Procedures Manual EXHOIT 17 F Dina[ Report -Utilization of DIsadvantaged Business Enterprises (DHE), First -Tier Subcontractors STATE OF CALIFORNIA- DBPARTmENT of TRANSPORTATION FINAL. REPORT -UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES ADANotlsa (DBE), FIRST -TIER SUBCONTRACTORS cii [g+ uaB5Ale-sdia orrTOD � Rtl erwnaaRects a AVOW* � Mu a .m. i:iso ron W.99, Bacromanto, CA 9W14 Cft-2:07F(REV0,V W$i CONTRACT NUMBER COUNTY I ROUTE POST MILES FEDERAL AID PROJECT NO. ADMINISTERING AGENCY CONTRACT COINPLETION DATE PFtWE CONTRACTOR 8USINESS ADDRESS ESTMATED CONTRACT AMOUNT $ RE M NO DESCRIPTION OF WORK PERFORMED AND IVIATERIAL PROVIDED COMPANY NAME AND BUSINESS ADDRESS DBE CERT. NUMBER CONTRACT PAYMENTS NON -DBE DBE DATEWORK COMPLETE DATE OF FINAL PAYMENT $ $ $ $ S $ S $ $ s s s OR(QfNAL COMMITMENT $ TOTAL $ $ DRE LM of FIM14lar Subcontroctors, Dosdeatagod Basln000 Entarprlsos (DBEs) ragudlos$ of Uar, whother or not to "o wore artglnaly gaud for gdai cmdii If actual USE uUihatlon (or Ram ntwork) waa dtRermA than that oppm"d atUmo of award, prorido LortmonLion back of fora. Ust actuaT amountpald to each onfll . I CERTIFY THAT THE ABOVE INFORMATION IS C2M PLETE AND CORRECT CONTRACTOR REPRESENTATIVE'S SIGNATURE BUSINESS PHONE NUMBER DATE TO THE BEST OF MY INFORMATION AND BELIEF THE ABOVE INFORMATION IS COMPLETE AND CORRECT RESIDENT ENGINEER'S SiGNATURE BUSINESS ?HONE NUMBER GATE spy nine utkn-0 I,w QwAmzLc Ortalad- Dieaiet Coneeca tku Copr Boaiaam saterImse ProFam CopT-C owutvr Copy Awdwt Ffiglneer Copy Dbtrgr kl lmea Aprrty coanam orasjaal- Dlsaic! Local Ara nice Engineer Copy- Aislriett Lanl Ausitaame t4cew Copy -Local Agency flan trvbmkud With the Repoet esvendltwe / e 1 Page 7-21 LPP-�4-02 July®1, 12 EXHIBIT 17-F Local Assistance Procedures Manual Final Report -Utilization of Disadvantaged Business Enterprises (DBE), First -Tier Subcontractors FINAL REPORT— UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES (DBE), FIRST -TIER SUBCONTRACTORS GEM 2402(F) (Rev. 02/2008) The form requires specific information regarding the construction project: Contract Number, County, Route, Post Miles, Federal -aid Project No., the Administering Agency, the Contract Completion Date and the Estimated Contract Amount. It requires the prime contractor name and business address. The focus of the form is to describe who did what by contract item number and descriptions, asking for specific dollar values of item work completed broken down by subcontractors who performed the work both DBE and non -DBE work forces. DBE prime contractors are required to show the date of work performed by their own forces along with the corresponding dollar value of work The form has a column to enter the Contract Item No. (or Item No's) and description of work performed or materials provided, as well as a column for the subcontractor name and business address. For those firms who are DBE, there is a column to enter their DBE Certification Number. The DBE should provide their certification number to the contractor and notify the contractor in writing with the date of the decertification if their status should change during the course of the project The form has six columns for the dollar value to be entered for the item work performed by the subcontractor_ The Non -DBE column is used to enter the dollar value of work performed for firms who are not certified DBE. The decision of which column to be used for entering the DBE dollar value is based on what program(s) status the firm is certified. This program status is determined by the California Unified Certification Program by ethnicity, gender, ownership, and control issues at time of certification. To confirm the certification status and program status, access the Department of Transportation Civil Rights web site at: http l(www.dotca og v/hq/bep or by calling (9I6) 324-1700 or the toll free number at (888) 810-6346. Based on this DBE Program status, the following table depicts which column to be used: DBE Program Status IColumn to be used If program status shows DBE only with no other programs listed I DBE If a contractor performing work as a DBE on the project becomes decertified and still performs work after their decertification date, enter the total dollar value performed by this contractor under the appropriate DBE identification column. If a contractor performing work as a non -DBE on the project becomes certified as a DBE, enter the dollar value of all work performed after certification as a DBE under the appropriate identification column. Enter the total of each of the six columns in Form CEM-2402(F). Any changes to DBE certification must also be submitted on Form-CEM 2403(F). Enter the Date Work Completed as well as the Date of Final Payment (the date when the prime contractor made the "final payment" to the subcontractor for the portion of work listed as being completed). The contractor and the resident engineer sign and date the form indicating that the information provided is complete and correct l Page 17- July 1, 2 2 LPP 09-02 Local Assistance Procedures Manual EX LBIT Bidder's List of Subcontractors (DBE and Nan BIDDER'S LIST OF SUBCONTRACTORS (DBE and NON -OBE)- PART The bidder shall list all subcontractors (both DBE and non•DBE) in accordance with Section 2-1.054 of the Stanftd Specifications and per Title 49, Section 26.11 of the Cod of Federal Regulations, This listing is required in addition to listing DBn Subcontractors elsewhere in the proposal. Photocopy this farm for additional firms. _ Firm Name/; " Address! - .. City, State, ZIP ... _ _ P.hauel . NFL Grass:: -Recei� is .. : Description of Portion a[ W_ or%to be Performed ..n• F. u se•. Name Phone L I<si maiian I/Ms 1W DBB #. �r fy <$5 mslllan ddrlress < S10 million Fax <515 million Age of Funs (Yrz.) CftyMafe ZrP U, $15 ME= Noma Pharos u<SIMAlion <S5milliou rlddrnra 0<510miffiun YYES fig DBE k Fax Phom 015 million CaySrafe W Naana E>Wmiffiw Age of Firm (Yrs.) Il P8S fist ABFS #: i El <$1 million $5 miflion Addrew <$10 nuiiiou Fax <£rl5 ml0ion City Stare ZIP ©T S15 million Agc of Firm (Yrs.) Nance Phor,c LJ < V milllon ;• 4 wylelll ° <SS ALlllou Addrrer 010 million f Y5S TrarDl38 #: Fax < S15 mlllian City Scare 71P Sly million L 5 " C. �• �° � _ �Pl: • �x Via;. Distribntlon:l) Original • L,ocal Agency File _ Pxgc 1 111 LPP 06-06 November 14, 2006 9 0 EXHIBIT 12-G Local Assistance Procedures Bidder's List of Subcontractors (DBE and ]'ion -DBE) BIDDER'S LIST OF SUBCONTRACTORS [OBE and NON -DBE)- PART fl 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 w Title 49. Section 26 of the Code of Federal Rexulations. Photoconv this form for additional firms. 11 91 r r 7 1 I 1 1 Y,tta��"r'� ! A 1 r! 1 1 ! 1 1 A! i f 6 � ( ,&p .�"'1ki T �( . Yr Y F>t S h3 ltiE MUM w s� A, TEL zv VA ME TO .:. C ♦�� Cs Y Distriba0on:1)Ori&mi— Local Agen yFile Page 12-112 November 14Y 2006 LPP Local Assistance Procedures Manual EXHIBIT 7-0 Disadvanta ed Business Enter rises (DI3E) Certification Status Chi e EX13i13I1' 17-0 DISADVANTAGED BUSINESS ENTERPRISES (XIBE+) CERTIFICATION STATUS C11A.NGE STATE OF CALIFORNIA — DEPARTMENTOF TRANSPORTATION CF-CEM-UO3M (New.10199) CONPRACTNUMBER COUNIT ROUTE POSTNULE3 ADMINISTERING AGENCY CONTRACTCOMPLETIONDATS PRIME CONTRACTOR BUSINESS ADDRESS ESTIMATED CONTRACTAMOUNT Prim Canrrador. List allDBEs rvlrh chatiges in cergficadon statue (eertifte&decerilflq while to your enTloy, whedser or notf rms were orlgbwUy listed forgood ereddil. Attach DBE etrt fa erdfon/Aeeert{(t[anon leo°er to accordance with the edal Provisions CONTRACT ITEM N@. SUBCONTRACTNAMBAND BUSINESS ADDRESS BUSINESS PHONE CERTIFICATION NUMBER AMOUNTPATD WHILE CERTIFIED DECBRTIPIC DATE Letter a 710N t S S E S S T S 5 Camn=ts: t CER'IW TftT nM ABOVE A4,1' MUT(ON IS COMPLETE AND CORRECT CONTRACfORREPRESENTATIVE SIGNATURE TITLE I I BVSINL+SSPHONENUNBER DATE TO TZM BEST OF M Y KNOWLEDGE, THE ABOVE INFOB.lMTION IS MPLETE AND CORRJECr RESIBfiNT EN024UR BUSINESS PHONE N[IM9ER VATS Distrlhntiatt Original oopy -DLAE Copy -I}Business Enterprise Program I) Prime Contactor 3) Local Agency 4) Resident Engineer 1 LPP I1-05 1:2 Page 7-43 December 12, 1011 0 EXHIBIT 17-0 Local Assistance Procedures Manual Disadvantaged Business Enterprises (DBE) Certification Status Change Form CP-CEM 2403 (F) (New 10/99) DISADVANTAGED BUSINESS ENTERPRISES (DBE) CHANGE IN CERTIFICATION STATUS REPORT The top of the form requires specific information regarding the construction project: Contract Number, County, Route, Post Miles, the Administering Agency, the Contract Completion Date, and the Estimated Contract Amount. It requires the Prime Contractor's name and Business Address. The focus of the form is to substantiate and verify the actual DBE dollar amount paid to contractors on federally funded projects that had a changed in Certification status during the course of the completion of the contract. The two situations that are being addressed by CP-CEM 2403 (F) are, if a firm certified as a DBE and doing work on the contract during the course of the project becomes Decertified, and if a non -DBE f rra doing work on the contract during the course of the project becomes Certified as a DBE. The form has a column to enter the Contract Item No (or Item Nos.) as well as a column for the Subcontractor's Name, Business Address, Business Phone, and contractor's Certification Number. The column entitled Amount Paid While Certified will be used to enter the actual dollar value of the work performed by those contractors who meet the conditions as outlined above during the time period they are Certified as a DBE. This column on the CP-CEM-2403(F) should only reflect the dollar value of work performed while the firm was Certified as a DBE. The column called Certification/Decertification Date (Letter attached) will reflect either the date of the Decertification Letter sent out by the Civil Rights Program or the date of the Certification Certificate mailed out by the Civil Rights Program. There is a box to check that support documentation is attached to the CP-CEM-2403 (F) form. There is a Comments section for any additional information that may need to be provided regarding any of the above transactions. The CEM-2403(F) has an area at the bottom where the Contractor and the Resident Engineer sign and date that the information provided is complete and correct. There is a Comments section for any additional information that may need to be provided regarding any of the above transactions. The CEM-2403(f) has an area at the bottom where the Contractor and the Resident Engineer sign and date that the information provided is complete and correct. Page 17-44 July 21, 2006 LPP 06-03 KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and ALLEGHENY CASUALTY COMPANY a corporation organized and existing under the laws of the State of New Jersey, having their principal office in the City of Newark, New Jersey, do hereby constitute and appoint V KEVIN E. VEGA, BRITTON CHRISTIANSEN, PHILIP E. VEGA, MYRNA SMITH Covina, CA. their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 20th day of July, 2010 and by the Board of Directors of ALLEGHENY CASUALTY COMPANY at a meeting duly held on the 10th day of July, 2015: "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Vice President or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as .defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any, such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and attested these presents on this 31st day of December, 2016. STATE OF NEW JERSEY rXSUALpy � County of Essex 1936 z< George R. James Executive Vice President (International Fidelity y JERs�y Insurance Company) and Vice President (Allegheny Casualty Company) On this 31 st day of December 2016, before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. `,,air uur prier SSW :0 NOTARY �. -f PUDLIC -0j 'p,'9�, �••�'IF2a'9. C., OFNEW� �1" %%% IN TESTIMONY WHEREOF, I have hereunto set m hand affixed my Official Seal, at the City of Newark, New Jersey the day and year first above written. V A NOTARY PUBLIC OF NEW JERSEY My Commission Expires April 16, 2019 """"" CERTIFICATION 1, the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. IN TESTIMONY WHEREOF, I have hereunto set my hand this / 7,et day of AC4 y 1-6 �Jf I4' `City of Huntington Beach Public Works Department 2000 Main Street Tel, (714) 536-5431, Fax (714) 374-1573 For Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue — CC 1465 HSIPL5181(178) August 11, 2017 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES. The Federal Labor Rates contained in Appendix I of the specifications for the: Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue - CC1465 HSIPL5181(178) shall be replaced with the following attached documents: The Federal Labor Rates dated August 4, 2017 shall be the labor rates in effect for the subject project. 2) PAGE C-1 — SECTION 3 — PROPOSAL The following sentence shall be inserted at the end of the first paragraph: The undeMkjowd Acknowledges that the issuance of Notice to Proceed will occur approximately three months after tt""rd of contract to allow procurement time for the city furnished equipment. STREET This i§tt$9&Sow�cfgjjEweipt and review of Addendum Number O e, dated August 11, 2017. RIVERSIDE, -1. , . T; 051.710.1000 F:951.710.1006 ESI Company Name y VM Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. de McRae Should you have any questions regarding this Addendum, please call William F. Janusz at (714) 536-5431. 8/11/2017 https:flwww,wdol.gov/wdol/scafiles/davi sbacon/CA35.dvb?v=12 General Decision Number: CA170035 08/04/2017 CA35 Superseded General Decision Number: CA20160035 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 Note: Under Executive Order (EO) 13658, an hourly minimum wage of $10.20 for calendar year 2017 applies to all contracts subject to the Davis -Bacon Act for which the contract is awarded (and any solicitation was issued) on or after January 1, 2015. If this contract is covered by the EO, the contractor must pay all workers in any classification listed on this wage determination at least $10.20 (or the applicable wage rate listed on this wage determination, if it is higher) for all hours spent performing on the contract in calendar year 2017. The EO minimum wage rate will be adjusted annually. Additional information on contractor requirements and worker protections under the EO is available at www.dol.gov/whd/govcontracts. Modification Number 0 1 2 3 4 5 6 7 8 9 10 11 12 ASBE0005-002 07/04/2016 Publication Date 01/06/2017 01/20/2017 01/27/2017 02/17/2017 03/10/2017 03/31/2017 05/12/2017 05/26/2017 06/02/2017 07/07/2017 07/14/2017 07/28/2017 08/04/2017 Rates Fringes Asbestos Workers/Insulator (Includes the application of all insulating materials, protective coverings, coatings, and finishes to all types of mechanical systems).....$ 38.37 20.13 Fire Stop Technician (Application of Firestopping Materials for wall openings and penetrations in walls, floors, ceilings and curtain walls) ...........................$ 26.15 17.31 ASBE0005-004 07/04/2016 https://www.wdol.gov/wdol/scafiles/davisbacon/CA35.dvb?v=12 1124 8/11/2017 hftps:/ANww.wdol.gov/wdol,iscafl Ies1davisbacoNCA35.dvb?v=12 Rates Fringes 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) .... $ 18.38 10.82 * BRCA0004-010 05/01/2017 Rates Fringes BRICKLAYER; MARBLE SETTER ........ $ 39.13 15.11 *The wage scale for prevailing wage projects performed in Blythe, China lake, Death Valley, Fort Irwin, Twenty -Nine Palms, Needles and 1-15 corridor (Barstow to the Nevada State Line) will be Three Dollars ($3.00) above the standard San Bernardino/Riverside County hourly wage rate ---------------------------------------------------------------- BRCA0018-004 06/01/2016 Rates Fringes MARBLE FINISHER ..................$ 29.20 12.93 TILE FINISHER ....................$ 24.53 11.08 TILE LAYER .......................$ 35,89 16.24 ---------------------------------------------------------------- BRCA0018-010 09/01/2016 Rates Fringes TERRAZZO FINISHER ................$ 28.53 12.27 TERRAZZO WORKER/SETTER ........... $ 35.57 13.14 ---------------------------------------------------------------- CARP0409-001 07/01/2016 Rates Fringes CARPENTER (1) Carpenter, Cabinet Installer, Insulation Installer, Hardwood Floor Worker and acoustical installer ...................$ 39.83 15.50 (2) Millwright ..............$ 40.90 15.50 (3) Piledrivermen/Derrick Bargeman, Bridge or Dock Carpenter, Heavy Framer, Rock Bargeman or Scowman, Rockslinger, Shingler (Commercial) ................$ 40.53 15.50 (4) pneumatic Nailer, Power Stapler ...............$ 40.09 15.50 (5) Saw -Filer ...............$ 39.83 15.50 (6) Scaffold Builder ....... $ 31.60 15.50 (7) Table Power Saw Operator ....................$ 40.93 15.50 https://www,wdol.gov/wdol/scafiiles/davi sbacon/CA35.dvb?v=12 2124 B/11/2017 https://www.wdol.govtwdol/scafiles/davisbacon/CA35.dvb?v=12 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 07/01/2015 Rates Fringes Drywall DRYWALL INSTALLER/LATHER .... $ 40.40 15.03 STOCKER/SCRAPPER ............ $ 10.00 7.17 ---------------------------------------------------------------- CARP0409-008 08/01/2010 Rates Fringes Modular Furniture Installer ...... $ 17.00 7.41 ---------------------------------------------------------------- * ELEC0011-002 07/31/2017 COMMUNICATIONS AND SYSTEMS WORK Rates Fringes Communications System Installer ...................$ 30.73 14.00 Technician ..................$ 32.18 3%+27.32 SCOPE OF WORK: Installation, testing, service and maintenance of systems utilizing the transmission and/or transference of voice, sound, vision and digital for commercial, educational, security and entertainment purposes for the following: TV monitoring and surveillance, background -foreground music, intercom and telephone interconnect, inventory control systems, microwave transmission, multi -media, multiplex, nurse call systems, radio page, school intercom and sound, burglar alarms, fire alarm (see last paragraph below) and low voltage master clock systems in commercial buildings. Communication Systems that transmit or receive information and/or control systems that are intrinsic to the above listed systems; inclusion or exclusion of terminations and testings of conductors determined by their function; excluding all other data systems or multiple systems which include control function or power supply; excluding installation of raceway systems, conduit systems, line voltage work, and energy management systems. Does not cover work performed at China Lake Naval Ordnance Test Station. Fire alarm work shall be performed at the current inside wireman total cost package. ---------------------------------------------------------------- ELEC0441-001 02/27/2017 Rates Fringes CABLE SPLICER ....................$ 44.20 18.83 ELECTRICIAN ......................$ 42.26 18.77 ---------------------------------------------------------------- * ELEC0441-003 12/26/2016 https://www,wdol.gov/wdol/scafiles/davisbacorVCA35.dvb?v=12 3/24 8/11/2017 hftps://www.wdol.gov/wdol/scafiles/davi sbacorJCA35.dvb?v=12 COMMUNICATIONS & SYSTEMS WORK (excludes any work on Intelligent Transportation Systems or CCTV highway systems) Rates Fringes Communications System Installer ...................$ 32.50 12.64 Technician ..................$ 31.23 15.39 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 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 02/27/2017 Rates Fringes https:ilvvww.wdol.govlwdol/scafi les/davisbacotVCA35,dvb?v=12 4/24 8/11/2017 https:/Ywww.wcd.gov/Wdol/scafilesldavisbacorYCA35.dvb?v= 12 ELECTRICIAN (TRANSPORTATION SYSTEMS, TRAFFIC SIGNALS & STREET LIGHTING) Cable Splicer/Fiber Optic Splicer .....................$ 44.20 18.83 Electrician .................$ 42.26 18.77 Technician ..................$ 31.76 16.75 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 TRANSPDRTATION ELECTRICIAN shall perform all tasks necessary toinstall the complete transportation system. JOURNEYMAN TECHNICIAN duties shall consist of: Distribution of material at job site, manual excavation and backfill, installation of system conduits and raceways for electrical, telephone, cable television and comnmunication systems. Pulling, terminating and splicing of traffic signal and street lighting conductors and electrical systems including interconnect, dector loop, fiber optic cable and video/data. * ELEC1245-001 06/01/2017 Rates Fringes LINE CONSTRUCTION (1) Lineman; Cable splicer..$ 55.49 3%+17.65 (2) Equipment specialist (operates crawler tractors, commercial motor vehicles, backhoes, trenchers, cranes (50 tons and below), overhead & underground distribution line equipment) ........... $ 44.32 3%+17.65 (3) Groundman...............$ 33.89 3%+17.65 (4) Powderman...............$ 49.55 3%+17.65 HOLIDAYS: New Year's Day, M.L. King Day, Memorial Day, https://www.wdol.gov/wdol/scarles/davisbacorVCA35.dvb?v=12 524 8/11 /2017 https://www.wdol.gov/wdol/scaftiies/davi sbacon/CA35.dvb?v=12 Independence Day, Labor Day, Veterans Day, Thanksgiving Day and day after Thanksgiving, Christmas Day ---------------------------------------------------------------- ELEV0018-001 01/01/2017 Rates Fringes ELEVATOR MECHANIC ................$ 52.21 31.585 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. ---------------------------------------------------------------- ENGI0012-003 07/01/2016 Rates Fringes OPERATOR: Power Equipment (All Other work) GROUP 1....................$ 39.95 23.35 GROUP 2....................$ 40.73 23.35 GROUP 3....................$ 41.02 23.35 GROUP 4....................$ 42.51 23.35 GROUP 5....................$ 41.86 23.35 GROUP 6....................$ 41.83 23.35 GROUP 8....................$ 42.84 23.35 GROUP 9....................$ 42.19 23.35 GROUP 10....................$ 42.96 23.35 GROUP 11....................$ 42.31 23.35 GROUP 12....................$ 43.13 23.35 GROUP 13....................$ 43.23 23.35 GROUP 14....................$ 43.26 23.35 GROUP 15....................$ 43.34 23.35 GROUP 16....................$ 43.46 23.35 GROUP 17....................$ 43.63 23.35 GROUP 18..... ............... $ 43.73 23.35 GROUP 19....................$ 43.84 23.35 GROUP 20....................$ 43.96 23.35 GROUP 21....................$ 44.13 23.35 GROUP 22....................$ 44.23 23.35 GROUP 23....................$ 44.34 23.35 GROUP 24....................$ 44.46 23.35 GROUP 25....................$ 44.63 23.35 OPERATOR: Power Equipment (Cranes, Piledriving & Hoisting) GROUP 1....................$ 43.20 22.15 GROUP 2....................$ 43.98 22.15 GROUP 3....................$ 44.27 22.15 GROUP 4....................$ 44.41 22.15 GROUP 5....................$ 44.63 22.15 GROUP 6....................$ 44.74 22.15 GROUP 7....................$ 44.86 22.15 GROUP 8....................$ 45.03 22.15 GROUP 9....................$ 45.20 22.15 GROUP 10....................$ 46.20 22.15 GROUP 11....................$ 47.20 22.15 GROUP 12....................$ 48.20 22.15 GROUP 13....................$ 49.20 22.15 hftps://www.wdol.gov,fwdol/scafiles/davisbacorVCA35.dvb?v=12 6/24 8/11/2017 hrips://www.wdol.gov/wdol/scafilesidavisbacor�CA35.dvb?v=12 OPERATOR: Power Equipment (Tunnel Work) GROUP 1....................$ GROUP 2....................$ GROUP 3....................$ GROUP 4....................$ GROUP 5....................$ GROUP 6....................$ GROUP 7....................$ 41.80 23.35 42.58 23.35 42.87 23.35 43.01 23.35 43.23 23.35 43.34 23.35 43.46 23.35 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 GROUP 2: Asphalt -rubber plant operator (nurse tank operator); Concrete mixer operator -skip type; Conveyor operator; Fireman; Forklift operator (includes loed, lull or similar types over 5 tons; Hydrostatic pump operator; oiler crusher (asphalt or concrete plant); Petromat laydown machine; P)U side dum jack; Screening and conveyor machine operator (or similar types); Skiploader (wheel type up to 3/4 yd. without attachment); Tar pot fireman; Temporary heating plant operator; Trenching machine oiler GROUP 3: Asphalt -rubber blend operator; Bobcat or similar type (Skid steer); Equipment greaser (rack); Ford Ferguson (with dragtype attachments); Helicopter radioman (ground); Stationary pipe wrapping and cleaning machine operator GROUP 4: Asphalt plant fireman; Backhoe operator (mini -max or similar type); Boring machine operator; Boxman or mixerman (asphalt or concrete); Chip spreading machine operator; Concrete cleaning decontamination machine operator; Concrete Pump Operator (small portable); Drilling machine operator, small auger types (Texoma super economatic or similar types - Hughes 100 or 200 or similar types - drilling depth of 30' maximum); Equipment greaser (grease truck); Guard rail post driver operator; Highline cableway 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 (up to 6 ft.); Vacuum or much truck https://www.wdol.gov/wdol/scafiiesldavisbacon/CA35.dvb?v=12 7124 8/11/2017 https://www.wdol.govi�Adol/scafiies/davisbacotvCA35.dvb?v= 12 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 330, 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-7ohnson-Bidwell or similar); Micro tunnel system (below ground); Pavement breaker operator (truck mounted); Road oil mixing machine operator; Roller operator (asphalt or finish), rubber -tired earth moving equipment (single engine, up to and including 25 yds. struck); Self-propelled tar pipelining machine operator; Skiploader operator (crawler and wheel type, over 3/4 yd. and up to and including 1-1/2 yds.); Slip form pump operator (power driven hydraulic lifting device for concrete forms); Tractor operator -bulldozer, tamper -scraper (single engine, up to 100 h.p. flywheel and similar types, up to and including D-5 and similar types); Tugger hoist operator (1 drum); Ultra high pressure waterjet cutting tool system operator; Vacuum blasting machine operator GROUP 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 unit); Self- propelled curb and gutter machine operator; Shuttle buggy; Skiploader operator (crawler and wheel type over 1-1/2 yds. up to and including 6-1/2 yds.); Soil remediation plant operator; Surface heaters and planer operator; Tractor https://www.wdol.gov/wdolJscafiles/davisbacordCA35.dvb?v=12 8124 8/11/2017 https://www,wdol.gov/wdol/scafi I es/davisbacorVCA35.dvb?v= 12 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 equipment operator (multiple engine, Euclid, caterpillar and similar over 25 yds. and up to 50 yds, struck), Tower crane repairman; Tractor loader operator (crawler and wheel type over 6-1/2 yds.); Woods mixer operator (and similar Pugmill equipment) GROUP 11: Heavy Duty Repairman - Welder Combination, Welder - Certified. GROUP 12: Auto grader operator; Automatic slip form operator; Drilling machine operator, bucket or auger types (Calweld, auger 200 CA or similar types - Watson, auger 6000 or similar types - Hughes Super Duty, auger 200 or similar types - drilling depth of 175' maximum); Hoe ram or similar with compressor; Mass excavator operator less tha 750 cu. yards; Mechanical finishing machine operator; Mobile form traveler operator; Motor patrol operator (multi -engine); Pipe mobile machine operator; Rubber -tired earth- moving equipment operator (multiple engine, Euclid, Caterpillar 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) https://www.wdol.govlvdol/scafiles/davisbacon/CA35.dvb?v=12 9124 8/11/2017 h#ps://www.wdol.gov/wdollscafiles/davisbaconiCA35.dvb?v=12 GROUP 16: Rubber -tired earth -moving equipment operator, operating equipment with push-pull system (single engine, over 50 yds. struck); Rubber -tired earth -moving equipment operator, operating equipment with push-pull system (multiple engine, Euclid, Caterpillar and similar, over 25 yds. and up to 50 yds. struck) GROUP 17: Rubber -tired earth -moving equipment operator, operating equipment with push-pull system (multiple engine, Euclid, Caterpillar and similar, over 50 cu. yds. struck); Tandem tractor operator (operating crawler type tractors in tandem - Quad 9 and similar type) GROUP 18: Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps and similar types in any combination, excluding compaction units - single engine, up to and including 25 yds. struck) GROUP 19: Rotex concrete belt operator (or similar types); Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps and similar types in any combination, excluding compaction units - single engine, Caterpillar, Euclid, Athey Wagon and similar types with any and all attachments over 25 yds.and up to and including 50 cu. yds. struck); Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps and similar types in any combination, excluding compaction units - multiple engine, up to and including 25 yds. struck) GROUP 20: Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps and similar types in any combination, excluding compaction units - single engine, over 50 yds. struck); Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps, and similar types in any combination, excluding compaction units - multiple engine, Euclid, Caterpillar and similar, over 25 yds. and up to 50 yds. struck) GROUP 21: Rubber -tired earth -moving equipment operator, operating in tandem (scrapers, belly dumps and similar types in any combination, excluding compaction units - multiple engine, Euclid, Caterpillar and similar type, over 50 cu. yds. struck) GROUP 22: Rubber -tired earth -moving equipment operator, operating equipment with the tandem push-pull system (single engine, up to and including 25 yds. struck) GROUP 23: Rubber -tired earth -moving equipment operator, operating equipment with the tandem push-pull system (single engine, Caterpillar, Euclid, Athey Wagon and similar types with any and all attachments over 25 yds. and up to and including 50 yds. struck); Rubber -tired earth -moving equipment operator, operating with the tandem push-pull system (multiple engine, up to and including 25 yds. struck) GROUP 24: Rubber -tired earth -moving equipment operator, operating equipment with the tandem push-pull system (single engine, over 50 yds. struck); Rubber -tired earth -moving equipment operator, operating equipment with the tandem push-pull system (multiple engine, Euclid, Caterpillar and similar, over 25 yds. and up to 50 yds. https://www.wdol.gov/wdol/scafiles/davisbaDarVCA35,dvb?v= 12 10124 8/11/2017 https://www,wdol,gov/wdol/soafi les/davi sbacon/CA35.dvb?v=12 struck) GROUP 25: Concrete pump operator -truck mounted; Rubber -tired earth -moving equipment operator, operating equipment with the tandem push-pull system (multiple engine, Euclid, Caterpillar and similar type, over 50 cu. yds. struck) CRANES, PILEDRIVING AND HOISTING EQUIPMENT CLASSIFICATIONS GROUP 1: Engineer oiler; Fork lift operator (includes loed, lull or similar types) GROUP 2: Truck crane oiler GROUP 3: A -frame or winch truck operator; Ross carrier operator (jobsite) GROUP 4: Bridge -type unloader and turntable operator; Helicopter hoist operator GROUP 5: Hydraulic boom truck; Stinger crane (Austin -Western or similar type); Tugger hoist operator (1 drum) GROUP b: 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 50 tons mrc); Highline cableway operator; Hoist operator, stiff legs, Guy derrick or similar type (over 25 tons up to and including 50 tons mrc); K-crane operator; Polar crane operator; Self erecting tower crane operator maximum lifting capacity ten tons GROUP 10: Crane operator (over 50 tons and up to and including 100 tons mrc); Derrick barge operator (over 50 tons up to and including 100 tons mrc); Hoist operator, stiff legs, Guy derrick or similar type (over 50 tons up to and including 100 tons mrc), Mobile tower crane operator (over 50 tons, up to and including 100 tons M.R.C.); Tower crane operator and tower gantry GROUP 11: Crane operator (over 100 tons and up to and including 200 tons mrc); Derrick barge operator (over 100 tons up to and including 200 tons mrc); Hoist operator, stiff legs, Guy derrick or similar type (over 100 tons up to and including 200 tons mrc); Mobile tower crane operator (over 100 tons up to and including 200 tons mrc) https:llwww.wdol.gov/v✓dollscafiles/davisbacotVCA35.dvb?v=12 11124 8/11/2017 https://www,wdol.gov/wdollsoafiles/davisbacon/CA35.dvb?v=12 GROUP 12: Crane operator (over 200 tons up to and including 300 tons mrc); Derrick barge operator (over 200 tons up to and including 300 tons mrc); Hoist operator, stiff legs, Guy derrick or similar type (over 200 tons, up to and including 300 tons mrc); Mobile tower crane operator (over 200 tons, up to and including 300 tons mrc) GROUP 13: Crane operator (over 300 tons); Derrick barge operator (over 300 tons); Helicopter pilot; Hoist operator, stiff legs, Guy derrick or similar type (over 300 tons); Mobile tower crane operator (over 300 tons) TUNNEL CLASSIFICATIONS GROUP 1: Skiploader (wheel type up to 3/4 yd. without attachment) GROUP 2: Power -driven jumbo form setter operator GROUP 3: Dinkey locomotive or motorperson (up to and including 10 tons) GROUP 4: Bit sharpener; Equipment greaser (grease truck); Slip form pump operator (power -driven hydraulic lifting device for concrete forms); Tugger hoist operator (1 drum); Tunnel locomotive operator (over 10 and up to and including 30 tons) GROUP 5: Backhoe operator (up to and including 3/4 yd.); Small Ford, Case or similar; Drill doctor; Grouting machine operator; Heading shield operator; Heavy-duty repairperson; Loader operator (Athey, Euclid, Sierra and similar types); Mucking machine operator (1/4 yd., rubber -tired, rail or track type); Pneumatic concrete placing machine operator (Hackley-Presswell or similar type); Pneumatic heading shield (tunnel); Pumperete gun operator; Tractor compressor drill combination operator; Tugger hoist operator (2 drum); Tunnel locomotive operator (over 30 tons) GROUP 6: Heavy Duty Repairman GROUP 7: Tunnel mole boring machine operator ENGINEERS ZONES $1.00 additional per hour for all of IMPERIAL County and the portions of KERN, RIVERSIDE & SAN BERNARDINO Counties as defined below: That area within the following Boundary: Begin in San Bernardino County, approximately 3 miles NE of the intersection of I-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 W 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, R37E, MDM. Continue W along the Kern and Tulare County https://www.wdol,govlwdoi/scafiles/davisbaco,-i/CA35.dvb?v= 12 12/24 8/11 /2017 https:/Iwww.wdol.gov/wdol/scafilesidavisbacon/CA35.dvb?v=12 boundary, until that point which is the NW corner of T25S, R32E, MDM. Continue S following R32E lines to the NW corner of T31S, R32E, MDM. Continue W to the NW corner of T31S, R31E, MDM. Continue S to the SW corner of T32S, R31E, MDM. Continue W to SW corner of SE quarter of Section 34, T32S, R30E, MDM. Continue S to SW corner of T11N, R17W, SBM. Continue E along south boundary of T11N, SBM to SW corner of T11N, R7W, SBM. Continue S to SW corner of T9N, R7W, SBM. Continue E along south boundary of T9N, SBM to SW corner of T9N, R1E, SBM. Continue S along west boundary of R1E, SMB to Riverside County line at the SW corner of T1S, R1E, SBM. Continue E along south boundary of Tls, SBM (Riverside County Line) to SW corner of T1S, R10E, SBM. Continue S along west boundary of R10E, SBM to Imperial County line at the SW corner of TSS, R10E, SBM. Continue W along Imperial and Riverside county line to NW corner of T9S, R9E, SBM. Continue S along the boundary between Imperial and San Diego Counties, along the west edge of R9E, SBM to the south boundary of Imperial County/California state line. Follow the California state line west to Arizona state line, then north to Nevada state line, then continuing NW back to start at the point which is the NW corner of Section 1, T17N, R14E, SBM $1.00 additional per hour for portions of SAN LUIS OBISPO, KERN, SANTA BARBARA & VENTURA as defined below: 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 5AN BERNARDINO County as defined below: That area within the following Boundary: Begin at the intersection of the northern boundary of Mono County and the https://www.wdol.govlwdol/scafiles/davisbacontCA35.dvb7v= 12 13/24 8/11/2017 https://www,wdol.govtwdol/scan es/davisbacorVCA35.dvb?v=12 California state line at the point which is the center of Section 17, T10N, R22E, Mt. Diablo Meridian. Continue S then SE along the entire western boundary of Mono County, until it reaches Inyo County at the point which is the NE corner of the Western half of the NW quarter of Section 2, 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 NW quarter of Section 6, T25S, R42E, MDM. Continue S to that point which is the SW corner of the NW quarter of Section 6, T27S, R42E, MDM. Continue E in a straight line to the California and Nevada state border at the point which is the NW corner of Section 1, T17N, R14E, San Bernardino Meridian. Then continue NW along the state line to the starting point, which is the center of Section 18, T10N, R22E, MDM. REMAINING AREA NOT DEFINED ABOVE RECIEVES BASE RATE ---------------------------------------------------------------- ENGIO012-004 08/01/2015 Rates Fringes OPERATOR: Power Equipment (DREDGING) (1) Leverman........... I .... $ 49.50 23.60 (2) Dredge dozer ............ $ 43.53 23.60 (3) Deckmate................$ 43.42 23.60 (4) Winch operator (stern winch on dredge) ............ $ 42.87 23.60 (5) Fireman -Oiler, Deckhand, Bargeman, Leveehand...................$ 42.33 23.60 (6) Barge Mate ..............$ 42.94 23.60 IRON0377-002 07/01/2016 Rates Fringes Ironworkers: Fence Erector ...............$ 28.33 20.64 Ornamental, Reinforcing and Structural ..............$ 34.75 29.20 PREMIUM PAY: $6.00 additional per hour at the following locations: China Lake Naval Test Station, Chocolate Mountains Naval Reserve-Niland, Edwards AFB, Fort Irwin Military Station, Fort Irwin Training Center -Goldstone, San Clemente Island, San Nicholas Island, Susanville Federal Prison, 29 Palms - Marine Corps, U.S. Marine Base - Barstow, U.S. Naval Air Facility - Sealey, Vandenberg AFB $4.00 additional per hour at the following locations: Army Defense Language Institute - Monterey, Fallon Air Base, Naval Post Graduate School - Monterey, Yermo Marine Corps https://www,w dol.govtwdol/scafil es/davi sbacon/CA35.dvb?v=12 14/24 8/1112017 https://www.wdol.govlwdol/scafiles/davisbacorVCA35.dvb?v=12 Logistics Center $2.00 additional per hour at the following locations: Port Hueneme, Port Mugu, U.S. Coast Guard Station - Two Rock ---------------------------------------------------------------- LAB00300-005 01/01/2017 Rates Fringes Asbestos Removal Laborer ......... $ 31.88 16.82 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. ---------------------------------------------------------------- LAB00345-001 07/02/2017 Rates Fringes LABORER (GUNITE) GROUP 1.....................$ 41.08 17.39 GROUP 2.....................$ 40.13 17.39 GROUP 3.....................$ 36.59 17.39 FOOTNOTE: GUNITE PREMIUM PAY: Workers working from a Bosn'n's Chair or suspended from a rope or cable shall receive 40 cents per hour above the foregoing applicable classification rates. Workers doing gunite and/or shotcrete work in a tunnel shall receive 35 cents per hour above the foregoing applicable classification rates, paid on a portal-to-portal basis. Any work performed on, in or above any smoke stack, silo, storage elevator or similar type of structure, when such structure is in excess of 75'-0" above base level and which work must be performed in whole or in part more than 75'-0" above base level, that work performed above the 75'-0" level shall be compensated for at 35 cents per hour above the applicable classification wage rate. GUNITE LABORER CLASSIFICATIONS GROUP 1: Rodmen, Nozzlemen GROUP 2: Gunmen GROUP 3: Reboundmen ---------------------------------------------------------------- LAB00652-001 07/03/2017 Rates Fringes LABORER (TUNNEL) GROUP 1.....................$ 39.04 18.24 GROUP 2.....................$ 39.36 18.24 GROUP 3.....................$ 39.82 18.24 GROUP 4.....................$ 40.51 18.24 https://www.wdol.gov/wdol/scafi I es/davi sbaconlCA35.dvb7v=12 15/24 a/11/2017 https:ltwww.wdol.gov/wdol/scafiles/davisbacorVCA35.dvb?v=12 LABORER GROUP 1.....................$ 32.34 19.07 GROUP 2.....................$ 32.89 19.07 GROUP 3.....................$ 33.44 19.07 GROUP 4.....................$ 34.99 19.07 GROUP 5.....................$ 35.34 19.07 LABORER CLASSIFICATIONS GROUP 1: Cleaning and handling of panel forms; Concrete screeding for rough strike -off; Concrete, water curing; Demolition laborer, the cleaning of brick if performed by a worker performing any other phase of demolition work, and the cleaning of lumber; Fire watcher, limber, brush loader, piler and debris handler; Flag person; Gas, oil and/or water pipeline laborer; Laborer, asphalt -rubber material loader; Laborer, general or construction; Laborer, general clean-up; Laborer, landscaping; Laborer, jetting, Laborer, temporary water and air lines; Material hose operator (walls, slabs, floors and decks); Plugging, filling of shee bolt holes; Dry packing of concrete; Railroad maintenance, repair track person and road beds; Streetcar and railroad construction track laborers; Rigging and signaling; Scaler; Slip form raiser; Tar and mortar; Tool crib or tool house laborer; Traffic control by any method; Window cleaner; Wire mesh pulling - all concrete pouring operations GROUP 2: Asphalt shoveler; Cement dumper (on 1 yd. or larger mixer and handling bulk cement); Cesspool digger and installer; Chucktender; Chute handler, pouring concrete, the handling of the chute from readymix trucks, such as walls, slabs, decks, floors, foundation, footings, curbs, gutters and sidewalks; Concrete curer, impervious membrane and form oiler; Cutting torch operator (demolition); Fine grader, highways and street paving, airport, runways and similar type heavy construction; Gas, oil and/or water pipeline wrapper - pot tender and form person; Guinea chaser; Headerboard person - asphalt; Laborer, packing rod steel and pans; Membrane vapor barrier installer; Power broom sweeper (small); Riprap stonepaver, placing stone or wet sacked concrete; Roto scraper and tiller; Sandblaster (pot tender); Septic tank digger and installer(lead); Tank scaler and cleaner; Tree climber, faller, chain saw operator, Pittsburgh chipper and similar type brush shredder; Underground laborer, including caisson bellower GROUP 3: Buggymobile person; Concrete cutting torch; Concrete pile cutter; Driller, jackhammer, 2-1/2 ft. drill steel or longer; Dri-pak-it machine; Gas, oil and/or water pipeline wrapper, 6-in, pipe and over, by any method, inside and out; High scaler (including drilling of same); Hydro seeder and similar type; Impact wrench multi -plate; Kettle person, pot person and workers applying asphalt, lay-kold, creosote, lime caustic and similar type materials ("applying" means applying, dipping, brushing or handling of such materials for pipe wrapping and waterproofing); operator of pneumatic, gas, electric tools, vibrating machine, pavement breaker, air blasting, come-alongs, and similar mechanical tools not separately classified herein; Pipelayer's backup person, coating, grouting, malting of joints, sealing, caulking, diapering and including rubber gasket joints, pointing and any and all other services; Rock slinger; Rotary scarifier or multiple head concrete chipping scarifier; Steel headerboard and guideline setter; Tamper, Barko, Wacker and similar type; Trenching machine, https://www.wdol.govlwdol/scafiles/davisbacorVCA35.dvb?v=12 16/24 8/11/2017 hand -propelled https://www.wdol,gov/wdol/scafiles/davisbacon/CA35.dvb?v=12 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 performir:g all services in the laying and installation of pipe from the point of receiving pipe in the ditch until completion of operation, including any and all forms of tubular material, whether pipe, metallic or non-metallic, conduit and any other stationary type of tubular device used for the conveying of any substance or element, whether water, sewage, solid gas, air, or other product whatsoever and without regard to the nature of material from which the tubular material is fabricated; No -joint pipe and stripping of same; Prefabricated manhole installer; Sandblaster (nozzle person), water blasting, Porta Shot -Blast GROUP 5: Blaster powder, all work of loading holes, placing and blasting of all powder and explosives of whatever type, regardless of method used for such loading and placing; Driller: All power drills, excluding jackhammer, whether core, diamond, wagon, track, multiple unit, and any and all other types of mechanical drills without regard to the form of motive power; Toxic waste removal 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 person; Grout pump person; Jackleg miner; Jumbo person; Kemper and other pneumatic concrete placer operator; Miner, tunnel (hand or machine); Nozzle person; Operating of troweling and/or grouting machines; Powder person (primer house); Primer person; Sandblaster; shotcrete person; Steel form raiser and setter; Timber person, retimber person, wood or steel; Tunnel Concrete finisher GROUP 4: Diamond driller; Sandblaster; Shaft and raise work LAB00652-003 07/01/2017 Rates Fringes Brick Tender .....................$ 31.36 17.82 ---------------------------------------------------------------- LABO1184-001 07/01/2017 https://www.wdol.govhA,dol/scafiles/davisbaco.*vCA35.dvb7v=12 17124 8/11/2017 https://www.wdol.gov/wdol/scafiles/davisbacorVCA35.dvbW=12 Rates Fringes Laborers: (HORIZONTAL DIRECTIONAL DRILLING) (1) Drilling Crew Laborer...$ 34.65 13.20 (2) Vehicle Operator/Hauler.$ 34.82 13.20 (3) Horizontal Directional Drill Operator ..............$ 36.67 13.20 (4) Electronic Tracking Locator .....................$ 38.67 13.20 Laborers: (STRIPING/SLURRY SEAL) GROUP I .....................$ 35.86 16.21 GROUP 2.....................$ 37.16 16.21 GROUP 3.....................$ 39.17 16.21 GROUP 4.....................$ 40.91 16.21 LABORERS - STRIPING CLASSIFICATIONS GROUP 1: Protective coating, pavement sealing, including repair and filling of cracks by any method on any surface in parking lots, game courts and playgrounds; carstops; operation of all related machinery and equipment; equipment repair technician GROUP 2: Traffic surface abrasive blaster; pot tender - removal of all traffic lines and markings by any method (sandblasting, waterblasting, grinding, etc.) and preparation of surface for coatings. Traffic control person: controlling and directing traffic through both conventional and moving lane closures; operation of all related machinery and equipment GROUP 3: Traffic delineating device applicator: Layout and application of pavement markers, delineating signs, rumble and traffic bars, adhesives, guide markers, other traffic delineating devices including traffic control. This category includes all traffic related surface preparation (sandblasting, waterblasting, grinding) as part of the application process. Traffic protective delineating system installer: removes, relocates, installs, permanently affixed roadside and parking delineation barricades, fencing, cable anchor, guard rail, reference signs, monument markers; operation of all related machinery and equipment; power broom sweeper GROUP 4: Striper: layout and application of traffic stripes and markings; hot thermo plastic; tape traffic stripes and markings, including traffic control; operation of all related machinery and equipment ---------------------------------------------------------------- * LABO1414-001 08/02/2017 Rates Fringes LABORER PLASTER CLEAN-UP LABORER .... $ 32.50 18.29 PLASTER TENDER ..............$ 35.05 18.29 Work on a swing stage scaffold: $1.00 per hour additional. ---------------------------------------------------------------- * PAIN0036-001 07/01/2017 Rates Fringes https:! www.wdol.gov/wool/scafiles/davisbacon'CA35.dvb?v=12 18/24 8/11/2017 https:i/www.wdol.govAvdol/scaftles/davisbacorVCA35.dvb?v=12 Painters: (Including Lead Abatement) (1) Repaint (excludes San Diego County) ...............$ 27.59 13.94 (2) All Other Work .......... $ 31.12 13.94 REPAINT of any previously painted structure. Exceptions: work involving the aerospace industry, breweries, commercial recreational facilities, hotels which operate commercial establishments as part of hotel service, and sports facilities. ---------------------------------------------------------------- PAIN0036-008 10/01/2016 Rates Fringes DRYWALL FINISHER/TAPER ........... $ 37.18 17.99 ---------------------------------------------------------------- PAIN0036-015 06/01/2016 Rates Fringes GLAZIER ..........................$ 41.70 21.13 FOOTNOTE: Additional $1.25 per hour for work in a condor, from the third (3rd) floor and up Additional $1.25 per hour for work on the outside of the building from a swing stage or any suspended contrivance, from the ground up ---------------------------------------------------------------- PAIN1247-002 05/01/2017 Rates Fringes SOFT FLOOR LAYER .................$ 32.35 14.56 ---------------------------------------------------------------- * PLAS0200-009 08/02/2017 Rates Fringes PLASTERER ........................$ 41.26 14.46 ---------------------------------------------------------------- PLAS0500-002 07/01/2016 Rates Fringes CEMENT MASON/CONCRETE FINISHER ... $ 33.30 23.33 ---------------------------------------------------------------- PLUM0016-001 07/01/2017 Rates Fringes PLUMBER/PIPEFITTER Plumber and Pipefitter 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 https://www.wdol.gov/wdol/scafiilestdavisbacon/CA35.dvb?v=12 19/24 8/11/2017 https://www.wdol.gov/wdol/scafi 1 es/davi sbaco-,VCA35.dvb?v=12 improvement and remodel work .......................$ 49.28 21.61 Work ONLY on new additions and remodeling of bars, restaurant, stores and commercial buildings not to exceed 5,000 sq. ft. of floor space .................$ 47.76 20.63 Work ONLY on strip malls, light commercial, tenant improvement and remodel work ....... ................$ 36.91 18.96 PLUM0345-001 07/01/2014 Rates Fringes PLUMBER Landscape/Irrigation Fitter.$ 29.27 19.75 Sewer & Storm Drain Work .... $ 33.24 17.13 ---------------------------------------------------------------- * ROOF0036-002 08/01/2017 Rates Fringes ROOFER ...........................$ 37.07 16.17 FOOTNOTE: Pitch premium: Work on which employees are exposed to pitch fumes or required to handle pitch, pitch base or pitch impregnated products, or any material containing coal tar pitch, the entire roofing crew shall receive $1.75 per hour "pitch premium" pay. ---------------------------------------------------------------- SFCA0669-008 04/01/2017 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 .... ............. $ 39.07 15.84 ---------------------------------------------------------------- SFCA0709-003 07/01/2015 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) .......... $ 42.93 24.04 ---------------------------------------------------------------- SHEE01OS-003 07/01/2016 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 https://www.wdol.gov/vvdol/scafiles/davisbaconICA35.dvb?v= 12 20/24 8/11/2017 https://www.wdol.gov/wdol/scafi 1es/davisbacon1CA35.dvb?v=12 SHEET METAL WORKER (1) Commercial - New Construction and Remodel work ........................$ 41.86 26.88 (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 ... $ 41.86 26.88 ---------------------------------------------------------------- TEAM0011-002 07/01/2017 Rates Fringes TRUCK DRIVER GROUP I ....................$ 29.59 27.74 GROUP 2 ....................$ 29.74 27.74 GROUP 3 ....................$ 29.87 27.74 GROUP 4 ....................$ 30.06 27.74 GROUP 5 ....................$ 30.09 27.74 GROUP 6 ....................$ 30.12 27.74 GROUP 7 ....................$ 30.37 27.74 GROUP 8 ....................$ 30.62 27.74 GROUP 9 ....................$ 30.82 27.74 GROUP 10 ....................$ 31.12 27.74 GROUP 11 ....................$ 31.62 27.74 GROUP 12 ....................$ 32.05 27.74 WORK ON ALL MILITARY BASES: PREMIUM PAY: $3.00 per hour additional. [29 palms Marine Base, Camp Roberts, China Lake, Edwards AFB, E1 Centro Naval Facility, Fort Irwin, Marine Corps Logistics Base at Nebo & Yermo, Mountain Warfare Training Center, Bridgeport, Point Arguello, Point Conception, Vandenberg AFB] TRUCK DRIVERS CLASSIFICATIONS GROUP 1: Truck driver GROUP 2: Driver of vehicle or combination of vehicles - 2 axles; Traffic control pilot car excluding moving heavy equipment permit load; Truck mounted broom GROUP 3: Driver of vehicle or combination of vehicles - 3 axles; Boot person; Cement mason distribution truck; Fuel truck driver; Water truck - 2 axle; Dump truck, less than 16 yds. water level; Erosion control driver GROUP 4: Driver of transit mix truck, under 3 yds.; Dumperete truck, less than 6-1/2 yds. water level GROUP 5: Water truck, 3 or more axles; Truck greaser and tire person ($0.50 additional for tire person); Pipeline and utility working truck driver, including winch truck and plastic fusion, limited to pipeline and utility work; slurry truck driver GROUP 6: Transit mix truck, 3 yds. or more; Dumperete truck, https:,'/www.wdol.gov/wdol/seaftiles/davisbacon/CA35.dvb?v=12 21124 8/11/2017 https://www.wdol.gov/wdol/scafiles/davisbacorVCA35.dvb?v=12 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; Ross 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 WELDERS - Receive rate prescribed for craft performing operation to which welding is incidental. Note: Executive Order (EO) 13706, Establishing Paid Sick Leave for Federal Contractors applies to all contracts subject to the Davis -Bacon Act for which the contract is awarded (and any solicitation was issued) on or after January 1, 2017. If this contract is covered by the EO, the contractor must provide employees with 1 hour of paid sick leave for every 30 hours they work, up to 56 hours of paid sick leave each year. Employees must be permitted to use paid sick leave for their own illness, injury or other health -related needs, including preventive care; to assist a family member (or person who is like family to the employee) who is ill, injured, or has other health -related needs, including preventive care; or for reasons resulting from, or to assist a family member (or person who is like family to the employee) who is a victim of, domestic violence, sexual assault, or stalking. Additional information on contractor requirements and worker protections under the EO is available at www,dol.gov/whd/govcontracts. 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 a union rate (current union negotiated rate for local), a survey rate (weighted average rate) or a union average rate (weighted union average rate). https:/rwww.wdol .gov/vvdol/scafiles/davisbaconICA35.dvbW= 12 22/24 8/11 /2017 https:/Iwww.wdol,gov/wdol/scafi I es/davisbacoNCA35.dvb?v=12 Union Rate Identifiers A four letter classification abbreviation identifier enclosed in dotted lines beginning with characters other than "SU" or "UAVG" denotes that the union classification and rate were prevailing for that classification in the survey. Example: PLUM0198-005 07/01/2014. PLUM is an abbreviation identifier of the union which prevailed in the survey for this classification, which in this example would be Plumbers. 0198 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. 07/01/2014 is the effective date of the most current negotiated rate, which in this example is July 1, 2014. Union prevailing wage rates are updated to reflect all rate changes in the collective bargaining agreement (CBA) governing this classification and rate. Survey Rate Identifiers Classifications listed under the "SU" identifier indicate that no one rate prevailed for this classification in the survey and the published rate is derived by computing a weighted average rate based on all the rates reported in the survey for that classification. As this weighted average rate includes all rates reported in the survey, it may include both union and non -union rates. Example: SULA2012-007 5/13/2014. SU indicates the rates are survey rates based on a weighted average calculation of rates and are not majority rates. LA indicates the State of Louisiana. 2012 is the year of survey on which these classifications and rates are based. The next number, 007 in the example, is an internal number used in producing the wage determination. 5/13/2014 indicates the survey completion date for the classifications and rates under that identifier. Survey wage rates are not updated and remain in effect until a new survey is conducted. Union Average Rate Identifiers Classification(s) listed under the UAVG identifier indicate that no single majority rate prevailed for those classifications; however, 100% of the data reported for the classifications was union data. EXAMPLE: UAVG-OH-0010 08/29/2014, UAVG indicates that the rate is a weighted union average rate. OH indicates the state. The next number, 0010 in the example, is an internal number used in producing the wage determination. 08/29/2014 indicates the survey completion date for the classifications and rates under that identifier. A UAVG rate will be updated once a year, usually in January of each year, to reflect a weighted average of the current negotiated/CBA rate of the union locals from which the rate is based. WAGE DETERMINATION APPEALS PROCESS 1.) Has there been an initial decision in the matter? This can be: https:/Jwww.wdol.gov/wdol/scaflles/davisbacon/CA35.dvb?v= 12 23/24 8/11/2017 https.1/www.wdol.govlwdol/scafiles/davisbaco,VCA35.dvb?v=12 * 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 CFR Part 1.8 and 29 CFR Part 7). Write to: Wage and Hour Administrator U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 The request should be accompanied by a full statement of the interested party's position and by any information (wage payment data, project description, area practice material, etc.) that the requestor considers relevant to the issue. 3.) If the decision of the Administrator is not favorable, an interested party may appeal directly to the Administrative Review Board (formerly the Wage Appeals Board). Write to: Administrative Review Board U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 4.) All decisions by the Administrative Review Board are final. END OF GENERAL DECISION https:Gwww.wdol.gov/wdollscafil es/davis baCon/CA35.dvb?v=12 24/24 CERT[FICATE OF CORPORATE RESOW"rioN I Bri an I'endoza ; Secretary of p T M General Engineering Service 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 (),ear), 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 zuthcrized to sign & er_ecute 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 Mendoza de 14c.ae, --e_idenc/CF0 ..... OR .... S__an Miendoza, v___ 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 tens and conditions as he in his discretion deems to be in the best interests of the Corporate on. I further certify that the foregoing votes are in full force this date without rescission, modification or amendment. Signed this ,?Ihlday of 44-� A TRUE RECORD ATTEST (Corporate Seal) J .i 60 Sect--tary/Clerk Brian Mendoza Vice President/Secretary MAPS Apsypea: of ininsKal Alalms - Conlacl ME-, Page 2 of -2 Search ResAts Oi-e regis-,,Gi-ed Details Legal Name Registration County Number PTM GENERAL "aw ENGMERING SERVICES TNC DIR :�ZSWS, Wins & comnissiz Epon as 5c, 1 vn7 CRY Rewstradan Expiration Date Date 10001140 RIVERSIDE PAVERSIDE co's / 0 -11 ,, 2 0 17 06 /3 0 / 2 0 1, S 5270017 Brian Alendoza P.O.B ox 7745 Riverside CA, 92513-7745 Email:brian@ptm-eng.com Cell 951.722.5 755 Chief Estimator and Supervisor of Outside Operations Supervisor of Outside operations with over 18 years of e-:perience electrician with over 20 years of es:perience An effective communicator and team leader, e�,perienced in coordinating and executing large and fast paced projects. CAREER EXPERIENCE Freeway Electric/ PTM Engineering Sen-ices. h1c. Riverside CA 06/2006 to Date Chief Esti-i iatori Supervisor of Outside Operations In charge of managing the estimating department and finalizing bid packages: coordinating the beginning phase of an awarded project bet«-een the company and agency. Project submittals, contract review Coordinated and manage crews California region: handled various sized projects ranging in size from S1,000 to S4.5 million dealing with dry utilities, wet utilities, traffic signals, and road improvements, maintained coordination Freeway Electric / PTNI General Engineering and subcontractor. and project owners. In charge of handling projects adnuristrative worh: mont111v cross estimates, project progress schedule; materials requisitions; contract change order negotiations and equipment purchase and rental. High Light Electric hie. / Pete & Sons Construction Inc. Riverside. CA 10/1995' to 06/2006 Chief Estimator In charge of nanaging the estiniatnig department and finalizing bid packages Coordinating the beginn lg phase of an awarded project benveen the company and agency or prime contractor that include project submittals, contract review. Successfully bid on projects totaling S 12 million v ith an average spread 6%. Area Sunen>isor Coordinated and manage 10 crews consisting of 6 members per team in the southern Californi region: handled various sized projects ranging 1 size from S1,000 to S4.5 million dealing with dry utlities, wet utilities, traffic signal, and road improvements. 'Maintained coordination between High Light Electric hie. and subcontractor, general contractor and project owners hi charge of handling projects adii11nlistr ative work; mont�Iv gross estimates, project progress schedule, materials requisitions, contract change order negotia ior-s and equipment purchase and rentals. Pace 1 of 4 Brian Mendoza C_ -REER E_YPERIENCE CONTTIIv=D �_ _.._... .. _�.v_.... . MBE Electric, inc. in Riverside. CA 10/1989 TO 10/1995 Vice President and Head of Outside O-perations Manage outside operations for all projects ranging in size from & 1.000 to 2.5 m pion. Headed an around the clock electric ci-tvv and coordinated with CC Meyers to repair the I-10 Santa Monica Frecw,ay after it collapsed during the 1994 Northridge Earthquake to complete the fast paced project inn 66 days. Maintain coordination between MBB Electric and subcontractors, general contractor and project owners: implemented and enforced safety c-'uidelLles. Handled adiiiil�.istratlVe ��-ork: 701thil% progress eslimai.es. material requlslIlons. contract change order negotlati on s. Vasco Conooration in Sag Fernando, CA 10/198 7 to 06/1989 Foreman (Part Time) Managed day to day operations of'work crews and various project ranging in size from S 1,000 to S5.000 in Eastern Los Angeles COunt� traffic signals. street lighting; signal interconnect. Raymore Electric in Roseniead. CA 06/1986 to 10/1987 Crew- Lender (Part Tine} In Charge of worlQnU crtws on projects that rancairig 1 om S 25.000 to 250,000 throughout Los Anaeles County. \k7ORKNIG SK-I] LS • Capable of operating hea-vy equipment such as sin loaders, cranes, and back -hoes Q Hands-on experience v ith hand tools and power tools ® Capablee of overseeing fast -paced and high profile project _fin effective conmhunicator and leader EDUC_ , Tl_ON a Iiitemational Brotherhood of Electrical v'orkers e Corllple:ed tra;,,"_ltr course (1988-1989} in street li ThtLig and traffic sig-hal nstallations. code enfor'_crncnt and blue 17);`nt readLlU. r South Gate High School e Received Hicah School Dioloma in 1988 ?aae 2 of 4 • English (Native) • Spanish (Fluent) BRL�N MENDOZA CONTINUED LANGUAGES A iT�7ARD RECENED • Recipient of the U.S. Small Business "Young Entrepreneur of the year" A«ward in 1996, nationally. • Recipient of the Certificate of Recognition by the City to Los Angeles for `'Small Business" in 1997. • Recipient of the Certificate of Recognition by the State Assembly. Assemblvillan Mr. Rod Pacheco, for the "Top 500 Inland Empire Small Business" in 1997. e Ranked among the "Top 500 hdand Empire Hispanic Owned Companies" Since 1997. e Certlficatlon of Appreclatlon for our participation and nnaximizatlon In the'` Century Freeway A_-iirniativ e action" by CFAAC PROFESSIONAL AND PERSONAL REFERNCES Caltrans pr0ject-071224U4 (Electrical contract amount S4.5 inillion) Description of project: Installation of traffic signals, ramp metering, sing illumination, Highway Lighting, Fiber option communication and electrical irrigation along the I-10 Freeway in Los knaeles Count�w. ® Doug Davwson — Project Manager for prime contractor, Balfour Bea«y Cell (949) 232-3276 and Office (909) 397-8010. Patty Galvan —Resident Engineer- Of ice (909) 594-?270 e Veronica Ross— Electrical Lnspector; Cell (714) 606-631 1 Pa'=��Cf- BRIAN MENDOZA REFERNCES CONTINUED City of Redlands Contract n208300-72304/41008 (Electrical contract amount is S218,800) project Completed in 2003 Description of project: Installation of traffic signals, modification of ramp meternng. liahtizn2 and sign illuinination. Bill Hensley— Senior Civil Engizneer— Office (909) 798-7586 ext.2 o Juan Olvera — Project Manager for general contractor, H&H Construction — Cell (951) 453-7712 and Office (909) 473-7331. Caltrans project�08-4567V4) Elect contract amount is S 938,238) project completed in 2003 Description of project: Installation of lighting system along the I-15 Freeway_ in San Bernardino County. Gary Vogel — Proj ect Manager for prime contractor, Granite Construction Cell: (661) 549-3953 and Office (661) 726-4447. Sandbag Projects, Segment 1, 2, 3 early segment 9, and alder Ave. (Total electr cal contract amount «7as 53.2 nnillion) Project completed in 2004. Description of Projects: Installation of traffic signals, ramp metering, sign illumination, lnighway lighting, fiber optic conununication, and electrical irrigation along the I-10 Freeway in San Bernardino County. Harold Lantis — Sandbag Contract Manager — Cell: (760) 802-7730 and Office (909) 873-8029 ext.213. Tim Hanable — Caltrans Inspector — Cell: (951) 712-0021 Al Ortega — Proj ect' onager for prime contractor, Yeager Skanska — Cell: (7,14) 240-5333. City of Indio Project,—===ST0137 (Electrical contract amount was 51.4 million) project completed In 2005. Description of project: Installation of street lightnia system. traffic signals, electrical irrigation, and dry Utilities. Gary Bexter — Area Manager for prime contractor; Yeager Skanska Construction Cell: (909) 721-9749 and Office (760) 343-5472. Tommy Young — Project Manager for prLnze contractor — Cell: (931) 232-6618 and Office (760) 343-5472. Mellsan Sepehri — City Engineer — Cell: (760) 250-2201 Additional Professional_ References: Zale Harris — Caltrans Inspector — Cell: (951) 289-0047 Ray Robles — Caltra_s area supervisor — Cell: (909) 799-0646 PaL,e 4 of f RTM General i naineerine services, Inc. Jobs References 2CIC PTM Jo6 No: P 16-o 1 Owner Job No: 172 Job Location: Cypress, CA Description of Wori.: Installation of Rectangular Rapid FlaShina beacon Systems Owner: City of Cypress Contact: Mr. {lamran Dadbeh, City Engineer Address: 5275 Orange Ave CitVState: Cypress, CA 90650 Telephone:714.229.6750 Fax No. 71 4.229.01 54 F mail: kdad6ehgci.cypress.ca.us Contract Date: March, 201 6 Date: Completed: In ProSr-ess Contractvalue:5101,999.00 End Value: InproSress PTM Jo6 No: P 1 6-o5 Owner Jo6 No: Contract No. 08-1 N0804 Job Location: San Bernardino, CA Description of Wori.: At the Intersection of Rte. 66 and 4'1' St. Replacement & Relocation of Electrical E_duipment & Concrete Work Owner: Department of Transportation Contact: Chee On-, Fro�ect Mana,er Address: 1 727 j0,k St. CitVState: Sacramento, CA 955 16 Telephone: 909.585.641 7 Fax No. 909.555 6472 F mail: chee.onagdot.ca.aov Contract Date: March, 201 n' Corn lress pete Date: In Prog Contract Value 5280000.00 EnclValue: In progress PTM Jo6 No: P 16-o4 Owner Jo6 No: 2016-0125 Jo6 Location: Baldwin Park, CA Description of Wori.: Traffic Signal Installation at Los Angeles St. and Horn6rook Ave. Owner: City of Baldwin Part: Contact: Mr. Jesus Saenz, Department Asst. Address: I++o3 E-ast Pacific Ave CitVState: Baldwin Park, CA 91706 Telephone:626.960.4o1 1 ext.479 Fax No. 626.962.2625 F mail: jsaenzg6alclWinpark.com Contract Date: May, 2016 Complete Date: rebruary, 2017 Contract Value: $ 10,996.00 E_nd Value: $204, 1 62.19 PTM Jo6 No: P 1 6-05 Owner Jo6 No: IFB 1 5-058 Jo6 Location: Riverside, CA Description of Wori.: Rapid I ink Bus Stop Project Owner: Riverside Transit A,ency Contact: Mr. Robert Wyman, Contract Administrator Address: 1 825 Third St. CitVState: Riverside; CA925 17 Telephone: 95 1.565.51 90 Fax No. 95 1.565.5001 F mail: rwymangriversidetransit.com Contract Date: May, 2016 Complete Date: March, 2017 Contract Value:52,650,900.00 End Value: $2,681,079.21 PTM Jo6 No: P 1 6-o6 Owner Jo6 No: 1 2A 1651 Jo6 Location: Oran, CA Description of Work: r lectrical Repair F, Replacement Service Owner: Department of Transportation Contact: Ms. I-athleen StonetaLai, Contract Analyst Address: 1727 30rk Street, MS-65 CitVState: Sacramento, CA 95 1 86 Telephone: 9 1 6.2 27.6 i 24 I=ax No. 91 6.227.6 1 55 F mail: K athleen.stonetakaigdot.ca.gov Contract Date: July, 2016 Complete Date: In Pro,ress ContractValue:5261,857.50 End Value: In Progress PTM Jo6 No: P 16-07 Owner Jo6 No: 2 1 020 Jo6 Location: Rosemead, CA Description of Work: Hellman/ Del Mar Intersection Improvement Project Owner: City of Rosemead Contact: Mr. Rafael Fajardo, P.E. Address: 5558 E. valley blvd. Citvstate: Rosemead, CA91770 Telephone: 626 569.21 5 1 Fax No. (26.507 921 8 F mail: rfajardogcityofrosemeand.ors Contract Date: June, 201 6 Complete Date: In Progress Contract Value: $595,595.00 E,ndValue In Proyess Page 1 of 2 RT!! General Unaineerina Services, Inc. Jcbs References 2®1G PTM Jo6 No P 16-os Qwner Job N0: 257 2 J06 Location: Westminster, CA Description of WA: Traffic Si,nal Modification Westminster Blvd and Olive St. Owner-. City of Westminster Contact: Ms. Veronica Johnson Sr. Administrative Aast. Public Worlx/E-n,. ,address: 8200 Westminster 514 C&L /State: ` n5tminster, CA 92685 Telephone: 7 14.545.5465 Fax No. 714.595.4499E mail: vejohnson@westminster-ca.aov Contract pate: January, 2017 Complete Date: In Progress Contract Value: $ 1 49,99 1.00 End Value: In Progress PTM J06 No: P 16-09 Owner Job No: o8A2657 Job Location: Various Locations in Kiverside & San Bernardino County in CA. Description of Woric: Ejnctrical Services Pedestal Knplacement Services Owner: Department of Transportation Contact: Mr. Kasen Knight, Contract Analyst ,address: 1727 50r1'Street CitL�/State: Sacramento, CA 958 16 Telephone: 9 1 6.227.(025 Fax No. 9 16.22J.6 1 5S E mail: Kasen.6,kt9dot.ca.gov Contract Date: November, 201 6 Complete Date: June, 201 7 Contractvalue: E-nd value: 540,599.99 PTM Job No: P 1 6-1 O Owner Job No: Agreement #A 170131 Po # 170005 1481 70053 6 Job Location: Whittier, CA Description Work: Street Lightning Improvements for Washin-ton Blvd. & Whittier Blvd. @ Various Locations and I R W.L. Owner: City of Whittier Contact: Mr. Carl Hassel, P.E ,address: 1 525o 17-. Penn St. City/j' tat- Whittier, CA 9060Z Telephone: 562.567.9502 Fax No. 562.567.2874-Email: chassel@cityofwhittier.org Contract Date: February, 201 7 Complete Date: In Progress Contract value: $ 1 , 1 47, 1 1 4.00 End value: In Progress PTM Job No: P 16-1 1 Owner Job No: SJ-526 Job Location: San Jacinto, CA Description Work: Sanderson Ave. & Ramona Blvd. Signalization Project. Owner: City of San Jacinto Contact: Gary NguJon E-ngineer ,address: 595 j' . San Jacinto Ave. CitL/State: j' an Jacinto, CA 92585 Telephone:(951)654.5592Fax No. (951)654.5672 mail:gary@trilakeconsultans.com Contract Date: January, 201 7 Complete Date: In Progress Contract value: $264,240.00 E-nd Value: In Progress PTM Job No: P 16-1 2 OwnerJo6 No: SJ-53o; H51PL 5075(15) Job Location: San Jacinto, CA Description Work:j' an Jacinto Pedestrian. upgrade. Owner: City ofj' an Jacinto Contact: Mr. Har6i6 Motlaah, City En'. ,address: 595 S San Jacinto Ave. CitL/State: San Jacinto, CA 92585 Telephone: (95 1)654.5672 Pax No: (95 0654.5672 Email: Cary@trilakecor.sultans.com Contact Date: January, 2017 Complete Date: In Progress Contract Value: $227,272.00 E-nd Value: In Progress Page 2 of 2 FTM General Enaineerina Services, Inc. Mobs References 2G15 PTM Job No: P 1 5-o 1 Owner Job No.: 1958 Job Location: Montebello, CA Description of Work: Montebello Way Traffic Signal Improvements from Mines Ave. to Olympic Blvd. Owner: City of Montebello Contact: Mr. Normoz vapid Address: 1 60O W fjeverly ff)W. Montebello, CA 9064-0 Telephone: 325.887.1470 Fax: E_mail: HVahid@cityofmontebello.com Contract ate: November, 201 5 Completed ate: In ProSress Contract`\/alue: $692,039.00 End`\/alue: In Prowess PTM Job No: P 15-os Owner Job No.: None Job Location: Lawndale, CA Description of Work: Citywide Traffic Signal (jpgrades and Modifications Owner: City of Lawndale Contact: Mr. Miguel Alvarez Address: 1471 7 ff)urin Ave.. Lawndale, CA 90260 Telephone: 3 1 0.; 73 3265 Fax: 3 1 0.7 93.28 1 3 mail: malvarez@lawndalecity.org Contract ate: August, 20 15 Completed ate: July, 2016 Contract Value: s 6 3 6,o3 6.00 E.nJValue: $692,639.87 PTM Job No: P 1 5-06 Owner Job No.: 201 3-008 Job Location: baldwin Park, CA Description of Work: Two new traffic signal Inst. at baldwin Park fjlvd. at Ohio St & Los An,eles St at La Rica Ave. Owner: City of ff)aldwin Park Contact: Mr. Carlos Aguirre Address: 14405 r-_. Pacific Ave. Baldwin Park, CA 91706 Telephone: 626.8 1 3.5206 Fax: 626.962.2625 mail: caau'uirre@6alciwinpark.com Contract ate: June, 20 1 5 Completed ate: December, 2015 Contract Value: $343,933.00 E-ncl Value: $386,372.1 5 PTM Job No: P 1 5-07 Owner Job No.: 1 5-008 Job Location: Riverside, CA Description of Work: bus Ramp Project Owner: RTA Contact: Mr. Rob Wyman Address: 1825 T,ird Street Riverside, CA 92507 Telephone: 951.565.5000 Fax: 95 1 .565.5001 F mail: ru,yman@riversidetransit.com Contract ate: June, 201 5 Completed ate: June, 201 5 Contract Value: $38,038.00 E-ndvalue: $38,038.00 PTM Jo6 No: P 15-08 Owner Job No.: 14/ 15-os J06 Location: La Canada ; Iintridge, CA Description of Work: Traffic Signal Improvements Foothill blvd. and Cornishon Ave. Owner: City of La Canada rlintridge Contact: Mr. NasserShoushtarian Address: 1 327 roothill 5Ivd La Canada Flirtridge, CA % 101 1 Telephone: 81 8.790.8882 rax: 8 1 8.790.7536 F mail: nasser.sh@Icf.ca.,1ov Contract ate: June, 201 5 Completed ate: Octo6er, 201 5 Contractvalue: $87:787 00 E_nd Value: $SM21 .i 5 Page 1 of 4 PTM General Enaineerine Services, Inc. Jobs References 2c15 PTM Jo6 No: P 15-o9 Owner Job No.: 1408 1 7 Job Location: Kialto, CA Description of Work: Loothill Blvd. at rIome Depot Tragic Signal and Cedar Ave. Median Improvements Owner: City of Rialto Contact: Mr. Eddie Chan Address: 535 W. Kialto Ave. Kialto, CA 92576 Telephone: 909.820 265, rax: 909.820.2527 F mail: echan@rialtoca.gov Contract Date: November, 2015 Completed Date: April, 201 6 Contract Value: $358,058.00 FndValue: $555,485.57 PTM Job No P 1 5-1 I OwnerJo6 No.: NSIP-5526(017) Job Location: Montclair, CA Description of Work: Traffic jignaI Improvement Project Central Ave. and San Bernardino St. Owner: City of Montclair Contact: Mr. Steve Stanton Address: 5 1 1 1 Benito Street, Montclair, CA 91765 Telephone: 909.625.9444 rax: 909.621.1 584 Email: sstanton@cityo�montclair.org Contract Date: November, 201 5 Completed Date: May, 2016 Contract Value:$206,906.00 rndValue: $209,429.05 PTM Job No: P 1 5- 1 2 Owner Job No.: 14-6799 14-6800 Job Location: Santa Ana: CA Description of Work: New Traf-(ic Signal or. Newhope Street and Camille Street (6799) Traffic Signal Modification on Newhope Street and Camille Street (6800) Owner: City ofjanta Ana Contact: Mr. Victorjo Address: 20 Civic Center Plaza — M-ZZjanta Ana, Ca 92702 Telephone: 714-647-5076 rax:714.647.5258 Email: vso@santa-ana.org Contract Date: Le6ruary, 2015 Completed Date: May, 201 7 Contract Value:$575,975.00 EnclValue: $5692586.25 PTM Job No I 1 5- 1 3 Owner Job No.: 10701 1 5-008 I Job Location. Bell Gardens, CA Description of Work: Feplacement of Internally Illuminated Street Name Signs Owner: City of Bell Gardens Contact: Mr. Jerome Joaquin Address: 8327 Garfield Ave. Bell Cjardens, CA 90201 Telephone: 6Z6.657.7000 rax: 626.657.6000 Email joaquin@agi.com.co Contract Date: Marcie, 201 6 Completed Date: May, 2016 Contract Value: $ 3 Z7,027.00 End Value: $ 35 1, 1 87.43 PTM Job No: P 15-1 4 Owner Job No.: 20 1 5-05 Job Location: }Zosemeacl, CA Description of Work: Garvey Avenue - rjigkway Safety Project Owner: City of Fosemead Contact: Mr. jean Sullivan Address: 8838 [- Valley Blvd. Kosemead, CA 91 770 Telephone: 6Z6.569.Z 1 17 rax: [_mail: ssullivan@cityofrosemead.org Contract Date: October, 2015 Completed Date: July, 201 6 Contract Value:$479,079.00 [-ndValue: $519,266.0o Page 2 of 4 rTM General unaineerina Se"ices, Inc. Jcbs References 2c15 PTM Job No: Pi 5- 1 5 Owner Job No.: CIF 001 7Job Location: Wildomar, CA Description of Work: Minton Keith Road/Hidden 5pri Ss Rd. Tra4ic SiSnal jouthbound Left Turn Modification Owner: City of Wildomar Contact: Mr. Matt F)ennett Address: 25875 Clinton Keith Rd. #201 Wildomar, CA92595 Telephone: 95 1 .677.775 1 Pax: 95 I .698.1463 Finail: mbennett@wildomar.org Contract Date: December, 2015 Completed Date: December, 201 5 Contract value:$55,955.00 E_ndValue: $56,110.00 PTM Job No: P 1 5- 16 Owner Job No.: None Job Location: Irwindale, CA Description of Work: Traffic jignal Improvement at Longden Avenue and Myrtle Avenue Owner: City of Irwinclale Contact: Mr. Francisco Carillo Address: 5o5o N. Irwindale Ave. Irwindale, CA 91 706 Telephone: 626.430.2210 Pax: 626.9-50.2295 Finail: fcarrillo@ci.irwindale.ca.us Contract Date: May, 2016 Completed Date: June, 201 7 Contractvalue:$215,512.00 E_ndvalue: $267,417.29 PTM Job No: P 15-17 Owner Job No.: CC- 1 485 Job Location: Huntington Beach, CA Description of Work: bolsa Chica 5t. at 5olsa Ave. Traffic signal Modification. Owner: City of Nuntinaton each Contact: Mr. John Griffin Address: 200o N. Main 5t. Nur.tinSton each, Ca 926-1-8 Telephone 714-.575.501 1 Pax J14.536.5204 mail: jgriffin9surEcity-h9.org Contract Date: February, 201 6 Completed Date: January, 201 7 Contractvalue:.1 30, I05.00 End value: $ 1 55,755.96 PTM Job No P 1 5-1 8 Owner Job No.: 05- 1 62804 Job Location: San Luis Obispo, Santa bar6ara and Santa Cruz Counties, CA Description of Work: Modify -,;anal-, install countdown and accessible pedestrian si-nals Owner: Caltrans Contact: Lilian 5ennetzen Address:2055 Presikcr Lane, 5te. E 5anta Maria, Ca 95534 Telephone: 805.`f41.6955 Pax: 805 922.25 1 1 F mail: lilian.bennetzen@dot.ca.gov Contract Date: May, 201 6 Completed Date: April, 201 7 Contractvalue: $ 1;086;896.00 E-ndvalue: $ 1 1 12, 947.Z7 PTM Job No: P 1 5-1 9 Owner Job No.: 9659 Job Location: Paramount, CA Description of Work: Lighting Improvements at All American Park Owner: City of Paramount Contact: Sarah No Address: 1 550o Downey rave Paramount, CA 90725 Telephone: 562.220.21 57 Pax: 562.220 2105 F mail: shogparamountcity.Com Contract Date: April, 201 6 Completed Date: March, 201 7 Contract value: $ 1 1 9,91 I .00 E_nd value: $ 115,856.00 Page 3 of 4 RTAA General i=naeneerene Services, Inc. Jcbs References 2®15 PTM Job No: P 1 5-20 Owner Job No.: SP-3 I Job Location: Orange, CA Description of Work: Taft Li6rary & rire Station #5 ri6er Optic Cable Installation Project Owner: City of Orange Contact: Matthew Lorenzen Address: 300 E. Chapman Ave. Orange, Ca 92866 Telephone:714.744.5566 Fax:714.749-.5575 Email: mlorenzen@cityoforange.com Contract Date April, 201 6 Completed Date: December, 201 6 Contract Value: 5218,812.00 EndValue: $210.�42.40 PTM Job No: P 1 5-21 Owner Job No.: 07-297204 Job Location: Lynwood & Paramount, CA Description of Work: For Construction on State Higkway in Los Angeles County in Lynwood and Paramount at Route 1 05171 0 Separation Owner: Caltrans Contact: Edgar Herrera Address: 1 8750 S. Wilmington Ave. Ste. 1 O3 Rancho Dominguez, Ca �0220 Telephone: 3 1 0.609.0264 ext. 25 1 Fax: F mail: ecigar.herreragdot.ca.gov Contract Date: September, ? 01 5 Completed Date: In progress Contract Value: $3, 1 99, 199 00 End Value: In Progress PTM Jo6 No: P 1 5-22 Owner Jo6 No.: NI/A J06 Location: Rollin Hills, CA Description of Work: Traffic Signal Modification on Palos Verdes Dr. N. & Rolling Hills Rd./Portuguese Eend Rd. Owner. City of Rolling Hills Contact: Ms. Here Nolan Address: 4045 Palos Verdes Dr. N. Rolling Hills Estates, Ca 9027-i- hone: 3 10.577.1577 Ext. 107 Fax: 3 1 0.577.4468 mail: hopenCrollinghillsestate.ca.gov Telep Contract Date: July, 201 6 Completed Date: July, 201 7 Contract Value: End Value: 235,507.62 PTM Job No: P 1 5-z3 Owner Jo6 No.: 20I 5-o6- I Jo6 Location: Claremont, CA Description of Work: Traffic Signal Modification at 5ase Line Road and Monte Vista Avenue Owner: City of Claremont Contact: Mr. Vince Ramos Address: 207 Harvard Ave. Claremont, CA � 1 7 1 1 Telephone: 99.5465 Fax: 9o9.j99.5492 F mail: vramosCci.claremont.ca.us Contract Date: rebruary, 201 6 Completed Date: March, 201 6 Contract Value: $ 1 7,007.00 End Value: $ 1 7,007.00 PTM Job No: P 1 5-24 Owner Jo6 No.: TS- 1 60z Job Location: Inciio, CA Description of Work: Jefferson Street at Dunbar Drive Traffic Signal Owner: City of Indio Contact: Eric W'eck Address: 1 00 Civic Center Mall, Indio; CA i220I Telephone: 760.625. i 858 Fax: 760.59 I .6429F mail: eweck@indio.org Contract Date: May, 201 6 Completed Date: December, 201 6 Contract Value: $ 23 1, 1 3 2.00 End Value: $ 7-1 2,022.00 Page 4 of 4 rT,N General U-naeneerone Services, Inc. Jobs References 2O1 ,t I t M Job No: P 1 4-o 1 Owner,Jo6 No.: SPEC 205 ,Jo6 Location: Mali6u, CA Description ofWor�_Rte- I Pacific Coast Highway Intersection improvements Owner: City of Malibu Contact: Mr. 'Arthur Ala djadjian Address: 23825 Stuart Ranch (load Cit_9/5tate: Mali6u, CA Telephone: (3 1 0) 456-24S9 Fax No.: b I0)3 1 7-0950 Contract Date: re6ruary, 201 3 Completed Date: AUza--)Ust, 2014 Contract Value: $ 149,049.00 E_nJValue: $208,832.31 PTM Job No: P 1 4-02 Owner,Jo6 No.: 1 2A 1 5 2 2 EA 1 2-oN 1 o 1 4 ,Jo6 Location: Huntington each, CA Description of Work: Remove Section of E-xi.ting Median kland and Reconstruct McJian Nose at Rte.39at Chrysler. Owner: Department of Transportation Contact: Mr. Dank Thai, PE Address: 1 727 3O'k Street Cit'q/State: Sacramento, CA 9 581 6 Telephone: (91 ()227-6000 Fax No.: (9 1 6)227-6 1 55 Email: danh.thai@dot.ca.gov Contract Date: re6ruary, 201 4 Completed Date: December, 20I4 ContractValue: $ 57,57(.00 EnJ Value: $55,575.60 PTM Job No: P 14-03 Owner,Jo6 No.: 5950 ,Jo6 Location: San Marino, CA Description of Woric: Traic Calming Pro)ect at Oa1k, Knoll & Monterey Road. Owner: City o4 San Marino Contact: Mr. Chucl: Richey, Project Manager Address: 2200 Huntington Drive Citq/State: San Marino, CA 9 1108 Telephone: (626)300-0793 Fax No.: (626)300-0709 mail: cityofsanmarino.org Contract Date: March, 201 3 Completed Date: Decem6er, 20 1 4 Contract Value: $92,599.00 End Value: $92,597 56 PTM Job No: P14-04 Owner,Jo6 No.: CAP 331202, f5id No. 14-1oo6 ,Jo6 Location: Irvine, CA Description Of Work: Northbound On -Ramp Traffic signals Improvement at Warner Ave. & jam6oree Rd. Owner: City of Irvine Contact: Mr. Darrell Hartman Address: One Civic Center Drive Cit_q/State: Irvine, CA 92623 Telephone: (949)724-6000 Fax No.: (949)725-7556 mail: Asrtman@irvine.ca us Contract Date: April, 2014 Completed Date: June, 201 5 Contract Value: $435,064.00 End Value: $435,064.45 PTM J-6 No: P 14-o5 Owner Job No.: 227-5 8069, 5R25L-5070 (028) ,Job Location: Pomona, CA Description of WorL Traffic Modification at Lexington From Garet' to White Ave. Owner: City of Pomona Contact: Mr. Ron. Chan, PE Address: 5o5 5 Garet' Ave. Cit-4/5tate: Pomona, CA 9 1 769 Telephone: (909)620-2261 Fax No.: (9o9)620-2269 F mail: Ronald_chan@ci.pomoma.ca.us Contract Date: March, 201 4 Completed Date: Octo6er, 201 5 ContractValue: $571,209.00 E_nJValue: $571,209.22_ Page 1 of 4 UTA General Unaineerina Services, Inc. Jobs References 2c14 PTM Job No: P 1 4-06 Owner Job No.: 41 8-7) )7 1 Job Location: Murrieta, CA Description of Work: Pedestrian jafety E_nhancement Project Phase 11 Owner: City of Murrieta Contact: Mr. ff)rian jtephenson, PE Address: 1 Town Center5quare Cita/jtate: Murrieta, CA 92562 Telephone: (95 046 1-6070 Fax No.: (909)461-6049 Finail: 6stephenson9murrieta.0rg Contract Date: April, z O 1 4 Completed Date: October, 201 4 Contract Value: $ 15),8) 1 .00 E_ncl Value: $ 1 87,276.) 5 PTM Job No: P 14-07 Owner Job No.: 1 34-27 Jo6 Location: Orange, CA tion of Work: Drainage and jtreet Improvement at Vista Ridge Drive. Descr p Owner: City of Orange Contact: Mr. Matthew Lorenzen, Project Manager Address: )00 E-. Chapman Citra/5tate: Orange, CA 92866 Telephone: (714)744-555) Fax No.: (714)744-557) E mail: nil ore nzen@cityoforail ge.orl� Contract Date: April, 201 4 Completed Date: Sept., 20 1 4 ContractValue: $ 1 05, 1 87.00 E_nd Value: $ 1 00,0-+-71 PTM Job No: P 14-08 Owner Job No.: C4-005 5 Jo6 Location: County of Riverside, CA Description of Work: Traffic Si,nal Liahtin- Project in the Community of f rencn valiey 6riSns Rd. on board Rd. Owner: County of Riverside Contact: Mr. Joel Jimenez, Project Manager Address: )325 14" Street Citra/jtate: Riverside, CA 92504 Telephone: (95 15i55-1 5)7 Fax No.: (95 I )955-3 1 64- Finail:jrjimenez@rtlma.org Contract Date: April, 201 4 Completed Date: Fe6., 2015 Contract Value: $ 1 79, 1 3 2.00 E_nd Value: $ 1 79, 1 3 2.) 1 PTM Job No: P 14-09 Owner Job No.: City Project No. 1 5-2o Job Location: Costa Mesa, CA Description of Work: Illuminated Crosswalk Project Placentia Ave. at 20' `jt. Owner: City of Costa Mesa Contact: Mr. Thomas banks, PE Address: 77 [-air Drive Citra/jtate: Costa Mesa, CA 92628 Telephone:(714)754-5)55 Fax No.: (714)754-5028 Email:tom.6anks@costamesaca.gov Contract Date: ,rune, 201 4 Completed Date: In Progress Contract Value: 8130,990.00 E-nclValue: $134,75)-76 PTM Job No: P 1 4- 1 1 Owner Job No.: City Project No. 1 3-I 3, rederal Project No. N5IPL-5) 1 2 (085) Job Location: Costa Mesa, CA Description of Work: Tragic jgnal Modification jun Flower Ave. at Anton Blvd. Owner: City of Costa Mesa Contact: Mr. Thomas banks, PF Address:77 'lair Drive Citra/5tate: Costa Mesa, CA92628 Telephone: (719)754-5355 Fax No.: (714)754-5028 F mail: tom.�anks@costamesaca.�ov Contract Date: May, 201 4 Completed Date: In progress ContractValue: $255,825.00 E-ndUalue: $2561200.00 Page 2 of 4 rTM General Eneineerine Services, Inc. Jobs references 2C14 PTM Job No: P 14-1 2 Owner Job No.: 3-K-13 Jo6 Location: La Habra, CA Description of Work: Annual Siclewalk and Wheelchair Improvement Project at Various Locations. Owner: City of La Habra Contact: Mr. Christopher Johansen, Project Manager Address: 201 F. La Habra Drive Citry/jtate: La Habra, CA 9063 I Telephone: (562)3S3-41 5 I Fax No.: (562)3S3-4476 mail: engineering@laha6raca.gov Contract Date: May, 201 4 Completed Date: December, 2014 Contract Value: $ 1 82,353.00 Fnd Value: $ 1 82,382.60 PTM Jo6 No: P 14-1 3 Owner Jo6 No.: None J06 Location: Stanton, CA Description Of Work: Traffic Signal Improvements at E)each E)Ivd. & Village Ctr. Drive. Owner: City of Stanton Contact: Ms. Stephanie Camorlinga, rng. Asst. Address: 7800 Katella ,Avenue Cit_q/State: Stanton, CA 90680 Telephone: (714)890.4204 Fax No.: (714)800-1443 mail: scamorlinaaOci.stanton.ca.us Contract Date: June, 2014 Completed Date: In Progress Contract Value:$3S8,SS8.00 FndValue: $446,168.24 PTM Jo6 Not P14-14 OwnerJ06No.:ProjectNo.11-354CIPs438 Jo6 Location: Murrieta, CA Description of Work: Traffic Signal Installation at Alta Murrieta & Whitewood. Owner: City of Murrieta Contact: Mr. Brian Stephenson, PF Address: I Town Center Square Cit_q/State: Murrieta, CA92562 Telephone: (9 5 I )46 1 -6070 Fax No.: (9o9)46 I -6o49 F mail: 6stephenson0murrieta.org Contract Date: August, 2014 Completed Date: June, 201 5 Contract Value:$24S,951.00 FndValue: $248,951.03 PTM Jo6 No: P 14-1 5 Owner Jo6 No.: C2M 14-39 Jo6 Location: Alhambra, CA Description of Work: Tragic Signal and Highway Safety Lighting System at Garfield Ave. & Talmage 5urke Way. Owner: City of Alhambra Contact: Ms. Amanda Fitel Address: I I I South Pirst Street Cit-q/State: Alhambra, CA92562 Telephone: (626)570-5062 Fax No.: ((26)458-4201 Email: aeitel0cityofa%am6ra.org Contract Date: July, 20 14 Completed Date: May, 201 5 Contract Value: $ 106,757 00 Fnd Value: $166,757.00 PTMJo6 No: P14-I 6 OwnerJo6 No.: 21 29-2; Feceral No. HSIPL-5)51(o23) Jo6 Location: Pico Kivera, CA Description of Work: Traffic Signal Safety Improvements Owner: City of Pico F\ivera Contact: Mr. Jose Loera Address: 66 15 Prisons Blvd. Cit_q/state: Pico Rivera, Ca 92503 Telephone: (562)So 1-435o Fax No.: (562)949-7506 F_mail:jloera@picorivera.org Contract Date: June/20I4 Completed Date: August 2014 Contract Value: $ 1 ,937,5 10.68 Fnd Value: `� 1,937,510.65 Page 3 of 4 PTM General IfniineerinQ Services, Inc. Jobs Leferences 2CU PTM Jo6 No: F 14-1 7 Owner Job No.: 14-04-1 Jo6 Location: Moreno Valley, CA Description of Work: Mall Stop Fnkanccements Froject in Moreno Valley. Owner: Riverside Transit Agency (RTA) Contact: Mr. Andrew Frost Address: 1 825 Third St. Cit_q/State: Riverside, CA 92507 Telephone: (95 1)565-5 1 90 Fax No. : (95 1 )565-5 19 1 Email: afrsot@riversidetransit.com Contract Date: September, 201 4 Completed Date: August, 201 4 Contract Value: $599,662.00 FndValue:5596,662.85 PTM Jo6 No: F 1 4- 18 Owner Jo6 No.: 227-58070 J06 Location: Fomona, CA Description of Wori : Traffic Signal Foles Relocation at Fairplex Drive. Owner: City of Fomona Contact: Mr. Ron Chan, FE Address: 505 S. Garey Ave. Cit_q/State: Fomona, CA 91 769 Telephone: (909)620-2261 Fax No.: (909)620-2269 Finail: Ronald_chan@ci.pomoma.ca.us Contract Date: November, 20 1 4 Completed Date: April, 2015 Contract Value: $ 1 5,85-1.00 Fnd Value: $ 1 5,854.00 Page 4 of 4 UTA General l=naineerina Services, Inc. .lobs Ueferences 2®13 PTM Job No: F 15-o i Owner Job No.: C2-o 1 5 1 Jo6 Location: Thousand Palms, CA Description of Work: Traffic jignal and Lighting Project @ F\amona }load & Monterrey Ave. &,sierra Del `jol. Owner: County Of Riverside Contact: Mr. Joel Jimenez/Project Manager Address: 5j2j 14'1'_jtreet Citj/5tate: Riverside, CA 92501 Telephone: (95 I) 955-6750 Fax No.: (95 1) 955-5464 F mail:jrjimenez@rtlma.ors Contract Date: Aril, 20 1 5 Completed Date: December, 20 1 5 Contract Value: 5244,021.60 rndValue: $236,451.70 PTM Job No: F 15-02 Owner Job No.: 41065 Job Location: Ktcliands, CA Description of Work: Pedestrian jafety improvements at Kedlands, Cope & Mckinly. Owner: City of }Zedands Contact: Mr. anon Montgomery/FE Address: 55 Cajon 5t Suite + City/5tate: F'edlands, CA92575 Telephone: 1"905)793-7584 Ext. 5 Fax No.: (9o9)795.7670 Email:jmontaomery@cityofredlands.or�; Contract Date: April, 20 1 5 Completed Date: October, 2015 ContractValue:$59,760.00 End Value: 559„'60.05 PTM Job No: F 1 5-o5 Owner Job No.: Contract No. 12A1475 Job Location: Oran,-e County, CA Description of Work: Upgrade Traffic jignals and Kelat:ed Electrical Components at 5olsa Chica State }load. Owner: Department of Trannportation Contact: Mr. DA, Thai/FF Address: 1727 50th jtreet City/jtate: Sacramento, CA95 i S6 Telephone: (91 6)227-6000 Fax No.: (9 1 6)227-61 55 F mail: danh.thai@dot.ca.gov Contract Date: February, 201 5 Completed Date: December, 2o14 Contract Value: $ 15-1-,58+00 End Value; 5154,SS4.58 PTM Job No: F 15-o4 Owner Job No.: None Job Location: Inglewood, CA Description of Work: Traffic jianal Modification Project at Crenshaw 51vd. & 104r1 `jt. Owner: City of j"Iewood Contact: Mr. Alan Mai, FF Address:One Manchester5Ivd City/jtate: Inglewood, CA9o3ol Telephone: (5 1 O)41 2-5555Fax No.. (5 10)41 2-5552 1= mail: amai@cityofinslewood or- Contract Date: April, 20 1 5 Completed Date: In Proa)re55 Contract Value: 51 64,050.00 End Value: $ 1 6 1 ,5 S0. i 5 PTM Job No: F 1 5-o5 Owner Job No.: 7125 Job Location: Garden Grove, CA Description of Work: Traffic ji,,naI Installation and Modifications at Various Locations, Owner: City of Garden Grove Contact: Mr. Mr. Dai C. Vu, I Address: 1 1 222 Acacia Parkway Citr�/jtate: Garden Grove, CA92S40 Telephone: (714-)741-5 189 Fax No.: (7 14)741-5578 F mail: daivCaci..aarden-arove.ca.us Contract Date: March, 20 1 5 Completed Date: December, 201 5 Contract Value:$575,795.00 End Value:$575.79S.00 Page 1 of 7 IFT0! General Unaineerine Services, Inc. ichs References 2C13 PTM Job No: I 1 3-06 Owner Job No.:41 8-73371 Federal Project Id. H51PL-5070(O25) Job Location: Pomona, CA Description of WorL Intersection Reconfiguration at Monroe 5t. & OranSe. Owner: City of Pomona Contact: Mr. Ati Eskandari, PE Address: 505 South Garet' Ave Citr,/State: Pomona, CA 5 1769 Telephone: (909)620-2261 Fax No.: (909)620-2278 Email: aam@cityo pomona.com Contract Date: May, 201 3 Completed Date: December, 201 3 Contract Value:5122,392.00 Fnd Value:5122,061.00 PTM Job No: P 1 3-07 Owner Job No.: 6 1 095 Job Location: Placentia, CA Description of Wori : Intersection Improvement Project at Rose Dr. & Yorba Linda. Owner: City of Placentia Contact: Mr. Michael McConalia Address:4o l )_. Chapman Citr,/State: Placentia, CA 92870 Telephone: (714)993-8 1 17 rax No.: (7 14)528-46`t-O mail: administration@placentia.orS Contract Date: April, 201 3 Completed Date: December-, 201 3 Contract Value: 5124,533-+3 E-ndValue: 5124,533.43 PTM Job No: P 13-o8 Owner Job No.: C5-o 1 92 Job Location: Vernon, CA Description of WorI : Pedestrian Countdown Head Replacement Project Owner, City of Vernon Contact: Mr. Samuel Wilson Address: 4305 Santa j e Avenue Citr,/State: Vernon, CA 90058 Telephone: (325) 583-88 I I E-xt: 21 5 Fax No.: (523)826-1435F mail: Lwilson@ci.vernon.ca.us Contract Date: May, 201 5 Completed Date: January, 201 `t Contract Value: 584, I 17.00 Fnd Value: 584, 1 1 6.0 8 1 I M Job No: P 1 3-p9 Owner Job No. 1 2-67 60; Federal Project No. H51PL-5o63(I 41) Job Location: Santa Ana, CA Description of Wori : Traffic Signal Modification at McFadden & Lyon. Owner. City of Santa Ana Contact: Mr. �dward Torres, Assistant E- ngineer Address: 20 Civic Center Plaza Citr,/State: Santa Ana, CA 92701 Telephone: (714)647-5680 rax No.:714.647.5058 F mail: etorees@santa-ana.ora Contract Date: Ma,, 201 3 Completed Date: July, 201 4 Contract Value:$285,12000 E-ndValue:$289,338.00 PTM Job No: P 13- 1 O Owner Job No. CI P 5 548 Job Location: Hemet, CA Description of WorL Safe i`Zoutes to School Project Owner. City of Hemet Contact: Mr. Steve Latino, PE Address: 445 East Florida Avenue Citr,/State: Hemet, CA 92545 Telephone: (95 I )7 65-2343 Fax No.: (95 1 )765-2349 mail: Slatino@cityofhemet.ora Contract Date: Sept., 201 4 Completed Date: November, 201 4 Contract Value: $9,575 50 End Value: $9J75 50 Page 2 of 7 UTM General rnitineerinit Services, Inc. .Dubs references 2®13 PTM Job No: P 1 3- I 1 Owner Job No. None Job Location: Riverside, CA Description of Work: Traffic Signal and Lighting Project at Cajalco Rd. & Alexanders St. in Mead /alley. Owner: County of Riverside City of Contact: Mr. ,Joel Jimenez, Project Mnna,ed Address: 3525 14rh st. Cit', /State: Riverside, CA 925001 Telephone: (95 1) 955-o'7So Fax No.: (951) 955-3464 Email:jrjimenez@rtlma.org Contract Date: December, 201 3 Completed Date: July, 201 4 Contract Value:$334,886.00 End Value: $329,12IA4 PTM Job No: P 1 3-1 3 Owner Job No.: E5PL 535 BJob Location: Rosemead, CA Description of Work: Intersection Improvement Projects at Hellman & San Gabriel. Owner: City of Rosemead Contact: Mr. Rafael Fajardo, PE Address: 8838 E. Vallcy blvd. Cit', /State: Rosemead, CA 9 177o Telephone: 626.569.2 100 Fax No.: 626.307.921 8 Email: rfajardo@cityofrosemead.org Contract Date: May, 201 3 Completed Date: December, 201 3 Contract Value: $4S 2,024.30 End Value: $-+58,7-+2.80 PTM Job No: P 1 3-1 4 Owner Job No.: Contract No. o7A3421 W7 T49o�) Job Location: Loy Angeles, CA Description of Work: Electrical Owner: Department of Transportation Contact: Mr. Javier Guzman, PE Address: 1727 30r Street Citcj/State: Sacramento, CA951 S( Telephone: (91 6)227-6000 Fax No.: (91 6)227-61 55 Email:javierbguzman@gmail.com Contract Date: June, 201 3 Completed Date: March, 2015 Contract Value: $203, 1 3 1.00 End Value: $ 1 94.895.09 PTM Job No: P 13-15 Owner Job No.: Contract No. o7A34o9 (o74T61 o4) Job Location: Loy Angeles, CA Description of Work: Electrical Highway LiAtin, Owner: Department of Transportation Contact: Mr. Mike Fardoun, PE Address: 1 727 3O'k Street Cit', /State: Sacramento, CA 95136 Telephone: 626.339. 1 60 i Ext. 1 1 9 Fax No.: (9 1 6)227-6 15 5 E mail: mike.fardoun@dot.ca.gov Contract Date: June, 2019 Completed Date: Jan, 2015 Contract Value:$26,000.00 End Value: $26,00000 PTM Job No: P 13-i 6 Owner Job No.: Federal Project No. HSIPL-536o(o 12) Job Location: Lawndale, CA Description of Work: Traffic Signal Modification at beack & Firmora Ave. Owner: City of Lawndale Contact: Mr. Miguel Alvarez, PE Address: 147 17 burin Avenue Cigc/5tate: Lawnc;ale, CA 90260 Telephone: (3 i 0)973-3265 Fax No.: (3 1 o)644-9-556 Email: malvarez@lawndalecity.org Contract Date: June, 201 3 Completed Date: May, 201 4 Contract Value: $ 1 60,��0.00 End Value: $ 160,��0.1 6 Page 3 of 7 riAO General Rnaineerine services, Inc. Jobs References 2C13 PTM Job No: P 1 3-1 7 Owner Job No.: None Job Location: Duarte, CA Description of Work: Traffic Signal and Intersection Improvements Project at Huntington Dr. at Pops Rd. Owner: City of Duarte Contact: Mr }zafael Casillas, PE Address: 1600 Huntington Drive GtLL/State: Duarte, CA 9 1 01 0 Telephone: ((26)357-i93I Pax No.: (6z6)358-001 8 E_mail: rcasillas@accessduarte.com Contract Date: ,June, 201 j Completed Date: May, 20 14 Contract Value: $j 1 5,677 00 E-ndValue: 5j 1 3,6J6.92 PTMJo6 No: P13-1 S OwnerJob No.: 1 5-365, CIP NO.5430 Job Location: Murrieta, CA Description of Work: Rectanlaular dashing 5eacon installation at Nutmeg St and St. Ralph Dr. Owner: City of Murrieta Contact: Mr. Brian Stephenson, PE Address: 1 Town Square CitLj/State: Murrieta, CA 9z56z Telephone: (95 1 )504.z4S9 Fxt: 6z39 Pax No.: (95 1 )3O4.z489 F mail: 6stephenson@m1Jrrieta.org Contract Date: August, 2015 Completed Date: March, zO 14 Contract Value:$30,899.00 E_ndValue: $50,889.00 PTMJo6 No: P13-19 Owner Job No.: None Job Location: Riverside, CA Description of Work: Fjus Shelter Project at E nt Vale and Mead Valley. Owner: Riverside Transit Agency Contact: Mr. Andrew Frost, Project Manager Address: 1 Sz5 Third Street Cih�/State: Riverside, CA9z5 17 Telephone: (95 I )565-5000 Pax No.: (95 1 )565-5001 mail: afrostoriversidetransit.com Contract Date: ,June, 201 3 Completed Date: November, z01 3 Contract Value; 5(6,456.00 End Value: $66,456.00 PTM Job No: P 1 3-zo Owner Job No.. 71 9 J06 Location: Norwalk, CA Description of Work: Pedestrian Crossing Improvements at Rosecrans Ave. at Crossdale Ave. Owner: City of Norwalk Contact: Mr. Randy Hillman, Project Manager Address: 1 z7oo Norwalk E)Ivd. Cit-v5tate: Noi--alk, CA 90651 Telephone: (56z)929-5 700 Fax No.: (j 62)929-5 J75 Finail: rhillman@norwalkca.gov Contract Date: ,July, zo 1 3 Completed Date: December, z01 3 Contract Value:540,5-�-8.00 E_ndValue: $40,548= PTM Job No: P 13-z 1 Owner Job No.: 61 1 1 4 Job Location: Orange, CA Description of Work: Safe Routes to School at Monr oeSt. Owner: City of Placentia Contact: Mr. Michael McConaha, Project Manager Address:401 E. Chapman Ave. GtL�/State: Placentia, CA 9z870 Telephone: (J 14)9 -8 1 J 1 j=ax No.: (J 14)5zS-46,t-O mail: administration@placentia.org Contract Date: July, 201 j Completed Date: December, zO 13 Contract Value: $50T 9.00 E_nd Value: $ I z3,3z4.00 Page 4 of 7 RTA® General UmineermnLo Services, Inc. Jcbs References 2®13 PTM Job No: P 1 5-22 Owner Job No.: ST-5 1 6 Job Location: La Palma, CA Description of Work: Walker Junior IJigh School Pedestrian Safety Improvements Project from Crescent to La Palma. Owner: City of La Palma Contact: Mr. Michael 5el6ap, Community Services Director ,address: 7322 Waller Street City/State: La Palma, CA 90623 Telephone: (714)00-3500 rax No.: (714)525-2141 F mail: miLe6@cityoflapalma.org Contract ate: 5eptem6er, 201 5 Completed ate: July, 2014 Contract Value: $ 1 10,707.00 End Value: $ 1 10,706.76 PTM Jo6 No: P 1 3-24 Owner Jo6 No.: 1 2- 14, Federal Prorect No. f J5IP3-5 5 1 2 (034) J06 Location: Costa Mesa, CA Description of Work: Intersection Improvements at Victoria St. & Valley Rd. and Pacific Ave. Owner. City of Costa Mesa Contact: Mr. Tom Banks, PE ,address: 7322 WalLerStreet City/State: Costa Mesa, CA Telephone: (714)754-5535 rax No.: (714)754-5264 E mail: tom.6anLs@costames9ca.aov Contract ate: July, 201 5 Completed ate: July, 201 5 Contract Value: $322,41 6.32 Fnd Value: $522,41 5.32 PTM Jo6 No: P 1 5-26 Owner Jo6 No. 301 0040 70 77 J06 Location: Moreno Valley, CA Description of Work: Fiscal Year 201 1/201 2 Citywide Pedestrian Enhancements in Moreno Valley CA. Owner: City of Moreno Valley Contact: Mr. buy Pe,an, PE ,address: 141 77 Frederick Street City/State: Moreno Valley, CA 2 Telephone: (95 041 5-5 1 15 rax No. 95 I .41 3.3 153 Email: guyp@moval.orS Contract ate: Au. -List, 201 3 Completed ate: August, 2014 Contract Value: $407,�41 .00 End Value: $407,940.50 PTM Jo6 No: P 15-27 Owner Jo6 No. None Jo6 Location: Irwindale, CA Description of Work: Installation of Speed Ta6le and Street Improvements at Ayon Ave. Owner: City of Irwindale Contact: Mr. Armando j Jegdahl ,address: 5050 North Irwindale CitvState: Irwindale, CA 91 706 TelePbone: (626)430-2200 rax No.: (626)962-42090 Contract ate: August, 2015 Completed ate: Sept., 201 3 Contract Value:$55,355.00 End Value: $53,53500 PTM Jo6 No: P 1 5-23 Owner-Jo6 No.: None Jo6 Location: San Bernardino, CA Description of Work: Sidewalk Project at Almond Ave. Owner: City of San P)er nardino Contact: Mr. Grant C, Mann, Froect Manager Address: 325 E-ast Third Street City/State: San 5ernardino, CA 92`i 1 5 Telephone: (9O9)337-7920 rax No.: (9O9)337-3 1 jO Contract ate: Au,aust, 201 5 Completed ate: July, 2014 Contract Value: $ 1 54, 108.00 End Value: $ 1 54, 1 03.25 Page 5 of 7 IDTA General Ifnaineerina Services, Inc. Jcbs References 2C13 PTM Job No: P 1 5-29 Owner Job No.: 1 5-COE5-511 Joh Location: Coronado, CA Description of Work: Scenic Bike Loop owner: City of Coronado Contact: Mr. Marco Mendoza, F ns. Tech. Address: 1 825 Strand Way Ciq/State: Coronado, CA 921 13 Telephone: (6 1 9)522-7584 Fax No.: (6 1 2)5 22- 1 7520 E-mail: mmendoza@coronado.cs.us Contract Date: September, 201 5 Completed Date: December, 2014 Contract Value: $71,804.00 E-nJValue: $71,805.51 PTM Job No: P 1 5-50 Owner Joh No. 5548 Joh Location: �Jemet, CA Description of Work: Safe Route, to School Project at Cawston Ave. & Monlo Ave. Owner: City of 1 '1emet Contact: Mr. Steve Latino, rF AJJress:445 E-ast Florida Avenue Cift/State: �Jemet, CA 92545 Telephone: (95 1)765-2362 Fax No.: (95 1)765-2557 E_mail: slatino@cityofhemet.org Contract Date: October, 201 5 CompleteJ Date: Auk, 201 4 Contract Value: $645, 106.00 Encl Value: i645, 106.76 PTM Job No: P 1 5-5 1 Owner Joh No.: None Joh Location: Colton, CA Description of Work: Street Improvement Plans, Quiet zone Owner. City of Colton Contact: Mr. Victor Ortiz Address: 650 North La Cadena Drive Cift/State: Colton, CA 92524 Telephone: (909)37 0-5065 Fax No.: (909)VO-5072 E_mail: vortiz@ci.colton.ca.us Contract Date: August, 201 5 Complete] Date: in -Process Contract Value: $929;961.00 E-nclValue: i98Z,53015 PTM Job No: P 1 5-52 OwnerJoh No. OS-0521 Joh Location: Corona, CA Description of Work: Traffic SiSnal Installation Lincoln Ave. & ParkriJge Ave. Owner; City of Corona Contact: Ms. ViLl i Li, P>= AJJress:400 S. Vicentia Avenue Ste. 21 O CitrL/State: Corona, CA 92882 Telephone: (95 1 )7 56-3 548 Fax No.: (95 1)279-5(2 7 E-mail: vikki.li@ci.corona.caus Contract Date: November-, 201 5 CompleteJ Date: Sept., 20 1 4 Contract Value: $552,109.00 E-nclValue: 5552,109.99 PTM Job No: P 1 5-35 Owner Joh No.: None Joh Location: Culver, CA Description of Work: Safe Rouges to School Project Lynwood to E-. owe. Owner: City of Culver City Contact: Mr. Sammy Komo Address: 9770 Culver City CitrL /State: Culver City, CA 9O232 Telephone: (3 l 0)255-5619 Fax No.: (5 l 0)253.5626mail Sammy.romo cuvercit9.or,7 Contract Date: Decemher, 201 5 CompleteJ Date: September, 2014 Contract Value: 8451,914.00 EnclValue: 5451.915.55 Page 6 of 7 ID -FA General Engineering Services, Inc. Jobs Ueferences 2®13 FTM Job No: F, j-55 Owner Job No.. None Job Location: City of Colton in San Bernardino County. Description of Work: Safe }zoute to School Morns Ejeme. School & William Jehue Middle School. Owner: County of San Bernardino Contact: Mr. victor Ortiz Address: 65o North La Cadena Drive Citt /state: Colton, CA9z3z4- Telephone: (9O9)570-5o65 rax No. (9O9)VO-5072 F mail: vortiz@ci.colton.ca.us Contract Date: December, 201 3 Completed Date: June, 2015 Contract Value: $ 1 8,888.00 E_nd Value: $ 1 8,888.00 PTM Job No: F 13-36 Owner Job No.: 4 1 040 ,Job Location: City of Redlands, Description of Wor- Safe Routes to Schools, Cycle 8 Owner: City of }zeAands Contact: Mr. ,Jason Montgomery Address: 3 j Cajon St. Suite 4 Citt /state: Redlands, CA 92373 Telephone: (9O9)798-7584 Pax No.: (°O9)789.7 670 mail:jmonta mery cityofredlands.org Contract Date: December, 201 j Completed Date: ,June, 2014 Contract Value: i775,8 1 8.00 Fnd Value: $770,049.9`F PTM Job No: F 1 5-V Owner Job No.: 41 040Jo6 Location: I-iawthorne, CA Description of Work: r urnishin, and Installing role and Associated Conduits and Full Boxes for the Installation of License Plate }zecoanition Cameras in Crenshaw Blvd. Owner: City of rIawthorne Contact: Mr. Alan Leung, FE- W. 1 26th Street Citc5/5tate: rIawthorne, CA902j0 Telephone: (3 I o)5+9-290 i Pax No.: O mail. aleun,@cityofhawthorne.ora Contract Date: May, 201 4 Completed Date: June, 201 -1- Contract Value: $ 5 3, 5 3 2.00 rnclValue: $35,352.00 PTM Job No: F 13-38 Owner Job No.: 07Aj5 j 2 (074X0204) Job Location: Los Angeles, CA Description of Worl : }zepair Damaged rump Stations at }zoute 105. Owner: Depaitment of Transportation Contact: Ms. Joan Crews, FE Address: 1727 50'h Street Citt /state: Sacramento, CAS 9BZB Telephone:(2j1)620-9.8j2raxNo.: NoneFinail:joan.crews@dot.ca.aov Contract Date: December, 2015 Completed Date: April, 201 j Contract Value: $715)9; I48.32 Fnd Value: $79 148.32 Page 7 of 7 KNOW ALL MEN BY THESE PRESENTS, That we, PTM GENERAL ENGINEERING SERVICES, INC. as Principal, and INTERNATIONAL FIDELITY INSURANCE COMPANY authorized to transact a general surety business in the State of NEW JERSEY bound unto CITY OF HUNTINGTON BEACH in the full and just sum of TEN PERCENT OF AMOUNT BID BOND NO. BBSU a corporation as Surety, are held and firmly (hereinafter called the Obligee) Dollars, ($ 10% ) 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 TRAFFIC SIGNAL MODIFICATIONS AT THE INTERSECTIONS OF GOTHARD STREET AND TALBERT AVE., GOTHARD STREET AND HEIL AVENUE AND AT SPRINGDALE STREET AND McFADDEN AVENUE. 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 17TH PTM GENERA'LI NGINEERING SERVICES, INC. day of tlizabeth H. Mendoza de McRae PRESIDENT/CFO By: Principal AUGUST , 2017 YEAR INTERNATION�IDELITY INSURANCE COMPANY Surety Attorney -in -Fact CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of LOS ANGELES On 9 . � /- ;2�/q before me, PHILIP VEGA, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared ELIZABETH H. MENDOZA de McRAE 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. PHILIP VEGA ) d COMM. # 2152121 { "o NOTARY PUSLIC•C to / r c�tmonM�� LOS ANGELES COUNTY Ill MY COMM, EXR MAY 31, 2020 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 o icial seal. Signature Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual El Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): El Partner — El Limited El General El Individual ❑ Attorney in Fact El Trustee ❑ Guardian or Conservator El Other: Signer Is Representing: ©2014 National Notary Association • www.Nationa]Notary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of LOS ANGELES On AUG 17 2017 Date personally appeared before me, KEVIN EDWARD VEGA, NOTARY PUBLIC Here Insert Name and Title of the Officer PHILIP E. VEGA 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. KEVIN EDWARD VEGA Notary Public - California Z°/� Los Angeles County Z Commission # 2151113 D My Comm Expires Apr 29, 2020 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 Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 02014 National Notary Association - www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 .v:^ ron .W I Via d 4. :i RECEIVED 2111 AUG 22 PM 1: 58 CITY CLERK CITY OF HUNTINGTON BEACH V TM Gcncral r ngineerin_g5crvicc5, Inc. 59,+2 Acorn St. Kivcr-91de, C,d, 9Z504 951.710-1000 City of Huntington 5cack Att: City Clef 2000 Main `7't Z'. rloor �Juntirigton Fjeac� Ca, 926$8 (714) 556-5227 Tillie or 5ij: 2:00Fm Date off- bic ::Tucgl a� Aussust 22, 201 7 rrajec1 't No, -IJII L� 1 s 1 0 78) CC 1 -+65 Desc: Gotkarc Cjt & Tal6crt Ave Gatka,J �5t & Heil Ave & Springdalc 5t & McFadJcn Avenuc. Taff-ic 5grtal Modifications, 5ID F-NGLO,5F-D - DO NOT OrE-N WIT1 i REGULAK MAIL. City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachea.gov Office of the City Clerk Robin Estanislau, City Clerk January 31, 2018 Steiny Electric Company 12907 E. Garvey Avenue Baldwin Park, CA 91706 RE: Traffic Signal Modifications at Gothard St.& Talbert Ave./Gothard St. & Heil Ave./Springdale St. & McFadden Ave. — CC-1465 Enclosed please find your original bid bond for CC-1465. Sincerely, Robin Estanislau, CIVIC City Clerk RE:ds Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand '�� SECTION C PROPOSAL for the construction of Traffic Signal Modifications from At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue And Springdale Street and McFadden Avenue CC No. 1465 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 60 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 18. Addenda The effect of all addenda to the contract documents shall be considered in the bid package and said addenda shall be made part of the contract documents and shall be returned with the bid package. Failure to submit any such addenda with the bid package may render the bid irregular and may result in its rejection by the AGENCY. 19. Bid Protest To be considered timely, a bid protest must be filed within the following time limits: (a) Protests based upon alleged defects or improprieties in the bid documents shall be filed prior to the date of bid opening. (b) All other protests must be filed within five calendar days after the protester knew or should have known the basis of the protest, but no later than five calendar days after the date of when the Bids were due to the AGENCY. 20. Questions to the Engineer Questions regarding the bid documents (i.e. plans, specifications, contract documents, bid forms, etc.) will be received by the Engineer up to five working days prior to the bid opening as specified in SECTION A. Questions asked of the Engineer after this time will not be addressed. B-6 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 13 l 1) (3Ot 1jo 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: I b °to Addenda No. Date Received Bidder's Signature C-2 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TAL,BERT AVENUE, GOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE BID ITEMS Item, Description Quantity Unite r Unit ,Cost' f -+Total *Cost'.., No K z;. (EX>tension)� 1 Mobilization 1 LS S a06000� $ �p 000 2 Furnish Project Traffic Control 1 LS �00t)- $ t%Ob— 3 Furnish and Install Traffic Striping and Signing 1 LS ,420" $ al_ g� 4 Preparation of WPCP and installation and of Maintenance of 1 LS S' S BMP's per the approved WPCP. �5p�" Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case A and Typical Section at New Curb Ramps 5 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 2 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, MOO- S `r� S I l 0o retaining curb, slot pave, etc.) i Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case B and Typical Section at New Curb Ramps 6 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 1 EA appurtenances, curb and gutter, depressed curb, sidewalk, S Q _ truncated, domes, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case C and Typical Section at New Curb Ramps 7 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 5 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.). Excludes the Northeast Gothard Street Heil Avenue. S 0 WO S 4,50(� corner of and , Construct Curb Ramps, Truncated Domes, Sidewalk, Curb and Gutter and Railing at the Northeast Corner of Gothard 8 Street and Heil Avenue and per Detail on Sheet 5. (Item 1 LS includes all appurtenances, curb and gutter, depressed curb, sidewalk, railings, truncated domes, retaining curb, slot pave, r� $I d��� S 00— etc.) Construct Curb, Access Ramps and Concrete Sidewalk on the Raised Island at the Southwest quadrant of the Intersection of 9 Springdale Street and McFadden Avenue. See the Details on 1 LS Sheet 5. (Item includes all appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, S �'Oob S 5r+100� slot pave, etc.) 10 Modify Traffic Signal at Gothard Street and Talbert Avenue. in 1 LS ' 533 $ 0�00� Item includes all work plans not included in other items. 11 Modify Traffic Signal at Gothard Street and Heil Avenue. Item includes in included in items. 1 LS $ 007i $ �3 OOJ� all work plans not other r 12 Modify Traffic Signal at Springdale Street and McFadden Ave. Item includes all work in not included in other items. 1 LS S 4- W S `►'iS plans C-2.1 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) GOTHARD STREET AT TALBERT AVENUE, GOTHARD STREET AT HELL AVENUE AND SPRINGDALE STREET AT MCIFADDEN AVENUE Item�r Description r.Quantity, Unit; Uriit Cost Total Cost . '`No (Extension) m 00 n TOTAL BID AMOUNT TOTAL BID AMOUNT IN WORDS: Note: Refer to Section 9, Measure and Payment. All extensions of unit prices will be subject to verification by Owner. In case verification is required between the unit price and the extension, the unit price will govern. The Owner reserves the right to reject any or all proposals and bid items. The City will provide the traffic signal equipment, as listed in the pole schedules, (also includes anchor bolts) to the contractor. The contractor is to pick up the materials, with its own labor, at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 536-5530. C-2.2 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 or $10,000, whichever is greater, and the portion of the work to be done by such subcontractor. Bid Items) Name and Address of Subcontractor State License Number Class DIR PWC Registration # Dollar Amount % of Contract C-3a [00000 5 Us n * 19 C190 �-Ar [DI tt Orb. LIA Ioobod(Vto q�Sr + Pto #5-q Apo EOWA41FS CDVWA I e..�p, P. loom I�YS a51�00V I3 4- By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID 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%. a`�_��, at �,AupWtN 4WL, ti Date City State ©� N ZU.P? being first duly sworn, deposes and says that he or she is of sib im4 t tA&cjAxt-, UwP7kJ4 t 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. 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 Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue, (I)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: � � - 1� -Wr: WL -UtA PP - ?Mt DIE1A Title C-5 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 "�'W No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. Date: DOWEl� ZIAPPSS1Qi15 Title C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Bidder Name 1 � qZ r� E . 6 AAAJ 4J Business Address NAUDw I N PAW, CIA City, State Zip (o-6 ) fib)--(0�5 DZU,PP (.• 51111JJ LO . UV, -- Telephone Number Email Address -'(0)' 2W A"gTt-" State Contractor's License No. and Class �9 -- \-3 -1 r\ Ori mal Date Issued t- 30 - 19 Expiration Date The work site was inspected by WA68OWWC of our office on g - 17 , 2011. The following are persons, firms, and corporations having a principal interest in this proposal: DAM I LKW — PAkS 6U (, AU c, U - 't4 a /%\,*�S V- A%M {q$ V1- C` Li 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. Printed or Typed Signature C-8 NOTARY CERTIFICATE Subscribed and sworn to before me this _ day of , 201_ 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 ) County of ) On Month, Day, and Year personally appeared before me, Insert Name and Title of Notary 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 Signature of Notary Public (PLACE NOTARY SEAL ABOVE) C-9 Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work, specifically referencing the construction of {Describe specific work and experience necessary for project. For example, "Sanitary sewer line installation of at least of 1,000 of 8-inch and greater in public right-of- way. Sanitary sewer lift stations of similar size, project work within public streets, an area containing high ground water and pipeline construction in high ground water regions with trench depths of 8-feet to the invert."}. 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: 1P0o (iav-4,ST Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Provide additional project description to show similar work: Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Provide additional project description to show similar work: Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Provide additional project description to show similar work: C-to Date Completed Date Completed 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. M1) A)J, iJ [ tit AfkAb Name of proposed Project Manager Telephone No. of proposed Project Manager: Grc'6 - 9 b a - 10�5 K\) A1Vto&uC tKpboi fia"y � Project Name & Contract Amount Type of Work Date Completed Project Name & Contract Amount Type of Work Project Name & Contract Amount Type of Work 0140 ((,AAbuNO Name of proposed Superintendent Telephone No. of proposed Superintendent: V 7G - _t V � - ( O q Date Completed Date Completed At 1 �Ai � a-�t�' v�P o�► �� �� S� Project Name & Contract Amount Type of Work Date Completed Project Name & Contract Amount Type of Work Project Name & Contract Amount Type of Work C-t t Date Completed Date Completed CONTRACTOR REGISTRATION WITH CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS (DIR) CERTIFICATE Pursuant to SB 854 (citing Labor Code Section 1771.1(a)), passed by the California State Senate on June 20, 2014, established a new public works Contractor Registration Program, which requires all contractors and subcontractors bidding and performing work on Public Works Projects to register on an annual basis (each July I through June 30 state fiscal year) with the California Department of Industrial Relations (DIR). Currently the annual non-refundable registration fee for Contractors is $300. Each contractor to whom a public works contract has been awarded shall sign the following certificate. DIR FACT SHEET on SB 854 http://www.dir.ca.gov/DLSE/PublicWorks/SB854FactSheet_6.30.14.pdf DIR's Contractor Registration Link — Call (844) 522-6734 https://efiling.dir.ca. gov/P WCR/ActionServlet?action--displayP WCRegistrationFortn DIR's Contractor Registration searchable database: https://efiling.dir.ca.gov/PWCR/Search.action I am aware and will comply with the provisions of Labor Code Section 1771.1(a) which states: "A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5. It is not a violation of this section for an unregistered contractor to submit a bid that. is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the contractor is registered to perform public work pursuant to Section 1725.5 at the time the contract is awarded." I furthermore will comply by providing proof of registration with DIR as the primary contractor, as well as for ALL subcontractors at the time of submitting the bid. Date: � " PWC Registration #: IDODU j00 5 Title C-12 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 requirements 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: aTt l ►J !A �1,� Cjldlt�C, �SD tM,PeA1�1 l/' Contact Person: i-)%v 1--L Z-Lx PP Contact P 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-13 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder , proposed subcontractor hereby certifies that he has "`1 . ...............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. C-14 PUBLIC CONTRACT C O D E 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. Signature Print Name Date 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? Ll Yes No If the answer is yes, explain the circumstances in the following space. C-15 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. Il•-L zL'P - prtqs Signature Print Name Date C-16 IN oncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY of Huntington Beach DEPARTMENT OF PUBLIC WORKS. In 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 Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. B cautioned that making a false certification may subject the certifier to criminal prosecution. Sianaturt I Print Name Date C-17 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 detennined 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. okA uc, tpAaApt� 1�ti ImPe q- Dr-1 Print Name Date C-18 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. C-19 DISCLOSURE OF LOBBYING ACTIVITIES 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: Pa. contract Fla. bid/offer/application C a. initial Brant b. initial award b. material chance c. cooperative agreement c. post -award d. loan For Material Change Only: e. loan guarantee year quarter_ f. lAn insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, ElEnter Name and Address of Prime: Prime E] 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 0 (If individual, last name, first name, MI) (attach Continuation 11. Amount of Payment (check all that apply) $ actual planned 12. Form of Payment (check all that apply): 8 a. cash 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. I Oa) (last name, first name, MI) heet(s) if necessary) 13". Type of Payment (check all that apply) a. retainer \b one-time fee c. commission d: contingent fee b. in -kind; specify: nature — e deferred value f. other, specify 14. Brief Description of Services Performed or to be performed and Date(s)'of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 1 1: (attach Continuation Sheet(s) if necessary) 15. Continuation Sheet(s) attached: Yes No ❑ 16. Infonnation 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 fails to file the required Title: disclosure shall be subject to a civil penalty of not less than $ I0,000 and not more than $100,000 for each such failure. Telephone No.: —Date: Federal Use O C-20 Authorized for Local Reproduction Standard Form - LLL 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 tiling 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 tiling 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 I (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 employees) 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. sr-1-1-I.-Instnictions Rev 06-04-4o«exolr» C-21 Local Assistance Procedures Manual Exhibit 15-G Construction Contract DBE Commitment EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT 1. Local Agency: City of Huntington Beach 2. Contract DBE Goal: 10.00% 3. Project Description: Traffic Signal Modifications at Gothard St/Talbert/Av, Gothard St/Heil Av, Springdale St/McFadden 4. Project Location: CGothard SUTalbert/Av, Gothard St/Heil Av, Springdale St/McFadden Av. p 00 5. Bidder's Name: JT16 [N� 19V4�_V_, ItDWAPLA 6. Prime Certified DBE: ❑ 7. Bid Amount: 37 8. Total Dollar Amount for ALL Subcontractors: 9. Total Number of ALL Subcontractors: 10. Bid Item Number 11. Description of Work, Service, or Materials Supplied . 12DBE Certification Number 13. DBE Contact Information (Must be certified on the date bids are opened) 14, DBE Dollar Amount No fu�t�,� RA�a$wo.n.�Lr APo C)4C Rfws-tS ,1P t. A-"> 0 � 09 5l,000,— Local Agency to,Complete this Section, 15. TOTAL CLAIMED DBE PARTICIPATION 21. Local Agency Contract Number:CC-1465 13� 22. Federal -Aid Project Number: HSIPL-5181(178) 23. Bid Opening Date: 24. Contract Award Date: IMPORTANT: Identify all DBE firms being claimed for credit, regardless of tier. Names of the First Tier DBE Subcontractors and their respective item(s) of work listed above must be consistent, where applicable with the names and items of the work in the Local Agency certifies that all DBE certifications are valid and information on this form is complete and accurate. "S bcontractor List" submitted with your bid. Written confirmation of ea ted BE is re 'red. 25. Local Agency Representative's Signature 26. Date 16. Preparer's Signature 17. Date WN-U. pW AnA> U�16-11165 - 455 27. Local Agency Representative's Name 28. Phone 18. Preparer's Name 19. Phone �I (�1EC?tow 0 F �Si l M.�AZt N� 29. Local Agency Representative's Title 20. Preparer's Title DISTRIBUTION: 1. Original — Local Agency 2. Copy — Caltrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract execution may result in de -obligation of federal funds on contract. Include additional copy with award package. ADA Notice: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654- 3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. Page 1 of 2 C-22 Local Assistance Procedures Manual Exhibit 15-H DBE Information - Good Faith Effort EXHIBIT 15-H DBE INFORMATION —GOOD FAITH EFFORTS DBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. HSIPL-5181 (178) Bid Opening Date The established a Disadvantaged Business Enterprise (DBE) goal of 10.00% 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.): Names of DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation C-23 Local Assistance Procedures Manual Exhibit 15-H 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 Performs Item (Y/N) Breakdown of Amount Percentage Items N Of 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: 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: C-24 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: 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. C-25 Local Assistance Procedures Exhibit 12-B Bidder's List of Subcontractors (DBE and NON -DBE) Exhibit 12-B Bidder's List of subcontractor (DBE and Non -DBE) Part 1 As of March 1, 2015 Contractors (and sub -contractors) wishing to bid on public works contracts shall be reostered with the State Division of Industrial Relations and certified to bid on Public Works contracts. Please registerat: https://efiling.dir.ca.gov/PWCR/ActionServlet?action=di splay PWCRegistrati onForm In accordance with Title 49, Section 26.11 of the Code of Federal Regulations, and Section 4104 of the Public Contract Code of the State of California, as amended, the following information is required for each sub -contractor who will perform work amounting to more than one half of one percent (0.5%) of the Total Base Bid or $10,000 (whichever is greater). Photocopy this form for additional firms. Subcontractor Name and Location Line Item & Description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor License Number DBE (Y/N) DBE Cert Number Annual Gross Receipts DIR Reg Number Na ap ` V\ �Wwi�f\1vM ��V SlA� C� �+ �� 6�V A IY�' '7 /� g�3$G d' ' _ <$1 million <$5 million City, State, A7LxiA �i0�tPb <$10 million <$15million of Firm:yrs. N e: ^ t u to �/ t , L40PS qq by O L �4518 _ _ <$1 million <$5 million City, State: 000o �t 10 <$lOmillion <$15 million ge of Firm:_yrs. Name: 1 1 1% 1 i1 n A��� )Wr+ Doe I C�1 (�• ^�:'->',�,,`f •'� 4..: �..�.: <$1 million <$5 million City, State: v�►u►� ►'t� woo IQ9 5 <$10million <$15 million _Age of Firm:_yrs. Name: ; <$1 million <$5 million City, State: 1771 <$10 million <$15 million Age of Firm:yrs. Name: .,Lj - <$1 million <$5 million City, State: Lj <$10 million <$15 million Age of Firm:yrs. Name: , .,; ;:,',:.; - <$1 million <$5 million City, State: <$10mill'on <$15 million Age of Firm:_yrs. Distribution: 1) Original -Local Agency File 2) Copy-DLAE w/ Award Package Page 26 of 2 Local Assistance Procedures Exhibit 12-B Bidder's List of Subcontractors (DBE and NON -DBE) t - B Bidder's List of subcontractor (DBE and Non -DBE) Part 2 In accordance with Title 49, Section 26 of the Code of Federal Regulations, the Bidder shall list all subcontractor who provide a quote or bid but were not selected to participate as a subcontractor on this project. Photocopy this form for additional firms. Subcontractor Name and Location Line Item & Description Subcontract Amount Percentage of Bid Item Sub- contracted Contractor License Number DBE (Y/N) DBE Cert Number Annual Gross Receipts DIR Reg Number Name: 'r<--' ' w�. •:'.tF'`,�<;r,,,, <$1 million <$5 million City, State: \\'O�� 'v <$10 million <$15 million Age of Firm:_yrs. Name: ' .f '- - ' <$1 million <$5 million City, State: < 10 million <$15 million Age of Firm:_yrs. Name: • <$1 million <$5 million City, State: <$10 million <$15 million Age of Firm:_yrs. Name: fi: <$1 million 5 million City, State: <$10 million <$15 million ' Age of Firm:_yrs. Name: • <$1 million million City, State: <$10 million <$15 million Age of Firm:yrs. Name:i - <$1 million <$5 million City, State: <$10 million <$15 million Age of Firm:rs. Distribution: 1) Original -Local Agency File 2) Copy-DLAE w/ Award Package Page 27 of Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby make, constitute and appoint Anne Wright, Cyndi Beilman, Dana Michaelis, Individually of La Mesa, CA, its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by the shareholders of the corporation. In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on this 1 st day of July, 2015. WESTERN SURETY COMPANY ��SE pV,%'sue aul T. Bruflat, Vice President State of South Dakota 1 County of Minnehaha J ss On this lst day of July, 2015, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires S. EICH f February 12, 2021 ' NOTARY PUBLIC ' i�SOUTH DAKOTA�i S. Eich, Notary Public CERTIFICATE I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof 1 have hereunto subscribed my name and affixed the seal of the said corporation this 14 th day of August 1 2017 WESTERN SURETY COMPANY aW�4�p Ajt�ia 2 / L. Nelson, Assistant Secretary Forth F4280-7-2012 Authorizing By -Law ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the shareholders of the Company. Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile. BID BOND CONTRACTOR (Name, legal status and address) Steiny Electric Company 12907 E. Garvey Avenue Baldwin Park, CA 91706 OWNER: (Name, legal status and address) City of Huntington Beach 2000 Main Street, Huntington Beach, CA 92648 BOND AMOUNT: ten percent (10%) of total amount bid PROJECT: SURETY: (Name, legal status and address) Western Surety Company 1455 Frazee Road #300 San DieLo, CA 92108 This document has important legal consequences. Consultation with an attorney is encouraged with respect to its completion or modification. Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. (Name, location or address, and Project number. if any) Traffic Signal Modifications at the Intersection of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such tithe period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. MM64 4th day of Ctiy t, 2017 Eleric o an ' (Witness) CAP&(, tNi% > (Prin (Seal) (Title i Z le S Western Sure om a (Witness) (SUIT& f ' (Seal) (Title) Anne Wright, Attorney -in -Fact This Document conforms to the AIA Document A310""— 2010 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County of San Diego On August 14, 2017 Date personally appeared before me, Pam Davis , Notary Public, Insert Name of Notary exactly as it appears on the official seal Anne Wriqht me(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), DAVISand that by his/her/their signature(s) on the instrument the PAM COMM. # AVIS 4 person(s), or the entity upon behalf of which the person(s) y ms NOTARY PUBLIC • CALIFORNIA s acted, executed the instrument. SANDIEGCOUNTY Commission Expires Oct. 20, 1 certifY under PENALTY OF PERJURY under the laws of --- the State of California that the foregoing paragraph is true and correct. Witness my hand and icial seal. �' II Signature Place Notary Seal Above Signatu of Notary Public Pam Davis 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 the 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 ❑ Limited ❑ General d Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer —Title(s): ❑ Partner ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Los Angeles ss. On August 22, 2017 before me, Cynthia Perez, Notary Public Date Name and Title of Officer (e g. 'Jane Doe, Notary Public") personally appeared Daniel Zupp******************************************** Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/hey executed the same in his/heBlIhe-ir authorized capacity(ies), and that by his/her4hek 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 CYNTHIA PEREZ COMM. #2044560 y IL v NOTARY PUBLIC-CALIFORNIA T yrye LOS ANGELES COUNTY °, ,• My Comm. Expires Oct 7, 2017 (Seal) OPTIONAL Though the information below is not required by law, it mayprove valuable to persons relying on the document and could prevent fraudulent removal and reattachment ofthis form to another document. Description of Attached Document: PROPOSAL - CITY OF HUNTING BEACH - TRAFFIC SIGNAL Title or Type of Document: MODIFICATION Document Date: 8/22/2017 Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer Signer's Name: ❑ Individual Q Corporate Officer - Title(s): ❑ Partner(s) - ❑ Limited ❑ Attorney -in -Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: ❑ General Number of Pages Vice President Top of thumb here \\Sshv01\Users\cper98\My DOCUmentS\AP FILES\2015 Notary Forms blank 8/22/2017 2017 AUG �22 PM 1 • ! 4 `� Y 'x H t CITY, M It1.+NTIN0TQ!� B� CH y � ` y 4 ip�X7 IT, ..... 1p p + . ... __. ,.:� ��,sz,� r_..{:•,?. t� ,� _� a�.�.xl�.F�s... � �' _,tip? r4ro.�, . ELECTRIC COMPANY LIC#1027830 Bidder: Steiny Electric Company 12907 E Garvey Ave. Baldwin Park, CA 91706 Project: Traffic Signal Modifications Gothard St & Springdale St. CC No. 1465 Federal Project HSIPL-5181(178) City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 r x' xiy'.li Ya c�> hFtV q Cti' s fe . , , "gyp . x .++ a;� � � b '' V} , wat City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Robin Estanislau, City Clerk January 31, 2018 Sturgeon Electric California, LLC 13501 Benson Avenue Chino, CA 91710 RE: Traffic Signal Modifications at Gothard St.& Talbert Ave./Gothard St. & Heil Ave./Springdale St. & McFadden Ave. — CC-1465 Enclosed please find your original bid bond for CC-1465. Sincerely, i 4 `: Robin Estanislau, CIVIC City Clerk RE:ds Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand SECTION C PROPOSAL for the construction of Traffic Signal Modifications from At the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue And Springdale Street and McFadden Avenue CC No. 1465 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 60 working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, find bid bond in the amount of 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 forlo % ", 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 SECTION C PROJECT BID SCHEDULE CC-I465, HSI PIL-5I8I (178) OOTHARD STREET AT TALBERT AVENUE, OOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MCFADDEN AVENUE BID ITEMS Item Description, Quantity Unit Unit Cost- ".Total Cost . No. (Extension) 1 Mobilization 1 LS $ $ 2 Furnish Project Traffic Control 1 LS $ 8, q 84. $ 3 Furnish and Install Traffic Striping and Signing 1 LS $ ISM g75• $ I51$75. 4 Preparation of WPCP and installation and of Maintenance of 1 LS $ �� 123. $ Ni IZ3 7 BMP's per the approved WPCP. Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case A and Typical Section at New Curb Ramps 5 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 2 EA appurtenances, curb and gutter, depressed curb, sidewalk, $ 13,3b1 — $ truncated domes, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case B and Typical Section at New Curb Ramps 6 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 1 EA appurtenances, curb and gutter, depressed curb, sidewalk, $ 16,1U. $— truncated, domes, retaining curb, slot pave, etc.) Construct Curb Access Ramp per Caltrans Standard Plan No. A88A, Case C and Typical Section at New Curb Ramps 7 Adjacent to AC Paving Detail on Sheet 5. (Item includes all 5 EA appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, slot pave, etc.). Excludes the 11653, 40 57 '747, Northeast corner of Gothard Street and Heil Avenue. $ $ Construct Curb Ramps, Truncated Domes, Sidewalk, Curb and Gutter and Railing at the Northeast Corner of Gothard 8 Street and Heil Avenue and per Detail on Sheet 5. (Item 1 LS includes all appurtenances, curb and gutter, depressed curb, sidewalk, railings, truncated domes, retaining curb, slot pave, $ 17,539.— $ 17� 539•" C Construct Curb, Access Ramps and Concrete Sidewalk on the Raised Island at the Southwest quadrant of the Intersection of 9 Springdale Street and McFadden Avenue. See the Details on 1 LS Sheet 5. (Item includes all appurtenances, curb and gutter, depressed curb, sidewalk, truncated domes, retaining curb, $ $ slot pave, etc.) i I 10 Modify Traffic Signal at Gothard Street and Talbert Avenue. Item includes in included in items. 1 LS $ 30 0a0, $ 30/ OaO. all work plans not other 11 Modify Traffic Signal at Gothard Street and Heil Avenue. Item includes in included in items. 1 LS $ 103,511. $ 103F 591. all work plans not other 12 Modify Traffic Signal at Springdale Street and McFadden Ave. Item includes all work in plans not included in other items. 1 LS $ y5I sy7 $ 48,S47.— C-2.1 SECTION C PROJECT BID SCHEDULE CC-1465, HSIPL-5181(178) OOTHARD STREET AT TALBERT AVENUE, OOTHARD STREET AT HEIL AVENUE AND SPRINGDALE STREET AT MClFADDEN AVENUE Item t . - Description, Quantity Unit Unit Cost Total Cost . TOTAL BID AMOUNT $ 3a01 Io7 TOTAL BID AMOUNT IN WORDS: Tree. kyJaJ siO Aim&Ad dour 69,re-off den dollars "d zirb cenis Note: Refer to Section 9, Measure and Payment. All extensions of unit prices will be subject to verification by Owner. In case verification is required between the unit price and the extension, the unit price will govern. The Owner reserves the right to reject any or all proposals and bid items. The City will provide the traffic signal equipment, as listed in the pole schedules, (also includes anchor bolts) to the contractor. The contractor is to pick up the materials, with its own labor, at the City Yard, 17371 Gothard Street. Contact George Ruff two working days in advance for pick up at (714) 536-5530. C-2.2 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 or $10,000, whichever is greater, and the portion of the work to be done by such subcontractor. Bid Item(s) Name and Address of Subcontractor State License Number Class DIR PWC Registration # Dollar Amount % of Contract ID, � ( 5nnl-lnscv� E(.c�l�ric 0(0%i . CA ` ?-V4-7 61g51b C-10 100000 16 10 q�2so- 2.5/ µear- CdV► Car►S-iwLb&-A Cpvin0� I CA 91-793 9'i S °I 55 q 1000012 & 99 114, 707 - 33 '/. 3 Co�� TracKirlq ,✓nc. QiVer*'Jf, jCA 925o9 991la2- C-32. 100001n50 10)9DO" 2.11 By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND 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 8i22n7 , at Chino , CA Date City State Steven P. Goad being first duly sworn, deposes and says that he or she is Vice President of Sturgeon Electric California, LLC 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. Sturgeon Electric California, LLC Name of Bidder Signature of Bidder 13501 Benson Avenue, Chino, CA 91710 Address of Bidder C-4 California All -Purpose Certificate of Acknowledgment A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Bernardino a S.S. On August 22, 2017 before me, AnclPla Sherlin, NnitqrV Public personally appeared Steven P. Goad who proved to me on the basis of satisfactory evidence to be the personA whose name(,) is/a.re-subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/hedtheir authorized capacity�esj, and that by his/her/their signature(s) on the instrument the person-W, or the entity upon behalf of which the persons) 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. ANGELA K. SHE comm. 0217654S Notary Public • cdoonpA WITNE y ha . d an official seal. z San Bernard t pyol�t / 1 OPTIONAL INFORMATION ,.. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document titled/for the purpose of containing pages, and dated The signer(s) capacity or authority is/are as: 0 Individual(s) ' i Attorney -in -fact F; Corporate Officer(s) I-- Guardian/Conservator i_` Partner - Limited/General L­ Trustee(s) Other: representing: Method of Signer Identification Proved to me on the basis of satisfactory evidence form(s) of identification j credible witness(es) Notarial event is detailed in notary journal on - Page # Entry # Notary contact: Other Additional Signer [� Signer(s) Thumbprints(s) UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue, (I)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Date: August 22, 2017 Sturgeon Electric California, LLC Contractor By Steven P. Goad Vice President Title C-5 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 ® No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. Date: August 22, 2017 Sturgeon Electric California, LLC Contractor By Steven P. Goad Vice President Title C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Sturgeon Electric California, LLC Bidder Name 13501 Benson Avenue Business Address Chino CA 91710 City, State Zip 909 ) 591-0000 asherlin@myrgroup.com Telephone Number Email Address 1009619, A, C-10 State Contractor's License No. and Class 12/10/2015 Original Date Issued 12/31 /2017 Expiration Date The work site was inspected by Nickolas Roberts of our office on Auy4 12 , 201-7 The following are persons, firms, and corporations having a principal interest in this proposal: Mindy Mclff - President Steven P. Goad - Vice President Richard Reyes - Secretary and Vice President Judy Weaver - Treasurer 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. Sturgeon Electric California, LLC Company Name Signature of Bidder Steven P. Goad, Vice President Printed or Typed Signature C-8 NOTARY CERTIFICATE Subscribed and sworn to before me this 22 day of August 12017 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 San Bernardino On August 22, 2017 Month, Day, and Year personally appeared before me, Angela Sherlin, Notary Public Insert Name and Title of Notary Steven P. Goad 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. r? , Signature ANULA R. COMM. L 7i 5 Notary Pubk • CaMonf San Bernwd Cam► Comm. Ex ires De,- 22 2�0 ignature of Notary Public (PLACE NOTARY SEAL ABOVE) C-9 Bidder's Project History For the purposes of this project, the bidder shall provide project history of similar work, specifically referencing the construction of {Describe specific work and experience necessary for project. For example, "Sanitary sewer line installation of at least of 1,000 of 8-inch and greater in public right-of- way. Sanitary sewer lift stations of similar size project work within public streets an area containing high ground water and pipeline construction in high ground water regions with trench depths of 8-feet to the invert."I. 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: l . City of Santa Clarita - Name and Address of Public Agency Name and Telephone No. of Project Manager: Joseph Meidl - 909-536-5712 1,992,900.00 Contract Amount intelligent Transportation Systems Phase IV July 2017 Type of Work Provide additional project description to show similar work: 2. City of San Marino Name and Address of Public Agency Name and Telephone No. of Project Manager: Joseph Meidl - 909-536-5712 550,579.00 Contract Amount Date Completed Street Light Conversion Project July 2017 Type of Work Provide additional project description to show similar work: 3. Los Angeles DOT Name and Address of Public Agency Name and Telephone No. of Project Manager: Joseph Meidl - 909-536-5712 21,000 Contract Amount Traffic Signal Modification Type of Work Provide additional project description to show similar work: C-10 Date Completed 10/2016 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. Joseph Meidl Name of proposed Project Manager Telephone No. of proposed Project Manager: 909-536-5712 Caltrans 07-240704 $5,203,000.00 High Advisory Radio and Flashing Beacons Current Project Name & Contract Amount Type of Work Date Completed Agoura Hills Widening $496,484 Street Lighting and Traffic Signal 07/2017 Project Name & Contract Amount Type of Work Date Completed Wilmington Ave Interchange Street Liahtino and Traffic Sianal Current Project Name & Contract Amount Type of Work Date Completed Wayne Tesoriero Name of proposed Superintendent Telephone No. of proposed Superintendent: 909-536-8476 Caltrans 07-2159C4 $990,464 Street Lighting and Traffic Signals ' Current Project Name & Contract Amount Type of Work Date Completed Santa Clarita ITS Phase IV 1,992,900.00 Conduit FihPr Optor Cahle and Radio systems 2017 Project Name & Contract Amount Type of Work Date Completed San Marino St. Light Conversion $550,579 Street Lighting July 2017 Project Name & Contract Amount Type of Work Date Completed C-11 CONTRACTOR REGISTRATION WITH CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS (DIR) CERTIFICATE Pursuant to SB 854 (citing Labor Code Section 1771.1(a)), passed by the California State Senate on June 20, 2014, established a new public works Contractor Registration Program, which requires all contractors and subcontractors bidding and performing work on Public Works Projects to register on an annual basis (each July 1 through June 30 state fiscal year) with the California Department of Industrial Relations (DIR). Currently the annual non-refundable registration fee for Contractors is $300. Each contractor to whom a public works contract has been awarded shall sign the following certificate. DIR FACT SHEET on SB 854 http://www.dir.ca.gov/DLSE/PublieWorks/SB854FactSheet_6.30.14.pdf DIR's Contractor Registration Link — Call (844) 522-6734 https://efiling. dir.ca. gov/P WCR/ActionServlet?action=displayPWCRegistrationForm DIR's Contractor Registration searchable database: https://efiling.dir.ca.gov/PWCR/Search.action I am aware and will comply with the provisions of Labor Code Section 1771.1(a) which states: "A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5. It is not a violation of this section for an unregistered contractor to submit a bid that is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the contractor is registered to perform public work pursuant to Section 1725.5 at the time the contract is awarded." I furthermore will comply by providing proof of registration with DIR as the primary contractor, as well as for ALL subcontractors at the time of submitting the bid. Date: August 22, 2017 PWC Registration #: 1000037 3a7 Sturgeon Electric California, LLC Contractor By teven P. Goad Vice President Title C-12 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 requirements 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: Sturgeon Electric California, LLC Contact Person: Nickolas Roberts Contact Phone: 909-536-8693 Signed: I Date: August 22, 2017 j *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-13 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder X , proposed subcontractor hereby certifies that he has X . ...............has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has 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. C-14 PUBLIC CONTRACT C O D E 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 X been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public 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 ctioned that making a false certification may subject the certifier to criminal prosecution. -1J �� Signature Steven P. Goad 08/22/2017 Print Name Date 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. C-15 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. Steven P. Goad 08/22/2017 Signature Print Name Date C-16 IN oncollusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY of Huntington Beach DEPARTMENT OF PUBLIC WORKS. In 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 Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature ofthis Non -collusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. — Steven P. Goad 08/22/2017 Signature / I Print Name Date C-17 California All -Purpose Certificate of Acknowledgment_ A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Bernardino s.s. On August 22, 2017 before me, vela Sherlon, Notary Puhli� personally appeared Steven P. Goad who proved to me on the basis of satisfactory evidence to be the person() whose name() is/are subscribed to the within instrument and acknowledged to me that he/she/trey-executed the same in his/her/their-authorized capacity(aes)-, and that by his/her/their-signatureGs,)"on the instrument the persons), 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 Arm AMCELA K. 3MERl� true and correct.�� COMM.yPublic is - C tw arc Notary Pr�liC • Colitis WITNESS my h1nd an official seal. s San Bernardino Cou�lp COMM. ires Qet. OPTIONAL INFORMATION Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document titled/for the purpose of containing pages, and dated The signer(s) capacity or authority is/are as: EJ Individual(s) Ci Attorney -in -fact Corporate Officer(s) C Guardian/Conservator ) Partner - Limited/General C' Trustee(s) ❑ Other: representing: Method of Signer Identification Proved to me on the basis of satisfactory evidence: j form(s) of identification L_f credible witness(es) Notarial event is detailed in notary journal on: Page # Entry # Notary contact: i Other Additional Signer L�i Signer(s) Thumbprints(s) 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. Steven P. Goad 08/22/2017 Print Name Date C-18 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. C-19 N/A DISCLOSURE OF LOBBYING ACTIVITIES 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: Pa. contract Fla. bid/offer/application C a. initial b. erant b. initial award b. material chanee 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 known: b. Individuals Performing Services (including address if different from No. I Oa) (last name, first name, MI) (attach Continuation Sheet(s) if necessary) 11. Amount of Payment (check all that apply) 13. Type of Payment (check all that apply) $ I I actual planned a. retainer b. one-time fee 12. Form of Payment (check all that apply): c. commission Ha.cash d. contingent fee b. in -kind; specify: nature e deferred value _ f. other, specify 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including ofticer(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 reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Signature: Print Name: Steven P. Goad Title: Vice President 909-591-0000 08/22/2017 Telephone No.: —Date: Authorized for Local Reproduction Standard Form - LLL C-20 `City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE For Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue — CC 1465 HSIPL5181(178) August 11, 2017 Notice to All Bidders: Please note the following clarification to the Project Plans, Specifications, and Technical Provisions: 1) FEDERAL LABOR RATES. The Federal Labor Rates contained in Appendix I of the specifications for the: Traffic Signal Modifications at the intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and Springdale Street and McFadden Avenue - CC1465 HSIPL5181(178) shall be replaced with the following attached documents: The Federal Labor Rates dated August 4, 2017 shall be the labor rates in effect for the subject project. 2) PAGE C-1— SECTION 3 — PROPOSAL The following sentence shall be inserted at the end of the first paragraph: The undersigned acknowledges that the issuance of Notice to Proceed will occur approximately three months after the award of contract to allow procurement time for the city furnished equipment. This is to acknowledge receipt and review of Addendum Number One, dated August 11, 2017. 5kraeo» QCZis a// rnia Compdny Name Date M,let ale ge rnaxt By All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call William F. Janusz at (714) 536-5431. THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No, 7774433 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West Amercan Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint. Brenda Johnston Cindy Stellhorn; Cynthia L. Jenkins; Edward L. Mournighan; Ginger J. Krahn; Kimberly E. Kinkead; Michael H. Bill; Michael J. Marsella; Michael M. Bill; Rebecca A. Virt; Sheree Hsieh all of the city of Indianapolis state of IN each individually if there be More than one named, its true and lawful attorney -in -fact to make, execute, seal. acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations. in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 19th day of May 2017 The Ohio Casualty Insurance Company ° " f Liberty Mutual Insurance Company tC W 0) West American Insurance Company STATE OF PENNSYLVANIA ss David M Carey;"Assistant Secretary ++ s- COUNTY OF MONTGOMERY NOn ibis 19th day of May 2017 , before me Personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance v E— v N Company_ The Ohio Casualty Company. and West American Insurance Company, and that he, as such, be ng authorized so to do, execute the foregoing instr;,ment for the purposes >,(I) LU O 2 M therein contained by signing on behalf of the corporations by himself as a duly authorized officer E > IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia. Pennsylvania, on the day and year firs; above written. O CL TT PAS, COMMONWEALTH OF_PENNSYLVANIA /�/f'��� lIr^^.l sea ___ - „Pf N - ✓QgJJ f� 4 Q M {P / /l ! .( �iL-'yc'W� C , -erzss Pasty la. Notary Public By:I.- O �Y O i istfl ...... __ .._...__ .................. uP Upper V1enonT,w•p., Mcntgome.y County Teresa Pastella, Notary Public y_ ay My ;n exp res Marc` 2F.. 20 4 a�CL qw hlcmber P': lsyl,),ua At>so�'i,,tu:r, of Nr;idn�s E Th s Power of Attorney is made and executed pursuant to and by authority of the 'ollowing By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual •(1) O Insurance Company. and 'Nest American Insurance Company which resolutions are now in full force and effect reading as follows. -� R3 a) ARTICLE IV- OFFICERS - Section 12. Power of Attorney Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject O C � 4) to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal. O ,� acknowledge and deliver as surety any and all undertakings, bords, recognizances and other surety obligations. Such attorneys -in -fact, subject to :he'imitations set forth in their respective T3 E pourers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so N 0 M executed. such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under 7 •0 the provisions of this artice may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII - Execution of Contracts - SECTION 5 Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, +, N 00 a) and subtec: to such limitations as 'he chairman or the president may prescribe, shall appoint such attorneys-m-`act, as may be necessary to act in behalf of the Company to make, execute, M O sea., acknowledge and deliver as surety any and all undertakings. bonds. recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their ao Z v respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so 0 O executed such instruments shall be as binding as if signed by the president and attested by the secretary. O c0 Certificate of DesignaHbn`�The President of the Company, Ding pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in- E— fac'. as may be necessa%.o' act on behalf of the Company to'make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other sure'y obligations. ; ` Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile cr mechanically reproduced signature of any assistant secretary of the ,Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection vvith surety bonds, shall be valid and binding upon the Company with the same force and effect as though manially affixed. I, Renee C. Llewellyn, the undersigned. Assistant Secretary, The Ohio Casualty Insurance Company, Lioery Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full. true and correct copy of the Power of Attorney executed by said Companies. is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 2 2 nd day of 11cir1 20 17 . A Renee C. Llewei , ssistant Secretary � a o 180 of 200 LIVIS 12875 022017 mDocument A31 0 TM -2010 CONTRACTOR: SURETY: (Name, legal status and address) (Name. Legal status ar7d piii7cipal place Sturgeon Electric California, LLC ofbusiness) Liberty Mutual Insurance Company 13501 Benson Avenue 175 Berkeley Street This document has important legal Chino, CA 91710 Boston, MA 02116 consequences. Consultation with OWNER: an attorney is encouraged with (Name, legal status and address) respect to its completion or City of Huntington Beach modification. 2000 Main Street Any singular reference to Huntington Beach, CA 92648 Contractor, Surety, Owner or BOND AMOUNT: e Ten percent of the accompanying bid (10 /e) other party shall be considered plural where applicable. PROJECT: (Name, location or address, and Pvojeci m n7ber, if am) Traffic Signal Modifications at the Intersections of Gothard Street and Talbert Avenue, Gothard Street and Heil Avenue and at Springdale Street and McFadden Avenue, Project No. CC1465 The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and othenvise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof,, or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requitement shall be deemed incorporated herein. When so furnished, the intent is that th• o d shall be construed as a statutory bond and not as a common law bond. Signed an se I 2 day of August 2017 Sturgeon Electric California, LLC (P7•r:ncipal} (Seal) (T3'il77ess (Title) Ste% jVICU­ yl (Wi ness) (Title) Brenda John on Attorney -in- act (Seal) Init. AIA Document A31011- 2010. Copyright ®1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNING; This AIA® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA° Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. i Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org, 061110 STATE OF bnlFVV0f) ) ss COUNTY OF`,-->W On this the 22nd day of August 2017, before me, the undersigned Notary Public in and for said County and State, personally appeared P. Uor�'Q , the VIC V9�6, 1D� i of Sturgeon Electric California, LLC a(n) 1 0!tWf'(L7 corporation, personally known to me (or 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 entity on behalf of which she acted, executed the instrument. WITNESS my hand and offirinl sPnl My commission expires: = it COMM. 0217GS45 Notary Public • Calilat� San BernarAino CauMf► Comm. Expires Dec. 22, 20M0 STATE OF Indiana ) ss COUNTY OF Marion On this the 22nd day of August, 2017, before me, the undersigned Notary Public in and for said County and State, personally appeared Brenda Johnston, the Attorney -in -Fact of Liberty Mutual Insurance Company a(n) Massachusetts corporation, personally known to me (or 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 entity on behalf of which she acted, executed the instrument. WITNESS my hand and official seal. Notary Public, Sheree Hsieh My commission expires: April 16, 2018 Sturgeon 1=iectric Catilt�r«ia, I.LC 13301 Benson Avenue CALIFORNIA _ Chino, CA 91710 DUET 08,22i2017 BEFORE: 010O PM PROJE.Cf: 'rP\AFFl{_- SIGf\: 1L 1%IODIFICA-IIt(-)NS 1 f Tl-TF I;,"fl i'SF:('-FllONi P OF C;()TIIARD ST. )` i\D 'I ?,LS R`` Ati E, GO!'HAIZI� ST t'�ti°D F!I~1L, �+T'itt�'t:�D,1L.F. 5-1. r�;\D RiCFr1[?i7c'.�i A L I:, RECEIVED 2011 AUG 22 PM 1: 29 CITY CLERK CITY Of HUNTINGTON BEACI! CITY 0F HUNTIZGTON BEACH 200. i NIAIN STREET, SECOND FLOOR HL,, NTING TON BEACH, CA • Sk:IL�17 Sffl—f�C� UCz'I L7I'o=;w 1VI11-i f��CL;L��Ti i�l:lli..".