Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Vido Samarzich, Inc. - 2017-02-06
RECEIVED19y: I % CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office (Namee) after signing/dating (Date) CITY OF HUNTINGTON BEACH ., INTERDEPARTMENTAL COMMUNICATION lr l� TO: City Treasurer FROM: City Clerk 1 DATE: ) --1 SUBJECT: Bond Acceptance I have received the bonds for (Company Name) 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. Approved � JJ (Council Approval ate) CC No. �� `-f` Agenda Item No. MSC No. City Clerk Vault No. A�991 JD Other No. SIRE System ID No. g:/forms/bond transmittal to treasurer CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION DATE: 9/21/2017 TO: THOSE LISTED HEREON FROM: Joseph Dale, PW Construction Manager SUBJECT: Retention Release Payment- PO#22872 OJ Supplier#101329 Co.#1235 FY 16/17 Curb Access Ramp Installation, Project#1541 Contractor's Name: Vido Samarzich Address: 4972 Crestview Place City, State and Zip Code: Alta Loma, CA, 91701 Phone Number: 909-987-3677 City Business License Number: (City Lic#Here) Notice of Completion (Date by City Clerk): 8/9/2017 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. t%t Date Travis K. H Akins, Director of Public Works I certify that there are no outstanding invoices on file. po/d,) ) rr �YO 4_t - Date Joyc6 Zabks, Deputy City Treasurer I certify that no,stop notices are on file, and that a guaranty bond has been filed with the City Clerk's Office. �° -1-f-/ZOl Date Robin Estanislau, City Clerk Attachments DJ� _0 ) 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 VII of the Civil Rights Act and Equal Employment Opportunity Act of 1972 6. Consent for Release letter from the Surety Company Certification of Compliance with Prevailing Wage Laws To: City of Huntington Beach Department of Public Works 2000 Main Street/P.O. Box 190 Huntington Beach, CA 92648 Re: Certification of Compliance with Prevailing Wage Laws Contract: Project: �P�`!� Lu_� ANSI lRf>'i" The undersigned contractor on the above-referenced project ("Project") hereby certifies that all laborers, mechanics, apprentices, trainees, watchmen and guards employed by him or by any subcontractor performing work under the contract for the Project have been paid pursuant to the minimum wage and bona fide fringe benefit requirements specified for each particular classification of work, as set forth in the wage-rate determinations of the State of California, Department of Industrial Relations, and/or the United States Department of Labor. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed this 1074f day of_4(A6ttS( , 20 (_), at California. V/ P VI P0 (Contractor[game) APPROVED.AS.TO FORM By: Michael E. Gates City Attorney 1 CONTRACTOR'S CERTIFICATE I, VI De L.6A,,tA92(Cfr state and certify that: (Name of Declarant) 1. �!pt> ��,�,,}�� (�,�(, TNe,, is the general contractor to the City of Huntington Beach ("City") on Contract No. tom- l Sal L (the "Contract") for the construction of the public work of improvement entitled: _FY110 6iu _ 5-s_ RAtrP Iiys r4 J cat 7c�y 4>An,7-E4! (the"Project"). 2. All work to be performed pursuant to the Contract has been completed in accordance with the Contract Documents (as such term is defined in the Contract). 3. Except for the claims listed below and the disputed claims listed in paragraph five (5), all persons supplying labor, services, materials and equipment to the Project, including all claims against the contractor arising from the performance of the Contract, have been paid and satisfied (list unpaid debts and claims; if none, write "NONE"): AIS&E 4. Attached hereto are the lien waivers required by the Contract Documents, which lien waivers have been executed by all persons who performed work on or supplied labor, services, materials, and/or equipment for use at the Project. 5. Set forth below is a list of disputed claims or claims that are the subject of a Notice to Withhold filed pursuant to the Civil Code of the State of California(list all disputed claims; if none, write "NONE"). Ale &E I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed at 6, Vc>y j� on this_1y�day of GUb� 20_17 (Signature of eclarani) APPROVED AS T.OTORM Michael=E. Gates City,Attorney 1 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: 6G 1's q/ Project: FY (6ho Z-LCRa 6at,6s5 R !,_ p 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 tOTff day of Ac.c&ws r 20 . at CCU(wy California. VJI70 S zw blll (Contractor Name) j V'o ao L. APPROVED ,TO FORM vi ck— P Ito�3-. AS By: Michael E. Gates City Attorney 1 RECEIVED BY: CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office (Name) after signing/dating (Date) CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION TO: City Treasurer FROM: City Clerk DATE: Zo SUBJECT: Bond Acceptance I have received the bonds for, (Company Name) CAPITAL PROJECTS (Includes CC's and MSC's) Performance Bond No. Payment Bond (Labor and Materials) Bond No. �7 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. Approved (Council Approval ate) CC No. Agenda Item No. MSC No. City Clerk Vault No. 4Jx V 1 Other No. SIRE System ID No. —3 gAorms/bond transmittal to treasurer Bond No.:08712155-M (One of Two Originals) MAINTENANCE BOND KNOW ALL PERSONS BY THESE PRESENTS: That Vido Samarzich,Inc. (contractor's name) 4972 Crest View Place,Altaloma,CA 91701 (contractor's street address,city and state and zip code) as Principal (hereinafter called Contractor),and: Fidelity and Deposit Company of Maryland (surety's name) 777 S.Figueroa Street,Suite 3900,Los Angeles,CA 90017 (surety's street address,city and state and zip code) a corporation organized and existing under the laws of the State of Maryland with its principal office in the City of Owings Mills as Surety(hereinafter called Surety),are held firmly bound unto CITY OF HUNTINGTON BEACH as Obligee (hereinafter called Owner), in the amount of Seven Hundred Twenty Seven Thousand* Dollars ($ 727,799.13 ), 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, * Seven Hundred Ninety Nine and 13/100 Dollars 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 February 6th ,20 7,entered into a contract with Owner for the FY 2017 Curb Access Ramp Installation Project in accordance with drawings and specifications prepared by Joseph F.Fuentes which contract is by reference made a part hereof(hereinafter referred to as the Contract);and 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 8th ,2017 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if Contractor shall, for a period of one year from and after the date of completion and acceptance of the Contract by Owner, repair and/or replace any and all defects arising in the Work, whether resulting from defective materials or defective workmanship, then this obligation shall be null and void; otherwise it will remain in full force and effect. The Surety hereby waives notice of any alteration or extension of time made by the Owner. Whenever Contractor shall be, and declared by Owner to be in default under the Contract, the Surety shall, within thirty (30) days following 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. 15-4594/118138 1 Whenever the Principal shall be, and declared by the Owner to be in default under the Contract, which shall include without limitation, any breach or default of the Contract, then, after written notice from the Owner to the Surety, as provided for below,the Surety shall either: (a) remedy the default or breach by the Principal;or(b)shall promptly and faithfully take charge of the Work and complete the Work in accordance with the requirements of the Contract with a contractor other than the Principal,at its own expense, and make available as work progresses sufficient funds to pay the cost of completion less the unpaid balance of the Contract including other costs and damages for which the surety may be liable hereunder, provided, however, that the procedure by which the Surety undertakes to discharge its obligations under this Bond shall be subject to the advance written approval of the Owner. Within thirty (30) days after Surety's receipt of a written notice from Owner of the failure of performance of the Contract by the Principal, it shall be the duty of the Surety to give to the Owner a notice, in writing, of the Surety's election to(a)remedy the default(s) of the Principal promptly,or(b)arrange for performance of the Contract promptly by a contractor other than the Principal, time being of essence to this Bond. In said Notice of Election, the Surety shall state the date of commencement of its cure or remedy of the Principal's default(s) or its performance of the Contract. The Surety's obligations for cure or remedy, include but are not limited to: correction of defective work and completion of the Contract, additional legal, design professional and delay costs arising from Surety's actions or failure to act; and liquidated damages (or if no liquidated damages are specified in the Contract, actual damages caused by delayed performance or non-performance by the Principal). The Surety shall give prompt written notice to the Owner upon completion of the cure or remedy of the Principal's default(s)of its performance of the Contract. If the Surety does issue its Notice of Election and does not proceed to cure or remedy the Principal's default(s) of its performance of the Work within thirty(30) days after receipt of a written notice from Owner, Surety shall be deemed to be in default on this bond, and the Owner shall be entitled to enforce any remedy available to Owner. No right of action shall accrue on this bond to or for the use of any person or corporation other than the owner named herein or the successors of Owner. Signed and sealed this 16th day of August 20 17 Principal Raised Corporate Seal Vido Samarzich,Inc. [MUST BE AFFIXED] (Contractor Name) By: B/ (Seal) I I Principal Raised Corporate Seal y1 A0 S fjr( 2-1 Gi'� [MUST BE AFFIXED] V)GE Alta S /0 ar-i T (Title) Fidelity and Deposit Company of Maryland r ty Na e) By: (Sea!' Randy Spohn,Att icy ' -Fact APPROV D AS RM: B NOTES: IC E. Ga es, City Attorney 1. Acknowledgments must be completed and returned s as part of the bond. 0 2. Raised Corporate Seals are mandatory. 3. Please attach Power of Attorney. 15-4584/118138 2 ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW 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 GERALD F.HALEY,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 Randy SPORN,Matthew R. DOBYNS and Hamilton KENNEY, all of Santa Ana, California, EACH its true and lawful agent and Attorney-in-Fact,to make,execute,sea]and deliver,for,and on its behalf as surety,and as its 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 Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 5th day of April,A.D.2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND USWG} _,T. D..�o f* J GPN,IN...... 's, BEAL ^0Qj4r•C' WY t O ? • ' •,"'sir N`` By. At Secretary Vice President Eric D.Barnes Gerald F.Haley State of Maryland County of Baltimore On this 5th day of April,A.D. 2016,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified, GERALD F. HALEY,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 acknowledged the execution of same,and being by me duly swom,deposeth and saith,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 fast above written. Constance A.Dunn,Notary Public My Commission Expires:July 9,2019 POA-F 012-3955A 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 16th, 2017 before me, ASHLEY MARIE SPOHN, NOTARY PUBLIC, personally appeared RANDY SPOHN , ® 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 (yes}, and that by his/her/their signature(-sr} on the ASHLEY MARIE SPOHN ` instrument the person(s), or the entity upon behalf of which the person(-s} NOTARY LI2188665 m NOTARY PUBLIC CALIFORNIA acted executed the instrument. o 3 ORANGE COUNTY ro ?� My comm.expires mar.27,2o21JC 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. Sio,oture of Notary 0 PT Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER ❑ PARTNER(S) ❑ LIMITED ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: SIGNER IS REPRESENTING. NAME OF PERSON(S) OR ENTITY(IES) Batch 2463895 - Print Confirmations Page 1 of 1 Recorded in Official Records,Orange County Hugh Nguyen,Clerk-Recorder II I I II �� II I I II II II I I I I I II NO FEE PLEASE COMPLETE THIS INFORMATION + $ R 0 0 0 9 4 7 6 9 1 2 $ RECORDING REQUESTED BY: 2017000337220 3:45 pm 08/09/17 7 405 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 WHEN RECORDED MAIL TO: CITY OF HUNTINGTON BEACH i PUBLIC WORKS DEPARTMENT Attn:Joseph Fuentes P.O.Box 190—2000 Main Street Huntington Beach,CA 92648 THIS SPACE FOR RECORDER'S USE ONLY TITLE OF DOCUMENT NOTICE OF COMPLETION NOTICE IS HEREBY GIVEN by the City of Huntington Beach,owner in fee,2006 Main Street,Huntington Beach,CA 92648,that the contract heretofore awarded to Vido Samarzich,who was the company thereon for doing the following work to-wit: FY 16117 Curb Access Ramp Installation,Project#1541 That said work was completed 08/0812 01 7 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 08/08/2017,per City Council Resolution No.2003-70 adopted October 6,2003. That upon said contract Fidelity and Deposit Company of Maryland,was surety for the bond given by the said company as required This document is solely for the official business of the City of Huntington Beach,as contemplated under Government Code Section 27383 and should be recorded free of charge. i D f)>y1�7 Director of ors or City Engineer at 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 Huntington Beach,as contemplated a AMunder Government code section.27383 and Dire r of or City Engineer Dame should be recorded free of charge. City of Huntington Beach,California I THIS PAGE IS ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION (Additional recording fee applies) 1 i I https:Hgs.secure-recording.com/Batch/PrintConfirmations 8/9/2017 RECEIVED BY:`&, CITY CLERK RECEIPT COPY f� t. Return DUPLICATE to City Clerk's Office (Name) / after signing/dating (Date) CITY OF HUNTINGTON BEACH r INTERDEPARTMENTAL COMMUNICATION TO: City Treasurer FROM: City Clerk DATE: Mll�l—li r SUBJECT: Bond Acceptance ` C I have received the bonds for I// J ) (Company Name) CAPITAL PROJECTS (Includes CC's and MSC's) _ Performance Bond No. �(J Y -- �/ Payment Bond (Labor and Materials) Bond No. r 7, 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 e Re: Tract No. Approved r (Council Approval Date) CC No. � �/- / Agenda Item No. MSC No. City Clerk Vault No. f Other No. SIRE System ID No. g:/forms/bond transmittal to treasurer CDBG FUNDED CONSTRUCTION CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND VIDO SAMARZICH, INC. FOR FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT THIS AGREEMENT ("Agreement") made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY," and VIDO SAMARZICH, INC., a California, hereinafter referred to as "CONTRACTOR." WHEREAS, the Federal Department of Housing and Urban Development is providing partial funding for this Contract to CITY through a Community Development Block Grant; WHEREAS, CITY has solicited bids for a public works project. hereinafter referred to as "PROJECT," more fully described as FY 16/17 Curb Access Ramp Installation Project (CC- 1541) 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: I. 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 16-5215/142605.doc l action 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; 16-5215/142605.doc 2 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 Specifications for Public Works Construction, published by Builders' News, Inc., 10801 National Boulevard, Los Angeles. CA 90064. and all amendments thereto, written and promulgated by the Southern California chapter of the American Public Works Association and the Southern California District Associated General Contractors of the California .Joint Cooperative Committee as specified in the particular Plans, Specifications, Special Provisions and Addenda applicable to the Project; E. All bid documents, including the Notice Inviting Bids, the Special Instructions to Bidders, CONTRACTOR's proposal, (attached as Exhibit "A"), "Form HUD-4010," the Federal Labor Standards Provision of the United States (attached as Exhibit "B"), and "Standard Federal Equal Employment Opportunity Construction Contract Specifications," as established by Federal Executive Order 11246 (attached as Exhibit"C"). 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, 16-5215/142605.doc 3 Special provisions, or Addenda. the matter shall be immediately submitted by CONTRACTOR to the Department of Public Works of CITY (hereinafter referred to as "DPW"), and CONTRACTOR shall not attempt to resolve or adjust the discrepancy without the decision of DPW, save only at its own risk and expense. 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, sub ect to any additions or deductions made under the provisions of this Agreement or the Contract Documents, a sum not to exceed Six Hundred Seventy Eight Thousand and Nine Hundred Dollars ($678,900.00), 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 seventy (70) consecutive working days from the day the Notice to Proceed is issued by DPW, excluding delays provided for in this Agreement. 5. TIME OF THE ESSENCE The parties hereto recognize and agree that time is of the essence in the performance of this Agreement and each and every provision of the Contract Documents. 16-5215/142605.doc 4 CONTRACTOR shall prepare and obtain approval as required by the Contract Documents for all shop drawings, details and samples, and do all other things necessary and incidental to the prosecution of its work in conformance with the progress schedule set forth in the Contract Documents. CONTRACTOR shall coordinate its work with the work of all other contractors, subcontractors, and CITY forces working on the PROJECT in a 111anner 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 16-5215/142605.doc 5 submitted by CONTRACTOR; thereupon, CITY will promptly issue an adjusted change order to CONTRACTOR and the Agreement price will be adjusted upward or downward accordingly. 7. NOTICE TO PROCEED No work, services, material, or equipment shall be performed or furnished under this Agreement unless and until a Notice to Proceed has been given to CONTRACTOR by CITY. CITY does not warrant that the work will be available on the date the Notice to Proceed is issued. In the event of a delay in commencement of the work due to unavailability of the job site, for any reason, relief to CONTRACTORZ 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: 1. A bond in the amount of one hundred percent (100%) of the Agreement price to guarantee CONTRACTOR's faithful performance of the work; and 2. A bond in the amount of one hundred percent of the Agreement price to guarantee payment of all claims for labor and materials furnished. In addition, CONTRACTOR shall submit to CITY a bond in the amount of one hundred percent (100%) of the final Agreement price, including all change orders, to warrant such performance for a period of one (1) year after CITY's acceptance thereof within ten (10) days of filing of the Notice of Completion. 16-5215/142605.doc 6 9. WARRANTIES CONTRACTOR unconditionally guarantees all work done under this Agreement including, but not limited to, any workmanship, installation, fabrication, material or structural facilities constructed. CONTRACTOR, within ten (10) days after notice by CITY of any defect in the work, shall have the option to make appropriate repairs or replace the defective item or items. Upon expiration of such ten- (10) day period, CITY may then make appropriate repair or replacement at CONTRACTOR's risk and own cost and expense. 10. INDEPENDENT CONTRACTOR It is understood and agreed that CONTRACTOR is, and shall be, acting at all times hereunder as an independent contractor and not an employee of CITY. CONTRACTOR shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, social security, state disability insurance compensation, unemployment compensation and other payroll deductions for CONTRACTOR and its officers, agents and employees and all business licenses, if any, in connection with the PROJECT and/or the services performed hereunder. 11. LIQUIDATED DAMAGES/DELAYS It is agreed by the parties hereto that in case the total work called for hereunder is not in all parts and requirements finished or completed within the number of calendar days as set forth herein, damage will be sustained by CITY; and that it is, and would be, impractical and extremely difficult to ascertain and determine the actual damage which CITY would sustain in the event of and by reason of such delay. It is, therefore, agreed that CONTRACTOR will pay to CITY, as liquidated damages and not as a penalty, the sum of Five Hundred Dollars ($500.00) per 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 16-5215/142605.doe 7 hereto to estimate a fair compensation for the foreseeable damages CITY would sustain in the event of and by reason of such delay; and CONTRACTOR agrees to pay these damages herein provided, and further agrees that CITY may deduct the amount thereof from any monies due or that may become due to CONTRACTOR hereunder. For projects on the National Highway System (NHS),the local formula for liquidated damages will be provided. CONTRACTOR will be granted an extension of time and will not be assessed damages for any portion of the delay in the completion of the work due to unforeseeable causes beyond the control and without the fault or negligence of CONTRACTOR, including, but not limited to. acts of God or of the public enemy, tire, floods, epidemics, quarantine restrictions, strikes. unsuitable weather, or delays of subcontractors due to such causes. CONTRACTOR shall, within fifteen (15) days from the beginning of any such delay (unless DPW shall grant a further period of time), notify DPW in writing of the cause of the delay and CITY shall extend the time for completing the work if, in its judgment, the findings of fact thereon justify the delay; and the decision of DPW shall be conclusive on the parties hereto. Should CONTRACTOR be delayed in the prosecution or completion of the work by the act. neglect or default of CITY, or should CONTRACTOR be delayed by waiting for materials required by this Agreement to be furnished by CITY, or by damage caused by fire or other casualty at the job site for which CONTRACTOR is not responsible, or by the combined action of the workers, in no way caused by or resulting from default or collusion on the part of CONTRACTOR, or in the event of a lockout by CITY, then the time herein fixed for the completion of the work shall be extended by the number of days CONTRACTOR has thus been 16-5215/142605.doc 8 delayed, but no allowance or extension shall be made unless a claim therefor is presented in writing to CITY within fifteen (15) days of the commencement of such delay. No claims for additional compensation or damages for delays, irrespective of the cause thereof, and including without limitation the furnishing of materials by CITY or delays by other contractors or subcontractors,will be allowed and an extension of time for completion shall be the sole remedy of CONTRACTOR. 12. DEMANDS FOR ADDITIONAL TIME OR MONEY A. Definitions. (1) "Change Order" means a document signed by 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 CONTRACTOR for any of the following: (a) A time extension; (b) Payment of money or damages arising from work done by, or on behalf of, 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 16-5215/142605.doc 9 unknown physical conditions at the job site. of an unusual nature, differing materially from those ordinarily encountered and generally recognized as inherent to work of the PROJECT; or (f) A request for a tine 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 CONTRACTOR has submitted a Demand to the DPW (or his or her 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 documents necessary to substantiate the Dernand. The DPW shall act on the Demand within f►fteen (15) days after receipt, including by requesting additional information from CONTRACTOR to determine whether to approve the Change Order the Demand seeks. The DPW shall act on the Demand within f►fteen (15) days after receipt of the additional information or within a period of time no greater than the time 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 CITY may promptly investigate the conditions. 16-5215/142605.doc 10 E. If CONTRACTOR disputes the DPW's written response on the Demand, or the CITY fails to respond within the time prescribed, CONTRACTOR may so notify the City Engineer, in writing, either within fifteen (15) days of receipt of the City Engineer's response or 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 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, 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 1 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 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 16-5215/142605.doc II quantities listed in the bid schedule, the bid price shall prevail subject to the provisions of this Section. DPW may, at its sole discretion, when warranted by the facts and circumstances, order an equitable adjustment, upwards or downwards, in payment to CONTRACTOR where the actual quantities used in construction of the PROJECT are in variation to the quantities listed in the bid schedule. No claim by CONTRACTOR for an equitable adjustment in price or time for completion shall be allowed if asserted after final payment under this Agreement. If the quantity variation is such as to cause an increase in the time necessary for completion, DPW shall ascertain the facts and circumstances and make such adjustment for extending the completion date as in its sole judgment the findings warrant. 14. PROGRESS PAYMENTS Each month DPW will make an estimate in writing of the work performed by CONTRACTOR and the value thereof. From each progress estimate, five percent (5%) will be deducted and retained by CITY and the remainder of the progress estimate, less the amount of all previous payments since commencement of the work, will be paid to CONTRACTOR. When CONTRACTOR has, in the judgment 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 tip 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 uncncu III bered, shall be made thirty (30) 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 16-5215/142605.doc 12 and CONTRACTOR, CITY may withhold from the final payment an amount not to exceed 150 percent of the value of any disputed amount of work. Payments shall be made on demands drawn in the manner required by law, each payment to be accompanied by a certificate signed by DPW, affirming that the work for which payment is demanded has been performed in accordance with the terms of the Agreement and that the amount stated in the certificate is due under the terms of the Agreement. Partial payments on the contract price shall not be considered as 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 withheld by CITY to ensure performance under the terms of this Agreement. 16. AFFIDAVIT'S OF SATISFACTION OF CLAIMS After the completion of the work contemplated by this Agreement, CONTRACTOR shall file with DPW its affidavit stating that all workers and persons employed, all firms supplying materials and all subcontractors working upon the PROJECT have been paid in dill 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. 16-5215/142605.doc 13 17. WAIVER OF CLAIMS The acceptance by CONTRACTOR of the payment of the final certificate shall constitute a waiver of all claims against CITY under or arising out of this Agreement. 18. INDEMNIFICATION. DEFENSE, HOLD HARMLESS CONTRACTOR hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all claims, damages. losses. expenses, judgments, demands, defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to CONTRACTOR's employees and damage to CONTRACTOR's property, arising directly or indirectly out of the obligations or operations herein undertaken by CONTRACTOR, caused in whole or in part by any negligent act or omission of CONTRACTOR, any subcontractors, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the CITY, its officers, elected or appointed officials, employees, agents, and 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. 16-5215/142605.doc 14 19. WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY INSURANCE Pursuant to California Labor Code Section 1861, CONTRACTOR acknowledges awareness of Section 3700 el seq. of this Code, which requires every employer to be insured against liability for workers' compensation; CONTRACTOR covenants that it will comply with such provisions prior to commencing performance of the work hereunder. CONTRACTOR shall maintain workers' compensation and employer's liability insurance in an amount of not less than the State statutory limits. CONTRACTOR shall require all subcontractors to provide such workers' compensation and employer's liability insurance for all of the subcontractors'employees. CONTRACTOR shall furnish to CITY a certificate of waiver of subrogation under the terms of the workers' compensation and employer's liability insurance and CONTRACTOR shall similarly require all subcontractors to waive subrogation. 20. INSURANCE In addition to the workers' compensation and employer's liability insurance and CONTRACTOR's covenant to defend. hold harmless and indemnify CITY, CONTRACTOR shall obtain and furnish to CITY, a policy of general public liability insurance, including motor vehicle coverage covering the PROJECT. This policy shall indemnify CONTRACTOR, its officers, employees and agents while acting within the scope of their duties, against any and all claims arising out or in connection with the PROJECT, and shall provide coverage in not less than the following amount: combined single limit bodily injury and property damage, including products/completed operations liability and blanket contractual liability, of One Million Dollars ($1,000,000) per occurrence. If coverage is provided under a form which includes a designated 16-5215/142605.doc 15 general aggregate limit, the aggregate limit must be no less than One Million Dollars ($1,000,000) for this PROJECT. This policy shall name CITY, its officers, elected or appointed officials, employees, agents, and volunteers as (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 without the express written consent of CITY; however, an insurance policy"deductible"of$5,000.00 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: 1. provide the name and policy number of each carrier and policy; 2. state that the policy is currently in force; and 16-5215/142605.doc 16 3. promise to provide that such policies will not be canceled or modified without thirty (30)days' prior written notice of CITY. CONTRACTOR shall maintain the foregoing insurance coverages in force until the work under this Agreement is fully completed and accepted by CITY. The requirement for carrying the foregoing insurance coverages shall not derogate from the provisions for indemnification of CITY by CONTRACTOR under the Agreement. CITY or its representative shall at all times have the right to demand the original or a copy of all the 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 CONTRAC:TOR's insurance policies, naming CITY, its officers, elected and appointed officials, employees, agents and volunteers as Additional Insureds, to the City Attorney for approval prior to any payment hereunder. 22. PAYROLL RECORDS CONTRACTOR agrees to keep accurate payroll record showing the name, address, social security number, work classification, straight time and overtime hours worked each day and week, and the actual per diem wages paid to each journeyman, apprentice or worker employed by it in connection with the PROJECT and agrees to require each of its subcontractors to do the same. CONTRACTOR further agrees that its payroll records and those of its subcontractors, if any, shall be available at all reasonable times to the CITY, and the employee or his representative, and the Division of Labor Standards Enforcement and the Division of Apprenticeship Standards, and to comply with all of the provisions of California Labor Code Section 1776, in general. 16-5215/142605.doc 17 23. CALIFORNIA PREVAILING WAGE LAW AND FEDERAL DAVIS- BACON ACT. 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 ($25) for each calendar day or portion thereof for each worker paid (either by CONTRACTOR or any of its subcontractors) less than the prevailing wage rate established for that particular craft or type of work. C. This Agreement also is subject to the Federal Davis-Bacon Act. The minimum rate of wages for each craft or type of worker needed to execute the PROJECT shall be those as determined by the United States Secretary of Labor. If there is a difference between the minimum wage rates predetermined by the Secretary of Labor and the general prevailing wage rates determined by the Director of the California Department of Industrial Relations for similar classifications of labor, CONTRACTOR and subcontractors shall pay not less than the higher wage rate. 16-5215/142605.doc 18 24. CALIFORNIA EIGHT-HOUR LAW A. California Labor Code, Sections 1810 et seq, shall apply to the performance of this Agreement. thereunder, not more than eight (8) hours shall constitute one day's work and CONTRACTOR and each subcontractor employed by its hereunder, shall not require more than eight (8) hours of labor per day or forty (40) hours per week from any one person employed by it hereunder. except as stipulated in California Labor Code Section 1815. CONTRACTOR and each subcontractor employed by it hereunder shall, in accordance with California Labor Code Section 1812. keep an accurate record. open to inspection at all reasonable hours, showing the name and actual hours worked each calendar day and each calendar week by each worker employed in connection with the PROJECT. B. Pursuant to this Agreement and in accordance with California Labor Code Section 1813, CONTRACTOR shall, as a penalty to CITY, forfeit twenty-five dollars ($25) for each worker employed hereunder by CONTRACTOR or any subcontractor for each calendar day during which such worker is required or permitted to work more than eight (8) hours in any one (1) calendar day or forty (40) hours in any one (1) calendar week in violation of California Labor Code Section 1815. 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. 26. EMPLOYMENT OF APPRENTICES Section 1777.5 of the California Labor Code, regarding the employment of apprentices is applicable to this PROJECT. 16-5215/142605.doc 19 27. EQUAL EMPLOYMENT OPPORTUNITY During the performance of this Agreement, CONTRACTOR agrees as follows: A. CONTRACTOR will not discriminate against any employee or applicant for employment because of race. color, religion, sex, sexual orientation, gender identity, or national origin. CONTRACTOR will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. CONTRACTOR agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination clause. B. CONTRACTOR will. in all solicitations or advertisements for employees placed by or on behalf of CONTRACTOR, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. C. CONTRACTOR will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation infiormation of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such 16-5215/142605.doc 20 disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with CONTRACTOR's legal duty to furnish information. D. CONTRACTOR will send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice to be provided by the agency contracting officer, advising the labor union or workers' representative of CONTRACTOR's commitments unde►- Section 202 of Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. E. CONTRACTOR will comply with all provisions of Executive Order 11246 of September 24, 1965. and of the rules, regulations. and relevant orders of the United States Secretary of Labor. A copy of Executive Order 1 1246. as amended, is attached as Exhibit C. F. CONTRACTOR will furnish all information and reports required by Executive Order 11246 of September 24. 1965. and by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto. and will permit access to his books, records, and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. G. In the event of CONTRACTOR's non-compliance with the nondiscrimination clauses of this contract or with any of such rules, regulations, or orders, this contract may be canceled, terminated or suspended in whole or in part and CONTRACTOR may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order 11246 of September 24. 1965, and such other sanctions may be 16-5215/142605.doc 21 imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor. or as otherwise provided by law. H. CONTRACTOR will include the provisions of sub-paragraphs A through G in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965. so that such provisions will be binding upon each sub-contractor or vendor. CONTRACTOR will take such action with respect to any subcontract or purchase order as may be directed by the Secretary of Labor as a means of enforcing such provisions including sanctions for noncompliance: Provided, however, that in the event CONTRACTOR becomes involved in, or is threatened with, litigation with a sub-contractor or vendor as a result of such direction, CONTRACTOR may request the United States to enter into such litigation to protect the interests of the United States. 28. RECORD RETENTION Financial records, supporting documents, statistical records, and all other CONTRACTOR records pertinent shall be retained for a period of three years from the date of the City filing the Notice of Completion of the PROJECT. The only exceptions are the following: A. If any litigation, claim, or audit is started before the expiration of the 3- year period. the records must be retained until all litigation, claims, or audit findings involving the records have been resolved and final action taken. B. When the non-Federal entity is notified in writing by the Federal awarding agency, cognizant agency for audit, oversight agency for audit, cognizant agency for indirect costs, or pass-through entity to extend the retention period. 16-5215/142605.doc 22 C. Records for real property and equipment acquired with Federal funds must be retained for 3 years after final disposition. D. When records are transferred to or maintained by the Federal awarding agency or pass-through entity, the 3-year retention requirement is not applicable to the non- Federal entity. E. Records for program income transactions after the period of performance. In some cases recipients must report program income after the period of performance. Where there is such a requirement, the retention period for the records pertaining to the earning of the program income starts from the end of the non-Federal entity's fiscal year in which the program income is earned. F. Indirect cost rate proposals and cost allocations plans. This paragraph applies to the following types of documents and their supporting records: indirect cost rate computations or proposals, cost allocation plans. and any similar accounting computations of the rate at which a particular group of costs is chargeable (such as computer usage chargeback rates or composite fringe benefit rates). (1) If submitted for negotiation. ll' the proposal, plan, or other computation is required to be submitted to the Federal government (or to the pass- through entity) to form the basis for negotiation of the rate, then the 3-year retention period for its supporting records starts from the date of such submission. (2) If not submitted for negotiation. If the proposal, plan. or other computation is not required to be submitted to the Federal government (or to the pass- through entity) for negotiation purposes, then the 3-year retention period for the proposal, 16-5215/142605.doc 23 plan, or computation and its supporting records starts from the end of the fiscal year (or other accounting period) covered by the proposal, plan, or other computation. 29. NOTICE OF THIRD-PARTY CLAIM Pursuant to Public Contracts Code Section 9202, CITY shall provide notice to CONTRACTOR of receipt of any claim tiled with CITY or a court of competent jurisdiction which arises out of performance of this agreement \\ithin ten (10) days of receipt of such claim or claims. 30. DEFAULT AND TERMINATION If CONTRACTOR fails or refuses to prosecute the work hereunder with diligence, or fails to complete the work within the time specified, or is adjudged bankrupt or makes an assignment for the benefit of creditors or becomes insolvent, or violates any provision of this Agreement or the Contract Documents, CITY may give CONTRACTOR notice in writing of its intention to terminate this Agreement. Unless the violation is cured within ten (10) days after such Notice of Intention has been served on CONTRACTOR, CITY may, without prejudice to any other remedy it may have. terminate this Agreement upon the expiration of that time. Upon such default by CONTRACTOR. CITY may elect not to terminate this Agreement; in such event CITY may make good the deficiency in which the default consists and deduct the resulting costs from the progress payments then or to become due to CONTRACTOR. If it is subsequently determined by a court of competent jurisdiction that CITY's termination of this Agreement under this Section was wrongful, such termination shall be converted to a termination for convenience under Section 29 and any damages shall be assessed as set forth in Section 29. 16-5215/142605.doc 24 31. 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, CONTRACTOR shall be entitled to receive payment for work executed, and costs incurred by reason of such termination. In no event shall CONTRACTOR be entitled to recover overhead, profit or CONTRACTOR's fee on work not performed. Such payment by CITY shall be CONTRACTOR's sole and exclusive remedy for termination by CITY for its convenience and CITY shall have no further obligation to CONTRACTOR. 32. 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. 33. 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. 16-5215/142605.doc 25 34. CITY EMPLOYEES AND OFFICIALS CONTRACTOR shall employ no CITY official nor any regular CITY employee in the work performed pursuant to this Agreement. No officer or employee of CITY shall have any financial interest in this Agreement in violation of the California Government Code. 35. 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. 36. NOTICES Any notices, certificates. or other communications hereunder shall be given either by personal delivery to CONTRACTOR's agent (as designated in Section 1 hereinabove) or to CITY as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and depositing the same in the United States Postal Service, to the addresses specified below; provided that CITY and CONTRACTOR, by notice given hereunder, may designate different addresses to which subsequent notices, certificates or other communications will be sent: 16-5215/142605.doc 26 TO CITY: TO CONTRACTOR: City of Huntington Beach VIDO SAMARZICH, INC. ATTN: Joseph Fuentes ATTN: Vido Samarzich 2000 Main Street 4972 Crestview Place Huntington Beach, CA 92648 Alta Loma, CA 91701 37. SECTION HEADINGS The titles, captions, section, paragraph. and subject headings, and descriptive phrases at the beginning of the various sections in this Agreement are merely descriptive and are included solely for convenience of reference only and are not representative of maters included or excluded from such provisions, and do not interpret, define, limit or describe, or construe the intent of the parties or affect the construction or interpretation of any provision of this Agreement. 38. 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. 39. 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. 16-5215/142605.doc 27 40. 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 attorney's fees and the prevailing party shall not be entitled to recover its attorney's fees from the nonprevailing party. 41. INTERPRETATION OF THIS AGREEMFNT The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties. If any provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining covenants and provisions of this Agreement. No covenant or provision shall be deemed dependent upon any other unless so expressly provided here. As used in this Agreement, the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the context so indicates or requires. Nothing contained herein shall be construed so as to require the commission of any act contrary to law, and wherever there is any conflict between any provision contained herein and any present or future statute, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law. 42. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 16-5215/142605.doc 28 43. 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. 44. 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. 45. SIGNATORIES Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully for any injuries or damages to CITY in the event that such authority or power is not, in fact. held by the signatory or is withdrawn. 46. ENTIRETY The foregoing, and Exhibits "A." and "B" attached hereto, set forth the entire Agreement between the parties. No waiver or modification of this Agreement shall be valid unless in writing duly executed by both parties. The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiations. and that each has had the opportunity to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no representations. inducements. promises, agreements or warranties. oral or otherwise., have been made by that party or anyone acting on that party's 16-5215/142605.doc 29 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 �2017. CONTRACTOR CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California PMJWjhA:-L1j1ij1 By: al——14 VIVO l_ MPMAZIc-H __,. 410- ayor tj U print Warne ITS: (circle one) Chairman/Presiden ice n -� rest et Ch y Clerk AND INITIATED AND APPROVED: --'( - By: Director of Public Works print name ITS: (circle one) Secretary/Chief Financial REVIE ED AND APPROVED: Officer/Asst. Secretary -Treasurer .it Manager APPROVED AS ' FORM: City Attorney 16-5215/142605.doc 30 D.DMA � j r NO.433290A - 972 ORE STVIEW PLACE, ALTA L4 A, M QS'98.7 6377 '.PAX ".9-98:7-6-988 • ' S+ ,�, b k��•��-•ram'..•. WEA � •, ? j pS The-Roa-ro of olre�so' l leetirig•a;4972 rsst ie +Noce,'141t 1. t t to 2, . 'ire fql :-V - present; being•all'txmbrs:oFttie 8rd ' i S4tt' r;M%qlca:S-*Mrz Vi'do-Srttaatzic3r :r:setved as• ttta+t xliting,: # iiil a sisv► d as The Cha�trt tan 'a ttxounced`drat.. t tyre i# i s I :.ea mratrc r r rar l: t W hers- of the board be Av ri gid -o ekbr ate-contrsnt doo rtt � :itreluci tg�fd`d-wt rtents _ �y and .all oth +contractual doountents which y.fie rad > order, -.A . this° corpbtbttonj.:tct A. .an�3 utter into ooatracts ta:perform-construction yR stic i6 �,k ail meter oortt total.qbl attons. After general. disoussidn and on m W ::d i ri d , -and secc nd d and up fi,tou .ly .carried,'Che followingresoiutipn was.a�op s. ] 4 'ghat tkte'Fraes lent,S':ecre ry, n�= iae llrestdertt arrd airy-one o ''them,:ale. hereby a ;ti orrzeti ;to-."ect te.any tl-aid, knts, tnirl�dirt� [�c� ��c�t�tte�xts ���uU1, d tux :x##any b rand . o ta eo sor fion to i'fd der ter.,into .aautt' gig t t fo eon i?! Yv*"k': Other cst~irtraatr' 1 p 'tgatioi►s t�t1' hehalfa tiff:aoc, afia©n;, attd,:eaehrr+ every act.of signing.f y the- P.rbsjdent,.SecrEt-ar y, -v`: qv' s'I t;•ousv tYo' a z n is tt r 8y fitt'ly assented and_adnpt .d'as tto'aat.of':tih�s Vqitp� i0010 . px � ' n-OilyTsere being o ;t to l , seconded Aa.-d untini'znously carried,the meet g v tsi l r red, • s � ,'� ice,. �+� •..�i '+�".•'..�•''.. EXHIBIT A (Contractor's Proposal) 16-5215/142605.doc City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE for FY 2016/17 CURB ACCESS RAMP INSTALLATION PROJECT C.C. No. 1541 January 3, 2017 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Special Provisions: 1) Replace Section D "Sample Contract" in it's entirety in the Specifications with updated Section D in this Addendum. The "Sample Contract" was updated in December 2016. 2) Replace Appendix K, the "Prevailing Wage Schedule" in it's entirety in the Specifications with updated Appendix K in this Addendum. "General Decision Number: CA60035 11/11/2016" will be replaced with "General Decision Number: CA60035 12/23/2016." 3) Replace Appendix L, the "Federal Documents for CDBG Projects" in it's entirity in the Specifications with updated Appendix L in this Addendum. The documents were updated in December 2016. This is to acknowledge receipt and review of Addendum Number One, dated January 3, 2017. Sr4w�/grt-ZI C- rt /�✓� Company Name B I '57 Zo Date' All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Joseph Fuentes at (714) 536- 5431. 1 SECTION C PROPOSAL for the construction of FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT from VARIOUS LOCATIONS CC No. 1541 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 70 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 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 BID ITEMS }�� �}c a �r �'Sd� lye.G,�i'i'� � -xw z�a ,��=�w ��•: Y �+ l� �'p 3'� � �� �tfi_a�xgA'�°�...e'�' �� ��'i� £i '�" �yi�. f � �' t�{�{�T 4 �. vs��;. �y���. z �K .� �'��� 3zx""��i�� ��� �,. .tv.`�� �C,,•J , `. : �� `�"� � ��� �+r r� .?4 hl<•�R��:� �.�a4�t��4 .�"e� � �"£� $� v `' •"�i�.-s� r ' ._. '�'x���xi¢d�" � '' fs .'�''§.tG � �1v�� �F� 4 1 Mobilization 1 LS $ L6 00 $ /6 v�00•a0 Construct Curb Access Ramp per Caltrans Std.Plan A88A from BCR to ECR as shown on Curb Ramp Detail 1 in 2 Appendix H of Specifications (Item includes all appurtenances,curb&gutter,depressed curb,sidewalk, domes, retaining curb, sawcut, slot pave, etc.) 68 EA $ ?A m•0a $ ZN yo goo-00 Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR using horizontal curb cutting machine as 3 shown on Curb Ramp Detail 2 in Appendix H of Specifications (Item includes all appurtenances, curb&gutter,depressed curb,sawcut,sidewalk,domes, retaining curb,etc.) 63 EA $7-oo.d® $ Zd 1, boo.oo Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 3 in 4 Appendix H of Specifications (Item includes all appurtenances,curb&gutter, depressed curb,sawcut, sidewalk,domes, retaining curb,slot pave,etc.) 5 EA $ 3 700.0D $ Soo•00 Construct Case C Midblock or Case F/Case G/Case CM or Type C Directional Curb Access Ramp per Caltrans Std. Plan 5 A88A/A8813(Item includes all appurtenances,curb&gutter, depressed curb, sidewalk,domes, retaining curb, slot pave, etc.) 20 EA $ Y o0.00 $ 8 000_,0 0 6 Install truncated domes to existing Curb Ramp 123 EA $y00- 00 $ Y 5 2.00.00 7 Remove existing improvements and construct concrete meandering sidewalk per HB Standard Plan 207 500 SF $1 Z_00 $ 000. 00 Remove and reconstruct Cross Gutters per HB Standard Plan 8 205(Item includes all appurtenances, curb&gutter,slot pave, etc.) 3,800 SF $/�. 00 $ 00, Y00.00 Remove and replace existing 6"or 8"Curb and Gutter per HB 9 Standard Plan 202(Item includes all appurtenances and slot pave,etc.) 100 LF $ 75-,oo $ ? 57o0. Vo 10 Install 4"PVC Sleeve for Street Assembly Sign per City of HB Std. Plan 401 10 EA $ I00• 00 $ Ji 000. 00 11 Prepare Storm Water Pollution Prevention Plan(SWPPP) 1 LS $ 500.00 $ Sro. 00 12 Install&Maintain Construction 13MPs 1 LS $ 000.00 $ 000. 00 TOTAL BID AMOUNT(BASIS OF AWARD) —SCHEDULE A $ ,j C-2.1 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1.541 TOTAL BID AMOUNT IN WORDS: SIN Hyr,0A4C1A SEvE-N-r-1 616 NT -rHousAtYD N/r✓E H V rjo r-F.o bo i L.+2 S F.✓EAl Note: 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. C-2.2 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 T3 ► fl Q®NA in the amount of 1.064 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 Bid er's Si nature ! 3 ► 7 C-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 Dollar % of Item(s) Subcontractor License Number Amount Contract Number 0'2- F C.-crae— C—PTOkI g-9 e,o, aoX fOt,s 903/b /9 t00000i7�, Zs000.op 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 iZ, at 4i-TA L-Oo-/t C,,4 lov City ,State 1/1 90 Ly being first duly sworn, deposes and says that he or she is �I vE e AZ S 1 pe N T of V 1 vo -sh,•,A A-7-1 LM. 114< 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�I �p S A r•-� A rcz r �rl /i✓�• Name of Pidder liy 1 pa Signature of id er CA 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 FY 16/1.7 CURB ACCESS RAMP INSTALLATION PROJECT, (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. Contractor L By Title Date: i /. U 41 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 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. V t"Z7 0 9 A m om( C Contractor - I LIJ - By Title Date: 1 )o 7-047 C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: I/ j PO //jC. Bidder Name y�?Z 77V Business Address Aur A to,_ A- c 9 a?o r City, State Zip 00 9 g )- 6 377 /1 C>o S.+, i &- M-HOO CO,--7 Telephone Number Email Address lj3.3z10 14 State Contractor's License No. and Class Original bate Issued 1 14 7 , -C-0 , c? Expiration bate V e po l.. 54.pnjj/iZ(twl The work site was inspected by of our office on 1 6 '�''�> , 2017. The following are persons, firms, and corporations having a principal interest in this proposal: I/ 1 �� S,a•^-r,�.�-Z r ��� n�s o d E.�-r- C-s The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. r•'1 v ComjaT/j Signature of B der I-f 1 L. z [ c-r1 Printed or Typed Signature Subscribed and sworn to before me this i0 day of S/l��/r`�r , 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. Nl)� -1C r—Ii,c� ) County of LS N'LS�if� ) qq n On :��� � � �� before me, _� .1 ��i�,G�,l Vk-i I k� ����:��i Mont D y, and Year nsert Name and Title of Notard personally appeared cv VA Name(�4,of Signt�s who proved to me on the basis of satisfactory evidence to be the Eshrfttmy-executed on( whose name is� subscribed to the within instrument and acknowledged to me that the same i his erfth-eir authorized capacity(i�, and that by is er H eir signatures on the instrument th ~ erso ), or the entity upon behalf of which the perso 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. JL WITNESS my hand and official seal. KRYSTAL MEDINA �t COMM.#2098976 Notary Public- 1"Is m I LOS ANGELES COUNTY A Comm.Ex .Feb.5 2019 Signature S gn re 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, nroiect 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: 1. G_/T7 OF / 800 19t c /9-.n*tic-.f#J wn'f Name and Address of Public Agency Name and Telephone No. of Project Manager: T//1r-) P Nftr l -(7/H, S17 8 3r�6 � 1 Zd 0 000.0o Gurcre rt Iw L ii LZIo Contract Amount Type Jf Work Date Completed Provide additional project description to show similar ork: jOV"11 G(-osSb,,r-*trr � ►o�wR���d /�A-✓ii'` 2. C- 1 r7' F C.4j F,S 7,/ ?ir+S7 LOA Y00 /mil 6W7e✓U Name and Address of Public Agency Name and Telephone No. of Project Manager: 34KE /J 6 y ®(71) "8, -- -Y 7 C000.00 /p"Irib /o! zoe6 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: J / poyR" /LOSS Lvov-K-,r I7Lyt/Vh 3. <i•`'"Y 0 S ov f-! fl o,.J Name and Address of Public Agency Name and Telephone No. of Project Manager: 4")e e-M0✓ —r� L6� s; �Q -* 0 S>p d 1 boo mm0.av f%osvG/��►t !'/�-��� 3 �o�C Contract Amount Type of ork Date Completed Provide additional p oject 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. 1. xic1 Vo L. r�;4 -r719-nZ.l G M Name of proposed Project Manager Telephone No. of proposed Project Manager: �� Z 6� P l, Z00,000.o0 G? Tf OF wssTrn►o-s ier^ Project Name & Contract Amount Type of WorV Date 6ompleted MA6.)OL-oi1AoLs4 :Pv-re/v Y7q i °lam , 40(00.00 �� � l a Zo/b Project Name & Contract Amount Type of Work Date Completed F L cz.Nrli-o /W rz,91464. 1 1 00 000. 0 0 k2!L4L/,—VI G Project Name & Contract Amount Type of WA Date Completed 2. /✓0 C- - -i rJA lrexo Name of proposed Superintendent 901 Telephone No. of proposed Superintendent: VA, 8 3 if II 100, 000.0 c-- o f W F-5 Ir-**r to,4 teA Coetr-t-�ezw& -�,V, --0/ 1 Project Name Contract Amount Type of Wori Date tompleted t °I 7 S, 0 0 0,c0, GO.^rP e� //.� IO zoi 6 Project Name& Contract Amount Type of Wo Date Completed r-L G-e.4ro /eve "Wit. Project Name & Contract Amount Type of WorkV DEG 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/ActionServiet?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. `I i two Contractor By Title Date: Ili 1 DIR#: �� o Z 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): 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: Contact Person: J' i t7p C, 5A--*"t4n-zr �1 Contact Phone: C o q 8) - 6 3> , Signed: Date: 1 io 1 2.0 1 *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 EXHIBIT A DISADVANTAGED BUSINESS ENTERPRISE (DBE) This Project is subject to Part 200.321, Title 2, Code of Federal Regulations entitled "Contracting with Small and Minority Businesses, Women's Business Enterprises, and Labor Surplus Area Firms." The Regulations in their entirety are incorporated herein by this reference. It is the policy of the City that disadvantaged business enterprises (DBEs), as defined in Part 200.321, Title 2 CFR, shall be encouraged to participate in the performance of Contracts financed in whole or in part with federal funds. The Contractor should ensure that DBEs, as defined in Part 200.321, Title 2 CFR, have the opportunity to participate in the performance of this Contract and shall take all necessary and reasonable steps, as set forth in Part 200.321, Title 2 CFR, for this assurance. The Contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of subcontracts. Failure to carry out the requirements of this paragraph shall constitute a breach of Contract and may result in termination of this Contract or other remedy the City may deem appropriate. Bidders shall be fully informed respecting the requirements of the Regulations and are urged to obtain DBE participation in this project, although there is no specific goal for DBE participation. C-14 EXHIBIT B DBE INFORMATION—GOOD FAITH EFFORTS Federal-aid Project No. 4 a / S`/ 1 Bid Opening Date /h.f 1� The City of Huntington Beach-established a Disadvantaged Business Enterprise (DBE) goal of 0% 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 r./ a. 7 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 Solicitation and Dates �-J 4- C-15 C. The items of work which the bidder made available to DBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items M of (Y/N) Contract D. The names, addresses and phone numbers of rejected DBE fines, 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-16 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: hit 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-17 IF A SOLE OWNER OR SOLE CONTRACTOR SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname) of proprietor. (3) Place of Business r4 (Street and Number) City and State q/+- (4) Zip Code elit Telephone No. N/ (5) E-Mail IF A PARTNERSHIP. SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname and character of partner) (Note: Signature must be made by a general partner) ti/e- (3) Place of Business �f/4 (Street and Number) City and State �1 (4) Zip Code NI Telephone No. (5) E-Mail 4 T C-18 IF A CORPORATION, SIGN HERE: (1) Name under which business is conducted VYC70 s �► n-zi t-1 i✓c. (2)_ I//J U (Signatur V)cz l�v�-�S ►r� F v-'`l' (Title) Impress Corporate Seal here (3) Incorporated under the laws of the State of LdFL t F O A_,JI 09 (4) Place of Business y g-'Z C-"_5T-VI F4V PCAf-& (Street and Number) City and State A-UrA t-0,-7,4 C14 (5) Zip Code ° 4'I o i Telephone No. 190 01 ) 9 7 - 6 3 > (6) E-Mail Z O'boSrR- G yA-1400, C-0~1 NOTARIAL ACKNOWLEDGMENT OF EXECUTION BY ALL SIGNATORIES MUST BE ATTACHED C-19 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 L On( O' l\' u� -)CAI I�-1 before me, `* � c. \ I a c (i` se name and title of the officer) personally appeared who proved to me on the basis of satisfactory evidence to be the erson(s whose narns�i lare--- subscribed to the within instrument and acknowled ed to me that hie s#e/# ey executed the same in hi er their authorized capacity'i , and that by hi e r signaturdta,) on the instrument the person or the entity upon behalf of which the p rson*,,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. KRYSTAL MEDINA WITNESS m hand and officials I. 'damy COMM.#20989M vNotary Public-C ltIOMIa mLOS ANGELES COUNTY.p Comm.Exp.Feb.5,2019 4 Signatu (Seal) List below names of president, vice president, secretary and assistant secretary, if a corporation; if a partnership, list names of all general partners and managing partners: 1 t7(2 Z 1 c-rl IDS ► P7 T C-20 EXHIBIT C LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCAL AGENCY: C 1't'1'_OF �_ NTrµlor_�_ _&4C44 LOCATION: C I"-.'Ili*E. PROJECT DESCRIPTION: TOTAL CONTRACT A OUNT:$. b 7 _900,00 BID DATE: I 1 0 ZO r BIDDER'S NAME: CONTRACT DBE GOAL: — 3— 'ONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE DOLLAR AMOUNT ITEM NO. OR SERVICES TO BEANDEXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened- include DBE address O BE PROVIDED(or contracted if the and phone number) bidder is a DBE) ZT- 7 For Local Agency to Complete: Local Agency Contract Number: Total Claimed DBE z S 0p� t b Y Participation F Federal-aid Project Number: % Federal Share: Contract Award Date: Local Agency certifies that all DI3E certifications have been verified and information is complete and accurate. Sig trgqof Bj'�ldcr I l lo/ ►7 �09� 9 D� —ro3» Date (Area Code)Tel.No. Print Name Signature Date V l!29 5;A'"/q JsZ I L(!:I Local Agency Representative Person to Contact (Please Type or Print) (Area Code)Telephone Number: Local Agency Bidder DBE Connnitrnent(Construction Contracts) (Rev 6i26/09) C-21 PLEASE NOTE: This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must be submitted and received as specified in the Special Provisions. Failure to submit the required DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project regardless of tier. Names of the First-Tier DBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of DBE firms. Exhibit 15-G must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local 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. C-22 EXHIBIT D EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder V 1 '20 [proposed subcontractor J hereby certifies that he/she/it 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/she/it 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. (ecoc.gov/employers/eeolsurvey/index.cfm) 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. Signature: Date: / /'L 1 Print Name: / i i7-0 vn/.I- Nz/ /I✓L Title: C-23 EXHIBIT E NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) [NAME OF CONTRACT] To the City of Huntington Beach In conformance with Title 23 United States Code Section 112 and California 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 Bidder's Proposal. By signing the Proposal, the Bidder has also signed this Noncollusion Affidavit. Bidders are cautioned that making a false Certification may subject the Bidder to criminal prosecution. 1,/ Signature: Date: I /c Print Name: ��p T29 [. CAr'►R/Lvl Ll� Title: C-24 EXHIBIT F 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 with Bidder 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 him/her 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. Note: 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. Signature: Date: /o / Print Name: L• Title: V. - C-25 EXHIBIT G ti 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 a d that all such subrecipients shall certify and disclose accordingly. Signature: a ( Date: /1-// Print Name: i a c? L Title: n C-26 EXHIBIT H 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: Fla.contract Ela.bid/offer/application ❑ a.initial b.grant b.initial award b.material change c.cooperative agreement c.post-award d.loan For Material Change Only: e.loan guarantee year quarter f.loan insurance date of last report 4. Name and Address of Reporting Entity 5. if Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: Prime El Subawardee Tier ifknown Congressional District,if known Congressional District,if known 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number,if applicable 8. Federal Action Number,if known: 9. Award Amount,if known: 10. a.Name and Address of Lobby Entity b. Individuals Performing Services (including (If individual,last name,first name,MI) address if different from No. IOa) (last name,first name,MI) (attach Continuation Shcet(s)if necessary) 11. Amount of Payment(check all that apply) 13. Type of Payment(check all that apply) $ Actual planned a.retainer b.one-time fee 2. Form of Payment(check all that apply): c.commission ea.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(%)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 I 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: .w�( L'U was placed the tier above when his transaction was made or D entered into.. C'This disclosure is required pursuant to 31 U.S. . Print Name: y O 1352. This information will be reported to Congress /� semiannually and will be available for public inspection.Any Title: VDU/ person who fails to file the required disclosure shall be subject 9 0p1 9`, I / ,0 1, to a civil penalty of not less than$10,000 and not more than Telephone No.:_0 (f b Date:_( $100,000 for each such failure. Authorized for Local Reproduction Federal Use Only: Standard Form-LLL Standard Form LLL Rev.09-12-97 C-27 INSTRUCTIONS FOR COMPLETION OF EXHIBIT H, 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 C-28 (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12)Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13)Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 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. By my signature on this proposal I certify, under penalty of perjury under the laws of the State of California, that the foregoing questionnaire and statements of Public Contract Code Sections 10162, 10232 and 10285.1 are true and correct and that the bidder has complied with the requirements of Section 8103 of the Fair Employment and Housing Commission Regulations (Chapter 5, Title 2 of the California Administrative Code). C-29 EXHIBIT I FEDERAL LOBBYING RESTRICTIONS Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower tier subrecipient 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 Proposal. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Proposal. Signing the Proposal 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: 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 person(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. C-30 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 �TG►n�.(GYL1 S "ZC�I^l before me, ERIKA GUIDO, NOTARY PUBLIC, personally appeared MATTHEW R. DOBYNS , ® who proved to me on the basis of satisfactory evidence to be the person( whose names) is/afe 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(} on the instrument the person(), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of CC COMM.#20 California that the foregoing paragraph is true and correct. o ERM,#20 26 r71 � WITNESS m nd and official seal.226 � NOTARY PUBLIC CALIFORNIA p ORANGE COUNTY ^®' '( My Comm.expires May 5.2017 l Z gnature &A6tary Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER ❑ PARTNER(S) ❑ LIMITED ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) FIDELITY AND DEPOSIT COMPANY OF MARYLAND BOND NO: VIDSA-1812 BID BOND KNOW ALL MEN BY THESE PRESENTS: That we, VIDO SAMARZICH, INC., (hereinafter called the Principal), and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation organized and doing business under and by virtue of the laws of the State of MARYLAND, and duly licensed for the purpose of making, guaranteeing or becoming sole surety upon bonds or undertakings required or authorized by the laws of the State of CALIFORNIA, as Surety, are held and firmly bound unto CITY OF HUNTINGTON BEACH, hereinafter called the obligee) in the sum equal to 10% of the accompanying bid of the Principal, not, however, in excess of TEN PERCENT OF THE TOTAL AMOUNT OF THE BID Dollars (10% OF THE BID AMOUNT), for the payment of which, well and truly to be made, we hereby bind ourselves and our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT WHEREAS, the above bounden Principal as aforesaid, is about to hand in and submit to the obligee a bid for the FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT, JOB/BID NO. CC-1541, in accordance with the plans and specifications filed in the office of the obligee and under the notice inviting proposals therefore. NOW, THEREFORE, if the bid or proposal of said principal shall be accepted, and the contract for such work be awarded to the principal thereupon by the said obligee, and said principal shall enter into a contract and bond for the completion of said work as required by law, then this obligation to be null and void, otherwise to be and remain in full force and effect. IN WITNESS WHEREOF, said principal and said Surety have caused these presents to be duly signed and sealed this 5T"day of JANUARY, 2017. VIDO SAP ARZICH/INaC. BY: Z_d /J FIDELITY ANO DEPOSIT COMPANY OF MARYLAND BY: MATTHEW R. DOBYNS, Atto ey-in-Fact ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW 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 GERALD F.HALEY,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 Randy SPOHN,Matthew R.DOBYNS and Hamilton KENNEY,all of Santa Ana,California, EACH its true and lawful agent and Attorney-in-Fact,to make,execute,seal and deliver,for,and on its behalf as surety,and as its act and deed:any and all bonds 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 Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 5th day of April,A.D.2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND EAL oc? u% 1O Secretary Vice President Eric D.Barnes Gerald F.Haley State of Maryland County of Baltimore On this 5th day of April,A.D.2016,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,GERALD F. HALEY,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 acknowledged the execution of same,and being by me duly sworn,deposeth and saith,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. /irr•Ahia�"t`� rr+/111/1111� Constance A.Dunn,Notary Public My Commission Expires:July 9,2019 POA-F 012-3955A llv11 � CA01 -16 Z O v c O O M a O 00 _ Z 00 U X _ p CDQ f V O U CY, � C O C> bA w_ U a U O W ) w �-- Q Z t w0 O ice., OL O = U _' w F--I (N Q w � Q EXHIBIT B (Form HUD-401 0, the Federal Labor Standards Provision of the United States) Federal Labor Standards Provisions U.S.Department of Housing and Urban Development Office of Labor PLt--Iatioris Applicability (1) The work to be performed by the classification The Project or Program to which the construction work requested is not performed by a classification in the wage covered by this contract pertains is being assisted by the deteifnination: and United Stiles of America and the following federal Labor (2) The ciassifirition is utilized In the area by the Standards Provisions are included in this Contract construction industry; and pursuant to the provinions applicable to such Fedorni ?3) The proposed wage rate, including any none fide assistaoue. fringe benefits, bears a reasonable relationship to the A. 11. (1) Minimum Wages. All laborers and inechanics wage rates contained in the wage deternilriation, employed or working upon the site of the work,will be paid (b) If the contractor and the laborers and Mechanics to be unconditionally and not less often than once a week, and employed in the classification (if knownt, or their wliliout aub5tquent deduction or iebatl: on any ai.Guunt representatives, and HUD or its designee agree on the (except such payroll deductions as are permitted by classification and wage fate (including the amount regulations issued by the Secretary of Labor under the designated for(tinge benefits where appropriate), a report Copeland Act (29 CFR Part. 3), the full amount of wages of the action taken shall he sent by HUD or its designee,to and bona fide fringe benefits (or cash equivalent% thereof) the Administrator of the Wage and Hour Division, due at time of payment computed at isles not less than £inploymrnt Standards Administration, U S. Department of those contained in the wagc, dohliniinstiori, Of the tabor, Vilashcrigloo, 0,G 20210. file Administrator, of an Secretary of Labor which Is attached herato and made a authorized representative, will approve modify, or par! hereof, regardless of any contractual relationship disapprove every additional classification action within 30 which may be alleged to exist between the contractor and days of receipt and so advise HUD at its designed or will such laborers and mechanics. Contributions "lade or notify HUD of its designee within the 30-day period that costs reasonably anticipated for bona Ude fringe benefits additional time is necessary. (Approved by the Office of under Section I(b)(21) of the Davis-Sicon, Act on behalf of Management and Budget under OMB control number 1215. laborers or mechanics are considered wages paid to such 0140,) labrifefs of mechanics. subject to the provisions of 29 Cf'[R Jc) fn the event the contractor, the labufei�. or fnec�hanics also, regular contributions inade or costs incurred for more than a weekly period (but not less often to bf." orriploytid in 111 e, classification or their than quarterly) under plans, fund--, or programs, which repie-sentativeq, and HUD or its designee do not agree oil cover the particular weekly period, are deemed to be the proposed classification and wage rate (including the constructively made or incurred during such weekly period, amount de-signated for fringe benefits, where appropriate), HUD or its designee shall refer the questions. including Stich latinrerg and mechanics shall be paid the appropriate the views of all Interested parties and the recommendation wage rate and fringe benefits on the wage determination of HUD or its designee, to the Administrator for for this classification of work actually performed, without determination. The Ad fninist rotor, or an authorized regard to skill, except as provided in 29 CFR 5.6(a)(4), representative. will issue a determination within 30 days of taborers or mechanics performing work in snore than one foceipt and so advise HLID or its designee or will notify classification may be rornpensated at the rate specified for HLAD or its designee within the 30 oil/ period that each classification for the time actually worked thureiw, additional lime, is necessary. (Approved by file Office of Provided. That the employer's payroll lecords accurately Management and Budget under 01010 Control Number set forth the finie spent in each classHlcativn in which 12-,5-0140,) Work is performed- the wage determination (including any Jd) The wage rate (including fringe benefits where additional classification and wage, rates conformed under appropriate) de-ni-minod pursuant to subparagraphs 29 CFR 5.5(a)(1)(ii) and the Davis-Sacion poster (WH- 1321) shah he posted at all times by file contractor and its (1)ih)(b) or (c) of this paragraph, shall be paid to all subcontractors at the site of the work in a pfuthinent end workers performing work in file ClasSifiV.3lion under this accessible, place where it can be easily seen by the coolracl from the first day on which work is performed in workers, the classification (11) (a) Any class of laborers or mechanics which Is not Jill) Whenever the rnintraurn wage rate prescribed in the listed in the wage determination and which is to be C001laCt for a class of laborers or mechanics includes a employed kuridni- the contract shalt be classified in fringe benefit which is not expressed as an hourly rate, the conformance with the wage determination. HUD shail contractor shall either pay the benefit as stated in the approve art additional classification and wage rate and wage determination or shall pay another bona fide fringe fringe benefits therefor only when the foll(lwing criteria benefit(it On houriy cash equivalent thereot. have been rriet: 00 If the contractor does not make payments to a trustee or other third person, the contractor may conjide( as part form HUD-40110(0rr12009) Previous editions on,obsolete r1ye I of t, f4A Handbook 13441 16-5215/142605.doc of the wager, of any laborer at mechanic the amount of any communicated in writing to the laborers or mechanics costs reasonably anticipated In providing bona fide tringe, affected, and rocvvds which show the costs anticipated of benefits Under a plan or program, Provided, That the the 1clual test Incurred in providing suCJi benefits. S,ccretary of Labor has found, open the Wrilten NtqL)P.%1 nf Grrnt�rrfriots empkiying apprentices or trainees under the contractor, that the applicable standards of the Davis- approvvill frogionis shall maintain written evidence of the Bacon Act have been met. The Secretary of tabor may Jpgistratiun of apprenticeship programs and certification of require the contractor to sat aside in a separAie account trainee programs, the registration of the apprentices and assets for the meeting of obligations under the plan of trainees, and the ratios and wage rates prescribed in the program, (Approved by the Office of Management ind appicable programs, (Approved by the Office of Budget under OMB Central Number 1715-0140.) Management and Budget under OMB Control Numbers 2. Withholding. HUD or its designee shall upon its own 121�1-0140 and 1215-0017 � action or upon written request of an authorized (it) (a) The contractor shall submit weekly for each week representative of the Department of Labor withhold or in which any cootiaCt work is performed a copy of all cause to be withheld from the contractor under ,his payrolls to HUD or its designee if the agency is a patty to contract or any other Federal contract with The same prime the conlract, but if the agency is not such a party- the contractor, or any other F-Ptlerally-assisted contract contractor will Submit the payrolls to the applicant subject to Davis-Bacon pievait'il; wage requirements, sponsor, or owner,as the case tinily be,lot*lianswissian to whlCrt il neld tty the rAm(,, prime onrit-Actor ro much of 1,1ir- HUD or iff, deslqneo. The payrolls submitted shni<ret out accrued payments or advances as may be considered accurately and completely all of the Information required necessary to pay laborers and mechanics, including to br, maililainiit tinflez'211 CPR 5.5i'a)tl)(i'1 oxcf,,pl that full e apprnficeemployeds, Iraineeq and helpers, employed by the social security numbers and home addresses shall not he contractor or any Subcontractor trip full amount of wnqc�, included up weekly hansmitlars. Instead the payrulN% shall requited by the contract to the event of failure to pay any on,y need to include an individually identifying number for laborer or mechanic, Including any ippri-rilice, trainee or each employee (e.g.,the last four digits of the employee s helper, employed or working on the site of the work, all or social Security number) The requited weekly paytoll part of the wages required by 0e aoril4a,.t. HUD or its information may be submitted in any form desired, dosignoo may, after written notice to the contractor, Optional Form WH-347 is available for this purpose from sponsor, applicant, of owner, take such action as rnsy be the Wage and Hour Division Web site at necessary to cause the susficrinturi of any forlhei i g,)/wwkv,Or)? or its payment, advance. of guarantee of funds until such successor site 'The prime contractor is resporsibip for vtoiations have ceased. HUD or its designee may, after the submission at copies of payrolls by all written notice to the contractor, disburse Such amounts Contractors and subcontractors shall maintain the full withheld for and on account at the, contractor or social security number and current address of each subcontractor to the respective ennplovees to whom they covered worker, and shall provide them upon request to are due, The Comptroller General shall make such HUD or its rleaiqiipe it the agency is a party to the disbursements in the case of direct Mavis-flacon Act nantrent, but if the agency is not such a party, the contracls, eunitactor will subuirt the payrolls to the applicant A. (i) Payrolls and basic records. Flayrolis and basil, aficansor, of owner, as the case of ay be, for tian,,rivssion it) records relating thereto shall be maintained by the HOD of its designee, the contractor, or the Wage,and floor contractor during the course of the work preserved lot a Division of the Depatimeril of Labor for purposes of an period of three years thereafter for oil laborerp and investigation or audit of compliance with prevailing wage r morhanim, narking 11 the rita of tht) work. Such records ieciMfealenig. It is not a Violation of this subparagraph for shall contain the narne, a(1,3tess, rind social qeourity a pirmic contractor to ri?quiry a subcontractor to provide number of each such worker, his or her correct addresser, wind social securily numbers to the prime classification. hourly rates of,vanes paid (including rates, contiwxlos for its own records, without weekly suornis%ion of contributions or costs anticipated for bona fide fringe to HUD or its designee, (Approved by the office of benefits or cash equivalent',thereof of the types df,s:jib<,d 1,01anageafent and Budget under OMB Comro€ Number in Section of the Davir-baron Act), lolly and 1215-0149,) weekly number of hours worked, deducticris made and (b) Each payroll Submitted shall be accompanied by a actual wages paid. Whenever the Secretary of Labor bat `Statement of Compliance.' signed by the, c*nlractor or found under 29 CFR 5,5 that the wager,; of any subcontractor at his or hey agent who pays at supervises laborer or mechanic include (tie amount of any costs the payment of the persons employed wider the CGRttad tua", ni*ly anticipated in providing henefim under a ,Aan oriel shall certify the following or program described in Serbon i(o)(2)(H) of the Davis- (i) that the payrrilt for the payroll period cDnl3ins the Bacon Act, the contractor shall maintain rccuidii which inloirnation requited to be provided under 29 Cl R 6.5 show that the commitment to provide such brinents if; (a)(!)lli), the appropriate information Is being maintained enforceanle, IhM the plan or program is financially uridor 29 CPR and that such information Is rimponsible. and that lire plan or program his been correct and complete; Previous editions are obsolete form HUD-4010(W,'2Q09) Paqfi 2 of 15 rof.Harldhodit 1344 1 16-5215/142605.doc (2) That each isborer or mechanic(including each helper. is not registered of otherwise employed as stated above, apprentice and trainee) employed or. the Contract during shall be paid not less than the applicable wage rate on the the payroll period has been paid the full weekly wages wage delorrmnaliun for the classification of work actually earned. without rebate, either directly or fildriecily, and performed. fit a0dition, any apprentice perfofmir.q work on that no deductions have been made either directly of the Job site in ext-Css of the ratio permitted tinder the Indirectly from the tail wages earned, other than registered program shall be paid not less than the permissible deductions as set forth in 29 GFR Part 3: applicable wage rate on the wage determination for the (3) That each laborer or mechamc has bvon paid not less work actually performed Where a contractor t,i pCifortoing than Inc, applicable wage rates And 16-1ge beneivtti Of cash construction ort a project in a locality other than that in equivalents for the classification of work performed, as which its program is registered, the ratios and wage rates specified In the applicable wage determination lcxntc3,;ed in percentages of the journeyman's hourly incorporated into the contract falf*'j spe'tified in the Contractor's or subcontractor's reg'�stofod program shall be observed. Evety apprentice (c) The weekly svbmission of a property ox0cut,00 most be paid at not less than the late specified in the certification set forth on the reverse side of Optional Form registered p�oqrarn for the of the level of progress, WIi--347 shall satisfy tire requirement for subrnis��iori of the rxpre,,�sed a�, a ppmentage of the journeymen houd,y rate 'Slatornunt of Compliance' required by subparagraph ��Peoififryeo � "Ine loplicable wa�4e deterillination. A 3,(si)(h), Apprentices shall be paid fringe benefits in accordance (d) The falsification of any or the above oeirtifications may with the pr,,.1vt5ions of the, apprenticeship progfarn. 11 the subject the rmwactot of subcontractor to civil or 0ininal apprentice&hrp program does; not specify fringe horefits, prosecuVon under Section 1001 of Title ',8 irid Section apprentices must be paid the full amount of fringe benefits 231 of I Jtv. 31 of Inc Uaiied States""offrx. listind on the wage determination for the applicable (fit) The f-'antfactor or subc-.0,4rat-lor Shall make the classification. It tho Administrator delefatiriez; that a fecords requited tinder subpairaqfaph A 3 (1) available for different practice orevaits for the applicable apprentice ins,pection, copying, or transcription by authorized vlasiiification,fringes shall be paid in accordance with that representatives of HUO or its designee or the Department detefiri ',I the event the Office of Apprenticeship of tabor, and shall permit such re-prt'sartatives to Training. Employer and Labor Services, or a State interview employees during working hours on the job, It Apprenticeship Agency recognized by the Office, the Contractor of subcontractor tails to submit the required withdraws approval of an apprenticeship program, the records of to make them available, HUD at its designee contractor will no longer be permitted to utilize may, after written notice to the contractor, sponsor, apprentices at less than the applicable predetermined rate applicant or owner, take such action as may be necessary for the work performed until an acceptable program is to cause the suspension of any further payment, advance, approved. or guarantee of funds. Furthermore, failure to submit the (it) Trainees. EXalept as provided in 29 CFR S,16, require,ti, record- upon request or to make such records Wmees will not be, permitted to work at less than the available may be grounds for debafrileril tieficiri pursuant to pictietetruirled rate for the work performed unless they are 29 C F R 5.12. employed pursuant 'Jo and individually registered in a 4. Apprentices and Trainees. program which has received prior approval, evidem;ed by lit Apprentices. Apprentices will be pefrnfthed 16 work at formal certification by The U.S, Dopwinwnt of Laboi, less than the predetermined late to,, this work they Employment and Training Administration. The ratio of performed when they are employed pursuant to and trainees to journeymen on the job site shall flat be greaten individually registered in a bone itie apprenticeship than permitted under the plan approved by the program registered with the U.S. Departmant of Labor, FmPtoymant and Training Administration. Every trainee Employrnetil and Training Adminia'NattDri, Office of must be paid at not less than the rate specified in the Apprenticeship Training, Employrit, anci Labot Fervicer,, fir apptuviid program for the trainee's level of progress, with a Slate Apprenticeship Agency recognized by the expressed as a percentage of the journeyman hourly rate Office; or if N person is employed in his or her first 90 specified in the applicable wage determination. Trainees days of probationary eniptoyrnent as an aplu;vnfici? its such shall be paid fringe benefits in accordance witty the all apprenticeship program, wile ris not n1d'v'Aually provir.ionsof file trainer program, it the traint"," progmin iegislenvd in the program. but who has boon certified by does riot mentiork fringe benefits, train(,,es shall be paid the Office of Apprenticeship Training, Cmpioyer and Labor the full amount of fringe benefits listed on the. wage Services or a State Apprenticeship Agency (whiafe doteirnmalion unlesa the Administrator of the Wage and appropriate) to be eligible for probrifiortary employinarit as Hour Division daterrmaee that there i, an apprenticeship 311 apprentice The allowable ratio of apprentices to program associated with the corresponding journeyman journeymen on the job site in any craft classification shall wa-,,'ie rate art the wage determination which provides for not be greater than the ratio permitted to the contractor as loss than full fringe benefits for apprenficcs. Any to the entire work force under the registered program. Any employee listed On the payroll at a trainee rate who is not worker listed on a payroll at an apptentice wage late, who teqistere#J and participating in a training plan approved by Previous editions are obsolete form HUD-4010(00/2009) Page 3 of 5 ;el.Handbook 1344.1 16-5215/142605.doc ................. ............... the Employment and Training Adininisliation shalt be uiiiJ awarded H1.10 ,'onhiicts of participate In HUD programs not less than the applicable waye rule Oil the Wage pursuant to 24 CFR Part 24. detervii.nation for the work actually performed. In addition, (it) No part of this contract shall be subcontracted to any any trainpe performing work on the job site in excess at person or firm inelioible for award of a Government the ratio permitted under the registered program shall be contract by virtize of Sviclion 3(a) of the Davis Bacon Act paid not Jess than the appiicatlle wage rake on the wage P1 �11 . —f CFR 6.12(i.011 or lQ be awarded MUD cilntrac,13 or determination for the work actually performed. In lire parlir;ipate in I 1UL)programs pursuant to '.4 Call part 24 event Ille Employment and Training Administration III) 'fric.-penalty for making false statements is pr,�-sciibed withdraws approval of a training program, thirl switractot will no lonqet be permitted to utilize haineas at less martin the U S. Criminal Code. 18 U.S.C, 1001. Addiiolnal�y, U S. Criminat Code, Section 1 01 0, Title Iri U,S.C., the applicable predetermined rare for the work performed "Federal Housing Administration transacilons', provide's in until an acceptable program is approved, part. 'Whoever, for the purpose of . . . influencing in any (M) Equal employment opportunity. The utilization of way the actinil of such Administration,.... makes, utters or apprentices, trainees and journeymen rimier 24 CPR Part ", publishes any stalsmant knowing the sarne to be false..... shalt be in conformity with the equal employment shall bi fined not more than $5„000 or imprisonied not opportunity icquiremerils of Executive Order 11246. as rnwe man two years, or both' amonaii.a.and 29 I.:;Fk Part 30 111 Complaints, Proceedings, or Testimony by 5, Compliance with Copeland Act requirements, The Employcv-s, No laboror or inectianic to whom the wage, contractor salary, or other labor standards provisions of rhi,,Cuiltact for shall comply with trip. requirefrents of 29 .;Fit Part 3 which are incorporated by iefuience err this conitacl are applicable shall be. discharged or in any other manner 6. Subcontracts. the contractor or suLconlracluf will discriminated against by the Contractor or any Insert In ally tubconbact, the causes containeo in sutrcontractur because such ernployev has Wad any subparagraphs I through 11 in this paragraph A and sucti Complaint or instituted or caused to be instituted any other ciaui-,es as HUD or its designee rnay by appfoptiata p,on"tflnq lit has leslifirid or is about to testily in any instruchoris require, and a ropy of the ippFr;ihlP prnoeprhng under or ro'hiting to the labor roaildaTds prevailing wage decision, and also a clause requiring the applicable under this Contract to his employer, subcuritractvi5 to include these clav%vs in any Iolviir tier S. Contract Wort, Hours and Safely Standards Act. The stjbooritezlcfs. The prime contractor shall be provisions of this paragraph B are applicable whore the amount of the for the compliance by any subrontr3ritor or lowi-,r tier prime contrart exceeds SIOO,OW. As used in this para�aph, like subcoritir,n0nir with )It the contract nlausnn in this olio"rnechanrr..c°include watchmen and auard , paragraph, (1)k Overtime requirements. No Contractor or sionorimalor 7. Contract termination, debarment. A brcarb of the omiracting for any prid of the contract work Which may require or contract Aauses in 29 CPR 5.5 may he q,okip1r, for jnvt)1vc mL omilloyinont of laborers or mechanics nivalf niqjire or termination of the contract and for debarment a pf-.11nil,tang SUCI)laborer Of fTl('(-JWniC in any workweek in whitch the contractor and a subcontractor as provided in " CtR Indirvidmil is employed on such work to work in excess of 41).hours in 11.12- such workweek unless such laborer or mechanic receives S. Compliance with Davis-Bacon and Related Act Requirements, com;Kinsation at a rate not less than one,and one-half firnes the basic All rtilings and interpretations of the and rat(4 of pay for all hous, worked in excess of 40 hours in such Related Auts contained in 29 CFR F`30s 1, 5, a,d ` li'r workweek. herein iricr)rporated by reference in this rontuic.t J2) Violation; liability for unpaid wages; liquidated 9. Disputes concerning labor standards. Disputes damages. In the event of any violation of the clause. set arising out of the labor standards provisions of this forth in subparagraph (1)of this paragraph, the contractor Contract shall not be subject to the general dksp-Aes and any subcontractor responsible therefor shall be, liable clause of this contract. Such disputes serail bat resuived in for the unpaid wages. In addition, such contractor and arcordance with the procridures of the Department of subcontractor shall be liable to the United States (in the Labor sor forth in 29 GFR Prkvts 5, 6, And 7 nisrutes C,,re of work done order contract for the Dr$trirj of within the. meaning of this Clause include cl;sputes between f2olurnbia Or a territory, to such District Or to bQQh the Cantraiaor (or any of its sub( rioirj HIJD ,rr imfitofy). for liquidated damages. Such liquidated its designee. the U.S. Deparimerit of Labor cf the damages shall be computed with respect to each individual amployl,ps or their repre rniativnr. 1.1hornr of mechanic, including watchmen and quards, W (1) Certification of Eligibility. By entering into this ernriloypd in violation of the clause set Forth in contract lhe! contractor (mirlifies, that rini hot A {nor fie -it suboaraqfapti III I of this paragraph, in the surn of$10 for each she) nor ally person or fiffn wh%i, ha"; sn mfewl&t in calendar day on which such individual was required or permitted!to 11sontraeltol s firm is a person of hill) inn ligiWte to t", wrlilt in excess of ttw;Wndard worimeoh of 40 hours without payment awartled Goveftirrient contract,. by v0oc of ectiori"3(a) of of the overltine wages required by the. Clause so' lofth in sub the Davis flacon Act or 29 CPR o '(,, he pAragriph fl}of this paragraph. Previouseditions are obsolete form HUD-101010612009) Page 4 of 5 ref.Handbook 13441 16-5215/142605.doc (3) Withholding for unpaid wages and liquidated damages. HUD of its de,109nO0 shall 01)nrl 11t< OvIn RC'VOo, or ovon written request of an authorized f epi ese n1la live of the Department of Labor wiltihold or cause to be. withheld, from any moneys payable on account of work perfoirved by the contractor or subcontractor under any such contrast or any Ohpr Federal contract with the swine prima, coriliacL, or wy other Federally,assisted conf,vcr sutrjetf to file Contract Work Hours and Safety Standards Act which it held by the same prime contw.tor suu.n sunis tis may be determined to be nttcessary to, satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated darnog", is provided in the ciause set forth in subparagraph(2) of this paragraph (4) Subcontracts. The contrartot or subaontrnitor ',hall insert in any subcontracts the clauses set forth in suopArafuipph (1) through (4) of this pnmq 4ph and also a clause requiring the subcontractors to include. these clauses in any lower tier sobcoftfta—*5, The prime contractor shall be responsible for compliencf, by any subcontractor or lower tier subcontractor with the ciau"s so*, forth in subparagraphs (1) through (4) of thgs paragraph. C Health and Safety- The provisions 0 thi,s pwwt taph C are aplific,ablewtic-re the amount of the $100.M0 (1) No laborer or mrchanir. shall he reqmred to work in surroundings or under working conditions which are unsanitary, hazardaus, vi dangerous to his health and safety as under cul)Ouuliun safety and huatth standards promulqatod by the Si>oclaq of tol)vi 1,y regulation (2) The Contractor shall comply with all regulations issued by Ine Secretary of Labor pursuant to lwo 29 Part 1926 and failure to comply may ee-iflt in imposition of sanctions pursuant to the Contract Work Hours and Safety Standards Act, (Public Law 91,54, 83 slat 96), (3) life contractor shelf include the provisions of this paragraph in every subcontract to that:-,iloh provisoes will be binding on each subcontractor, The contractor shall take such action with respect to any subcontractor as the Secretary of Housing and Orlin T)Pvolopmenl at the Secretary of Labor shall direct as a means of enforcing Such wovisiolls, Previous otirtions art,obnoletz, form HUD401U(OM2009) Page 5 of 5 rel.Hiindhook IM4.1 16-5215/142605.doc EXHIBIT C United States Department of Labor Office of Federal Contract Compliance Programs Office of Federal Contract Compliance Programs(OFCCP) Executive Order 11246,As Amended —DISCLAIMER— Executive Order 11246—Equal Employment Opportunity SOURCE:The provisions of Executive Order 11246 of Sept,24,1965,appear at 30 FR 12319,12935,3 CFR,1964- 1965 Comp.,p.339,unless otherwise noted. Under and by virtue of the authority vested in me as President of the United States by the Constitution and statutes of the United States,it is ordered as follows- Part I—Nondiscrimination in Goverfiment Employinent [Part I sijoerseded by EO 11478 of Atiq.,9, 1969,34 FR 12985,3 CFR,1966.-1970 Corrip.,p.803] Part II-Nondiscrimination in Employment by Government Contractors and Subcontractors Subpart A—Duties of the Secretary of Labor SEC. 201 The Secretary of Labor shall be responsible for the administration and enforcement of Parts II and HI of this Order.The Secretary shall adopt such rules and regulations and issue such orders as are deemed necessary and appropriate to achieve the purposes of Parts II and III of this Order. (Sec.201 amended by EO 12086 of Oct.5, 1978,43 FR 46501,3 CFR,1978 Comp,,p.230] Subpart 8—Contractors'Agreements SEC. 202 Except in contracts exempted in accordance with Section 204 of this Order,all Govemment contracting agencies shall include in every Government contract hereafter entered into the following provisions: During the performance of this contract,the contractor agrees as fo%ows: 1.The contractor will not discriminate against any employee or applicant for employment because of race,color, religion,sex,sexual orientation,gender Identity,or national origin.The contractor will take affirmative action to ensure that applicants are employed,and that employees are treated during employment,without regard to their race,color,religion,sex,rxixual orientation,gender identity,or national origin.Such action shall include, but not be limited to the following;employment,upgrading,demotion,or transfer; recruitment or recruitment advertising;layoff or termination;rates of pay or other forms of compensation;and selection for training, �nclucling apprentic hip.The agrees to post in conspicuous places,available to employees and applicants for employment,notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination dause. 16-5215/142605.doc 2.The contractor will,in all solicitations or advancements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race,color, religion,sex,sexual orientation,gender identity,or national origin. 3.The contractor will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about,discussed,or disclosed the compensation of the employee or applicant or another employee or applicant.This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information,unless such disclosure is in response to a formal complaint or charge,in furtherance of an investigation,proceeding,hearing,or action,including an investigation conducted by the employer,or is consistent with the contractor's legal duty to furnish information. 4.The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding,a notice,to be provided by the agency contracting officer,advising the labor union or workers'representative of the contractor's commitments under Section 202 of Executive Order No. 11246 of September 24,1965,and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 5.The contractor-will comply with all provisions of Executive Order No, 11246 of Sept.24,1965,and of the rules, regulations,and relevant orders of the Secretary of Labor. 6.The contractor will furnish all information and reports required by Executive Order No.11246 of September 24, 1965,and by the rules,regulations,and orders of the Secetary of Labor,or pursuant thereto,and will permit access to his books,records,and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules,regulations,and orders. 7.to the event of the contractor's noncompliance with the nondiscrimination clauses of this contract or with any of such rules,regulations,or orders,this contract may be cancelled,terminated,or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order No. 11246 of Sept.24, 1965,and such other sanctions may be imposed and remedies invoked as provided in Fxecutive Order No. 1.1246 of September 24, 1965,or by rule,regulation,or order of the Secretary of Labor,or as otherwise provided by law. 8.The contractor will include the provisions of paragraphs(1)through(8)in every subcontract or purchase order unless exempted by rules,regulations,or orders of the Secretary of Labor Issued pursuant to Section 204 of Executive Order No.11246 of September 24, 1965,so that such provisions will be binding upon each subcontractor or vendor.The contractor will take such action with respect to any subcontract or purchase order as may be directed by the Secretary of Labor as a means of enforcing such provisions including sanctions for noncompliance: Provided,however,that in the event the contractor becomes involved in,or is threatened with, litigation with a subcontractor or vendor as a result of such direction,the contractor may request the United States to enter into such litigation to protect the interests of the United States. [Sec 202 amended by EO 11375 of Oct. 13,1967,32 FR 14303,3 CFR, 1966-1970 Comp.,p.684,EO 12086 of Oct.5,1978,43 FR 46501,3 CFR, 1978 Comp.,p. 230,EO 13665 of April 8,2014,79 FR 20749,EO 13672 of July 21,2014,79 FR 429711 SEC. 203 a.Each contractor having a contract cortcinina the provisions prescribed in Section 202 shall file,and shall cause each of his subcontractors to file,Compliance Reports with the contracting agency or the Secretary of Labor as may be directed.Compliance Reports shall be filed within:such times and shall contain such information as to the practices,policies,programs,and employment policies,programs,and employment statistics of the contractor and each subcontractor,and shall be in such form,as the Secretary of Labor may prescribe. b.Bidders or prospective contractors or subcontractors may be required to state whether they have participated in any previous contract subject to the provisions of this Order,or any preceding similar Executive order,and in 16-5215/142605.doc that event to submit,on behalf of themselves and their proposed subcontractors,Compliance Reports prior to or as an initial part of their bid or negotiation of a contract. c.Whenever the contractor or subcontractor has a collective bargaining agreement or other contract or understanding with a labor union or an agency referring workers or providing or supervising apprenticeship or training for such workers,the Compliance Report shall include such information as to such labor union's or agency's practices and policies affecting compliance as the Secretary of Labor may prescribe: Provided,that to the extent such information is within the exclusive possession of a labor union or an agency referring workers or providing or supervising apprenticeship or training and such labor union or agency shall refuse to furnish such information to the contractor,the contractor shall so certify to the Secretary of Labor as part of its Compliance Report and shall set forth what efforts he has made to obtain such information. d.The Secretary of Labor may direct that any bidder or prospective contractor or subcontractor shall submit,as part of his Compliance Report,a statement in writing,signed by an authorized officer or agent on behalf of any labor union or any agency referring workers or providing or supervising apprenticeship or other training,with which the bidder or prospective contractor deals,with supporting information,to the effect that the signer's practices and policies do not discriminate on the grounds of race,color,religion,sex,sexual orientation,gender identity,or national origin,and that the signer either will affirmatively cooperate in the implementation of the policy and provisions of this Order or that it consents and agrees that recruitment,employment,and the terms and conditions of employment under the proposed contract shall be in accordance with the purposes and provisions of the order.In the event that the union,or the agency shall refuse to execute such a statement,the Compliance Report shall so certify and set forth what efforts have been made to secure such a statement and such additional factual material as the Secretary of Labor may require. [Sec.203 amended by EO 11375 of Oct.13,1967,32 FR 14303,3 CFR,1966-1970 Comp.,p.684;EO 12086 of Oct. 5,1978,43 FR 46501,3 CFR,1978 Comp.,p.230,EO 13672 of July 21,2104,79 FR 42971] SEC. 204 a.The Secretary of Labor may,when the Secretary deems that special circumstances in the national interest so require,exempt a contracting agency from the requirement of including any or all of the provisions of Section 202 of this Order in any specific contract,subcontract,or purchase order. b.The Secretary of Labor may,by rule or regulation,exempt certain classes of contracts,subcontracts,or purchase orders(1)whenever work is to be or has been performed outside the United States and no recruitment of workers within the limits of the United States is involved;(2)for standard commercial supplies or raw materials;(3)involving less than specified amounts of money or specified numbers of workers;or(4)to the extent that they involve subcontracts below a specified tier. c.Section 202 of this Order shall not apply to a Government contractor or subcontractor that is a religious corporation,association,educational institution,or society,with respect to the employment of individuals of a particular religion to perform work connected with the carrying on by such corporation,association,educational institution,or society of its activities.Such contractors and subcontractors are not exempted or excused from complying with the other requirements contained in this order. d.The Secretary of Labor may aim provide,by,ule,regulation,or order,for the exemption of facilities of a contractor that are in all respects separate and distinct from activities of the contractor related to the performance of the contract: provided,that such an exemption will not interfere with or impede the effectuation of the purposes of this Order:and provided further,that in the absence of such an exemption all facilities shall be covered by the provisions of this Order. [Sec.204 amended by EO 13279 of Dec. 16,2002,67 FR 7714?,3 CFR,2002 Comp.,p.77141—771441 Subpart C—Powers and Duties of the Secretary of Labor and the Contracting Agencies 16-5215/142605.doc SEC. 205 The.Secretary of Labor shall be responsible for securing compliance by all C3ovemment contractors and subcontractors with this Order and any implementing rules or regulations.All contracting agencies shall comply with the terms of this Order and any implementing rules,regulations,or orders of the Secretary of Labor.Contracting agencies shall cooperate with the Secretary of Labor and shall furnish such information and assistance as the Secretary may require. [Sec.205 amended by EO 12086 of Oct.S,1978,43 FR 46501,3 CFR, 1978 Comp.,p.230] SEC. 206 a.The Secretary of Labor may investigate the employment practices of any Government contractor or subcontractor to determine whether or not the contractual provisions specified in Section 202 of this Order have been violated.Such investigation shall be conducted in accordance with the procedures established by the Secretary of Labor. b.The Secretary of labor may receive and investigate complaints by employees or prospective employees of a Government contractor or subcontractor which allege discrimination contrary to the contractual provisions specified in Section 202 of this Order. [Sec.206 amended by EO 12086 of Oct.5, 1978,. 43 FIR 46501,3 CFR, 1978 Comp.,p.230] SEC. 207 The Secretary of Labor shall use his/her best efforts,directly and through interested Federal,State,and local agencies, contractors,and all other available instrumentalities to cause any labor union engaged in work under Government contracts or any agency referring workers or providing or supervising apprenticeship or training for or in the course of such work to cooperate in the implementation of the purposes of this Order.The Secretary of Labor shall,in appropriate cases,notify the Equal Employment Opportunity Commission,the Department of Justice,or other appropriate Federal agencies whenever it has reason to believe that the practices of any such labor organization or agency violate Title VI or Title VII of the Civil Rights Act of 1964 or other provision of Federal law. [Sec.207 amended by EO 12086 of Oct. 5. 1978,43 FIR 46501,3 CFR, 1978 Comp.,p.2301 SEC. 208 a.The Secretary of Labor,or any agency,officer,or employee in the executive branch of the Government designated by rule,regulation,or order of the Secretary,way hold such hearings,public or private,as the Secretary may deem advisable for compliance,enforcement,or educational purposes. b.`f he Secretary of Labor may hold,or cause to be held,hearings in accordance with Subsection of this Section prior to imposing,ordering,or recommending the imposition of penalties and sanctions under this Order.No order for debarment of any contractor from further Government contracts under Section 209(6)shall be made without affording the contractor an opportunity for a hearing. Subpart D—Sanctions and Penalties SEC. 2u3 In accordance with such rules,regulations,or orders as Me Secretary of Labor may issue or adopt,the Secretary may: 1.Publish,or cause to be publishe,4,the names of contractors or unions which it has concluded have complied or have failed to comply with the provisions of this Order or of the rules,regulations,and orders of the Secretary of Labor. 2.Recommend to the Department of Justice that., :,cases in which there is substantial or material violation or the threat of substantial or material violation c,f the contractual provisions set forth in Section 202 of this Order, appropriate proceedings be brought to enforce those provisions,including the enjoining,within the limitations 16-5215/142605.doc 4 of applicable taw,of organizations,individuals,or groups who prevent directly or indirectly,or seek to prevent directly or indirectly,compliance with the provisions of this Order. 3.Recommend to the Equal Employment Opportunity Commission or the Department of Justice that appropriate proceedings be instituted under Title VII of the Civil Rights Act of 1964. 4.Recommend to the Department of Justice that criminal proceedings be brought for the furnishing of false information to any contracting agency or to the Secretary of Labor as the case may be. S.After consulting with the contracting agency,direct the contracting agency to cancel,terminate,suspend,or cause to be cancelled,terminated,or suspended,any contract,or any portion or portions thereof,for failure of the contractor or subcontractor to comply with equal employment opportunity provisions of the contract. Contracts may be cancelled,terminated,or suspended absolutely or continuance of contracts may be conditioned upon a program for future compliance approved by the Secretary of Labor. 6.Provide that any contracting agency shaft refrain from entering into further contracts,or extensions or other modifications of existing contracts,with any noncomplying contractor,until such contractor has satisfied the Secretary of Labor that such contractor has established anc will carry out personnel and employment policies in compliance with the provisions of this Order. (b)Pursuant to rules and regulations prescribed by the Secretary of Labor,the Secretary shall make reasonable efforts, within a reasonable time limitation,to secure compliance with the contract provisions of this Order by methods of conference,conciliation,mediation,and persuasion before proceedings shall be instituted under subsection(a)(2)of this Section,or before a contract shall be cancelled or terminates in whole or in part under subsection(a)(5)of this Section. [Sec.209 amended by EO 12086 of Oct.5, 1978,43 FR 46501,3 CFR,1978 Comp.,p.230] SEC. 210 Whenever the Secretary of Labor makes a determination under Section 209,the Secretary shall promptly notify the appropriate agency.The agency shall take the action directed by the Secretary and shall report the results of the action it has taken to the Secretary of Labor within such time as the Secretary shall specify.If the contracting agency fails to take the action directed within thirty days,the Secretary may take the action directly. [Sec.210 amended by EO 12086 of Oct.s, 1978,43 FR 46501,3 CFR,1978 Comp.,p 230] SEC. 211 If the Secretary shall so direct,contracting agencies shall not enter into contracts with any bidder or prospective contractor unless the bidder or prospective contractor has satisfactorily complied with the provisions of this Order or submits a program for compliance acceptable to the Secretan/of Labor. [Sec.211 amended by EO 12086 of Oct.5. 1978,43 FR 46501,3 CFR,1978 Comp.,p.230] SEC. 212 When a contract has been cancelled or terminated under Section 209(a)(5)or a contractor has been debarred from further Government contracts under Section 209(a)(6)of this Order,because of noncompliance with the contract provisions specified in Section 202 of this Order,the Secretary of Labor shall promptly notify the Comptroller General of the United States. [Sec.212 amended by EO 12086 of Oct.5, 1978,43 FR 46501,3 CFR,1978 Comp.,p.2301 Subpart E—Certificates of Me dt SEC. 2131 16-5215/142605.doc 5 The Secretary of Labor may provide for issuance of a United States Government Certificate of Merit to employers or labor unions,or other agencies which are or may hereafter be engaged in work under Government contracts,if the Secretary is satisfied that the personnel and employment practices of the employer,or that the personnel,training,apprenticeship, membership,grievance and representation,upgrading,and other practices and policies of the labor union or other agency conform to the purposes and provisions of this Order. SEC. 214 Any Certificate of Merit may at any time be suspended or revoked by the Secretary of Labor if the holder thereof,in the judgment of the Secretary,has failed to comply with the provisions of this Order. SEC. 215 The Secretary of Labor may provide for the exemption of any employer,labor union,or other agency from any reporting requirements imposed under or pursuant to this Order if such employer,labor union,or other agency has been awarded a Certificate of Merit which has not been suspended or revolted. Part III—Nondiscrimination Provisions in Federally Assisted Construction Contracts SEC. 301 Each executive department and agency,which administers a program involving Federal financial assistance shall require as a condition for the approval of any grant,contract,loan,insurance,or guarantee thereunder,which may involve a construction contract,that the applicant for Federal assistance undertake and agree to incorporate,or cause to be incorporated,into all construction contracts paid for in whole or in part with funds obtained from the Federal Government or borrowed on the credit of the Federal Government pursuant to such grant,contract,loan,insurance,or guarantee,or undertaken pursuant to any Federal program involving such grant,contract,loan,insurance,or guarantee,the provisions prescribed for Government contracts by Section 202 of this Order or such modification thereof,preserving in substance the contractor's obligations thereunder,as may be approved by the Secretary of Labor, together with such additional provisions as the Secretary deems appropriate to establish and protect the interest of the United States in the enforcement of those obligations.Each such applicant shall also undertake and agree(1)to assist and cooperate actively with the Secretary of 1.3hor it ebtainin-2 the c^mpliance of contractors and subcontractors with those contract provisions and with the rules,regulations and relevant orders of the Secretary,(2)to obtain and to furnish to the Secretary of Labor such information as the Secretary may require for the supervision of such compliance, (3)to carry out sanctions and penalties for violation of such obligations imposed upon contractors and subcontractors by the Secretary of Labor pursuant to Ira,t II,Subpart D,of this Grder,and(4)to refrain from entering into any contract subject to this Order,or extension or other modification of such a contract with a contractor debarred from Government contracts under Part 11,Subpart D,of this Order. [Sec.301 amended by EO 12086 of Oct...5, 1978,43 FIR 46r01,3 7R, 1978 Comp.,p.230] SEC. 302 a."Construction contract"as used in this Order means any contract for the construction,rehabilitation,alteration, conversion,extension,or repair of buildings,highways,or other improvements to real property. b.The provisions of Part II of this Order shall apply to such construction contracts,and for purposes of such application the administering department or agency shall be considered the contracting agency referred to therein. c.The term"applicant"as used in this Order means an applicant for Federal assistance or,as determined by agency regulation,other program participant,with respect to whom an application for any grant,contract,loan, insurance,or guarantee is not finally acted upon prior to the effective date of this Part,and it includes such an applicant after he/she becomes a recipient of such Federal assistance. SEC. 303 16-5215/1,12605.doc 6 a.The Secretary of Labor shall be responsible for obtaining the compliance of such applicants with their undertakings under this Order.Each administering department and agency is directed to cooperate with the Secretary of Labor and to furnish the Secretary such information and assistance as the Secretary may require in the performance of the Secretary's functions under this Order. b.In the event an applicant fails and refuses to comply with the applicant's undertakings pursuant to this Order, the Secretary of Labor may,after consulting with the administering department or agency,take any or all of the following actions:(1)direct any administering department or agency to cancel,terminate,or suspend in whole or in part the agreement,contract or other arrangement with such applicant with respect to which the failure or refusal occurred;(2)direct any administering department or agency to refrain from extending any further assistance to the applicant under the program with respect to which the failure or refusal occurred until satisfactory assurance of future compliance has been received by the Secretary of Labor from such applicant; and(3)refer the case to the Department of Justice or the Equal Employment Opportunity Commission for appropriate law enforcement or other proceedings. c.In no case shall action be taken with respect to an applicant pursuant to clause(1)or(2)of subsection(b) without notice and opportunity for hearing. [Sec. 303 amended by EO 12086 of Oct.5, 1978,43 FR 46501,3 CFR, 1978 Gump.,p.230] SEC. 304 Any executive department or agency which imposes by rule,reguiation,or order requirements of nondiscrimination in employment,other than requirements imposed pursuant to this Order,may delegate to the Secretary of Labor by agreement such responsibilities with respect to compliance standards,reports,and procedures as would tend to bring the administration of such requirements into confbrmity with the administration of requirements imposed under this Order:Provided,That actions to effect compliance by recipients of Federal financial assistance with requirements imposed pursuant to Title VI of the Civil Rights Act of 1964 shall be taken in conformity with the procedures and limitations prescribed in Section 602 thereof ar.d the reguGations of the administering department or agency issued thereunder. Part IV—Miscellaneous SEC. 4Zi The Secretary of Labor may delegate to any officer,agency,or employee in the Executive branch of the Government, any function or duty of the Secretary under Parts 11 and Ill of this Order. [Sec.401 amended by EO 12086 of Oct.5,197fs,43 F2 46501,3 CFR,1978 Comp.,p.230] SEC.402 The Secretary of Labor shall provide n:'minfst=r'v::rapper*for the execution of the program known as the"Plans for Progress." SEC.403 a.Executive Orders Nos.10590(January 19,1955),10722(August 5,1957),10925(March 6,1961), 11114 'June 22, 1963),and 11162(luly 28,1964),are hereby superseded and the President's Committee on Equal Employment Opportunity established by Executive Order No.10925 is hereby abolished.All records and property in the custody of the Committee shall be transferred to the Office of Personnel Management and the Secretary of Labor,as appropriate. b.Nothing in this Order shall be deemed to relieve any person of any obligation assumed or imposed under or pursuant to any Executive Order superseded by this Order.All rules,regulations,orders,instructions, designations,and other directives issued by the President's Committee on Equal Employment Opportunity and those issued by the heads of various departments or agencies under or pursuant to any of the Executive orders superseded by this Order,shall,to the extent that they are not inconsistent with this Order,remain in full force 16-5215/142605.doc 7 and effect unless and until revoked or superseded by appropriate authority.References in such directives to provisions of the superseded orders shall be deemed to be references to the comparable provisions of this Order. [Sec.403 amended by EO 12107 of Dec.28,1978,44 FR 1055,3 CFR,1478 Comp.,p,2641 SEC. 404 The General Services Administration shall take appropriate action to revise the standard Government contract forms to accord with the provisions of this Order and of the rules and regulations of the Secretary of Labor. SEC.405 This Order shall become effective thirty days after the date of this Order. 16-52151142605.doc 8 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE for FY 2016117 CURB ACCESS RAMP INSTALLATION PROJECT C.C. No, 154,1 January 3, 2017 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Special Provisions: 1) Replace Section D "Sample Contract" in it's entirety in the Specifications with updated Section D in this Addendum. The ",Sample Contract' was updated in December 2016. 2) Replace Appendix K, the"Prevailing Wage Schedule" in it's entirety in the Specifications with updated Appendix K in this Addendum. "General Decision Number: CA60035 11/11/2016" will be replaced with "Lena al Decision Number: CA60035 12/23/2016." 3) Replace Appendix L, the "Federal Documents for CDBG Projects" in it's entirity in the Specifications with updated Apper idix L in ,his:addendum. The documents were updated in December 2016. This is to acknowledge receipt and renew oA Addendum Number One, dated January 3, 2017. Company Name ^EiyJ � t � j x All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Joseph Fuentes at (714) 536- 5431. 1 DATE(MM1DDlYYYY) ACoRLn® CERTIFICATE OF LIABILITY INSURANCE 2/15/2017 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(tes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain pollcles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER CONTACT Lisa Burrill NAME: Southern California Insurance Brokerage PRONE (909)592--2215 FAX (909)305-0391 3333 Concours, Bldg 5 E' E s certificates@socalinsurance.com License #G177159 INSURERS AFFORDING COVERAGE NAICB _ Ontario CA 91764 INSURERA:Financial Pacific Insurance Company 31453 INSURED INSURERB:State Compensation Ina. Fund 35076 Vida Samarzich, Inc. INSURERC: 4972 Crestview Place INSURER 0: INSURER E: Alta Loma CA 91701 1 INSURER F: COVERAGES CERTIFICATE NUMBER:16/17 GL & XS RENEWAL REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR ADDLSUBR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY, MBE MJ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DM AO E T75 A CLAIMS-MADE a OCCUR PRE'MISS EaEM occurrence) S 100,000 X Y 60455974 12/23/2016 12/23/2017 M,;EDEXP(Any one person) g 5,000 = PERSONAL&ADV INJURY $ 1,D00,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY1:1 JECT1:1 LOC APPROVED A5 O FORM PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY p `T� . B ED SINGLE LIMIT $ By: `��Jf acs-7 E nt ANY AUTO �1ICHAELE. ATES BODILY INJURY(Per petson) s AUTOS AUTOSULED CITY ATTORNEY BODILY INJURY(Peracddent) s NON-OWNED CITY OF HUNTING ON BEACH PROPERTY DAMAGE $ HIREDAUTOS L $ AUTOS _ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 X OED RETENTON 60455974 12/23/2016 12/23/2017 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X TA E Efl ANY PROPRIETORPARTNERrEXECUTIVE YIN N E.L.EACH ACCIDENT $ 1 000 000 B OFFICERMEM.tBER EXCLUDED? ❑ NIA 9100682-16 5/22/2016 5/22/2017{Mandatory in Nil) E.L.DISE 00 000 IIres descdhe under D S RIPT)ON OF OPERATIONS beta, E.L.DISEASE-POLILYA 1 000 a al DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: FY 16/17 CURB ACCESS RAMP INSTALLATION, PROJECT #1541. CITY OF HUNTINGTON BEACH, ITS OFFICERS, ELECTED OR APPOINTED OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AS RESPECTS GENERAL AND AUTO LIABLILITY AND THIS INSURANCE IS PRIMAY AND NONCONTRIBUTORY WITH ANY OTHER INSURANCE OF THE ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT, PER ATTACHED ENDORSEMENTS. SHOULD ANY POLICY BE CANCELLED BEFORE THE EXPIRATION DATE THE CARRIER WILL MAIL 30 THIRTY) DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDERS WHICH REQUIRE SUCH ACTION PER WRITTEN CONTRACT OF CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF HUNTINGTON BEACH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2000 MAIN ST. ACCORDANCE WITH THE POLICY PROVISIONS. HUNTINGTON BEACH, CA 92648 AUTHORIZED REPRESENTATIVE L Burrill, CISR/CERTS 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2oi4oi) COMMENTS/REMARKS AGREEMENT, EXCEPT 10 DAYS NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM. -SPECIFIC A/I (ON-GOING & COMP. OPS) WITH PRIMARY WORDING, WAIVER, PER PROJECT AND 30--DAY NOC ATTACHED. OFREMARK COPYRIGHT 2000, AMS SERVICES INC. - - - - - - - - - - - - - - - CERTI DATE OF LIABILITY INSURANCE CO21612017 / THIS CERTIFICATE I$ISSUED AS A NIA ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATiVE�Y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR17EO REPRESENTATIVE OR PRODUCER,AND HE CERTIFICATE HOLDER. IMPORTANT: If the certificate hoidor toe ADDITIONAL INSURED,Ilia policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain poticles may requiro an endorsement.A statement on This certificate does not confer rights to the certificate holder In lieu of such sndorsem nt(s). PROnWER RICHARD H.VOSSMEYER,iAGENT e oT ICHARQ H.VO$SMEY9R _ LICENSE#.0532881 Pit xli;.�L-84g-4403 ino No1181$9 StateFarRT 1111 FOOTHILL BLVD.,STIa.B ll •RICHARD.VOSSMEYE .B6RZ STATEFARM.COM . LA CANADA,CA 9101 i alsvae nPFORox;o a Rao NATO s ' WSOAERAt.51816 Farni atu IAu Tahtt insgranw gompanye INSURE4 VIDOSAMARZICH,INC. txsuRrRe 4972 CRESTVIEW PLACE IRse ct RANCHO CUCAMONGA,CA 91701-1260 visumo` WSURRB E INSURER F COVERAGES CERTtFI ATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOWM$TANDING ANY REQUI"ENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROCO BY THE POLICIES DESCRIDED HEREIN IS SUBJECT YO ALI_THE TERMS, EXCLUSIONS AND CONDITIONSOF SUCH POLIUE-S,LIMITS SHOWN IAAY HAVE BEEN REDUCED BY PAID CLAIMS _ rMIOPPOURANCE E%OYRUMBER I p C111wJP�t LtC MOTS 43FNERALUABILITY PA CHOCCURREh!C£ 5 GETOR COIAULRCWI GENERAL L(ABILTTY E , ate orarrwtcol II - - CLAItAS L1AOE OCCUR vow . nawfWAI s PERSONALAADVINRTRY S _ GEE(ERALAGGKOATE $ Itt Ot-aTL AGMOATE Ugrr APPLIES PER PRODUCTS-CGYAPAOP AGG S I POLICY PRb• LOG S AUTO6dOB"LIARP 17YUWT A Y Y 1484179-D12-76 04lS112015 041f212017 Aoa O E s t,000,000 AWAUrrO scxelwLED 2762485-A09•76 OMD12017 0110912018 IWLY A tr�RY{Par�non} s AUTOS AUTOS 049 2620-F27-76 t2 V2016 12127/2017 BoaLY INIURY(Per acUdrrAl g x 1,11116DAUT08 X A6110 na GE S S t114aRR"LLAU 00" 0"OCCURRer* II EXCSSSUAB HCIJVV."AW ACLGREGATE s I I OEO RETL•N 0 S � WORXERSCOWENSATION S 07 AND E.MPLOYERW UABaITY ' 1 ANYMTOPRIETO"ARTNERRMCl1TIVE Y�� C.L.EA01AWOENT $ -. OFFI-awMsMfxCLQ0�07 E_.] NIA (Mendoloty to nN) 61.aS!AS8•EA T uPLOY S -- ura>ae ¢e O.L.DISEASi:-POUCY LIMIT s MSCA&TIGN Of OPERATIONS!LOCATIONS i VEHICLES IAtpth ACORD 101,AdeMonal Romrka Schediet.It more tprt m to mqulted) Scheduled Autos: 2007 CHEVROLF.T C160O V.I.N.:iGCEC18017Z6441b1/2006 CHF-VROLET C1600 V.I,N.I 10CEC19V0521 i66Z8 Project: FY16/17 CURB ACCESS RAMP INSTAL TION,PROJECT#IrAl CITY OF HUNTINGTON BEACH,ITS OFFICERS,ELECTED OR APPOINTED OFFICIAL,EMPLOYEES,AGENTS AND VOLUNTEERS ARE NAMES AS ADDITIONAL INSURED AS RESPECTS AUTO LI sILITY,AND HIS INSURANCE IS PRIMARY AND NON CONTRIBUTORY WITH ANY OTHER INSURANCE OF THE ADDITIONAL INSURED AS REQUIRED 9Y WRITTEN CONTRACT PER ATTACHED ENDORSEMENTS i CERTIFICATE HOLDER CANCELLATION i CITY OF HUNTINCTON BEACH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE THE EXPIRATION DAYS THEREOF, NOTICE WILL B£ DELIVERED IN I 2000 MAIN ST ACCOROANCe WITH THC POLICY PROVISIONS, HUNTIN13TON BEACH,CA 92648 A lOR>Y RE NTAs� Q'4'� C Tt Q 1958-20t0 CO D CORPORA' All ridhfs served. ACORD 25(2010106) The kCORD name and logo are registered arks of ACORD 1001486 132849.0 01-23-2013 I POLICY NUMBER: 60455974 COMMERCIAL GENERAL LIABILITY CG 20 10P 11 86 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: PREMIUM 100 COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: THE CITY OF HUNTINGTON BEACH, ITS OFFICERS, ELECTED OR APPOINTED OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS ACTING WITHIN THE SCOPE OF THEIR DUTIES THAT ARE CONTROLLED & SUPERVISED BY THE PRIMARY (FIRST) ADDITIONAL INSURED. 2000 MAIN STREET, HUNTINGTON BEACH, CA 92648 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that person or organization is held liable for "your work" for that person or organization by or for you. When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. This endorsement applies to the following work:COMMERCIAL WORK ONLY: REMODELING / REPAIRS - INSTALL CONCRETE ACCESS RAMPS Description of Job: FY 16/17 CURB ACCESS RAMP INSTALLATION; PROJECT #1541 Location of Job: CITYWIDE -- HUNTINGTON BEACH, CA Al only effective from: Effective Bate: 2/2 3/17 Expiration Date:l 2/2 3/17 CG 20 10P 11 85 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. POLICY NUMBER: 60455974 COMMERCIAL GENERAL. LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s); Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I—Coverage A,and for expenses shall reduce the Designated all medical expenses caused by accidents under Construction Project General Aggregate Limit Section I — Coverage C, which can be attributed for that designated construction project. Such only to ongoing operations at a single designated payments shall not reduce the General construction project shown in the Schedule above: Aggregate Limit shown in the Declarations nor 1. A separate Designated Construction Project shall they reduce any other Designated General Aggregate Limit applies to each Construction Project General Aggregate Limit designated construction project, and that limit is for any other designated construction project equal to the amount of the General Aggregate shown in the Schedule above. Limit shown in the Declarations. 4. The limits shown in the Declarations for Each 2. The Designated Construction Project Genera( Occurrence, Damage To Premises Rented To Aggregate Limit is the most we will pay for the You and Medical Expense continue to apply. sum of all damages under Coverage A, except However, instead of being subject to the damages because of"bodily injury " or"property General Aggregate Limit shown in the damage" included in the "products-completed Declarations, such limits will be subject to the operations hazard", and for medical expenses applicable Designated Construction Project under Coverage C regardless of the number of: General Aggregate Limit. a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 26 03 06 09 ©Insurance Services Office, Inc., 2008 Page 1 of 2 CG 25 03 05 09 B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "products-completed operations hazard" is provided, "occurrences" under Section I—Coverage A, and for any payments for damages because of "bodily all medical expenses caused by accidents under injury" or "property damage" included in the Section I — Coverage C, which cannot be attributed "products-completed operations hazard" will reduce only to ongoing operations at a single designated the Products-completed Operations Aggregate construction project shown in the Schedule above: Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General 1. Any payments made under Coverage A for Aggregate Limit. damages or under Coverage C for medical expenses shall reduce the amount available D. If the applicable designated construction project has under the General Aggregate Limit or the been abandoned, delayed, or abandoned and then Products-completed Operations Aggregate restarted, or if the authorized contracting parties Limit, whichever is applicable; and deviate from plans, blueprints, designs, specifications or timetables, the project will still be 2. Such payments shall not reduce any Designated deemed to be the same construction project. Construction Project General Aggregate Limit. E. The provisions of Section III — Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 2 of 2 POLICY NUMBER: 60455974 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: THE CITY OF HUNTINGTON BEACH,ITS OFFICERS,ELECTED OR APPOINTED OFFICIALS, EMPLOYEES,AGENTS,AND VOLUNTEERS ACTING WITHIN THE SCOPE OF THEIR DUTIES THAT ARE CONTROLLED&SUPERVISED BY THE PRIMARY(FIRST)ADDITIONAL INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV--Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 06 09 © insurance Services Office, Inc., 2008 Page 1 of 1 UW17300211 1308 60455974 44-0302 VIDO SAMARZICH INC SOUTHERN CAL INS BROKERAGE NOTIFICATION ENDORSEMENT FOR CANCELLATION/NON-RENEWAL or MATERIAL CHANGE IN COVERAGE THIS ENDORSEMENT SUPPLEMENTS THE TERMS OF THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY COMMERCIAL PROPERTY COMMERCIAL UMBRELLA COMMERCIAL INLAND MARINE 1. If the Schedule below indicates `Cancellation/Non-Renewal Notification". we agree to provide written notice to the person(s) or organization(s) shown in the Schedule due to a cancellation or non-renewal of the policy to which this form is endorsed. The number of days'notice we will provide is indicated in the Schedule. 2. If the Schedule below indicates'Material Change in Coverage Notification", we agree to provide written notice to the person(s) or organization(s) shown in the Schedule due to a material change in the policy to which this form is endorsed. For purposes of this endorsement a material change is a change: a. that is initiated by us; and b. in which the First Named Insured is provided written notification by us. The number of days' notice we will provide is indicated in the Schedule. SCHEDULE Name of Person(s) or Organization(s)and Mailing Address CITY OF HUNTINGTON BEACH 2000 MAIN ST HUNTINGTON BEACH CA 92648-2702 Cancellation/Non-renewal Notification. Number of Days:30 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) UW 17 30 02 11 /KLS RECEIVED BY: CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office (Name) after signing/dating (Date) CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION TO: City Treasurer FROM: City Clerk DATE: 3//4�-&)L SUBJECT: Bond Acceptance have received the bonds for ( F� (Compa y Name) CAPITAL PROJECTS (Includes CC's and MSC's) �i Performance Bond No. 0+ — a 's Payment Bond (Labor and Materials) Bond No. 7" 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. Approved (Council Approval Date) CC No. Agenda Item No. G MSC No. City Clerk Vault No. 10 Other No. SIRE System ID No. g:/forms/bond transmittal to treasurer TJJC FINAL PREMIUM IS PREDICATED ON THE ANAL CONTRACT PFUCIE Bond No.08712155 (1 of 3 Originals) PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS: WHEREAS,City of Huntington Beach(hereafter referred to as"City")has,by written agreement dated February 6 2017 entered into a contract with Vido Samarzich,Inc. 4972 Crest View Place Altaloma CA 91701 i (name and address of Contractor) (hereinafter referred to as"Principal"),for performance of the work described as follows: FY 16/17 Curb Access Ramp Installation Project(CC-1541) (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 Fidelity and Deposit Company of Maryland 777 S.Figueroa St Ste 3900 Los Angeles CA 90017 (name and address of Surety) as Surety,are held and firmly bound unto City in the penal sum of Six Hundred Seventy Eight Thousand Nine Hundred and 00/100 Dollars($ 678,900.00 ),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. 08712155 to automatically adjust the penal sum of this Bond to reflect such adjustments,alterations,changes, deletions,additions or other modifications. Surety agrees to provide written confirmation of such adjustments in the penal sum to City on not less than a quarterly basis. Surety also waives the provisions of Civil Code§§2845 and 2849. The obligations of this Bond shall survive the completion of the work described in the Contract as to all obligations and liabilities of the Principal which survive completion of the work. IN WITNESS WHEREOF,each party represents and warrants that this instrument has been duly executed by Principal and Surety,on the date set forth below,that the name of each corporate party being affixed hereto is such party's proper legal name and that the individuals signing this instrument have been duly authorized pursuant to the authority of its governing body. Surety, by execution of this bond,waives any defense which Surety has or may have by reason of any failure of the Principal to execute or properly execute this bond. Dated: February 15,2017 ATTEST Vido Samarzich,Inc. ,ow JI (Corporate Seal) P incip Nam By: Name: V o po LICr►r Lr c H Title: V 1'LC P2ES t D,E 7- ATTEST Fidelity and Deposit Company of Maryland (Corporate Seal) (Surety ame) By: Name: nohn (Signa re of Attorne -in-Fact for Surety) (Attach Attorney-in-Fact Certificate) (2�270-07 4 (Area Code&Telephone Number for Surety) APPROVED AS TO F By: ichael 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 attomey-in-fact must be attached. PERFORMANCE BOND Page 2 of 2 15-4584/117374 ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW 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 GERALD F.HALEY,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 Randy SPOHN,Matthew R.DOBYNS and Hamilton KENNEY,all of Santa Ana, California, EACH its true and lawful agent and Attorney-in-Fact,to make,execute,seal and deliver,for,and on its behalf as surety,and as its act and deed:any and all bonds 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 Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 5th day of April,A.D.2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND o o r arr Secretary Vice President Eric D.Barnes Gerald F.Haley State of Maryland County of Baltimore On this 5th day of April,A.D.2016,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,GERALD F. HALEY,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 acknowledged the execution of same,and being by me duly sworn,deposeth and saith,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. 3ar � Constance A.Dunn,Notary Public My Commission Expires:July 9,2019 POA-F 012-3955A 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 ��b� 1a� t �J , 2 01-1 before me, ERIKA GUIDO, NOTARY PUBLIC, personally appeared RANDY SPOHN , ® who proved to me on the basis of satisfactory evidence to be the person(5) whose name(a) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(+es), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person() acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ERIICA GU►D�F COMM.#2022671 WITNESS m hand and official seal. NOTARY PUBLIC CALIFORNIA G 3 ORANGE COUNTY ^' 9lMy Comm.expires May 5,2017 S' fl tore o ary Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER ❑ PARTNER(S) ❑ LIMITED ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) 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 Calif nia County of C A� (,1V/ej ) On e b La t v2o�W X/ before me, (,Ldsert name and title of the officer) J personally appeared � /LYYY� u C—V who proved to me on the basis of satisfactory evidence to be the person(�whose name, is eFe_ subscribed to the within instrument and acknowledged to me tha&e/—ey executed the same in � i �thefr"'authorized capacity`l�s�,`and that b is �,�-sianatureon the instrument the ersonTs,,or the entity upon behalf of which the rsonc�ted, execute the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. a WITNESS my hand and off I sea KRYSTAL MEDINA COMM.#2098976 00 8 Notary Public-California m LOS ANGELES COUNTY� My Comm.Exp.Feb.5,2019 Signature � � ` (Seal) V r Bond No.08712155 (1 of 3 Originals) PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS: WHEREAS,City of Huntington Beach(hereafter referred to as"City")has awarded to Vido Sainarzich,Inc. 4972 Crest View Place Altaloma CA 91701 (name and address of Contractor) (hereinafter referred to as'Principal"),a contract("Contract")for the work described as follows: FY 16/17 Curb Access Ramp Installation Project(CC-1541) (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 Fidelity and Deposit Company of Maryland 777 S.Figueroa St. Ste.3900,Los Angeles,CA 90017 (name and address of Surety) as Surety,are held and firmly bound unto City in the penal sum of Six Hundred Seventy Eight Thousand Nine Hundred and 00/100 dollars($ 678,900.00 ),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. PAYMENT BOND Page 1 of 2 1 5-45 84/1 1 73 5 7 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: Fehrnar; 15,2017 ATTEST Vido Samarzich,Inc. (Corporate Seal) r'ncipa am By: Name: l Po e. S R�►tA2yi c H Title: yl GF Pm4:S i'o E ry T ATTEST Fidelity and Deposit Company of Maryland (Corporate Seal) (Surety ame) BY: 1i Name:Rand S ohn (Signa ure of Attor`e -in-Fact for Surety) (Attach Attomey-in-Fact Certificate) �270-0 14 (Area Code&Telephone Number for Surety) APPROVED AS T RM: BY: Ehael E.Gates, ity ttorney I 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 attomey-in-fact must be attached. PAYMENT BOND Page 2 of 2 15-4584/117357 ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW 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 GERALD F.HALEY,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 Randy SPOHN,Matthew R.DOBYNS and Hamilton KENNEY, all of Santa Ana,California, EACH its true and lawful agent and Attorney-in-Fact,to make,execute,seal and deliver,for,and on its behalf as surety,and as its act and deed: any and all bonds 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 Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 5th day of April,A.D.2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND v„yi�, QpDE/ps J•���INS(/,py~y ¢ �Nyk,�-t`?GO/NbJ •iC(92 SBAL � "" —• By. At Secretary Vice President Eric D.Barnes Gerald F.Haley State of Maryland County of Baltimore On this 5th day of April,A.D.2016,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,GERALD F. HALEY,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 acknowledged the execution of same,and being by me duly sworn,deposeth and saith,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 WIIEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. �`''�ppOT+ys'• Constance A.Dunn,Notary Public My Commission Expires:July 9,2019 POA-F 012-3955A 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 2 hnAa!24 t�� 2C�1'7 before me, ERIKA GUIDO, NOTARY PUBLIC, personally appeared RANDY SPOHN , ® who proved to me on the basis of satisfactory evidence to be the persons} 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 signaturefa) on the instrument the person(s), 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. } ER{KA GUIQO COMM.#2022671 WITNESS m and and official seal. NOTARY PUBLIC CALIFORNIA a ORANGE COUNTY ^' 9 M Comm.expires May 5,2017 nature owotgry Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER ❑ PARTNER(S) ❑ LIMITED ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) ACKNOWLEDGMENT Fattac,thed. oary public or other officer completing this certificate verifies only the identity of the individual o signed the document to which this certificate is and not the truthfulness, accuracy, or d ' of that document. State of Calif"U S County of I} r� On f' rj 2 � , C before me, (i s)en: name and title of the officer) personally appeared who proved to me on the asis of satisfactory evidence to be the person `whose name, )i/are— subscribed to the within instrument and acknowled ed to me th e,sft&4Aey executed the same in his/ eir authorized capacity(ie and that by�herftlTetr-signatur�on the instrument the p rsonm),'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 a d official se KRYSTAL MEDINA �t COMM.#2098976 t5 Notary Public-California -i ca LOS ANGELES COUNTY a M Comm.Ex .Feb.5,2019 Sionature (Sea., r Surety Bonds - Certified Companies Page 8 of 23 Explorer Insurance Company(NAIC#40029) BUSINESS ADDRESS:P.O.BOX 85563,SAN DIEGO,CA 92186-5563,PHONE:(858)350-2400 x-2550. UNDERWRITING LIMITATION b/:$10,147,000.SURETY LICENSES c,f/:AZ,CA,CO,CT, HI,ID,IL,IN,IA, MD,MA,MI,MS,MT,NJ,NV,NM,OR,PA,TN,TX,UT,VT,VA,WA,WV.INCORPORATED IN:California. t Back To Top F Fair American Insurance and Reinsurance Company(NAIC#35157). BUSINESS ADDRESS:One Liberty Plaza, 165 Broadway,New York,NY 10006.PHONE:(212)365-2200. UNDERWRITING LIMITATION b/:$24,182,000.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:New York, Farmers Alliance Mutual Insurance Company(NAIC#19194) BUSINESS ADDRESS:P.O.Box 1401,McPherson,KS 67460.PHONE:(620)241-2200,UNDERWRITING LIMITATION b/:$16,564,000.SURETY LICENSES c,f/:CO,ID, IA,KS,MN,MO,MT,NE,NM,ND,OK,SD. INCORPORATED IN:Kansas. Farmington Casualty Company(NAIC#41483) BUSINESS ADDRESS:ONE TOWER SQUARE, HARTFORD,CT 06183,PHONE:(860)277-0111. UNDERWRITING LIMITATION bl:$29,133,000.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:Connecticut. Farmland Mutual Insurance Company(NAIC#13838) BUSINESS ADDRESS:ONE WEST NATIONWIDE BLVD.. 1-04-701,COLUMBUS,OH 43215-2220.PHONE: (515)508-3300.UNDERWRITING LIMITATION b/:$17,059,000.SURETY LICENSES c,f/:AL,AZ,AR,CA, CO,DE,DC,FL,GA,ID,IL,IN,IA, KS,KY,MD,MI,MN,MS,MO,MT,NE,NV,NC, ND,OH,OK,OR,PA,SC, SD,TN,TX,UT,VA,WA,WV,WI,WY.INCORPORATED IN:Iowa. FCC[Insurance Company(NAIC#10178) BUSINESS ADDRESS:6300 University Parkway,Sarasota,FL 34240-8424.PHONE:(800)226-3224. UNDERWRITING LIMITATION b/:$53,562,000,SURETY LICENSES c,f/:AL,AZ,AR,CO,FL,GA,IL,IN,IA, KS,KY,LA,MD,MI,MS,MO,NE,NC,OH,OK,PA,SC,TN,TX,VA.INCORPORATED IN: Florida. Federal Insurance Company(NAIC#20281) BUSINESS ADDRESS: 15 Mountain View Road,Warren,NJ 07059.PHONE:(908)903-2000. UNDERWRITING LIMITATION bl:$1,186,080,000.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,MP,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:Indiana. FEDERATED MUTUAL INSURANCE COMPANY(NAIC#13935) BUSINESS ADDRESS: 121 EAST PARK SQUARE,OWATONNA,MN 55060.PHONE:(507)455-5200. UNDERWRITING LIMITATION b/:$286,243,000.SURETY LICENSES c,f/:AL,AK,AZ,AR,CA,CO,CT,DE, DC,FL,GA,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT, NE,NV,NH,NJ, NM,NY, NC,ND, I C D N TI , A WI WY IN OR OKAYED IN:Minnesota. Fidelity and Deposit Company of Maryland(NAIC#39306) BUSINESS ADDRESS: 1299 ZURICH WAY,SCHAUMBURG, IL 60196-1056.PHONE:(847)605-6000. UNDERWRITING LIMITATION b/:$14,738,000.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,MP,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,Wl,WY.INCORPORATED IN:Maryland. FIDELITY AND GUARANTY INSURANCE COMPANY(NAIC#35386) BUSINESS ADDRESS:One Tower Square,Hartford,CT 06183.PHONE:(860)277-0111.UNDERWRITING LIMITATION b/:$1,929,000.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. Fidelity and Guaranty Insurance Underwriters,Inc.(NAIC#25879) BUSINESS ADDRESS:One Tower Square,Hartford,CT 06183,PHONE:(860)277-0111,UNDERWRITING LIMITATION b/:$8,620,000.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:Wisconsin, Financial Casualty&Surety,Inc.(NAIC#35009) BUSINESS ADDRESS:3131 Eastside,Suite 600,Houston,TX 77098.PHONE:(800)392-1604. UNDERWRITING LIMITATION b/:$1,506,000.SURETY LICENSES c,f/:AZ,CA,CT,DE,FL,GA,ID,IN,IA, KS,LA,MD,MI,MN,MS,MO,MT,NV,NJ,NY, NC,ND,OH, PA,SC,SD,TN,TX,UT,VT,VA,WA,WV. INCORPORATED IN:Texas. Financial Pacific Insurance Company(NAIC#31453) BUSINESS ADDRESS:P.O.BOX 73909,CEDAR RAPIDS,IA 52407-3909.PHONE:(319)399-5700. UNDERWRITING LIMITATION b/:$10,205,000.SURETY LICENSES c,f/:AK,AZ,AR,CA,CO,FL,ID, IL,IA, KS,MN,MO,MT,NE,NV,NM,ND,OK,OR,SD,TX,UT,WA,WI.INCORPORATED IN:California. https://www.fiscal.treasury.gov/fsreports/ref/suretyBnd/c570_a-z.htm 2/24/2017 Company Profile Page 1 of 2 DEPARTMENT „ T CALIFORNIA COMPANY PROFILE Company Profile Company Search Company Information Company Search Results FIDELITY AND DEPOSIT COMPANY OF MARYLAND Company 1299 ZURICH WAY Information SCHAUMBURG, IL 60196 Old Company 800-382-2150 Names Agent for Service Old Company Names Effective Date Reference Information NAIC Group List Agent For Service Lines of Business KARISSA LOWRY Workers' 2710 GATEWAY OAKS DRIVE Compensation SUITE 15ON Complaint and SACRAMENTO CA 95833 Request for Action/Appeals Contact Information Reference Information Financial Statements PDF's NAIC#: 39306 Annual Statements California Company ID#: 2479-4 Quarterly 11 Statements Date Authorized in California: O1/01/1982 Company Complaint Company License Status: UNLIMITED-NORMAL Performance& (Company Type: Property&Casualty Comparison Data I Company State of Domicile: MARYLAND Enforcement Action Composite Complaints Studies back to top Additional Info Find A Company NAIC Group List Representative In Your Area View Financial NAIC Group #: 0212 ZURICH INS GRP Disclaimer 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 CREDIT FIRE LIABILITY MARINE MISCELLANEOUS PLATE GLASS SPRINKLER SURETY TEAM AND VEHICLE https:Hinteractive.web.insurance.ca.gov/companyprofile/companyprofile?event=companyP... 2/24/2017 City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachea.gov fFB•`!7 1909;� Office of the City Clerk Robin Estanislau, City Clerk March 14, 2017 Vido Samarzich, Inc. ATTN: Vido Samarzich 4972 Crestview PI Alta Loma, CA 91701 Re: FY 16/17 Curb Access Ramp Installation Project— CC-1541 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, �&4v4j� Robin Estanislau, CIVIC City Clerk RE:pe Enclosures: Copy of Contract including Proposal Copies of insurance/bonds Bid Bond (original) Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand Dept.ID PW 17-007 Page 1 of 2 Meeting Date:2/6/2017 CITY OF HUNTINGTON BEACH REQUEST FOR. CITY COUNCIL ACTION MEETING DATE: 2/6/2017 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 execution of a construction contract in the amount of $678,900 to Vido Samarzich, Inc. for the FY 16/17 Curb Access Ramp Installation Project, CC-1541; and, authorize an appropriation in the amount of $150,000 Statement of Issue: On January 10, 2017, bids were opened for FY 16/17 Curb Access Ramp Installation Project, CC- 1541. City Council Action is requested to award the construction contract to Vido Samarzich, Inc., the lowest responsive and responsible bidder. Financial Impact: Total funds in the amount of $756,083 are available for this project. Funds of $306,083 are available in the Community Development Block Grant Fund (CDBG). Funds in the amount of $111,030 are available from CDBG Account No. 123585001.82000, $67,788.76 from CDBG Account No. 86385002.82000, $101,375.99 from CDBG Account No. 120885002.82000, $25,888.25 from CDBG Account No. 121985002.82000. Funds in amount of $300,000 are available from the Gas Tax Fund, Account No. 20790054.82300. Staff is seeking an appropriation of$150,000 from the undesignated Gas Tax Fund. Recommended Action: A) Accept lowest responsive and responsible bid submitted by Vido Samarzich, Inc. in the amount of$678,900; and, B) Authorize the appropriation of$150,000 from undesignated Gas Tax Funds to account 20790054.82300; and, C) Authorize the Mayor and City Clerk to execute a construction contract in a form approved by the City Attorney. Alternative Action(s): Reject all bids and provide staff with an alternative direction. Analysis: The project consists primarily of installing curb access ramps at various locations throughout the City in the residential neighborhoods. The American with Disabilities Act (ADA) statute requires the city to provide facilities and programs that are accessible to individuals with disabilities. Many of our street intersections and crossings lack the curb access ramps necessary to comply with ADA requirements. In 2016, Public Works was awarded a Community Development Block Grant for B -87- Item 4. - 1 Dept.ID PW 17-007 Page 2 of 2 Meeting Date:2/6/2017 construction of curb access ramps throughout the city. The project will provide ramps at locations in the residential reporting districts depicted in the Attachment 1 location map. These locations are prioritized from a list compiled by Public Works staff, based on staff and street condition. The bids were publically opened on January 10, 2017, with the verified bid amounts listed below: Bidding Contractor Submitted Bid Verified Bid VIDO SAMARZICH INC. $678,900.00 $678,900.00 GSCI 721 050.00 $721,050.00 CJ CONSTRUCTION $725 850.00 $725 850.00 EBS GENERAL ENGINEERING 730 000.00 $730,000.00 NOBEST INC. $774,000.00 $774,000.00 KALBAN $797 440.00 $797 440.00 HARDY & HARPER $818,000.00 $818 000.00 GENTRY GENERAL ENGINEERING $974,800.00 $974 800.00 MINCO CONSTRUCTION 1 005 250.00 1 005 250.00 Staff recommends award of the contract to Vido Samarzich, Inc. in the amount of $678,900. The experience and reference check for the company has provided acceptable responses from past clients for similar projects. The total estimated project cost is $756,083, which includes the construction contract, project management, and construction contingency (inspection and labor compliance services). The budget for this project was $551,083 based on the cost of the two previous curb ramp projects. Bids for this project came in higher than anticipated; therefore staff is requesting an appropriation of $150,000 from undesignated Gas Tax funds in order to award the project. Public Works Commission Action: The Public Works Commission reviewed and approved the project was in substantial conformance with the CIP on October 19, 2016, with a vote of 6-0-1 (Commissioner Troxell absent). Environmental Status: The project is categorically exempt pursuant to Class 1, Section 15301 of California Environmental Quality Act. Strategic Plan Goal: Enhance and maintain infrastructure Attachment(s): 1. Vicinity Maps Item 4. - 2 H - 8- moo. O V) LSA AVE. CO NTS Q v~i = v~i M FADD AV . Z U C3 Q Q RD RD i1 iRD 0 0 p 152 153 Qi 155m HEIL Q AVE. 62 RD a RD RD NAVE. 405 163 : 164 165 0 R AVE. 174 175 V) w S TER Q o V) o w w ,o z zz Q z TA BERT VE. a w o V o EL IS AVE. GARFIELD M AVE. PO o � v~i v~i v~i Q �'< 3 YORKTOWN AVE. m A AMS AVE. A Q Q AVE. _ PROJECT LOCATION �L. Y 0 0 V) o CURB RAMP INSTALLATIONS INCLUDE A LANTA 0 mAVE.o REPORTING DISTRICT'S (RD) 152, 153, 154, oC w 155, 162, 163, 164, 165, 174, AND 175 "n, Z HAMIL ON A . 1DSoutheast Corner Garfield Ave/Holly Ln Install Case CM Directional Ramp y �'}- BANNING LEGEND AVE. PROJECT BOUNDARY ------ RD BOUNDARY ZONE 10 OVERLAY PROJECT LOCATION MAP CITY OF HUNTINGTON BEACH DEPARTMENT OF PUBLIC WORKS 1 of 1 K -89- Item 4. - 3 CITY OF HUNTINGTON BEACH PROJECT NAME: FY 16/17 Curb Access Ramp Installation CC#: 1541 BID OPENING DATE: 1/10/2016 TIME & LOCATION: 2:00 P.M. Council Chambers ENGINEER'S ESTIMATE: $500,000.00 BIDS SUBMITTED (AS READ AT OPENING) BIDDER'S NAME FINAL APPARENT BID RANK AMOUNT All American Asphalt;Corona" CJ Concrete Construction, Santa Fe Springs °�- ✓ EBS General Engineering, Corona 3D 000°= FS Contractors, Inc. Gentry General Engineering, Rancho Cucamonga G/ joo'"o°C? 4,_�. /j �... � jam' �/ // /! / GSCI, Placentia ll4JJ/V00 c � ���� ✓ Hardy& Harper, Santa Ana HYM Engineering, Inc, Buena Park ✓ Kalban,, Inc, Santa Clarita .�� „ '140 . MGB Construction, Riverside Minco Construction, Gardena --- ui, „ Nobest, Inc.,Westminster flq, i - Premier Developing Services, Inc, Westminster _ �I iijd m' Sully Miller, Brea Vido Smarzich, Inc.,Alta Loma ' e Q ,d ' pkt 1 ( ��a q oii t � �ii41i�$W i T' j Mi i PTS 09222016 Version 15—CC 1541 c) ( C y / Ob 3' C7 > CV i,j A ol Mill- LIOZ 6s 1 01 NVC LIN 00 d 01 N LIH j .iL 1Z16 ///6 SECTION A NOTICE INVITING SEALED BIDS for the construction of FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT CC No. 1541 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 P.M. on January 10, 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 S10.00 nonrefundable fee if picked up, or payment of a S30.00 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. http://www.huntingtonbeachca.gov/government/departments/public works/Bids/ 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: This project will provide the construction of curb access ramps and truncated domes to existing ramps throughout the city. These locations are prioritized from a list compiled by Public Works staff, based on staff and public requests. The proposed locations are listed in the Appendix along with Contractor guidelines and provisions to meet all Federal requirements. The contract shall allow the Contractor 70 working days to complete the contract. The Project Disadvantage Business Enterprises (DBE) goal is 0% 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 Esparza, Patty From: David Ward [dward@ocregister.com] Sent: Wednesday, December 07, 2016 9:17 AM To: Esparza, Patty Subject: Re: Legal Ad for HB Wave - NISB - CC-1541 ...Now 2 of 3.... Ad#10221389 Run Dates 12/15, 12/22, 12/29 & 1/5/17 Cost $804.00 PROOF i SECTION A NOTICE INVITING SEALED BiDS tot the construction of FY IW17 Chilli ACCESS RAMP INS i"Au,1 lroo"PiRojecT CC No.1541 in the CITY OF HUNTINIMTON BEACH PUBLIC NOTICE IS HEREBY GIVEN that the CITY OF HUNTINGTON BEACH,as AGENCY,invites sealed gins for the above stated projects and will receive such bias in the office of the City Clerk, Second Floor, 2000 Main Street, Huntington Beach, California, 92648,up to the hour of 2,00 P.M.on January 10, 2017. Bids will be publicly opened in the Council Chambers unless oche se posted, Copies of me Plans, Specifications,and contract documents are available from the Office of the Director of Public:Works, 20DO Alain Street, Huntingloo Beach,CA 912648,upon pay- ment of a M.00 acnref°;.ndabie fee€f picked up, or payment of a$30.00 nonrefundable fee if want by UPS ground delivery jbidder shall pay a digital casts for special del"],, Flans, Specificatiom, and contract documents can be downloaded tree on AGENCY web- site. http,avw v,htsntirrgton aoh ,grnvigovemm�nii fepartmentstpu€�lic wori ,'ktids� This is at Davis-Bacon project and the Fedefal.Regulations will to€nforced, Any contract entered into pursuant to this notice will incorporate the provisions of the Fedarail Labor Standards:which are can file at office of the Director of Public o ,2000 Main Street, Huntington Bead,CA 92648, The AGENCY will dMuct 5% retention from all progress payments. The Contractor,may substitute an escrow holder suret,�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 afford- ed full opponunily to submit bids in resp se to this notice and will not be discriminated. against on the basis race, color, neti€rrial origin; ancestry.sex.or religion in any consid- eration leadrng is the award of contract, No bid shall be considered unless A is larepaleod on approved Proposal forms in con- formance with the Instructions to Bidders as determined by the AGENCY.The bid must be accompanied by a certified ilk= 9 is check,or bidder's bond made pale to the AGENCY for an amount nd.less fttan 10%of amount bid, The successful bidder'rl'aafl 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 open, The success' fail Contractor and his satbcontraetors wilt be requiredto possess business be--rises from the AGENCY.All extension of uRR prime will be subject to vefificafion by the AGENCY, in case of a variation between the unit price and the extension,the unit price will govern: Project Description: This project will prnvfde the construction of curia access ramps and truncated dames to existing ramps throughout the city. These locations are prioritized from a list compiled by Public Warks staff, fused on staff and pukriic requests.The pro- posed locations are listed in the Appendix alb with Contractor guidelines and provisions. to meet all Federal requirements_ The contract shall alloy the Contractor 70 working days to complete the contract. The Project Disadvantage Business Enterprises(DBE)goal The AGENCY rese ms the; right to reject any or all bias,to waive any irregularity and to take all bids under advisement for a maidrraum period of 60 days. BY ORDER of the CITY COUNCIL of the CITY OF HUNTINGTON BEACH,CAUFOnNIAs,tare 6th clay of September 2016.by Resolution No.2016.58, Attest_ vs'Robin Estanislau CITY CLERK OF THE CITY OF HUNTINGTON BEACH Published:The Huntington Beach Wave Dec 15.22.29.2016.Jan S.2817 10221389 On Tue, Dec 6, 2016 at 1:34 PM, Esparza, Patty <PEsparzaAsurfcity-hb.org> wrote: Not a problem —thanks for the heads-up! From: David Ward [mailto:dwardCcbocregister.com] Sent: Tuesday, December 06, 2016 12:13 PM To: Esparza, Patty Subject: Re: Legal Ad for HB Wave - NISB - CC-1541 2 Hello Patty How are you doing? I hope it is okay with you, but I am currently working on a special project that will take me through the end of the day and I will have to send you the proofs tomorrow morning. Have a great day. On Tue, Dec 6, 2016 at 10:42 AM, Esparza, Patty<PEsparza(&,,surfcity-hb.org>wrote: Hi David: Attached is a legal ad to be published in the HB Wave on the following dates: December 15, 2016 December 22, 2016 December 29, 2016 January 5, 2017 Please confirm when possible—thanks! Patty Esyarza, CHIC Senior Deputy City Clerk City of Huntington Beach 2000 Main Street Huntington Beach, CA 92648 3 (714) 536-5260 David Ward Legal Advertising Phone: 714-796-6764 Email: dwardAocregister.com E-Fax: 714-347-2724 David Ward Legal Advertising Phone: 714-796-6764 Email: dward a,ocregister.com E-Fax: 714-347-2724 4 AFFIDAVIT OF PUBLICATION Proof of Publication STATE OF CALIFORNIA, SECTION A ) NOTICE INVITING SEALED BIDS for the construction of ss. FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT County of Orange ) cc in the a1 in the CITY OF HUNTINGTON BEACH PUBLIC NOTICE IS HEREBY GIVEN that the CITY OF HUNTINGTON BACK,as I am a citizen Of the United States and a resident 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 of the County aforesaid; I am over the age of 92648,up to the hour of unless s otherwise on January 10,2017. Bids will be publicly opened in the Council Chambers unless othenvise posted. Copies of the Plans,Specifications,and contract documents are available from the Office eighteen years, and not a party to or interested in of the Director of Public Works,2000 Main Street,Huntington Beach,CA 92648,upon pay- ment of a$10.00 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). the above entitled matter. I am the principal clerk Plans,Specifications,and contract.documents can be downloaded free on AGENCY web- site: http://www.hu ntin gton bb achca.gov/government/departments/p u bl ic_works/Bids/ of the Huntington Beach Wave, a newspaper 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 Federal Labor that has been adjudged to be a newspaper of Standards,which are on file at the office of the Director of Public Worksks,,20 2000 Main Street, Huntington Beach,CA 92648. general circulation by the Superior Court Of the 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 County of Orange, State of California, on July 1, owner of the surety and shall receive any interest thereon. The AGENCY hereby affirmatively ensures that minority business enterprises will be afford- 1998, Case No. A-185906 in and for the City of ed 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 consid- Huntington Beach, County of Orange, State of eration leading to the award'of contract.' y No bid shall be considered unless it is prepared.on the approved Proposal forms in con- formance with the Instructions to Bidders as determined by the AGENCY.The bid must be California; that the notice, of which the annexed 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 is a true printed copy, has been published in each 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 success- ful 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. regular and entire issue of said newspaper and case of a variation between the unit price and the extension,the unit price will govern. Project Description:This project will.provide the construction of curb access ramps not in any supplement thereof On the following and truncated domes to existing ramps throughout the city.These locations are prioritized from a list compiled by Public Works staff,based on staff and'public,requests.The pro- posed locations are listed"in the Appendix along with Contractor guidelines and provisions dates,to wit: to meet all Federal requirements. The contract shall allow the Contractor 70 working days to complete the contract; December 15,22,29,2016,January 5,2017 The Project Disadvantage Business Enterprises(DBE)goal is 0% "I certify (or declare) under the penalty Of 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. - perjury under the laws of the State of California BY ORDER of,the CITY COUNCIL of the CITY OF HUNTINGTON BEACH,CALIFORNIA,the 6th day of September 2016,by Resolution No.2016-58. r' that the foregoing is true and correct': Attest: /s/Robin Estanislau ' Executed at Santa Ana, Orange County, _ ==- 'CITY CLERK OF THE CITY OF HUNTINGTON BEACH g ty, Published:The Huntington Beach Wave Dec 15,22,29;2016,Jan 5,2017 10221389 California, on anuary 5,2017 Signature Huntington Beach Wave 625 N.Grand Ave. Santa Ana,CA 92701 (714)796-2209 AFFIDAVIT OF PUBLICATION Proof of Publication STATE OF CALIFORNIA, SECTION A NOTICE INVITING SEALED BIDS SS. - for the construction of County Of Orange ) FY 16/17 CURB ACCESS RAMP,INSTALLATION PROJECT CC No.1641 n the CITY OF HUNTINGTON BEACH I am a citizen Of the United States and a resident 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 of the County aforesaid; I am over the age Of 92648,up to the hour of 2:00 P.M.on January 10,2017. Bids will be publicly opened in the Council Chambers unless otherwise posted. eighteen years, and not a party to Or interested in Copies of the Plans,1$pecifications,and contract documents are available from the'Office of the Director of Public Works,2000 Main Street,Huntington Beach,CA 92648,upon pay- ment of a$10.00 nonrefundable fee if picked up,or payment of a$30.00 nonrefundable the above entitled matter. I am theprincipal clerk 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'web- site. ' Of the Huntington Beach Wave, a newspaper http://www.huntingtbnbeachca.gov/gIovernment/departments/public_works/Bids/ This is a Davis-Bacon,project and the Federal Regulations will be enforced. Any contract that has been adjudged to be a newspaper Of 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. ° general circulation by the Superior Court of the ` 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 County Of Orange, State Of California, On July 1, provisions of the Public Contract Code,Section 10263, The Contractor shall be beneficial owner of the surety and shall receive any interest thereon. . 1998, Case No. A-185906 in and for the City Of The AGENCY hereby affirmatively ensures that minority business enterprises will be afford- ed full opportunity;to submit bids in response to this notice and will not be discriminated against on the basis of race,color,national ongin ancestry,sex;or religion in any consid- Huntington Beach, County Of Orange, State Of eration leading to the award of'contract No bid shall be considered unless it is prepared on the approved Proposal forms in con- California; that the notice, Of which the annexed formance 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 is a true printed copy, has been published in each be licensed in.accordance with provisions of the Business and Professions Code and shall Fpossess a State Contractor's License Class A at the time of the bid opening. The success- ful Contractor and his subcontractors will be at to possess business licenses from regular and entire issue Of said newspaper and 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. not in any supplement thereof On the following Project Description:This project will provide the construction of curb access ramps and truncated domes to existing ramps throughout the city.These locations are prioritized from a list compiled by•Public Works staff,based on staff and public requests.The pro- dates,to wit: posed locations are listed in the Appendix along with Contractor guidelines and provisions' to meet all Federal requirements. December 15,22,29,2016,January 5,2017 The contract shall allow the Contractor 70 working days to complete the contract. "I certify (or declare) under the penalty of The Project Disadvantage Business Enterprises(DBE)goal is 0% The AGENCY reserves the right to reject any or all bids,to waive any irregularity and to perjury under the laws Of the State Of California 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. that the foregoing is true and correct . Executed at Santa Ana, Orange County, Attest: CI YCLRobEEsta FTH -CITY CLERK OF THE CITY OF HUNTINGTON BEACH ' California, On Published The HuntingtomBeach'-Wave Dec 15-22.29 2016.Jan 5 2017- 10221389_ •� w January 5,2017 Signature Huntington Beach Wave 625 N. Grand Ave. Santa Ana,CA 92701 (714)796-2209 UNSUCCESSFUL BIDS CC- 1541 FY 2016/17 Curb Access Ramp Installation Project City ®f Huntington Beach 2000 Main Street o Huntington Beach, CA 92648 (714) 536-5227 o www.huntingtonbeachca.gov _.EB4' �P. ♦ Office of the City Clerk 77,19Dg Robin Estanislau, City Clerk April 27, 2017 C J Concrete Construction, Inc. 10142 Shoemaker Ave. Santa Fe Springs, CA 90670 RE: FY 2016/17 Curb Access Ramp Installation Project—CC-1541 Enclosed please find your original bid bond for CC-1541. Sincerely, Robin Estanislau, CIVIC City Clerk RE:pe Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand ,f r r 441 U aloft VP. • rLAr 13 S eta &a .. � cA rYC 1 O 2. to 3 SECTION C PROPOSAL for the construction of FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT from VARIOUS LOCATIONS CC No. 1541 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 70 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 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 BID ITEMS .Items Descript�om Quantity !,Unit Unit Cost Total!Cost „i ,, a x H , -.�E%tensbDtu 1 Mobilization 1 LS $ S,Ga'" $ Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 1 in 2 Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed curb, sidewalk, domes, retaining curb, sawcut, slot pave, etc.) 68 EA $ S��GG $ 25$,yG0 Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR using horizontal curb cutting machine as 3 shown on Curb Ramp Detail 2 in Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed $ 3 �' U $ 23`'1 G 6`c GO curb,sawcut, sidewalk, domes, retaining curb, etc.) 63 EA , tl Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 3 in 4 Appendix H of Specifications (Item includes all appurtenances, curb&gutter,depressed curb, sawcut, 0 1 sidewalk,domes, retaining curb, slot pave, etc.) 5 EA $ ` $ G�OOG Construct Case C Midblock or Case F/Case G/Case CM or Type C Directional Curb Access Ramp per Caltrans Std. Plan 5 A88A/A8813 (Item includes all appurtenances, curb&gutter, depressed curb,sidewalk, domes, retaining curb, slot pave, �, c etc.) 20 EA $ c-}'G U $ pt000 6 Install truncated domes to existing Curb Ramp 123 EA $ GG $ 7 Remove existing improvements and construct concrete a0 meandering sidewalk per HB Standard Plan 207 500 SF $ aL $ Remove and reconstruct Cross Gutters per HB Standard Plan 8 205(Item includes all appurtenances, curb&gutter, slot pave, oU etc.) 3,800 SF $ S O $ Remove and replace existing 6"or 8"Curb and Gutter per HB_ 9 Standard Plan 202(Item includes all appurtenances and slot pave, etc.) 100 LF $ $ 10 Install 4"PVC Sleeve for Street Assembly Sign per City of HB w �c Std. Plan 401 10 EA $ $ 11 Prepare Storm Water Pollution Prevention Plan (SWPPP) 1 LS $ 500p• $ 011C, 12 Install&Maintain Construction BMPs 1 LS $ TOTAL BID AMOUNT (BASIS OF AWARD)—SCHEDULE A $ '65 L-J" C-2.1 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 TOTAL BID AMOUNT IN WORDS: f� t Vtrl h,,hdr,,cl ���`� �'1 V`C /► cis 4YiG� --P °��� hundo- f:1 fl de-11calf Note: 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. C-2.2 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. ,f Accompanying this proposal of bid, find � f�v� t�S � � 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 Re eived 'dder's i nature I C-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 Dollar % of Item(s) Subcontractor License Number Amount Contract Number a h oU 1 UO suVVt y�� �S- 1s3� 17, 000Ji vS yG 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 onI q- 7, at -JotVa (•¢ Date City State being first duly sworn, deposes and sav,st that he or-+e is 1Pl�S% �h1' of C1�CraC cn tc �A e party making the foregoing bid that the bid is not made i he 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. CT CCn&C--fL N-dme of Bidder Sign ur of Bidder Address of Bidder SG?,q f C-4 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 `S I ) On muciv C# 60before me, och-el ftreG )imeneZ Date �Ihn / ( Here Insert Name and Title of the Officer personally appeared �" G 'Se+f h U Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person* whose name(s;js/are subscribed to the within instrument and acknowledged to me that he/eheAhey executed the same in his/her/their authorized capacity(ies),and that by hisAief=/ veir signature(*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. HEL Ra MMi aion# 1220JM 4 WITNESS my hand and official se I. ireCommission#2122040 a Notary Public-California z Los Angeles County MY Comm.Expires Aug2,2019+ Signature Signature of Notary bli () 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 �C)Q�I anUQ� h��G'� Title or Type of Document:K01(�IC)SIGn Document Date,: Number of Pages: Signer(s) Other Than Named Above: Y10 Etna S 19ae r Capacity(ies) CI m Vy Sigs5s)n0 Signer's Name: I y , Signer's Name: ❑ Corporate Officer — Title(s): P f(,S i ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑ Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑ Other: ❑ Other: Si ner Is G�� nti Signer Is Representing: f �1 02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 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 FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT, (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. C CCf?Gy Cc/Z1 fv�f jcL 117C ontractor By Title Date: /` dc17 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 0~ o 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. CT Cc1?CrG Cc� Svc yi, � -• ontractor By �rPsic%�� Title Date: C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: CT CGnQC Bi der Name Ip/qa JhKe'og&l- IfVe Business Address �nf,' R C4- c�to70 City, State Zip 7"�'7 -2222 gc}7GI @c Ccncf CCnS�jiC-*? I nC-cons Telephone Number Email Ad ress --7aOgZN 7'� State Contractor's License No. and Class �± S , Gto Original Date Issued L4 �C)'aa"�g Expiration Date The work site was inspected by r *tril r1af our office on JCft)LV)'` U, ZO1 1 The following are persons, firms, and corporations having a principal interest in this proposal: C— Cafffde Cc uc oh c s-cirno C-8 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. . CT cwc(cAe cor),�fwg-Nor) , inc - Company Name VJ� Signature of Bidder I Ich o c. s arna Printed or Typed Signature Subscribed and sworn to before me this q d y of O//lt/G//L , 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 County of e's ) ,�,,// -- On alkl lf° �yh O�/7 before me,ipac&/ llpdtnri , Jlfnt /� N Oel")" fC Month, ay, and Year Insert Name and Title of Notary personally appeared jcbn C- jgo?o 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. sa WITNESS m hand and official seal. RAC HEI CA—ND JiMEN0 y Commission#2122040 Notary Public-California i f Los Angeles County My Comm.Expires Aug2,2019 Signature Signature of Notary P li (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 irea_ter 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: 1. p/CG.I-e S re lWoc-12-pd 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: 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: Contract 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. 0 z e-k-r sew +- Name of proposed Project Manager Telephone No. of proposed Project Manager: 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. c-V' iunand-ez Name of proposed Superintendent ll ` Telephone No. of proposed Superintendent: jyoy ,4 e 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 C-11 CJ Concrete Construction, Inc. LETTER OF QUALIFICATION Confidential Company Information Corporate Office: 10142 Shoemaker Ave. Santa Fe Springs, Ca. 90670 Phone: 562-777-2222 Fax: 562-777-2220 Bid Manager Rachel Jimenez rachelw(a)ciconcreteconstructioninc.con contractors Class & License: A-720989 (established 1993) exp.6-30-2018 Cal. Resale#: NONE Fed. ID Number: 95-4578126 State EIN#: 423-6338 D & B Number: NONE California Corporation #: 1770884 9-29-1995 NAICS 238910 DIR Public Work Reg # 1000006673 exp.6-30-17 COMPLETED OR CURRENT PROJECTS Owner Class of Work/Description Date Completed Value CITY OF LONG BEACH Annual Maintenance Contract Pat Abadi Curb Gutter Sidewalks Driveways ADA Ramps 9-2012 to Current 18,000,000.00 Capital Projects Coordinator N Department of Public Works 562-570-6963 333 W.Ocean Blvd.Long Beach,Ca.90802 CITY OF ONTARIO Annual Maintenance Contract Dale Adcock Curb Gutter Sidewalks Driveways ADA Ramps 6-2011 to Current 8,000,000.00 Senior Engineer Management Services 909-395-2605 1425 Bonier Ave.Ontario,Ca.91761 CITY OF GARDEN GROVE Annual Maintenance Contract Bob Mungey Curb Gutter Sidewalks Driveways ADA Ramps 6-2011 to Current 6,000,000.00 Senior Engineer Department of Public Works 714-741-5040 11222 Acacia Parkway Garden Grove,CA.92842 CITY OF LAKEWOOD Annual Maintenance Contract Max Withrow Curb Gutter Sidewalks Driveways ADA Ramps 6-2010 to Current 9,000,000.00 Senior Engineer Department of Public Works 562-866-9771 5050 Clark Ave.Lakewood,Ca.90712 CITY OF CERRITOS Annual Maintenance Contract Mary Anne Wozniak Curb Gutter Sidewalks Driveways ADA Ramps 6-2012 to Current 2,500,000.00 Department of Public Works Maintenance Superintendent 18125 Bloomfield Ave.Cerritos,Ca.90703 562-860-0311 CITY OF ORANGE Annual Maintenance Contract Alan Troung Curb Gutter Sidewalks Driveways ADA Ramps 6-2013 to Current 1,275,000.00 Senior Engineer Department of Public Works 714-744-5568 300 E.Chapman Ave.Orange,Ca.92866 CITY OF COSTA MESA Annual Maintenance Contract Fariba Fazelia Curb Gutter Sidewalks Driveways ADA Ramps 6-2012 to Current 6,200,000.00 Senior Engineer 77 Fair Dr.Costa Mesa,Ca.92626 714-754-5222 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/P WCR/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." 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. c) GcncrL7'�- C��s Contractor Ix— B n�Jic/-P� Title Date: DIR#: / 0066VUCe73 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 S'S 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: C T CtPcfGl ccnWc 7'c-or /!�C- Contact Person: Contact Phone: 0--t- 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 EXHIBIT A DISADVANTAGED BUSINESS ENTERPRISE (DBE) This Project is subject to Part 200.321, Title 2, Code of Federal Regulations entitled "Contracting with Small and Minority Businesses, Women's Business Enterprises, and Labor Surplus Area Firms." The Regulations in their entirety are incorporated herein by this reference. It is the policy of the City that disadvantaged business enterprises (DBEs), as defined in Part 200.321, Title 2 CFR, shall be encouraged to participate in the performance of Contracts financed in whole or in part with federal funds. The Contractor should ensure that DBEs, as defined in Part 200.321, Title 2 CFR, have the opportunity to participate in the performance of this Contract and shall take all necessary and reasonable steps, as set forth in Part 200.321, Title 2 CFR, for this assurance. The Contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of subcontracts. Failure to carry out the requirements of this paragraph shall constitute a breach of Contract and may result in termination of this Contract or other remedy the City may deem appropriate. Bidders shall be fully informed respecting the requirements of the Regulations and are urged to obtain DBE participation in this project, although there is no specific goal for DBE participation. C-14 EXHIBIT B DBE INFORMATION—GOOD FAITH EFFORTS Federal-aid Project No. Bid Opening Date The City of Huntington Beach-established a Disadvantaged Business Enterprise (DBE) goal of 0%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 Dat s 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 Solicitation and Dates C-15 C. The items of work which the bidder made available to DBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items M of (Y/N) Contract D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each DBE if the selected firm is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: �i�a�S[ �S=C� �fCfG lecf Names, addresses and phone numbers of firms selected for the work above: �I�cr�ft S-ee 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-16 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: h CA,ram(. F , 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 v Jj!�a�C �7-ee- ,a dj c7r_( 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-17 IF A SOLE OWNER OR SOLE CONTRACTOR SIGN HERE: (1) Name under which business is conducted If (2) Signature (given and surname) of proprietor (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail IF A PARTNERSHIP, SIGN HERE: (1) Name under which business is conducted IA- (2) Signature (given and surname and character of partner) (Note: Signature must be made by a general partner) (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail C-18 IF A CORPORATION, SIGN HERE: (1) Name under which business is conducted C ccr�GYe CGS 7 Gl (2) Signature) �'lCSicPP� (Title) Impress Corporate Seal here (3) Incorporated under the laws of the State of CG1 li7'Or0%a (4) Place of Business 1,67 9— (Street and Number) City and State (5) Zip Code 1,4070 Telephone No. ,5fPc) - 7 77 a Z�-c3,�. (6) E-Mail Yacht/ NOTARIAL ACKNOWLEDGMENT OF EXECUTION BY ALL SIGNATORIES MUST BE ATTACHED C-19 List below names of president, vice president, secretary and assistant secretary, if a corporation; if a partnership, list names of all general partners and managing partners: Jchn C - _5 fr?6 j�-hi'1 C- Jam 0 Ge r-sic Gh C- C-20 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 1 CIS On G�nl)d11/� I O i before me, Gh C I � flj rlfq j i ene Z, Date Here Insert Name and Title of the Officer personally appeared j C;hn C. .5 cl j r)G 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/ehe4tey-executed the same in hislien*heir-mthorized capacity0es)-and that by his/ er ' nature(*on the instrument the person_4 or the entity upon behalf of which the person(eHaeted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph RACHEL MREA JIMENEZ is true and correct. Commission#2122040 Z WITNESS my hand and official seal. Notary Public-California Los Anpbs County CeramAug 2.2019 Signature Signature of Notary PubQ) 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: 'p YUF03G I Document Date, i G l-7 Number of Pages: Signers) Other Than Named Above: Y)0 Gl I)f1' )Jig n-e r Capacity(ies) Claimed by Signer(s Signer's Name: - s- __ Signer's Name: _L2'Corporate Officer — Title(s): P ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑ Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑Other: ❑ Other: Signer Is R pr�senti ng: s ' Signer Is Representing: 02014 National Notary Association • www.NationedNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5907 EXHIBIT C LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFEjR�PTO INSTRUCTION ON THE REVERSE SIDE OF THIS�F^ORM LOCAL AGENCY: C I Nn� �C LOCATION j� b ctCh C-+ ,fin PROJECT DESCRIPTION: C-Uf b GCC?5_5 f CA `P 1 n 51_4 ICA C" TOTAL CONTRACT AMOUNT: BID DATE: 1 ( C BIDDER'S NAME: CONTRACT DBE GOAL: CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE OLLAR AMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened- include DBE address O BE PROVIDED(or contracted if the and phone number) bidder is a DBE) For Local Agency to Complete: Total Claimed DBE $ Local Agency Contract Number: Participation Federal-aid Project Number: Federal Share: Contract Award Date: Local Agency certifies that all DBE certifications have been verified and information is complete and accurate. ign ture of Bidde_ 1 - % 'I 2•lq'7���a Date (Area Code)Tel.No. Print Name Signature Date b hr) C- .5 C V r'L _5W `—M I,)?> Local Agency Representative Person to Contact (Please Type or Print) (Area Code)Telephone Number: Local Agency Bidder DBE Commitment(Construction Contracts) (Rev 6/26/09) C-21 PLEASE NOTE: This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must be submitted and received as specified in the Special Provisions. Failure to submit the required DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project regardless of tier. Names of the First-Tier DBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of DBE firms. Exhibit 15-G must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local 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. C-22 EXHIBIT D EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder f Gmrt-# (Gns�G / tG�i�1�j f [proposed subco�`ri�ractor J hereby certifies that he/sire/it hasJ/, 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/she/it 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. (eeoc.gov/employers/eeolsurvey/index.cfm) 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. 2G Signature: IA—JMt7 -SO—MCIDate: Print Name: C- O-r�CI Title: C-23 EXHIBIT E NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) [NAME OF CONTRACT] To the City of Huntington Beach In conformance with Title 23 United States Code Section 112 and California 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 Bidder's Proposal. By signing the Proposal, the Bidder has also signed this Noncollusion Affidavit. Bidders are cautioned that making a false Certification may subject the Bidder to criminal prosecution. Signature: Date: 1 Print Name: Title: P/���fjG(ew-/- C-24 EXHIBIT F 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 with Bidder 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 him/her 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 thi's 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. Note: 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. Signature: Date: Print Name: l`I W S o rn G Title: pl' cs C-25 EXHIBIT G 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. Signature: Date: / q'17 Print Name: C Sqr� Title: preil dent- C-26 EXHIBIT H 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: [Zia.contract [a.bid/offer/application Fla.initial b.grant b.initial award b.material change c.cooperative agreement c.post-award d.loan For Material Change Only: e.loan guarantee year quarter f.loan insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: ,Prime Subawardee Tier if known Congressional District,if known Congressional District,if known 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number,if applicable 8. Federal Action Number,if known: 9. Award Amount,if known: 10. a.Name and Address of Lobby Entity b. Individuals Performing Services (including (If individual,last name,first name,MI) address if different from No. 10a) (last name,first name,MI) (attach Continuation Sheet(s)if necessary) 11. Amount of Payment(check all that apply) 13. Type of Payment(check all that apply) $ Actual planned a.retainer b.one-time fee 12. Form of Payment(check all that apply): c.commission 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: Yes ❑ No El M. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above when his transaction was made or VTe entered into.This disclosure is required pursuant to 31 U.S.C. Print Name: 1352. This information will be reported to Congress semiannually and will be available for public inspection.Any Title: /I I-e',S iCte n 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 Telephone No.: -42.777 Date: $100,000 for each such failure. Authorized for Local Reproduction Federal Use Only: Standard Form-LLL Standard Form LLL Rev.09-12-97 C-27 INSTRUCTIONS FOR COMPLETION OF EXHIBIT H, 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 C-28 (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12)Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13)Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 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. By my signature on this proposal I certify, under penalty of perjury under the laws of the State of California, that the foregoing questionnaire and statements of Public Contract Code Sections 10162, 10232 and 10285.1 are true and correct and that the bidder has complied with the requirements of Section 8103 of the Fair Employment and Housing Commission Regulations (Chapter 5, Title 2 of the California Administrative Code). C-29 EXHIBIT I FEDERAL LOBBYING RESTRICTIONS Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower tier subrecipient 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 Proposal. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Proposal. Signing the Proposal 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: 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 person(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. C-30 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE for FY 2016/17 CURB ACCESS RAMP INSTALLATION PROJECT C.C. No. 1541 January 3, 2017 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Special Provisions: 1) Replace Section D "Sample Contract" in it's entirety in the Specifications with updated Section D in this Addendum. The"Sample Contract" was updated in December 2016. 2) Replace Appendix K, the "Prevailing Wage Schedule" in it's entirety in the Specifications with updated Appendix K in this Addendum. "General Decision Number: CA60035 11/11/2016" will be replaced with "General Decision Number: CA60035 12/23/2016." 3) Replace Appendix L, the "Federal Documents for CDBG Projects" in it's entirity in the Specifications with updated Appendix L in this Addendum. The documents were updated in December 2016. This is to acknowledge receipt and review of Addendum Number One, dated January 3, 2017. C ompany Name By /- g - /-7 Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Joseph Fuentes at (714) 536- 5431. 1 Compliance News Daily Focus Journal Publication Affidavit-Declaration of Publication -- State of California CJ Concrete Construction Inc Contact:Rachel Jimenez is seeking certified and qualified 10142 Shoemaker Ave DVBE,DBE,MBE,WBE subs and/or suppliers to Santa Fe Springs,CA,90670 provide Phone:(562)777-2222 Survey, Traffic Control,SWPPP,and NPDES Fax:(562)777-2220 Complaince Email:rachelj@cjconcreteconstructioninc.com for City of Huntington Beach 2000 Main St. Bid Due on:01/10/2017 at 02:00 PM Huntington Beach,CA 92648 in Huntington Solicitation Number:CC-1541 Beach,CA We are an Equal Opportunity Employer. The CJ Concrete Construction Inc Good Faith Effort ad has been published in both the Compliance News Internet and Hard-Copy publications. Located Online at:http://www.compliancenews.com/classified—daily The undersigned declares: I am over the age of 18 years and a citizen of the United States.I am the principal publisher of the Compliance News Monthly Trade Journal in the City of Long Beach,County of Los Angeles,and the State of California.The notice,a true copy of which is attached was published on Thu Jan 05 19:00:10+0000 2017 I declare under penalty of perjury that the foregoing is true and correct.Executed at Long Beach, California Henry Sprague III Copyright 2005 Compliance News DVBE#0018455 All Rights Reserved C. Summary of Firms Sent Bid Invitations 30 total firms were sent invitations. Company Name: Tec Management Consultants, Inc. Address: 400 Goddard Irvine,CA, 92618 Phone: (949) 450-8200, Fax: (949) 450-8210 Work Categories: Management&Public Relations Phone Solk4tation Informat^io� Date/s-Time/s Solicited by Phone: �'� 1 '� C4.( Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: S F C COMMUNICATIONS, INC. Address: 65 POST, SUITE 1000 IRVINE,CA, 92618 Phone: (949) 702-1145, Fax: (949) 266-9390 Work Categories: Consultant, Environmental, Environmental Consulting Services, 541620 Phone of atio Information Date/s-Time/s Solicited by Phone: I I.. 51 G m Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: A P S I CONSTRUCTION MANAGEMENT Address: 8885 RESEARCH IRVINE,CA, 92618 Phone: (949) 679-0202, Fax: (949) 679-0212 Work Categories: Engineering Services, Management Services, Management Consulting Services, Facilities Support Management Services, Engineering Services Management Consulting Facilities Support Construction Management Project Management Scheduling Cost Estimating Claims A Phon olioitotion Infor ation Date/s-Time/s Solicited by Phone: i G P M ' Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Analytical Topo Maps Address: One Technology Parkway, Bldg., E-301 Irvine,CA, 92618 Phone: (949) 453-1700, Fax: (949) 453-8259 Work Categories: Consultant Pho a So ' itation Information Date/s-Time/s Solicited by Phone: `-\ 1 c 12.23 F'M Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Advantec Consulting Engineers Inc Address: 1200 ROOSEVELT Irvine,CA, 92620 Phone: (949) 861-4999, Fax: (949) 502-5522 Work Categories: TRAFFIC ENGINEER; ENGINEERING; CONSULTANT, ENGINEERING; CIVIL ENGINEERING; Phon Soli 'tation Informatio�n�, Date/s-Time/s Solicited by Phone: 1• lj I� Person Contacted and Commments for Solicitation.CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: EI&C ENGINEERING INC. Address: 15635 Alton Parkway, Suite 117 IRVINE,CA, 92618 Phone: (949) 679-8760, Fax: (949) 679-8865 Work Categories: Electrical Instrumentation Control Engineering 811017 - Electrical And Electronic Engineering 811024 - Electrical Power Transmission Engineering, Environmental Engineer, 541330, Engineering Services, Consultant, Engineering, Electrical Engineers 811017 - Pho a Solicitation Inlownation Date/s-Time/s Solicited by Phone: (- —1' 11 ej . 2 Z CT f1'1 ' Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Pivox Corporation Address: 16 Technology Drive, Ste 152 Irvine,CA, 92618 Phone: (949) 727-1400, Fax: (949) 727-1455 Work Categories: Construction Management Phone Solif�' ation I orma n Date/s-Time/s Solicited by Phone: �• -1'1-7 ( A) cr.3 cr(" ' Person Contacted and Commments for Solicitation.-CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Dot.dat.inc Address: 4 Sweetwater Irvine,CA, 92603 Phone: (949) 854-3522, Fax: (949) 854-3522 Work Categories: Computer& Data Processing Services, Computer Processing Data Preparation Services 811120 -Data Services Phone Soli*-' Inf rmation Date/s-Time/s Solicited by Phone: '1'1`7 0 1 4'J Gi-M Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: MATERIAL ACQUISITION SERVICES, INC. Address: 7545 IRVINE CENTER DRIVE#200 IRVINE,CA, 92618 Phone: (949) 623-8330, Fax: (888) 317-8898 Work Categories: Machinery, Equipment, & Supplies, Industrial Machinery And Equipment Merchant Wholesalers, Freight Transportation Arrangement, 423830, Industrial Machinery Manufacturing, Broker Phone Solic' ation Information Date/s-Time/s Solicited by Phone: I '�• 0. 69 64,r'1 Person Contacted and Commments for Solicitation: C-1541 City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: Sequoia Consultant, Inc Address: 361 W. Grove Avenue Orange,CA, 92865 Phone: (714) 974-6316, Fax: (714) 974-6193 Work Categories: Small Structures, Construction Materials Testing And Inspection Materials Engineering Construction Management Quality Assurance Quality Control 411146 - Metals And Metallurgy And Structural Materials Testing Instruments 781416 - Inspection 811015 -Civil Phone Soli •tation Info mationnyy Date/s-Time/s Solicited by Phone: I C) Person Contacted and Commments for Solicitation: C-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Advanced Earth Sciences, Inc. Address: 9307 Research Drive Irvine,CA, 92618 Phone: (949) 379-2450, Fax: (949) 379-2470 Work Categories: Civil Engineering, Safety Studies, 541330, Engineering Services,Architectural Engineer, Mechanical Engineers, Right Of Way Engineer, Feasibility Studies, Traffic Engineer Phone Solicit tion Information Date/s-Time/s Solicited by Phone: 1 • ,- it (d 1 ` 19- Gi'rn Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: Intueor Consulting, Inc. Address: 7700 IRVINE CENTER DRIVE, SUITE 470 IRVINE,CA, 92618 Phone: (949)466-5663, Fax: (510) 899-0440 Work Categories: BUSINESS ADMINISTRATION; MANAGEMENT INFORMATION SYSTEMS; TRAFFIC ENGINEER; FEASIBILITY STUDIES; ENGINEERING; CONSULTANT, ENGINEERING; ARCHITECTURAL ENGINEER; CIVIL ENGINEERING; SAFETY STUDIES; MECHANICAL ENGINEERS; COMPUTER PROGRAMMING; INTEGRATED SYSTEMS Phone SoliqKation Information Date/s-Time/s Solicited by Phone: V -1' I—) I O " i-I Gt ty) Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: Afsaneh Enterprises, Inc. Address: 9910 Irvine Center Drive Irvine,CA, 92618 Phone: (949) 333-1000, Fax: (949) 333-1001 Work Categories: Telephone Communications, 517310, Telecommunications Resellers Phone Solic' tion Information Date/s-Time/s Solicited by Phone: I • "I.1-1 1 J 1 a'•�-7 CA(Y) ' Person Contacted and Commments for Solicitation: C-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Fpl And Associates, Inc. Address: 10 Corporate Park, #310 Irvine,CA, 92606 Phone: (949) 252-1688, Fax: (949) 252-0088 Work Categories: Engineering, Civil Traffic Transportation Engineering Consulting 811015 - Civil Engineering 811017 - Electrical And Electronic Engineering 811022- Transportation Engineering, Consultant, Engineering, 541330, Engineering Services, Traffic Engineer, Drafti Pl ne Solici 'on Information Date/s-Time/s Solicited by Phone: ' il 16'. 64. Person Contacted and Commments for Solicitation: G1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Tagg Industries Inc Address: 23210 Del Lago Dr Laguna Hills,CA, 92653 Phone: (949) 770-9029, Fax: (949) 770-3016 Work Categories: Medical, Dental, & Hospital Equipment& Supplies, Fabricated Rubber Products N.e.c. Hardware Surgical Medical Instruments Apparatus Orthopedic Prosthetic Appliances Supplies, First Aid And Medical Supplies 391016 - Lamps And Lightbulbs 421316 -Medical St Phone S it tion Inforation Date/s-Time/s Solicited by Phone: 1 '�t �• �LPmGt'(n ' Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Ddb Engineering, Inc. Address: 25 Mauchly Suite 323 Irvine,CA, 92618 Phone: (949) 727-4008, Fax: (949) 727-4079 Work Categories: Civil Engineering, Civil Engineering Primarily Related To Water, Wastewater, And Recycled Water Projects. Permitting And Regulatory Compliance. Design And Project Management. Grant Writing. 811015 -Civil Engineering, 541330, Engineering Services, Feasibi Phone Solicitati Information Date/s-Time/s Solicited by Phone: I. -I• yj (0 � 1 6-7 Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: Mendoza Berger& Company, Up Address: 9838 Research Drive Irvine,CA, 92618 Phone: (949) 387-9850, Fax: (949) 387-9652 Work Categories: Services,Nec Phone Solicitation Information Date/s-Time/s Solicited by Phone: \' 1. 1-1 P 11 1� C. Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: Clr Analytics, Inc Address: 4000 Barranca Pkwy., Suite 250 Irvine,CA, 92604 Phone: (949) 705-8566, Fax: (949) 262-3264 Work Categories: Consultant,Traffic Control Operation Management Metering Transportation Engineering Planning Travel Demand Forecasting Simulation Modeling Paramics Vissim Transmodeller Transcad Advanced Sensors Plugin Development Training Smartphone Smart-signal Vehicle Phone Solicit tion Information Date/s-Time/s Solicited by Phone: I I 1 -7 Cl•� ' Person Contacted and Commments for Solicitation: C-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Digital Services Enteprises, Inc Address: 40 Tesla Suite B Irvine,CA, 92618 Phone: (949) 387-6200, Fax: (949) 387-6300 Work Categories: Mailing, Reproduction, Stenographic, Printing, Copying, Mailing Services, Direct Mail, Posters, Banners, Graphic Design, Typesetting, Catalogs, Brochures, Publications,promotional Products, 541860, Direct Mail Advertising, Services, Nec, Printing Trade Se Phone Solicitation Information Date/s-Time/s Solicited by Phone: i•'-I- I) (-4-� 11. 7q Ci-m- Person Contacted and Commments for Solicitation: 'C-1541 City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: Schafer Consulting Inc Address: 8105 Irvine Center Drive Suite 1020 Irvine,CA, 92618 Phone: (949) 788-7780, Fax: (949) 788-7781 Work Categories: Management Consulting, Offices Of Certified Public Accountants, Other Management Consulting Services Phone Solici ation Information Date/s-Time/s Solicited by Phone: I• . 1-1 (( I I 39- GT M - Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: Transglobal Engineering, Inc. Address: 110 Retreat Irvine,CA, 92603 Phone: (949) 300-9397, Fax: (949) 737-7643 Work Categories: Civil Engineering, 541330, Engineering Services Phone Solicit 'on Information Date/s-Time/s Solicited by Phone: i • '7. 1� (0 11 4 a Gt f)') Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: MLM& ASSOCIATES ENGINEERING, INC. Address: 23011 Moulton Parkway Suite F-5 Laguna Hills,CA, 92653 Phone: (949) 586-1900, Fax: (949) 586-5757 Work Categories: CONSULTANT, NON ENGINEERING; ENVIRONMENTAL QUALITY; Phone SolicitaAiQn Information Date/s-Time/s Solicited by Phone: ' T f-7 (.0 I !:S3 eq,m ` Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Global Geo-engineering,inc Address: 3 Corporate Park, Suite 270 Irvine,CA, 92606 Phone: (949) 221-0900, Fax: (949) 221-0091 Work Categories: Safety Studies, Feasibility Studies, 541330, Engineering Services, Consultant, Engineering, Civil Engineering Phone SolicA#tion Information Date/s-Time/s Solicited by Phone: 2 v-7 Lo I/)� : G(p V07, Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: NEW DYNASTY CONSTRUCTION CO Address: 20 Morgan Ste 100 IRVINE,CA, 92618 Phone: (949) 502-6400, Fax: (949) 502-6404 Work Categories: General Building Contractor/Services 721211 - Commercial And Office Building Construction Services, 236115,New Single-family Housing Construction (except Operative Builders) Phone Solicit 'on Information Date/s-Time/s Solicited by Phone: ' 1'1 h'► Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: V A C, Inc. Address: 6400 Oak Canyon#150 Irvine,CA, 92618 Phone: (949) 788-1110, Fax: (949) 788-7770 Work Categories: Consultant Phone So}0tation Information Date/s-Time/s Solicited by Phone: I- I- I'-) (co I/)— i W YA - Person Contacted and Commments for Solicitation: CC-1541 City of untington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Kal Architects, Inc. Address: 12 j Mauchly Drive, Irvine,CA, 92618 Phone: (949) 450-8420, Fax: (949) 450-8424 Work Categories: Interior Decorating & Design, Civil Engineering, 541310, Architectural Services, Building Construction hone Solicitation Inform tion Date/s-Time/s Solicited by Phone: `-7'I�l ,2 Person Contacted and Commments for Solicitation: -1541 City of Yuntington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: Zma Inc Address: 15615 Alton Pkwy Suite 450 Irvine,CA, 92618 Phone: (949) 608-7350, Fax: (949) 266-9168 Work Categories: Services,N.e.c., Vapor Intrusion Studies Environmental Permitting Compliance Programs Auditing Pollution Prevention Sustainability Air Water Waste Hazardous Waste Risk Analysis Data Management Systems Modeling Environmental Ceqa Environmental Impact Repo _Phone SoloKation Information Date/s-Time/s Solicited by Phone: I• ' I 9-: 2---z M . Person Contacted and Commments for Solicitation: CC-1541 City of untington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: Civilsource, Inc. Address: 500 Wald Irvine,CA, 92618 Phone: (949) 585-0477, Fax: (949) 585-0433 Work Categories: Services To Buildings, Design, 541330, Engineering Services, Land Surveying, Construction Management, Drafting, Consultant, Engineering Phone Solic ion nformation Date/s-Time/s Solicited by Phone: I --I- I'7 31P.M . Person Contacted and Commments for Solicitation: CC-1541 City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Company Name: C2PM Address: 16520 BAKE PKWY SUITE#250 IRVINE,CA, 92618 Phone: (949) 333-3700, Fax: (949) 333-3701 Work Categories: Construction Program Project Management Transportation Water Wastewater Aviation Ports Maritime Consulting Management 801015 - Business And Corporate Management Consultation Services, Management & Public Relations, 541350, Building Inspection Services, Co Phone Solicitation Information Date/s-Time/s Solicited by Phone: i ' I -1I c la I- U-z✓ R m Person Contacted and Commments for Solicitation: CC- 41 City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Company Name: Ultrasystems Environmental Inc Address: 16431 Scientific Way Irvine,CA, 92618 Phone: (949) 788-4900, Fax: (949) 788-4901 Work Categories: Environmental Quality, Ceqa Nepa Air Quality Ghg Emissions Cultural Resources Environmental Sbe Wbe Dbe 771015 - Environmental Impact Assessment 771016 - Environmental Planning 771215 -Air Pollution 771316 -Noise Pollution 931417 - Culture, Environmenta Phone Solicitn Information Date/s-Time/s Solicited by Phone: ' �- 1� tio 12-- L�5V p m Person Contacted and Commments for Solicitation: CC-1541 City of fluntington Beach 2000 Main St. Huntington Beach , CA 92648 Affidavit of Fax Solicitation The undersigned employee of Compliance News Publishing, located in the City of Long Beach, County of Los Angeles, and the State of California, declares that bid solicitation letters have been faxed to the following 30 firms listed below at 07:OOPM on 01/05/2017. I am over the age of 18 years and a citizen of the United States. I declare under penalty of perjury that the foregoing is true and correct. Executed at Long Beach, California. Henry Sprague III CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Tec Management Consultants, Inc. 400 Goddard Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: S F C COMMUNICATIONS, INC. 65 POST, SUITE 1000 IRVINE,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: A P S I CONSTRUCTION MANAGEMENT 8885 RESEARCH IRVINE,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Analytical Topo Maps One Technology Parkway, Bldg., E-301 Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Advantec Consulting Engineers Inc 1200 ROOSEVELT Irvine,CA,92620 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DV13E,DI3E,MI3E,WI3E subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: EI&C ENGINEERING INC. 15635 Alton Parkway, Suite 117 IRVINE,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Pivox Corporation 16 Technology Drive, Ste 152 Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP,and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Dot.dat.inc 4 Sweetwater Irvine,CA,92603 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: MATERIAL ACQUISITION SERVICES, INC. 7545 IRVINE CENTER DRIVE#200 IRVINE,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP,and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DV13E,DI3E,MI3E,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Sequoia Consultant, Inc 361 W. Grove Avenue Orange,CA,92865 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP,and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Advanced Earth Sciences, Inc. 9307 Research Drive Irvine,CA,92618 We are seeking certified and qualified DVl3E,Dl3E,Ml3E,Wl3E subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP,and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Intueor Consulting, Inc. 7700 IRVINE CENTER DRIVE, SUITE 470 IRVINE,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP,and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Afsaneh Enterprises, Inc. 9910 Irvine Center Drive Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Fpl And Associates, Inc. 10 Corporate Park, #310 Irvine,CA,92606 We are seeking certified and qualified DVl3E,Dl3E,Ml3E,Wl3E subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Tagg Industries Inc 23210 Del Lago Dr Laguna Hills,CA,92653 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP,and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Ddb Engineering, Inc. 25 Mauchly Suite 323 Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Mendoza Berger& Company, Up 9838 Research Drive Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10,142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Or Analytics, Inc 4000 Barranca Pkwy., Suite 250 Irvine,CA,92604 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DV13E,Dl3E,MI3E,WI3E subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Digital Services Enteprises, Inc 40 Tesla Suite B Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to(562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Schafer Consulting Inc 8105 Irvine Center Drive Suite 1020 Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP,and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Transglobal Engineering, Inc. 110 Retreat Irvine,CA,92603 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: MLM&ASSOCIATES ENGINEERING, INC. 23011 Moulton Parkway Suite F-5 Laguna Hills,CA,92653 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Global Geo-engineering,inc 3 Corporate Park, Suite 270 Irvine,CA,92606 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to(562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: NEW DYNASTY CONSTRUCTION CO 20 Morgan Ste 100 IRVINE,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: V A C, Inc. 6400 Oak Canyon#150 Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to(562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Kal Architects, Inc. 12 j Mauchly Drive, Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Zma Inc 15615 Alton Pkwy Suite 450 Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Civilsource, Inc. 500 Wald Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to(562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: C2PM 16520 BAKE PKWY SUITE#250 IRVINE,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. CJ Concrete Construction Inc 10142 Shoemaker Ave Santa Fe Springs,CA 90670 Telephone: (562) 777-2222 Fax: (562) 777-2220 INVITATION TO BID January 05, 2017 Attn: Ultrasystems Environmental Inc 16431 Scientific Way Irvine,CA,92618 We are seeking certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for: Project: City of Huntington Beach 2000 Main St. Huntington Beach , CA 92648 Location: Huntington Beach,CA Bid Due Date: 01/10/17 at 02:00 PM PST Solicitation Number: CC-1541 Contact: Rachel Jimenez Quotes are needed for: Survey, Traffic Control, SWPPP, and NPDES Complaince. Please indicate if you will be bidding on this project and fax your response to (562) 777-2220. Yes, we will bid No, not interested We are an Equal Opportunity Employer and intend to seriously negotiate with certified and qualified DVBE,DBE,MBE,WBE subcontractors and/or suppliers for project participation. Subcontractors will be required to enter into our standard contract.No modifications to the contract are permitted. If you have any questions please do not hesitate to contact us. FEDER 4TED INSURANCE® Bond No. 6038321 Bid Bond KNOW ALL PERSONS BY THESE PRESENTS, that we C J CONCRETE CONSTRUCTION INC 10142 SHOEMAKER AVE SANTA FE SPRINGS, CA 90670 as Principal and Federated Mutual Insurance Company , a corporation, organized and existing under the laws of the State of MINNESOTA and having its principal place of business at 121 East Park Square, Owatonna, Minnesota, as Surety, are held and firmly bound unto CITY OF HUNTINGTON BEACH 2000 MAIN ST HUNTINGTON BEACH, CA 92648 as Obligee, in the sum of 10% OF THE PROPOSAL Dollars ($ ) for payment of which the Principal and the Surety bind themselves, their heirs, executors, administrators, successors and assigns,jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, That, whereas the Principal has submitted or is about to submit a proposal to the Obligee on a contract for FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT NOW, THEREFORE, if the said contract be awarded to the Principal and the Principal shall, within such time as may be specified, enter into the contract in writing, and give bond, with surety acceptable to the Obligee for the faithful performance of the said contract; or if the Principal shall fail to do so, pay to the Obligee the damages which the Obligee may suffer by reason of such failure not exceeding the penalty of this bond, then this obligation shall be void; otherwise to remain in full force and effect. Signed and sealed this _ 10TH day of JANUARY 2017 C J CONCRETE CONSTRUCTION INC (Pr' al) BY: J HN C SARNO-PRESIDENT (Title) Fede ated Mutual Insurance Company BY: SH LLY ROHWER �.,ney-,,�,-faci) AF-30M Ed.11-16 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That FEDERATED MUTUAL INSURANCE COMPANY, a corporation duly organized and existing under the laws of the State of Minnesota, and having its principal office in the City of Owatonna, State of Minnesota, does hereby constitute and appoint: SHELLY ROHWER of the City of OWATONNA State of MINNESOTA its true and lawful attorney for the following purposes: To sign its name as surety to, and to execute, affix the seal, acknowledge and deliver any and all surety bonds and penalties not exceeding: ONE HUNDRED THOUSAND DOLLARS ($100,000) EACH CJ CONCRETE CONSTRUCTION INC SANTA FE SPRINGS, CA The execution of such bonds or undertakings in pursuance of these presents shall be binding upon the Company as if they had been executed and acknowledged by the regularly elected officers of the Company. This Power of Attorney granted by Federated Mutual Insurance Company shall terminate when the designee ceases to be: 1) Employed by Federated Mutual Insurance Company or 2) Employed by Federated Mutual Insurance Company in a job for which such Power of Attorney is required. IN WITNESS WHEREOF,the said FEDERATED MUTUAL INSURANCE COMPANY has caused this instrument to be signed and its corporate seal to be affixed by its Executive Vice President and Assistant Secretary this.tlie 8TH day of APRIL 2016 FEDERATED MUTUAL INSURANCE COMPANY BYi�� (SEAL) E ecutive Vice President and BY sistant Secretary STATE OF MINNESOTA COUNTY OF STEELE On this 8TH day of APRIL 2016 personally appeared before me, the undersigned notary public, James A. Thon and Jonathan R. Hanson to me personally known, who, each being duly sworn by me, did say that they are respectively the Executive Vice President and Assistant Secretary of the FEDERATED MUTUAL INSURANCE COMPANY and that the seal affixed to this instrument is the corporate seal of said Corporation and that this instrument was signed and sealed of behalf of said Corporation by authority of its Board of Directors and said James A. Thon and Jonathan R. Hanson acknowledge said instrument to be the free act and deed of said corporation. - ,.. KELLYJ.HAGEN t. NOTARY PUBLIC-MINNESOTA (SEAL) My Commission Expires Jan.31,2020 -2 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 16 5 On JGnW f( )0'"12CObefore me, he I Ahd tm , )ffleff Z, Nctj_ ✓/ P(jbllc Date Here Insert Name and Title of the Officer personally appeared c ch (I C - 50rnG Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(sj-whose names) islaxe.. subscribed to the within instrument and acknowledged to me that hefshe`they executed the same in hisflierfthi�tr authorized capacity(fes , nd that by hisHierftheir signature(s}an the instrument the person*, or the entity upon behalf of which the person(s�-acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. RACHEL ANOREA JIMENEZ CAmnda;lon 02122040 WITNESS my hand and official seal. wry PubOe-Cw0rnia I foa Anita Cgxrilr 2,20t9 Signature Signature of Notary Publi 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 , 1 —7 Title or Type of Document: ,old �Gn�i Document Date• )0 / Number of Pages: Signer(s) Other Than Named Above: t�ah S fCi rl Capacity(ies) Claimed b�(Si ner(s) Signer's Name: In ( Pirno Signer's Name: I�Corporate Officer — Title(s): (1 1 eelr ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑ Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑ Other: ❑ Other: Si ner Is Repf� ting:ccnC Signer Is Representing: 02014 National Notary Association - www.NationaiNotary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907 City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachea.gov `Ea:;; �yoy`4� ♦ Office of the City Clerk Robin Estanislau, City Clerk April 27, 2017 EBS General Engineering, Inc. 1320 E. Sixth St., Stet. 100 Corona, CA 92879 RE: FY 2016/17 Curb Access Ramp Installation Project—CC-1541 Enclosed please find your original bid bond for CC-1541. Sincerely, 4�� �&470j� Robin Estanislau, CIVIC City Clerk RE:pe Enclosure Sister Cities: Anjo, Japan o Waitakere, New Zealand Q LO N Z ti . � U OV- � •N N 0 U o CO �,C] ti o ui -� to lL — 00 r O d- N U LL cu c V N c Q T ws� z� mY oU Ono -!!f LL. o (1) � , �UC/) ca � m LU C �'' � N � C) 4- CU c 4- O ls H > _V O La C N O o r UON = SECTION C PROPOSAL for the construction of FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT from VARIOUS LOCATIONS CC No. 1541 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 70 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 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 BID ITEMS Item, Desenp��rn F x t uantity Unity N fJnit CvstT0tal most 1 Mobilization 1 LS $ ,C1Q0 $ �D Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 1 in 2 Appendix H of Specifications (Item includes all appurtenances,curb&gutter, depressed curb, sidewalk, , Q��_ $ domes, retaining curb, sawcut,slot pave, etc.) 68 EA $ Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR using horizontal curb cutting machine as 3 shown on Curb Ramp Detail 2 in Appendix H of Specifications (Item includes all appurtenances, curb&gutter,depressed curb, sawcut,sidewalk, domes, retaining curb, etc.) 63 EA $ $ 12. ACC Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 3 in 4 Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed curb,sawcut, sidewalk, domes, retaining curb, slot pave, etc.) 5 EA $ �,©�'U $ Construct Case C Midblock or Case F/Case G/Case CM or Type C Directional Curb Access Ramp per Caltrans Std. Plan 5 A88A/A88B(Item includes all appurtenances, curb&gutter, depressed curb, sidewalk, domes, retaining curb, slot pave, etc.) 20 EA $ ,CW $ bO, MCA 6 Install truncated domes to existing Curb Ramp 123 EA $ 5 00 $ 101 C90" 7 Remove existing improvements and construct concrete meandering sidewalk per HB Standard Plan 207 500 SF $ $ Remove and reconstruct Cross Gutters per HB Standard Plan 8 205(Item includes all appurtenances, curb&gutter,slot pave, , etc.) 3,800 SF $ Z2 $ S�,LeeC Remove and replace existing 6"or 8"Curb and Gutter per HB 9 Standard Plan 202(Item includes all appurtenances and slot pave, etc.) 100 LF $ $ 75ao 10 Install 4"PVC Sleeve for Street Assembly Sign per City of HB Std. Plan 401 10 EA $ '00 $ '7 00 C' 11 Prepare Storm Water Pollution Prevention Plan(SWPPP) 1 LS $ iZoD- $ ) 2-00" 12 Install&Maintain Construction BMPs 1 LS $ 2-OC O` $ TOTAL BID AMOUNT (BASIS OF AWARD) SCHEDULE A $ -7 220 , oC o C-2.1 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION,CC 1541 TOTAL BID AMOUNT IN WORDS: Note: 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. C-2.2 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 logo bid amount 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 Bid er".'s Si na ure 1/3/17 ✓� C-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 g State Class, DIR Dollar %of Item(s) Subcontractor License Number Amount Contract Number Nonce 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 1/6/17, at Corona _, CA Date City State Joseph A. Nand , being first duly sworn, deposes and says that he or she is President of EBS General 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. EBS General Engineering, Inc. Name of Bidder Signature of Bidder Joseph A. Nanci 1320 E. Sixth St., Ste 100 Corona CA 92879 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 FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT, (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. EBS General Engineering, Inc. Contractor By President Title Date: 1/6/17 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 VNo 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. EBS General Engineering, Inc. Contractor By President Title Date: 1/6/17 C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: EBS General Engineering, Inc. Bidder Name 1320 E. Sixth St., Ste 100 Business Address Corona C.A 92879 City, State Zip ( 951 ) 279-6869 bids@ebsgeneral.com Telephone Number Email Address 720016 A State Contractor's License No. and Class 3/31/96 Original Date Issued 3/31/18 Expiration Date The work site was inspected by Joseph A. Nanci of our office on 12/28 ,201_6_. The following are persons, firms, and corporations having a principal interest in this proposal: Joseph A.Nanci,President C-8 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in . accordance with the plans and specifications set forth. EBS General Engineering, Inc. Company Na Signature of Bidder Toseph A Nanci President Printed or Typed Signature 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 before me, 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(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 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 Riverside } On January 09, 2017 before me, K. Fairweather Notary Date Insert Name and Title of the officer Public, personally appeared Joseph Nanci 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. K:fAMWEAtHER WITNESS m hand and official seal. Nosy etsidPub4s•oultorMe Y Riverside County Z Commission#r 2149313 My Comm.Expires A r 21,2020 Si -------------------------------------------------------------OPTIONAL------------------------------------------------------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent attachment 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) Signers Name: Signers Name: ❑ Corporate Officer—Title(s) ❑ Corporate Officer—Title(s) ❑ Partner- ❑ Limited ❑ General ❑ Partner- ❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑ Trustee ❑Guardian or Conservator ❑ Trustee ❑Guardian or Conservator ❑ Other: ❑ Other: Signer is Representing: Signer is Representing: 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: 1. See attached reference sheet 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: 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: Contract Amount Type of Work Date Completed Provide additional project description to show similar work: C-10 Raa.. 3 YEAR REFERENCES — PUBLIC WORKS 1. Project Name 2014/2015 Citywide Curb, Gutter, Sidewalk, Driveway Repairs Project Address Owner Various Locations City of Riverside Principal Contact Phone Secondary Proiect Contact Danny Cwiak, Construction Project Manager (951) 377-5514 Steve Howard Price of Contract Type of Work Dates $407,628 Curb+Gutter, Ramps 11/2014 to 2/2015 2. Proiect Sewer Replacement Project Proiect Address Owner Various Locations City of Fullerton Contact Phone Eric Villagracia, Public Works Dept. (714)738-6853 Price of Contract Type of Work Dates $998,151.00 Sewer, Curb +Gutter 1/2012 to 2/2013 3. Project Sewer Manhole Surface Repair PH II Project Address Owner Fairview and Newport, City of Costa Mesa Costa Mesa Sanitary District Contact Phone Robin Hamers, District Engineer (949) 548-1192 Price of Contract Type of Work Dates $47,420.00 Manhole Repairs 1/2016 4. Proiect Annual Concrete Repair FY 2014-15 Project Address Owner Various Locations City of Rancho Santa Margarita Contact Phone E. Maximous, Public Works Director (949) 635-1805 Price of Contract Type of Work Dates $53,550.00 Sidewalk 4/2015 to 5/2015 3 YEAR REFERENCES — PUBLIC WORKS 5. Project Grand Avenue Widening Project Address Owner Grand Ave.from First St.to Fourth St. City of Santa Ana Contact Phone Tyrone Chesanek, Principal Civil Engineer (714)647-5074 Price of Contract Type of Work Dates $172,000.00 Curb+ Gutter, Bus Pad 11/2014 to 9/2015 6. Project Concrete Street Rehabilitation, FY 2015-16 Project Address Owner Various Locations City of Orange Contact Phone Matthew Lorenzen, Project Manager (714) 744-5566 Price of Contract Type of Work Dates $574,850 Minor Concrete,Street Improvements 7/16 to 10/16 7. Project Name Improvements of Livingston Drive Project Address Owner Livingston Dr. between Termino Ave. &2"d St. City of Long Beach Contact Phone: Danny Besabella (562) 577-6192 Price of Contract Type of Work Dates $1,254,000.00 Street Improvement 8/2012 to 2/2013 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. Willie Ellis Name of proposed Project Manager Telephone No. of proposed Project Manager: 951-279-6869 ext 120 All projects listed on attached reference sheet 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. Dave Sulik Name of proposed Superintendent Telephone No. of proposed Superintendent: 951-279-6869 ext 128 All projects listed on attached reference sheet 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 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:Hefiling.dir.ca.gov/PWCR/ActionServ]et?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. EBS General Engineering, Inc. Contractor By President Title Date: 1/6/17 DIR#: 1000005295 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: EBS General Engineering,Inc. Contact Person: Joseph A.Nanci Contact Phone: 951-279- 869 Signed: Date: 1/6/17 *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 EXHIBIT A DISADVANTAGED BUSINESS ENTERPRISE (DBE) This Project is subject to Part 200.321, Title 2, Code of Federal Regulations entitled "Contracting with Small and Minority Businesses, Women's Business Enterprises, and Labor Surplus Area Firms." The Regulations in their entirety are incorporated herein by this reference. It is the policy of the City that disadvantaged business enterprises (DBEs), as defined in Part 200.321, Title 2 CFR, shall be encouraged to participate in the performance of Contracts financed in whole or in part with federal funds. The Contractor should ensure that DBEs, as defined in Part 200.321, Title 2 CFR, have the opportunity to participate in the performance of this Contract and shall take all necessary and reasonable steps, as set forth in Part 200.321, Title 2 CFR, for this assurance. The Contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of subcontracts. Failure to carry out the requirements of this paragraph shall constitute a breach of Contract and may result in termination of this Contract or other remedy the City may deem appropriate. Bidders shall be fully informed respecting the requirements of the Regulations and are urged to obtain DBE participation in this project, although there is no specific goal for DBE participation. C-14 EXHIBIT B DBE INFORMATION—GOOD FAITH EFFORTS Federal-aid Project No. CC1541 Bid Opening Date 1/10/17 The City of Huntington Beach_established a Disadvantaged Business Enterprise (DBE) goal of 0% 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 Solicitation and Dates Ray's Trucking ' Call 1/6/17 C-15 C. The items of work which the bidder made available to DBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items M of (Y/N) Contract D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each DBE if the selected firm is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: Names, addresses and phone numbers of firms selected for the work above: 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-16 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-17 NIA IF A SOLE OWNER OR SOLE CONTRACTOR SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname) of proprietor (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail IF A PARTNERSHIP, SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname and character of partner) (Note: Signature must be made by a general partner) (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail C-1 8 IF A CORPORATION, SIGN HERE: (1) Name under which business is conducted EBS General Engineering, Inc. (2) L J . . (Signature) President (Title) Impress Corporate Seal here (3) Incorporated under the laws of the State of CA (4) Place of Business 1320 E. Sixth St., Ste 100 (Street and Number) City and State Corona CA (5) Zip Code 92879 Telephone No. 951-279-6869 (6) E-Mail bids@ebsgeneral.com NOTARIAL ACKNOWLEDGMENT OF EXECUTION BY ALL SIGNATORIES MUST BE ATTACHED C-19 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 Riverside } On January 09, 2017 before me, K. Fairweather Notary Date Insert Name and Title of the officer Public, personally appeared Joseph Nanci 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..oflalif=ia_that the foregoing paragraph is true and correct. �K.FOIUpWEA HER Notary Public•California WITNESS my hand and official seal. i Riverside County = Commission 4t 2149313 My Comm.Expires Apr 21,2020 Signa e: ------------------------------------------------------------OPTIONAL------------------------------------------------------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent attachment 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) Signers Name: Signers Name: ❑ Corporate Officer—Title(s) ❑ Corporate Officer—Title(s) ❑ Partner- ❑ Limited ❑ General ❑ Partner- ❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑ Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑ Other: ❑ Other: Signer is Representing: Signer is Representing: List below names of president, vice president, secretary and assistant secretary, if a corporation; if a partnership, list names of all general partners and managing partners: SC:� Za-t-�a i�r �Ct��-y' r�Sd l�.t�'p�✓1 C-20 ACTION AND RESOLUTION BY THE.BOARD OF DIRECTOR OF EBS GENERAL ENGINEERING, INC A CALIFORNIA CORPORATION M of the Board of Directors of EBS General Engineering,Inc.,desiring to insure that all the proper and authorTzed individuals,who have corporate authority to bind the said corporation to any and contracts executed by such authorized individuals, have been approved by the board of directors of EBS General Engineering, held a meeting on January 3,2010. The Board, following a review of the foregoing matter,and upon motion made and seconded.,the Board-of Directors hereby determines and votes unanimously as follows: BE IT THEREFORE RESOLVED that Joseph Nanci is hereby.designated,,authorized and empowered,to be duly authorized with all the attendant powers and authorizations related thereto,to bind,obligate and commit EBS General Engineering, Inc. to any and all contracts executed by and between EBS General Engineering,Inc. and any other contracting party. I There being no further or pending business before the Board,the meeting was adjourned. BOARD OF DIRECTORS Date:January 3,2010 Josep anci,,Sole Director ATTESTATION 1,being the Secretary of the above referenced corporati on,:do hereby certify that the above resolution is the resolution of the,corporation. 10 Dated: Jose anci.,. secretary ........... EXHIBIT C LOCAL AGENCY BIDDER DBE COMMITMENT(CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCAL AGENCY: City of Huntington Beach LOCATION: Huntington Beach PROJECT DESCRIPTION: FY16/17 Curb Access Ramp Installation TOTAL CONTRACT AMOUNT:$ BID DATE: 1/10/17 BIDDER'S NAME: EBS General Engineering, Inc. CONTRACT DBE GOAL: 0 CONTRACT ITEM OF WORK AND DESCRIPTION BE CERT NO. NAME OF EACH DBEDOLLARAMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened- include DBE address O BE PROVIDED(or contracted if the and phone number) bidder is a DBE) Trucking 2037 Res Trucking 1-2. , For Local Agency to Complete: Total Claimed DBE $ CCC, Local Agency Contract Number: Participation Federal-aid Project Number: Federal Share: Contract Award Date: Local Agency certifies that all DBE certifications have been verified and information is complete and accurate. Signature of Bidder 1/6/16 951-279-6869 Date (Area Code)Tel.No. Print Name Signature Date Joseph A.Nanci, President Local Agency Representative Person to Contact (Please Type or Print) (Area Code)Telephone Number: - Local Agency Bidder DBE Commitment(Construction Contracts) (Rev 6/26/09) C-21 PLEASE NOTE: This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must be submitted and received as specified in the Special Provisions. Failure to submit the required DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project regardless of tier. Names of the First-Tier DBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of DBE firms. Exhibit 15,G must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local 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. C-22 EXHIBIT D EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder EBS General Engineering, Inc. , [proposed subcontractor J hereby certifies that he/she/it has4 , 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/she/it 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. (eeoc.gov/employers/eeolsurvey/index.cfm) 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. J Z Signature: Date: 1/6/17 Print Name: Joseph A. Nanci Title: President C-23 EXHIBIT E NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) [NAME OF CONTRACT] FY 2016/17 Curb Access Ramp Installation Project To the City of Huntington Beach In conformance with Title 23 United States Code Section 112 and California 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 Bidder's Proposal. By signing the Proposal, the Bidder has also signed this Noncollusion Affidavit. Bidders are cautioned that making a false Certification may subject the Bidder to criminal prosecution. Signature: Date: i/6/i 7 Print Name: Joseph A.Nanci Title: President C-24 EXHIBIT F 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 with Bidder 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 him/her 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. Note: 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. Signature: Date: 1/6/17 Print Name: Joseph A.Nanci Title: President C-25 EXHIBIT G 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. Signature: /-, /�,I- Date: 1/6/17 Print Name: Joseph A.Nanci Title: President C-26 EXHIBIT H N/A 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 ❑a.bid/offer/application Ela.initial b.grant b.initial award b.material change C.cooperative agreement c.post-award d.loan For Material Change Only: e.loan guarantee year quarter f.loan insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: ❑Prime ❑ Subawardee Tier if known Congressional District,if known Congressional District,if known 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number,ifapplicable 8. Federal Action Number,if known: 9. Award Amount,if known: 10. a.Name and Address of Lobby Entity b. Individuals Performing Services (including (If individual,last name,first name,MI) address if different from No. I Oa) (last name,first name,MI) (attach Continuation Sheet(s)if necessary) 11. Amount of Payment(check all that apply) 13. Type of Payment(check all that apply) $ ❑ Actual planned a.retainer b.one-time fee 12. Form of Payment(check all that apply): c.commission ea.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 ❑ 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above when his transaction was made or entered into.This disclosure is required pursuant to 31 U.S.C. Print Name: Joseph A. NanCi 1352. This information will be reported to Congress president semiannually and will be available for public inspection.Any Title: person who fails to file the required disclosure shall be subject to a civil penalty of not less than$10,000 and not more than Telephone No.: 951-279-6869 Date: 1/6/17 $100,000 for each such failure. Authorized for Local Reproduction Federal Use Only: Standard Form-LLL Standard Form LLL Rev.09-12-97 C-27 INSTRUCTIONS FOR COMPLETION OF EXHIBIT H, 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 C-28 (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12)Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13)Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 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. By my signature on this proposal I certify, under penalty of perjury under the laws of the State of California, that the foregoing questionnaire and statements of Public Contract Code Sections 10162, 10232 and 10285.1 are true and correct and that the bidder has complied with the requirements of Section 8103 of the Fair Employment and Housing Commission Regulations (Chapter 5, Title 2 of the California Administrative Code). C-29 EXHIBIT I FEDERAL LOBBYING RESTRICTIONS Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower tier subrecipient 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 Proposal. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Proposal. Signing the Proposal 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: 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 person(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. C-30 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE for FY 2016/17 CURB ACCESS RAMP INSTALLATION PROJECT C.C. No. 1541 January 3, 2017 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Special Provisions: 1) Replace Section D "Sample Contract" in it's entirety in the Specifications with updated Section D in this Addendum. The "Sample Contract" was updated in December 2016. 2) Replace Appendix K, the "Prevailing Wage Schedule" in it's entirety in the Specifications with updated Appendix K in this Addendum. "General Decision Number: CA60035 11/11/2016" will be replaced with "General Decision Number: CA60035 12/23/2016." 3) Replace Appendix L, the "Federal Documents for CDBG Projects" in it's entirity in the Specifications with updated Appendix L in this Addendum. The documents were updated in December 2016. This is to acknowledge receipt and review of Addendum Number One, dated January 3, 2017. EBS General Engineering, Inc. Joseph A.Nanci Company Name By 1/6/16 Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Joseph Fuentes at (714) 536- 5431. 1 e Bond #3B i Premium Nil SureTec BID BOND KNOW ALL MEN BY THESE PRESENTS,that we EBS General Engineering Inc . as principal, hereinafter called the "Principal," and SURETEC INSURANCE COMPANY, 9737 Great Hills Trail, Suite 320,Austin,Tx 78759, as surety, hereinafter called the"Surety," are held and firmly bound unto City of Huntington Beach as obligee, hereinafter called the Obligee, in the sum of ten percent of amount bid 10% ) of the Amount Bid by Principal 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 FY 16/17 Curb Access Ramp Installation Project Project No. : CC No. 15TI NOW, THEREFORE, if the contract be timely awarded to the Principal and the Principal shall within such time as specified in the bid, enter into a contract in writing or, in the event of the failure of the Principal to enter into 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. PROVIDED, HOWEVER, neither Principal nor Surety shall be bound hereunder unless Obligee prior to execution of the final contract shall furnish evidence of financing in a,manner and form acceptable to Principal and Surety that financing has been firmly committed to cover the entire cost of the project; and PROVIDED, FURTHER, unless the bid documents require that bid security remain in effect for a longer period of time, Surety shall have no liability hereon if a contract for the bid amount is not awarded to Principal within 60 days of the date hereof. SIGNED, sealed and dated this 3 rd day of January 12017 EBS General Engineering, Inc . (Principal) BY: TITLE: J 17sf-V�, SureTec Insurance Company i BY: Spencer Flake Attorney-in-Fact suretec bid bond file.doc Rev 1.1.06 CALIFORNIA ALL-PU RPOSE 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 9 of Orange On 1-03-17 before me, Lexie Sherwood Notary Public, Date Insert Name of Notary exactly as it appears on the official seal personally appeared Spencer Flake 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 LEXIE SHERWOOD person(s), or the entity upon behalf of which the person(s) COMM.#2031782 3 acted, executed the instrument. NOTARY PUBLIC•CALIFORNIA n " ORANGE COUNTY I certify under PENALTY OF PERJURY under the laws of Comm.Exp.JULY 27,2017 the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal. Signature ut"'w Place Notary Seal Above Signature of of Public exle Sherwood 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: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑ Corporate Officer —Title(s): ❑ Partner ❑Limited ❑General ❑ Partner ❑Limited❑ General ❑ Attorney in Fact ❑ Attorney in Fact ❑ Trustee 'PF SIGNER ❑ TrusteeOF SIGNER' ❑ Guardian or Conservator Top of thumb here ❑ Guardian or Conservator Top of thumb here ❑ Other: ❑ Other: Signer is Representing: Signer is Representing: POA#: 510123 SureTec Insurance Company LIMITED POWER OF ATTORNEY Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents make, constitute and appoint Charles L. Flake, David L. Culbertson, Spencer Flake its true and lawful Attorney-in-fact,with full power and authority hereby conferred in its name, place and stead,to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for: Five Million and 00/100 Dollars($5,000,000.00) and to bind the Company thereby as fully and to the same extent as if such bond were signed by the President, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney-in-Fact may do in the premises. Said appointment shall continue in force until 5/18/2017 and is made under and by authority of the following resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and of behalf of the Company, to execute, acknowledge and deliver,any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attomey-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held on 20`� of April, 1999) In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its President, and its corporate seal to be hereto affixed this 18th day of May A.D. 2015 J�uy,)\\\I\IIIIIIli4l,lry�4j y/ SURETEC INSURANCE COMPANY �SV�AN.rF4 B John ox Jr: resident 5 State of Texas ss: �•. County of Harris On this 18th day of May A.D. 2015 before me personally came John Knox Jr.,to me known,who,being by me duly swam,did depose and say,that he resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed the above instrument;that he knows the seal of said Company;that the seal affixed to said instrument is such corporate seal;that it was so affixed by order of the B card of Directors of said Company; and that he signed his name thereto by like order. ?Ol\yB PUBS, JACOUELYN MALDONADO Notary Public State of Texas / My Comm.Exp.5/18/2017 Jacq elyn Maldonado,Notary Public My commission expires May 18, 2017 I,M.Brent Beaty,Assistant Secretary of SURETEC INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Company, which is still in full force and effect; and furthermore,the resolutions of the Board of Directors, set out in the Power of Attorney are in full force and effect. Given under my hand and the seal of said Company at Houston, Texas this 3RD day of JANUARY 2017 A.D. n Z": .Bre t Beaty,Assistant ecretary Any instrument issued in excess of the penalty stated above is totally void and without any validity. For verification of the authority of this power you may call(713)812-0800 any business day between 8:00 am and 5:00 pm CST. 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 Riverside } On January 09, 2017 before me, K. Fairweather Notary Date Insert Name and Title of the officer Public, personally appeared Joseph Nanci 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—U fornia that the foregoing paragraph is true and correct. K. FAIRWEATHER Notary Public -California WITNESS my hand and official seal. z .-e Riverside County D Z Commission #21419313 kMy Comm.Expires A r 21,2020 gnatur -------------------------------------------------------------OPTIONAL------------------------------------------------------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent attachment 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) Signers Name: Signers Name: ❑ Corporate Officer—Title(s) ❑ Corporate Officer—Title(s) ❑ Partner-❑ Limited ❑ General ❑ Partner-❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑ Trustee ❑Guardian or Conservator ❑ Trustee ❑Guardian or Conservator ❑ Other: ❑ Other: Signer is Representing: Signer is Representing: 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 April 27, 2017 Gentry General Engineering, Inc. 9277 Archibald Ave. Rancho Cucamonga, CA 91730 RE: FY 2016/17 Curb Access Ramp Installation Project— CC-1541 Enclosed please find your original bid bond for CC-1541. Sincerely, 4q4ftL, lib? 4vat4j Robin Estanislau, CIVIC City Clerk RE:pe Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand iL CD Us U-) CV OM w � s SECTION C PROPOSAL for the construction of FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT from VARIOUS LOCATIONS CC No. 1541 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 70 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 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 BID ITEMS a V,. W r6 . Desctl Lion uantl Unit Unit Cost �, Total Cost Item �' ;. �Q tY k �� r.,NO 1 Mobilization 1 LS T Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 1 in 2 Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed curb, sidewalk, $L� domes, retaining curb, sawcut, slot pave, etc.) 68 EA Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR using horizontal curb cutting machine as 3 shown on Curb Ramp Detail 2 in Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed _ �J , curb, sawcut, sidewalk,domes, retaining curb, etc.) 63 EA $� > $ J L,vl� Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 3 in 4 Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed curb, sawcut, sidewalk, domes, retaining curb, slot pave, etc.) 5 EA T T Construct Case C Midblock or Case F/Case G/Case CM or Type C Directional Curb Access Ramp per Caltrans Std. Plan 5 A88A/A88B(Item includes all appurtenances, curb&gutter, depressed curb, sidewalk, domes, retaining curb, slot pave, a _ $ y etc.) 20 EA $ '�\ ` 6 Install truncated domes to existing Curb Ramp 123 EA 7 Remove existing improvements and construct concrete qq� - meandering sidewalk per HB Standard Plan 207 500 SF $ Remove and reconstruct Cross Gutters per HB Standard Plan 8 205(Item includes all appurtenances, curb&gutter, slot pave, 00 etc.) 3,800 SF Remove and replace existing 6"or 8"Curb and Gutter per HB 9 Standard Plan 202(Item includes all appurtenances and slot pave,etc.) 100 LF $ $ 2 J — 10 Install 4"PVC Sleeve for Street Assembly Sign per City of HB _ Std. Plan 401 10 EA 11 Prepare Storm Water Pollution Prevention Plan(SWPPP) 1 LS $ ji v ) — $ 3! 000 12 Install&Maintain Construction BMPs 1 LS TOTAL BID AMOUNT (BASIS OF AWARD)-SCHEDULE A $ O,o C-2.1 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 TOTAL BID AMOUNT IN WORDS: h AnA,(e 6- u rd Ki) &A-�' Note: 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. C-2.2 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. yN� Accompan1 ng this proposal of bid, find o i,de a 1)LM in the amount of �1. N E' " 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 IReceived Bidder's Si nature 3 / z 6 /�- C-2 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE for FY 2016/17 CURB ACCESS RAMP INSTALLATION PROJECT C.C. No. 1541 January 3, 2017 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Special Provisions: 1) Replace Section D "Sample Contract" in it's entirety in the Specifications with updated Section D in this Addendum. The "Sample Contract" was updated in December 2016. 2) Replace Appendix K, the "Prevailing Wage Schedule" in it's entirety in the Specifications with updated Appendix K in this Addendum. "General Decision Number: CA60035 11/11/2016" will be replaced with "General Decision Number: CA60035 12/23/2016." 3) Replace Appendix L, the "Federal Documents for CDBG Projects" in it's entirity in the Specifications with updated Appendix L in this Addendum. The documents were updated in December 2016. This is to acknowledge receipt and review of Addendum Number One, dated January 3, 2017. Compa y Name By Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Joseph Fuentes at (714) 536- 5431. 1 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid 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' DIP Dollar % of Items) Subcontractor License Number Amount Contract Number By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT 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 �`1�� 1 , at w ht U.6 ot '�--d� Date City State e• n ,, being first duly sworn, deposes and s ys that he or she is - of , ��.� � ie Val4 making the fo regoing bid that the�id is n made in the of, or on t eheh—�f of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price, or that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay fee to any corporation,partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Name` f Bidder --q:;- -��. � l-� Signature of Bidder Address of Bidder C-4 UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT, (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. Contractb UreA,�h � y By ` Title Date: 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. Contra or 1�l`eih it.L, lx " By Title Date: C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: `3 r e-,A,+>^ 6�t� Bidder Name Business Address '4wL,O City, State Zip Telephone Number Email Address State Contractor's License No. and Class Original Date Issued &1,56)Z � Expiration Date The work site was inspected by h- %� r X�-�� of our office on H S G�, 201:Z-. The following are persons, firms, and corporations having a principal interest in this proposal: C-8 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Company Name " Signature of Bidder Printed or Typed Signature Subscribed and sworn to before me this�_day of § , 201D. 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 N*H" Iffi l(A ) County of ,�%o ��(�(�.��1��i! ) On j(_I EIU( N q E '10 C l before me, 1 �1����P C� V'�a��)YUm�l Month, Day, and Year Insert Naine and Titlel3f Notary personally appeared &P;A,(,� n ^ im; 1 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 g Signature ofof Notary Public (PLACE NOTARYSEAL 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, protect 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: 1. 6-1 6, U U— 1,320 qc,q 9 (-A 6I Name ands ddress of Pu lic Agency Name and Telephone No. of Project Manager: 7T=ttI24,4 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Name nd 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 nd Address of Public Agency Name and Telephone No. of Project Manager: .5k.,U& Contract Amount Type of Work Date Completed Provide addition 1 project description to show similar work: - C-10 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 ) On January 9, 2017 before me, Andrea Scarbrough (insert name and title of the officer) personally appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the person(;)whose name(t) is/qre� subscribed to the within instrument and acknowledged to me that he/sW" executed the same in his/hsrA4&authorized capacity(, and that by his/i eir signature* on the instrument the person(i or the entity upon behalf of which the person W 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. Mam ANOREA SCARBROUGH Notary Public•California WITNESS my hand and official seal. San Bernardino County D COfpRNssion#t 2144293 j MY Comm.Expire s Feb 27,2020 4 f. Signature ad,(LYk rLG (Seal) ff � 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. zfevd.-k, Orlst +" Name of proposed Project Manager Telephone No. of proposed Project Manager: Project Name&Contract Amount Type of Work Date Completed cis = ISO - Soles- Project Name&Contract A ount Type of Work Date Completed e G-�-t-r 651 e-),Ot Prof ct Name& Contract Amount Type of Work Date Completed 2. CNP—� Name of proposed Superi tendent ll Telephone No. of proposed Superintendent: � l Lf Project Name& Contract Amount Type of Work ate Completed Proj ct Name& Contract Amount Type of Work Date Completed Proj- t 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/PWCR/ActionServlet?action=displayPWCRegistrationForm DIR's Contractor Registration searchable database: https:Hefiling.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 perfonn 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. pp Contract r By Ve�O-tw+ Title Date: DIR 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: . Cre� 94� - , ,1- J Contact Person: G-e�iY\, Contact Phone: s3 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 EXHIBIT A DISADVANTAGED BUSINESS ENTERPRISE (DBE) This Project is subject to Part 200.321, Title 2, Code of Federal Regulations entitled "Contracting with Small and Minority Businesses, Women's Business Enterprises, and Labor Surplus Area Firms." The Regulations in their entirety are incorporated herein by this reference. It is the policy of the City that disadvantaged business enterprises (DBEs), as defined in Part 200.321, Title 2 CFR, shall be encouraged to participate in the performance of Contracts financed in whole or in part with federal funds. The Contractor should ensure that DBEs, as defined in Part 200.321, Title 2 CFR, have the opportunity to participate in the performance of this Contract and shall take all necessary and reasonable steps, as set forth in Part 200.321, Title 2 CFR, for this assurance. The Contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of subcontracts. Failure to carry out the requirements of this paragraph shall constitute a breach of Contract and may result in termination of this Contract or other remedy the City may deem appropriate. Bidders shall be fully informed respecting the requirements of the Regulations and are urged to obtain DBE participation in this project, although there is no specific goal for DBE participation. C-14 EXHIBIT B DBE INFORMATION—GOOD FAITH EFFORTS Federal-aid Project No. �l 1-i I Bid Opening Date 1 / 1 2— cJ The City of Huntington Beach_established a Disadvantaged Business Enterprise (DBE) goal of 0% 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 CiIA. 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 Solicitation and Dates C-15 C. The items of work which the bidder made available to DBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items M of (Y/N) Contract t is 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: tit�V,�C 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: 1)e- C-16 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: md� Ei'@�I�1�on -e 1 VJ'V P c� lit 1J t 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 Um-t H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): CAI 63 MA aw w( ' n- i1 v S Toe,c i k Z , - ITCA 1 NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. C-17 IF A SOLE OWNER OR SOLE CONTRACTOR SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname) of proprietor (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail IF A PARTNERSHIP, SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname and character of partner) (Note: Signature must be made by a general partner) (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail C-18 IF A CORPORATION, SIGN HERE: (1) Name under which business is conducted (2)"� �Lr�� (Signature) - (Title) u Impress Corporate Seal here _ (3) Incorporated under the laws of the State of (4) Place of Business (Street and Number) City and State (5) Zip Code Telephone No. (6) E-Mail C V� v NOTARIAL ACKNOWLEDGMENT OF EXECUTION BY ALL SIGNATORIES MUST BE ATTACHED C-19 List below names of president, vice president, secretary and assistant secretary, if a corporation; if a partnership, list names of all general partners and managing partners: C-20 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 ) On January 9, 2017 before me, Andrea Scarbrough (insert name and title of the officer) personally appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the personw whose name) is/ subscribed to the within instrument and acknowledged to me that he/sly/Dgr executed the same in his/he toer authorized capacity*s), and that by his/her/their signature(*) on the instrument the person($), or the entity upon behalf of which the person(e) 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. ANOREA SCARBROUGH Notary Public•California Ir WITNESS my hand and official seal. Z San Bernardino County Commission#►2144293 MY Comm.Eggires Feb 27,2020 ,ram Signatu4--^ %1 Z (Seal) EXHIBIT C LOCAL AGENCY BIDDER DBE COMMITMENT(CONSTRUCTION CONTRACTS) NOTE: PLEASE RED\FER TOE( yINSTRUCTIONS ON THE REVERSE SIDE {OF THIS },FORM LOCAL AGENCY: \ �� Vl.�O\ LOCATION: At(AiNOW IU h�}IVt JJ i ��V n 1kw PROJECT DESCRIPTION:C`)� yy TOTAL CONTRACT AMOUNT:$ BID DATE: BIDDER'S NAME: �1 CONTRACT DBE GOAL: CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE DOLLAR AMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened-include DBE address O BE PROVIDED(or contracted if the and phone number) bidder is a DBE) W6 606 #rl For Local Agency to Complete: Total Claimed DBE Local Agency Contract Number: Participation Federal-aid Project Number: I % Federal Share: Contract Award Date: Local Agency certifies that all DBE certifications have been verified and information is complete and accurate, �(Ji S nature of Bidder i All qW ►2-� �, Dayt�e, ) �1 ' (Area Code)Tel.No. Print Name Signature Date ,)a �/ Local Agency Representative Person to Contact (Please Type or Print) (Area Code)Telephone Number: Local Agency Bidder DBE Commitment(Construction Contracts) (Rev 6/26/09) C-21 PLEASE NOTE: This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must be submitted and received as specified in the Special Provisions. Failure to submit the required DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project regardless of tier. Names of the First-Tier DBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of DBE firms. Exhibit 15-G must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local 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. C-22 EXHIBIT D EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder 6reAAJ�� [proposed subcontractor (d,A Z J hereby certifies that he/she/it has k , 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/she/it 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. (eeoc.gov/employers/eeolsurvey/index.cfm) 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. Signature: -j" Date: Z 6 7 Print Name: ,V / Title: -y ? t 4— C-23 EXHIBIT E NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) [NAME OF CONTRACT] To the City of Huntington Beach In conformance with Title 23 United States Code Section 112 and California 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 Bidder's Proposal. By signing the Proposal, the Bidder has also signed this Noncollusion Affidavit. Bidders are cautioned that making a false Certification may subject the Bidder to criminal prosecution. Signature: (�� J - Date: I Print Name: ►-t ti o Title: C-24 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 ) On .January 9, 2017 before me, Andrea Scarbrough (insert name and title of the officer) personally-appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the person* whose name(.) is/am subscribed to the within instrument and acknowledged to me that he/may executed the same in his/W/ttW authorized capacityW), and that by his/PEWtb4R signature( on the instrument the person(,#), or the entity upon behalf of which the person($) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ANOREA 8CARBR000H NOWy Ptak•CdQorMa WITNESS my hand and official seal. '� Coo nnBBanadn 2/0 „ 44293 Mv Comm.Ej ino h0 27 2020 ! q Signatur �� (Seal) EXHIBIT F 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 with Bidder 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 him/her 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. Note: 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. Signature: �--7Z.y;.�j�-t,—� �`— Date: G( '7 Print Name: Title: -'•' > 51 A ell C-25 EXHIBIT G 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 confonnance 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. Signature: A�l P.r �� Date: , .1 1 2c, 7 Print Name: i`10-A V-(J^ �L.VA,k V Title: �- C-26 EXHIBIT H 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: ..contract ❑a.bid/offer/application ❑ a.initial b.grant b.initial award b.material change c.cooperative agreement c.post-award d.loan For Material Change Only: e.loan guaranteeLReporting year quarter f.loan insurance' date of last report 4. Name and Add ntity 5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: 13 Primebawardee r if kno Congressional Congressional District,if known 6. Federal Department/Agency: 07, eral Program Name/Description: DA Number,ifapplicable 8. Federal Action Number,if known: Amount,ifknown: 10. a.Name and Address of Lobby Entity ividuals Performing Services (including (If individual,last name,first name,MI) address if different from No.10a) (last name,first name,MI) (attach Continuation Sheet(s)if necessary) 11. Amount of Payment(check all that apply) 13. Type of Payment(check all that apply) S Actual planned a.retainer b.one-time fee 12. Form of Payment(check all that apply): c.commission Ba.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: Yes ❑ No ❑ I& Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above when his transaction was made or entered into.This disclosure is required pursuant to 31 U.S.C. Print Name: 1352. This information will be reported to Congress semiannually and will be available for public inspection.Any Title: person who fails to file the required disclosure shall be subject to a civil penalty of not less than$10,000 and not more than Telephone No.: Date: $100,000 for each such failure. Authorized for Local Reproduction Federal Use Only: Standard Form-LLL Standard Form LLL Rev.09-12-97 C-27 INSTRUCTIONS FOR COMPLETION OF EXHIBIT H, 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 (M1). 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 C-28 (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12)Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13)Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 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. By my signature on this proposal I certify, under penalty of perjury under the laws of the State of California, that the foregoing questionnaire and statements of Public Contract Code Sections 10162, 10232 and 10285.1 are true and correct and that the bidder has complied with the requirements of Section 8103 of the Fair Employment and Housing Commission Regulations (Chapter 5, Title 2 of the California Administrative Code). C-29 EXHIBIT I FEDERAL LOBBYING RESTRICTIONS Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower tier subrecipient 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 Proposal. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Proposal. Signing the Proposal 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: 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 person(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. C-30 Bid Bond Bid Bond Number: CSBA-3859 CONTRACTOR: SURETY: (Name,legal status and address) (Name,legal status and principal place of business) Gentry General Engineering,Inc. Indemnity Company of California 9277 Archibald Avenue 500 S.Kraemer Blvd.,Suite 300 Rancho Cucamonga,CA 91730 Brea,CA 92821 OWNER This document has important legal (Name, legal status and address) consequences. Consultation with City of Huntington Beach An attorney is encouraged with respect 2000 Main Street its completion or modification. Huntington Beach, CA 92648 Any singular reference to Contractor,Surety,Owner or other party shall be considered Plural where applicable. BOND AMOUNT: Ten Percent(10%) of Amount Bid PROJECT:FY 16/17 Curb Access Ramp Installation Project from Various Locations,CC No. 1541 Project Number,if any: The Contractor and Surety are bound to the Owner in the amount set forth above,for the payment of which the Contractor and Surety bind themselves,their heirs,executors,administrators,successors and assigns,jointly and severally,as provided herein.The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents,or within such time period as may be agreed to by the Owner and Contractor,and the Contractor either(1) enters into a contract with the Owner in accordance with the terms of such bid,and gives such bond or bonds as may be specified in the bidding or Contract Documents,with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner,for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof,or(2)pays to the Owner the difference,not to exceed the amount of this Bond,between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid,then this obligation shall be null and void,otherwise to remain in full force and effect.The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid.Waiver of notice by the Surety shall not apply to any extension exceeding sixty(60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents,and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty(60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor,the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to 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 here from 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 4th day of Ianuary,2017 Gentry General Engineering,Inc. (Principal) (Seal) � (Title) Indemnity Company of California (Surety) (Seal) (WY tness) Karen Rato (Title Dwight Reilly,Attorney-in-Fact By arrangement with the American Institute of Architects, the National Association of Surety Bond Producers(NASBP) (www.nasbp.or ) makes this form document available to its members, affiliates, and associates in Microsoft Word format for use in the regular course of surety business. NASBP vouches that t the original text of this document conforms exactly to the text in AIA Document A310-2010, Bid Bond. Subsequent modifications may be made to the original text of this document by users,so careful review of its wording and consultation with an attorney are encouraged before its completion, execution or acceptance. 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 01/04/2017 before me, Karen L. Ritto Notary Public personally appeared Dwight Reilly 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. KAREN L.RITTO @my COy P #2138527WI SS m hand and official seal. Notary Public-CaliforniaORANGE COUNTY a Comm.Expires Dec 30,2019 Signature of tary OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL Bid Bond ❑ CORPORATE OFFICER Title or Type of Document One ❑ PARTNER(S) Number of Pages ❑ MEMBER of LLC ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) 01/04/2017 ❑ GUARDIAN/CONSERVATOR Date of Document OTHER: SIGNER IS REPRESENTING: Signer(s) other than named above NAME OF PERSON(S) OR ENTITY(IES) Bond No. CSBA-3859 POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box 19725,IRVINE,CA92623 (949)263-3300 KNOWALL BYTHESE PRESENTS that except as expressly limited,DEVELOPERS SURETYAND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA,do each hereby make,constitute and appoint: ""`Andrew Waterbury, Shaunna Rozelle Ostrom, Michael Castaneda, Dwight Reilly, Daniel Huckabay,Arturo Ayala,jointly or severally— as their true and lawful Attorney(s)-in-Fact,to make,execute,deliver and acknowledge,for and on behalf of said corporations,as sureties,bonds,undertakings and contracts of suretyship giving and granting unto said Attomey(s)-in-Fact full power and authority to do and to perform every act necessary,requisite or proper to be done in connection therewith as each of said corporations could do,but reserving to each of said corporations full power of substitution and revocation,and all of the acts of said Attorney(s)-in-Fact,pursuant to these presents,are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA,effective as of January 1st,2008. RESOLVED,that a combination of any two of the Chairman of the Board,the President,Executive Vice-President,Senior Vice-President or any Vice President of the corporations be,and that each of them hereby is,authorized to execute this Power of Attorney,qualifying the attorney(s)named in the Power of Attorney to execute,on behalf of the corporations,bonds,undertakings and contracts of suretyship;and that the Secretary or any Assistant Secretary of either of the corporations be,and each cf them hereby is,authorized to attest the execution of any such Power of Attorney; RESOLVED,FURTHER,that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond,undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF,DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective officers and attested by their respective Secretary or Assistant Secretary this 18th day of April,2016. By: flLL ND�40'.. 4FAt1YO� Daniel Young,Senior Vice-PresidentogFaga OCT.5 � 1967 Mark Lansdon,Vice-President 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 April 18,2016 before me, Lucille Raymond,Notary Public Date Here Insert Name and Title of the Officer personally appeared Daniel Young and Mark Lansdon Name(s)of Signer(s) 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 LUCILLE RAYMOND which the person(s)acted,executed the instrument. Commission#2081945 z :'® Notary Public-California z I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is z Orange County D true and correct. My Comm.E ires Oct 13,2018 WITNESS my hand and official seal. Place Notary Seal Above Signature J Lucill ty-yiiirond,Notary Public CERTIFICATE The undersigned,as Secretary or Assistant Secretary of DEVELOPERS SURETYAND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA,does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and,furthermore,that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth in the Power of Attorney are in force as of the date of this Certificate. This Certificate is executed in the City of Irvine,California,this 4th day of January 2017 AND/Hp„ O ?AN Y oi. J aPo F gPoq • 0:GO R9T�?'Z• OCT CT. w 10 .n z. O 6y. Cassie J: rrisford,Assistant Se tary o� 1 9 3 s .' 1967 ¢ ID-1380(Rev.04/16) ''� 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 ) On January 9, 2017 before me, Andrea Scarbrough (insert name and title of the officer) personally appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the person($) whose name( is*..e subscribed to the within instrument and acknowledged to me that he/ftffty executed the same in his/Wt r authorized capacity(4es), and that by his/h.4�r/tkreir signature*) on the instrument the person*), or the entity upon behalf of which the person(p) 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. All WITNESS my hand and official seal. a No,�R�A SCARBROUGH z -v Y ubilc-California z San Bernardino Countyz Commlaelort 214429 / M Comm.Ex ires Feb 27, 3 Signature (Seal) City of Huntington Beach 2000 Main Street ® Huntington Beach, CA 92648 (714) 536-5227 ® www.huntingtonbeachea.gov 19 Office of the City Clerk Robin Estanislau, City Clerk April 27, 2017 Golden State Constructors, Inc. 208 E. Orangethorpe Ave. Placentia, CA 92870 RE: FY 2016/17 Curb Access Ramp Installation Project—CC-1541 Enclosed please find your original bid bond for CC-1541. Sincerely, & Robin Estanislau, CIVIC City Clerk RE:pe Enclosure Sister Cities: Anjo, Japan s Waitakere, New Zealand _ __ . ._ Aw' } V # i .. .. _ r.�:: \\ i t t l t ? - Y I 4� �¢ : t �a r_t lv � . s11", # a Pi. �, 'ta kx .r r4 'x J .. £ .W, r x 1 x,; 7 a z a ..4,_'�q3 n.s t. �'3 , t .s r +r `t _ -. -- - t 2 i l er a 4%z r '?'; i"t 4 �', 4 t Y `£ # ask vt �#4 'x y�.`�a < ti �t s 8-Ni 'r s t ! ti s 4 ? 5x4 "'r AVay 3 3 . ��r,"'i �� t, tic + t #x k a$1 r'�'` `i,�I:'4,.V' pX s c ! Ky ' p 3 , zs: a AG ,,n 5.* w t, t- 4 -fie aIIi c 0zrvdo 3t rt'as''��y f `k �iz �`#,. c LA v11 i #fT � a` §'a. , y"5ii- F. 14 Zt'Gf 3 a.: va z- . NW , 'l -:11 ,---'��il�6 qq< 0 R A ,-.,.� � -.'.�,,�ll'I'�-,�l"$;...S"�,,�,��,��,�t--"",��� w "!:. �, ,, Z ,�.�.�,�, a 9 A r 1$ 1 S�- € ya r€ -x p,7 e[ems£, �",* y ✓ R {.I ,k'-'��.,"��e-.�I�,, x t "lt�r�y� `r��a� t"fir -* "tF"'i,A7a ^,t-i� s } A. ',.�-':I-,,,0"I,,', Ii III 1. Y 44 0.,B S s x- 1-�.3't h z3.S t -,M; liE' ,ma's^�:_z <. >s��d `E�a K v 'S'�'.„ `"�",.`x,.s „tf 1't+# 1. n�.,S t r 1-y, 1- sa a,4 - ` yAt t 2..�, ;S 4 ire Cr 5&t �. , P i ' ��� `, '�,� t sk7+t4'St^'� `f .S R F 4d, r • a�,5'� !; s, R 4 F ar w ;ti l 11- a Kl# ,,a.t.„�u l-r, r k;"`r {x # ! r h R �� o . t$ lqt t s \ UNm £ #, Ste" `> .� 43F 7 A�z g _f }'.� _ - ,#rv��'^f a � s y� +may y -}, ', a t" + fimt lW :r' a it qp tt k r r 1k _ 3�zrj�zt,gr `yjf" `�{ y ��kiiW,y t a'r.' b,l r :a '� it,, a, t i �@� �t�`�j, �" Sar9,43 jr�r R �, s -jet a`.�! t` j€'€ ," c'fir',> ,. s�'3 f .�k z, r YS r7xt '?`,^-st I` xfz t pat x�' t 4 +( - - 1 '��r� stir �� s p^4 y 'F*m ar�'�.,�,,#,e»�sr, a j P # k t f 'M a�' ;d`'`���S r'` �Sd 1," r 'i, 2' �7 q t. «r `i#j t: fad t - R k It k RN a�'St�7p x 5�PVw z'f't;- I , $=` K t r - - f F „}�*a�,+ �`��'p finstoF #hrF ,".p `,r 3,--'a2 .fir°t S( £ L- w M��y',` �` Y r ;«3. qs K 'A"WI 7. K r ;-,L '� #ia �3 a4 eEd�#7'� 2 ,'t , k,xfjis�.�, r:,,,h v'£ 33, . e .n z`�"�`��,.3 °Y -'.I* rig.¢.l a� a r 4�%�;t, x- 3 i ._ 1 # k'�'�'. E A`F'u.' St'^�.. 'fr..'s",�r, a"-� F Y < t - Yza�, i ! I e �"4 r .. - a 'rt''4, s , ,a �' c x,,y..,'r� `c, fy i �: _ f - - � �¢-"`+e , s x K6 k x {� axx s r d N G'u� Ni :f -,i,rp, :". , b r,r U b O% s" 1{s r; u' r rr " '°1 4 '' i ya S a y t O '.�k � 1 Y srz $ .a '. '�^ } h ✓! t } QgrtT3 � v >r ' ez i '-��,��:�(,1 r O 01 �r.`P2 x t" 3 c k YJ. "` _� q, i' -'r- r v r "'Y R �� LA n +sL( 4 N L +- 0.` �frl he a t t t � 1 Y,t'�S }1 ^' ,`,F y f i r, a O t4 a 6 }r4 $ 4Y 3 R S ! y 7 fis x u ##b£ r y to F x s j - v t r t / ""E3 W �,:" ey l,�'z?S' ?Y `' `� 'zi z w tE$ a f:4 a.t X'' x, �t d �4 £` r z e.ls kk, a.,� 3; £v Y c t- 'x *`; i;.1 f+Y �� Y ��ri t .a a C 00 <. ' ram,K k �,t i +v+'#t a -e' r� fir` r�s -". J`,+.� fa 0 1 s a s f :7'n.+$f�t ,+ A ' 'F - x +t t kp'" fr,-",-1 zis ,r N 0-�'i t 1 �` frifj}"a mot`, --.. 4 Y'FI � a w` r d y z 3 .i9 t X �t - p a fi k x^k -fin 1n � '',a+r�yt `4 i t o 9'.✓;!t € '�i se. �I'W r ( _"jl ,$�, '-s, tfi�^``'z',`1 t ii��r"',¢5 S#£t S '� i#G�` i aS Z. } v x K ., '�,ta.t � '`fi," e $tkY 2��„.J kH i s9+?i" e N z a «t�ty-0to { r 3 t o: xi z 69R .. „#,t Jy' i „.# ,ci *Y'i t ta:4 tn' n t,-r 3 "g F z ," K , , "a2% ^z'i*-E rK �,et r SL4 3# t 3 r� *f' a"`J`,{'r;t;p' J t T', £, +.E.xx_..R,.,,_.... '`"4^,,'}i"}'v',r r,, .. 4 , ."_?=t ��` .0 +vr'?:Lix,� z..�..�..` ..`..-..i..... .... .ti`i,.n >& - City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE for FY 2016/17 CURB ACCESS RAMP INSTALLATION PROJECT C.C. No. 1541 January 3, 2017 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Special Provisions: 1) Replace Section D "Sample Contract" in it's entirety in the Specifications with updated Section D in this Addendum. The "Sample Contract" was updated in December 2016. 2) Replace Appendix K, the "Prevailing Wage Schedule" in it's entirety in the Specifications with updated Appendix K in this Addendum. "General Decision Number: CA60035 1 1/1 1/2016" will be replaced with "General Decision Number: CA60035 12/23/2016." 3) Replace Appendix L, the "Federal Documents for CDBG Projects" in it's entirity in the Specifications with updated Appendix L in this Addendum. The documents were updated in December 2016. This is to acknowledge receipt and review of Addendum Number One, dated January 3, 2017. Golden State Constructors Ronnie Cochran Company Name By 1/9/2017 Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Joseph Fuentes at (714) 536- 5431. 1 SECTION C PROPOSAL for the construction of FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT from VARIOUS LOCATIONS CC No. 1541 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 70 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 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 BID ITEMS Item Description Quantity Unit Unit Cost Total Cost No. (Extension) 1 Mobilization 1 LS $ 21,000 $ 21,000 Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 1 in 2 Appendix H of Specifications (Item includes all appurtenances,curb&gutter,depressed curb, sidewalk, domes, retaining curb,sawcut, slot pave, etc.) 68 EA $ 4500 $ 306,000 Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR using horizontal curb cutting machine as 3 shown on Curb Ramp Detail 2 in Appendix H of Specifications (Item includes all appurtenances, curb&gutter,depressed curb, sawcut, sidewalk,domes, retaining curb, etc.) 63 EA $ 3400 $ 214,200 Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 3 in 4 Appendix H of Specifications (Item includes all appurtenances,curb&gutter,depressed curb, sawcut, sidewalk,domes, retaining curb, slot pave,etc.) 5 EA $ 3600 $ 18,000 Construct Case C Midblock or Case F/Case G/Case CM or Type C Directional Curb Access Ramp per Caltrans Std. Plan 5 A88A/A88B(Item includes all appurtenances,curb&gutter, depressed curb, sidewalk, domes, retaining curb, slot pave, etc.) 20 EA $ 2800 $ 56,000 6 Install truncated domes to existing Curb Ramp 123 EA $ 400 $ 49,200 7 Remove existing improvements and construct concrete meandering sidewalk per HB Standard Plan 207 500 SF $ 8 $ 4000 Remove and reconstruct Cross Gutters per HB Standard Plan 8 205(Item includes all appurtenances,curb&gutter, slot pave, etc.) 3,800 SF $ 12 $ 45,600 Remove and replace existing 6"or 8"Curb and Gutter per HB 9 Standard Plan 202 (Item includes all appurtenances and slot pave, etc.) 100 LF $ 46 $ 4600 10 Install 4"PVC Sleeve for Street Assembly Sign per City of HB Std. Plan 401 10 EA $ 25 $ 250 11 Prepare Storm Water Pollution Prevention Plan(SWPPP) 1 LS $ 1800 $ 1800 12 Install &Maintain Construction BMPs 1 LS $ 400 $ 400 TOTAL BID AMOUNT (BASIS OF AWARD)—SCHEDULE A $721 ,050.00 C-2.1 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 TOTAL BID AMOUNT IN WORDS: SeftnHundredTwenty-OneThousand Fifty and 00/100--------------------------------------------- ------------------------------------- Note: 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. C-2.2 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 in the amount of 10% 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 42i#rs Signature 1 1/9/2017 C-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 Dollar % of Item(s) Subcontractor License Number Amount Contract Number r" r e� By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOI.LUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID 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 9J9t2o17, at Placentia , CA Date City State Ronnie Cochran , being first duly sworn, deposes and says that he or she is President of Golden State Constructors 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. Ronnie CocfiMn Name of i der Signature of Bidder 208 E.Orangethorpe Ave.Placentia,CA 92870 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 FY 16/1.7 CURB ACCESS RAMP INSTALLATION PROJECT, (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. Golden ftatc4onstructors Contractor r By President Title Date: 1/9/2017 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? 0 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. Golden St Constr tors Contrac r By President Title Date: 1/9/2017 C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Golden State Constructors Bidder Name 208 E.Orangethorpe Ave. Business Address Placentia CA 92870 City, State Zip ( 714 ) 625-8758 ron@goldensci.com Telephone Number Email Address 867060-A,B,C-8 State Contractor's License No. and Class 11/2005 Original Date Issued 3/31/2017 Expiration Date The work site was inspected by Ron Cochran of our office on January 9 , 2017. The following are persons, firms, and corporations having a principal interest in this proposal: Ronnie Cochran C-8 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Golden 5 a e Constr ctors Compan ame Signature of Bidder Ronnie Cochran Printed or Typed Signature Subscribed and sworn to before me this 9 day of January , 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 California ) County of Orange ) On January 9, 2017 before me, Claudia Cochran,Notary Public-------- Month, Day, and Year Insert Name and Title of Notary personally appeared --------------------Ronnie D.Cochran--------------------- Name(X) of Signer(X) who proved to me on the basis of satisfactory evidence to be the person( whose name(X) is/= subscribed to the within instrument and acknowledged to me that he/sue(" executed the same in his/IXA(f M authorized capacity(k%), and that by his/MXWsignature(k) on the instrument the person(s), or the entity upon behalf of which the person(k) 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. CLAUDIA COCHRAN i' WITNESS my hand and official seal. COMM # 2095862 ,,r�,t Z - ORANGE COUNTY Q !` NOTARY PUBLIC-CALIFORNIA Z Q MY COMMISSION EXPIRES -' JAN. 30. 2019 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, 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."l. 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 Anaheim, 200 5.Anaheim Blvd,Anaheim,CA 92805 Name and Address of Public Agency Name and Telephone No. of Project Manager: Mike Wood, (714) 765-5100 750,000 Remove Replace sidewalk,curb and gutter annual project 3/31/2017 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Removing and replacing curb and gutter and sidewalk,some asphalt work. 2. City of Irvine,6427 Oak Canyon,Bidg. 1,Irvine,CA 92618 Name and Address of Public Agency Name and Telephone No. of Project Manager: Reza Jafari, (949) 724-7545 450,000 Remove Replace sidewalk,curb and gutter annual project June 2017 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Removing and replacing curb and gutter and sidewalk,some asphalt work. 3. County of Orange, 2301 Glassell Street,Building A,Orange CA 92865 Name and Address of Public Agency Name and Telephone No. of Project Manager: Cesar Lopez, 714-955-0271 230,000 Remove Replace sidewalk,curb and gutter annual project April 2017 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Roomnyina and replacing curb and aitter and sidewalk,snme aSnhalt 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 levant projecthistory in addition to the projects listed herein. Name of proposed Project Manager Telephone No. of proposed Project Manager: ,� �— 7,.EF Project Name & Contract Amount Type of Work Date Completed Project Name & Contract Amount Type of Work Date Completed Project N e & Contract Amount Type of Work Date Completed 2. Name of proposed Superintendent ) —7 Telephone No. of proposed Superintendent: C-7 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 C-1 l 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:Hefiling.dir.ca.gov/P WCR/ActionServlet?action--displayPWCRegistrationForm DIR's Contractor Registration searchable database: https:Hefiling.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. Golden Aate Constructors Contra to 1� By President Title Date: 1/9/2017 DIR 4: 1000004019 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: Golden State Constructors Contact Person: Ron Cochran Contact Phone: 714- -5974 3 Signed: /1� ---------- Date: 1/9/2017 *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 EXHIBIT A DISADVANTAGED BUSINESS ENTERPRISE (DBE) This Project is subject to Part 200.321, Title 2, Code of Federal Regulations entitled "Contracting with Small and Minority Businesses, Women's Business Enterprises, and Labor Surplus Area Firms." The Regulations in their entirety are incorporated herein by this reference. It is the policy of the City that disadvantaged business enterprises (DBEs), as defined in Part 200.321, Title 2 CFR, shall be encouraged to participate in the performance of Contracts financed in whole or in part with federal funds. The Contractor should ensure that DBEs, as defined in Part 200.321, Title 2 CFR, have the opportunity to participate in the performance of this Contract and shall take all necessary and reasonable steps, as set forth in Part 200.321, Title 2 CFR, for this assurance. The Contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of subcontracts. Failure to carry out the requirements of this paragraph shall constitute a breach of Contract and may result in termination of this Contract or other remedy the City may deem appropriate. Bidders shall be fully informed respecting the requirements of the Regulations and are urged to obtain DBE participation in this project, although there is no specific goal for DBE participation. C-14 EXHIBIT B DBE INFORMATION—GOOD FAITH EFFORTS Federal-aid Project No. Bid Opening Date 1- 1d.-ram The City of Huntington Beach-established a Disadvantaged Business Enterprise (DBE) goal of 0% 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 Solicitation and Dates C-l5 C. The items of work which the bidder made available to DBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items M of (Y/N) Contract D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each DBE if the selected firm is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: Names, addresses and phone numbers of firms selected for the work above: 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-16 P. 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-17 IF A SOLE OWNER OR SOLE CONTRACTOR SIGN HERE: (1) Name under which business is conducted / (2) Signature (given and surname) of proprietor (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No (5) E-Mail IF A PARTNERSHIP, SIGN/character ZI (1) Name under which busine (2) Signature (given and surnf partner) (Note: Signature must be made by a general partner) (3) Place of Business (Street and Number) City and State (4) Zip Code/ Telephone No. (5) E-Mai C-1 s IF A CORPORATION, SIGN HERE: (1) Name under which business is conducted Golden State Constructors I (2) (Signature) President (Title) Impress Corporate Seal here (3) Incorporated under the laws of the State of California (4) Place of Business 208 E.Orangethorge Ave. (Street and Number) City and State Placentia CA (5) Zip Code 92870 Telephone No. 714-625-8758 (6) E-Mail ron@goldensci.com NOTARIAL ACKNOWLEDGMENT OF EXECUTION BY ALL SIGNATORIES MUST BE ATTACHED C-19 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 Orange } On 1- —I before me, Claudia Cochran. Notary Public ere vane an e personally appeared ----Ronnie Cochran ---- -who proved to me on the basis of satisfactory evidence to be the person(*whose name(&) is4ice subscribed to the within instrument and acknowledged to me that he/ehefthey executed the same in his/heFAhe'F authorized capacity(aes), and that by his/+leNtheir signature(s-) on the instrument the person(4 or the entity upon behalf of which the person(e) 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. CLAUDIA COCHRAN COMM N 2095862 WITNESS m d official seal. Z ,: ORANGE COUNTY Q NOTARY PUBLIC-CALIFORNIAZ Q MY COMMISSION EXPIRES JAN. 30. 2019 Notary Public Signature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Thisform complies with current California.statute.,regarding notary warding and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed,should be completed and attached to the document.Acknowledgments from other states may he completed for documents being sent to that slate so long as the wording does not require the California notary to violate California notmy law. (Title adescription of attached document) • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. (Title or description of attached document continued) • Date of notarization must be the dale that the signens)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 Number of Pages_Document Date commission followed by a comma and then your title(notary public). • Print the neme(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. ha/shc/tkey-is/are)or circling the correct forms.Failure to correctly indicate this ❑ Individual(s) information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be elm and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. El Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact A Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. AIndicate title or type of attached document,number of pages and dare. ❑ Other 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. List below names of president, vice president, secretary and assistant secretary, if a corporation; if a partnership, list names of all general partners and managing partners: President-Ron Cochran Treasurer-Ron Cochran C-20 EXHIBIT C LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCAL AGENCY: Ci' tic a/L�'� - LOCATION: PROJECT DESCRIPTION: r l /P C-f✓/� / ice G/� TOTAL CONTRACT AMOUNT:$ 771-4 r)JM BID DATE: BIDDER'S NAME: r_Z45 CONTRACT DBE GOAL: U/, CONTRACT ITEM OF WORK AND DESCRIPTION BE CERT NO. NAME OF EACH DBEDOLLARAMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened- include DBE address O BE PROVIDED(or contracted if the d phone number) bidder is a DBE) For Local Agency to Complete: Total Claimed DBE Local Agency Contract Number: Participation Federal-aid Project Number: 0 Federal Share: Contract Award Date: Local Agency certifies that all DBE certifications have been verified and information is complete and accurate. wik SiAature of Bidder D to /'� � (Area Code)Tel.No. Print Name Signature Date ,� (at fy,�Lc� Local Agency Representative Person to Contact (Please Type or Print) (Area Code)Telephone Number: Local Agency Bidder DBE Commitment(Construction Contracts) (Rev 6/26/09) C-21 PLEASE NOTE: This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must be submitted and received as specified in the Special Provisions. Failure to submit the required DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project regardless of tier. Names of the First-Tier DBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of DBE firms. Exhibit 15-G must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local 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. C-22 EXHIBIT D EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION mm The bidder rny J 'k C .���'v�h�� [proposed subcontractor J hereby certifies that he/zlw4t haste, has not , participated in a previous contract or subcontract subject to the Equal Opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he/she/it 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. (eeoc.gov/employers/eeolsurvey/index.cfm) 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 L Signature: Date: Print Name: Title: C-23 EXHIBIT E NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) [NAME OF CONTRACT] To the City of Huntington Beach In conformance with Title 23 United States Code Section 112 and California 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 Bidder's Proposal. By signing the Proposal, the Bidder has also signed this Noncollusion Affidavit. Bidders are cau ' ed that making a false Certification may subject the Bidder to criminal prosecution. Signature: Date: 1/9/2017 Print Name: Ron Cochran Title: president C-24 EXHIBIT F 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 with Bidder 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 him/her 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. Note: 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 t reof shall also constitute signature of this Certification. Signature: Date. 1/7/201 Print Name: Ron Cochran Title: President C-25 EXHIBIT G 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 Auage of this certification be included in all lower tier subcontracts, which exceed 100,OrDInd t s h subrecipients shall certify and disclose accordingly. Signature: Date: 1/9/2017 Print Name: Ron Cochran Title: President C-26 EXHIBIT H 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 ®a.bid/offer/application ® a.initial b.grant b.initial award b.material change c.cooperative agreement c.post-award d.loan For Material Change Only: e.loan guarantee year quarter f.loan insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No.4 is Subawardec, Enter Name and Address of Prime: Prime Subawardee Tier if known Congressional District,if known Congressional District,if known 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number,if applicable 8. Federal Action Number,if known: 9. Award Amount,if known. 10. a.Name and Address of Lobby Entity b. Individuals Performing Services (including (if individual,last name,first name,MI) address if different from No. 10a) (last name,first name,MI) (attach Continuation Sheet(s)if necessary) 11, Amount of Payment(check all that apply) 13. Type of Payment(check all that apply) $ � JA4i 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 c 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 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above when his transaction was made or / entered into.This disclosure is required pursuant to 31 U.S.C. Print Name: 1352. This information will be reported to Congress f �� semiannually and will be available for public inspection.Any Title: person who fails to file the required disclosure shall be subject �J �j to a civil penalty of not less than$10,000 and not more than Telephone No.: /�/ ��^_f 7) Date: $100,000 for each such failure. Authorized for Local Reproduction Federal Use Only: Standard Form-LLL Standard Form LLL Rev.09-12-97 C-27 NORTH AMERICAN SPECIALTY INSURANCE COMPANY BOND NO.: GOLST-334 BID BOND KNOW ALL MEN BY THESE PRESENTS: That we, GOLDEN STATE CONSTRUCTORS, (hereinafter called the Principal), and NORTH AMERICAN SPECIALTY INSURANCE COMPANY, a corporation organized and doing business under and by virtue of the laws of the State of NEW HAMPSHIRE, and duly licensed for the purpose of making, guaranteeing or becoming sole surety upon bonds or undertakings required or authorized by the laws of the State of CALIFORNIA, as Surety, are held and firmly bound unto CITY OF HUNTINGTON BEACH, (hereinafter called the obligee) in the sum equal to 10% of the accompanying bid of the Principal, not, however, in excess of TEN PERCENT OF THE TOTAL AMOUNT BID Dollars (10% OF BID AMOUNT), for the payment of which, well and truly to be made, we hereby bind ourselves and our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT WHEREAS, the above bounden Principal as aforesaid, is about to hand in and submit to the obligee a bid for FY 16/17 CURB ACCESS RAMP, JOB/BID NO. CC 1541, in accordance with the plans and specifications filed in the office of the obligee and under the notice inviting proposals therefore. NOW, THEREFORE, if the bid or proposal of said principal shall be accepted, and the contract for such work be awarded to the principal thereupon by the said obligee, and said principal shall enter into a contract and bond for the completion of said work as required by law, then this obligation to be null and void, otherwise to be and remain in full force and effect. IN WITNESS WHEREOF, said principal and said Surety have caused these presents to be duly signed and sealed this 5TH day of JANUARY, 2017. GOLDS A RUCTORS BY: NORTH MERIC N SPEgIALTY INSURANCE COMPANY BY: (�� RANDY S HN, AT( T O Y-IN-FACT NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Manchester,New Hampshire, and Washington International Insurance Company,a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg,Illinois,each does hereby make,constitute and appoint: RANDY SPOHN and MATTHEW R.DOBYNS JOINTLY OR SEVERALLY Its true and lawful Attomey(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION($50,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9t11 of May,2012: "RESOLVED,that any two of the Presidents,any Managing Director,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company 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 binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." pn�\�IULITY j///U� � mapNlnnwlmb4t� s yQt 4 0 G i ."Oft. / _ TF�Z5k By Q.C..t r G,py -f SEAL :a c Steven P.Anderson,Senior Vice President of Washington International Insurance Company SEAL _ n e 3�.r},'Z 1973 -to= &Senior Vice President of North American Specialty Insurance Company 6 O. :to c i b 00� .. By Michael A.Ito,Senior t' chest er nt l'��toTtiona insurance ompany �rRNN &Senior Vice President of North American Sperialty Insurance Company IN WITNESS WHEREOF,North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this I Oth day of May 2016 . North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Cook SS: On this IOth day of May 2016 ,before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Michael A.Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company,personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFICIAL SEAL MKENNY NOTARY PUBLIC,STATE OF IWNOIS M.Kenny,Notary Public MY COMMISSION EXPIRES 1 2/0 41201 7 I, Jeffrey Goldberg . the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company,which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this 5th day of January 20 17 . Jeffrey Goldberg,Vice President&Assistant Secretary of Washington International Insurance Company&North American Specialty insurance Company 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 A CAI W before me, ERIKA GUIDO, NOTARY PUBLIC, personally appeared RANDY SPOHN ® 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 signatures) 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 ERIKAGUIDO I California that the foregoing paragraph is true and correct. N COMM.#2022671 NOTARY PUBLIC CALIFORNIA WITNESS m and and official seal. ORANGE COUNTY �I M Comm.expires May 5,2017 I ure of a Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER ❑ PARTNER(S) ❑ LIMITED ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) e 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 Orange } On (— `R —i before me, Claudia Cochran, Notary Public , ere insen name and tile of the officer) personally appeared Cochran ------------ , who proved to me on the basis of satisfactory evidence to be the person(*whose name(&) is/aFe subscribed to the within instrument and acknowledged to me that hefty executed the same in his/her-lheiF authorized capacity4o&), and that by his/*e eii-signature(s) on the instrument the person(}, or the entity upon behalf of which the person( acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. c Au;lA cocHaAN �}i.. COMM#2095862 Z=�„'�c; ORANGE COUNTY WITNES and ici seal. Q y` NOTARY PUBLIC-CALIFORNIAZ i Q MY COMMISSION EXPIRES JAN. 30,2019 Notary Public Signature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT (needed,should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) • 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 (Title or description of attached document continued) 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 Number of Pages Document Date 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. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i,e. ire/she/they;-is Awe)or circling the correct forms.Failure to correctly indicate this ❑ Individual (s) information may lead to rejection of document recording. ❑ Corporate Officer • 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 Title sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other Indicate title or type of attached document,number of pages and date. ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document with a staple. City of Huntington Beach � a - 2000 Main Street o Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov FFB ; jgp9 : Office of the City Clerk Robin Estanislau, City Clerk April 27, 2017 Hardy & Harper, Inc. 1312 E. Warner Ave. Santa Ana, CA 92705 RE: FY 2016/17 Curb Access Ramp Installation Project—CC-1541 Enclosed please find your original bid bond for CC-1541. Sincerely, 4q4ftu (�G? Robin Estanislau, CIVIC City Clerk RE:pe Enclosure Sister Cities: Anjo, Japan a Waitakere, New Zealand art`'i �,^ rziH �`x�#a of zaraarr5 9rn� s � � i}dc jHplSi,& a3 rrki""" *,✓3.9.K7 Y v '` k�yx''a r'4' k'-a 'x'� v�.�Us x r >E,� 3' 3.i y 4 s- p ;r € ,Ncr, 2fiaRr�,}(t�sl � pW i `n rs� �-� ��� ttz���`��`�gE`,�^''"�n s;:±•s � �� �t�� ,'�d`smart xa, �'^Y 5q�'N i't„r`t§>e� 4 x �.'� P S"�B u\ a A"s#��'.4� ,.f` ^S�s��Ak",�e aF�t��al� '� e ��.,�+ r��• ,;x` �'� � � '��{�i•n n1. �= rf � r a a }-J �. "W�.A `L it . q.Lfd �� t s>;•' 2�'�j1 � '' �a� 1. r� �u�fis fir`�`*3i�� i �.`�t'i ��*',p�*+�; {�,q � -�s^ *. z�,{?J. 4'�• x"r t sk1� r�a`S k. ��ccR,;.ri'�i 1 �' .''�ay. 4 rY �9ti` 'i r' e,�2b, � f r f + ,. �&D � �Atv u"��' "����+" "t �Z "' '^v r'�o- n .y ' T °� � � t Ca I> a J Yi7 dFt�^.s+LT•E �i b..'� � +� � � qfl.�P+A' '� � 3E "".7 'i� - � 3rr� _. if, "-V! r +" y`�• L §4 # `i ��; �'j1TC 4 A{r ,2t '% r ",✓,.a t'�� � -� ,���` ��xrJ . '-fit r� *�'.� P .��.�� ��� a��;.:?� �`r� �kv'����^u �r,��33�� ����^�9� z����.��%{��..���u��.M.;.� f.,z,ar ," '� ,. �fi a✓yi ,fit ery,�.a . W,-''u, "�p`*�t+ x`'� a "�°�A t Cwt qmx1 � ,��fa�,s�c`��i i. rn !- _, � �arfi�w.'�.s $r 'f�" x�?...' �' , ., ,,��yy��sr+ P�� 1 �,�`•* �?` �• r �+" F x �.k'W'�( T z i 14, �Jr4 1 L '�nYG,.,.. ,.�"' � � -e v,�_ra��4�����a �' ?izF`�'R�°`•i�-��� ,Eaus�F "46RIP4 alWe �'^Nz `L as tk ta y, x ..u+aw Wn '; x F xyir ik. I /�� �I 4', f 11/ a{y� () • Lnca w Ln ON �� •".� U Cl Ln r--r OCD a�t O N 4-5 (� @era i NA t18 CD c a + ;5kwr eeSa C CD cu cn ct O = () a` �.raa 0 4— p��/;N/� �•. _ rx ;� �.id"�s,T. 3r >^d '^ 0. ai C z3*' alb�� "5 ,�2 af + �` @ en ri ;n . r d .+ Ll— '4' s r�s xxh ir3 U City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE for FY 2016/17 CURB ACCESS RAMP INSTALLATION PROJECT C.C. No. 1541 January 3, 2017 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Special Provisions: 1) Replace Section D "Sample Contract" in it's entirety in the Specifications with updated Section D in this Addendum. The "Sample Contract" was updated in December 2016. 2) Replace Appendix K, the "Prevailing Wage Schedule" in it's entirety in the Specifications with updated Appendix K in this Addendum. "General Decision Number: CA60035 11/11/2016" will be replaced with "General Decision Number: CA60035 12/23/2016." 3) Replace Appendix L, the "Federal Documents for CDBG Projects" in it's entirity in the Specifications with updated Appendix L in this Addendum. The documents were updated in December 2016. This is to acknowledge receipt and review of Addendu umber One, dat d January 3,y2017. flarpm Inc, Compbny Name BY �-�eVe kirschh�r- VtCt �esidsnt Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Joseph Fuentes at (714) 536- 5431. 1 SECTION C PROPOSAL for the construction of FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT from VARIOUS LOCATIONS CC No. 1541 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 70 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 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 BID ITEMS "E si s�` � �(11�" i s� sse Item Descr�p#�an . ' Quantity Unit T3n�#Cos# T©tat Gas# �(O €a E g aE d i€Itt . . ..... 1 Mobilization 1 LS $ 77 Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 1 in 2 Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed curb, sidewalk, _ domes, retaining curb, sawcut, slot pave, etc.) 68 EA $ $ Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR using horizontal curb cutting machine as 3 shown on Curb Ramp Detail 2 in Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed �iy Yoe curb, sawcut, sidewalk, domes, retaining curb,etc.) 63 EA T Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 3 in 4 Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed curb, sawcut, 6�a QV® sidewalk, domes, retaining curb, slot pave, etc.) 5 EA Construct Case C Midblock or Case F/Case G/Case CM or Type C Directional Curb Access Ramp per Caltrans Std. Plan 5 A88A/A88B(Item includes all appurtenances,curb&gutter, depressed curb, sidewalk, domes, retaining curb, slot pave, (1 U etc.) 20 EA 6 Install truncated domes to existing Curb Ramp 123 EA 7 Remove existing improvements and construct concrete meandering sidewalk per HB Standard Plan 207 500 SF Remove and reconstruct Cross Gutters per HB Standard Plan 8 205(Item includes all appurtenances, curb&gutter, slot pave, I J U 0 etc.) 3,800 SF $ �� $ / Remove and replace existing 6"or 8"Curb and Gutter per HB 9 Standard Plan 202(Item includes all appurtenances and slot pave, etc.) 100 LF $ $ 10 Install 4" PVC Sleeve for Street Assembly Sign per City of HB Std. Plan 401 10 EA 11 Prepare Storm Water Pollution Prevention Plan (SWPPP) 1 LS 12 Install&Maintain Construction BMPs 1 LS $(a TOTAL BID AMOUNT (BASIS OF AWARD)—SCHEDULE A C-2.1 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 TOTAL BID AMOUNT IN WORDS: Ho rd 6idd '15MI-41e6i -1kC2QSC22W Note: 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. C-2.2 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 in the amount of10%of Amount 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 forio % ", 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 id s Si nature C-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. k.Bid Name and Address of State_,, Class DIR Dollar_, %of Ite (s) r Subcontractor , License: Number` Amount Contract ...; Number"' A/ 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 12/21/16, at Santa Ana , CA Date City State Steve Kirschner , being first duly sworn, deposes and says that he or she is Vice President of Hardy&Harper,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. Hardy&Harper,Inc Name o idder Signature of Bidder Steve Kirschner-Vice President 1312 E.Warner Ave.,Santa Ana,CA 92705 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 FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT, (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. Hardy&Harper,Inc Contract By Steve Kirschner-Vice President Title Date: 12/21/16 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. Hardy&Harper,Inc Contract By Steve Kirschner-Vice President Title Date: 12/21/16 C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Hardy&Harper,Inc Bidder Name 1312 E.Warner Ave. Business Address Santa Ana CA 92705 City, State Zip ( 714 ) 444-1851 skirschner@hardyandharper.com Telephone Number Email Address 215952;A,C-8,C12 State Contractor's License No. and Class 3/13/63 Original Date Issued 12/31/17 Expiration Date The work site was inspected by Corey Kirschner of our office on December 20th , 201_6_. The following are persons, firms, and corporations having a principal interest in this proposal: Fred T.Maas,jr-President,Treasurer Dan T.Maas-CEO Steve Kirschner-Vice President Kristen S.Paulino-Secretary C-8 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Hardy&Harper,Inc C y Nam Signature of Bidder Steve Kirschner-Vice President Printed or Typed Signature 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 before me, 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(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 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE§8202 �-- -lc sS c rcc - Ssus s�?cC,nC sr—I_: 5'15: c is � ti, s4c4t Y�C niCs�c s ❑See Attached Document (Notary to cross out lines 1-6 below) ❑See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) 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 Subscribed and sworn to (or affirmed) before me County of Orange on this 21 day of December 20 16 by Date Month Year (1) c,1CNP/ �--i r:chn x_ _ (and (2) ), TINA PHAM Name(A of Signer( COMM.#2149384 M QMY Notary Public-CaliforniaORANGE COUNTY u proved to me on the basis of satisfactory evidence Comm.Expires Apr17,2020 to be the person(s) who appeared before me. Signature Signature of Notary Public Seal 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: Bidder's Information Document Date: December 21, 28 Number of Pages:__2__ Signer(s)Other Than Named Above: None XX7:G`W`Z f;T��.Z-,l./vC C`C�(?'t..r%C.`Y: 02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5910 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: 1• Please see attachment"A" 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: 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: Contract 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. 1. Mike Amundson Name of proposed Project Manager Telephone No. of proposed Project Manager: 714-444-1851 Schleisman Rd Overlay $333,333.00 Road Overlay Work 8/15 Project Name & Contract Amount Type of Work Date Completed Minor Street Maintenance Phase I $1,543,000.00 Street Maintenance 4/14 Project Name & Contract Amount Type of Work Date Completed Phase 3 Street Rehab $1,075,484.00 Street Rehabilitation 6/14 Project Name & Contract Amount Type of Work Date Completed 2. Dennis Beyle Name of proposed Superintendent Telephone No. of proposed Superintendent: 714-444-1851 Street Improvement&Main Street Bridge Rehabilitation $1,188,570.00 Street Improvement 1/15 Project Name & Contract Amount Type of Work Date Completed Foothill Blvd Pavement Rehabilitation $1,076,200.00 Pavement Rehabilitation 11/15 Project Name & Contract Amount Type of Work Date Completed Street Resurfacing Project $1,187,987.00 Resurfacing Project 12/15 Project Name & Contract Amount Type of Work Date Completed C-11 PUBLIC WORKS REFERENCES Attachment A 2015/2016 Owner/Agency Contact Project (Amount & Completion Date City of Simi Valley Fuad Shamout, P.E FY 2015-16 Annual Minor 2929 Tapo Canyon Road (805) 583-6788 Street Rehabilitation Simi Valley, CA 93063 FShamout(a7simivailey.orq $1 ,213,960.50 11/15 City of Walnut Natalie Avila, P.E Area 1 & 2 Street 21201 La Puente Rd. (909) 594-9702, Ext. 315 Resurfacing Project Walnut, CA91789 navila rkagroup.com $1 ,077,000.00 11/15 City of Rancho Cucamonga Romeo David Foothill Blvd Pavement 10500 Civic Center Drive (909)477-2740 Rehabilitation Rancho Cucamonga, CA 91730 Romeo.David cit ofrc.us $1,076,200.00 11/15 City of Palm Desert Bo Chen, P.E Portola Ave STP Rehabilitation 73-510 Fred Waring Drive (310) 370-5099 Project Palm Desert, CA 92260 bochen(a"Dcityofpalmdesert.o� $639,204.74 2/16 City of Lake Elsinore Ken Rukavina FY 15-16 Citywide Pavement 130 South Main Street (951) 674-3124 Rehab Phase 5 Lake Elsinore, CA 92530 krukavina(a7lake-eisinore.org $560,736.74 2/16 City of Lake Elsinore Ken Rukavina FY 15-16 Citywide Pavement 130 South Main Street (951) 674-3124 Rehab Phase 4 Lake Elsinore, CA 92530 krukavina�iake-eisinare.orq $895,665.91 3/16 City of Villa Park Akram Hindiyeh FY 15/16 Street Rehabilitation 17855 Santiago Blvd (714) 998-1500 Project Villa Park, CA 92861 ahindiyeh(a�villapark.org $592,140.91 3/16 City of Pasadena Sean Singletary Preventitive Maintenance of 100 N. Garfield Ave (626) 744-4273 Streets 2015 Pasadena, CA 91109 ssingletaryecltyofpasadena.net $1,182,829.46 4/16 City of Colton Jess Sotto FY 15-16 Asphalt Paving 650 N. La Cadena Drive (909) 370-5099 Project Colton, CA 92324 .1Sotto- coltonca..gov $1 ,569,242.84 4/16 City of Westminster Tuan Pham Citywide Street Improvement 8200 Westminster Blvd (714) 898-3311 For Various Residential Streets Westminster, CA 92683 tpham(cDwestrnirister-ca.gov $679,108.61 5/16 PUBLIC WORKS REFERENCES Attachment A 2015/2016 Owner/Agency Contact Project's Info City of Arcadia Jan Balanay Pavement Rehab Program 240 West Huntington Dr (626) 256-6582 Camino Real Ave & 6th Ave Arcadia, CA 91066 ibalanay@arcadiaca.gov Project# 33854016 $632,386.21 7/16 City of Fontana Ticha Loera Pavement Rehab of Slover Ave 8353 Sierra Ave (909) 350-6696 From Mulberry Ave to Cherry Fontana, CA 92335 tloera(@fontana.orq Ave $1 ,313,161.86 8/16 City of Rancho Cucamonga Romeo David Archibald Ave from Hillside Rd 10500 Civic Center Drive (909)477-2740 to N. City Limit & Haven Ave Rancho Cucamonga, CA 91730 Romeo.David(acit ov frc.us Wilson Ave $796,042.98 8/16 City of La Canada Flintridge Greg Kwolek 2016 Citywide Street 1327 Foothill Blvd (818) 790-8880 Resurfacing La Canada Flintridge, CA 91011 gkwo1ek[o)Icf.ca.gov $1,084,562.67 8/16 City of Huntington Beach Joseph Fuentes Nichols Lane Rehabilitation 2000 Main Street (714) 536-5431 from Slater Ave to Warner Ave Huntington Beach, CA 92648 ifuentes c(u).surfcity-hb.orq $644,000.00 9/16 City of Claremont Vincent Ramos Residental Slurry Preparation 207 Harvard Ave (909) 399-5396 CIP 2016-02 Claremont, CA 91711 vramos ci.claremont.ca.us $579,000.00 10/16 City of Rancho Palo Verdes Lea Reis Residential Street Rehabilitation 30940 Hawthorne Blvd LReisCa rpvca.goy Project Phase I Rancho Cucamonga Palos Verdes (310) 544-5307 $2,639,962.68 11/16 City of Cathedral City Bill Simmons Date Palm Dr. & Cathedral 68-700 Avenida Lalo Guerrero (760) 770-0340 Canyon Pavement Rehab Cathedral City, CA 92234 bsimmons d7cathedralcity.gov $939,000.00 11/16 City of Moreno Valley Henry Ngo Edgemont Neighborhood 14177 Frederick St (951) 413-3100 Pavement Rehabilitation Moreno Valley, CA 92552 lien ryn(d)mova1.org $383,000.00 12/16 City of Chino Hills Fe Rama FY 2016-2017 Street 14000 City Center Drive framaCu)chinohills.orq Improvement Project Chino Hills, CA 91709 (909) 364-2600 $1 ,039,000.00 12/16 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=disp layPWCRegi strationForm 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. Hardy&Harper,Inc Contract i By Steve Kirschner-Vice President Title Date: 12/21/16 DIR 4: 1000000076 C-12 1/5/2017 California Department of Industrial Relations-Contact DIR Public Works Public Works CC)i i:i"c,cto ! ~"v'4Y i ? . `oi sb," fit! 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 Coda_) Enter at least one search criteria to display active registered public works contractors)matching your selections. Registration Year: Current Fiscal Year: 2016/17 PWC Registration Number cxarnple 1234567890 Contractor Legal Name: Hardy&Harper, Inc Cor,Factor Li.e r ;e.Lookup License Number: oxa nple. 1234116 County: Select County Fxportas: Search Results One registered contractor found. 1 Details Legal Name Registration County City Registration Expiration Number Date Date View HARDY&HARPER,INC. 1000000076 ORANGE SANTA ANA 06/08/2016 06/30/2017 v2,20101101 €Z Conditions of Use Privacy Policy Disclaimer Disability accommodation Site Help Copyright©2015 State of California hftps:Hefiling.dir.ca.gov/PWCR/Search.action 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): 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: Hardy&Harper,Inc Contact Person: Steve Kirschner Contact Phone: 444 851 Signed: Date: 12/21/16 *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 EXHIBIT A DISADVANTAGED BUSINESS ENTERPRISE (DBE) This Project is subject to Part 200.321, Title 2, Code of Federal Regulations entitled "Contracting with Small and Minority Businesses, Women's Business Enterprises, and Labor Surplus Area Firms." The Regulations in their entirety are incorporated herein by this reference. It is the policy of the City that disadvantaged business enterprises (DBEs), as defined in Part 200.321, Title 2 CFR, shall be encouraged to participate in the performance of Contracts financed in whole or in part with federal funds. The Contractor should ensure that DBEs, as defined in Part 200.321, Title 2 CFR, have the opportunity to participate in the performance of this Contract and shall take all necessary and reasonable steps, as set forth in Part 200.321, Title 2 CFR, for this assurance. The Contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of subcontracts. Failure to carry out the requirements of this paragraph shall constitute a breach of Contract and may result in termination of this Contract or other remedy the City may deem appropriate. Bidders shall be fully informed respecting the requirements of the Regulations and are urged to obtain DBE participation in this project, although there is no specific goal for DBE participation. C-14 EXHIBIT B DBE INFORMATION GOOD FAITH EFFORTS Federal-aid Project No.1541 Bid Opening Date 1/10/17 The City of Huntington Beach established a Disadvantaged Business Enterprise (DBE) goal of 0% 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 ifs 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 DBI=; Commitment" form may not provide Sufficient documentation documentation to demonstrate that adequate good faith efforts were made. The following items are listed in the Section entitled "Submission of DBE Commitment" oil'the Special Provisions: A. The names and dates of each publication in which a request for DBE participation 1-or this project was placed by the bidder (please attach copies of advertisements or proofs of' publication): Publications Dates of"Advertisement Focus iournal 1/4/17 Trade Journal --- 1/4/17 ---- Twiner - - — --- 1/4/1"/-- — ------- 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 l'ollow Up Methods Solicitation and Dates Please see accompany_Goodlailh Documents C-15 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 accompany Goodfaith Documents 100%of subcontractors amount 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: sr- e, did MY feXl ve 00-i -%�- 0u0tt-'- rX1 -ftt/ Names, addresses and phone numbers of firms selected for the work above: n(A I_?. 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: Please see accompay Goodfaith Documents C-16 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: Plans and specs were provided via Email to interested DBE subcontractor 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 accompany Goodfaith Documents 1-1. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): Please see accompany Goodfaith Documents NOTE USI ADDITIONAL, SHEETS OF PAPER IF N17CESSARY. C-17 IF A SOLE OWNER OR SOLE CONTRACTOR SIGN HERE: (1) Name under which business is conducted (2) Signature(given and surname)of proprietor (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail IF A PARTNERSHIP, SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname and character of partner) (Note: Signature must be made by a general partner) (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail C-18 IF A CORPORATION. SIGN HERE: (1) Name under which business is conducted Hardy&Harper,Inc (2) (Signature) Steve Kirschner-Vice President (Title) Impress Corporate Seal here (3) Incorporated under the laws of the State of California (4) Place of Business 1312 E.warner Ave. (Street and Number) City and State Santa Ana,CA (5) Zip Code 92705 Telephone No. 714-444-1851 (6) E-Mail skirschner@hardyandharper.com NOTARIAL ACKNOWLEDGMENT OF EXECUTION BY ALL SIGNATORIES MUST BE ATTACHED C-19 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 Orange ) On December 21, 2016 before me, Tina Pham, Notary Public Date Here Insert Name and Title of the Officer personally appeared Steve Kirschner Nam ) of Signer() who proved to me on the basis of satisfactory evidence to be the person(x) whose name( is/aye subscribed to the within instrument and acknowledged to me that he/sKe/trey executed the same in his/her/their authorized capacity(iefi), and that by his/hor/their signature(x)on the instrument the person(a), or the entity upon behalf of which the person(x) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. TINA PHAM COMM.#2149384 M Notary Public-California T ~'s3 ORANGE COUNTY LL Signature_ °tea My Comm,Expires Apr17,2020 Sign ture 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: Corporation _ Document Date: December 21,2016_ Number of Pages: 1 Signer(s) Other Than Named Above: None _ Capacity(ies) Claimed by Signer(s) Signer's Name: Steve Kirschner Signer's Name: ❑✓ Corporate Officer — Title(s): dice PrPciriant ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑ Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: Hardy&Harper Inc e :< x ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item tt5907 List below names of president, vice president, secretary and assistant secretary, if a corporation; if a partnership, list names of all general partners and managing partners: Fred T.Maas,Jr-President,Treasurer Dan T.Maas-CEO Steve Kirschner-Vice President Kirsten S.Paulino-Secretary C-20 EXHIBIT C LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCAL AGENCY: City of Huntington Beach LOCATION: PROJECT DESCRIPTION: Curb Access Ramp Installation Project TOTAL CONTRACT AMOUNT:$ BID DATE: 1/10/16 BIDDER'S NAME: Hardy&Harper,Inc CONTRACT DBE GOAL: CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE DOLLAR AMOUNT ITEM NO. OR SERVICES TO BEANDEXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened- include DBE address O BE PROVIDED(or contracted if the and phone number) bidder is a DBE) For Local Agency to Complete: Total Claimed DBE Local Agency Contract Number: Participation Federal-aid Project Number: % Federal Share: Contract Award Date: Local Agency certifies that all DBE certifications have been verified and information is complete and accurate. Signature of Bidder 1/10/16 714-444-1851 Date (Area Code)Tel.No. Print Name Signature Date Steve Kirschner-Vice President Local Agency Representative Person to Contact (Please Type or Print) (Area Code)Telephone Number: Local Agency Bidder DBE Commitment(Construction Contracts) (Rev 6/26/09) C-21 PLEASE NOTE: This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must be submitted and received as specified in the Special Provisions. Failure to submit the required DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project regardless of tier. Names of the First-Tier DBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of DBE firms. Exhibit 15-G must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local 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. C-22 EXHIBIT D EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder Hardy&Harper,Inc [proposed subcontractor J hereby certifies that he/she/it 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/she/it 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. (eeoc.gov/employers/eeolsurvey/index.cfm) 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. Signature: Date: 12/21/16 Print Name: Steve Kirschner Title: Vice President C-23 EXHIBIT E NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) [NAME OF CONTRACT] To the City of Huntington Beach In conformance with Title 23 United States Code Section 112 and California 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 Bidder's Proposal. By signing the Proposal, the Bidder has also signed this Noncollusion Affidavit. Bidders are cautioned that making a false Certification may subject the Bidder to criminal prosecution. Signature: Date: 12/21/16 Print Name: Steve Kirschner Title: Vice President C-24 EXHIBIT F 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 with Bidder 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 him/her 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. Note: 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. Signature: 0 Date: 12/21/16 Print Name: Steve Kirschner Title: Vice President C-25 EXHIBIT G 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. '7� Signature: Date: 12/21/16 Print Name: Steve Kirschner Title: Vice President C-26 EXHIBIT H 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: [71 a.contract FAI a.bid/offer/application FA] a.initial b.grant b.initial award b.material change c.cooperative agreement c.post-award d.loan For Material Change Only: e.loan guarantee year quarter f.loan insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: ®Prime Subawardee Tier if known N/A Congressional District,if known Congressional District,if knovnn 6. Federal Department/Agency: 7. Federal Program Name/Description: N/A CFDA Number,if applicable 8. Federal Action Number,if known: 9. Award Amount,if known: N/A 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. I Oa) (last name,first name,MI) None None (attach Continuation Sheet(s)if necessary) 11. Amount of Payment(check all that apply) 13. Type of Payment(ebeck all that apply) None Actual planned a.retainer b.one-time fee 12. Form of Payment(ebeck all that apply): e.commission Ha.cash d.contingent fee b.in-kind; specify: nature e deferred value El 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: Hardy&Harper,Inc has not paid any funds in regards o thi pproject (attach ContiRation heet(ss}tFnecessary) 15. Continuation Sheet(s)attached: Yes No 16. Information requested through this form is authorized by Title Z"'�4 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above when his transaction was made or entered into.This disclosure is required pursuant to 31 U.S.C. Print Name: Steve Kirschner 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any Title: Vice President 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 Telephone No.: 714-444-1851 Date: 12/21/16 $100,000 for each such failure. Authorized for Local Reproduction Federal Use Only: Standard Form-LLL Standard Form LLL Rev.09-12-97 C-27 INSTRUCTIONS FOR COMPLETION OF EXHIBIT H, 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 C-28 (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12)Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13)Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 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. By my signature on this proposal I certify, under penalty of perjury under the laws of the State of California, that the foregoing questionnaire and statements of Public Contract Code Sections 10162, 10232 and 10285.1 are true and correct and that the bidder has complied with the requirements of Section 8103 of the Fair Employment and Housing Commission Regulations (Chapter 5, Title 2 of the California Administrative Code). C-29 EXHIBIT I FEDERAL LOBBYING RESTRICTIONS Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower tier subrecipient 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 Proposal. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Proposal. Signing the Proposal 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: 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 person(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. C-30 1/10/2017 Ad Proofs I FY 16/17 Curb Access Ramp Installation Project FOCUS JOURNAL AD The advertisement below was published in the DBE GoodFaith Minority, Women, Small, & Disabled Veteran Business Focus Journal at www.dbegoodfaith.com on 01/04/2017 07:25 AM. The ad ran from the publication date until the bid date listed on the notice. jVar11 &1,Ha,p,,, Ins: Hard & Harper, Inc. v is seeking qualified DBE Corey Kirschner FY 16/17 Curb Access Ramp Installation Project 1312 E.Warner Ave. 1541 Santa Ana, CA 92705 Tel: (714)444-1851 ext. Fax: (714)444-2801 Email: City of Huntington Beach cKirschner@hardyandharper.com Huntington Beach,Orange County,CA 01/10/2017 at 2:00 t atF Trucking, PVC Sleeves,Storm Water Pollution Prevention Plan, Truncated Domes We are an equal opportunity employer.The plans and specs are available for your review at our office or we can fax you the proposal schedule. Bonds will not be required from qualified subcontractors. https://www.dbegoodfaith.com/submit_order/dots/ad_proofs,php?docs_adid=372.20 1/3 1/10/2017 Ad Proofs I FY 16/17 Curb Access Ramp Installation Project TRADE JOURNAL AD The advertisement below was published in the DBE GoodFaith's Minority, Women, Small, & Disabled Veteran Business Trade Journal, Outreach Impact, at www.trade.dbegoodfaith.com on 01/04/2017 07.25 AM. The ad ran from the publication date until the bid date listed on the notice. lVall, & Harper, n(. Hardy & Harper, Inc. is seeking qualified DBE Corey Kirschner FY 16/17 Curb Access Ramp Installation Project 1312 E.Warner Ave. 1541 Santa Ana,CA 92705 Tel:(714)444-1851 ext. Fax:(714)444-2801 Email: City of Huntington Beach cKirschner@hardyandharper.com Huntington Beach,Orange County,CA 01/10/2017 at 2:00 Trucking, PVC Sleeves, Storm Water Pollution Prevention Plan, Truncated Domes We are an equal opportunity employer.The plans and specs are available for your review at our office or we can fax you the proposal schedule.Bonds will not be required from qualified subcontractors. TWITTER POST The Twitter post below was published at www.twitter.com/dbegoodfaith on 01/04/2017 07:25 AM. D13E GoodFaith Inc. Hardy & Harper, Inc. is seeking DBE s in Huntington Beach - dbegoodfaith .com/good-faith-ad. . . . https://www.dbegoodfaith.com/submit_order/docs/ad_proofs.php?docs_adid=37220 2/3 1/10/2017 Ad Proofs I FY 16/17 Curb Access Ramp Installation Project https://www.dbegoodfaith.com/submit—order/docs/ad_proofs.php?docs—adid=37220 3/3 1/10/2017 Sol iciation Log I FY 16/17 Curb Access Ramp Installation Project SOLICITATION LOG This document contains the solictations logs for: Project: FY 16/17 Curb Access Ramp Installation Project Contract/Bid #: 1541 Awarding Agency/Owner: City of Huntington Beach Certification Count Disadvantaged Business Enterprise (DBE) - 25 • Minority-Owned (MBE) - 17 • Women-Owned (WBE) - 8 TOTAL SOLICITED - 25 ACCESS GENERAL CONTRACTING INC 13736 GOLDENWEST ST.SUITE E•WESTMINISTER,CA,92683 Cert.#43229(Women-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status elizabeth@accessgeneralcontracting.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (714)646-6069 2017-01-04 08:13:58 Successful AMERICAN UTILITY PRODUCTS 1557 CANYON MEADOWS LANE•GLENDORA,CA,91740 Cert.#36950 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status sanjay.pandya@gmail.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date&Time Tranmission Status (626)335-9797 2017-01-04 08:12:52 Successful AYUS & CO 20908 ITASCA STREET•CHATSWORTH,CA,91311 Cert.#42425(Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. hftps://www.dbegoodfaith.com/submit_order/docs/solicitation_l og.php?docs_adi d=37220 1 1/10/2017 Soliciation Log I FY 16/17 Curb Access[Ramp Installation Project Email Transmission Email-Address Send Date&Time Delivery Status ayusandco@gmail.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (323)879-4848 2017-01-04 08:13:00 Successful BERT W SALAS, INC. 10769 WOODSIDE AVENUE,SUITE 201 •SANTEE,CA,92071 Cert.#77(Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status bsalaz@bertsalasinc.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date&Time Tranmission Status (619)258-3515 2017-01-04 08:12:58 Successful BUTLER & SON TRUCKING 441 E.MONTWOOD AVE.•LA HABRA,CA,90631 Cert.#15094 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status No Email Address n/a n/a Fax Transmission Fax Number Send Date &Time Tranmission Status (714)871-1834 2017-01-04 08:13:01 Successful CRIMSON MARIE COMPANY 11876 EABY RD•PHELAN,CA,92371 Cert.#37544 (Women-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date &Time Delivery Status SLT1992@yahoo.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (760)868-6814 2017-01-04 08:13:02 Successful CRUSH MATERIALS CORPORATION 4 DIAMANT WAY•ALISO VIEJO,CA,92656 https://www.dbegoodfaith.com/submit_order/docs/sol i citati on_l og.php?docs_adi d=37220 2H 1/10/2017 Soliciation Log I FY 16/17 Curb Access Ramp Installation Project Cert.#38958(Women-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status crush5555@aol.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (949)305-6634 2017-01-04 08:13:38 Successful DM TRUCKING 2872 W.KEYS LANE•ANAHEIM,CA,92804 Cert.#41119 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status dfmcampos@aol.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (714)821-7860 2017-01-04 08:13:00 Successful FMF PANDION 721 SNAPDRAGON STREET•ENCINITAS,CA,92024 Cert.#42834 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status admin@fmfpandion.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status No Fax Number n/a n/a G & C EQUIPMENT CORP. 1875 W.REDONDO BEACH BLVD.#207•GARDENA,CA,90247 Cert.#820(Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date &Time Delivery Status gene@gandccorp.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (310)515-5046 2017-01-04 08:13:03 Successful https://www.dbegoodfaith.com/submit_order/docs/sol i citati on_l og.php?docs_adi d=37220 3/7 1/10/2017 Soliciation Log I FY 16/17 Curb Access Ramp Installation Project GSJ UTILITY SUPPLY & SERVICE 14565 S.VALLEY VIEW AVENUE#Z•SANTA FE SPRINGS,CA,90670 Cert.#38438 (Women-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status sandy@gsj-utility.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date&Time Tranmission Status (888)356-1250 2017-01-04 08:13:10 Successful HER-CON CONSTRUCTION SERVICES, INC. 758 S.HOLLENBECK AVENUE•COVINA,CA,91723 Cert.#36281 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status hercon7774511@aol.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (626)331-3638 2017-01-04 08:14:38 Failed JCI DESIGN AND ENGINEERING 3664 HOWARD AVE• LOS ALIMITOS,CA,90720 Cert.#39605 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status johnjche@yahoo.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date&Time Tranmission Status No Fax Number n/a n/a JL STORMWATER CONSULTANTS, INC 1720 BRIDGEHAMPTON PLACE•EL CAJON,CA,92019 Cert.#37409(Women-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status jane@jlstormwater.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date&Time Tranmission Status https://www,dbegoodfaith.com/submit_order/docs/sol icitati on_l og.php?docs_adi d=37220 �// 1/10/2017 Sol iciation Log I FY 16/17 Curb Access Ramp Installation Project (619)334-6750 2017-01-04 08:13:02 Successful MASKELL PIPE & SUPPLY INC 560 W.RINCON ST.•CORONA,CA,92880 Cert.#40662 (Women-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date &Time Delivery Status salmab@maskellpipe.com 2017-01-0408:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (909)574-8663 2017-01-04 08:14:16 Successful MICHAEL BONSANGUE JR. TRUCKING 640 PEPPERWOOD DRIVE•BREA,CA,92821 Cert.#42879(Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date &Time Delivery Status MBonsangue23@gmail.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status No Fax Number n/a n/a ONE TIME UTILITY SALES, INC 501 GARFIELD STREET•SANTA ANA,CA,92701 Cert.#40854(Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date &Time Delivery Status brian@onetimeutility.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (714)953-5720 2017-01-04 08:13:18 Successful PVF SALES 13707 BORATE ST.•SANTA FE SPRINGS,CA,90670 Cert.#34382 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date &Time Delivery Status andrick@pvfsales.com 2017-01-04 08:05:14 Delivered https://www.dbegoodfai th.com/submit_order/docs/sol i ci tati on_l og.php?docs_adi d=37220 5/ 1/10/2017 Soliciation Log I FY 16/17 Curb Access Ramp Installation Project Fax Transmission Fax Number Send Date&Time Tranmission Status (562)623-0909 2017-01-04 0814:18 Successful RAMCO GENERAL ENGINEERING CONTRACTOR 10545 DALE ROAD •AGUA DULCE,CA,91390 Cert.#40944 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date &Time Delivery Status ramco@socal.rr.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (661)268-7353 2017-01-04 08:13:17 Successful SO CAL CONSTRUCTION & CONSULTING SERVICES, INC 1030 KNOLL PARK LANE•FALLBROOK,CA,92028 Cert.#37385 (Women-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date &Time Delivery Status shari@socalcontractorccs.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (760)723-2736 2017-01-04 08:13:28 Successful TERRA WEST, INC 1061 TIERRA DEL REY,STE 204•CHULA VISTA,CA,91910 Cert.#36931 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date &Time Delivery Status roberto@terrawestinc.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date &Time Tranmission Status (619)568-3475 2017-01-04 08:13:30 Successful TERRADYNE LAX, INC 24881 ALICIA PARKWAY,STE E-327 •LAGUNA HILLS,CA,92653 https://www.dbegoodfaith.com/submit_order/docs/sol i citati on_l og.php?docs_adi d=37220 6/ 1/10/2017 Soliciation Log I FY 16/17 Curb Access Ramp Installation Project Cert.#36927 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status APALANIAPPAN@TERRADYNE.COM 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date&Time Tranmission Status (949)231-1700 2017-01-04 08:13:30 Successful TRIUMPH GEO-SYNTHETICS, INC. 1235 NORTH GROVE ST•ANAH EIM,CA,92806 Cert.#9076(Women-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status mccaa@triumphgeo.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date&Time Tranmission Status (714)237-1549 2017-01-04 08:14:34 Successful V A P CONSTRUCTION INC. 15705 BIRCHWOOD ST•LA MIRADA,CA,90638 Cert.#39166 (Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date &Time Delivery Status arvind@vapci.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date&Time Tranmission Status (714)551-9420 2017-01-04 08:13:26 Successful WESSEX INDUSTRIES, INC. 8619 RED OAK STREET•RANCHO CUCAMONGA,CA,91730 Cert.#43157(Minority-owned)was identified in the California Unified Certification Program database on 01/04/2017. Email Transmission Email Address Send Date&Time Delivery Status a.castillo@wessex-industries-inc.com 2017-01-04 08:05:14 Delivered Fax Transmission Fax Number Send Date&Time Tranmission Status (909)944-0127 2017-01-04 08:13:32 Successful https://www.dbegoodfaith.com/submit_order/docs/sol i citati on_I og.php?docs_adi d=37220 7/j Bid Bond Bid Bond Number:CSBA-3817 C0114TRACTOR: SURETY: (Name, legal status and address) (Name,legal status and principal place of business) Hardy&Harper,Inc. Fidelity and Deposit Company of Maryland 1312 E.Warner Avenue 777 South Figueroa Street,Suite 3900 Santa Ana,CA 92705 Los Angeles,CA 90017 OWNER This document has important legal (Name, legal status and address) consequences.Consultation with City of Huntington Beach An attorney is encouraged with respect 2000 Nlain Street its completion or modification. Huntington Beach,CA 92648 Any singular reference to Contractor,Surety,Owner or other party shall be considered Plural where applicable. BOND AMOUNT: Ten Percent(10%) of Amount Bid PROJECT:FY 16/17 Curb Access Ramp Installation Project from Various Locations,CC No. 1541 Project Number,if any: The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves,their heirs,executors,administrators,successors and assigns,jointly and severally,as provided herein.The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents,or within such time period as may be agreed to by the Owner and Contractor,and the Contractor either(1) enters into a contract with the Owner in accordance with the terms of such bid,and gives such bond or bonds as may be specified in the bidding or Contract Documents,with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner,for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof,or(2)pays to the Owner the difference,not to exceed the amount of this Bond,between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid,then this obligation shall be null and void,otherwise to remain in full force and effect.The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid.Waiver of notice by the Surety shall not apply to any extension exceeding sixty(60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents,and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty(60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor,the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to 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 here from 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 23rd dap of December_2016 Hardy&Harper,Inc. q (Pnncipa!) (Seal) (W',tness) (Title Fidelity and Deposit Company of Maryland (Surety) (Seal) (fitness) Karen Ritto (Title)Dwight Reilly,Attorney-in-Fact By arrangement with the American Institute of Architects, the National Association of Surety Bond Producers(NASBP) (www.nasbp.or ) makes this form document available to its members, affiliates, and t associates in Microsoft Word format for use in the regular course of surety business. NASBP vouches that the original text of this document conforms exactly to the text in AIA Document A310-2010, Bid Bond. Subsequent modifications may be made to the original text of this document by users,so careful review of its wording and consultation with an attorney are encouraged before its completion, execution or acceptance. 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 Orange ) On December 23 2016 before me, Tina Pham, Notary Public Date Here Insert Name and Title of the Officer personally appeared Steve Kirschner Name( of Signer who proved to me on the basis of satisfactory evidence to be the person(x) whose name(4�) is/axe subscribed to the within instrument and acknowledged to me that he/sPfe/they executed the same in his/her/their authorized capacity(ies), and that by his/hxr/their signature(g) on the instrument the person(a), or the entity upon behalf of which the person(x) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph mo is true and correct. TINA PRAM It WITNESS my hand and official seal. '~.... COMM.#2149384 n Notary Public-California ORANGE COUNTY a MY COMM.Expires Apr 17,2020 Signature Signat re 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: Bid Bond Document Date: December 23, 2016 Number of Pages: 1 Signer(s) Other Than Named Above: Dwight Reilly Capacity(ies) Claimed by Signer(s) Signer's Name: Steve Kirschner Signer's Name: 10 Corporate Officer — Title(s): Vim, Pre-ident ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited ❑General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: Hardy& Harper, Inc ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item#5907 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 12/23/2016 before me, Karen L. Ritto Notary Public personally appeared Dwight Reilly 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. KAREN L.RITTO COMM.#2138527 N ilemy Notary Public-California WITNES d and Official seal. ORANGE COUNTY LL Comm.Expires Dec 30,2019 7;7�� ) Signature Of Notary OPTIONAL- Though the data below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRII'TION OF ATTACHED DOCUMENT ❑ INDIVIDUAL Bid Bond ❑ CORPORATE OFFICER Title or Type of Document One ❑ PARTNER(S) Number of Pages ❑ MEMBER of LLC ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) 12/23/2016 ❑ GUARDIAN/CONSERVATOR Date of Document OTHER: SIGNER IS REPRESENTING: Signer(s) other than named above NA 4E OF PERSON(S) OR ENTITY(IES) ZURICH AMERICAN INSURANCE COMPANY Bond No. CSBA-3817 COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW 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 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 Daniel HUCKABAY;Dwight REILLY,Andrew WATERBURY,Arturo AYALA,Shaunna Rozelle OSTROM and Michael CASTANEDA,all of Orange,California, EACH its true and lawful agent and Attorney-in-Fact,to make,execute,seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds 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 Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 5th day of December,A.D.2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND us+4try '*a CEPO f� .' i irist;�'�ti SEAL i'—•— io5 o_ Secretary Vice President Eric D.Barnes Michael Bond State of Maryland County of Baltimore On this 5th day of December,A.D.2016,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,MICHAEL 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 acknowledged the execution of same, and being by me duly swom,deposeth and saith,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.Dann,Notary Public My Commission Expires:July 9,2019 POA-F 012-0079B City of Huntington Beach 2000 Main Street ® Huntington Beach, CA 92648 (714) 536-5227 ® www.huntingtonbeachca.gov Office of the City Clerk f n,tsosA Robin Estanislau, City Clerk April 27, 2017 Kalban, Inc. 26450 Ruether Ave. #201 Santa Clarita, CA 91350 RE: FY 2016/17 Curb Access Ramp Installation Project—CC-1541 Enclosed please find your original bid bond for CC-1541. Sincerely, Robin Estanislau, CIVIC City Clerk RE:pe Enclosure Sister Cities: Anjo, Japan a Waitakere, New Zealand Vb tC� lk- City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE for FY 2016/17 CURB ACCESS RAMP INSTALLATION PROJECT C.C. No. 1541 January 3, 2017 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Special Provisions: 1) Replace Section D "Sample Contract" in it's entirety in the Specifications with updated Section D in this Addendum. The "Sample Contract"was updated in December 2016. 2) Replace Appendix K, the "Prevailing Wage Schedule" in it's entirety in the Specifications with updated Appendix K in this Addendum. "General Decision Number: CA60035 11/11/2016" will be replaced with "General Decision Number: CA60035 12/23/2016." 3) Replace Appendix L, the "Federal Documents for CDBG Projects" in it's entirity in the Specifications with updated Appendix L in this Addendum. The documents were updated in December 2016. This is to acknowledge receipt and review of Addendum Number One, dated January 3, 2017. a�nf '.)\ �C�fc � 1 A) C• �--- Company Name By � - 7 Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Joseph Fuentes at (714) 536- 5431. 1 SECTION C PROPOSAL for the construction of FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT from VARIOUS LOCATIONS CC No. 1541 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 70 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 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 BID ITEMS ,u Item I)esc i hon uant�1 ' t t -Ios s tat Cost _ o �z �IM -W," .01*3 r I N E �S g, Xte11S'"© 1 Mobilization 1 LS Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 1 in 2 Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed curb, sidewalk, domes, retaining curb, sawcut, slot pave,etc.) 68 EA $ Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR using horizontal curb cutting machine as 3 shown on Curb Ramp Detail 2 in Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed W _ curb, sawcut,sidewalk,domes, retaining curb, etc.) 63 EA $ �� $ Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 3 in 4 Appendix H of Specifications (Item includes all appurtenances,curb&gutter, depressed curb, sawcut, t , W co sidewalk, domes, retaining curb,slot pave,etc.) 5 EA $ (�(�"" $ ac (.� -- Construct Case C Midblock or Case F/Case G/Case CM or Type C Directional Curb Access Ramp per Caltrans Std. Plan 5 A88A/A88B(Item includes all appurtenances, curb&gutter, depressed curb,sidewalk, domes, retaining curb,slot pave, CA etc.) 20 EA $ L4 l7 $ -1 oc� 6 Install truncated domes to existing Curb Ramp 123 EA $ -3( $ 7 Remove existing improvements and construct concrete • r meandering sidewalk per HB Standard Plan 207 500 SF $ $ TJ�Oc" Remove and reconstruct Cross Gutters per HB Standard Plan 8 205(Item includes all appurtenances,curb&gutter,slot pave, etc.) 3,800 SF $ � $ a700 — Remove and replace existing 6"or 8"Curb and Gutter per HB 9 Standard Plan 202 (Item includes all appurtenances and slot co pave, etc.) 100 LF $ -S $ S$-(o- 10 Install 4" PVC Sleeve for Street Assembly Sign per City of HB co Std. Plan 401 10 EA $ $ 10co— 11 Prepare Storm Water Pollution Prevention Plan (SWPPP) 1 LS $ Sc pp $ co 12 Install&Maintain Construction BMPs 1 LS $ $ «U06 TOTAL BID AMOUNT (BASIS OF AWARD) —SCHEDULE A $ a l C-2.1 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 TOTAL BID AMOUNT IN WORDS: S ed� v\&\-e c Note: 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. C-2.2 f 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 iOY Zv o $o�y-P 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 forl&% ", 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 4 ldder s Si nature ' C-2 From:CASE LAND SURVEYING INC. 17146288905 01 /10/2017 07:03 #479 P.001/001 Case Land Survi ying, Inc. Surveying * �Mappi.ng * GBSSerrnces California D1R1WgW ration 5Vo. 1000001533 Garry Z'. Vase, P.L.S. License #L5411 SBE cert0ed BID SHEET TO: All Bidders BID DATE: January 10,2017 SITE: FY 16-17 Curb Access Ramp Installation Project Huntington Beach ADDENDUMS: 1 'fire following is the surveying scope of work for the above site. Any work performed outside the described scope of work, will be provided at our standard hourly rate and will be billed per our union agreement,in segments of 4,6 or 8 hours. This bid is valid for 6 months. • Control • Calculations • Removal Limits • Sawcuts • Curb Access Ramps BCR to ECR(Detail 1) • Curb Access Ramps BCR to ECR(Detail 2) • Curb Access Ramps BCR to ECR(Detail 3) • Curb Access Ramps Mid-block,Case"F" Case"G",Case"CM"or Type"C" • Meandering Sidewalk • Cross Gutters Total.................$17,600.00 .. ._ ....... .. ......... ... ........ ...._... _... .... (RENTovml LAWS SFTAL ONT S'<PSC'T.tTDF;.R',*2IOVAL 7 TNflT_ARRAS.TffAT T4AYF ST tEET STATTtrNINC'r 8 tcT l7tiEs As� TT.ars CE12T FICrS7IC1�fS, vv E�:rt t T3Es:axT PRESEI�VATI(7N a� SURIv1EY. MOW RFOR.14tETt IIV H�LTIt KEGM zNTS.TOR EACH DAY T2Egwgla 1. The above bid is predicated upon Owner/Agency, or Contractor providing signed, approved and complete set of construction plans,job specifications, a minimum of 2 Horizontal control points, 1 Vertical control point and an electronic file of the project (AntoCAD 2004 or 2012 drawing format). The bid is also predicated upon traffic control, when needed, is to be provided by the Owner/Agency. The maximum value of outstanding, unexecuted change orders shall not exceed five percent of the contract total. Additional change order work will not be priced or performed until the outstanding amount is below the five percent value. Extra work must be approved in writing prior to work being performed. A minimum of one week is required after receipt of plans and/or AutoCAD,and a written request,to schedule a survey crew. Case Land Surveying maintains Connmercial General Liability Insurance with a limit of$1 million with a general aggregate limit of$2 million;Automobile Liability with a$1 million-,and Professional Liability hisurance with a limit of$1 million. hi addition,we.maintain an Umbrella Liability Policy of$9 million whrich is follow-form to underlying liability policies. This gives us coverage up to$I I million. We also maintain Workers Compensation hisurance as prescribed by law with a$1 million limit per annual aggregate. Thank you for the oppor unity to bid this project. 6145AC EekioffStreet Orange, C4 92868 (714)628-8948 fa.C(714)628-8905 E-nzaifaddress: cfsi@casefatzdsurveyang.conz 1 ` LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid or $10,000, whichever is greater, and the portion of the work to be done by such subcontractor. Bid 1, re"an&Address o ti State a CZ ss DIR I�olla� %=of ii p iI I.. 'di aki �X n Rini �l �'•� i i I i! iJ �i�pe ;i a� H`Items " SubcontractoNi,'��' License' '� ; i� ,Number iG;id=�lmount ;! Contract up (I Ipm ,;� rigi iia ,� M P Number a r , xlr �TCA 7`J° C*T. `- , WIAJ Pifact e* �'/70F, � � _elfN � �aS�. i-sand �u�•/ey t-4 V\-0,C-C— i% — Ioao(bLS�3' By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on - -17 , at 6"r4 CC.A&TA rA Date City State —� being first duly sworn, deposes and says that he or she is �►GF pi2E5I-P4E-4 , of A;�f�$,�,�fr, ate' - 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. 4'4 4-F Ail J'A/ C - Name of Bidder Signature of Bidder .?(L7►,7o/Py6Tdr/e� .hI�'�201 G9�T.� C Erl�Aic^A,��94�,� Address of Bidder C-4 1 1 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 FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT, (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. Contractor By dleC Title Date: I " 2 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 JM 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. K4L:B J n]l , Contractor By V K )0je Sr0E-.A'17 Title Date: C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Bidder Name Business Address 15,11,gA CG Ate/774 C'/} 47 133�2 City, State Zip (S'l 7 ) t;2:5 V helas- 2,d ac . cc�� Telephone Number Email Address State Contractor's License No. and Class Original Date Issued 3- 3/ -1 ? Expiration Date The work site was inspected bygl*iQ7 eze— of our office on /2 —.'� f , 2016. The following are persons, firms, and corporations having a principal interest in this proposal: /1/,for/�.�� F�'�,�.✓ — ��s�.�.�r' it/XE-e- C-S/V F.�l C-8 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Company Name Signature of Bidder Printed or Typed Signature Subscribed and sworn to before me this day of; , 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 <41.14004 i A- ) County of LD S A&gr4 dr S ) On %iPn/ y 2Q/ 7 before me,/df/l /, �4� `� No-ratr fir' Month, Day, and Year Insert Name and Title of Notary personally appeared 'V19t, f- �dca C.c"" 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. " ' MICHAEL EDZI10 UF�EI' Commission # ------- f. z =o Notary Public-California z Los Angeles County ,, ' M Gomm.Expires Ma-5 )M B` Signature Signature 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: l. Sc lfTj� ,c—P ,t�E1GP�Fit/c d i,f T 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: 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: Contract Amount Type of Work Date Completed Provide additional project description to show similar work: C-10 "LBAN, INC. GENERAL ENGINEERING CONSTRUCTION 818-504-1065 Fax:818-504-1067 Recently Completed Projects and Reference List City of Burbank - Contact: Adam Salehi - 818-238-3946 2014-201 5 CDBG Street, Sidewalk Project Removal and Replacement of Damaged PCC Various Locations $432,876.00 2014 Sidewalk Repair Removal and Replacement of Damaged PCC Various Locations $625,000.00 2011-201 3 CDBG Street, Sidewalk Project Removal and Replacement of Damaged PCC Various Locations $626,944.00 2009-2012 CDBG Street, Sidewalk Project Removal and Replacement of Damaged PCC Various Locations $568,945.00 2010 - 2011 Sidewalk Repair Program Removal and Replacement of Damaged PCC Various Locations $1,571,050.00 2009 - 2010 Sidewalk Repair Program Removal and Replacement of Damaged PCC Various Locations $334,000.00 2008 - 2009 Sidewalk Repair Program Removal and Replacement of Damaged PCC Various Locations $1,100,000.00 2007 CDBG Street Project Removal and Replacement of Damaged PCC Various Locations $1 20,000.00 2006 Sidewalk Repair Project Removal and Replacement of Damaged PCC Various Locations $535,230.00 2005 Oak St. & Bel Air Dr. Improvements Street Reconstruction Asphalt Resurfacing, PCC Replacment $720,000.00 City of Anaheim - Contact: Mike Wood - 714-765-51 10 2014 Master Agreement Removal andiReplacement of Damaged PCC Various Locations $858,1 90.00 2013 Concrete R&R Services Annual Removal and Replacement of Damaged PCC Various Locations $1,500,000.00 2010 Concrete R&R Services Annual Removal and Replacement of Damaged PCC Various Locations $1,560,000.00 2008-2009 Resort Maintenance Removal and Replacement of Damaged PCC Various Locations $1 20,000.00 2007-2008 Resort Maintenance Removal and Replacement of Damaged PCC Various Locations $260,000.00 2005-2006 Resort Maintenance Removal and Replacement of Damaged PCC Various Locations $120,000.00 City of Inglewood - Hunter Nguyen - 310-412-5333 2013 Pedestrian Wheelchair Accessible Ramps Removal and Replacement of Damaged PCC Various Locations $407,000.00 2014 Sidewalk Replacement Project Removal and,Replacement of Damaged PCC Various Locations $256,000.00 2012 Sidewalk&Wheelchair Ramp Improvments Removal and Replacement of Damaged PCC Various Locations $531,443.00 City of Lawndale - Miguel Alvarez - 310-973-3265 166th &Condon Improvements Street Reconstruction Asphalt Resurfacing, PCC Replacment $1,579,048.00 2013 1 56th et al, Street Reconstruction Street Reconstruction Asphalt Resurfacing, PCC Replacment $495,840.00 2013 Citywide Concrete Repairs Removal and Replacement of Damaged PCC Various Locations $383,294.00 City of Paramount - Contact:John Crowe - 949-690-2412 2014 Annua.! Sidewalk Replacement Removal and Replacement of Damaged PCC Various Locations $273,000.00 2014 Annual Sidewalk Replacement Removal and Replacement of Damaged PCC Various Locations $310,000.00 City of Irvine - Contact: Reza Jafari - 949-724-7600 2014 Concrete Infrastructure Repair Removal and Replacement of Damaged PCC Various Locations $243,000.00 2013 Curb Ramp Upgrades ADA Compliance PCC& Misc Structures $868,781.00 City of Whittier - Contact: Alfredo Hernandez - 562-567-9850 Construction of Access Ramps Removal and Replacement of Damaged PCC Various Locations $1 21,612.00 Construction of Sidewalks Removal and Replacement of Damaged PCC Various Locations $1 70,000.00 2014 Construction of Access Ramps Removal and Replacement of Damaged PCC Various Locations $1 27,000.00 2013 Alley Improvement Rehabilitation Alley Improvements $1 84,578.00 City of Glendale - Contact: Sarkis Oganesyan - 818-937-8242 2013 ADA Curb ramp Installation Program Removal and Replacement of Damaged PCC Various Locations $799,335.00 2008/2009 ADA Curb Ramps Removal and Replacement of Damaged PCC Various Locations $1,234,404.00 2007/2008 ADA Curb Ramps Removal and Replacement of Damaged PCC Various Locations $1,038,000.00 2005/2006 ADA Curb Ramps Removal and.Replacement of Damaged PCC Various Locations $1,071,000.00 San Fernando Corridor Street Improvements Street Reconstruction Asphalt Resurfacing, PCC Replacment $422,000.00 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. ff?�.4liYEt� Name of proposed Project Manager Telephone No. of proposed Project Manager: 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. Name of proposed Superintendent Telephone No. of proposed Superintendent: 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 C-11 OFFICER EMPLOYMENT HISTORY Miron Kalebjian 1986—Present KALBAN,INC. Owner,President 1980— 1986 DYNO CONSTRUCTION General Manager, Chief Estimator.and Project Manager 1978— 1980 ANTHONY INDUSTRIES Chief Estimator and Project Manager 1976— 1978 URIBE CORPORATION Estimator Dave Poole 2000—Present KALBAN,INC. Vice President, Chief Estimator and Project Manager 1983 —2000 NOBEST,INC. Chief Estimator and Project Manager 1980— 1983 DYNO CONSTRUCTION Estimator and Project Manager 1978— 1980 EXCEL PAVING, INC. Estimator 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/PubllcWorks/SB 854FactSheet_6.30.14.pdf DIR's Contractor Registration Link—Call (844) 522-6734 https://efiling.dir.ca.gov/PWCR/ActionServlet?action=displayP WCRegistrationForm 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. KAG759 1 Contractor By Vl ccF ,O.PEs����✓'l Title Date: DIR#: /DOGL�,2'72 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: 1<4C.&n/A IV C_ . Contact Person: 'Tlq.�7F �OvoL e Contact Phone: Signed: Date: *Note: The above certification is required by the Department of Housing and Urban Development (24 CFR 135 and Subtitle A et al) and must be submitted by the bidders and proposed sub-contractors only in connection with contracts and subcontracts which are subject to Section 3 of the 1968 Housing and Urban Development Act, as amended in 1992 (HUD). Previous non-compliance with Section 3 could result in disqualification. C-13 EXHIBIT A DISADVANTAGED BUSINESS ENTERPRISE (DBE) This Project is subject to Part 200.321, Title 2, Code of Federal Regulations entitled "Contracting with Small and Minority Businesses, Women's Business Enterprises, and Labor Surplus Area Firms." The Regulations in their entirety are incorporated herein by this reference. It is the policy of the City that disadvantaged business enterprises (DBEs), as defined in Part 200.321, Title 2 CFR, shall be encouraged to participate in the performance of Contracts financed in whole or in part with federal funds. The Contractor should ensure that DBEs, as defined in Part 200.321, Title 2 CFR, have the opportunity to participate in the performance of this Contract and shall take all necessary and reasonable steps, as set forth in Part 200.321, Title 2 CFR, for this assurance. The Contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of subcontracts. Failure to carry out the requirements of this paragraph shall constitute a breach of Contract and may result in termination of this Contract or other remedy the City may deem appropriate. Bidders shall be fully informed respecting the requirements of the Regulations and are urged to obtain DBE participation in this project, although there is no specific goal for DBE participation. C-14 EXHIBIT B DBE INFORMATION—GOOD FAITH EFFORTS Federal-aid Project No. C'C Ale. 1 f 7l Bid Opening Date / —/D—/ 7 (? ,Z tov The City of Huntington Beach_established a Disadvantaged Business Enterprise (DBE) goal of 0% 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 ,yr-- 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 Solicitation and Dates C-15 KAILBAN, INC. GENERAL ENGINEERING CONSTRUCTION 26450 Ruether Ave., #201., Santa Clarita, CA 91350 Fax: 818-504-1067 License No.#507550-A December 30, 2016 Written Notice of Intent to Bid KALBAN,INC.is bidding the following project as a prime contractor. Included in this listing are the portions of work that we have allocated to be bid on by available subcontracting firms,including DBE/MBE/DVBE/WBE firms. City of Huntington Beach FY16-17 Curb Ramp Installation Project Bid Opening January 10,2017 @ 2:00 The work,in general,consists of removing and constructing sidewalk,curb&gutter and WCR's; and doing other work appurtenant thereto. 11%of the categories listed are allocated for MBE/WBE/DBE/DVBE sub-contracting. Traffic Control Systems Concrete Removal Excavation Truncated Domes Minor Concrete Utility Adjustment Minor Asphalt Con Trucking Rentals If you are an interested DBE/MBE/DVBE/WBE sub contractor, KALBAN INC. can provide information about the plans, specifications and requirements for the selected subcontracting work. KALBAN, INC. requests that your company submit a proposal for the sub-work allocated. Please be advised the KALBAN, INC.,when applicable can assist interested DBE subcontractors in obtaining bonds, lines of credit or insurance. If you have any questions about this project, please feel free to contact our DBE/MBE/WBE/DVBE administrator Michael E. Lifsey at 818-504-1065. Thank you for your time. 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: il�b.�Jtr ,��l�?cam 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: 4,k1OAV4-- C-16 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-17 IF A SOLE �ER OR SOLE CONTRACTOR SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname) of proprietor (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail IF A PARTNE<SHIP, SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname and character of partner) (Note: Signature must be made by a general partner) (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail C-18 IF A CORPORATION, SIGN HERE: (1) Name under which business is conducted _��ir{G MAI /N, (2) •�, , �"--� (Signature) kI�eE (Title) Impress Corporate Seal here (3) Incorporated under the laws of the State of eltfL/f:a& tJl� (4) Place of Business. 'C/0 4eLhMW_Ayc 42e j (Street and Number) City and State L75AA,1 TA— f 4,t,&j72V . rA (5) Zip Code Telephone No. III? An'ic__ (6) E-Mail /k-*,4 4-13•ti(1//V NOTARIAL ACKNOWLEDGMENT OF EXECUTION BY ALL SIGNATORIES MUST BE ATTACHED C-19 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 valididity of that document State of California ss. County of Los Angeles On / ^ 9 - / 7 . before me, Michael Edward Lifsey, Notary Public personally appeared David E. Poole who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entitiy upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true MICHAEL EDWARD LIFSEY and correct. Commission # 2063890 z Notary Public California D WITNESS my hand and official eal Z Los Angeles County M Comm.Expires May 5,2018 „ Signature;� u ot blic OPTIONAL Though the information below is not required by law, it may prove valuable to perso relying on the document and could prevent fradulent removal and reattachment of this form to a they document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer Other Than Named Above: Capacity Claimed by Signer Signer's Name: Dave Poole Individual Corporate Otticer-Title: Vice President Partner Attorney-in-fact Trustee Guardian Other: Signer is Representing: Kalban, Inc.! List below names of president, vice president, secretary and assistant secretary, if a corporation; if a partnership, list names of all general partners and managing partners: Afi ErR T)AA) 41 ry ytc E 0aeej Oi7�itly c-20 1 ' 1 EXHIBIT C LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCAL AGENCY: /�//V �.1� LOCATION: 44WJIQS PROJECT DESCRIPTION��� �Cc"e's S TOTAL CONTRACT AMOUNT:S BID DATE: J 10—r 1,/d BIDDER'S NAME: i-. CONTRACT DBE GOAL: CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE OLLAR AMOUNT ITEM NO, OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened-include DBE address O BE PROVIDED (or contracted if the and phone number) bidder is a DBE) RYA G/� For Local Agency to Complete: Total Claimed DBE $ ij t�yry Local Agency Contract Number: Participation i Federal-aid Project Number: , Federal Share: Contract Award Date: Local Agency certifies that all DBE certifications have been verified and \ information is complete and accurate. Signature of Bidder 1-9-/ T 011, y Date (Area Code)Tel.No. Print Name Signature Date -W or 4=%4 Local Agency Representative Person to Contact (Please Type or Print) (Area Code)Telephone Number: Local Agency Bidder DBE Commitment(Construction Contracts) (Rev 6/26/09) C-21 PLEASE NOTE: This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must be submitted and received as specified in the Special Provisions. Failure to submit the required DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date; Bidder's Name, and Contract DBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project regardless of tier. Names of the First-Tier DBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of DBE firms. Exhibit 15-G must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local 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. C-22 EXHIBIT D EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder I ,�/. [proposed subcontractor J hereby certifies that he/she/it 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/she/it 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. (eeoc.gov/employers/eeolsur-vey/index.cfm) 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. Signature: - J\ Date: Print Name: 0992: L Jr Title: Jf/re: idr C-23 EXHIBIT E NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) [NAME OF CONTRACT] To the City of Huntington Beach In conformance with Title 23 United States Code Section 112 and California 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 Bidder's Proposal. By signing the Proposal, the Bidder has also signed this Noncollusion Affidavit. Bidders are cautioned that making a false Certification may subject the Bidder to criminal prosecution. Signature: 1��` �"— Date: gam/1 Print Name: .s ���L F Title: GJ)Ccr Aa?e � �? C-24 EXHIBIT F 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 with Bidder 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 him/her 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. Note: 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. g �, e �—" --�Si nature: Date:,, � � 7 r- Print Name: Title: C-25 EXHIBIT G 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. Signature: Date:- Print Name: A!;-:- Title: UDC' JazgL T C-26 EXHIBIT H DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S./. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: F-1 a.contract F-1 a.bid/offer/application ❑ a.initial b,grant b.initial award b.materia ange e.cooperative agreement c.post-award d.loan For Mat ial Change Only: c.loan guarantee y r quarter f.loan insurance date of last report 4. Name and Address of Reporting Entity 5. if Reporting Entity i No.4 is Subawardee, Enter Name and dress of Prime: Prime ri Subawardee Tier ifknown Congressional District,if known Congress' nal District,if known 6. Federal Department/Agency: 7. Feder Program Name/Description: C A Number,if applicable 8. Federal Action Number,if known: 9. Award Amount,if known: 10. a.Name and Address of Lobby Entity Individuals Performing Services (including (If individual,last name,first name,MI) address if different from No.10a) (last name,first name,MI) (attach Contin tion Sheet(s)if necessary) IL Amount of Payment(check all that apply) 13. Type of Payment(check all that apply) $ Actual pi ned 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 Service erformed or to be performed and Date(s)of Service,including officer(s),employee(s),or ember(s)contacted,for Payment Indicated in Item 11: (attach Continuation Sheet(s)if necessary) 15. Continuation She (s)attached: Yes13 No 16. Information req sted through this form is authorized by Title 31 U.S.C. Se on 1352. This disclosure of lobbying reliance Signature: was placed the tier above when his transaction was made or entered i .This disclosure is required pursuant to 31 U.S.C. Print Name: 1352. is information will be reported to Congress semi, tmally and will be available for public inspection.Any Title: per n who fails to file the required disclosure shall be subject t a civil penalty of not less than$10,000 and not more than Telephone No.: Date: 100,000 for each such failure. Authorized for Local Reproduction ederal Use Only: Standard Form-LLL Standard Form LLL Rev.09-12-97 C-27 r INSTRUCTIONS FOR COMPLETION OF EXHIBIT H, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of covered Federal action or a material change to previous filing pursuant to title 31 U.S.C. section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered Federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. l) Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered Federal action. 2) Identify the status of the covered Federal action. 3) Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered Federal action. 4) Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5) If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. 6) Enter the name of the Federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7) Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8) Enter the most appropriate Federal identifying number available for the Federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001." 9) For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10)(a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered Federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (MI). 11)Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made C-28 (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12)Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13)Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 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. By my signature on this proposal 1 certify, under penalty of perjury under the laws of the State of California, that the foregoing questionnaire and statements of Public Contract Code Sections 10162, 10232 and 10285.1 are true and correct and that the bidder has complied with the requirements of Section 8103 of the Fair Employment and Housing Commission Regulations (Chapter 5, Title 2 of the California Administrative Code). C-29 EXHIBIT I FEDERAL LOBBYING RESTRICTIONS Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower tier subrecipient 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 Proposal. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Proposal. Signing the Proposal 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: 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 person(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. C-30 The Guarantee Company of North America USA 25800 Northwestern Highway, Suite 720, Southfield, MI 48075 BID BOND BOND NO. N/A KNOW ALL MEN BY THESE PRESENTS, That we, Kalban, Inc., 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 (10%) Percent of the Total Amount Bid, 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 FY 16/17 Curb Access Ramp Installation Project, CC No. 1541 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 sealed this 27th day of December, 2016. Kalban, Inc. BY- (Witness) Principal 'Q ITS: The Guarantee Company of North America USA i Corinne L.Hern ndez,Notary Publi (Witness) rWsr in,Attorney-In-Fact j THE The Guarantee Company of North America USA GUARANTEE© Southfield, Michigan POWER OF ATTORNEY NOW 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 Millennium Corporate Solutions,LLC William Syrkin,Sergio D.Bechara,Rebecca Ann Haas-Bates,Richard Leroy Adair its true and lawful attomey(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 31'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 Attomey-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 Attomey-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 Q TEE co its corporate seal to be affixed by its authorized officer,this 2n1 day of October,2015. '` THE GUARANTEE COMPANY OF NORTH AMERICA USA \vJM STATE OF MICHIGAN Stephen C.Ruschak,President&Chief Operating Officer Randall Musselman,Secretary County of Oakland On this 2nd day of October,2015 before me came the individuals who executed the preceding instrument,to me personally known,and being by me duly swom, 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 said K Cynthia A. Takai IN WITNESS WHEREOF,I have hereunto set my hand at The Guarantee Notary Public,State of Michigan Company of North America USA offices the day and year above written. County of Oakland �� �c•- My Commission Expires February 27,2018 Acting in Oakland County ww `" 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. 0° TEE-�*s IN WITNESS WHEREOF,I have thereunto set my hand and attached the seal of said Company this 27th day of December , 2016 o _ �oR71f AIAER�`P Randall Musselman,Secretary 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 2-1 ((P before me, Corinne L. Hernandez, Notary Public Date Here Insert Name and Title of the Officer personally appeared William Syrkin Name(s) of Signer who proved to me on the basis of satisfactory evidence to be the personN whose name() Ware subscribed to the within instrument and acknowledged to me that he/site/tf° executed the same in his/her/their authorized capacity(ies), and that by his/firer/their signatureO on the instrument the person(s), or the entity upon behalf of which the personN acted, executed the instrument. w I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing CORitdNE� HERN,4NDEZ i`y 9 9 I , Commission i�2033563 is true and correct. ate_. Notary Public California D WITNESS my hand,and offici I seal. mac " Los Angeles Count,/ my Comm.Expires Se 27 201C ` Sign ure .1 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:William Syrkin Signer's Name: Corporate Officer — Title(s). Corporate Officer — Title(s): Ll Partner — ❑ Limited ❑General L Partner — Ll Limited F-1 General 01 Individual XJ Attorney in Fact Ll Individual l Attorney in Fact •Trustee Guardian or Conservator I., Trustee C- Guardian or Conservator ❑ Other: ( Other: Si ner Is Representing:—Vht_ G o_rczrl-f-eC Signer Is Representing: Cit}1 cv t o� � -4V ri a SA ©2014 National Notary Association •www.NationalNotary.org• 1-800-US NOTARY(1-800-876-6827) Item#5907 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 valididity of that document State of California ss. County of Los Angeles On 1 —47 1 ? before me, Michael Edward Lifsey, Notary Public personally appeared David E. Poole who proved to me on the basis of satisfactory-evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entitiy upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true MICHAEL EDWARD biF AEY Commission # 2uo 090 and correct. Notary Fublic-California z Los Angeles County ' WITNESS my hand and officia seal My Comm.Ex ires May 5,2018 r i�-Fr C i' Signature of Notary P lic OPTIONAL Though the information below is not required by law, it may prove valuable to pers s relying on the document and could prevent fradulent removal and reattachment of this form to a other document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer Other Than Named Above: Capacity Claimed by Signer Signer's Name: Dave Poole Individual Corporate Officer-Title: Vice President Partner Attorney-in-fact Trustee Guardian Other: Signer is Representing: Kalban, Inc. City of Huntington Beach Fn 2000 Main Street ® Huntington Beach, CA 92648 (714) 536-5227 ® www.huntingtonbeachea.gov Office of the City Clerk 17,1909 Robin Estanislau, City Clerk April 27, 2017 Minako America Corporation dba Minco Construction 522 E. Airline Way Gardena, CA 90248 RE: FY 2016/17 Curb Access Ramp Installation Project—CC-1541 Enclosed please find your original bid bond for CC-1541. Sincerely, �&4vdjitu) Robin Estanislau, CIVIC City Clerk RE:pe Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand kit i,� r t 'Z a ✓ J } � �1� tx.. ti ti�ti e4'i 4za� J,tn i�.S'x.s'�' �i �,��' zl" ;. va fir• " ._ .. .....,... .. .__. __. _ _ - '.'f t .ir y 'ra '�d!~ 1't% � LJ� ++.l.j£' �[ x' Rf `� ,,#S` 7r ass. C �k«x✓ .,s^7% d'r 5.;3s a 3 " £ enemy x>gw � s���S sC F " a # �•' W '3 ' Yrt r»,r g 'F $ jar d'R E r 5 s is t mm s4 t E` !'� � a` 'r '$f�„�..+� a v e 'b Pik.--- ;R -•- >r.'r`�,3U-r� , � .2' E �c� ,,.�,.�y�k-�2�$ �P 4 ,- r 7�r-a � � (�g �vzP T �'•� '�a�d' i `#-�'r�r�'R'z� zr t -, �-y V t �f �, �# � a �°`Y^ s!a a 5l 'F s� M-d ' �'�~u�F {4 a � 4 i is f �: („� i•-I ? " LF `+� �; C� I - =e'• �tR �, e�akh"s E„ fk- �+�: � "�. ��'as r�'�` �rve�e" y "i�3xc) s t, (� � l e � `� 7 st a 2 f� � �t�'�� � TZ <" "+• a3 s" s 3 y— �R".:i�� r�?ln� �4'§g�Y`�xyr '� ��`zt ` a v ,p�al� °�' �Y` � � ,��' k €"'P � ••"" �� �' r . `5'f ?3 ^` "S" a" z 'St^m a fiat' t"z`^ F 6 �.v`yw.. .a -` v`5 -}Nr�' z� �a� z ,�. i�� �.7j�. F� � •3f � •� � a'� y s`x§s};��,.q#y�d C �.t"rjNrFti#'ww# :r�„� 7%1 ra3 .��;�;b" " �i av �� t"rx � i ri ny A '� ��� � "�^tr �1 �,,,� 0 i••I 2, d ;ham F �. ���q'�� ,,g,,�� °�'C{,t,� rs� � '�'S c��� "� k s i�` � 3� ¢„q • ■ y's - ,„ � M'�i .�`�i,f�"'' x's *r v lea °is�#.t,,�' k {y, V�{s ,�+�FY�� - }.+ F,r.%.!,,. _In -e &t-�„'�&i.... "�,#yi.�:;} r a ` r ,.i ' � 3 " 1f7'€�`'va � � x d,� �' r �, s-h{) e % :"a.#' ;x k,:a t r x fi + -.:agi Lf x�?�'m#� �2, ;E�� ..fie,; 14, O :a':a. :'�d s'� .,-a, �Z,� ,rf�` �"��;i �� � �',; �.3`�t �'� E�':"a� a. #� a `r�t^e�- #" �"' �Z�"% kA�';', �� �1�-t`, f ate?:.. yet� fit• Esc) f x" � its :F� .. ,i„�:,,g �, tr` �^*�'�,:�5, gt. *�.r E �•+� `''!_~€" �� , ��"?.«hr� "'s u: ar���'b�S�$..a�e''��� •��.t "s%`zfi r . C�3r-:'t�fr�.'�$ >-. ,� zb� fe� 3 -; t' 7s ' "$ .' r}*'?'4 '`'"p`s s'a,.d- ,`�k�'y 7 €sx s, srt,s1, •w eat .r-}sc='4 k { '. a _ � >~ =at �r"�-i. -,U r'3 `' # A» •rzM1 `e�"�x ' '3>==# t vkWw p. ze+.� ut rf nc Ejn.7 't t. �,, :a '` �S .yv�{ 4'>•:= 3;''` , } =d q.i�aa ,�si'i�, .,,;%R&,.�s t i # r. u' €' ;d..3- .':!$ ''t r-,=4t't#y"+a4�1':�,y *"' grv;.�,V4e," Ed.x'v lxl -r y'v {" `# .=t `i v�"r„ x +s -° a1- '� ,, I 041 !� ��ttJ' fz.rp �XA , �' w }% ,x '+ °"a:gar €' z�, ✓ r' R r c.1 a#,i 1 h , �r i"ix" h.{ f "a.a't 3'+,a v`' e ,�� a t c ,r rr t'Rsg g}W /V J •�� r� .3� �`'.�` `Y 4^C:S,�a }�t'�qt^ M'q Y4! N,h� 1 °fi '% `ty -sr � yU EL O 00 �* •r, � '5� ,t' §. et*;h a $' A. is !.€ x h ..•. '�" } x .;.p.4o ` 't Mt'+% e rY.� r ..a .f � a Y q 4 r a a e nor41 � 71. w, :. ce '. s.2.x` . City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE for FY 2016/17 CURB ACCESS RAMP INSTALLATION PROJECT C.C. No. 1541 January 3, 2017 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Special Provisions: 1) Replace Section D "Sample Contract" in it's entirety in the Specifications with updated Section D in this Addendum. The "Sample Contract" was updated in December 2016. 2) Replace Appendix K, the "Prevailing Wage Schedule" in it's entirety in the Specifications with updated Appendix K in this Addendum. "General Decision Number: CA60035 11/11/2016" will be replaced with "General Decision Number: CA60035 12/23/2016." 3) Replace Appendix L, the "Federal Documents for CDBG Projects" in it's entirity in the Specifications with updated Appendix L in this Addendum. The documents were updated in December 2016. This is to acknowledge receipt and review of Addendum Number One, dated January 3, 2017. Minako America Corporation dba Minco Construction '? " Company Name By Refa t Mina, President JAN 10, 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 Joseph Fuentes at (714) 536- 5431. 1 SECTION C PROPOSAL for the construction of FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT from VARIOUS LOCATIONS CC No. 1541 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 70 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 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 BID ITEMS 1 Mobilization 1 uS $`/?oaO $ 4 It oo 0 Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 1 in 2 Appendix H of Specifications (Item includes all appurtenances,curb&gutter,depressed curb,sidewalk, domes, retaining curb, sawcut, slot pave, etc.) 68 EA $��5 $ Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR using horizontal curb cutting machine as 3 shown on Curb Ramp Detail 2 in Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed � curb, sawcut, sidewalk, domes, retaining curb, etc.) 63 EA $S 75 rO $ 219,2 0.2S0 Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 3 in 4 Appendix H of Specifications (Item includes all appurtenances,curb&gutter, depressed curb, sawcut, sidewalk, domes, retaining curb, slot pave, etc.) 5 EA $ 6000 $ 30� DO0 Construct Case C Midblock or Case F/Case G/Case CM or Type C Directional Curb Access Ramp per Caltrans Std. Plan 5 A88A/A8813(Item includes all appurtenances,curb&gutter, depressed curb, sidewalk,domes, retaining curb, slot pave, O etc.) 20 EA $-1 $ 4000 6 Install truncated domes to existing Curb Ramp 123 EA $ O O $ 6/-s—o O 7 Remove existing improvements and construct concrete meandering sidewalk per HB Standard Plan 207 500 SF $ lS $ FY00 Remove and reconstruct Cross Gutters per HB Standard Plan 8 205(Item includes all appurtenances, curb&gutter, slot pave, etc.) 3,800 SF $ �� $ 5 40 C> Remove and replace existing 6"or 8"Curb and Gutter per HB 9 Standard Plan 202(Item includes all appurtenances and slot pave, etc.) 100 LF $ $ OO d 10 Install 4" PVC Sleeve for Street Assembly Sign per City of HB Std. Plan 401 10 EA $ 00 $ 0 Od 11 Prepare Storm Water Pollution Prevention Plan(SWPPP) 1 LS $ OOb $ OOo 12 Install&Maintain Construction BMPs 1 LS $ 000 $ Qop TOTAL BID AMOUNT (BASIS OF AWARD)-SCHEDULE A $ d0S aS0 C-2.1 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 TOTAL BID AMOUNT IN WORDS: �,•�a.., G(�c�,; 0--fjj2C,I4,A y �W0IAA d/�'e Od 61 do uTaAd b" i— Note: 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. C-2.2 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" in the amount of of thetoad lb9re pricei8 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: Addendd"' Date'IZeceived F 1 01/03/17 C-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. Name:"andAddress of State Class.: .DIR" Dollar %of Iterii(s) Subcontractor" " License Number Amount Contract Number- By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT 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 JAN10,2017 , at Gardena CA Date City State being first duly sworn, deposes and says that he or she is President of Minako America Corporation dba Minco Construction 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. Minako America Corporation dba Minco Construction Name of Bidder Si aturr dder Refaat H Mina, President 522 E Airline Way, Gardena, CA 90248 Address of Bidder C-4 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 JAN 10,2017 before me, Raffi Varooj Thomassian, Notary Public Date Here Insert Name and Title of the Officer personally appeared Refaat H Mina 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/sloe/they executed the same in his/Tier/+heir authorized capacity(iea),and that by his/hwA4eif signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. RAM VAROOJ THOMASSIAN t WITNESS my hand and official seal. Notary Public-California Z Los Angeles County M Comm.Expires Ma 12,2020 1 Signature t Commission #O / ignature 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: NONCOLLUSION AFFIDAVIT Document Date: 01/10/17 Number of Pages: One Signer(s) Other Than Named Above: No other signers Capacity(ies) Claimed by Signer(s) Signer's Name: Refaat H Mina Signer's Name: © Corporate Officer — Title(s): President ❑Corporate Officer — Title(s): ❑Partner — ❑ Limited ❑General ❑Partner — ❑ Limited ❑General ❑ Individual ❑Attorney in Fact ❑Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: 02014 National Notary Association - www.NationalNotary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907 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 FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT, (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. Minako America Corporation dba Minco Construction Contractor BY l Refaat Tina, President Title Date: 01/10/17 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. Minako America Corporation dba Minco Construction Contractor By Refaat H Mina, President Title Date: 01/10/17 C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Minako America Corporation dba Minco Construction Bidder Name 522 E Airline Way Business Address Gardena CA 90248 City, State Zip (310 ) 516-8100 mina@mincoconstruction.com Telephone Number Email Address 612429, A,B,C7,C10 State Contractor's License No. and Class FEB 10,1991 Original Date Issued 09/30/18 Expiration Date The work site was inspected by Amir Abraham of our office on DEC 28 , 2016 The following are persons, firms, and corporations having a principal interest in this proposal: Minako America Corporation dba Minco Construction Refaat H Mina, President,Secretary,Treasurer, Manager C-8 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Minako America Corporation dba Minco Construction ComAanym Sign urPina, idderRefaat HPresident Printed or Typed Signature Subscribed and sworn to before me this 110 day of JAN , 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 CA ) County of Los Angeles ) On JAN 10, 2017 before me, "Raffi Varooj Thomassian, Notary Public" Month, Day, and Year Insert Name and Title of Notary personally appeared Aiad Younan, Nashat Labib Habib Hana Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) i4are subscribed to the within instrument and acknowledged to me that ho ke/they executed the same in his44er/their authorized capacity(ies), and that by his/k*r/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. RAFFI VAROOJ THOM- - - Notary Public -California IL Z . m Los Angeles County Z � ,;* z Commission #2152450 Signature � ' L �"���.._ ........- My Comm.Expires May 12. 2020 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: 1. Los Angeles County, Department of Public Works, 900 South Fremont Ave. Alhambra, CA 91803 Name and Address of Public Agency Name and Telephone No. of Project Manager: Dennis Ittner, (562) 869-1176 $2,405,236.61 Repair and Maintenance Parkway Concrete 12/31/15 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Job order Contract for repair and Maintenance Parkway Concrete at Various Locations 2. City of Downey, 11111 Brookshire Avenue Downey, CA 90241-7016 Name and Address of Public Agency Name and Telephone No. of Project Manager: Desi Gutierrez, (562)622-3468 $ 544,796.00 Concrete 12/02/15 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Remove, Reconstruct, and Improvements PCC Sidewalk, Slab Ramp with Detectable Warning Device, Remove and Reconstruct Variable Height. 3. City of Brea, Public Works 1111 E.Artesia Boulevard 1 Civic center Circle, Brea, CA 92821 Name and Address of Public Agency Name and Telephone No. of Project Manager: Will Wenz, (714) 990-7695 $400,000 Concrete 06/30/16 Contract Amount Type of Work Date Completed Provide additional project description to show similar work: Removal and replacement of sidewalks, curbs and gutters,traffic control, saw cutting of pavement, removal of existing concrete, removal of tree roots, minor grading . 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. Moses Khalili Name of proposed Project Manager Telephone No. of proposed Project Manager: (310) 863-2201 Utilities Infrastructure Project Phase 2 $ 10,594,225.23 Utilities Infrastructure Project 01/13/14 Project Name & Contract Amount Type of Work Date Completed Annual Miscellaneous Concrete Construction and Repair $544,796.00 Concrete 12/02/15 Project Name & Contract Amount Type of Work Date Completed Parkway Concrete Maintenance $2,405,236.61 Concrete 12/31/15 Project Name & Contract Amount Type of Work Date Completed 2. Mina Ghaly Name of proposed Superintendent Telephone No. of proposed Superintendent: (310) 365-4656 Utilities Infrastructure Project Phase 2 $ 10,594,225.23 Utilities Infrastructure Project 01/13/14 Project Name & Contract Amount Type of Work Date Completed Parkway Concrete Maintenance $2,405,236.61 Concrete 12/31/15 Project Name & Contract Amount Type of Work Date Completed Annual Miscellaneous Concrete Construction and Repair $ 544,796.00 Concrete 12/02/15 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:Hefiling.dir.ca.gov/PWCR/ActionServiet?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." 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. Minako America Corporation dba Minco Construction Contractor By Refaat H Mina, President Title Date: 01/10/17 DIR#: 1000002728 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): X 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: Minako America Corporation dba Minco Construction Contact Person: Refaat H Mina Contact Phone: (310) 516- Signed: Date: 01 t 10t *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 EXHIBIT A DISADVANTAGED BUSINESS ENTERPRISE (DBE) This Project is subject to Part 200.321, Title 2, Code of Federal Regulations entitled "Contracting with Small and Minority Businesses, Women's Business Enterprises, and Labor Surplus Area Firms." The Regulations in their entirety are incorporated herein by this reference. It is the policy of the City that disadvantaged business enterprises (DBEs), as defined in Part 200.321, Title 2 CFR, shall be encouraged to participate in the performance of Contracts financed in whole or in part with federal funds. The Contractor should ensure that DBEs, as defined in Part 200.321, Title 2 CFR, have the opportunity to participate in the performance of this Contract and shall take all necessary and reasonable steps, as set forth in Part 200.321, Title 2 CFR, for this assurance. The Contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of subcontracts. Failure to carry out the requirements of this paragraph shall constitute a breach of Contract and may result in termination of this Contract or other remedy the City may deem appropriate. Bidders shall be fully informed respecting the requirements of the Regulations and are urged to obtain DBE participation in this project, although there is no specific goal for DBE participation. C-14 EXHIBIT B DBE INFORMATION—GOOD FAITH EFFORTS Federal-aid Project No. CC No.1541 Bid Opening Date 01/10/17 The City of Huntington Beach-established a Disadvantaged Business Enterprise (DBE) goal of 0%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 N/A 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 Solicitation and Dates N/A C-15 C. The items of work which the bidder made available to DBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items M of (Y/N) Contract N/A 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: N/A Names, addresses and phone numbers of firms selected for the work above: N/A E. Efforts made to assist interested DBEs in obtaining bonding, lines of credit or insurance, and any technical assistance or information related to the plans, specifications and requirements for the work which was provided to DBEs: N/A C-16 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: N/A 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 N/A H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): N/A NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. C-17 IF A SOLE OWNER OR SOLE CONTRACTOR SIGN HERE: (1) Name under which business is conducted N/A (2) Signature (given and surname) of proprietor (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail IF A PARTNERSHIP, SIGN HERE: (1) Name under which business is conducted N/A (2) Signature (given and surname and character of partner) (Note: Signature must be made by a general partner) (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail C-18 IF A CORPORATION, SIGN HERE: (1) Name under which business is conducted Minako America C rporation dba Minco Construction (2) r (Sig re) Refaat H Mina, esident (Title) Impress Corporate Seal here (3) Incorporated under the laws of the State of CA (4) Place of Business 522 E Airline Way (Street and Number) City and State Gardena, CA (5) Zip Code 90248 Telephone No. (310) 516-8100 (6) E-Mail mina@mincoconstruction.com NOTARIAL ACKNOWLEDGMENT OF EXECUTION BY ALL SIGNATORIES MUST BE ATTACHED C-19 List below names of president, vice president, secretary and assistant secretary, if a corporation; if a partnership, list names of all general partners and managing partners: Refaat H Mina, President Refaat H Mina, Vice President Refaat H Mina, Secretary Refaat H Mina, Assistant Secretary C-20 EXHIBIT C LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCAL AGENCY: City of Huntington Beach LOCATION: Huntington Beach, CA PROJECT DESCRIPTION: FY 16/17 Curb Access Ramp Installation Project TOTAL CONTRACT AMOUNT:$ Same as total bid amount C-2.1 BID DATE: 01/10/17 BIDDER'S NAME: Minako America Corporation dba Minco Construction CONTRACT DBE GOAL: As required by owner CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBEDOLLARAMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened-include DBE address O BE PROVIDED(or contracted if the and phone number) bidder is a DBE) Supplier Material Supplier Material 4595 Current Logan's Marketing As required For Local Agency to Complete: Total Claimed DBE $As required Local Agency Contract Number: Participation Federal-aid Project Number: As required % Federal Share: Contract Award Date: Local Agency certifies that all DBE certifications have been verified and , information is complete and accurate. Sign ure of B' er 01/1 /17 "Tel. Date Print Name Signature Date Refaat H na, Local Agency Representative Person to Contact (Please Type or Print) (Area Code)Telephone Number: Local Agency Bidder DBE Co nmitment(Construction Contracts) (Rev 6/26/09) C-21 PLEASE NOTE: This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must be submitted and received as specified in the Special Provisions. Failure to submit the required DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project regardless of tier. Names of the First-Tier DBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of DBE firms. Exhibit 15-G must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local 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. C-22 EXHIBIT D EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder Minako America Corporation dba Minco Construction , [proposed subcontractor Attached J hereby certifies that he/she/it 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/she/it 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. (eeoc.gov/employers/eeolsurvey/index.cfm) 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. Signature: Date: 01/10/17 Print Name: Refaat H Title: President C-23 EXHIBIT E NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) [NAME OF CONTRACT] To the City of Huntington Beach In conformance with Title 23 United States Code Section 112 and California 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 Bidder's Proposal. By signing the Proposal, the Bidder has also signed this Noncollusion Affidavit. Bidders are cautioned that making a false Certification may subject the Bidder to criminal prosecution. Signature: Date: 01/10/17 Print Name: Refaat H ' a Title: President C-24 EXHIBIT F 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 with Bidder 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 him/her 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. Note: 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. Signature: �d Date: 01/10/17 Print Name: Refaat H OUa Title: President C-25 EXHIBIT G 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. —4 Signature: � Date: 01/10/17 Print Name: Refaat 4na Title: President C-26 EXHIBIT H DISCLOSURE OF LOBBYING ACTIVITIES N/A 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 Ela.initial b.grant b.initial award b.material change c.cooperative agreement c.post-award d.loan For Material Change Only: e.loan guarantee year quarter f.loan insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: Prime Subawardee Tier if known Congressional District,if known Congressional District,if known 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number,if applicable 8. Federal Action Number,if known: 9. Award Amount,if known: 10. a.Name and Address of Lobby Entity b. Individuals Performing Services (including (If individual,last name,first name,MI) address if different from No. I Oa) (last name,first name,MI) (attach Continuation Sheet(s)if necessary) 11. Amount of Payment(check all that apply) 13. Type of Payment(check all that apply) $ ❑ Actual ❑planned a.retainer b.one-time fee 12. Form of Payment(check all that apply): c.commission 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: Yes11 No 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above when his transaction was made or entered into.This disclosure is required pursuant to 31 U.S.C. Print Name: 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any Title: person who fails to file the required disclosure shall be subject to a civil penalty of not less than$10,000 and not more than Telephone No.: Date: $100,000 for each such failure. Authorized for Local Reproduction Federal Use Only: Standard Form-LLL Standard Form LLL Rev.09-12-97 C-27 INSTRUCTIONS FOR COMPLETION OF EXHIBIT H, 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 C-28 (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12)Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13)Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 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. By my signature on this proposal I certify, under penalty of perjury under the laws of the State of California, that the foregoing questionnaire and statements of Public Contract Code Sections 10162, 10232 and 10285.1 are true and correct and that the bidder has complied with the requirements of Section 8103 of the Fair Employment and Housing Commission Regulations (Chapter 5, Title 2 of the California Administrative Code). C-29 EXHIBIT I FEDERAL LOBBYING RESTRICTIONS Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower tier subrecipient 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 Proposal. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Proposal. Signing the Proposal 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: 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 person(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. C-30 APPENDIX L FEDERAL DOCUMENTS FOR CDBG PROJECTS EXHIBIT A (Contractor's Proposal) SF:16-5 215/142605.doe/rev. 12/2016 EXHIBIT B (Form HUD-4010,the Federal Labor Standards Provision of the United States) Federal Labor Standards Provisions U.S.Department of Housing and Urban Development Office of Labor ReWlons Applicability (1) The work to be performed by the classification The Project or Program to which the construction work requested is not performed by a classification in the wage covered by this contract pertains is being assisted by the determination: and United States of America and the following Federal Labor (2) The classification is utilized In the area by the Standards Provisions are included In this Contract construction industry; and pursuant to the provisions applicable to such Federal (3) The proposed wage rate, including any bona fide assistance. fringe benefits,, bears a reasonable relationship to the A. 1. (1) Minimum Wages. All laborers and mechanics wage rates contained in the wage determination. employed or working upon the site of the work,will be paid (b) If the contractor and the laborers and mechanics to be unconditionally and not less often than once a week, and employed in the classification (if known), or their without subsequent deduction or rebate on any account representatives, and HUD or its designee agree on the (except such payroll deductions as are permitted by classification and wage rate (including the amount regulations issued by the Secretary of Labor under the designated for fringe benefits where appropriate), a report Copeland Act (29 CFR Part 3), the full amount of wages of the action taken shall be sent by HUD or its designee to and bona fide fringe benefits (or cash equivalents thereof) the Administrator of the Wage and Hour Division, due at time of payment computed at rates not less than Employment Standards Administration, U.S. Department of those contained in the wage determination of the Labor, Washington, D.C. 20210. The Administrator, or an Secretary of Labor which Is attached hereto and made a authorized representative, will approve, modify, or part hereof, regardless of any contractual relationship disapprove every additional classification action within 30 which may be alleged to exist between the contractor and days of receipt and so advise HUD or its designee or will such laborers and mechanics. Contributions made or notify HUD or Its designee within the 30-day period that costs reasonably anticipated for bona fide fringe benefits additional time is necessary. (Approved by the Office of under Section t(b)(2) of the Davis-Bacon Act on behalf of Management and Budget under OMB control number 1215- laborers or mechanics are considered wages paid to such 0140.) laborers or mechanics, subject to the provisions of 29 CFR (0) In b the event the contractor, the laborers or mechanics 5.5(a)(1)(Iv); also, regular contributions made or costs incurred for more than a weekly period (but not less often e employed in the classification or their re b than quarterly) under plans, funds, or programs, which representatives, and HUD or its designee do not agree hon e cover the particular weekly period, are deemed to be the proposed atedforfring and wage rate {including the constructively made or incurred during such weekly period. amount designated for fringe benefits, where appropriate), HUD or its designee shall refer the questions, including Such laborers and mechanics shall be paid the appropriate the views of all Interested parties and the recommendation wage rate and fringe benefits on the wage determination of HUD or its designee, to the Administrator for for the classification of work actually performed, without determination. The Administrator, or an authorized regard to skill, except as provided In 29 CFR 5.5(a)(4). representative,will issue a determination within 30 days of Laborers or mechanics performing work in more than one receipt and so advise HUD or Its designee or will notify classification may be compensated at the rate specified for HUD or its designee within the 30-day period that each classification for the time actually worked therein: additional time is necessary. (Approved by the Office of Provided, That the employer's payroll records accurately Management and Budget under OMB Control Number set forth the time spent In each classification In which 1215-0140.) work is performed. The wage determination (Including any (d) The wage rate (including fringe benefits where additional classification and wage rates conformed under 29 CFR 5.5(a)(1)(ii) and the Davis-Bacon poster (WH- appropriate) determined pursuant to subparagraphs 1321) shall be posted at all times by the contractor and its workers or (c) of this paragraph, shall io paid r all subcontractors at the site of the work in a prominent and workers performing work in the classification under this accessible, place where it can be easily seen by the contract from the first day on which work is performed in workers. the classification. (II) (a) Any class of laborers or mechanics which is not (lit) Whenever the minimum wage rate prescribed in the listed In the wage determination and which is to be contract for a class of laborers or mechanics includes a employed under the contract shall be classified in fringe benefit which is not expressed as an hourly rate, the conformance with the wage determination. HUD shall contractor shalt either pay the benefit as stated In the approve an additional classification and wage rate and wage determination or shall pay another bona fide fringe fringe benefits therefor only when the following criteria benefit or an hourly cash equivalent thereof. have been met: (iv) If the contractor does not make payments to a trustee or other third person, the contractor may consider as part form HUD-4010(0612009) Previous editions are obsolete Page 1 of 5 rel.Handbook 1344.1 SF:16-5215/142605.doc/rev. 12/2016 of the wages of any laborer or mechanic the amount of any communicated in writing to the laborers or mechanics costs reasonably anticipated in providing bona fide fringe affected, and records which show the costs anticipated or benefits under a plan or program, Provided, That the the actual cost Incurred in providing such benefits. Secretary of Labor has found, upon the written request of Contractors employing apprentices or trainees under the contractor, that the applicable standards of the Davis- approved programs shall maintain written evidence of the Bacon Act have been met. The Secretary of Labor may registration of apprenticeship programs and certification of require the contractor to set aside in a separate account trainee programs, the registration of the apprentices and assets for the meeting of obligations under the plan or trainees, and the ratios and wage rates prescribed in the program. (Approved by the Office of Management and applicable programs. (Approved by the Office of Budget under OMB Control Number 1215-0140.) Management and Budget under OMS Control Numbers 2. Withholding. HUD or Its designee shall upon its own 1215-0140 and 1215-0017.) action or upon written request of an authorized (it) (a) The contractor shalt submit weekly for each week representative of the Department of Labor withhold or in which any contract work is performed a copy of ail cause to be withheld from the contractor under this payrolls to HUD or its designee it the agency is a party to contract or any other Federal contract with the same prime the contract, but if the agency is not such a party, the contractor, or any other Federally-assisted contract contractor will submit the payrolls to the applicant subject to Davis-Bacon prevailing wage requirements, sponsor, or owner,as the case may be,for transmission to which is held by the same prime contractor so much of the HUD or Its designee. The payrolls submitted shall set out accrued payments or advances as may be considered accurately and completely all of the information required necessary to pay laborers and mechanics, including to be maintained under 29 CFR 5.5(a)(3)(i)except that full apprentices, trainees and helpers, employed by the social security numbers and home addresses shall not be contractor or any subcontractor the full amount of wages included on weekly Iransmlttals. Instead the payrolls shall required by the contract In the event of failure to pay any only need to include an individually Identifying number for laborer or mechanic, Including any apprentice, trainee or each employee (e.g., the last four digits of the employee's helper, employed or working on the site of the work, all or social security number). The required weekly payroll part of the wages required by the contract, HUD or its information may be submitted in any form desired. designee may, after written notice to the contractor, Optional Form WH-347 is available for this purpose from sponsor, applicant, or owner, take such action as may be the Wage and Hour Division Web site at necessary to cause the suspension of any further httor//www.dol.aov/esa/whd/formsAvh347instr.him or its payment, advance, or guarantee of funds until such successor site. The prime contractor is responsible for violations have ceased. HUD or its designee may, after the submission of copies of payrolls by all subcontractors. written notice to the contractor, disburse such amounts Contractors and subcontractors shall maintain the full withheld for and on account of the contractor or social security number and current address of each subcontractor to the respective employees to whom they covered worker, and shalt provide them upon request to are due. The Comptroller General shall make such HUD or its designee if the agency is a party to the disbursements in the case of direct Davis-Bacon Act contract, but if the agency is not such a party, the contracts. contractor will submit the payrolls to the applicant 3. (1) Payrolls and basic records. Payrolls and basic sponsor, or owner,as the case may be,for transmission to records relating thereto shall be maintained by the HUD or its designee,the contractor, or the Wage and Hour contractor during the course of the work preserved for a Division of the Department of Labor for purposes of an period of three years thereafter for all laborers and investigation or audit of compliance with prevailing wage mechanics working at the site of the work. Such records requirements. It Is not a violation of this subparagraph for shall contain the name, address, and social security a prime contractor to require a subcontractor to provide number of each such worker, his or her correct addresses and social security numbers to the prime classification, hourly rates of wages paid (including rates contractor for its own records, without weekly submission of contributions or costs anticipated for bona fide fringe to HUD or Its designee. (Approved by the Office of benefits or cash equivalents thereof of the types described Management and Budget under OMB Control Number in Section I(b)(2)(9) of the Davie-bacon Act), daily and 1215-0149.) weekly number of hours worked, deductions made and (b) Each payroll submitted shall be accompanied by a actual wages paid. Whenever the Secretary of Labor has 'Statement of Compliance,' signed by the contractor or found under 29 CFR 5.5 (a)(1)(iv) that the wages of any subcontractor or his or her agent who pays or supervises laborer or mechanic Include the amount of any costs the payment of the persons employed under the contract reasonably anticipated in providing benefits under a plan and shall certify the following: or program described in Section I(b)(2)(B) of the Davis- (1) That the payroll for the payroll period contains the Bacon Act, the contractor shall maintain records which information required to be provided under 29 CFR 5.5 show that the commitment to provide such benefits is (a)(3)(11), the appropriate Information is being maintained enforceable, that the plan or program Is financially under 29 CFR 5.5(a)(3)(I), and that such information is responsible, and that the plan or program has been correct and complete; Previous editions are obsolete form HUDr4010(0612009) Page 2 of 5 ref.Handbook 1344.1 SF:16-5215/142605.doc/rev. 12/2016 (2) That each laborer or mechanic (including each helper, is not registered or otherwise employed as stated above, apprentice, and trainee) employed on the contract during shall be paid not less than the applicable wage rate on the the payroll period has been paid the full weekly wages wage determination for the classification of work actually earned, without rebate, either directly or Indirectly, and performed. In addition, any apprentice performing work on that no deductions have been made either directly or the job site In excess of the ratio permitted under the Indirectly from the full wages earned, other than registered program shall be paid not less than the permissible deductions as set forth in 29 CFR Part 3: applicable wage rate on the wage determination for the (3) That each laborer or mechanic has been paid not less work actually performed. Where a contractor is performing then the applicable wage rates and fringe benefits or cash construction on a project In a locality other than that in equivalents for the classification of work performed, as which its program is registered, the ratios and wage rates specified in the applicable wage determination (expressed in percentages of the journeyman's hourly Incorporated into the contract. rate) specified in the contractor's or subcontractor's registered program shall be observed. Every apprentice (c) The weekly submission of a properly executed must be paid at not less than the rate specified in the certification set forth on the reverse side of Optional Form registered program for the apprentice's level of progress. WH-347 shall satisfy the requirement for submission of the expressed as a percentage of the journeymen hourly rate 'Statement of Compliance' required by subparagraph specified in the applicable wage determination. A.3.(Ii)(b). Apprentices shall be paid fringe benefits In accordance (it) The falsification of any of the above certifications may with the provisions of the apprenticeship program. If the subject the contractor or subcontractor to civil or criminal apprenticeship program does not specify fringe benefits, prosecution under Section 1001 of Title 18 and Section apprentices must be paid the full amount of fringe benefits 231 of Title 31 of the United States Code. listed on the wage determination for the applicable (tit) The contractor or subcontractor shalt make the classification. It the Administrator determines that a records required under subparagraph A.3.(t) available for different practice prevails for the applicable apprentice inspection, copying, or transcription by authorized classification,fringes shall be paid in accordance with that representatives of HUD or its designee or the Department determination. In the event the Office of Apprenticeship of Labor, and shall permit such representatives to Training, Employer and Labor Services, or a State interview employees during working hours on the job. If Apprenticeship Agency recognized by the Office, the contractor or subcontractor fails to submit the required withdraws approval of an apprenticeship program, the records or to make them available, HUD or its designee contractor will no longer be permitted to utilizo may, after written notice to the contractor, sponsor, apprentices at less than the applicable predetermined rate applicant or owner, take such action as may be necessary for the work performed until an acceptable program is to cause the suspension of any further payment, advance, approved. or guarantee of funds. Furthermore, failure to submit the (11) Trainees. Except as provided in 29 CFR 5.16, required records upon request or to make such records trainees will not be permitted to work at less than the available may be grounds for debarment action pursuant to predetermined rate for the work performed unless they are 29 CFR 6,12. employed pursuant '.to and individually registered in a 4. Apprentices and Trainees. program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, le Apprentices. edetAppre mine will be permitted to work at Employment and Training Administration. The ratio of less than the predetermined rate for the work they performed when they are employed pursuant to and trainees to journeymen on the job site shall not be greater Individually registered in a bona fide apprenticeship than permitted under the plan approved by the program registered with the U.S. Department of Labor, Employment and Training Administration. Every trainee Employment and Training Administration, Office of must be paid at not less than the rate specified In the Apprenticeship Training, Employer and Labor Services, or approved program for the trainee's level of progress, with a State Apprenticeship Agency recognized by the expressed as a percentage of the journeyman hourly rate Office, or if a person is employed In his or her first 90 specified In the applicable wage determination. Trainees days of probationary employment as an apprentice in such shall be paid fringe benefits in accordance with the an apprenticeship program, who is not individually provisions of the trainee program. If the trainee program registered in the program, but who has been certified by does not mention fringe benefits, trainees shall be paid the Office of Apprenticeship Training, Employer and Labor the full .amount of fringe benefits listed on the wage Services or a State Apprenticeship Agency (where determination unless the Administrator of the Wage and appropriate) to be eligible for probationary employment as Hour Division determines that there is an apprenticeship an apprentice. The allowable ratio of apprentices to program associated with the corresponding journeyman journeymen on the job site In any craft classification shall wage rate on the wage determination which provides for not be greater than the ratio permitted to the contractor as less than full fringe benefits for apprentices. Any to the entire work force under the registered program. Any employee listed on the payroll at a trainee rate who is not worker listed on a payroll at an apprentice wage rate, who registered and participating in a training plan approved by Previous editions are obsolete form HUDr4010(0612009) Page 3 of 5 ref.Handbook 1344.1 SF:16-5215/142605.doc/rev. 12/2016 the Employment and Training Administration shall be paid awarded HUD contracts or participate In HUD programs not less than the applicable wage rate on the wage pursuant to 24.CFR Part 24. determination for the work actually performed. In addition, (it) No part of this contract shall be subcontracted to any any trainee performing work on the job site In excess of person or firm ineligible for award of a Government the ratio permitted under the registered program shall be contract by virtue of Section 3(a) of the Davis-Bacon Act paid not less than the applicable wage rate on the wage or 29 CFR 5.12(a)(1) or to be awarded HUD contracts or determination for the work actually performed. In the participate in HUD programs pursuant to 24 CFR Part 24. event the Employment and Training Administration (ill) The penalty for making false statements is prescribed withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less than in the U.S. Criminal Code, 18 U.S.C. . Till Additionally, the applicable predetermined rate for the work performed U.S. ralminai Code, Section t ra 0. ions 18, U.S.C., until an acceptable program is approved. `federal Housing Administration transactions', provides in part: 'Whoever. for the purpose of . . . influencing in any (111) Equal employment opportunity. The utilization of way the action of such Administration..... makes, utters or apprentices, trainees and journeymen under 29 CFR Part 5 publishes any statement knowing the same to be false.._ shall be in conformity with the equal employment shall be fined not more than $5,000 or imprisoned not opportunity requirements of Executive Order 11248, as more than two years,or both.' amended,and 29 CFR Part 30. it. Complaints, Proceedings, or Testimony by S. Compliance with Copeland Act requirements. The Employees. No laborer or mechanic to whom the wage, contractor shall comply with the requirements of 29 CFR salary, or other labor standards provisions of this Contract Part 3 which are incorporated by reference in this contract are applicable shall be discharged or in any other manner 6. Subcontracts. The contractor or subcontractor will discriminated against by the Contractor or any insert in any subcontracts the clauses contained in subcontractor because such employee has filed any subparagraphs 1 through 11 in this paragraph A and such complaint or instituted or caused to be instituted any other clauses as HUD or Its designee may by appropriate proceeding or has testified or Is about to testify in any Instructions require, and a copy of the applicable proceeding under or relating to the labor standards prevailing wage decision, and also a clause requiring the applicable under this Contract to his employer. subcontractors to include these clauses in any lower tier B. Contract Work Hours and Safety Standards Act The subcontracts. The prime contractor shall be responsible provisions of this paragraph B are applicable where the amount of the for the compliance by any subcontractor or lower tier prime contract exceeds $100,000. As used in this paragraph, the subcontractor with all the contract clauses in this terms'laborers'and*mechanics'Include watchmen and guards. paragraph. (1) Overtime requirements. No contractor or subcontractor T. Contract termination; debarment. A breach of the contracting for any part of the contract work which may require or contract clauses in 29 CFR 5.5 may be grounds for involve the employment of laborers or mechanics shall require or termination of the contract and for debarment as a permit any such laborer or mechanic in any workweek in which the contractor and a subcontractor as provided in 29 CFR individual Is employed on such work to work in excess of 40 hours in 5.12. . such workweek unless such taborer or mechanlc receives 8. Compliance with Davis-Bacon and Related Act Requirements. compensation at a rate not less than one and one-half times the basic All rulings and interpretations of the Davis-Bacon and rate of pay for all hours worked in excess of 40 hours in such Related Acts contained in 29 CFR Parts 1, 3, and 5 are workweek. herein Incorporated by reference in this contract (2) Violation; liability for unpaid wages; liquidated 9. Disputes concerning labor standards. Disputes damages. In the event of any violation of the clause set arising out of the labor standards provisions of this forth in subparagraph (1) of this paragraph, the contractor contract shall not be subject to the general disputes and any subcontractor responsible therefor shall be liable clause or this contract. Such disputes shall be resolved in for the unpaid wages. In addition, such contractor and accordance with the procedures of the Department of subcontractor shall be liable to the United States (in the Labor set forth in 29 CFR Parts 5, 6, and 7. Disputes ease of work done under contract for the District of within the meaning of this clause include disputes between Columbia or a territory, to such District or to such the contractor (or any of its subcontractors) and HUD or territory), for liquidated damages. Such liquidated its designee, the U.S. Department of Labor. or the damages shall be computed with respect to each individual employees or their representatives. laborer or mechanic, Including watchmen and guards, 10. (1) Certification of Eligibility. By entering into this employed In violation of the clause set forth in contract the contractor certifies that neither it (nor he or subparagraph (1) of this paragraph, in the sum of$10 for each she) nor any person or firm who has an interest in the calendar day on which such Individual was required or permitted to contractor's firm is a person or firm ineligible to be work in excess of the standard workweek of 4D hours without payment awarded Government contracts by virtue of Section 3(a) of of the overtime wages required by the clause set forth in sub the Davis-Bacon Act or 29 CFR 5.12(a)(1) or to be paragraph(1)of this paragraph. Previous editions are obsolete form HUD-4010(D8/20D9) Page 4 of 5 ref.Handbook 1344.1 SF:16-5215/142605.doc/rev. 12/2016 (3) Withholding for unpaid wages and liquidated damages. HUD or its designee shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contract, or any other Federally-assisted contract subject to the Contract Work Hours and Safety Standards Act which is held by the some 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 subparagraph(2)of this paragraph. (4) Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in subparagraph (1) through (4) of this paragraph and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the Clauses set forth in subparagraphs (1) through (4) of this paragraph. C. Health and Safety. The provisions of this paragraph C are applicable where the amount of the prime contract exceeds$100,000. (1) No laborer or mechanic shall be required to work in surroundings or under working conditions which are unsanitary, hazardous. or dangerous to his health and safety as determined under construction safety and health standards promulgated by the Secretary of Labor by regulation. (2) The Contractor shall comply with all regulations issued by the Secretary of Labor pursuant to Title 29 Part 1926 and failure to comply may result In imposition of sanctions pursuant to the Contract Work Hours and Safety Standards Act, (Public Law 91.54. 83 Stat 96), 40 USC 3701 at sea. (3) The contractor shall include the provisions of this paragraph In every subcontract so that such provisions will be binding on each subcontractor. The contractor shall take such action with respect to any subcontractor as the Secretary of Housing and Urban Development or the Secretary of Labor shall direct as a means of enforcing such provisions. Previous editions are obsolete form HUD-4010(0612009) Page 5 of 5 ref.Handbook 1344.1 SF:16-5215/142605.doe/rev. 12/2016 EXHIBIT C United States Department of Labor Office of Federal Contract Compliance Programs Office of Federal Contract Compliance Programs(OI=CCP) Executive Order 11246,As Amended —DISCLAIMER— Executive Order 11246—Equal Employment Opportunity SOURCE:The provisions of Executive Order 11246 of Sept.24,1965,appear at 30 FR 12319,12935,3 CFR, 1964- 1965 Comp,,p.339,unless otherwise noted. Under and by virtue of the authority vested In me as President of the United States by the Constitution and statutes of the United Stag,it is ordered as follows: Part I—Nondiscrimination in Government Employment [Part I superseded by EO 11478 of Aug.8,1969,34 FR 12985,3 CFR,1966-=1970 Comp.,p.803] Part II-Nondiscrimination in Employment by Government Contractors and Subcontractors Subpart A—Duties of the Secretary of Labor SEC. 201 The Secretary of Labor shall be responsible for the administration and enforcement of Parts II and III of this Order.The Secretary shall adopt such rules and regulations and issue such orders as are deemed necessary and appropriate to achieve the purposes of Parts II and III of this Order. [Sec.201 amended by EO 12086 of Oct.5,1978,43 FR 46501,3 CFR,1978 Comp,,p.230] Subpart B—Contractors'Agreements SEC. 202 Except In contracts exempted in accordance with Section 204 of this Order,all.Government contracting agencies shall Include in every Government contract hereafter entered Into the following provisions: During the performance of this contract,the contractor agrees as follows: 1.The contractor will not discriminate against any employee or applicant for employment bemuse of race,color, religion,sex,sexual orientation,gender Identity,or national origin.The contractor will take affirmative action to ensure that applicants are employed,and that employees are treated during employment,without regard to their race,color,religion,sex,sexual orientation,gender Identity,or national origin.Such action shall Include, but not be limited to the following:employment,upgrading,demotion,or transfer;recruitment or recruitment advertising;layoff or termination;rates of pay or other forms of compensation;and selection for training, including apprenticeship.The contractor agrees to post In conspicuous places,available to employees and applicants for employment,notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination cause. SF:16-5215/142605.doc/rev. 12/2016 2.The contractor will,in all solicitations or advancements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race,color, religion,sex,sexual orientation,gender identity,or national origin. 3.The contractor will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about,discussed,or disclosed the compensation of the employee or applicant or another employee or applicant.This provision shall not apply to Instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information,unless such disclosure is in response to a formal complaint or charge,in furtherance of an investigation,proceeding,hearing,or action,including an investigation conducted by the employer,or is consistent with the contractor's legal duty to furnish information. 4.The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding,a notice,to be provided by the agency contracting officer,advising the labor union or workers'representative of the contractor's commitments under Section 202 of Executive Order No. 11246 of September 24,1965,and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 5.The contractor will comply with all provisions of Executive Order No.11246 of Sept.24,1965,and of the rules, regulations,and relevant orders of the Secretary of Labor. 6.The contractor will furnish all information and reports required by Executive Order No.11246 of September 24, 1965,and by the rules,regulations,and orders of the Secretary of Labor,or pursuant thereto,and will permit access to his books,records,and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules,regulations,and orders. 7.In the event of the contractor's noncompliance with the nondiscrimination clauses of this contract or with any of such rules,regulations,or orders,this contract may be cancelled,terminated,or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order No.11246 of Sept.24, 1965,and such other sanctions may be imposed and remedies invoked as provided in Executive Order No.11246 of September 24,1965,or by rule,regulation,or order of the Secretary of Labor,or as otherwise provided by law. 8.The contractor will Include the provisions of paragraphs(1)through(8)in every subcontract or purchase order unless exempted by rules,regulations,or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order No. 11246 of September 24, 1965,so that such provisions will be binding upon each subcontractor or vendor.The contractor will take such action with respect to any subcontract or purchase order as may be directed by the Secretary of Labor as a means of enforcing such provisions including sanctions for noncompliance: Provided,however,that in the event the contractor becomes involved in,or is threatened with, litigation with a subcontractor or vendor as a result of such direction,the contractor may request the United States to enter Into such litigation to protect the interests of the United States.[Sec 202 amended by EO 11375 of Oct. 13,1967,32 FIR 14303,3 CFR, 1966-1970 Comp.,p.684,EO 12086 of Oct.5,1978,43 FIR 46501,3 CFR,1978 Comp.,p.230,EO 13665 of April 8,2014,79 FIR 20749,EO 13672 of July 21,2014,79 FIR 42971] SEC. 203 a.Each contractor having a contract containing the provisions prescribed in Section 202 shall file,and shall cause each of his subcontractors to file,Compliance Reports with the contracting agency or the Secretary of Labor as may be directed.Compliance Reports shall be filed within such times and shall contain such information as to the practices,policies,programs,and employment policies,programs,and employment statistics of the contractor and each subcontractor,and shall be in such form,as the Secretary of Labor may prescribe. b.Bidders or prospective contractors or subcontractors may be required to state whether they have participated in any previous contract subject to the provisions of this Order,or any preceding similar Executive order,and in SF:16-5215/142605.doe/rev. 12/2016 that event to submit,on behalf of themselves and their proposed subcontractors,Compliance Reports prior to or as an initial part of their bid or negotiation of a contract. c.Whenever the contractor or subcontractor has a collective bargaining agreement or other contract or understanding with a labor union or an agency referring workers or providing or supervising apprenticeship or training for such workers,the Compliance Report shall Include such information as to such labor union's or agency's practices and policies affecting compliance as the Secretary of Labor may prescribe: Provided,that to the extent such information is within the exclusive possession of a labor union or an agency referring workers or providing or supervising apprenticeship or training and such labor union or agency shall refuse to furnish such information to the contractor,the contractor shall so certify to the Secretary of Labor as part of its Compliance Report and shall set forth what efforts he has made to obtain such information. d.The Secretary of Labor may direct that any bidder or prospective contractor or subcontractor shall submit,as part of his Compliance Report,a statement in writing,signed by an authorized officer or agent on behalf of any labor union or any agency referring workers or providing or supervising apprenticeship or other training,with which the bidder or prospective contractor deals,with supporting Information,to the effect that the signer's practices and policies do not discriminate on the grounds of race,color,religion,sex,sexual orientation,gender identity,or national origin,and that the signer either will affirmatively cooperate in the implementation of the policy and provisions of this Order or that It consents and agrees that recruitment,employment,and the terms and conditions of employment under the proposed contract shall be in accordance with the purposes and provisions of the order.In the event that the union,or the agency shall refuse to execute such a statement,the Compliance Report shall so certify and set forth what efforts have been made to secure such a statement and such additional factual material as the Secretary of Labor may require. [Sec.203 amended by EO 11375 of Oct.13,1967,32 FR 14303,3 CFR,1966-1970 Comp.,p.684; EO 12086 of Oct. 5,1978,43 FR 46501,3 CFR,1978 Comp.,p.230,EO 13672 of July 21,2104,79 FR 42971] SEC. 204 a.The Secretary of Labor may,when the Secretary deems that special circumstances in the national interest so require,exempt a contracting agency from the requirement of including any or all of the provisions of Section 202 of this Order in any specific contract,subcontract,or purchase order. b.The Secretary of Labor may,by rule or regulation,exempt certain classes of contracts,subcontracts,or purchase orders(1)whenever work is to be or has been performed outside the United States and no recruitment of workers within the limits of the United States is involved;(2)for standard commercial supplies or raw materials;(3)involving less than specified amounts of money or specified numbers of workers;or(4)to the extent that they involve subcontracts below a specified tier. c.Section 202 of this Order shall not apply to a Government contractor or subcontractor that is a religious corporation,association,educational institution,or society,with respect to the employment of individuals of a particular religion to perform work connected with the carrying on by such corporation,association,educational institution,or society of its activities.Such contractors and subcontractors are not exempted or excused from complying with the other requirements contained in this Order. d.The Secretary of Labor may also provide,by rule,regulation,or order,for the exemption of facilities of a contractor that are in all respects separate and distinct from activities of the contractor related to the performance of the contract:provided,that such an exemption will not interfere with or impede the effectuation of the purposes of this Order:and provided further,that in the absence of such an exemption all facilities shall be covered by the provisions of this Order. [Sec.204 amended by EO 13279 of Dec.16,2002,67 FR 77141,3 CFR,2002 Comp.,p.77141—77144] Subpart C—Powers and Duties of the Secretary of Labor and the Contracting Agencies SF:16-5 215/142605.doc/rev. 12/2016 SEC. 20S The Secretary of Labor shall be responsible for securing compliance by all Government contractors and subcontractors with this Order and any implementing rules or regulations.All contracting agencies shall comply with the terms of this Order and any implementing rules,regulations,or orders of the Secretary of Labor.Contracting agencies shall cooperate with the Secretary of labor and shall furnish such information and assistance as the Secretary may require. [Sec.205 amended by EO 12086 of Oct.5,1978,43 FR 46501,3 CFR,1978 Comp.,p.230] SEC. 206 a.The Secretary of Labor may investigate the employment practices of any Government contractor or subcontractor to determine whether or not the contractual provisions specified in Section 202 of this Order have been violated.Such investigation shall be conducted in accordance with the procedures established by the Secretary of Labor. b.The Secretary of Labor may receive and investigate complaints by employees or prospective employees of a Government contractor or subcontractor which allege discrimination contrary to the contractual provisions specified in Section 202 of this Order. [Sec.206 amended by EO 12086 of Oct.5, 1978,43 FR 46501,3 CFR,1978 Comp.,p.230] SEC. 207 The Secretary of Labor shall use his/her best efforts,directly and through interested Federal,State,and local agencies, contractors,and all other available instrumentalities to cause any labor union engaged in work under Government contracts or any agency referring workers or providing or supervising apprenticeship or training for or in the course of such work to cooperate in the implementation of the purposes of this Order.The Secretary of Labor shall,in appropriate cases,notify the Equal Employment Opportunity Commission,the Department of Justice,or other appropriate Federal agencies whenever it has reason to believe that the practices of any such labor organization or agency violate Title VI or Title VII of the Civil Rights Act of 1964 or other provision of Federal law. [Sec.207 amended by EO 12086 of Oct.5,1978,43 FR 46501,3 CFR,1978 Comp.,p.230] SEC. 208 a.The Secretary of Labor,or any agency,officer,or employee in the executive branch of the Government designated by rule,regulation,or order of the Secretary,may hold such hearings,public or private,as the Secretary may deem advisable for compliance,enforcement,or educational purposes. b.The Secretary of Labor may hold,or cause to be held,hearings in accordance with Subsection of this Section prior to imposing,ordering,or recommending the imposition of penalties and sanctions under this Order.No order for-debarment of any contractor from further Government contracts under Section 209(6)shall be made without affording the contractor an opportunity for a hearing. Subpart D—Sanctions and Penalties SEC. 209 In accordance with such rules,regulations,or orders as the Secretary of Labor may issue or adopt,the Secretary may: 1.Publish,or cause to be published,the names of contractors or unions which it has concluded have complied or have failed to comply with the provisions of this Order or of the rules,regulations,and orders of the Secretary of Labo r. 2.Recommend to the Department of Justice that,In cases In which there is substantial or material violation or the threat of substantial or material violation of the contractual provisions set forth in Section 202 of this Order, appropriate proceedings be brought to enforce those provisions,Including the enjoining,within the limitations SF:16-5215/142605.doc/rev. 12/2016 of applicable law,of organizations,individuals,or groups who prevent directly or indirectly,or seek to prevent directly or indirectly,compliance with the provisions of this Order. 3.Recommend to the Equal Employment Opportunity Commission or the Department of Justice that appropriate proceedings be instituted under Title VII of the Clvll Rights Act of 1964. 4.Recommend to the Department of Justice that criminal proceedings be brought for the furnishing of false information to any contracting agency or to the Secretary of Labor as the case may be. 5.After consulting with the contracting agency,direct the contracting agency to cancel,terminate,suspend,or cause to be cancelled,terminated,or suspended,any contract,or any portion or portions thereof,for failure of the contractor or subcontractor to comply with equal employment opportunity provisions of the contract. Contracts may be cancelled,terminated,or suspended absolutely or continuance of contracts may be conditioned upon a program for future compliance approved by the Secretary of Labor. 6.Provide that any contracting agency shall refrain from entering into further contracts,or extensions or other modifications of existing contracts,with any noncomplying contractor,until such contractor has satisfied the Secretary of Labor that such contractor has established and will carry out personnel and employment policies in compliance with the provisions of this Order. (b)Pursuant to rules and regulations prescribed by the Secretary of Labor,the Secretary shall make reasonable efforts, within a reasonable time limitation,to secure compliance with the contract provisions of this Order by methods of conference,conciliation,medlatlon,and persuasion before proceedings shall be Instituted under subsection(a)(2)of this Section,or before a contract shall be cancelled or terminated in whole or in part under subsection(a)(5)of this Section. [Sec 209 amended by EO 12086 of Oct.5, 1978,43 FIR 46501,3 CFR,1978 Comp.,p.230] SEC. 210 Whenever the Secretary of Labor makes a determination under Section 209,the Secretary shall promptly notify the appropriate agency.The agency shall take the action directed by the Secretary and shall report the results of the action it has taken to the Secretary of Labor within such time as the Secretary shall specify.If the contracting agency fails to take the action directed within thirty days,the Secretary may take the action directly. [Sec.210 amended by EO 12086 of Oct.5,1978,43 FIR 46501,3 CFR, 1978 Comp.,p 230] SEC. 211 If the Secretary shall so direct,contracting agencies shall not enter into contracts with any bidder or prospective contractor unless the bidder or prospective contractor has satisfactorily compiled with the provisions of this Order or submits a program for compliance acceptable to the Secretary of Labor. [Sec.211 amended by EO 12086 of Oct.5, 1978,43 FR 46501,3 CFR,1978 Comp.,p.230] SEC. 212 When a contract has been cancelled or terminated under Section 209(a)(5)or a contractor has been debarred from further Government contracts under Section 209(a)(6)of this Order,because of noncompliance with the contract provisions specified in Section 202 of this Order,the Secretary of Labor shall promptly notify the Comptroller General of the United States. [Sec.212 amended by EO 12086 of Oct.5, 1978,43 FIR 46501,3 CFR, 1978 Comp.,p.230] Subpart E—Certificates of Merit SEC. 213 SF:16-5215/142605.doc/rev. 12/2016 The Secretary of Labor may provide for issuance of a United States Government Certificate of Merit to employers or labor unions,or other agencies which are or may hereafter be engaged in work under Government contracts,if the Secretary is satisfied that the personnel and employment practices of the employer,or that the personnel,training,apprenticeship, membership,grievance and representation,upgrading,and other practices and policies of the labor union or other agency conform to the purposes and provisions of this Order. SEC. 214 Any Certificate of Merit may at any time be suspended or revoked by the Secretary of Labor if the holder thereof,in the judgment of the Secretary,has failed to comply with the provisions of this Order. SEC. 215 The Secretary of Labor may provide for the exemption of any employer,labor union,or other agency from any reporting requirements imposed under or pursuant to this Order if such employer,labor union,or other agency has been awarded a Certificate of Merit which has not been suspended or revoked. Part III—Nondiscrimination Provisions in Federally Assisted Construction Contracts SEC. 301 Each executive department and agency,which administers a program involving Federal financial assistance shall require as a condition for the approval of any grant,contract,loan,insurance,or guarantee thereunder,which may involve a construction contract,that the applicant for Federal assistance undertake and agree to incorporate,or cause to be incorporated,into all construction contracts paid for in whole or in part with funds obtained from the Federal Government or borrowed on the credit of the Federal Government pursuant to such grant,contract,loan,insurance,or guarantee,or undertaken pursuant to any Federal program Involving such grant,contract,loan,insurance,or guarantee,the provisions prescribed for Government contracts by Section 202 of this Order or such modification thereof,preserving in substance the contractor's obligations thereunder,as may be approved by the Secretary of Labor, together with such additional provisions as the Secretary deems appropriate to establish and protect the Interest of the United States in the enforcement of those obligations.Each such applicant shall also undertake and agree(1)to assist and cooperate actively with the Secretary of Labor in obtaining the compliance of contractors and subcontractors with those contract provisions and with the rules,regulations and relevant orders of the Secretary,(2)to obtain and to furnish to the Secretary of Labor such information as the Secretary may require for the supervision of such compliance, (3)to carry out sanctions and penalties for violation of such obligations imposed upon contractors and subcontractors by the Secretary of Labor pursuant to Part II,Subpart D,of this Order,and(4)to refrain from entering into any contract subject to this Order,or extension or other modification of such a contract with a contractor debarred from Government contracts under Part II,Subpart D,of this Order. [Sec.301 amended by EO 12086 of Oct.5, 1978,43 FR 46501,3 CFR,1978 Comp.,p.230] SEC. 302 a."Construction contract"as used in this Order means any contract for the construction,rehabilitation,alteration, conversion,extension,or repair of buildings,highways,or other improvements to real property. b.The provisions of Part II of this Order shall apply to such construction contracts,and for purposes of such application the administering department or agency shall be considered the contracting agency referred to therein. c.The term"applicant"as used in this Order means an applicant for Federal assistance or,as determined by agency regulation,other program participant,with respect to whom an application for any grant,contract,loan, insurance,or guarantee is not finally acted upon prior to the effective date of this Part,and it Includes such an applicant after he/she becomes a recipient of such Federal assistance. SEC. 303 SF:16-5215/142605.doc/rev. 12/2016 a.The Secretary of Labor shall be responsible for obtaining the compliance of such applicants with their undertakings under this Order.Each administering department and agency is directed to cooperate with the Secretary of Labor and to famish the Secretary such information and assistance as the Secretary may require in the performance of the Secretary's functions under this Order. b.In the event an applicant fails and refuses to comply with the applicant's undertakings pursuant to this Order, the Secretary of Labor may,after consulting with the administering department or agency,take any or all of the following actions:(1)direct any administering department or agency to cancel,terminate,or suspend in whole or in part the agreement,contract or other arrangement with such applicant with respect to which the failure or refusal occurred;(2)direct any administering department or agency to refrain from extending any further assistance to the applicant under the program with respect to which the failure or refusal occurred until satisfactory assurance of future compliance has been received by the Secretary of Labor from such applicant; and(3)refer the case to the Department of Justice or the Equal Employment Opportunity Commission for appropriate law enforcement or other proceedings. c.In no case shall action be taken with respect to an applicant pursuant to clause(1)or(2)of subsection(b) without notice and opportunity for hearing. [Sec.303 amended by EO 12086 of Oct.5,1978,43 FR 46501,3 CFR,1978 Comp.,p.230] SEC. 304 Any executive department or agency which imposes by rule,regulation,or order requirements of nondiscrimination in employment,other than requirements imposed pursuant to this Order,may delegate to the Secretary of Labor by agreement such responsibilities with respect to compliance standards,reports,and procedures as would tend to bring the administration of such requirements into conformity with the administration of requirements imposed under this Order: Provided,That actions to effect compliance by recipients of Federal financial assistance with requirements imposed pursuant to Title VI of the Civil Rights Act of 1964 shall be taken In conformity with the procedures and limitations prescribed In Section 602 thereof and the regulations of the administering department or agency issued thereunder. Part IV—Miscellaneous SEC.401. The Secretary of Labor may delegate to any officer,agency,or employee in the Executive branch of the Government, any function or duty of the Secretary under Parts II and III of this Order. [Sec.401 amended by EO 12086 of Oct.5,1978,43 FR 46501,3 CFR, 1978 Comp.,p.230] SEC.402 The Secretary of Labor shall provide administrative support for the execution of the program known as the"Plans for Progress." SEC.403 a.Executive Orders Nos.10590(January 19,1955),10722(August 5,1957),10925(March 6,1961),11114 (June 22, 1963),and 11162(July 28,1964),are hereby superseded and the President's Committee on Equal Employment Opportunity established by Executive Order No.10925 is hereby abolished.All records and property in the custody of the Committee shall be transferred to the Office of Personnel Management and the Secretary of Labor,as appropriate. b.Nothing in this Order shall be deemed to relieve any person of any obligation assumed or imposed under or pursuant to any Executive Order superseded by this Order.All rules,regulations,orders,instructions, designations,and other directives Issued by the President's Committee on Equal Employment Opportunity and those issued by the heads of various departments or agencies under or pursuant to any of the Executive orders superseded by this Order,shad,to the extent that they are not inconsistent with this Order,remain in full force SF:16-5 215/142605.d oc/rev. 12/2016 and effect unless and until revoked or superseded by appropriate authority.References in such directives to provisions of the superseded orders shall be deemed to be references to the comparable provisions of this Order. [Sec.403 amended by EO 12107 of Dec.28,1978,44 FR 1055,3 CFR,1978 Comp.,p,264] SEC.404 The General Services Administration shall take appropriate action to revise the standard Government contract forms to accord with the provisions of this Order and of the rules and regulations of the Secretary of Labor. SEC.405 This Order shall become effective thirty days after the date of this Order. SF:16-5215/142605.doc/rev. 12/2016 Moses Khalili General Constriction Manager Moses.K@mincoconstruction.com (310) 863-2201 Experience: Over Thirty years of experience in southern California—construction industry (private & public work) Education: BSC, MSC in Electrical & Electronics Engineering Brighton University, England, 1979 California State Contractor license C10, 16, 64 NICET Level II Various manufactures Certifications Employment History: 2003—Currently Minco Construction 1998—2003 CALICOS stems/Owner&Contractor 1996— 1998 Firemaster Operations Now Simplex/Grinnell 1990 - 1996 CALICO Electrical/Owner&Contractor 1986 - 1990 General Manager at Firetronics 1984— 1986 HMH Engineering &Construction Completed Public Work Projects (HVAC Related Projects): Position: Site Project Manager Minco Construction Project Name: The Joseph Jensen Water Treatment Plant Solids Transfer Spec. No. 1758, Project No. 104463 Proiect Amount: $1,977,700.00 Completion Date: July, 2015 Description of Work: The work consists of construction of approximately 7,600 feet of 6-inch to 10-inch PVC pipeline with approximately 100 feet of 10-inch HDPE pipe sleeve, a utility crossing structure, four solids lagoon inlet structures, fiber optic cables, and utility duct banks and cabinets; modification of sewer air gap; connection of PVC pipelines to the solids pump station piping system; installation of a new flow meter and replacement of an existing flow meter; replacement of approximately 3,700 feet of chain-link fence with welded wire mesh panel fence; replacement of a block wall structure; and other appurtenant work. Owner: Metropolitan Water District of Southern California 700 N. Alameda Street, Los Angeles, California 90012 Telephone (213) 217-6000 Project Name: San Jose Creek Water Quality Laboratory HVAC System Upgrade, Contract No. 4726 Proiect Amount: $4,053,797.48 Completion Date: December, 2014 Description of Work: Replacement of existing cooling tower and associated equipment while laboratories are functional by providing temporary air conditioning units. Replacement of all roof mounted air conditioning units, ventilation fans, mixing boxes, and all ductwork. Work included all electrical installation, commissioning and start up. Owner: County Sanitation District of Los Angeles County 1955 Workman Mill Road Whittier, CA 90601-1400 Kimberly S. Compton 562.699.7411 Proiect Name: Long Beach Main Pumping Plant Electrical System Modifications, Contract No. 4521 Contract No. 4521 File:85-08.05-31 Project Amount: $ 1,877,000.00 Description of work Completed: Provide and install infrastructure for two circuit 12kv substations from grounds up to completion and switch over in an operating waste water pumping plants. Work included 600V switchgear, MCC, PLC control, stand by Generator, 250 HP VFD, Control panels, motor replacement and new masonry Electrical room Project Address: 1238 W. 16th Street, Long Beach, CA 90813 Owner: County Sanitation District of Los Angeles County 1955 Workman Mill Road Whittier, CA 90601-1400 Kimberly S. Compton 562.699.7411 Contact Name: Walter Alkerman (310) 830-8050 Proiect Name: Contract No. FE07-20, "P2 Digester Gas Dryer Upgrades'_OCSD's Treatment Plant No. 2 located at 22212 Brookhurst Street, Huntington, Beach, CA 92646 Proiect Amount: $912,915.00 Description of work Completed: Provide and install (2) Gas Dryer at OCSD Wastewater Treatment Plant. The Work was performed with plant power generation plant in operation. Gas Dryer project consist of civil work, Electrical Div 1, class 1 work, mechanical, plumbing and control, including SCADA system connections. Gas dryer was used to feed Gas supplied on demand of power generation at the same plant. Owner: Orange County Sanitation District Contact Name: Andy DaSilva 10844 Ellis Avenue Fountain Valley, CA 92708 (714) 593-7843 adasilva@ocsd.com Project Name: Contract No. 4656-Joint Water Pollution Control Plant East Laboratory Central Plant, County Sanitation District No. 2 of LA County Proiect Location: 1928 Nelson Ave. Redondo Beach, CA 90278 Description of work: Demolition of existing facilities, and installation of new chiller, cooling tower, chilled water pumps, condenser pumps, and associated piping, electrical, instrumentation, and controls, Owner: County Sanitation District No. 2, of Los Angeles County 1955 Workman Mill Road, Whittier, CA 90601- 1400 Kimberly S. Compton (562) 699-7411 Final Contract Amount$602,705.39 Proiect Name: P2 City Water Pump Station Standby Power, Project No. FE07-19 Contractor Amount: $ 487,000.00 Description of work Completed: Provide infrastructure including Duct Bank installation throughout plant for installation of MV- 1200 A transfer switch feed from two utility source and power generation stand by Generators. The entire project was to provide back-up for city water station at OCSD plant 2. Work was completed ahead of schedule. Owner: Orange County Sanitation District Division 760, Resident Engineer Contact Name: Huan Hoang Nguyen 10844 Ellis Avenue Fountain Valley, California 92708-7018 (714) 593-7865 Proiect Name: FV129205, Main Kitchen Transformer Upgrade Project Number: 12 SR#4, Contract Number: FV129205 Description of work Completed: Replacement of 700 KVA, 5 KV Transformer for a Kitchen Facility supporting Fairview Hospital, Huntington Beach. Work included, civil work, Duct Banks, MV Cable pulling, splices, Terminations, new Switchgear and replacement under 4 hour shutdown windows at night. Owner: Department of Developmental Services, specifically Fairview Developmental Center Department of Developmental Services, Fairview Developmental Center 2501 Harbor Blvd. Costa Mesa, CA 92626 Contact Name: Attn: Kelly Vu (714) 957-5212 Proiect Name: C07-1023, Infrastructure & Central Plant, Phase I Cerritos Community College Contractor Amount: $10,603,697.58 Description of work Completed: Provide and install new 3000A, 12KV switchgear, Master clad by Square D. The new MV Gear replaced existing equipment occupied on same footprint. The work was performed without interruption to operation of the college campus. Work also included civil work, Duct Banks, Temp Generator, Temp 12KV switchgear, MV Cable pulling, MV splices and Terminations. Proiect Address: Cerritos Community College, 11110 Alondra Blvd, Norwalk, California 90650 Owner:Cerritos Community College District 16126 Studebaker Rd., Norwalk, CA 90650 Contact Name: Jerry Jones - (714) 600-2133 Year Completed: 2009 Proiect Name: "0708-03, Infrastructure & Central Plant, Phase II, Cerritos Community College" Description of work Completed: Underground site utilities including 12 KV Substation for new central plant building Project Address: Cerritos Community College, 11110 Alondra Blvd, Norwalk, California 90650 Contractor Amount: $1,737,000.00 Owner: Cerritos Community College District 16126 Studebaker Rd. Norwalk, CA 90650 Contact Name: Jerry Jones - (714)600-2133 Year Completed: 2009 Proiect Name: 0708-12, Infrastructure & Central Plant, Phase III Cerritos Community College Description of work Completed: Underground site utilities including 12 KV Substation for new central plant building Proiect Address: Cerritos Community College, 11110 Alondra Blvd, Norwalk, California 90650 Contractor Amount: $4,977,000.00 Owner: Cerritos Community College District 16126 Studebaker Rd. Norwalk, CA 90650 Contact Name: Jerry Jones (714) 600-2133 Year Completed: 2009 Proiect Name: Anderson Two Story Classroom Building, Project# 0001-11-12 (New Building, Structural, Steel, Conc., Elec., HVAC) Project Address: William Anderson Elementary School 4130 West 154th Street, Lawndale, CA 90260 Contractor Amount: $ 4,472,977.53 Owner: Lawndale Elementary School District 4161 West 147th Street, Lawndale, CA 90260 Contact Name: Kier Toth (858) 610- 3208 Completion date: November 26, 2012 Proiect Name: IFB 1420-10/11- Modernization Project-Lincoln School, Los Angeles County Office of Education (HVAC Units Replacements) Project Address: Lincoln Special Education School 600 E Grand Ave., San Gabriel, CA 91776 Description of work: School Modernization Project Contract Amount: $2,161,511.45 Owner: Los Angeles County Office of Education 9300 Imperial Highway, Downey, CA 90242 Construction Manager: Architects MSP, Inc. Edgar J. Paz, AIA 3575 Long Beach Boulevard, Long Beach, CA 90807 (562)427 5007 Completion date: March 12, 2012 Mina Ghaly Project Manager 17375 Brookhurst St. Fountain Valley, CA 92708 Cell: (714) 362-5941 Mina_Ghaly( vniai.l.corn. SUMMARY OF EXPERIENCE • Project: "San Stefano Grand Plaza" "http://test.san-stefano.com/enlllome.aspx" Engineering Department of Project consist of one hotel under the Four Season Hotels management, Commercial and multi screen Movie Theater and 11 residential towers of 30 stories The project is under the supervision of"Dar-El-Handasah"consultants group • General management responsibility and problem solving. • Working as Site Electrical Engineer in MOBINIL Cell Phone Network Company, Responsible of all Equipments and devices(Installation and Maintenance). • Design of Steam generators Electrical control used for Bakery • Design and install control circuits of machines(Including(Photo Cells,Proximity Switches, Limit Switches, Breakers, Relays, Contactors, Selector Switches, Push buttons, Fuses, Pneumatic, and Hydraulic Valves))and its electronics boards with full Maintenance. EDUCATION 2004 B. S. in Power Electrical Engineering, Faculty of Engineering, Alexandria University, Egypt, GPA 3.2 Graduation project"Control of Direct Current Motor" Excellent Grade. 1992-97 Diploma in Electrical Power, Alexandria Advanced Technical Professional School, Egypt. PROFESSIONAL EXPERIENCE "MINAKO America Corporation" Estimator, Estimating Department August 2010—December 2012 • Prepare take offs for various types of engineering projects. • Coordinate and attend preconstruction,submittals, and construction meetings with project managers, project owners, Inspectors and subcontractors. • Submit change orders and request for information(RFI)reports due to plans ambiguity. • Create and execute project work plans and revise as appropriate to meet changing needs and requirements. • Initiate and manage purchase orders. Irvine High School Classroom Addition(Project#600N-3-14-861), Bid Package 13 Electrical Irvine Unified School District • Manage and ensure successful execution of ongoing project. • Manage and lead project team to ensure timely and proper execution accruing to project schedule and timeline. • Manage project materials inventory and process purchase orders as needed. • Address and resolve all open issues/concerns related to project execution and completion. • Prepare short term schedule. • Prepare RFI's with its proposals. • Attend to weekly construction progress meeting. • Attend the coordination meetings with other phases contractors. • Prepare monthly pay app. • Site supervision Compton Community College-Utility Infrastructure Phase 2 December Work as superintendant • Manage and ensure successful execution of ongoing project. • Manage and lead project team to ensure timely and proper execution accruing to project schedule and timeline. • Manage project materials inventory and process purchase orders as needed. • Address and resolve all open issues/concerns related to project execution and completion. • Prepare short term schedule. • Prepare RFI's with its proposals. • Attend to weekly construction progress meeting. • Attend the coordination meetings with other phases contractors. • Prepare monthly pay app. • Site supervision • Prepare daily report. ABB "Automation" Senior Electrical Engineer, April 2007 To November 2009 Swiss Engineering Company, Cairo Branch, Egypt. http://www.eg.abb.com Duties and Responsibilities: ➢ Finalizing shop-drawings for the followinsystems: • Power system (race ways & panel phase balance). • BMS (Building management System). • Security system (CCTV (Closed Circuit TV), Access Control & intercom). • Interior& exterior Lighting system (wiring, raceways& phase balance calculation). • Fire alarm system. • Closet(power& low current systems). • Voice & data system. • Grounding system. • Lightning system. • Technical meeting with consultant and supplier engineers. • Prepare description for power and security systems. • Prepare calculations for sub-stations by using Ecodial program. ➢ Prepare As-built for above mentioned systems. ➢ Prepare material submittals. ➢ General management responsibility and problem solving. MOBINIL Cell Phone Network Company, Alexandria, Egypt. http://www.otelecom.com/ Site Electrical Engineer,January 2005 To March 2007 • Designing and installing direct control boxes and Alternate Current"AC" Panels. • Installing(cable tray, exposed conduits,junction box, cable laying, cable termination, and make phase balance). • Repair and maintenance [Automatic transfer switch "ATS", Air Conditioning"A/C"(Central unit control), Fire system, Lighting systems,Uninterruptible Power Supply"UPS", Rectifiers]. • Make alarm test for all previous systems. • Reset Alarms for all previous systems during 24 hours. Maintenance Engineer, POLIN Company, Alexandria Branch,Egypt 01/2000 To 12/2004 Maintenance of Bread Equipments, Cookie Machines and Pastry Equipments • Ovens and Proofers • Spiral Mixers • Rolls Design and install Steam generators Electrical control circuits used for Bakery PERSONAL: • Practical experience in designing and installing electronic boards. • Advanced MS Office(2007, 2010)user. • Strong experience in computer hardware and software(installation, parts assembly maintenance, and networking) • Strong practical experience in installing main AC electrical distribution boards and control boards. • AutoCAD and drafting certification by Faculty of Engineering Alexandria University • Electronic work Bench 5 (EWB 5)+Paint. • Study electrical offers and preparing drawings. • Design and install control circuits of machines and its electronics boards. MEMBERSHIP AND PROFESSIONAL AFFILIATIONS • Member of Egyptian Engineering Association RESOLUTION OF MINAKO AMERICA CORPORATION JDIBA MINCO CONSTRUCTION Whereas,the Board of Directors of Minako America Corporation convened on November 1, 2004; and Whereas, by unanimous vote authorized Refaat Mina, as President and Secretary of the corporation, to sign on behalf of the corporation. RESOLVED, that the Chairman of the Board, the President and any Vice President of the corporation be; and that each of them hereby is, authorized to execute any and all documents necessary for the transaction of corporate business, including but not limited to contracts, bonds, leases, loans and documents of title; and that.said officers and the corporation agree to be bound by the execution of any obligations executed by said officers. IN WITNESS WHEREOF, Minako America Corporation, dba, Minco Construction, has caused these presents to: be signed by its respective President, and attested by its Secretary this 1"day of November, 2004. Z Aefa6klina, President ATTEST: Ieefaat b,a. Secretary 15 - 112913 State of California s Q5Secretary of State Statement of Information (Domestic Stock and Agricultural Cooperative Corporations) FILED FEES(Filing and Disclosure): $25.00. secretary 8f State If this is an amendment, see instructions. IMPORTANT-READ INSTRUCTIONS BEFORE COMPLETING THIS FORM State of California 1, CORPORATE NAME SEP 0 8 265 MINAKO AMERICA CORPORATION. 522 E. AIRLINE WAY GARDENA CA 90248 cc r� Z- 2. CALIFORNIA CORPORATE NUMBER C2482226 This Space for Filing Use Only No Change Statement (Not applicable if agent address of record is a P.O.Box address. See instructions,) s., If,there have,been any changes to the information contained in the IastStatement;of:Information filed withthe'California Secretary of State,or io statement of information has been previously filed,this form must be completed in its entirety. If there has been no change in any of the information contained in the last Statement Information filed with the California Secretary of State,check the box and proceed to Item 17. complete Addresses for the'Following (Do not abbreviate the name of the city. items 4 and 5 cannot be P.O.Boxes;) 4. STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE CITY STATE, ZIP CODE 522 E.AIRLINE WAY GARDENA CA 90248 GARDENA CA 90248 5. STREET ADDRESS OF PRINCIPAL BUSINESS OFFICE IN CALIFORNIA,IF ANY CITY STATE ZIP CODE 522 E.AIRLINE WAY GARDENA CA 90248 GARDENA CA 90248 6, MAILING ADDRESS OF CORPORATION,IF DIFFERENT THAN ITEM 4 CITY STATE ZIP CODE Names and Complete Addresses of the Following Officers "' P g (The corporation must list thesethree officers. A comparable title forthe specific' officer may be added;however,the preprinted titles on this form must not be altered.) 7. CHIEF EXECUTIVE OFFICER/ ADDRESS CITY STATE ZIP CODE REFAAT H MINA 522-E AIRLINE WAY GARDENA CA 90248 8, SECRETARY ADDRESS CITY STATE ZIP CODE REFAAT H MINA 522 E AIRLINE WAY GARDENA CA 90248 9. CHIEF FINANCIAL OFFICER/ ADDRESS CITY STATE ZIP CODE REFAAT H MINA 522 E AIRLINE WAY GARDENA CA 90248 Names and Complete Addresses of All Directors, Including Directors Who are Also Officers (The corporation must have at reast one director. Attach additional pages,if.necessa .) 0, NAME ADDRESS 1REF4AT H MINA 522 E AIRLINE WAY GAR - SATE gszIPCODE DENA >' CA "` 90248 ,'' 11. NAME " ADDRESS CITY STATE ZIP CODE 12. NAME ADDRESS CITY STATE ZIP CODE 13. NUMBER OF VACANCIES ON THE BOARD OF DIRECTORS,IF ANY: Agent for Service of Process if the agent is an Individual,the agent must reside in California and Item 15 must be completed with a California street address, a,P.O. Box address is not acceptable. If the agent is another corporation:the agent must have on file with the California Secretary of State a certificate pursuant to California Corporations Code section 1505 and Item 15 must be left blank, 14. NAME OF AGENT FOR SERVICE,OF PROCESS REFAAT H MINA 15. STREET ADDRESS OF AGENT FOR SERVICE.OF'PROCESS IN CALIFORNIA,IF AN INDIVIDUAL CITY STATE ZIP CODE 522 E AIRLINE-WAY CA 90248 Type of Business 16. DESCRIBE THE TYPE OF BUSINESS-OF THE CORPORATION CONSTRUCTION 17. BY SUBMITTING THIS STATEMENT OF INFORMATION TO THE CALIFORNIA SECRETARY OF STATE, H CORPO ON - RTIFIES'THE INFORMATION CONTAINED HEREIN,INCLUDING ANY ATTACHMENTS,IS TRUE AND CORRECT. 08/28/2015 REFAAT H MIA PRESIDENT DATE TYPE/PRINT NAME OF PERSON COMPLETING FORM TITLE SIGNATURE S6200(REV 0112013) APPROVED.BY:SECRETARY OF STATE I Hereby certify that the foregoing transcript of pages) { is a full,true and �,-t copy of Me �¢ � original record in the custody of the ,4tq Calitornia Secretary of State's office. SEP 1 1 2015 Date: 0S���&^ ALEX PADILIA,Secretary of State ER 3 T A ACTIVE LICE�S` E 'VI I N' A�V; R,A C O R D OR i, DBA MINCC) A B C-7 Cl 0 Hog 09/30/2018 Legal N.— Regisirat on Numtier �,g_ v County"; City RegistrationExplretion�'Date° MINAKO AMERICA CORPORATION 1000002728 1 LOS ANGELES GARDENA 05/13/2016 06/30/2017 Bond No.: CMGB0000404 BID BOND Argonaut Insurance Company Deliveries Only: 225 W.Washington, 241h Floor, Chicago, IL 60606 United States Postal Service: P.O. Box 469011, San Antonio, TX 78246 KNOW ALL MEN BY THESE PRESENTS: That we Minako America Corporation dba: Minco Construction called the Principal, and Argonaut Insurance Company, an Illinois corporation, called the Surety, are held and firmly bound unto City of Huntington Beach called the Obligee, in the sum of Ten Percent of the Greatest Amount Bid U.S. Dollars ($10% of G.A.B. ), for the payment of which we bind ourselves, and our successors and assigns, jointly and severally, as provided herein. WHEREAS, Principal has submitted or is about to submit a bid to the Obligee on a contract for FY 16/17 Curb Access Ramp Installation Project ("Project"). NOW, THEREFORE, the condition of this bond is that if Obligee accepts Principal's bid, and Principal enters into a contract with Obligee in conformance with the terms of the bid and provides such bond or bonds as may be specified in the bidding or contract documents, then this obligation shall be void; otherwise Principal and Surety will pay to Obligee the difference between the amount of Principal's bid and the amount for which Obligee shall in good faith contract with another person or entity to perform the work covered by Principal's bid, but in no event shall Surety's and Principal's liability exceed the penal sum of this bond. Signed this 6th day of January 2017 Minako America Corporation PRINCIPAL dba: Minco Construction Title A UT CE COMPANY* Gabrie a Groy Attorney=in-Fact i "C/o CMGIA-20335 Ventura Blvd. Suite 426,Woodland Hills, CA 91364. Bond#CMGBoo00402 Argonaut Insurance Company Deliveries Only: 225 W. Washington, 24th Floor Chicago, IL 60606 United States.Postal Service: P.O. Box 469011, San Antonio, TX 78246 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the Argonaut Insurance Company,a Corporation duly organized and existing under the laws of the State of Illinois and having its principal office in the County of Cook,Illinois does hereby nominate,constitute and appoint: 4, aa3x: Gabriella Grady,Shilo Lee Losing,Stephanie Hope Shear �inf'Y Their true and lawful agent(s)and attorney(s)-in-fact,each in their separate capacity if more than one is named above'wto make°execute,seal and deliver for and on its behalf as surety,and as its act and deed any and all bonds,contracts,agreements of indemnity and other undertakings in suretyship provided, however,that the penal sum of any one such instrument executed hereunder shall not exceed the sum of. A , r," $10,000,000.00 i;- La_ This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolution adopted by the Board of Directors of Argonaut Insurance Company: "RESOLVED,.That the President,Senior Vice President,Vice President,Assistant Vice Presidenf;:,Secretary,Treasurer and each of them hereby is authorized to execute powers of attorney,and such authority can be executed by use of facsimile signature,which may be attested or acknowledged by any officer or attorney,of the Company,qualifying the attorney or attorneys named in the givempowet of attorney,to execute in behalf of,and acknowledge as the act and deed of the Argonaut Insurance Company,all bond undertakings and contracts of suretyship,and to affix the corporate seal thereto." r' IN WITNESS WHEREOF,Argonaut Insurance Company has caused rts official seal to be hereunto affixed and these presents to be signed by its duly authorized officer on the 18th day of July,2013. Argonaut Insurance Company ot z,Cj., 19e8 :_, by: * Joshua C.Betz Senior Vice President STATE OF TEXAS d COUNTY OF HARRIS SS: sr+ On this 18th day of July,2013 A.D.;before me,a Notary Public of the State of Texas,in and for the County of Harris,duly commissioned and qualified, came THE ABOVE OFFICER OF,THE COMPANY,to me personally known to be the individual and officer described in,and who executed the preceding instrument,and he acknowledged the,.execution of same,and being by me duly sworn,deposed and said that he is the officer of the said Company aforesaid, and that the seal affixed to`the preceding instrument is the Corporate Seal of said Company,and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said corporation,and that Resolution adopted by the Board of Directors of said.Company,referred to in the preceding instrument is now in force. 43. IN TESTIMONY WHEREOF,I have hereunto set my hand,and affixed my Official Seal at the County of Harris,the day and year first above written. gk6.+hu n-1 1 1.-rquA)w �.�• KATHLEEN M MEEKS NOTARY PUBLIC STATE OF TEXAS �'Fo•� MY COMM.EXP.07-15-2017 (Notary Public) I,the undersigned Officer of the Argonaut Insurance Company,Illinois Corporation,do hereby certify that the original POWER OF ATTORNEY of which the foregoing is a full,true and correct copy is still in full force and effect and has not been revoked. IN WITNESS WHEREOF,I have hereunto set my hand,and affixed the Seal of said Company,on the 6th day of January ,2017 C) ze. o �-��— �: Sarah Heineman VP-Underwriting Surety ..etoo.",�• THIS DOCUMENT IS NOT VALID UNLESS THE WORDS ARGO POWER OF ATTORNEY ARE IN BLUE.IF YOU HAVE QUESTIONS ON AUTHENTICITY OF THIS DOCUMENT CALL(210)321-8400. 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 �'AN 0 6 2017 before me, SHIRLEY GIGGLES, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared GABRIELLA GRADY 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 SHIRLEY GIGGLES is true and correct. Notary Public •California WITNESS my hand and official seal. Z :`� Los Angeles County Z Z Commission #F 2163817 My Comm. Expires Sep 7, 2020 Signature Sig e 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: Signer's Name: ❑Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑ Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: 02014 National Notary Association - www.NationalNotary.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 JAN 10, 2017 before me, Raffi Varooj Thomassian, Notary Public Date Here Insert Name and Title of the Officer personally appeared Refaat H Mina Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(q) is/a;e subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/leer/their authorized capacity(ies), and that by his/hw/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 RAFFI VAROD THOMASSIAN is true and correct. Notary Public-California Z WITNESS my hand and official seal. a -� Los Angeles County z i Commission # 2152450 MX Comm.Expires May 12,2020 Signature '/ C�— ignature 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: No other signers Capacity(ies) Claimed by Signer(s) Signer's Name: Refaat H Mina Signer's Name: ❑X Corporate Officer — Title(s): President ❑Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑General ❑Partner — ❑ Limited ❑General ❑ Individual ❑Attorney in Fact ❑Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: ©2014 National Notary Association• www.NationaiNotary.org• 1-800-US NOTARY(1-800-876-6827) Item#5907 City of Huntington Beach , ' ``}' y •• 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk !7,1999 Robin Estanislau, City Clerk April 27, 2017 Nobest, Inc. P. O. Box 874 Westminster, CA 92684-0874 RE: FY 2016/17 Curb Access Ramp Installation Project—CC-1541 Enclosed please find your original bid bond for CC-1541. Sincerely, 4�7� Robin Estanislau, CIVIC City Clerk RE:pe Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand cv c� ..t�.;` CD Itso 4J 6 tV v � s � o � VZ k of � • �� Z�tie W Z si � t �1 SECTION C PROPOSAL for the construction of FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT from VARIOUS LOCATIONS CC No. 1541 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 70 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 r 4 • SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 BID ITEMS Item ; r. Description ,. Quantity . Urut Umt,Cost Total Cost No.. "(Eil nsion 1 Mobilization 1 LS Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 1 in 2 Appendix H of Specifications (Item includes all appurtenances, curb&gutter, depressed curb, sidewalk, domes, retaining curb,sawcut,slot pave,etc.) 68 EA $ 7, DI.V $ Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR using horizontal curb cutting machine as 3 shown on Curb Ramp Detail 2 in Appendix H of Specifications (Item includes all appurtenances, curb&gutter,depressed -7 curb,sawcut,sidewalk,domes, retaining curb,etc.) 63 EA $ � $ Construct Curb Access Ramp per Caltrans Std. Plan A88A from BCR to ECR as shown on Curb Ramp Detail 3 in 4 Appendix H of Specifications (Item includes all appurtenances, curb&gutter,depressed curb,sawcut, �, QC © al sidewalk,domes, retaining curb,slot pave, etc.) 5 EA $ 1�f/-� $ Construct Case C Midblock or Case F/Case G/Case CM or Type C Directional Curb Access Ramp per Caltrans Std. Plan 5 A88A/A88B(Item includes all appurtenances, curb&gutter, depressed curb,sidewalk,domes, retaining curb,slot pave, etc.) 20 EA $ $ 6 Install truncated domes to existing Curb Ramp 123 EA $ Sy o 0— $ 7 Remove existing improvements and construct concrete �7 0� meandering sidewalk per HB Standard Plan 207 500 SF $ !. Remove and reconstruct Cross Gutters per HB Standard Plan 8 205(Item includes all appurtenances, curb&gutter,slot pave,etc.) 3,800 SF $ 17 Oc $ 6 4�40B Remove and replace existing 6"or 8"Curb and Gutter per HB 9 Standard Plan 202(Item includes all appurtenances and slot 0—K pave,etc.) 100 LF $ Install 4" PVC Sleeve for Street Assembly Sign per City of HB /� o0 10 Std. Plan 401 10 EA $ - 11 Prepare Storm Water Pollution Prevention Plan(SWPPP) 1 LS $ �Q $ 12 Install&Maintain Construction BMPs 1 LS $ 9,144 t4ffio TOTAL BID AMOUNT (BASIS OF AWARD) - SCHEDULE A $ -7 Ce C-2.1 SECTION C PROJECT BID SCHEDULE CURB ACESS RAMP INSTALLATION, CC 1541 TOTAL BID AMOUNT IN WORDS: S,evea K4orked Se��n!�e - real 'Na4eavi Note: 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. C-2.2 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 r✓�l�G1c°/ �s ��II in the amount of /,�02o 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 idder's i nat C-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 Dollar % of Item(s) Subcontractor License Number Amount Contract Number By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT 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 1 o-ij, at e� Qts'�, 6A— / Date City State L of(y Alo i /�d ni , being first duly sworn, deposes and says that he or she is P/�°s; y✓!f of NoPes A T h r. 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. Alo e s t z�Y1 L Name of Bidder SigR ture of Bi er Address of Bidder C-4 • CALIFORNIA ALL-PURPOSE CERtI'IFIC.ATE OF ACKNOWLEDGMENT State of California County of Orange On r �� - _ before me, Kay E. Anderson/Notary Public , (Here insert name and title of the officer) personally appeared Larry Nodland who proved to me on the basis of satisfactory evidence to be the person Wf whose name(s-y is/subscribed to the within instrument and acknowledged to me that he/5he9tffey°executed the same in his/,he;r/heir authorized capacity oes5, and that by his, eI they signaturnWon the instrument the persons);or the entity upon behalf of which the personp)racted, 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. KAY E. ANDERSON WITNESS m hand and official seal. •: �; Commission # 2031255 -'� Notary Public -California Z z : ._� Z Orange County D (Notary Sea My Comm.Expires Jun 27,2017 Signature of Notary Public ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM �I Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California.In such instances,any alternative „(Title or description of attached document) acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal jar a notary in California (i.e. certifying the authorized capacity of the signer). Please check the (Title or description of attached document continued) document carefully for proper notarial wording and attach this form ifrequired Number of Pages Document Date • 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. (Additional information) • 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. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. ❑ Individual(s) he/she/tlaey-is/are)or circling the correct forms.Failure to correctly indicate this information may lead to rejection of document recording. ® Corporate Officer e The notary seal impression must be clear and photographically reproducible. President Impression must not cover text or lines.If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) a Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. ❑ Other Indicate title or type of attached document,number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com 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 FY 16/17 CURB ACCESS RAMP INSTALLATION PROJECT, (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. Contractor By e)i(e s�Wep0o Title Date: " 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 0-N- o If the answer is yes, explain the circumstances in the space provided. N/9 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. 4 e 5 f Z,q r. Contractor By Title Date: C-7 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: ee be y f- -7p? C. Bidder Name 76&1)0 �6 a ,WvP- Business Address Ga��.�� G�a�� C'4 �a Oil City, State Zip Telephone Number Email Address 3s15F"a State Contractor's License No. and Class L Zef Original Date Issued -2 - 3/ -/9 Expiration Date The work site was inspected by M I ,P— LeW,+ of our office on 7017. , 2017. The followingare persons, firms, and corporations having a principal interest in this proposal: C-8 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Company Name Sign f Bi der G a✓i /Uo��Qn Printed or Typed Signatur Subscribed and sworn to before me this M day of--7'Awj , 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 G!--hLq ) County of ©A�N/ 6 it—) On before me 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�is/� subscribed to the within instrument and acknowledged to me that he/5texecuted the same in his/ t authorized capacity and that by his/�]beif signatur4( on the instrument the personyo *911 r the entity upon behalf of which the personWacted, 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. KAY E. ANDERSON Commission #2031255 C@My Notary Public-California z ZOrange Countyka..C'4 1� I D Comm.Expires Jun 27,2017 Signature Sign 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: 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: Contract Amount Type of Work Date Completed Provide additional project description to show similar work: C-10 NOBEST INCORPORATED REFERENCE LIST Page 1 No. 1 Project Name/Number: Bay Avenue Maintenance#6 Project Description: Remove and Replace Concrete Streets and Alleys Approximate Construction Dates: From: 3/2015 To: 6/2015 Agency Name: City of Newport Beach Contact Person: Mike Sinacori Telephone: (949) 644-3342 Original Contract Amount: $826,000 Final Contract Amount: $ 836,063 No. 2 Project Name/Number: Residential Tree Petition Street Improvements Project Description: Remove&Replace Curb&Gutter.Sidewalks Driveways.Cross Gutter.Tree Planting Coldmill and Overlav Approximate Construction Dates: From: 8/2015 To: In Progress Agency Name: City of Huntington Beach Contact Person: Dave Verone Telephone: (714) 536-5431 Original Contract Amount: $650,501 Final Contract Amount: $ In Progress NOBEST REFERENCE LIST Page 2 No. 3 Project Name/Number: Annual Concrete Maintenance Program Project Description: R&R Concrete Sidewalks Curb&Gutter Drive Approaches and Curb Rams Approximate Construction Dates: From: 2/2013 To: Present . Agency Name: City of Huntington Beach Contact Person: Dereck Livermore Telephone: (714) 960-8861 Original Contract Amount: $500,000 Final Contract Amount: $ In Progress No. 4 Project Name/Number: Section 2 Concrete Repair& Miscellaneous Slurry Project Project Description: Remove&Replace Sidewalks Driveways Curb Ramps and Curb& Gutter Approximate Constriction Dates: From: 8/2014 To: 10/2014 Agency Name: City of Manhattan Beach Contact Person: Juan Price Telephone: (310) 802-5310 Original Contract Amount: $1,119,790 Final Contract Amount: $ 1,138,600 NOBEST REFERENCE LIST Page 3 No. 5 Project Name/Number: Annual Concrete Rehabilitation Project 128 Project Description: Remove&Replace Sidewalk,Curb Ramps Curb &Gutter, and Tree Removals Approximate Construction Dates: From: 5/2015 To: 8/2015 Agency Name: City of Cypress Contact Person: Dario Simoes Telephone: (714) 229-6694_ Original Contract Amount: $514,000 Final Contract Amount: $ 431,883 No. 6 Project Name umber: Safe Routes to School Grant Project Description: Remove and Replace Sidewalk,Curb&Gutter Driveways Curb Ramps and Allevs Approximate Construction Dates: From: 8/2014 To: 7/2015 Agency Name: City of Pomona Contact Person: Matt Pilarz Telephone: (909) 620-3652 Original Contract Amount: S1,515,103 Final Contract Amount: S 1,700,000 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: 3 VAPUW-Z, 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. Name of proposed Superintendent f Telephone No. of proposed Superintendent: 7) f `-1 5�8 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 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/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. Contractor By Title Date: DIR#: �00V`�Sc�q' 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): 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: �1d6 z 5 4- Ti?C. Contact Person: C sOrJ Contact Phone: Signed: Date: *Note: The above certification is required by the Department of Housing and Urban Development (24 CFR 135 and Subtitle A et al) and must be submitted by the bidders and proposed sub-contractors only in connection with contracts and subcontracts which are subject to Section 3 of the 1968 Housing and Urban Development Act, as amended in 1992 (HUD). Previous non-compliance with Section 3 could result in disqualification. C-13 EXHIBIT A DISADVANTAGED BUSINESS ENTERPRISE (DBE) This Project is subject to Part 200.321,Title 2, Code of Federal Regulations entitled "Contracting with Small and Minority Businesses, Women's Business Enterprises, and Labor Surplus Area Firms." The Regulations in their entirety are incorporated herein by this reference. It is the policy of the City that disadvantaged business enterprises (DBEs), as defined in Part 200.321, Title 2 CFR, shall be encouraged to participate in the performance of Contracts financed in whole or in part with federal funds. The Contractor should ensure that DBEs, as defined in Part 200.321, Title 2 CFR, have the opportunity to participate in the performance of this Contract and shall take all necessary and reasonable steps, as set forth in Part 200.321, Title 2 CFR, for this assurance. The Contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of subcontracts. Failure to carry out the requirements of this paragraph shall constitute a breach of Contract and may result in termination of this Contract or other remedy the City may deem appropriate. Bidders shall be fully informed respecting the requirements of the Regulations and are urged to obtain DBE participation in this project, although there is no specific goal for DBE participation. C-14 EXHIBIT B DBE INFORMATION—GOOD FAITH EFFORTS Federal-aid Project No.4—f , /-5 ,Y I Bid Opening Date L - M 7 The City of Huntington Beach established a Disadvantaged Business Enterprise (DBE) goal of 0% 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 Solicitation and Dates C-15 C. The items of work which the bidder made available to DBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items M of (Y/N) Contract D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each DBE if the selected firm is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: Names, addresses and phone numbers of firms selected for the work above: 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-16 • 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-17 IF A SOLE OWNER OR SOLE CONTRACTOR SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname) of proprietor (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail IF A PARTNERSHIP, SIGN HERE: (1) Name under which business is conducted (2) Signature (given and surname and character of partner) (Note: Signature must be made by a general partner) (3) Place of Business (Street and Number) City and State (4) Zip Code Telephone No. (5) E-Mail C-18 IF A CORPORATION, SIGN HERE: (1) Name under which business is conducted N c) (2) Iature (Title) Impress Corporate Seal here (3) Incorporated under the laws of the State of (4) Place of Business / b O o A of 41�u /' (Street and Number) City and State 67"�'S b - �_j�' E e �� (5) Zip Code 2. Y-41 Telephone No. r) Ltl " 7(/ 2 — Y 5-f33 (6) E-Mail NOTARIAL ACKNOWLEDGMENT OF EXECUTION BY ALL SIGNATORIES MUST BE ATTACHED C-19 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Orange On t ^1 D _J I before me, Kay E. Anderson/Notary Public (Here insert name and title of the officer) personally appeared Larry Nodland who proved to me on the.basis of satisfactory evidence to be the person whose name(,s-'is/,aresubscribed to the within instrument and acknowledged to me that he/Aelthr-rexecuted the same in his/be-r/t_heir authorized capacitygesl, and that by his/�eI`Wr signature�Won 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 true and correct. A KAY E. ANDERSON WITNESS my nd and official seal. Commission # 2011255 a==� Notary Public -California z N� Z Orange County D (Notary Seal My Comm. Exoires Jun 27,2017 Signature of Notary Public ADDITIONAL OPTIONAL INFOR1VgATION INSTRUCTIONS FOR COMPLETING THIS FORM I Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California In such instances,any alternative ,,(Title or description of attached document) acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California(i.e. certifying the authorized capacity of the signer). Please check the (Title or description of attached document continued) document carefully for proper notarial wording and attach this form if required • State and County information must be the State and County where the document Number of Pages Document Date 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. (Additional information) • 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. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. ❑ Individual(s) he/she/tlwwy,-is/are)or circling the correct forms.Failure to correctly indicate this information may lead to rejection of document recording. ® Corporate Officer • The notary seal impression must be clear and photographically reproducible. President Impression must not cover text or lines.If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) a Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact 4. Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. ❑ Other Indicate title or type of attached document,number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com List below names of president, vice president, secretary and assistant secretary, if a corporation; if a partnership, list names of all general partners and managing partners: C-20 EXHIBIT C LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCAL AGENCY: c o �tae-h LOCATION: VOCASrI Ds �ca�i0/15 PROJECT DESCRIPTION: 6,�+j Q U rb Cee-CA5 t am s TOTAL CONTRACT AMOUNT:$ � 7 7, (/�D• BID DATE: /—a )� —/� �s BIDDER'S NAME: / �/ O CONTRACT DBE GOAL: D 1D CONTRACT ITEM OF WORK AND DESCRIPTION BE CERT NO. NAME OF EACH DBE DOLLAR AMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened-include DBE address O BE PROVIDED (or contracted if the and phone number) bidder is a DBE) 0Z03 s Tvr4GkJr1 oDp — Po 13ax S ce CA oSo For Local Agency to Complete: Total Claimed DBE � � Local Agency Contract Number: Participation $ / /� Federal-aid Project Number: - p/o Federal Share: Contract Award Date: IL Local Agency certifies that all DBE certifications have been verified and information is complete and accurate. lure .idd - 10-17 'H- g I ^ S, :�> p4e�� /� (Area Code)T o. Print Name Signature Date K A,4> s Local Agency Representative Person to'Contact (Please Type or Print) (Area Code)Telephone Number: Local Agency Bidder DBE Commitment(Construction Contracts) (Rev 6/26/09) C-21 Unified Certification Program Page 1 of 1 Back To Query Form Search Returned 1 Records Tue Jan 10 09:19:16 PST 2017 Query Criteria Firm ID: 02037 Firm T e: DBE Firm ID 2037 Firm/DBA Name RAYS TRUCKING Address Line1 17103 S HASS AVENUE Address Line2 City TORRANCE State CA Zip Code1 90504 Zip Code2 Mailing Address Line1 P.O.BOX 6553 Mailing Address Line2 Mailing City TORRANCE Mailing State CA Mailing Zip Code1 90504 Mailing Zip Code2 Certification Type DBE Entail luckylady5555@sbcglobal.net Contact Name SHARON ALEXANDER Area Code (310) Phone Number 538-9891 Alt Area Code ( ) Alt Phone Number Fax Area Code (310) Fax Phone Number 327-6922 Agency Name DEPARTMENT OF TRANSPORTATION Counties 19;30;36;56; Districts 07;08; 12; DBE NAILS 425120;484110; ACDBE NAICS Work Codes C9602 BOTTOM DUMP TRUCKING;C9774 TRUCKER;C9771 TRUCK BROKER; Licenses Trucks FOR HIRE-2; Gender F Ethnicity CAUCASIAN Firm T e DBE Back To Query https://ucp.dot.ca.gov/QuerySubmit.do 1/10/2017 PLEASE NOTE: This information may be submitted with your bid. If it is not, and you are the apparent low bidder or the second or third low bidder, it must be submitted and received as specified in the Special Provisions. Failure to submit the required DBE commitment will be grounds for finding the bid nonresponsive The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract DBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by DBEs including, if the prime is a DBE, work performed by its own forces, if a DBE. The DBE shall provide a certification number to the Contractor and expiration date. Enter the DBE prime's and subcontractors' certification numbers.The form has a column for the Names of DBE contractors to perform the work (who must be certified on the date bids are opened and include the DBE address and phone number). IMPORTANT: Identify all DBE firms participating in the project regardless of tier. Names of the First-Tier DBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts), to determine how to count the participation of DBE firms. Exhibit 15-G must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local 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. C-22 EXHIBIT D EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder fi C F4�C-- -!�,,Y [proposed subcontractor J hereby certifies that he/she/it 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/she/it 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. (eeoc.gov/employers/eeolsurvey/index.cfm) 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. Signature: ate: 1 4 a —17 Print Name: Title: C-23 EXHIBIT E NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) [NAME OF CONTRACT] To the City of Huntington Beach In conformance with Title 23 United States Code Section 112 and California 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 Bidder's Proposal. By signing the Proposal, the Bidder has also signed this Noncollusion Affidavit. Bidders are cautioned that making a false ion may subject the Bidder to criminal prosecution. Signature: a e: Print Name: Title: Qom - C-24 EXHIBIT F 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 with Bidder 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 him/her 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. Note: 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 consti to signa of this Certification. Signature: Date: l Print Name: "- .A,7N Title: ?r,7- -1 C-25 EXHIBIT G 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 certificatio included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients sha `certify and disclose accordingly. Signature: Date: ! /0 Print Name: Title: C-26 EXHIBIT H 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 F-1.bid/offer/application ❑ a.initial b.grant b.initial award b.material change c.cooperative agreement c.post-award d.loan For Material Change Only: e.loan guarantee year quarter f.loan insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: Prime Subawardee Tier ifknown Congressional District,if known Congressional District,if known 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number,if applicable 8. Federal Action Number,if known: 9. Award Amount,if known: 10. a.Name and Address of Lobby Entity b. Individuals Performing Services (i cluding (If individual,last name,first name,MI) address if different from No. 10a) ,( st name first e, ' (a �.� c ontt twn Sheets)ifnec1ssary)0 16— It. Amount of Payment(check all that apply) 13. Type of Payment(check all that apply) $ Actual planned a.retainer b.one-time fee 12. Form of Payment(check all that apply): c.commission ea.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 II: c (attach Continuation Sheet(s)if necessary) 15. Continuation Sheet(s)attached: Yes No 16. Information requested through this fonn is authorized by Title 31 U.S.C. Section 1352.This disclosure of lobbying reliance Signatu was placed by the tier above when his transaction was made or into.This disclosure is required pursuant to 31 U.S.C. Print Name: ID 1352. This information will be reported to Congress semiannually and will be available for public inspection.Any Title: person who fails to file the required disclosure shall be subject � `S- to acivil penalty of not less than$]0,000 and not more than Telephone No.: � e. $100,000 for each such failure. Authorized for Local Reproduction Federal Use Only: Standard Foam-LLL Standard Foam LLL Rev.09-12-97 C-27 r • INSTRUCTIONS FOR COMPLETION OF EXHIBIT H, 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 C-28 • (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12)Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13)Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 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. By my signature on this proposal I certify, under penalty of perjury under the laws of the State of California, that the foregoing questionnaire and statements of Public Contract Code Sections 10162, 10232 and 10285.1 are true and correct and that the bidder has complied with the requirements of Section 8103 of the Fair Employment and Housing Commission Regulations (Chapter 5, Title 2 of the California Administrative Code). C-29 • EXHIBIT I FEDERAL LOBBYING RESTRICTIONS Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower tier subrecipient 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 Proposal. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Proposal. Signing the Proposal 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: 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 person(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. C-30 9 City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 536-5431, Fax (714) 374-1573 ADDENDUM NUMBER ONE for FY 2016/17 CURB ACCESS RAMP INSTALLATION PROJECT C.C. No. 1541 January 3, 2017 Notice To All Bidders: Please note the following clarification to the Project Plans, Specifications, and Special Provisions: 1) Replace Section D "Sample Contract" in it's entirety in the Specifications with updated Section D in this Addendum. The"Sample Contract' was updated in December 2016. 2) Replace Appendix K, the "Prevailing Wage Schedule" in it's entirety in the Specifications with updated Appendix K in this Addendum. "General Decision Number: CA60035 11/11/2016" will be replaced with "General Decision Number: CA60035 12/23/2016." 3) Replace Appendix L, the "Federal Documents for CDBG Projects" in it's entirity in the Specifications with updated Appendix L in this Addendum. The documents were updated in December 2016. This is to acknowledge receipt and review of Addendum Number One, dated January 3, 20 7. NaG e 5 - Company Name y Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Joseph Fuentes at (714) 536- 5431. 1 Bid Bond Bid Bond Number:CSBA-3867 CONTRACTOR: SURETY: (Name,legal status and address) (Name,legal status and principal place of business) Nobest Incorporated Merchants Bonding Company(Mutual) 7600 Acacia Ave. 6700 Westown Parkway Garden Grove,CA 92841 West Des Moines,IA 50266 OWNER: This document has important legal (Name,legal status and address) consequences.Consultation with City of Huntington Beach An attorney is encouraged with respect 2000 Main Street its completion or modification. Huntington Beach,CA 92648 Any singular reference to Contractor,Surety,Owner or other party shall be considered Plural where applicable. BOND AMOUNT: Ten Percent(10%)of Amount Bid PROJECT:FY 16/17 Curb Access Ramp Installation Project Project Number,if any: CC No. 1541 The Contractor and Surety are bound to the Owner in the amount set forth above,for the payment of which the Contractor and Surety bind themselves,their heirs,executors,administrators,successors and assigns,jointly and severally,as provided herein.The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents,or within such time period as may be agreed to by the Owner and Contractor,and the Contractor either(1)enters into a contract with the Owner in accordance with the terms of such bid,and gives such bond or bonds as may be specified in the bidding or Contract Documents,with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner,for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof,or(2)pays to the Owner the difference,not to exceed the amount of this Bond,between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid,then this obligation shall be null and void,otherwise to remain in full force and effect.The Surety hereby waives any notice'of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid.Waiver of notice by the Surety shall not apply to any extension exceeding sixty(60)days in the aggregate beyond the time for acceptance of bids specified in the bid documents,and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty(60) days. If this Bond is issued in connection with a subcontractors 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 here from and provisions conforming to such statutory of 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 4th day of January.2017 Nobest Incorporated (Principal) eal) (lPlitness) (Title) \ r (Mutual) (Seal)Merchants Bondin C (F,tness) Ruy Urieta (Su (Title)Shaunna Rozelle Ostrom,Attorney-in-Fact By arrangement with the American Institute of Architects, the National Association of Surety Bond Producers(NASBP) (www.nasbp.or ) makes this form document available to its members,affiliates,and associates in Microsoft Word format for use in the regular course of surety business.NASBP vouches that t the original text of this document conforms exactly to the text in AIA Document A310-2010, Bid Bond. Subsequent modifications may be made to the original text of this document by users,so careful review of its wording and consultation with an attorney are encouraged before its completion, execution or acceptance. CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Orange On /0-/7 before me, Kay E. Anderson/Notary Public , (Here insert name and title of the officer) personally appeared Larry Nodland and Robert Nodland II who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)rere subscribed to the within instrument and acknowledged to me thaU�/�Jidthey executed the same in t is their authorized capacity(ies), and that by WX&eir 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. C771Z KAY E. ANDERSON Commission #2031255 WI my d and Official seal. Z.F!a. - Notary Public -California z Z �'' Orange County D My Comm.Expires Jun 27,2017 Signature of Notary Public (Notary Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM DESCRIPTION OF THE ATTACHED DOCUMENT Try acknowledgment ab leedgm1� completed in California must contain verbiage exactly as appearsnotary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California In such instances, any alternative (Title or description of attached document) acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California(i.e. certifying the authorized cmpacity of the signer). Please check.the (Title or description of attached document continued) document carefully for proper notarial wording and attach thisform ifrequired • State and County information must be the State and County where the document Number of Pages Document Date 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. (Additional information) • 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. CAPACITY CLAWED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. El Individual(s) 4e/she/tiey-is/ara)or circling the correct forms.Failure to correctly indicate this information may lead to rejection of document recording. [X Corporate Officer(s • The notary seal impression must be clear and photographically reproducible. Larry Nodland—President Impression must not cover text or lines.If seal impression smudges,re-seal if a (Title)Robert Nodland II—Sec. sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. ❑ Other - Indicate title or type of attached document,number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA vl2.10.07 80C-873-9865 www.NoLuyClasses.com 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 01/04/2017 before me, Rudy Urieta Notary Public personally appeared Shaunna Rozelle Ostrom 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 RUDY URIETA true and correct. COMM.#2159828 n Notary Public-California ORANGE COUNTY a WITNESSyay-t 1 and Official seal ow+' My Comm.ExpiresJul 14,2020 Signature of Notary Rudy Urieta OPTIONAL Though the data below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL Bid Bond ❑ CORPORATE OFFICER Title or Type of Document One ❑ PARTNER(S) Number of Pages ❑ MEMBER of LLC ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) 01/04/2017 ❑ GUARDIAN/CONSERVATOR Date of Document OTHER: SIGNER IS REPRESENTING: Signer(s) other than named above NAME OF PERSON(S) OR ENTITY(IES) Bond No.CSBA-3867 MERCHANTS BONDING COMPANY. POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC.,both being corporations of the State of Iowa(herein collectively called the"Companies")do hereby make,constitute and appoint, individually, Andrew Waterbury; Arturo Ayala; Daniel Huckabay; Dwight Reilly; Michael Castaneda; Shaunna Rozelle Ostrom their true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver on behalf of the Companies,as Surety,bonds, undertakings and other written obligations in the nature thereof,subject to the limitation that any such instrument shall not exceed the amount of: TWENTY MILLION($20,000,000.00)DOLLARS This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company(Mutual)on April 23,2011 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 24,2011. "The President,Secretary,Treasurer,or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attomeys-in-Fact,and to authorize them to execute on behalf of the Company,and attach the seal of the Company thereto,bonds and undertakings, recognizances,contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond,undertaking,recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." 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. 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. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 22nd day of November 2016 I li1/iiiy �,a *''",'t0ll i"'• •'•G '• MERCHANTS BONDING COMPANY(MUTUAL) ,� "tt ......... •Q�.... j• . MERCHANTS NATIONAL BONDING,INC. Z By STATE OF IOWA '!'� '• COUNTY OF Dallas ss. "" •••••••• President On this 22nd day of November 2016 , before me appeared Larry Taylor,to me personally known,who being by me sworn did say that he is President of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC.;and that the seals affixed to the foregoing instrument are the Corporate seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. �pRIA4s WENDY WOODY o > Commission Number 784654 7 My Commission Expires �owP June 20, 2017 Notary Publr , County, Iowa (Expiration of notary's commission does not invalidate this instrument) I,William Warner,Jr.,Secretary of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 4th day of January 2017 ...... •".t0Q +w� •moo ��Po99 9•• _p_ '►—:— o o:3• Secretary <t: zt 1- 'Q: 1933 ' ZC03 POA 0014 (6/15) •,•j`''�ii„iliii}{,W'+ ••..