CONTRACT 4438A Amendment CLOSEDAgreement No. 4438A
AMENDMENT TO
AGREEMENT NO.4438 BETWEEN
THE CITY OF EL SEGUNDO AND
NCM ENGINEERING CORPORATION
THIS 1st AMENDMENT ("Amendment") is made and entered into this 1st day of July, 2013, by
and between the CITY OF EL SEGUNDO, a general law city and municipal corporation existing
under the laws of California ("CITY"), and NCM Engineering Corporation ("CONTRACTOR").
1. Pursuant to Section 35 of Agreement No. 4438 ("Agreement"), Section 11 of the
Agreement is amended to include Exhibit D: Federal Contract Requirements.
2. This Amendment may be executed in any number or counterparts, each of which will be
an original, but all of which together constitutes one instrument executed on the same
date.
Except as modified by this Amendment;, all other terns and conditions of Agreement
No. 4438 remain the sane.
[SIGNATURES ON NEXT PAGE]
Agreement No, 4438A
IN WITNESS WHEREOF the parties hereto
first hereinabovewritten,
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Agreement No. 4438A
FEDERAL CONTRACT REQUIREMENTS
ATTACHMENT D
General Compliance with Laws and Wage Rates
The consultant shall be required to comply with all federal, state and local laws and
ordinances applicable to the work. This includes compliance with California prevailing
wage rates, certified payrolls, and payment in accordance with California Labor Code,
Section 1775.
Subcontracting, Assianment and Transfer
Consultant services are considered to be a personal relationship between client and
principal; therefore, contracts in which participating federal or state funds are furnished
shall contain a clause expressly prohibiting the subcontracting, assignment, or transfer of
any of the work except, as otherwise, provided for in the executed contract. All contracts
shall provide that subcontracts exceeding $25,000 in cost shall contain all required
provisions of the prime contract.
Disadvantaged Business Enterprise Considerations
Consultants must give consideration to DBE firms as specified in 23 CFR § 172.5(b), 49 CFR,
Part 26, and in Exhibit 10-I Notice to Proposers DBE Information. If the contract has a DBE goal,
the consultant must meet the goal by using DBEs as subconsultants or document a good faith
effort to have met the goal. If a DBE subconsultant is unable to perform, the consultant must
make a good faith effort to replace him/her with another DBE subconsultant if the goal is not
otherwise met.
Exhibits 104, 10-J, 10-01, 10-02, and 17-F to be included, and are incorporated by reference.
Nonlobbyina Certification
Exhibit 10-P to be included, and is incorporated by reference.
Debarment and Suspension Certification
Exhibit 12-E, Attachment E to be included, and is incorporated by reference.
Non -Discrimination Clause
Exhibit 10-V to be included, and is incorporated by reference.
Certification of Consultant Commission & Feeds
Exhibit 10-F to be included, and is incorporated by reference.
Consultant Certification of Contract Costs and Financial Management System
Exhibit 10-K to be included, and is incorporated by reference..
Agreement No. 4438A
Local Assistance Procedures Manual EXHBIT 10-F
Certification of Consultant, Commissions & Fees
EXHIBIT 10-F CERTIFICATION OF CONSULTANT, COMMISSIONS & FEES
I HEREBY CERTIFY that I am the Principal &CFO,,,,,,, _,,,,,,,,,,,,,,,, and duly authorized
representative of the firm of NCM Engineering Corp whose address is
22362 Gilberto, Suite 125, Rancho Santa Margarita, CA 92688 , and that, except as hereby
expressly stated, neither I nor the above firm that I represent have:
(a) employed or retained for a commission, percentage, brokerage, contingent fee, or other consideration,
any firm or person (other than a bona fide employee working solely for me or the above consultant) to
solicit or secure this contract; nor
(b) agreed, as an express or implied condition for obtaining this contract, to employ or retain the services
of any firm or person in connection with carrying out the contract; nor
(c) paid, or agreed to pay, to any firm, organization or person (other than a bona fide employee working
solely for me or the above consultant) any fee, contribution, donation, or consideration of any kind, for or
in connection with, procuring or carrying out this contract.
I acknowledge that this Certificate is to be made available to the California Department of Transportation
(Caltrans) in connection with this contract involving participation of federal -aid highway funds, and is subject to
applicable state and federal laws, both criminal and civil.
July 1,_ 2013
(Date)
Distribution: 1) Local Agency Project File (Original & Contract)
2) DLAE (with contract copy)
I_..................................... ..................... -......
( gtlattlre)
Guilherme "William" Nascimento
Principal/Project Manager
NCM Engineering
Page 1 of 1
LPP 13-01 May 8, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXHBIT 10-I
Notice to Proposers DBE Information
EXHIBIT 10-I NOTICE TO PROPOSERS DBE INFORMATION
The Agency has established a DBE goal for this Contract of 12%
OR
The Agency has not established a goal for this Contract. However, proposers are encouraged to obtain DBE
participation for this contract.
1. TERMS AS USED IN THIS DOCUMENT
• The term "Disadvantaged Business Enterprise" or "DBE" means a for -profit small business concern
owned and controlled by a socially and economically disadvantaged person(s) as defined in Title 49,
Code of Federal Regulations (CFR), Part 26.5.
• The term "Agreement" also means "Contract."
• Agency also means the local entity entering into this contract with the Contractor or Consultant.
• The term "Small Business" or "SB" is as defined in 49 CFR 26.65.
2. AUTHORITY AND RESPONSIBILITY
A. DBEs and other small businesses are strongly encouraged to participate in the performance of Contracts
financed in whole or in part with federal funds (See 49 CFR 26, "Participation by Disadvantaged
Business Enterprises in Department of Transportation Financial Assistance Programs"). The Consultant
must ensure that DBEs and other small businesses have the opportunity to participate in the performance
of the work that is the subject of this solicitation and should take all necessary and reasonable steps for
this assurance. The proposer must not discriminate on the basis of race, color, national origin, or sex in
the award and performance of subcontracts.
B. Proposers are encouraged to use services offered by financial institutions owned and controlled by DBEs.
3. SUBMISSION OF DBE INFORMATION
If there is a DBE goal on the contract, Exhibit 10-01 Consultant Proposal DBE Commitment must be
included in the Request for Proposal. In order for a proposer to be considered responsible and responsive, the
proposer must make good faith efforts to meet the goal established for the contract. If the goal is not met, the
proposer must document adequate good faith efforts. All DBE participation will be counted towards the
contract goal; therefore, all DBE participation shall be collected and reported.
Exhibit 10-02 Consultant Contract DBE Information must be included with the Request for Proposal. Even if
no DBE participation will be reported, the successful proposer must execute and return the form.
4. DBE PARTICIPATION GENERAL INFORMATION
It is the proposer's responsibility to be fully informed regarding the requirements of 49 CFR, Part 26, and the
Department's DBE program developed pursuant to the regulations. Particular attention is directed to the
following:
A. A DBE must be a small business firm defined pursuant to 13 CFR 121 and be certified through the
California Unified Certification Program (CUCP).
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LPP 13-01 May 8, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXUBIT 10-I
Notice to Proposers DBE Information
B. A certified DBE may participate as a prime consultant, subconsultant, joint venture partner, as a vendor
of material or supplies, or as a trucking company.
C. A DBE proposer not proposing as a joint venture with a non -DBE, will be required to document one or a
combination of the following:
1. The proposer is a DBE and will meet the goal by performing work with its own forces.
2. The proposer will meet the goal through work performed by DBE subconsultants, suppliers or
trucking companies.
3. The proposer, prior to proposing, made adequate good faith efforts to meet the goal.
D. A DBE joint venture partner must be responsible for specific contract items of work or clearly defined
portions thereof. Responsibility means actually performing, managing, and supervising the work with its
own forces. The DBE joint venture partner must share in the capital contribution, control, management,
risks and profits of the joint venture commensurate with its ownership interest.
E. A DBE must perform a commercially useful function pursuant to 49 CFR 26.55, that is, a DBE firm
must be responsible for the execution of a distinct element of the work and must carry out its
responsibility by actually performing, managing and supervising the work.
F. The proposer shall list only one subconsultant for each portion of work as defined in their proposal and all
DBE subconsultants should be listed in the bid/cost proposal list of subconsultants.
G. A prime consultant who is a certified DBE is eligible to claim all of the work in the Contract toward the
DBE participation except that portion of the work to be performed by non -DBE subconsultants.
5. RESOURCES
A. The CUCP database includes the certified DBEs from all certifying agencies participating in the CUCP. If
you believe a firm is certified that cannot be located on the database, please contact the Caltrans Office of
Certification toll free number 1-866-810-6346 for assistance.
B. Access the CUCP database from the Department of Transportation, Office of Business and Economic
Opportunity Web site at: http://www.dot.ca.gov/hq/bep/.
1. Click on the link in the left menu titled Disadvantazed Business Enterprise•,
2. Click on Search for a DBE Firm link;
3. Click on Access to the DBE Query Form located on the first line in the center of the page.
Searches can be performed by one or more criteria. Follow instructions on the screen.
6. MATERIALS OR SUPPLIES PURCHASED FROM DBES COUNT TOWARDS THE DBE GOAL UNDER THE
FOLLOWING CONDITIONS:
A. If the materials or supplies are obtained from a DBE manufacturer, count 100 percent of the cost of the
materials or supplies. A DBE manufacturer is a firm that operates or maintains a factory, or establishment
that produces on the premises the materials, supplies, articles, or equipment required under the Contract
and of the general character described by the specifications.
B. If the materials or supplies purchased from a DBE regular dealer, count 60 percent of the cost of the
materials or supplies. A DBE regular dealer is a firm that owns, operates or maintains a store, warehouse,
or other establishment in which the materials, supplies, articles or equipment of the general character
described by the specifications and required under the Contract are bought, kept in stock, and regularly
sold or leased to the public in the usual course of business. To be a DBE regular dealer, the firm must be
an established, regular business that engages, as its principal business and under its own name, in the
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LPP 13-01 May S, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXHBIT 10-I
Notice to Proposers DBE Information
purchase and sale or lease of the products in question. A person may be a DBE regular dealer in such bulk
items as petroleum products, steel, cement, gravel, stone or asphalt without owning, operating or
maintaining a place of business provided in this section.
C. If the person both owns and operates distribution equipment for the products, any supplementing of
regular dealers' own distribution equipment shall be, by a long-term lease agreement and not an ad hoc or
Agreement -by -Agreement basis. Packagers, brokers, manufacturers' representatives, or other persons
who arrange or expedite transactions are not DBE regular dealers within the meaning of this section.
D. Materials or supplies purchased from a DBE, which is neither a manufacturer nor a regular dealer, will be
limited to the entire amount of fees or commissions charged for assistance in the procurement of the
materials and supplies, or fees or transportation charges for the delivery of materials or supplies required
on the job site, provided the fees are reasonable and not excessive as compared with fees charged for
similar services.
Page 3 of 3
LPP 13-01 May 8, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXHBIT 10-J
Standard Contract Provisions for Subconsultant/DBE Participation
EXHIBIT 10-J STANDARD CONTRACT PROVISIONS FOR SUBCONSULTANT/DBE PARTICIPATION
1. Subconsultants
A. Nothing contained in this Contract or otherwise, shall create any contractual relation between the Agency
and any subconsultants, and no subcontract shall relieve the Consultant of his/her responsibilities and
obligations hereunder. The Consultant agrees to be as fully responsible to the Agency for the acts and
omissions of its subconsultants and of persons either directly or indirectly employed by any of them as it
is for the acts and omissions of persons directly employed by the Consultant. The Consultant's obligation
to pay its subconsultants is an independent obligation from the Agency's obligation to make payments to
the Consultant.
B. Any subcontract in excess of $25,000, entered into as a result of this Contract, shall contain all the
provisions stipulated in this Contract to be applicable to subconsultants.
C. Consultant shall pay its subconsultants within ten (10) calendar days from receipt of each payment made
to the Consultant by the Agency.
D. Any substitution of subconsultants must be approved in writing by the Agency's Contract Administrator
in advance of assigning work to a substitute subconsultant.
2. Disadvantaged Business Enterprise (DBE) Participation
A. This Contract is subject to 49 CFR, Part 26 entitled "Participation by Disadvantaged Business Enterprises
in Department of Transportation Financial Assistance Programs". Proposers who obtain DBE
participation on this contract will assist Caltrans in meeting its federally mandated statewide overall DBE
goal.
B. If the contract has a DBE goal, the Consultant must meet the goal by committing DBE participation or
document a good faith effort to meet the goal. If a DBE subconsultant is unable to perform, the
Consultant must make a good faith effort to replace him/her with another DBE subconsultant, if the goal
is not otherwise met. A DBE is a firm meeting the definition of a DBE as specified in 49 CFR.
C. DBEs and other small businesses, as defined in 49 CFR, Part 26 are encouraged to participate in the
performance of contracts financed in whole or in part with federal funds. The Consultant or subconsultant
shall not discriminate on the basis of race, color, national origin, or sex in the performance of this
Contract. The Consultant shall carry out applicable requirements of 49 CFR, Part 26 in the award and
administration of US DOT- assisted agreements. Failure by the Consultant to carry out these requirements
is a material breach of this Contract, which may result in the termination of this Contract or such other
remedy as the local agency deems appropriate.
D. Any subcontract entered into as a result of this Contract shall contain all of the provisions of this section.
E. A DBE may be terminated only with prior written approval from the local agency and only for the reasons
specified in 49 CFR 26.53(f). Prior to requesting local agency consent for the termination, the prime
consultant must meet the procedural requirements specified in 49 CFR 26.53(f).
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LPP 13-01 May 8, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXHBIT 10-J
Standard Contract Provisions for Subconsultant/DBE Participation
3. Performance of DBE Consultant and other DBE Subconsultants/Suppliers
A. A DBE performs a commercially useful function when it is responsible for execution of the work of the
Contract and is carrying out its responsibilities by actually performing, managing, and supervising the
work involved. To perform a commercially useful function, the DBE must also be responsible with
respect to materials and supplies used on the Contract, for negotiating price, determining quality and
quantity, ordering the material, and installing (where applicable) and paying for the material itself. To
determine whether a DBE is performing a commercially useful function, evaluate the amount of work
subcontracted, industry practices; whether the amount the firm is to be paid under the Contract is
commensurate with the work it is actually performing; and other relevant factors.
B. A DBE does not perform a commercially useful function if its role is limited to that of an extra participant
in a transaction, Contract, or project through which funds are passed in order to obtain the appearance of
DBE participation. In determining whether a DBE is such an extra participant, examine similar
transactions, particularly those in which DBEs do not participate.
C. If a DBE does not perform or exercise responsibility for at least 30 percent of the total cost of its Contract
with its own work force, or the DBE subcontracts a greater portion of the work of the Contract than would
be expected on the basis of normal industry practice for the type of work involved, it will be presumed
that it is not performing a commercially useful function.
4. Prompt Payment of Funds Withheld to Subconsultants
A. Any subcontract entered into as a result of this Contract shall contain all of the provisions of this section.
(Local agency to include either B, C, or D below; delete the other two.)
B. No retainage will be withheld by the Agency from progress payments due the prime Consultant.
Retainage by the prime Consultant or subconsultants is prohibited, and no retainage will be held by the
prime Consultant from progress due subconsultants. Any violation of this provision shall subject the
violating prime Consultant or subconsultants to the penalties, sanctions, and other remedies specified in
Section 7108.5 of the California Business and Professions Code. This requirement shall not be construed
to limit or impair any contractual, administrative, or judicial remedies, otherwise available to the prime
Consultant or subconsultant in the event of a dispute involving late payment or nonpayment by the prime
Consultant or deficient subconsultant performance, or noncompliance by a subconsultant. This provision
applies to both DBE and non -DBE prime Consultants and subconsultants.
C. No retainage will be held by the Agency from progress payments due the prime Consultant. Any
retainage held by the prime Consultant or subconsultants from progress payments due subconsultants
shall be promptly paid in full to subconsultants within 30 days after the subconsultant's work is
satisfactorily completed. Federal law (49 CFR26.29) requires that any delay or postponement of payment
over the 30 days may take place only for good cause and with the Agency's prior written approval. Any
violation of this provision shall subject the violating prime Consultant or subconsultant to the penalties,
sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code. These
requirements shall not be construed to limit or impair any contractual, administrative, or judicial
remedies, otherwise available to the prime Consultant or subconsultant in the event of a dispute involving
late payment or nonpayment by the prime consultant, deficient subconsultant performance, or
noncompliance by a subconsultant. This provision applies to both DBE and non -DBE prime consultant
and subconsultants.
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LPP 13-01 May 8, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXHBIT 10-J
Standard Contract Provisions for Subconsultant/DBE Participation
D. The Agency shall hold retainage from the prime consultant and shall make prompt and regular
incremental acceptances of portions, as determined by the Agency, of the contract work, and pay
retainage to the prime consultant based on these acceptances. The prime consultant, or subconsultant,
shall return all monies withheld in retention from a subconsultant within 30 days after receiving payment
for work satisfactorily completed and accepted including incremental acceptances of portions of the
contract work by the agency. Federal law (49 CFR26.29) requires that any delay or postponement of
payment over 30 days may take place only for good cause and with the agency's prior written approval.
Any violation of this provision shall subject the violating prime consultant or subconsultant to the
penalties, sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code.
These requirements shall not be construed to limit or impair any contractual, administrative, or judicial
remedies, otherwise available to the prime consultant or subconsultant in the event of a dispute involving
late payment or nonpayment by the prime Consultant, deficient subconsultant performance, or
noncompliance by a subconsultant. This provision applies to both DBE and non -DBE prime consultant
and subconsultants.
5. DBE Records
A. The Consultant shall maintain records of materials purchased or supplied from all subcontracts entered
into with certified DBEs. The records shall show the name and business address of each DBE or vendor
and the total dollar amount actually paid each DBE or vendor, regardless of tier. The records shall show
the date of payment and the total dollar figure paid to all firms. DBE prime consultants shall also show
the date of work performed by their own forces along with the corresponding dollar value of the work.
B. Upon completion of the Contract, a summary of these records shall be prepared and submitted on the form
entitled, "Final Report -Utilization of Disadvantaged Business Enterprise (DBE), First -Tier
Subconsultants," CEM-2402F (Exhibit 17-F, Chapter 17, of the LAPM), certified correct by the
Consultant or the Consultant's authorized representative and shall be furnished to the Contract
Administrator with the final invoice. Failure to provide the summary of DBE payments with the final
invoice will result in 25 percent of the dollar value of the invoice being withheld from payment until the
form is submitted. The amount will be returned to the Consultant when a satisfactory "Final Report -
Utilization of Disadvantaged Business Enterprises (DBE), First -Tier Subconsultants" is submitted to the
Contract Administrator.
6. DBE Certification and Decertification Status
If a DBE subconsultant is decertified during the life of the Contract, the decertified subconsultant shall
notify the Consultant in writing with the date of decertification. If a subconsultant becomes a certified
DBE during the life of the Contract, the subconsultant shall notify the Consultant in writing with the date
of certification. Any changes should be reported to the Agency's Contract Administrator within 30 days.
Page 3 of 3
LPP 13-01 May 8, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXHBIT 10-K
Consultant Certification of Costs and Financial Management System
EXHIBIT 10-K CONSULTANT CERTIFICATION OF CONTRACT COSTS AND FINANCIAL
MANAGEMENT SYSTEM
(Note: If requesting to utilize the Safe Harbor Indirect Cost Rate submit Attachment 1 of
DLA-OB 13-07 - Safe Harbor Indirect Cost Rate for Consultant Contracts found at
http://www.dot.ca.gov/hq/Loca1Programs/DLA OB/DLA OB.htm in lieu of this form.)
Certification of Final Indirect Costs:
Consultant Firm Name: NCM Engineering Co .
Indirect Cost Rate: 148%
Fiscal Period Covered for Indirect Cost Rate Developed (mm/dd/yyyy to mm/dd/yyyy): _ 1/1/20�13 to Ito 12/31/2013
Date of Proposal Preparation (mm/dd/yyyy): 6/3/2013
1, the undersigned, certify that I have reviewed the proposal to establish final indirect cost rates for the fiscal
period as specified above and to the best of my knowledge and belief:
1. All costs included in this proposal to establish final indirect cost rates are allowable in
accordance with the cost principles of the Federal Acquisition Regulations (FAR) of Title 48,
Code of Federal Regulations (CFR), Part 31.
2. This proposal does not include any costs which are expressly unallowable under the cost
principles of the FAR of 48 CFR, Part 31.
All known material transactions or events that have occurred affecting the firm's ownership, organization, and
indirect cost rates have been disclosed as of the date of proposal preparation noted above.
Certification of Financial Management System:
I, the undersigned, certify to the best of my knowledge and belief that our financial management system meets the
standards for financial reporting, accounting records, internal and budget control as set forth in the FAR of Title
49, CFR, Part 18.20 to the extent applicable to Consultant.
Certification of Dollar Amount for all A&E contracts:
I, the undersigned, certify that the approximate dollar amount of all A&E contracts awarded by Caltrans or a
California local agency to this firm within the last three (3) calendar years for all State DOT and Local Agencies
is $ 0.00 IT and the number of States in which the firm does business is
Certification of Direct Costs:
1, the undersigned, certify to the best of my knowledge and belief that all direct costs identified on the cost
proposal(s) in this contract are reasonable, allowable and allocable to the contract in accordance with the cost
principles of the FAR of Title 48, CFR, Part 31. Allowable direct costs to a Government contract shall be:
1. Compliant with Generally Accepted Accounting Principles (GAAP) and standards promulgated
by the Cost Accounting Standards Board (when applicable).
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LPP 13-01 (Technical Change) September 16, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXHBIT 10-K
Consultant Certification of Costs and Financial Management System
2. Compliant with the terms of the contract and is incurred specifically for the contract.
3. Not prohibited by 23 CFR, Chapter 1, Part 172 —Administration of Engineering and Design
Related Service Contracts to the extent requirements are applicable to Consultant.
All costs must be applied consistently and fairly to all contracts. All documentation of compliance must be
retained in the project files.
Subconsultants (if applicable)
Proposed Contract Amount (or amount not to exceed if on -call contract): $_,$2_�7,6_3330
w
Prime Consultants (if applicable)
Proposed Total Contract Amount (or amount not to exceed if on -call contract): $ _ 16$362,146.56µ
Prime, list all subconsultants and proposed subcontract dollar amounts (attach additional page if necessary):
Wilson & Com an Railroad 12.4 534.5''1
BKF (Drain_a e/Snrvc in /R $ (i2 2�;
DYA Geotechnical $ 36.210.32
LSA_ Environmental) ` , 071.
LIN (TrafficDesigri $ 1;675
OPC RW Data Sheen $ 5M6.82
* Consultant Certification Signature: — T l
......................
Consultant Certifying (Print Name and Title):
Name: (Iii1hemie "William" Nascimento
Title:
Consultant Contact Information:
Email: Wd[i.atrt�ri+ncmcivil.com
Phone number: 949-357-9015
Date of Certification (mm/dd/yyyy): 7/1/2013
*An individual executive or financial officer of the consultant's organization at a level no lower than a Vice
President or Chief Financial Officer, or equivalent, who has authority to represent the financial information
utilized to establish the indirect cost rate proposal submitted in conjunction with the contract.
Note: Per 23 U.S.C. 112(b)(2)(B), Subconsultants must comply with the FAR Cost Principles contained in 48 CFR, Part 31.
23 CFR Part 172.3 Definitions state: Consultant means the individual or firm providing engineering and design related services as a party
to the contract. Therefore, subconsultants as parties of a contract must complete a certification and send originals to A&[ and keep copies
in Local Agency Project Files.
Distribution: 1) Original to Caltrans Audits and Investigations
2) Retained in Local Agency Project Files
Page 2 of 2
LPP 13-01 (Technical Change) September 16, 2013
Agreement No. 4438A
Local Assistance Procedures Manual
EXHIBIT 10-01
Consultant Proposal DBE Commitment
EXHIBIT 10-01 CONSULTANT PROPOSAL DBE COMMITMENT
(Inclusive of all DBEs listed at bid proposal. Refer to instructions on the reverse side of this form)
Consultant to Complete this Stetion
1. Local Agency Name: City of El Segundo
2. Project Location: Park Place Extension, El Segundo, CA
3. Project Description: Park Place Extension between Nash and Allied WAY
4. Consultant Name: NCM Engineering Corp
5. Contract DBE Goal %: 12
DBE Commitment Information
6. Description of Services to be Provided
7. DBE Firm
8. DBE Cert.
9. DBE %
Contact Information
Number
Geotechnical
Diaz Your man & Assoc.
CT-033250 _
6%
Nadesh Nadeswaran 714 412-2112
Traffic Design
LIN Consulting_.UCP
Firm Number
6%
Denwun Lin 626 512-5266
28897
I
Local Agency to Complete this Beetled
11�•'1" p l
% Claimed'
_® %
16. Local Agency Contract Number:
17. Federal -aid Project Number: 5235 (012)
18. Proposed Contract Execution Date:
Local Agency certifies that all DBE certifications are valid and the
information on this form is complete and accurate:
11.6'vePtarvrignat w'e
Stgphanie Katsoulcasr
Guilherme "William" Nascimento
12. Preparer's Name (Print)
19. Local Agency Representative Name (Print)
CFO
e Agrttc rresesxta five Signature 21. Date
13. Preparer's Title
Director of Public Works 310-524-2356
7/1/2013 1 1 949-357-901514.
22. Local Agency Representative Title 23. (Area Code) Tel. No.
Date 15. (Arta Code) Tel. No.
Distribution: (1) Original — Consultant submits to local agency with proposal
(2) Copy — Local Agency files
Page 1 of 2
LPP 13-01 May 8, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXHIBIT 10-02
Consultant Contract DBE Information
EXHIBIT 10-02 CONSULTANT CONTRACT DBE INFORMATION
(Inclusive of all DBEs listed at contract award. Refer to instructions on the reverse side of this form)
ons uttant"to Comple(V this Section
1. Local Agency Name: City of El Segundo
2. Project Location: Park Place Extension, El Seggndo, CA
3. Project Description: Park Place Extension between Nash and Allied Way
4. Total Contract Award Amount: $ 629,780.26
5. Consultant Name: NCM EngineeringCoro
6. Contract DBE Goal %: 12
7. Total Dollar Amount for all Subconsultants: $ 288,323.70
S. Total Number of all Subconsultants: 6
Award DBE/DBE Information
9. Description of Services to be Provided 10. DBE/DBE Finn
11. DBE Cert. 12. DBE Dollar
Contact Information
Number Amount
Geotechnical
Diaz Yourman & Assoc.
CT-033250
6%
Nadesh Nadeswaran 714 41.2-2112
Traffic Desigg
LIN Consulting
UCP Firm Nwnber
6%
Denwun Lin 626) 512-5266
28897
1Joca1 Agen..cy t#so Com let Sect°ion
13. Total
ilollm S 1 579.58
20. Local Agency Contract Number: PSA #4438
'Claimed
21. Fedeml-aid Project Number: 5235 (012)
14. Total
22. Contract Execution Date: July 1, 2013
%Claimed 12 %
Local Agency certifies that all DBE certifications are valid and the
IT"
information on this form is complete and accurate:
N=hM aAatsuulcas
2.3, Local gentry Representative Name (Print)
24. L a1 A enc Rep, g 25. Date
g y rresctatative sign 25.
Director of Public Works 310-524-235_
,/✓R�G�rr�[Jo
26. Local Agency Representative Title 27. (Area Code) Tel. No.
15. Preparer's Sig
aturc
Caltrans,to Core' late t#ti C%t#ttli
Guilherme "William" Nascimento
16. Preparer's Name (Print)
Caltrans District Local Assistance Engineer (DLAE) certifies that this form
Fta _.
has been reviewed for completeness:
17. Preparer's Title
7/1/20 33 949-357-9015
28. DLAE Name (Print) 29. DLAE Signature 30. Date
18. Date 19. (Area Code) Tel. No.
Nstrlbutlom (1) Copy- Etnail a copy to the Caltrans District Local AssistanceEngineer (DLAE) within 30 days of contract award. 1"4ilurc to send a
copy to the DLAE within 30 days of contract award may result in delay of payment.
(2) Copy - Include in award package sent to Caltmns DLAE
(3) Original - Local agency files
Pagel of 2
LPP 13-01
May 8, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXHIBIT 10-P
Nonlobbying Certification for Federal -aid Contracts
EXHIBIT 10-P NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS
The prospective participant certifies by signing and submitting this proposal/bid to the best of his or her
knowledge and belief that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or employee of any federal
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any federal contract, the making of any
federal grant, the making of any federal loan, the entering into of any cooperative agreement, and
the extension, continuation, renewal, amendment, or modification of any federal contract, grant,
loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any federal agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying
Activities," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file
the required certification shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
The prospective participant also agrees by submitting his/her proposal/bid that he/she shall require that
the language of this certification be included in all lower -tier subcontracts which exceed $100,000 and
that all such sub -recipients shall certify and disclose accordingly.
Sign Here:^'
Guilherme " illiaiif' Nascimento
Project Manager
NCM Engineering Corp
Pagel of 1
LPP 13-01 May S, 2013
Agreement No. 4438A
Local Assistance Procedures Manual EXHIBIT 10-V
Non -Discrimination Clause
EXHIBIT 10-V NON-DISCRIMINATION CLAUSE
(To be included in Consultant Contract)
NON-DISCRIMINATION CLAUSE
During the performance of this Contract, Consultant and its subconsultant shall not unlawfully
discriminate, harass, or allow harassment against any employee or applicant for employment because of
sex, race, color, ancestry, religious creed, national origin, physical disability (including HIV and AIDS),
mental disability, medical condition (e.g., cancer), age (over 40), marital status, and denial of family care
leave. Consultant and subconsultants shall insure that the evaluation and treatment of their employees and
applicants for employment are free from such discrimination and harassment. Consultant and
subconsultants shall comply with the provisions of the Fair Employment and Housing Act (Gov. Code
§ 12990 (a-f) et seq.) and the applicable regulations promulgated thereunder (California Code of
Regulations, Title 2, Section 7285 et seq.). The applicable regulations of the Fair Employment and
Housing Commission implementing Government Code Section 12990 (a-f), set forth in Chapter 5 of
Division 4 of Title 2 of the California Code of Regulations, are incorporated into this Contract by
reference and made a part hereof as if set forth in full. Consultant and its subconsultants shall give written
notice of their obligations under this clause to labor organizations with which they have a collective
bargaining or other Agreement.
Consultant shall include the nondiscrimination and compliance provisions of this clause in all
subcontracts to perform work under the Contract.
Page 1 of 1
LPP 13-01 May 8, 2013
Agreement No. 4438A
DEPARTMENT OF TRANSPORTATION
DEBARMENT AND SUSPENSION CERTIFICATION
FISCAL YEAR 2013/2014
SIGNATURE PAGE
In signing this document, I declare under penalties of perjury that the foregoing certifications and
assurances, and any other statements made by me on behalf of the Applicant are true and correct.
Signature Date 7/1/2013
Printed Name Guilherme "William" Nascimento
As the undersigned Attorney for the above named Applicant, I hereby affirm to the Applicant
that it has the authority under state and local law to make and comply with the certifications and
assurances as indicated on the foregoing pages. I further affirm that, in my opinion, these
certifications and assurances have been legally made and constitute legal and binding obligations
of the Applicant.
I further affirm to the Applicant that, to the best of my knowledge, there is no legislation or
litigation pending or imminent that might adversely affect the validity of these certifications and
assurances or of the performance of the described project.
AFFIRMATION OF APPLICANT'S ATTORNEY
For NCM Engineering, Cora (Name of Applicant)
Signature Date 2/.13/2014
Printed Name Richard Casey Hanne an
of Applicant's Attorney
Agreement No. 4438A
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Agreement No. 4438A
EXHIBIT 17-F Local Assistance Procedures Manual
Final Report -Utilization of Disadvantaged Business Enterprises (DBE), First -Tier Subcontractors
FINAL REPORT — UTILIZATION OF DISADVANTAGED BUSINESS
ENTERPRISES (DBE), FIRST -TIER SUBCONTRACTORS
CEM 2402(F) (Rev. 02/2008)
The form requires specific information regarding the construction project: Contract Number, County, Route, Post
Miles, Federal -aid Project No., the Administering Agency, the Contract Completion Date and the Estimated Contract
Amount. It requires the prime contractor name and business address. The focus of the form is to describe who did what
by contract item number and descriptions, asking for specific dollar values of item work completed broken down by
subcontractors who performed the work both DBE and non -DBE work forces. DBE prime contractors are required to
show the date of work performed by their own forces along with the corresponding dollar value of work.
The form has a column to enter the Contract Item No. (or Item No's) and description of work performed or materials
provided, as well as a column for the subcontractor name and business address. For those firms who are DBE, there is a
column to enter their DBE Certification Number. The DBE should provide their certification number to the contractor and
notify the contractor in writing with the date of the decertification if their status should change during the course of the
project.
The form has six columns for the dollar value to be entered for the item work performed by the subcontractor.
The Non -DBE column is used to enter the dollar value of work performed for firms who are not certified
DBE.
The decision of which column to be used for entering the DBE dollar value is based on what program(s)
status the firm is certified. This program status is determined by the California Unified Certification Program
by ethnicity, gender, ownership, and control issues at time of certification. To confirm the certification status
and program status, access the Department of Transportation Civil Rights web site at:
http. / 4v�N� ,dot.ca go h%,.' p or by calling (916) 324-1700 or the toll free number at (888) 810-6346.
Based on this DBE Program status, the following table depicts which column to be used:
DBE Pro ram Status IColumn to be used
If program status shows DBE only with no other programs listed I DBE
If a contractor performing work as a DBE on the project becomes decertified and still performs work after their
decertification date, enter the total dollar value performed by this contractor under the appropriate DBE identification
column.
If a contractor performing work as a non -DBE on the project becomes certified as a DBE, enter the dollar value of all
work performed after certification as a DBE under the appropriate identification column.
Enter the total of each of the six columns in Form CEM-2402(F).
Any changes to DBE certification must also be submitted on Form-CEM 2403(F).
Enter the Date Work Completed as well as the Date of Final Payment (the date when the prime contractor made the
"final payment" to the subcontractor for the portion of work listed as being completed).
The contractor and the resident engineer sign and date the form indicating that the information provided is complete and
correct.
Page 17-22
July 1, 2012 LPP 09-02