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CONTRACT 4597 Bid CLOSEDAgreement No. 4597 Addscape, Inc. t March 6, 2014 ADDENDUM NO. 1 to THE CONTRACT DOCUMENTS, SPECIFICATIONS AND PLANS for ADA RAMP INSTALLATION PROJECT PROJECT NO. PW 13-14 COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROJECT NO. 601608-13 ATTENTION BIDDERS: The following additions, modifications, and clarifications to the specifications shall be included in, and become a part of, any contract which may be executed for the above project in the City of El Segundo: 1. The bid due date and time is still Tuesday, March 11, 2014, at 11 :00 am. 2. Replace pages VI-A-16 to VI-A-41 with pages VI-A-16R to VI-A-41R (Davis- Bacon Prevailing Wage Rates) of the specifications. As evidence that the BIDDER has read this Addendum, the BIDDER must acknowledge same in the space provided below and submit this Addendum with the Bid Proposal. Failure to provide such acknowledgement shall render the bid as non-responsive and subject to rejection. Signature: .. Date: ...._. . _ . � .. _...� Print Company Name: .. _..rte.._ _... ......... ...®..��w. Page 1 of 1 350 Main Street, El Segundo, CA 90245-3895 (310) 524-2300 Fax(310) 640-0489 PROPOSAL FOR THE ADA RAMP INSTALLATION PROJECT PROJECT NO.: PW 13-14 COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)PROJECT NO.: 601608-13 Date 1 �t-20 4, Company Name: A��C�+m TO THE CITY OF EL SEGUNDO: In accordance with the City of El Segundo's Notice Inviting Sealed Bids, the undersigned BIDDER hereby proposes to furnish all materials, equipment, tools, labor, and incidentals required for the above stated project as set forth in the Plans, Specifications, and contract documents therefor, and to perform all work in the manner and time prescribed therein. BIDDER declares that this proposal is based upon careful examination of the work site,Plans, Specifications, Instructions to Bidders, and all other contract documents. Submittal of this bid shall be considered evidence that the BIDDER has satisfied himself regarding the contract documents,access and any other field conditions which may effect bid prices.If this proposal is accepted for award,BIDDER agrees to enter into a contract with the City of El Segundo 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 the City of El Segundo of the proposal guarantee 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 CITY OF EL SEGUNDO RESERVES THE RIGHT TO INCREASE OR DECREASE THE AMOUNT OF ANY QUANTITY SHOWN AND TO DELETE ANY ITEM FROM THE CONTRACT.It is agreed that the unit and/or lump stun prices bid include all apparent expenses,taxes,royalties,and fees.In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. If awarded the Contract, the undersigned further agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within ten working days after the date of the City of El Segundo's notice of award of contract to the BIDDER,including sending by U.S.Mail a Public Works Contract for signature by the Awardee,the proceeds of the security accompanying this bid shall become the property of the City of El Segundo and this bid and the acceptance hereof may, at the City of El Segundo's option,be considered null and void. I-C-1 EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE BIDDER certifies that in all previous contracts or subcontracts, all reports which may have been due under the requirements of any agency,State,or Federal equal employment opportunity orders have been satisfactorily filed, and that no such reports are currently outstanding. AFFIRMATIVE ACTION CERTIFICATION BIDDER certifies that affirmative action has been taken to seek out and consider minority business enterprises for those portions of the work to be subcontracted, and that such affirmative actions have been fully documented, that said documentation is open to inspection, and that said affirmative action will remain in effect for the life of any contract awarded hereunder.Furthermore, BIDDER certifies that affirmative action will be taken to meet all equal employment opportunity requirements of the contract documents. NONCOLLUSION AFFIDAVIT BIDDER declares that the only persons or parties interested in this proposal as principals are those named herein;that no officer,agent,or employee of the City of El Segundo is personally interested, directly or indirectly, in this proposal;that this proposal is made without connection to any other individual, firm, or corporation making a bid for the same work and that this proposal is in all respects fair and without collusion or fraud. 1-C-a BID SCHEDULE ADA RAMP INSTALLATION PROJECT PROJECT NO.: PW 13-14 COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)PROJECT NO.: 601608-13 Company Name: 4 a _» ° BASE BID ITEMS Item Description No.� Item_ „ _ _._.Intersection Corner QTY Unit I Unit Price Total Install new Mariposa Ave. 1 .. ADA Ramp . .� Illinois Ct:_... NE 1 _ ...LS. ..... ', $ & .. � 2 Install new Walnut Ave. & SW 1 LS $ $ ,SdU ADA Ramp Washington St ...._._.�__ ADA Rai.__.�..._m. 3 Install new Walnut Ave. & SE 1..__ mm' LS $ Sf _ Ramp Washington St. 4 tall n ..�....��� .... _ ......�._..�.� _�..�e_... .� _ .�_..µ...._�._. W�........ .... 4 Ins new�e � � Walnut Ave. & NE 1 LS $ ,9V $ _ amp California St. ADA R 5. ADA ..._.�.. ._�...,�.. �....��. .......b.��....._—_ Install new Walnut Ave & NW 1 LS $ 3 $ 5� Ramp California St._ ADA Ramp I California a_,_....._ .,_ ._.._.N_ .... $ _ ....._p....._ .. new J 6 Install n Ave. Walnut Av ....___� SE 1 LS $... uw. �. TOTAL ID $ TOTAL BID WRITTEN IN WORDS: '��' ._ I-G-3a BID SCHEDULE CONSTRUCTION OF ADA RAMPS PROJECT NO.: PW 13-14 CDBG PROJECT NO.: 601608-13 Company Narne: &"4 ° 1.,TEIINATIVE BID ITEMS It aaa Dese i p.ttcarn No. Item _ Intel'section Cornet- Q' Y Ilal t ljnit Price Total Al ADA Ramp Walnut Ave. & N 171, 1 Ls $ ' Bungalow Or. _ D Ram ea&raaat Ave. c � �� 1 L ..._ lraaa, a�1w OaY. Penn St. IaFI aaaa t _ ..�.... ............ pelin St, I-C- BIDDER'S INFORMATION CompanyName: BIDDER certifies that the following information is true and correct: Form of Legal Entity (i.e., individual,partnership, corporation, etc.) If corporation, State of Incorporation 6/:., Business Address 11-723 -C.1AAW191V Telephone No Facsimile No. State Contractor's License No. and Class Original Date Issued Expiration The following are the oanfoo,iitlno, addresses, and phone ooznbdrn 8f all iudividoo)x, Gon members,ynrbnczo,joint venturers, and/or corporate officers having principal interest iothis proposal: The date of any voluntary or involuntary bankruptcy judgments against any principal having an interest io this proposal iauufollows: All current and prior DBA's, aliases, and/or fictitious business names for any principal having an interest in this proposal are as DoDop/a: I-C'4 BIDDER'S INFORMATION (CONTINUED) CompanyNam-e: .44IMe"V* ................ T-7 Biddershal I list the name of the person whoattended the mandatory pre-bid job wa I k: Name: as, ec- I-C-5 IN ' °"I T 'l S WHEREOF,BIDDER exectites and submits this propcisal with(lie nanies,tiff s, hands, and Is ofall a lbrenamed pilricipals this d—Lday of 20-14 13IDDER ASI-6 ............. .......... ...... Subscribed and sworn to this.----.day of T 20 NOTARY'RUBLIC' See Aft, 80hed Ymm,,NO tARIZED CERTIFICATE I-C- CALIFORNIA JURAT CERTIFICATE State of California County of Subscribed and sw+ r1i to (or affirmed)before me on this day of /�elS2 20 i�,by t e D tJ 6 L . proved to me on the basis of satisfactory evidence to be the person'*who appeared before me, RONALD NORRIS MCGHEE WITNESS MY HAND AND OFFICIAL SEAL. Commission#2003044 Notary Public-California Los Angeles County M Comm.Expires Jan 0,2017 n M illawa t of Notary Public (Notary Seal) OPTIONAL INFORMATION The jurat contained within thiilka rent is in accordance with California law. Any affidavit subscribed and sworn to before a notary shall use the preceding warding orsRatastaart'ialla�ranra'lrra^wording pursuant to Civil Code sections'1189 and 8202.A jurat certificate cannot be affixed to a document sent by mail or otheil) " e delivered to a notary public, including electronic means,whereby the signer did not personally appear before the notary plt if the signer is known by the notary public. The seal and signature cannot be affixed to a document without the correct nova vording. As an additional option an afftant can produce an affidavit on the same document as the notarial awrtif�"W vording to eliminate the use of additional documentation. DESCRIPTION OF ATTACHED DOCUMENT A ICLAIMED BY THE SIGNER itAtlt I (Title ---of document) Corporate ;,pr Partner Number of Pages (Including jurat) Attorney-In-Fact Trustee Document Date Other: (Additional Information) MMX V.BAN2 510.409.1334 wwwwa IlayArezallotarry.c om Bond No 11 -154-040 PROPOSAL GUARANTEE BID BOND ADA RAMP INSTALLATION PROJECT PROJECT NO.:PW 13-14 COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)PROJECT NO.: 601608-13 KNOW ALL MEN BY THESE PRESENTS that, Addsca a Inc. dba A1�D e&ad Builders P ,a , The Ohio Casualty Insurance Company ,as SURETY,are held and firmly bound unto the City of El Segundo,in the penal sum of tEn =33t cf bid DOLLARS(S10J4,which is ten (10%)percent of the total amount bid by BIDDER to the City of El Segundo for the above stated project,for the payment of which sum,BIDDER and SURETY agree to be bound,jointly and severally,firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that,whereas BIDDER is about to submit a bid to the City of El Segundo for the above stated project,if said bid is rejected,or if said bid is accepted and a contract is awarded and entered into by BIDDER in the manner and time specified,then this obligation shall be null and void,otherwise it shall remain in full force and effect in favor of the City of El Segundo. IN WITNESS WHEREOF the parties hereto have set their names,titles,hands,and seals this 11 thday of March ,2014 . 11723 S Western Ave, BIDDER* Addscape, Inc. - Los Angeles, CA 90047 dba Alpha Omega Builders 323-242-0049 ply,, AM ZeP j, SURETY* The Ohio Cp(,Sualty Insurance Company i 9450 Seward Rd, Fairfield, OH 45014 Blake A Pfis Der, - 5 Attorney in Fact 800-298-4826 24591 Del Prado #201 , Dana Point, CA 92629 Subscribed and sworn to this day of ___ ,20 NOTARY PUBLIC *Provide BIDDER/SURETY name, title, address and telephone number and the name, title, address and telephone number for authorized representative. I-C-7 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CML CODE§ 1189 s';,#,+�.R,r,�v: �.^C.4` ,��"brn�a�'+' .,w�..'�''".r'm��`.+..�'"�C,4'.•'�°"�;�C�'�S.<S`.",,.�"�'`c;t^.:^S'�;Aru.t�°�.'�.�..+..�,G��.<:da.'t,c-7 d"^;�'i�'xc"y�C'.C;�".G'�;�+;,�°�':r;K` ��.4;'�`.t:'�"`✓;`;�'.i"�'ti�i:^+:n'��`£"b�','""ii:"� ,,.���.�,+�"a`.`4`'.:�. a. I State of California ' Oran Count of„ �. ..._.g e County OnFebruaryl9 , 2014tefore me , Notary....... Public...µ.... Leanne Nahi Ha' �.. Date Insert Name and Title of the Officer B l a k e A. P f i s ter personally appeared Name(s)oisigner(s) .....�_. ._�....��,�.-_ .�.... ......... who roved to me on... .—.�..� p the basis of satisfactory evidence to be the personO whose name(s) is/m subscribed to the within instrument and acknowledged :° tl MMIINE NAHNA to me that he/ate executed the same in 0010 it his/ authorized capacity(WO, and that by C), his/i m*Wn r signature(s) on the instrument the y; "A,lY G t if('10i IJ N FY w person(g), or the entity upon behalf of which the 1, person(o 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. Si nature ofm to Pu ���i/�� Signature: �"� � Place Notary Seal Above 9 Notary OPTIONAL the information below is not requira may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Y Description µB n of Attached Document �,,.. .._ _„ ._.... � ....._.........��....... Title or Type of Document„ imd Bond 11 15 4-040 Document Date March 11 , None �.w. Number of Pages , Signer(s) Other Than Named Above: .Non _.�...�_��. _ q Capacity(ies) Claimed by Signer(s) t fis Blake A . Per Signer's Name: Signer's Name: is ter C Corporate Officer — Title(s) .. ❑Corporate Officer — Title(s): ...... ❑ Individual ❑ Individual C Partner — ❑Limited ❑General Top of thumb here 71 Partner — Limited -General Top of thumb here Attorney in Fact Attorney in Fact i C' Trustee -Trustee i' ❑ Guardian or Conservator Guardian or Conservator b: ❑ Other: Other . Sig Representing:Signer Is resentm Re The Ohio Signer Is Representing as. '�r� a . .e�..C.a.r .p:a, y... .___ _..._...._ — _...�........ m. — ... �..... �... .. . I ©2010 National Notary Association-NationalNotary,org•1-800-US NOTARY(1-800-876-6827) Item#5907 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attomey limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No„6379476 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company PO W�FR OF1AT ��RIjF o KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Blake A. Pfister all of the city of DANA POINT state of CA each individually if there be more than one named,its true and lawful attomey-in-fact to make,execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 1 o1h day of December �)m s ;a American Fire and Casualty Company -a The Ohio Casualty Insurance Company Liberty Mutual Insurance Company c / West American Insurance Company � By: STATE OF PENNSYLVANIA ss David M.Care ,AssistantSecretary a M +± COUNTY OF MONTGOMERY c dOn this 10th day of December 2013, before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire f0 F, w 7 and Casualty Company, Liberty Mutual Insurance Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do, , O execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. a> > IN WITNESS WHEREOF,I have hereunto subscribed t1 ry paw and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. O � O Teresa Pastella,Notary IPublic L w i 3 ry O O E C M This Power ofAttomey is made and of the following By-laws and Authoriizations ofArnerican Fire and Casualty Cornpany,The Ohio Casualty Insurance m p 6 L' Company,Liberty Mutual Insurance Company,an t WeistAmencan Insurance Company which resolutions are now in full force and effect reading as follows: w ea L? ARTICLE IV—OFFICERS—Section 12,Power of Attorney.Any officer or other official of the Corporation authorized forthat purpose in writing by the Chairman or the President,and subject O r- �r to such limitation as the Chairman or the President may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, >d O C acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attomeys-in-fact,subject to the limitations set forth in their respective p 3 E y powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so 'g am executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey-in-fact under >.0 the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. a)Q ARTICLE All—Execution of Contracts—SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, o? > and subject to such limitations as the chairman orthe president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute, O seal,acknowledge and deliver as surety any and all undertakings,bonds, recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their c o0 Z r„r respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so v o executed such instruments shall be as binding as if signed by the president and attested by the secretary. O Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in- ~ fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I,Gregory W.Davenport,the undersigned,Assistant Secretary,of American Fire and Casualty Company,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attomey executed by said Companies,is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 11 th day of March 2014 u By: p Gregory W,Davenport,Assistant Secretary a 66 of 500 LMS 12873 122013 CONTRACTOR'S LICENSE DECLARATION (Business and Professions Code Section 7028.15) 1. BIDDER'S Contractor's License Number is: Class No.: ,.,,h 2. The expiration date of BIDDER'S Contractor License is: 3. BIDDER acknowledges that Section 7028.15(e)of the Business and Professions Code provides as follows: "A licensed contractor shall not submit a bid to a public agency unless his or her contractor's license number appears clearly on the bid,the license expiration date is stated, and the bid contains a statement that representations herein are made under penalty of perjury. Any bid not containing this infonnation, or a bid containing information which is subsequently proven false, shall be considered non-responsive and shall be rejected by the public agency." The undersigned declares,under penalty of perjury,that the representations made by the undersigned in this bid proposal are true and correct. Executed on , 20 , at (insert City and State where Declaration signed). .. ._ Signature 9ye.,oy'%/ ,6 e T ed ame Title � a - ....—. �_ �� w..... Company, ame I-C-8 NON-COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ) ) ss. County of ) S w r (�'o vt, , being first duly sworn, deposes and say that he or she is v L the party making the foregoing bid 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. Signature --� Name of idder/Com an Nan p y le AVIO,A/ Slvr e, 1611C Z? `ype aame Date Title I-C-9 CALIFORNIA JURAT CERTIFICATE State of California County of . Subscribed and sworn to (or affirmed)before me on this A Ir ay of---- 20 by proved to me on the basis of satisfactory evidence to be the person(s�_who appeared before me. RONALD NORRIS MCGHEE a Commission#2003044 WITNESS MY HAND AND OFFICIAL SEAL. Notary Public-California Los Angeles County ' M Comm. x Ices Jan b,2017 a r aatu of Notar y lic (Notary Seal) OPTIONAL INFORMATION The jurat contained roithin loraearae)r t is in accordance evitli California law. Any affidavit subscribed and sworn to before a notary shall use the preceding wording or substant similar wording pursuant to Civil Code sections 1189 and 8202.A jurat certificate cannot be of lxed to a document sent by mail or of,a i e delivered to a notary public, including electronic means,whereby the signer did not personally appear before the notary pu :"„ even if the signer is known by the notary public. The seal and signature cannot be affixed to a document without the correct tro it wording. As an additional option an affiant can produce an affidavit on the same document as the notarial Gerd e wording to eliminate the use of additional documentation. DESCRIPTION OF ATTACHED DOCUMENT � PACITY CLAIMED BY THE SIGNER _ 'dual Title of docume -� ( nt) ...... _Corpora Meer Partner Number of Pages (Includingjurat) Attorney-In-Fact Trustee Document Date �. ......__. (Additional Information) tion) MMX V BAN2510.409.1334 w\vww 13ayAreaallotury.com WORKER'S COMPENSATION CERTIFICATION Section 1861 OF THE LABOR CODE (Workers' Compensation) Pursuant to Seetion 1861 of the Labor Code, the BIDDER, in subinitting his/her PROPOSAL, shall sign the following certification: "I am aware of the provisions of Section 3700 of the Labor Code which require evety CnIP10yer W be inSUrcd against liability for workers'coaxal)ensation or to undertake self- insurance in accordance with the provisions of that code, and f will eoinj)ly with such 1novisions before commencing the performance of the work ol"this contract." Signature of Bidder: 'fitle: Business Narne: Alle�,N /V" Business Address. X175 1'elephone Number: (323 �142-404 ---------------- Dated this At, day of A1#1L,,ze 20/1 J 1-c-1 DESIGNATION OF SUBCONTRACTORS ADA RAMP INSTALLATION PROJECT PROJECT NO.: PW 13-14 COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROJECT NO.: 601608-13 Company Name: . � ` BIDDER will perform the majority of the work and proposes to subcontract certain portions of the work which are in excess of one-half of one percent (1/2 of 1%) of the bid and to procure materials and equipment from suppliers and vendors as follows: ,Description o,., f Name of portion of Work Estimated Subcontractor Address Subcontracted $Amount (Number and Street) ......City,Zip Code) ..........._.._...__... _... .. __ _._... ._ s..._ ..._—_ _..............._._ ... _ .. m _.. I-C-1 1 REFERENCES Company Name: The following are the names, addresses, and telephone numbers for public agencies for which BIDDER has performed similar work as the prime contractor or major subcontractor within the past five (5) years: 1. Project Title: k7�.11140 4- ✓ez, 6vy� Location: f3d,2 A1,10pq AP,4/rk �llC�?� 09 fr Nan abd address of owner 1-'P11 atio? 67emy--910 Name and current telephone number of person familiar with project Type of Work: e i Iolv A/nZ& 4 � Contract amount: $a3/7,,1949 Date completed: Amount of work done by my/our firm under contract$ Did your firm have any financial interest in Project? Ad 2. Project Title: i 'w , Location: " 9 / I'r � ✓� `% ? Naa , a address of oware 90 . / Name and current telephone number of person familiar with p p project YID � Contract amount: $S9 Date completed: / Amount of work done by my/our firm under contract$ Did your firm have any financial interest in Project?.._...../`�® I-C-12 3. Project Title: Location: 3 l ZA lep Nall . and War f owner Name and current telephone number of person familiar with project Type of Work: a � k, Contract amount: $ 2#IeM •. ._..... Date completed: �' Amount of work done by my/our firm under contract$ ./ Did your firm have any financial interest in Project?.—A/O.. Company Name: 4. Project Title: " r Location: Vajo�, f 1; ; " Name and a6dress of owner r✓7 � N am me and current telephone Baum aer of person familiar with project:. Type of Work: e Contract amount: $ /¢2,37J Date completed: y Amount of work done by m /our firm tinder contract f Did your firm have any financial interest in Project? Alb 5. Project Title: " Location: Led—ell� "' �� � (Wei Name and add ss o 'Mier I-C-13 Name and cdrew telephone number of person I�amffiar with pro,joct.; II ypc of Work: C01111-actmi'lount.$ Date completed: Arrioutit of work done by niy/our firm under contract$ :2"*,,; 5?d' Did yourfimi have any financia I interest in Pro ect? J .- —, .............. Bideler may attacli a(Mitional rql�,reucepizge�v if itecessoij" "I'he following are the maines,addresses,and telephone numbers for all brokers and surefics fivin whom 131,DDER intends to procure insurance bonds: ............ 2,01 ........... . ......... .. .........- I-C_14 BIDDER'S STATEMENT OF PAST CONTRACT DISQUALIFICATIONS ADA RAMP INSTALLATION PROJECT PROJECT NO.: PW 13-14 COMMUNITY DEVELOPMENT BLOCK GRANT CDBG PROJECT NO.: 601608-13 Company Name: 1G9411- l : ' Please state all instances of being disqualified, removed, or otherwise prevented from bidding on, or completing, a federal, state, or local government project due to a violation of a law or safety regulation. I. Have you ever been disqualified from any government contract? Yes ❑ No IDJ 2. If yes, explain the circumstances: 0 _. Bidder's Signature . .. _mm... .. 410 on Lon Lze Nae( ase Pr' t ....�.........n....._......w. �.........w.w........... I-C-15 INSURANCE REQUIREMENTS [MUST BE SUBMITTED WITH PROJECT PROPOSAL] ADA RAMP INSTALLATION PROJECT PROJECT NO.: PW 13-14, CDBG PROJECT NO.: 601608-13 Company Name: ��- To be awarded this contract, the successful bidder must procure and maintain the following types of insurance with coverage limits complying, at a minimum, with the limits set forth below: Type of Insurance Limits Commercial general liability: $2,000,000 Business automobile liability: $1,000,000 Workers compensation: Statutory requirement Commercial general liability insurance must meet or exceed the requirements of ISO-CGL Form No.CG 00 01 11 85 or 88. The amount of insurance set forth above must be a combined single limit per occurrence for bodily injury, personal injury, and property damage for the policy coverage. Liability policies must be endorsed to name the City,its officials,and employees as"additional insureds"under said insurance coverage and to state that such insurance will be deemed "primary" such that any other insurance that may be carried by the City will be excess thereto. Such endorsement must be reflected on ISO Form No. CG 20 10 11 85 or 88, or equivalent. Such insurance must be on an "occurrence,"not a "claims made,"basis and will not be cancelable or subject to reduction except upon thirty(30)days prior written notice to the City. Insurer will agree in writing to waive all rights of subrogation against the City, its officers, officials, employees and volunteers for losses arising from work performed by Contractor for the City. Automobile coverage must be written on ISO Business Auto Coverage Form CA 00 01 06 92, including symbol 1 (Any Auto). The Consultant must furnish to the City duly authenticated Certificates of Insurance evidencing maintenance of the insurance required under this Agreement,endorsements as required herein,and such other evidence of insurance or copies of policies as may be reasonably required by the City from time to time. Insurance must be placed with admitted insurers with a current A.M. Best Company Rating equivalent to at least a Rating of"A:V1I." Certificate(s)must reflect that the insurer will provide thirty (30) day notice of any cancellation of coverage. The Consultant will require its insurer to modify such certificates to delete any exculpatory wording stating that failure of the insurer to mail written notice of cancellation imposes no obligation, and to delete the word "endeavor" with regard to any notice provisions. The City requires California Worker's Compensation Coverage with the associated Waiver. Out-of-state coverage will not be accepted in lieu of the California coverage, because the work is being performed in the State of California. By signing this form, the bidder certifies that it has read, understands, and will comply with these insurance requirements if it is selected as the City's consultant. Failure to provide this insurance will render the bidder's proposal "nonresponsive." Date 7 Bidders Siganatui I-C-16 END PROPOSAL SECTION I-C-17