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CONTRACT 4596 Bid CLOSEDAgreement No. 4596 Addscape, Inc. d wil lvi� t March 6, 2014 ADDENDUM NO. 2 to THE CONTRACT DOCUMENTS, SPECIFICATIONS AND PLANS for 2013-2014 CURB, GUTTER, SIDEWALK, AND OTHER CONCRETE IMPROVEMENTS PROJECT PROJECT NO. PW 13-22 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. Please see this project's attached Supplement to Addendum 2 for contractor questions and the City's responses to theirs. 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: " C d ...... ...... _. - , Page 1 of 1 350 Main Street, El Segundo, CA 90245-3895 (310) 524-2300 Fax(310) 640-0489 CITY OF EL SEGUNDO 2013-2014 CURB, GUTTER, SIDEWALK, AND OTHER CONCRETE IMPROVEMENTS PROJECT PROJECT NO. PW 13-22 ADDENDUM NO. 2 SUPPLEMENT DATE: March 6, 2014 TO: All Prospective Bidders The following questions have been raised regarding this bid. The response to each question is provided here and made available to all prospective bidders. The information and clarification provided in this Addendum shall be considered as incorporated into the specifications for the above-referenced project. All other portions of Contract Documents and previous Addenda not specifically mentioned in this Addendum remain in force. Question 1: Do I need to include the alternate bid prices listed on page I-C-3b in the total bid amount line on page I-C-3a? Answer: No, your total bid shall be the total amount of your Base Bid. Question 2: On the PW 13-22 Project Item#4 on the alternate bid, are we replacing the entire drain or just repairing it?You also mentioned that there are 2 more just like it making it a total of 3. Can you please clarify? Answer: Please refer to Section IV—Measurement and Payment of the Specifications. It clearly indicate the scope of work required to do each items. It was also suggested at the pre-bid job walk to field visit all project sites before bidding. That way, you have a better idea on what was required to be improved/repaired in the Specifications. ,. January 30, 2014 ADDENDUM NO. 1 to THE CONTRACT DOCUMENTS, SPECIFICATIONS AND PLANS for 2013-2014 CURB, GUTTER, SIDEWALK,AND OTHER CONCRETE IMPROVEMENTS PROJECT PROJECT NO. PW 13-22 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 Mandatory Pre-bid Job Walk date and time has been changed to Wednesday,February 26, 2014 at 10:00. 2. The bid due date and time has been changed to Tuesday, March 11, 2014, at 11:00 am. 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 F subject to rejection. ' Signature; .. _ Date " Print Company Name: ; ^ m;_ f�, Page 1 of 1 350 Main Street,El Segundo, CA 90245-3895 (310) 524-2300 Fax (310) 640-0489 PROPOSAL FOR THE 2013-2014 CURB, GUTTER, SIDEWALK,AND OTHER CONCRETE IMPROVEMENTS PROJECT PROJECT NO. PW 13-22 Date 20 Company Name: .., 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 sum 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. I-C-2 BID SCHEDULE 2013-2014 CURB, GUTTER, SIDEWALK,AND OTHER CONCRETE IMPROVEMENTS PROJECT PROJECT NO. PW 13-22 � Company Name: ° .� . r D ITEMS BASE BL m. -Item Description .... a Oty Unit Unit Price ($) Total ($) 1 4" Thick Sidewalk Improvements 625 SF I� efl 7Q7.0Q .. .._.. __.-- 2 6"Thick Driveway Approach 186 SF Improvements 120 Oda 3,7 0 or7 _...._- Concrete Improvement... .......m.�.._ .. ,.._ ...... ........ . ... Improvements at NE 3 corner of Continental Blvd. and El LS LS 37r_,,v ���7j 100 Segundo Blvd. corner of Douglas St. and Park — - 4 Concrete Improvements at SW LS LS ark Pl. ® S r TOTAL BID /h _. TOTAL BID WRITTEN IN WORDS:., � �✓ ° I-C-3a ALTERNATE BID SCHEDULE 2013-2014 CURB, GUTTER, SIDEWALK,AND OTHER CONCRETE IMPROVEMENTS PROJECT PROJECT NO. PW 13-22 CompanyName: _.............. .. ......_.............. ­_-m........... __ .................................. .._ ALTERNATE BID ITEMS .... -... ......_.. .. -...._,_.e _ Item Description Otv Unit Unit Price ($) Total ($) Al " Sidewalk Imp- 9 5 -SF 4 Thick S Improvements 956 A2 6" Thick Driveway Approach 160 SF Improvements k -A3 6"....�._....__ ....... -....� m....� Curb Only Improvements 21 LF A3 Concrete Improvements at 600 LS LS Allied Way A4. Grand Avm Improvements at.�.�� �� ---- w Crete I p 2100 E. LS LS . Ave. ® / ._ _..,..... / I-C-3b BIDDER'S INFORMATION Company Name: 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 (i.e., California) ` ✓ ✓ Business �'y .. :..... r Address 117.2 " ................... P y Tele hone No .... � �� ..� �_w... 6............... m Facsimile No. , .., " _..... .._.._. ....... ...... State Contractor's License No. and Class ' / Original Date Issued Expiration Date—.0513112-414 The following are the names, titles, addresses, and phone numbers of all individuals, firm members, partners,joint venturers, and/or corporate officers having principal interest in this proposal: _ ....... .......__... a , z f°,�, 1io. .?v The date of any voluntary or involuntary bankruptcy judgments against any principal having an interest in this proposal is as follows: _ ......... - ... .e.")..._ All current and prior DBA's, aliases, and/or fictitious business names for any principal having an interest in this proposal are as follows: I-C-4 BIDDER'S INFORMATION(CONTINUED) Cornpany Name: Bidder Shall list tile lialne of the person whoattended the mandatory prey-bid djob walk: Name: r ....... IN WITNESS WHEREOF,BIDDER executes and subrnits this proposal vvith the nan-tes.filler,, li,,'i n(is, sand seals of all a forenarned imIncipals fl-fis 2"4ay ol 4 20 BIDDER ............. .............. ................. -V- 7 ................... ............. . ..... .................... .......... ......................... ............. .. ....... dubs cailed and sworn to this day of'..___...... 20. NOTARY PUBLIC Al"ladied �1 , ltIZEDCEIqTlIIIP""I'CM' J-C!-6 CALIFORNIA JURAT CERTIFICATE State of California County of QJ- ✓6 4--f Subscribed and sworn to (or affirmed)before me on this 2(o tgay of 49� f ": 20 �,by � �,., proved to me on the basis of satisfactory evidence to be the personXwho appeared before me, RONALD NORRIS MCGHEE WITNESS MY HAND AND OFFICIAL SEAL. Commission#2003044 Notary Public-California Los Angeles County C M„ Comm.Ex Tres Jan 5,2017 Si tadua` of Notary Public (Notary Seal) OPTIONAL INFORMATION The jurat contained within this r,'o; rcrtd is in accordance with California law. Any affidavit subscribed and sworn to before a notary shall use the preceding wording or substantially s ar wording pursuant to Civil Code sections 1189 and 8202.A jurat certificate cannot be affixed to a document sent by mail or othejivis 1 ive:rcal to a notary public, including electronic means,whereby the signer did not personally appear before the notary public, a if the signer is known by the notary public. The seal and signature cannot be affixed to a document without the correct noraand riling. As an additional option an affiant can produce an affidavit on the same document as the notarial eert6,jica rd'ing to eliminate the use of additional documentation. DESCRIPTION OF ATTACHED DOCUMENT CA. CI'I Y CLAIMED BY THE SIGNER Indivi (Title of document) Corporate 01 Partner Number of Pages (Including jurat) Attorney-In-Fact Trustee Document Date m ,_ Other: (Additional ..........._. .�..��...Information) NEMX V.BAN2 510.409.1334 www.BayAreallotary,com Bond No 11 -154-039 PROPOSAL GUARANTEE BID BOND 2013-2014 CURB, GUTTER, SIDEWALK,AND OTHER CONCRETE IMPROVEMENTS PROJECT PROJECT NO.PW 13-22 KNOW ALL MEN BY THESE PRESENTS that, dba Alpha Omega Builders _Addscape,_Inc. _ ,as BIDDER,and The Ohio Casualty Insurance Company ,as SURETY,are held and firmly bound unto the City of El Segundo, in the penal sum of tm pm33t cf lid DOLLARS($1_Q4,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 201 4 . 11723 S Western Ave, BIDDER* _ �p — Angeles,_ _ .. 9 7 � A dscape, Inc. Los CA 004mmmmm dba Alpha Omega Builders 323-242-0049 "- The Ohio SURETY* � y J n a , 9_ ..CaMpany 450 Seward Rd Fairfield, OH 45014 ... Blake A Pfister, 617-357-9500 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 �"::�.�``.�x".�.�'�✓'.Y"'�'.�s:,°;a�,':'.�'�a,4'�e,^�^.z�'%�'�^�"�`;<�`.�' ,�:fix"�'�C�^.4.�::��;r,�t K�r-:^{'.t�t�".�:��`.r:�t',�'��:*,�4^�;".�:�'+:"'�C.�' :, '.t,w..�.*��i;:�"",n.�"",�'"�^ �'".�.5'.a�x.n.�:*!'a;K"�':�,'�-;:�'�,?".�.�"�"��.�`:�,.. .. 2, State of California ' Orange "i y Co ouar 19 2014 Lianne Nahina , Notary Public O�i ebr Y ' before me, .. _ Date H ere Insert Name and Title..o..f.the O Officer personally a ppeared �..._.,w.., .. � ..+ Blake A Pf ister .................�, F........_... . �_..we,..�.�.--�...�._ .A.,� Name-(s)of Signer(s)......._... _............ 1 who proved to me on the basis of satisfactory evidence to be the person(:) whose name(s) is/aw subscribed to the within instrument and acknowledged to me that he 1alwm6Wq executed the same in l 1111 i'jE k�11\i 14i,jA his/bumMeik authorized capacity(", and that by c4 P '� ��k�. �( fl� �F ai��s � his/ signature(s) on the instrument the P erson(f), or the entity upon behalf of which the tY P persons acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.: Signature: ure; �,,. ��_...... " Place Notary Seal Above Signature of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document yp d„ 11-154-039 Document nt DateD March l la 2014� Number _ .._�....�_ �_ e —.... _...._. _ _. _W ber of Pages:..1_ Signer(s) Other Than Named Above: None N on__.._ .. -­-­-- . a ac Claimed Si Signer's Name Blake P f i s t er Si g n er's Nae L] Corporate Officer — TI tle(s). i ❑Corporate Officer — Title(s): Individual El Individual MCIM51105 I_ ' I�41i .' J�4 • ❑ Partner — ❑Limited ❑General Partner — Limited = General Top of thumb here Top of thumb here IX Attorney in Fact -Attorney in Fact ❑ Trustee Trustee ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: .m. -Other: �..n.... _.... — K Signer Is Re resentin i. .....g Signer Is Representing: _ g p g:mr o nr, sentin ' . Y Insurance... -......- ce Coan ..... - -....... ._ _ ... �. - .... Casualt r w ©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 Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No 6979475 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company PBOondE oOE' T1TP4="639 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 theretothis tom day of„_,Dece_mber 2oin American Fire and Casualty Company The Ohio Casualty Insurance Company y Liberty Mutual Insurance Company c West nerican Insurance Company rn to � • � � � - By: ^ STATE OF PENNSYLVANIA ss David M.Carey;"Assistant Secretary C +� L COUNTY OF MONTGOMERY _ eat � tiOn this loth day of December , 2013, before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire O 3 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, pia execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. L@ > IN WITNESS WHEREOF,I have hereunto subscribed my nanae and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. O 0, / ) O Teresa Pastella,Notary Public y do O = d a i4 This Power of Attorney is made and executed p6rsal if to nd,by au4h6atty of the following By-laws and Authorizations ofAmerican Fire and Casualty Company,The Ohio Casualty Insurance to p y; Company,Liberty Mutual Insurance Company,aA1 I stAnVoctan Insurance Company which resolutions are now in full force and effect reading as follows: i3! M i ARTICLE IV—OFFICERS—Section 12.Power of Attorney,Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O C 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, O 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 E r 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 aty L 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 >o ,a A 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. = ARTICLE XIII—Execution of Contracts—SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, o? > L and subject to such limitations as the chairman or the president may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Company to make,execute, co 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 00 Z v respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. io 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 Attorney executed by said Companies,is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 11 tNay of March ­2014 p r By: Gregory W,Davenport,Assistant Secretary J Js, 65 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 Nor: . .. 2. The expiration date of BIDDER'S Contractor License is; _j�201 , 20*_ 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 information, 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 , 2Cl m, at (insert City and State where Declaration signed), Signature mm.. g e �`/c�orJ9 .�U�ir9 Lee lyl eci � �s�wn Title Company ame I-C-8 NON-COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ) ss. County of ) v s e"S 6-Y'V ('(-*1 Lek,being first duly sworn, deposes and say that he or she is . .. Q. of 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 Iie1dcr/(",'('.inipany Name ........ .... .. .....__ .. Typed Name Date Title Z� SOO w ����! I-C-9 CALIFORNIA JURAT CERTIFICATE State of California j County of �DJ �iJle� G Subscribed and s orn to (or affirmed)before me on this 2 *day of 1i ' 20 by proved to me on the basis of satisfactory evidence to be the, ersora x a peared before me" DONALD NORRIS MCGHEE ommisslon#2003044 Notary Public-California WITNESS MY HAND AND OFFICIAL SEAL. Los Angeles County M Comm.Explr s Jan „2017 I Al Signat e of Notary Public (Notary Seal) OPTIONAL INFORMATION The jurat contained tort i his document is in accordance with California law, Any affidavit s��,bscribed,and sworn to before a notary shall use tlie preceding wording ar SUb,5 tially Similar wo-ding purse ant to Civil Code sections 1189 and 8202, Tura!certificate cannot be affixed to a document sent by mail o therwise delivered to a notary public, including electronic ml ears, whereby the signer did not personally appear before the nota ublaco even if the signer is blown by the notary publia,The seal and signature cannot be a ixed to a document without the Corr otarial wording. As an additional option an affi Sit can produce an aidavit on the Jf some document as the not trficate wording to eliminate the use ofaddittowl documentation. i i DESCRIPTION OF ATTACHED DOCUMENT >C,I,PA CI,AI7Y'E BY THE SIGNER vidiu1(Title of document) M Od f ao r eT Number of Pages (Includingjurat) ney-In-ee Document Date ; (Additional Information) I NfN(X V.BAN2 510.409 1334 www, ayAreal4oG;;',com k i i WORKER'S COMPENSATION CERTIFICATION Section 1861 OF THE LABOR CODE (Workers' Compensation) Pursuant to Section 1861 of the Labor Code, the BIDDER, in submitting his/her PROPOSAL, shall sign the following certification: "I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers' 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." Signature of Bidder: Title: Business Name; ...- ......... .... , —............ ..... ....._.............. �. Business Address: 11723 4P-) zzx A C� Telephone Number: „ . Dated this ... day of ._ _mm.. , 204 I-C-10 DESIGNATION OF SUBCONTRACTORS 2013-2014 CURB, GUTTER, SIDEWALK, AND OTHER CONCRETE IMPROVEMENTS PROJECT PROJECT NO. PW 13-22 � �Com an 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 of Name of portion of Work Estimated Subcontractor Address Subcontracted $ Amount ........ ......,,......... �P (Number and Street) (City...Zp..Code).... _._.. Nine 1-C-11 REFERENCES Company Name: . ����� � �11� 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: I Project Title: f� Location: x 4 r' Name and address of owner z,go, r' -c/ Name and current telephone number of person familiar with project Type of Work: Contract amount: $ 5/° Date comp � pleted: Amount of work done by my/our firm under contract Did your firm have any financial interest in Project?�m/�U 2. Project Title: )i/1)/L &14 Location: 1'4 f r f 412 1f1 5-E11`1 ! -A .A", ��i'�r '/ )?g5 Na rrr tan(. address of owner ! Name and current telephone number of person familiar with project Type of Work: z Contract amount: $ IT_, Date completed: ,,,_ l" Amount of work done by my/our firm under contract Did your firm have any financial interest in Project? NO I-C-12 3. Project Title; ee Location: S Iir A* �, �' / w Sa Natm auid adds, ss of owim, J � s "„ Name and current telephone number of person f,'tnifliar with project Type of Work: Contract amount: _ ..., Date completed:_ „f �'�,,,,, Amount of work done by my/our firm under contract$ .21�9 Did your firm have any financial interest in Project? IVO _ Company Name: 4. Project Title. . Location: mvw Name and addi'ss of owner � -)IV, 1064 �31d)-79C- 119d Name and current telephone number of person familiar with project. Type of Work: 4�xn/r y114 Contract amount: _..,._... Date completed: Amount of work done by my/our firm under contract$ /T7 Did your firm have any financial interest in Project? dam,,,,,,,,,,,,,,,,,,,, 5. Project Title: clddrie Location: e�11110eg Al Name and address ;f own I-C-13 kl�x '44e- Name and current telephone number of person familiar with project: Type of Work: /t S> c Contract amount: $ 233 Date completed: ....... /. ., -- Amount of work done by my/our firm under contract$233,5?9 Did your firm have any financial interest in Project?, ........_w_..... .................................................... .yy ------.... Bidder naay attach additional reference pages if necessary. The following are the names,addresses,and telephone numbers for all brokers and sureties from whom BIDDER intends to procure insurance bonds: -2401 01114z6 I-C-14 BIDDER'S STATEMENT OF PAST CONTRACT DISQUALIFICATIONS 2013-2014 C(JRB, (31JI"'MR,, SIDEWALX, AN't.) 0-11117,1� COWIZEIT' IMPROVEMENTS PROJECT MOJECT NO�, PW 13-22 CompanyNalne: ................. ..... .. ]'lease stale all instances ol'being disqualified, removed, or ollierwise prevented 17roini bidding (Al, or con-iplefing, a federa 1, s tale, or local government pro.ject (file to a Violation of a law or Safety regukltioll. I" Have you ever been disqualified t"roni any goverrin-ijent contract? Yes 0 No P9 1 If yes, explain the cirCURIStalICCS: ............. .......... ........................ ................ ................ - — -------- ---------------- ---------------- .......... ----------------------- ............... . ...... ....... .......... ..............................- .....................--- ---- . ......... .................. ...... -------........... .............................--------................................. ......... .............. ------------------ ........... B i d d e�ls i3�n I-,'-C-'- X 1, Na arcs ase Prim) 7F,.c 1-C-15 INSURANCE REQUIREMENTS [MUST BE SUBMITTED WITH PROJECT PROPOSAL] 2013-2014 CURB, GUTTER, SIDEWALK, AND OTHER CONCRETE IMPROVEMENTS PROJECT, PROJECT NO. PW 13-22 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:VII." 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 L Bidder s Signature I-C-16 END PROPOSAL SECTION I-C-17