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HomeMy WebLinkAboutItem No. 06 PWCA Black RockText File City of Lake Elsinore 130 South Main Street Lake Elsinore, CA 92530 www.lake-elsinore.org File Number: ID# 17-738 Agenda Date: 7/24/2018 Status: Consent AgendaVersion: 1 File Type: AgreementIn Control: City Council / Successor Agency Agenda Number: 6) Page 1 City of Lake Elsinore Printed on 7/19/2018 Award SB821 Lakeshore Drive SidewalkProject Page 1 of 2 REPORT TO CITY COUNCIL To:Honorable Mayorand Members of the City Council From:Grant Yates, City Manager Prepared By: Farid Dost, Senior Civil Engineer Date:July 24, 2018 Subject:Public Works Construction Agreement with Black Rock Construction for Senate Bill 821 Lakeshore Drive Sidewalk Project CIP Project No. Z10010 Recommendation 1. Authorize the City Manager to execute the agreement in the amount of $439,165.00, in such final form as approved by the City Attorney; and, 3. Authorize the City Manager to execute Change Orders not to exceed the 10 percent contingency amount of $43,916.50; and, 4. Authorize the City Clerk to record the Notice of Completion once it is determined the work is complete by the City Engineer and the improvements are accepted into the City maintained roadway network. Background On June 26, 2017, the City received confirmation from Riverside County Transportation Commission (RCTC), that certain proposed projectsas part of the SB 821 Grant Program were approved for funding. The SB 821 Lakeshore Drive Sidewalk Project was one of them. On June 4, 2018, City staff completed the design. The project was advertised on June 13, 2018. On July 12, 2018, the bids werepubliclyopened. The initial apparent low bidder L.C. Paving, realized they had made multiple bid errors and requested to withdraw their bid, which was approved. Black Rock Construction is the second mostresponsive and qualified bidder. Discussion Contractor bids were opened publicly on July 12, 2018, at 2:30p.m. The City received nine (9) bids from qualified contractors.Staff recommends awarding the project to the secondlowest bidder Black Rock Construction. Award SB821 Lakeshore Drive SidewalkProject Page 2 of 2 The bid results are summarized below: Contractor (Bidder) Bid Amount _ 1.L.C. Paving $368,993.50 2.Black Rock Construction $439,165 3.EBS General Engineering, Inc.$463,655 4.Leonida Builders, Inc.$475,330 5.Hillcrest Contracting, Inc. $483,182 6.All American Asphalt $502,410 7.Beador Construction Company, Inc.$509,700 8.CT&T Concrete Paving, Inc $586,294.75 9.Aramexx Construction $1,073,940 Fiscal Impact Funding for this project has been allocated within the approved CIP Budget. Exhibits A –Agreement B –Proposal @BCL@AC3FDDBD.docx Page 1 AGREEMENT FOR PUBLIC WORKS CONSTRUCTION Black Rock Construction Company SB 821 Lakeshore Drive Sidewalk Project CIPNo. Z10010 This Agreement for Public Works Construction (“Agreement”) is made and entered into as of July24, 2018, by and between the City of Lake Elsinore, a municipal corporation (‘‘City") and Black Rock Construction Company, a California corporation("Contractor"). The City and Contractor, inconsideration of the mutual promises and covenants set forth herein, agree as follows: 1.The Project and Project Documents. Contractor agrees to construct the following public improvements (“work”) identified as: SB 821 Lakeshore Drive Sidewalk Project(the “Project”). The City-approved plans for the construction of the Project, which are incorporated herein by reference, are identified as: SB 821 Lakeshore Drive Sidewalk Project CIP Project No. Z10010 The Project Documents include this Agreement and all of the following: (1) the Notice Inviting Bids, Instructions to Bidders, Bid Documents including Bidder’sProposal as submitted by the Contractor, Contract Documents, General Specifications, Special Provisions, and all attachments and appendices; (2) everything referenced in suchdocuments, such as specifications, details, standard plans or drawings and appendices, including all applicable State and Federal requirements; (3) all required bonds, insurance certificates, permits, notices, and affidavits; and (4) any and all addenda or supplemental agreements clarifying, amending or extending the work contemplated as may be required to insure completion in an acceptable manner. All of the provisions of the above-listed documents are made a part of this Agreement as though fully set forth herein. 2.Compensation. a.For and in consideration of the payments and agreements to be made and performed by City, Contractor agrees to construct the Project, including furnishing all materials and performing all work required for the Project, and to fulfill all other obligations as set forth in the Bidder’s Proposal, such contract price being Four Hundred ThirtyNineThousand One Hundred Sixty Five dollars($439,165). b.City hereby promises and agrees to employ, and does hereby employ, Contractor to provide the materials, do the work, and fulfill the obligations according to the terms and conditions herein contained and referred to, for the prices set forth, and hereby contracts to pay the same at the time, in the manner, and upon the conditions set forth in the Project Documents. Page 2 c.Contractor agrees to receive and accept the prices set forth in the Bidder’s Proposalas full compensation for furnishing all materials, performing all work, and fulfilling all obligations hereunder. Such compensation shall cover all expenses, losses, damages, and consequences arising out of the nature of work during its progress or priorto its acceptance including those for well and faithfully completing the work and the whole thereof in the manner and time specified in the Project Documents; and also including those arising from actions of the elements, unforeseen difficulties or obstructions encountered in the prosecution of the work, suspension or discontinuance of the work, and all other unknowns or risks of any description connected with the work. 3.Completion of Work. a.Contractor shall performand completeall work within Forty(40)working days from the date of commencement specified in the Notice to Proceed, and shall provide, furnish and pay for all the labor, materials, necessary tools, expendable equipment, and all taxes, utility and transportation services required for construction of the Project. b.All work shall be performed and completed in a good workmanlike manner in strict accordance with the drawings, specifications and all provisions of this Agreementas hereinabove defined and in accordance with applicable laws, codes,regulations, ordinances and any other legal requirements governing the Project. c.Contractor shall not be excused with respect to the failure to so comply by any act or omission of the City, the Director of Public Works, the City Engineer, a City inspector, or a representative of any of them, unless such act or omission actually prevents the Contractor from fully complying with the requirements of the Project Documents, and unless the Contractor protests at the time of such alleged prevention that the actor omission is preventing the Contractor from fully complying with the Project Documents. Such protest shall not be effective unless reduced to writing and filed with the City within three (3) working days of the date of occurrence of the act or omissionpreventing the Contractor from fully complying with the Project Documents. d.City and Contractor recognize that time is of the essence in the performance of this Agreement and further agree that if the work called for under the Agreement is not completed within the time hereinabove specified, damages will be sustained by the City and that, it is and will be impracticable or extremely difficult to ascertain and determine the actual amount of damages the City will sustain in the event of, and by reason of, such delay. It is, therefore, agreed that such damages shall be presumed to bein the amount of Five Hundred dollars ($500)per calendar day, and that the Contractor will pay to the City, or City may retain from amounts otherwise payable to Contractor, such amount for each calendar day by which the Contractor fails to complete the work, including corrective items of work, under this Agreement within the time hereinabove specified and as adjusted by any changes to the work. 4.Changesto Work.City and Contractor agree that the City may make changes to the work, or suspend the work, and no matter how many changes, such changes or suspensions are within the contemplation of the Contractor and City and will not be a basis for a compensable delay claimagainst the City nor be the basis for a liquidated damages claims against the Contractor. Any change to the work shall be by way of a written instrument (“change order”) signed by the City and the Contractor, stating their agreement to the following: Page 3 a.The scope of the change in the work; b.The amount of the adjustment to the contract price; and c.The extent of the adjustment to the Schedule of Performance. The Director of Public Works is authorized to sign any change order provided that sufficient contingency funds are available in the City’s approved budget for the Project. All change in the work authorized by the change order shall be performed under the applicable conditions of the Project Documents. City and Contractor shall negotiate in good faith and as expeditiously as possible the appropriate adjustments for such changes. 5.Bonds.Contractorshall provide, before commencing work, a Faithful Performance Bond and a Labor and Material Bond, each forone-hundred percent (100%)of the contract price in the form that complies with the Project Documents and is satisfactory to the City Attorney. 6.Non-Assignability. Neither this Agreementnor any rights, title, interest, duties or obligations under this Agreementmay be assigned, transferred, conveyed or otherwise disposed of by Contractor without the prior written consent of City. 7.Licenses. Contractorrepresents and warrants to City that it holds the contractor’s license or licenses set forth in the Project Documents, is registered with the Department of Industrial Relations pursuant to Labor Code Section 1725.5, and holds such other licenses, permits, qualifications, insurance and approvals of whatsoever nature which are legally required of Contractor. Contractorrepresents and warrants to City that Contractorshall, at its sole cost and expense, keep in effect or obtain at all times during the term of this Agreement, any licenses, permits, insurance and approvals which are legally required of Contractorto practice its profession. Contractor shall maintain a City of Lake Elsinore business license. 8.Indemnity. Contractor shall indemnify, defend, and hold harmless the City and its officials, officers, employees, agents, and volunteers from and against any and all losses, liability, claims, suits, actions, damages, and causes of action arising out of any personal injury, bodily injury, loss of life, or damage to property, or any violation of any federal, state, or municipal law or ordinance, to the extent caused, in whole or in part, by the willful misconduct or negligent acts or omissions of Contractor or its employees, subcontractors, or agents, by acts for which they could be held strictly liable, or by the quality or character of their work. The foregoing obligation of Contractor shall not apply when (1) the injury, loss of life, damage to property, or violation of law arises from the sole negligence or willful misconduct of the City or its officers, employees, agents, or volunteers and (2) the actions of Contractor or its employees, subcontractor, or agents have contributed in no part to the injury, loss of life, damage to property, or violation of law. It is understood that the duty of Contractor to indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil Code. Acceptance by City of insurance certificates and endorsements required under this Agreement does not relieve Contractor from liability under this indemnification and hold harmless clause. This indemnification and hold harmless clause shall apply to any damages or claims for damages whether or not such insurance policies shall have been determined to apply. By execution of this Agreement, Contractor acknowledges and agrees to the provisions of this Section and that it is a material element of consideration. Page 4 9.Insurance Requirements. a.Insurance. Contractor, at Contractor’s own cost and expense, shall procure and maintain, for the duration of the Agreement, unless modified by the City’s Risk Manager, the following insurance policies. i.Workers’ Compensation Coverage. Contractor shall maintain Workers’ Compensation Insurance and Employer’s Liability Insurance for his/her employees in accordance with the laws of the State of California. In addition, Contractor shall require each subcontractor to similarly maintain Workers’ Compensation Insurance and Employer’s Liability Insurance in accordance with the laws of the State of California for all of the subcontractor’s employees. Any notice of cancellation or non-renewal of all Workers’ Compensation policies must be received by the City at least thirty (30) days prior to such change. The insurer shall agree to waive all rights of subrogation against City, its officers, agents, employees and volunteers for losses arising from work performed by Contractor for City. In the event that Contractor is exempt from Worker’s Compensation Insurance and Employer’s Liability Insurance for his/her employees in accordance with the laws of the State of California, Contractor shall submit to the City a Certificate of Exemption from Workers Compensation Insurance in a form approved by the City Attorney. ii.Commercial General Liability Coverage. Contractor shall maintain commercial general liability insurance in an amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If a commercial general liability insurance form or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit. Required commercial general liability coverage shall be at least as broad as Insurance Services Office Commercial General Liability occurrence form CG 0001 (ed. 11/88) or Insurance Services Office form number GL 0002 (ed. 1/73) covering comprehensive General Liability and Insurance Services Office form number GL 0404 covering Broad Form Comprehensive General Liability. No endorsement may be attached limiting the coverage. iii.Automobile Liability Coverage. Contractor shall maintain automobile liability insurance covering bodily injury and property damage for all activities of the Contractor arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and non-owned vehicles, in an amount of not less than one million dollars ($1,000,000) combined single limit for each occurrence. Automobile liability coverage must be at least as broad as Insurance Services Office Automobile Liability form CA 0001 (ed. 12/90) Code 1 (“any auto”). No endorsement may be attached limiting the coverage. iv.Builder’s Risk Coverage. Prior to the commencement of any construction of the Project, Contractorshall obtain (or cause to be obtained) and keep in force during the term of any construction, builder’s risk insurance insuring for all risks of physical loss of or damage (excluding the perils of earthquake and flood). b.Endorsements. Each general commercial liability and automobile liability insurance policy shall be with insurers possessing a Best’s rating of no less than A:VII and shall be endorsed with the following specific language: Page 5 i.The City, its elected or appointed officers, officials, employees, agents and volunteers are to be covered as additional insured with respect to liability arising out of work performed by or on behalf of the Contractor, including materials, parts or equipment furnished in connection with such work or operations. ii.This policy shall be considered primary insurance as respects the City, its electedor appointed officers, officials, employees, agents and volunteers. Any insurance maintained by the City, including any self-insured retention the City may have, shall be considered excess insurance only and shall not contribute with it. iii.This insurance shall act for each insured and additional insured as though a separate policy had been written for each, except with respect to the limits of liability of the insuring company. iv.The insurer waives all rights of subrogation against the City, its elected or appointed officers, officials, employees or agents. v.Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its elected or appointed officers, officials, employees, agents or volunteers. vi.The insurance provided by this Policy shall not be suspended, voided, canceled, or reduced in coverage or in limits except after thirty (30) days written notice has been received by the City. c.Deductibles and Self-Insured Retentions. Any deductiblesor self-insured retentions must be declared to and approved by the City. At the City’s option, Contractor shall demonstrate financial capability for payment of such deductibles or self-insured retentions. d.Certificates of Insurance. Contractor shall provide certificates of insurance with original endorsements to City as evidence of the insurance coverage required herein. Certificates of such insurance shall be filed with the City on or before commencement of performance of this Agreement. Current certification of insurance shall be kept on file with the City at all times during the term of this Agreement. 10.Notices. Any notice required to be given under this Agreement shall be in writing and either served personally or sent prepaid, first class mail. Any such notice shall be addressed to the other party at the address set forth below. Notice shall be deemed communicated within 48 hours from the time of mailing if mailed as provided in this section. If to City:City of Lake Elsinore Attn: City Manager 130 South Main Street Lake Elsinore, CA 92530 With a copy to:City of Lake Elsinore Attn: City Clerk 130 South Main Street Lake Elsinore, CA 92530 Page 6 If to Contractor:Black Rock Construction Company Attn: Bill Goshen 615 N. Berry St. Suite G Brea, CA 92521 11.Entire Agreement. This Agreement constitutes the complete and exclusive statement of agreement between the City and Contractor. All prior written and oral communications, including correspondence, drafts, memoranda, and representations, are superseded intotal by this Agreement. 12.Amendments. This Agreement may be modified or amended only by a written document executed by both Contractor and City and approved as to form by the City Attorney. 13.Assignment and Subcontracting. Contractor shall be fully responsible to City for all acts or omissions of any subcontractors. Assignments of any or all rights, duties or obligations of the Contractor under this Agreement will be permitted only with the express consent of the City. Nothing in this Agreement shall create any contractual relationship between City and any subcontractor nor shall it create any obligation on the part of the City to pay or to see to the payment of any monies due to any such subcontractor other than as otherwise is required by law. 14.Waiver. Waiver of a breach or default under this Agreement shall not constitute a continuing waiver of a subsequent breach of the same or any other provision under this Agreement. 15.Severability. If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect. 16.Controlling Law Venue. This Agreement and all matters relating to it shall be governed by the laws of the State of California and any action brought relating to this Agreement shall be held exclusively in a state court in the County of Riverside. 17.Litigation Expenses and Attorneys’ Fees. If either party to this Agreement commences any legal action against the other party arising out of this Agreement, the prevailing party shall be entitled to recover its reasonable litigation expenses, including court costs, expert witness fees, discovery expenses, and attorneys’ fees. 18.Mediation. The parties agree to make agood faith attempt to resolve any disputes arising out of this Agreement through mediation prior to commencing litigation. The parties shall mutually agree upon the mediator and share the costs of mediation equally. If the parties are unable to agree upon a mediator, the dispute shall be submitted to JAMS or its successor in interest. JAMS shall provide the parties with the names of five qualified mediators. Each party shall have the option to strike two of the five mediators selected by JAMS and thereafter the mediator remaining shall hear the dispute. If the dispute remains unresolved after mediation, either party may commence litigation. 19.Authority to Enter Agreementand Administration. Contractor has all requisite power and authority to conduct its business and to execute, deliver, and perform the Agreement. Each party warrants that the individuals who have signed this Agreement have the legal power, right, and authority to make thisAgreement and to bind each respective party. The City Manager is authorized to enter into an amendment or otherwise take action on behalf of the City to make Page 7 the following modifications to the Agreement: (a) a name change; (b) grant extensions of time; (c) non-monetary changes in the scope of services; and/or (d) suspend or terminate the Agreement. The Director of Public Works shall act as the Project administrator on behalf of the City. 20.Prohibited Interests. Contractor maintains and warrants that it has not employed nor retained any company or person, other than a bona fide employee working solely for Contractor, to solicit or secure this Agreement. Further, Contractor warrants that it has not paid nor has it agreed to pay any company or person, other than a bona fide employee working solely for Contractor, any fee, commission, percentage, brokerage fee, gift or other consideration contingent upon or resulting from the award or making of this Agreement. For breach or violation of this warranty, City shall have the right to rescind this Agreement without liability. For the term of this Agreement, no member, officer or employee of City, during the term of his or her service with City, shall have any direct interest in this Agreement, or obtain any present or anticipated material benefit arising therefrom. 21.Equal Opportunity Employment. Contractor represents that it is an equal opportunity employer and it shall not discriminate against any subcontractor, employee or applicant for employment because of race, religion, color, national origin, handicap, ancestry, sex or age. Such non-discrimination shall include, but not be limited to, all activities related to initial employment, upgrading, demotion, transfer, recruitment or recruitment advertising, layoffor termination. 22.Prevailing Wages. a.Contractor and all subcontractors shall adhere to the general prevailing rate of per diem wages as determined and as published by the State Director of the Department of Industrial Relations pursuant to Labor Code Sections 1770, 1773, and 1773.2. Copies of these rates and the latest revisions thereto are on file in the office of the City Clerk of the City of Lake Elsinore and are available for review upon request. b.Contractor's attention is directed to the provisions of Labor Code Sections 1774, 1775, 1776, 1777.5 and 1777.6.Contractor shall comply with the provisions of these Sections. The statutory provisions for penalties for failure to comply with the State's wage and the hours laws will be enforced. c.Labor Code Sections 1774 and 1775 require the Contractor and all subcontractors to pay not less than the prevailing wage rates to all workmen employed in the execution of the contract and specify forfeitures and penalties for failure to do so. The minimum wages to be paidare those determined by the State Director of the Department of Industrial Relations. Labor Code Section 1776 requires the Contractor and all subcontractors to keep accurate payroll records, specifies the contents thereof, their inspection and duplication procedures and certain notices required of the Contractor pertaining to their location. The statutory penalties for failure to pay prevailing wages will be enforced. If the Project has been awarded to Contractor on or after April 1, 2015, Contractorand its subcontractors must furnish electronic certified payroll records to the Labor Commissioner. Beginning January 1, 2016, Contractorand its subcontractors must furnish electronic certified payroll records to the Labor Commissionerwithout regard to whenthe Project was awarded to Contractor. d.Labor Code Section 1777.5 requires Contractor or subcontractor employing tradesmen in any apprenticeable occupation to apply to the Joint Apprenticeship Page 8 Committee nearest the site of the public works project, which administers the apprenticeship program in that trade for a certificate of approval. The certificate will also fix the ratio of apprentices to journeymen to be used in the performance of the Agreement. The Contractor is required to make contributions to funds established for the administration of apprenticeship programs if the Contractor employs registered apprentices or journeymen in any apprenticeable trade and if other contractors on the public works site are making such contributions. Information relative to apprenticeship standards, contributions, wage schedules and other requirements may be obtained from the State Director of Industrial Relations or from the Division of Apprenticeship Standards. Labor Code Section 1777.6 provides that it shall be unlawful to refuse to accept otherwise qualified employees as registered apprentices solely on the grounds of race, religious creed, color, national origin, ancestry, sex, or age. e.Eight hours labor constitutes a legal day's work, as set forth in Labor Code Section 1810. 23.Termination. (a)City may cancel this Agreement at any time upon seven (7) days written notice to Contractor. Contractor agrees to cease all work under this Agreement on or before the effective date of such notice. (b)In the event of termination or cancellation of this Agreement by City, due to no fault or failure of performance by Contractor, Contractor shall be paid full compensation for all services performed by Contractor, in an amount to be determined as follows: For work done in accordance with all of the terms and provisions of this Agreement, Contractor shall be paid an amount equal to the amount of services performed prior to the effective date of termination or cancellation; provided, in no event shall the amount of money paid under the foregoing provisions of this paragraph exceed the amount which would be paid Contractor for the full performance of the services required by this Agreement. 24.Execution. This Agreement may be executed in several counterparts, each of which shallconstitute one and the same instrument and shall become binding upon the parties when at least one copy hereof shall have been signed by both parties hereto. In approving this Agreement, it shall not be necessary to produce or account for more than one such counterpart. [Signatures on next page] Page 9 IN WITNESS WHEREOF,the parties have caused this Agreement to be executed on the date first written above. “CITY” CITY OF LAKE ELSINORE, a municipal corporation Grant Yates, City Manager ATTEST: City Clerk APPROVED AS TO FORM: City Attorney “CONTRACTOR” Black Rock Construction Company, a California corporation By:_____________________ Its:_____________________ By:_____________________ Its:_____________________ CITY OF LAKE ELSINORE CIP Project No. Z10010 [a] } : F : • + SB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 Company: G (C- 40 G le- ` on S Ar 07 Honorable Mayor, Members of the Council: In accordance with the Notice Inviting Bids pertaining to the receiving of sealed proposals by the City Clerk of the City of Lake Elsinore for the above titled improvement, the undersigned hereby proposes to furnish all Work to be performed in accordance with the Specifications, Standard Drawings, and the Contract Documents, for the unit price or lump sum set forth in the following schedule: Time of Completion: Forty (40) Working Days from Issuance of Notice to Proceed (NTP) by City to Contractor. BID SCHEDULE ITEM NO. DESCRIPTION MOBILIZATION AND PROJECT INFORMATION SIGN TRAFFIC CONTROL PLAN & IMPLEMENTATION UNIT QUANTITY UNIT COST TOTAL COST 1 2 LS 1 ZZ 6 p r 2Z 00 e LS 1 3 CONSTRUCTION SURVEY AND STAKING LS 1 U Er 00 4 STORM /NON STORM WATER POLLUTION CONTROL AND IMPLEMENTATION LS 1 �r 000 3 19 0 ' 5 CLEARING & GRUBBING SAWCUT EXISTING A.C. PAVEMENT LS 13,000 000 0 0�7 6 LF 1,620 `� L9 b L V-0 7 REMOVE A.C. PAVEMENT AND BASE MATERIAL SF 3,270 3. 00 8 REMOVE CURB & GUTTER LF 25 f d 1, 3i S 9 REMOVE PCC DRIVEWAY SF 305 /0.00 3 05 10 GRIND A.C. IN PLACE (0.1') SF 7,750 "2 11 MINOR GRADING/ EXCAVATION LS 1 3.Z, o00 3s' Dav 12 CONSTRUCT 6" AGG. BASE CLASS II CY 60 be © 3 boo. 13 CONSTRUCT 4" ASPHALT CONCRETE TON 80 Z) , 0 14 ASPHALT OVERLAY (0.1') TON S6 15 ADJUST M.H. TO GRADE EA 1 bop. d (3b C -7 CITY OF LAKE ELSINORE CIP Project No. Z10010 16 CONSTRUCT CURB & GUTTER (TYPE 6) LF 1,150 '43. oo Z6 Q> o 17 CONSTRUCT PCC SIDEWALK SF 4,630 'L? 7?0 18 REMOVE AND REPLACE TRAFFIC PULL BOX EA 1 SU ,,DD 19 NEW TRAFFIC LOOP AND SPLICE LS 1 399v 20 RELOCATE SIGN EA 7 '3-5-0 V, SWJ-rQ 21 INSTALLSIGN EA 2 -3,v Ck 7w 22 CONSTRUCT A.C. BERM AND TRANSITION LF 50 iD aq / Y n4 23 CONSTRUCT ADA CURB RAMP AND TRUNCATED DOMES (TYPE III MODIFIED) EA 6 Z.z vo q -L JD j, 24 CONSTRUCT ADA CURB RAMP AND TRUNCATED DOMES (TYPE I MODIFIED) EA 3 ZZ 000 25 CONSTRUCT CROSS GUTTER PER COUNTY OF RIVERSIDE STD. NO. 403 MODIFIED SF 1,730 ) 09 "20,'7 6 26 CONSTRUCT PCC DRIVEWAY PER COUNTY OF RIVERSIDE STD. NO. 213 MODIFIED SF 570 /J. 9 '5- 7po 27 CONSTRUCT STREETLIGHT FOUNDATION EA 11 �LS"�, i3�'7S 28 STREETLIGHTS AND BASE COVER EA 11 jj Dew 6i 3 -9v 29 STREETLIGHT SHIELDS EA 2 'ZOO, V" 99P 30 REMOVE EXISTING STRIPING AND MARKING LS 1 I Z, no I'2, Vw 31 1ST SLURRY SEAL AND CRACK SEAL SF 89,300 0.5-0 4 >1' 45'D 32 STRIPING AND PAVEMENT MARKING LS 1 SDDD g, ov0 Total Bid Price Note: Estimated quantities are for the purpose of Bid comparison only; payments will be made on the basis of actual measurement of Work completed, except for lump sum (LS) and final pay (F) quantities. (S) denotes a specialty item. The Bid Price shall include, but not be limited to, sales tax and all other applicable taxes and fees. Total Bid: y3 °1,/65. OD (Figures'? Total Bid: JA 4 sJJ1NA =6T, 111161154JUR • •• :• , :. 1�• ••r Ae CITY OF LAKE ELSINORE CIP Project No. Z10010 The undersigned agrees to enter into and execute a contract, with necessary bonds, at the unit prices set forth herein and in case of default in executing such contract, with necessary bonds, the check or bond accompanying this bid and the money payable thereon shall be forfeited thereby to and remain the property of the City of Lake Elsinore. The above unit prices include all work appurtenant to the various items as outlined in the Specifications and all work or expense required for the satisfactory completion of said items. In case of discrepancies between unit prices and totals, the unit prices shall govern. The undersigned declares that it has carefully examined the Plans, Specifications, and Contract Documents, and has investigated the site of the work and is familiar with the conditions thereon. Date: —2 12- — ( 4 Contractor's State License No.: -7 Class: By: — 33og Department of Industrial Relations Registration No: Registration Date: 5- — (� �— 13 Address: 6) 1 °1 ]dreg Phone: FAX: (f -q Contractor /00 00 0 y Expiration Date: 6 3 o 5r'. W.1- 3 (o Z m'7 CITY OF LAKE ELSINORE CIP Project No. Z10010 ACKNOWLEDGMENT OF A012ENDA RECEIVED SB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 The Bidder shall acknowledge the receipt of addenda by placing an "X" by each addendum received. Addendum No. 1 Addendum No. 2 Addendum No. 3 Addendum No. 4 If an addendum or addenda have been issued by the City and not noted above as being received by the Bidder, the Bid Proposal may be rejected. Print Name C -10 Date 0•! Title NON - COLLUSION AFFIDAVIT SB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 STATE OF CALIFORNIA ) SS COUNTY OF ORANGE ) (NAME) Bill Goshen, Jr. affiant being first duly sworn, deposes and says: That he or she is Vice President CITYOF LAKE ELSINORE CIP Project No. Z10010 (sole owner, partner or other proper title) of Black Rock Construction Company 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 associations, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham Bid. (Public Contract Code Section 7106) Address: 929 Mariner St., Brea, CA 92821 Telephone No. (T 14) 632 -3000 Print Name: Bill Goshen, Jr. Signature: Title: Vice Date: July 11, 2018 SIGNING INSTRUCTIONS T© THE CONTRACTOR Non - Collusion Affidavit must be accompanied by notary certificates for signature. Note the description of the document on the notary certificate. Attach notary certificate C -11 immediately followina this pane. If the Bidder fails to properly sign or omits the required signature, the bid will be considered non - responsive and will be rejected. C -12 x..3102 i:101: CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Orange } On JUL 1 1 2018 before me, Beata A. Sensi, Notary Public , ere insert name ana tine of the6fcer) personally appeared Bill Goshen, Jr. who proved to me on the basis of satisfactory evidence to be the persons} whose name(s) is/efe subscribed to the within instrument and acknowledged to me that hefshefthep executed the same in histlie,ttt ei, authorized capacityhes), and that by his heFAhei signatures) on the instrument the person(s), or the entity upon behalf of which the person(&) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. BEA I A SENSI Notary Public - California 7 n Orange County WITNESS my hand and official seal. �; 'r`� Commission g2222034 My Comm. Expires Dec 14, 2021 No cr tic Signature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT /ion- Co / /u3.`en (Title or description of attached document) Black Rock Construction Company (Title or description of attached document continued) of Pages Document Date-7 Zll l 8 CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) 0 Corporate Officer Vice President (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other 2015 Version www.NotaryClasses.com 800 - 873 -9865 INSTRUCTIONS FOR COMPLETING THIS FORM This farm complies with current California statutes regarding notary wording and, if needed, should be completed and attached to the document. Acknolwedgents from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public) • Print the name(s) of document signer(s) who personally appear at the time of notarization • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e he /she /*ey, is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document Indicate title or type of attached document, number of pages and date Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i e. CEO, CFO, Secretary). • Securely attach this document to the signed document with a staple. CITY OF LAKE ELSINORE CIP Project No. Z10010 BOND NO. N/A SB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 KNOW ALL MEN OR WOMEN BY THESE PRESENTS: That we Black Rock Construction Company , as PRINCIPAL, hereinafter referred to as "Contractor ", and Philadelphia Indemnity Insurance Company a duly authorized corporate as "Surety," are held and firmly bound unto the City of Lake Elsinore in the penal sum of TEN PERCENT (10 %) OF THE TOTAL AMOUNT OF THE BID of the Contractor above named, submitted by said Contractor to the City of Lake Elsinore for the work for said project entitled above, for the payment of which sum in lawful money of the United States, well and truly to be made, to the City of Lake Elsinore to which said bid was submitted, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. In no case shall the liability of the surety hereunder exceed the amount of Ten Percent of the Bid Arrlount (10% of Bid) THE CONDITION OF THIS OBLIGATION IS SUCH: That whereas the Contractor has submitted the above - mentioned Bid to the City of Lake Elsinore as aforesaid for the work for said project entitled above. NOW, THEREFORE, if the aforesaid Contractor is awarded the Contract and, within the time and manner required under the Contract documents, after the prescribed forms are presented to him or her for signature, enters into a written Agreement in the prescribed form and in accordance with the Contract documents, and files two bonds with the City of Lake Elsinore, one to guarantee faithful performance and the other to guarantee payment for labor and materials, in accordance with said Contract documents, and as required by law, and files the required insurance certificate(s) in accordance with said Contract documents, then this obligation shall be null and void; otherwise, it shall be and remain in full force and effect until execution of the Agreement or forfeiture pursuant to the Provisions of Sections 20172 and 20174 of the Public Contract Code. In the event suit is brought upon this bond by the City and judgment is recovered, the Surety shall pay all costs incurred by the City in such suit, including a reasonable attorney fee to be fixed by the court. (SIGNATURE PAGE FOLLOWS) C -13 CITY OF LAKE ELSINORE CIP Project No. Z10010 BIUDER'S BOND SIGNATURE PAGE SIB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 IN WITNESS WHEREOF, we have hereunto set our hands and seals on this 11th day of July , 2018 BIDDER: CORPORATE SURETY: Contractor Name: Black Rock Construction Company Company Name: Philadelphia Indemnity Insurance Company Address: 929 Mariner St. Address: 251 S. Lake Ave., Suite 360 Brea, CA 92821 Pasadena, CA 91101 Telephone No.: (714) 632 -3000 Telephone No.: (626) 639 -1320 Print Name: Bill Goshen, Jr. Print Name: Shane Wolf Title: Vice President Title: Attorney -in -Fact Signature: Signature: Date: July 11, 2018// Date: July 11, 2018 SIGNING INSTRUCTIONS TO THE CONTRACTOR Bidder's Bond must be accompanied by notary certificates for EACH signature. Note the description of the document on the notary certificate. Attach BOTH notary certificates immediately following this page. Corporate Seal may be affixed hereto. The attorney -in -fact for corporate surety must be registered, as such, in at least one county in the State of California. Attach one original Power of Attorney immediately following the notary certificates. If the Bidder fails to properly sign or omits the required signatures, the bid will be considered non - responsive and will be rejected. C -14 ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Orange } On JUL 11 2018 before me, Beata A. Sensi, Notary Public (Here art name ana an a of me oar) personally appeared Bill Goshen, Jr_ who proved to me on the basis of satisfactory evidence to be the persons} whose name(s) is/af:e subscribed to the within instrument and acknowledged to me that he/sheithey executed the same in his/l imitheii authorized capacity(ies), and that by his/heFftel signature* on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. BEATAA SENSI ,r NotaryPublic- California Orange County WITNESS my hand and official seal. y,i Commission # 2222034 My Comm Expires Dec 14, 2021 Nota P is Signature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) Black Rock Construction Company (Title or description of attached document continued) of Pages •2 Document Date ,+ r► / a CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) El Corporate Officer Vice President (Title) F1 Partner(s) ❑ Attorney -in -Fact F-] Trustee(s) Other 2015 Version www NotaryClasses.com 800 - 873 -9865 9 INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, if needed, should be completed and attached to the document Acknolwedgenls from other stales may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public) • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e lie /she /they- is /are ) or circling the correct forms Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible Impression must not cover text or lines If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document Indicate title or type of attached document, number of pages and date Indicate the capacity claimed by the signer If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document with a staple. ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Oran On July 11, 2018 before me, Susan E. Morales, Notary Public_ Here insert name and title of trie ollicer personally appeared Shane Wolf who proved to me on the basis of satisfactory evidence to be the persons) whose nameH isltee subscribed to the within instrument and acknowledged to me that hem executed the same in his/tier/t' eii authorized capacity(fes), and that by hist"trrertheir signatureH on the instrument the person(s), or the entity upon behalf of which the person(-) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. SUSAN E= PAORA,I..E:a WITNESS my hand and official seal. ' � � � it ,r � . ,�. 140 illR Y P118{.IC - rALIFUiililh it CRANGE C C UN 1Y ~` Comm. I Xpires fAmch 28, 2.010. Notary Public Signature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT Bid Bond (Title or description of attached document) _Philadelphia Indemnity Insurance Co. (Title or description of attached document continued) Number of Pages 2 Document Date 7/11/18 CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) El Attorney -in -Fact ❑ Trustee(s) ❑ Other 2015 Version www NotaryClasses.com 800 - 873 -9865 INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, if needed, should be completed and attached to the document. Acknolwedgents from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public) • Print the names) of document signer(s) who personally appear at the time of notarization • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he /she /they, is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording • The notary seal impression must be clear and photographically reproducible Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document Indicate title or type of attached document, number of pages and date Indicate the capacity claimed by the signer If the claimed capacity is a corporate officer, indicate the title (i e CEO, CFO, Secretary) • Securely attach this document to the signed document with a staple. Bid Bond PHILADELPHIA INDEMNITY INSURANCE COMPANY 231 St. Asaph's Rd., Suite 100 Bala Cynwyd, PA 19004 -0950 Power or Attorney KNOW AI.I. PERSONS BY TIIESE PRESENTS: That PHILADELPHIA INDEMNITY INSURANCE COMPANY (the Company), a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint 'Todd M. Rohm, Shane Wolr, Cheryl L. Thomas and Beata A. Sensi of Rohm Insurance Agency, its true and lawful Attorney-in-fact with full authority to execute on its behalf bonds, undertakings, recognizences and other contracts of indemnity and writings obligatory in the nature thereof, issued in the course of its business and to bind the Company thereby, in an amount not to exceed 525,000,000.00, This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority ofthe following Resolution adopted by the Board of➢ircctors of PI[ILADELP[ILA INDEMNITY INSURANCE COMPANY at a meeting duly called the 1" day ofluly, 2011 RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the Company to: (L) Appoint Attorney(s) in Fact and authorize the Attorney(s) in Fact to execute on behalf of the Company bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof and to attach the seal of the Company thereto; and (2) to remove, at any time, any such Attomey -in -Fact and revoke the authority given. And, he it FURTHER RESOLVED: That the signatures of such officers and the seal of the Company may be affixed to any such Power of Attomey or certificate relating thereto by facsimile, and any such Power of Attorney so executed and certified by facsimile signatures and facsimile seal shall be valid and biding upon the Company in the future with the respect to any bond or undertaking to which it is attached. IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED111IS INSTRUME.iNF'n) BF SIGNED AND ITS CORPORATE SEAL'IO BE AFFIJ`'ED BY US AUTHORIZED OFFICE THIS 10"' DAY OF JUNE 2013. 1I i�•J} ` "tr � 2i ; (Seal) Robert I). O'Leary Jr., President & CEO Philadelphia Indemnity Insurance Company On this 10°i day of June 2013, before me carne the individual who executed the preceding instrument, to me personally known, and being by me duly s-wom said that he is the therein described and authorized officer ofthe PHILADELPHLA, INDEMNITY INSURANCE COMPANY; that the seal affixed W said instrument is the Corporate seal ofsaid Company, that the said Corporate Seal and his signature were duly affixed. w memo 6" raa tap x gnpo 1. m++ro nex urJMrwn'r+g alrpq�MM1�'cr*r t+u. iii pus _ rru. ire wm (Notary Seal) Notary Public: 64�a residing at: Bala Cynwyd. PA My commission expires: December 18 -2016 I, Edward Sayago, Corporate Secretary of PHILADF..LPIIIA INDEMNITY INSURANCE COMPANY, do herby certify that the foregoing resolution ofthe Board of Directors and this Power of Attomey issued pursuant thereto on this IOrn day of June 2013 true and correct and are still in full force and effect. I do further certify that Robert f) O'Leary Jr., who executed the Power of Attorney as President, was on the date of execution of the attached Power of Attorney the duly elected President of PHILADELPHIA INDEMNITY INSURANCE COMPANY, In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this 11th day of J Uly 20 18 (_7 i 927 # Edward Sayago, Corporate Secretary PHILADELPHIA INDEMNITY INSURANCE COMPANY CITY OF LAKE ELSINORE CIP Project No. Z10010 LIST OF SUBCONTRACTORS SIB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 The bidder is required to fill in the following blanks in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Chapter 2 of Division 5, Title 1 of the Government Code of the State of California) and should familiarize itself with Sections 2 -3 of the Standard Specifications. Name Under Which Subcontractor is Licensed: cv, License Number: 43 t? 3 6 0 Address of Office, Mill or Shop: 2,25c> k5 61 &O A 5 , �.a ��•., Ct, 1$O Specific Description of Sub - Contract: and Bid Items of Work:_��_� ra f ii Name Under Which Subcontractor is Licensed: s c � &Ge License Number: '31 -1 5- Address of Office, Mill or Shop: I/S' zE Specific Description of Sub - Contract: and Bid Items of Work /" 1� 7, Z V . Z q Name Under Which Subcontractor is Licensed: r License Number:y Address of Office, Mill or Shop:_ /V I Specific Description of Sub - Contract: and Bid Items of Work: — Name Under Which Subcontractor is Licensed: &Z/L"' AL'_' I License Number: y (c3 C Address of Office, Mill or Shop: r 2Z y 1Z r' _ c 7 �r (/C lIel C� Specific Description of Sub - Contract: and Bid Items of Work: Subcontractors listed in accordance with the provisions of Section 2 -3 must be properly licensed under the laws of the State of California for the type of work that they are to perform. Do not list alternate subcontractors for the same work. C -15 CITY OF LAKE ELSINORE CIP Project No. Z10010 REFERENCES SB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 Failure to demonstrate adequate experience may result in rejection of the bid. For all public agency projects with a similar scope of work which you have worked on (or are currently working on) in the past three (3) years, provide the following required information: 1. Name (Firm /Agency) G�� y Z-t4 1Ab^°., Address Project Title Ally Project Location C Type of Work kL - Project Manager Contact Phone Dated Completed 3-31-17 Contract Amount 2. Name (Firm /Agency) C4' ('. 144", Address 1411 Ly 1'y-e 'ovce-w 3 Project Title Project Location Type of Work A 1- 12- Gan&rr o t Project Manager Contact c Phone_ Dated Completed _1- �/ 7 Contract Amount Z vw, 3. Name (Firm /Agency) Address Project Title 411 irf fb _ Project Location Type of Work ,Z +-1, Cane -"ee Project Manager Contact Dated Completed 3- 31 - lbw Phone Contract Amount i', loo ) o,ft AlIL', CITY OF LAKE ELSINORE CIP Project No. Z10010 List any other projects (private, older than three (3) years, etc.) that may represent qualifying or similar experience: 4. Name (Firm /Agency) 6-14�y 4 Address - Project Title Project Location Type of Work d- CY- i C Project Manager Contact _ Phone Dated Completed Y-15-14 Contract Amount 9 75, oao 5. Name (Firm /Agency) G`' c0e- wti e sLAw -c Address Project Title S ��.wwt l� Sicc Project Location rnJG. t-j e Type of Work _ I�tR �,,✓IGrZdr Project Manager Contact Phone /� Dated Completed =r - / - / 7 Contract Amount Z5-,.v� A Name (Firm /Agency) Address - Project Title Project Location Type of Work Project Manager Contact Dated Completed._ _ Phone Contract Amount C -17 CITY OF LAKE ELSINORE CIP Project No. Z10010 SB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 Contractor's License No.: 1 Y 33 0 g Class: _ a. Date first obtained: z -1 o Expiration b. Has License ever been suspended or revoked? l( lb If yes, describe when and why: c. Any current claims against License or Bond? o If yes, describe claims: Principals in Company (List all — attach additional sheets if necessary): 6a C�1r or Cod �.Ll-�►'1 TITLE C -18 LICENSE NO. (If Applicable) CITY OF LAKE ELSINORE CIP Project No. Z10010 SB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 Has your firm or its officers been assessed any penalties by an agency for noncompliance or violations of Federal, State or Local labor laws and /or business or licensing regulations within the past five (5) years relating to your construction projects? YES / NC (circle one) Federal / State / Local (circle one) If "YES," identify and describe, (including agency and status): Have the penalties been paid? YES / NO (circle one) 2. Does your firm or its officers have any ongoing investigations by any public agency regarding violations of the State Labor Code, California Business and Professions Code or State Licensing Laws? YES /' (circle one) Code /Laws: Section /Article: If "yes," identify and describe, (including agency and status): Si nature Date Print Name Title (9 a G Contractor Name C -19 CITY OF LAKE ELSINORE CIP Project No. Z10010 QISQUALIFI!ATIQN QR DEBARMENT SB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 Has your firm, any officer of your firm, or any employee who has a proprietary interest in your firm ever been disqualified, removed, or otherwise prevented from bidding on, performing work on, or completing a federal, state or local project because of a violation of law or a safety regulation? YES / 00 (circle one) If yes, provide the following information (if more than once, use separate sheets): Date: Location: Reason: Entity: Provide Status and any Supplemental Statement: Has your firm been reinstated by this entity? YES / NO (circle one) Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signaturq,of this Certification. 4�� 4::�� 2,,-( 2- Signature Date 6 "SL' o — T2 Print Name Title C -20 6l( < e, le- , Cis i. Contractor Name If the Bidder fails to properly sign or omits the required signature, the bid will be considered non - responsive and will be rejected. UTILITY AGREEMENT SB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 HONORABLE MAYOR AND CITY COUNCIL CITY OF LAKE ELSINORE, CALIFORNIA The undersigned hereby promises and agrees that in the performance of the work specified in this contract for Project No. Z10010 Cultural Center Parking Lot Improvements, (1) (we) (it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary, primary or transmission facilities. The term "Qualified person" is defined in Title 8, California Administrative code, Section 2700, as follows: Qualified Person: A person who by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved." The undersigned also promises and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Sgnat By: 6�5 Name v +/0 Title 44 (- �_ Contractor Name C -21 PUBLIC CONTRACT CODE SB 821 LAKESHORE DRIVE CURB, GUTTER AND SIDEWALK PROJECT CIP PROJECT NO. Z10010 Public Contract Code Section 10285.1 Statement In accordance with Public Contract Code Section 10285.1 (Chapter 376, State. 1985), the bidder hereby declares under penalt of perjury under the laws of the State of California that the bidder has , has not been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute - signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Public Contract Code Section 10162 Questionnaire In accordance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire: Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation: Yes NO-)( If the answer is yes, explain the circumstances in the following space. Public Contract Code 10232 Statement In accordance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediate preceding two -year period because of the Contractor's failure to comply with an order of federal court which orders the Contractor to comply with an order of the National Labor Relations Board. Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. 7 --(2 - -(u Signatdre C -22 Date Print Name Title �- Contractor Name C -23