HomeMy WebLinkAboutCAMINO PROPOSAL DOC CITY OF LAKE ELSINORE
CIP Project No. Z10030
SECTION C
BID DOCUMENTS
B-6
CITY OF LAKE ELSINORE
CIP Project No. Z10030
BIDDER'S PROPOSAL
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
Company: ANEEN CONSTRUCTION,INC.
Honorable Mayor, Members of the Council:
In accordance with the Notice Inviting Bids pertaining to the receiving of bid proposals by 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: Thirty-Five (35) Working Days from Issuance of Notice to Proceed
(NTP) by City to Contractor.
BID SCHEDULE A
ITEM UNIT TOTAL
NO. DESCRIPTION UNIT QTY COST COST
1 MOBILIZATION, DEMOBILIZATION AND CLEANUP LS 1 20,000 20,000
2 CLEARING AND GRUBBING LS 1 1 10,000 10,000
3 TRAFFIC CONTROL LS 1 10,000 10,000
4 DUST ABATEMENT LS 1 5,000 5,000
5 K-RAIL REMOVAL COORDINATION L1 1 1.00 1.00
6 DELINEATOR REMOVAL EA 52 61.00 3,172.00
7 MIDWEST GUARDRAIL SYSTEM-TYPE 11B STEEL POST LF 1948 53.50 104,218
8 MIDWEST GUARDRAIL SYSTEM-TYPE 11E STEEL POST LF 136 62.00 8,432.00
9 GUARD RAILING DELINEATOR EA 102 20.00 2,040.00
10 END TERMINAL SYSTEM SRT M10 EA 9 5,403 48,627
11 BACKFILL AC DIKE 4' WIDE MIN. AND COMPACT SOIL TO 90% SF 8200 5.00 41,000
TOTAL BID PRICE 252,490.00
TOTAL BID PRICE BASED ON BID SCHEDULE TOTAL OF UNIT PRICES FOR
CAMINO DEL NORTE GUARDRAIL PROJECT Z10030
252,490.00
Total Bid Price in Numbers
$ two hundred fifty two thousand,four hundred ninety dollars and zero cents
Total Bid Price in Written Form
In case of discrepancy between the written price and the numerical price, the written price
shall prevail.
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.
All work described on the plans and in the specifications and other incidentals necessary to complete the project shall be paid under
items above. No additional payments will be allowed.
*BID MAY BE REJECTED IF TOTAL IS NOT SHOWN FOR BOTH FIGURES AND WORDS.
C-7
CITY OF LAKE ELSINORE
CIP Project No. Z10030
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.
ANEEN CONSTRUCTION,INC.
Contractor
Date: MARCH-22-2022 By: TAMER KHALIL
Contractor's State License No.: 1004775
Class: CLASS A
Department of Industrial Relations Registration No: 1000033880
Registration Date: DEC-30-2020 Expiration Date: JUN-30-2022
Address: 9860 INDIANA AVE.#18 RIVERSIDE,CA92503
Phone: 909-913-3024
FAX:
C-8
CITY OF LAKE ELSINORE
CIP Project No. Z10030
ACKNOWLEDGMENT OF ADDENDA RECEIVED
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
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.
MARCH-22-2022
Bidder's Signature Date
TAMER KHALIL PRESIDENT
Print Name Title
C-9
CITY OF LAKE ELSINORE
CIP Project No. Z10030
NON-COLLUSION AFFIDAVIT
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO.Z10030
STATE OF CALIFORNIA )
COUNTY OF ) SS
(NAME) TAMER KHALIL
affiant being first duly sworn, deposes and says:
That he or she is PRESIDENT of
(sole owner, partner or other proper title)
ANEEN CONSTRUCTION,INC. 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: 98601NDIANAAVE.#18 RIVERSIDE,CA92503
Telephone No.: 909-913-3024
Print Name: TA ER KHALIL
Signature:
1,
Title: PRESIDENT Date: MARCH#2022
SIGNING INSTRUCTIONS TO 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
immediately following this page If the Bidder fails to properly sign or omits the required
signature, the bid will be considered non-responsive and will be rejected.
C-10
CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT
cexowieocucxreanowuocrnexrncrcxawi_. ocmexrecxnowieocme—rcxowu. axowieocwexruxxow r,u:.
A notary public or other officer completing this certificate verifies only the identity of
the individual who signed the document to which this certificate is attached,and not
the truthfulness,accuracy,or validity of that document.
State of Calif
County of )
i
✓— E
On before me, � �
V� ` �
��---- (here insert name a title o the fficer) R
personally appeared
who proved to me on the basis of satisfactory evidence to be the perso s whose name(s) is/are subscribed to
the within instrument and acknowledged to me that he/she/they execute the same in -bisLaer/their
authorized capacit ies _ that by his/her/their signature(s on the instrument thenerson(s), or the entity _
upon behalf of which the erson s)act^ec—�ecuted t e Instrument.
I certify under PENALTY OF PERJURY under the laws of the
State of California that the foregoing paragraph is true and correct.
R
K. DUNN
COMM. #2290617 zz
WITNESS my and and official seal. o Notary Public•California o
z '` Riverside County
N` M Comm.Ex Tres June 24,onoq
Signature
(Seal)
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Optional Information
Although the information in this section is not required by law,it could prevent fraudulent removal and reattachment of this acknowledgment to an
unauthorized document and may prove useful to persons relying on the attached document.
Description of Attached Document Additional Information
The preceding Certificate of Acknowledgment is attached to a document Method of Signer Identification
titled/for the purpose of Proved to me on the basis of satisfactory evidence:
0 form(s)of identification 0 credible witness(es)
Notarial event is detailed in notary journal on:
containing pages,and dated Page# Entry#
The signer(s) capacity or authority is/are as: Notary contact:
❑ Individual(s) Other
❑ Attorney-in-Fact ❑ Additional Signer(s) ❑ Signer(s)Thumbprint(s)
❑ Corporate Officer(s)
Title(s) ❑
❑ Guardian/Conservator
❑ Partner-Limited/General
❑ Trustee(s)
❑ Other:
representing:
Name(s)of Person(s)or Entlty(ies)Signer is Representing
0 Copyright 2007-2018 Notary Rotary,PO Box 41400,Des Moines,IA 50311-050T All Rights Reserved. Item Number 101772. Please contact your Authorized Reseller to purchase copies of this form.
CITY OF LAKE ELSINORE
CIP Project No. Z10030
BOND NO. N/A
BIDDER'S BOND
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
KNOW ALL MEN OR WOMEN BY THESE PRESENTS:
That we Aneen Construction Inc. as PRINCIPAL,
hereinafter referred to as"Contractor", and American Contractors Indemnity 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(10%)of the Total Amount of the 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-1 1
CITY OF LAKE ELSINORE
CIP Project No. Z10030
BIDDER'S BOND SIGNATURE PAGE
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO.Z10030
IN WITNESS WHEREOF, we have hereunto set our hands and seals on
this 22nd day of March 20 22
BIDDER: CORPORATE SURETY:
Contractor Name: Aneen Construction. Inc. Company Name: American Contractors Indemnity Company
Address: 9860 Indiana Ave. #18 Address: 801 S. Figueroa St.. Suite 700
Riverside QA 22503 _Los Angeles CA 9n017
Telephone No.: (909)913-3024 Telephone No.: (310)649-0990
Print Name: 7 A Wl.b IZ ILt4.A l,l Print Name: Patricia Zenizo
Title: 17 U, I— Title. Attorney-in-Fact
Signature: Signature:
Date: 1A 6M-Gtf f a• 2 a'L-2-- Date: March 22.2022
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-12
CITY OF LAKE ELSINORE
CIP Project No.Z10030
BIDDER'S BOND SIGNATURE PAGE
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
IN WITNESS WHEREOF, we have hereunto set our hands and seals on
this 22nd day of March 20 22
61DDER: CORPORATE SURETY:
Contractor Name: Aneen Construction, Inc. Company Name: American Contractors Indemnity Company
Address: 9860 Indiana Ave. #18 Address: 801 S. Figueroa St., Suite 700
-Riverside. A 925n.1 Ins Angeles CA 90017
Telephone No.: (909) 913-3024 Telephone No.: (310)649-0990
Print Name: 1 A Wlb D 1L.t+4 Print Name: Patricia Zenizo
Title: Qt`^�i t1E t Title: Attorney-in-Fact
Signature: Signature:
Date: IA ML44 Date: March 22,2022
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-12
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
CIVIL CODE§ 1189
Epublic or other officer completing this certificate verifies only the identity of the individual who signed thet to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California )
County of_ Los Angeles )
On MAR 2 2 2022 before me, Elisabete Salazar Notary Public
Date Here Insert Name and Title of the Officer
personally appeared Patricia Zenizo
Name(s)of Signer(s)
who proved to me on the basis of satisfactoryevidence to be the person(g) whose name() is/a'i6
subscribed to the within instrument and acknowledged to me that */she/tfidy executed the same in
tft/her/tfYfr authorized capacityoes),and that by WS/her/t)', r signature(p)on the instrument the person(p),
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.
ELIS0:1il -C.0"My
Lary P bli SAZRWITNESS m hand and official seal.
Notary Public California yLos Angeles County
Commission#2342511
Comm.Expires Jan 19,2025 Signature
i lure gff Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: Document Date:
Number of Pages: Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: ___ Signer's Name:
Corporate Officer — Title(s): [7,Corporate Officer — Title(s):
- Partner — Limited General C Partner — I Limited i_ !General
Individual ! Attorney in Fact ❑ Individual Attorney in Fact
Trustee Guardian or Conservator ❑Trustee i Guardian or Conservator
Other: ❑ Other: -__--
Signer Is Representing: Signer Is Representing:
n•
C2014 National Notary Association • www,NationaiNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907
or
KIOAAARINE
CC
00
POWER OF ATTORNEY
AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY
UNITED STATES SURETY COMPANY U.S.SPECIALTY INSURANCE COMPANY
KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company, a California corporation, Texas Bonding
Company, an assumed name of American Contractors Indemnity Company, United States Surety Company, a M aryland corporation
and U.S. Specialty Insurance Company, a Texas corporation (collectively, the "Companies"), do by these presents make, constitute
and appoint:
PATRICIA ZENIZO, PIETRO MICCICHE, ELISABETE SALAZAR of GLENDALE, CALIFORNIA
its true and lawful Attomey(s)-in-fact, each in their separate capacity if more than one is named above, with full power and authonty
hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances,
undertakings or other instruments or contracts of suretyship to include riders, amendments, and consents of surety,
providing the bond penalty does not exceed
""Five Million""'
This Power of Attorney shall expire lars
without further action on April 23rd,2022.This Power of Attomey is granted
under and by authority of the following rrASOILltions adopted by the Boards of Directors of the Companies.,
Be it Resolved,that the President,any Vice-President,any Assistant Vice-President,any Secretary or any Assistant Secretary shall be and is hereby
vested with full power and authority to appoint any one or more suitable persons as Attomey(s)-in-Fact to represent and act for and on behalf of the
Company subject to the following provisions:
Attomey-in-Fact may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and deliver,any
and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents
for the release of retained percentages and/or final estimates on engineering and construction contracts,and any and all notices and documents
canceling or terminating the Company's liability thereunder,and any such instruments so executed by any such Attorney-in-Fact shall be binding upon
the Company as if signed by the President and sealed and effected by the Corporate Secretary.
Be It Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any
certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding
upon the Company with respect to any bond or undertaking to which it is attached.
IN WITNESS WHEREOF,The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this
1s'day of June. 2018.
AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING OMPANY
UNITED STATES SURETY CW4,13ANY U.S.SPECIALTY INSURANCE COMPANY
y -.1H
State of California i4 �� L 4Pty l`
-'�
County of Los Angeles
,1''aM1[1FOPM\voc F ie ter£ ' ` S By:
of Daniel P.Aguilar,Vice President
A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to
which this certificate is attached and not the truthfulness accuracy,or validity of that document
On this I"day of June,2018,before me,Sonia O.Carrejo,a notary public,personally appeared Daniel P.Aguilar,Vice President of
American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S. Specialty Insurance
Company who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument
and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument
the person,or the 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.
WITNESS my hand and official seal. "AO uAnuo
N.Wy%btk C.41 4 t
• Commhuon I I3H979
Signature (seal) Mrcomm.c.ml..m»,:0:1
I, Kio Lo, Assistant Secretary American Contractors Indemnity Company, Texas Bonding Company, United States Surety
Company and U.S.Specialty Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power
of Attorney,executed by said Companies,which is still in full force and effect; furthermore,the resolutions of the Boards of Directors,
set out in the Power of Attorney are in full force and effect.
In Witne s Whereof, I have hereunto set mXX hand and affixed the seals of said Companies at Los Angeles, California this
day of Whereof,
CCk _C _
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g SUREX e••av
Corporate Seals �''. "�.'°AG�0,••'� ..:o;:� ter,: .`..n ��F/ \ok
Bond No.
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Agency No. 3057 '��; „ �M � P9 �'* ` ••S••• Kio Lo, Assi t Secretary
ylf OFw•h,,,.r �'ly'Innn+`^ '�'nlun a\\\a\\O\�j
HCCSMANP0A062018
visit tmhcc.corn/surety for more information
CITY OF LAKE ELSINORE
CIP Project No. Z10030
LIST OF SUBCONTRACTORS
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO.Z10030
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: ALCORN FENCE COMPANY
DIR NO.1000001986
License Number: 122954 EXP.FEB-28-2022
Address of Office, MITI or Shop: 6445 PEDLEY ROAD,RIVERSIDE,CA92509
Specific Description of Sub-Contract: and Bid Items of Work: GUARDRAIL,LINE ITEMS 7-10
Name Under Which Subcontractor is Licensed:
License Number:
Address of Office, Mill or Shop:
Specific Description of Sub-Contract: and Bid Items of Work
Name Under Which Subcontractor is Licensed:
License Number:
Address of Office, Mill or Shop:
Specific Description of Sub-Contract: and Bid Items of Work:
Name Under Which Subcontractor is Licensed:
License Number:
Address of Office, Mill or Shop:
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-13
CITY OF LAKE ELSINORE
CIP Project No. Z10030
REFERENCES
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
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 two (2)years, provide the following required information:
1. Name (Firm/Agency) CITY OF CORONA PUBLIC WORKS
Address 400 SOUTH VICENTIAAVE.,CORONA,CA,92879
Project Title OVERLOOK
Project Location CITY OF CORONA SOUTH
Type of Work STREET IMPROVEMENT,GURADRAIL,RETAINING WALLS AND GRADING
Project Manager Contact PETER RAMEY Phone 909-855-1720
Dated Completed FEB-2021 Contract Amount 890,000
2. Name (Firm/Agency) CITY OF RIVERSIDE PUBLIC WORKS
Address 3900 MAIN ST,RIVERSIDE,CA,92522
Project Title WILLIAM ST.IMPROVEMENTS
Project Location CITY OF RIVERSIDE
Type of Work STREET IMPROVEMENTS
Project Manager Contact DAVID HATCH Phone 951-288-3633
Dated Completed JUL-2021 Contract Amount 320,00
3. Name (Firm/Agency) CITY OF CORONA
Address 400 SOUTH VICENTIAAVE.,CORONA,CA,92879
Project Title ONTARIO AVE.
Project Location CITY OF CORONA
Type of Work STREET IMPROVEMENT
Project Manager Contact PETER RAMEY Phone 909-855-1720
Dated Completed DEC-2020 Contract Amount 780,000
C-14
CITY OF LAKE ELSINORE
CIP Project No. Z10030
List any other projects (private, older than three (3) years, etc.)that may represent qualifying or
similar experience:
4. Name (Firm/Agency)
Address
Project Title
Project Location
Type of Work
Project Manager Contact Phone
Dated Completed Contract Amount
5. Name (Firm/Agency)
Address
Project Title
Project Location
Type of Work
Project Manager Contact Phone
Dated Completed Contract Amount
6. Name (Firm/Agency)
Address
Project Title
Project Location
Type of Work
Project Manager Contact Phone
Dated Completed Contract Amount
C-15
CITY OF LAKE ELSINORE
CIP Project No. Z10030
CONTRACTOR INFORMATION
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO.Z10030
Contractor's License No.: 100475 Class: CLASS A
a. Date first obtained: JUN-26-2015 Expiration JUN-30-2023
b. Has Bidder's License ever been suspended or revoked? NO
If yes, describe when and why:
c. Any current claims against License or Bond? NO
If yes, describe claims:
Principals in Company Aist all—attach additional sheets if necessary):
NAME TITLE LICENSE NO.
(If Applicable)
TAMER KHALIL PRESIDENT
C-16
CITY OF LAKE ELSINORE
CIP Project No. Z10030
VIOLATIONS OF FEDERAL, STATE OR LOCAL LAWS
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO.Z10030
1. 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 / NO (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 0
(circle one)
Code/Laws:
Section/Article:
If"yes," identify and describe, (including agency and status):
3. Has Bidder been "default terminated" by an owner (other than for convenience), or has a
Surety completed a contract for Bidder within the last five (5) years?
YES QNOa�, (circle one)
If"yese explain:
4. Has Bidder been cited more than twice for failure to pay prevailing wages in the last five (5)
years?
YES NO (circle one)
If"yes," ase explain:
C-17
CITY OF LAKE ELSINORE
CIP Project No. Z10030
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 signature of this Certification.
i
MARCH-22-2022
Signature Date
TAMER KHALIL PRESIDENT
Print Name Title
ANEEN CONSTRUCTION,INC.
Contractor Name
C-18
CITY OF LAKE ELSINORE
CIP Project No. Z10030
DISQUALIFICATION OR DEBARMENT
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO.Z10030
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 / NO (circle one)
If yes, provide the following information (if more than once, use separate sheets):
Date: Entity:
Location:
Reason:
Provide Status and any Supplemental Statement:
Has your firm been reinstated by this entity?
YES 0
(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 signature of this Certification.
MARCH-22-2022
- Ivy
Signature Date
TAMER KHALIL PRESIDENT
Print Name Title
ANEEN CONSTRUCTION,INC.
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.
C-19
CITY OF LAKE ELSINORE
CIP Project No. Z10030
UTILITY AGREEMENT
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO.Z10030
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. Z10030, CAMINO DEL NORTE GUARDRAIL PROJECT, (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.
Signature i
By: TAMER KHALIL
Name
PRESIDENT
Title
ANEEN CONSTRUCTION,INC.
Contractor Name
C-20
CITY OF LAKE ELSINORE
CIP Project No. Z10030
PUBLIC CONTRACT CODE
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO.Z10030
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 penalty of perjury under the laws of the State of California that the bidder has
, has not X 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 X
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;fialse certification may subject the certifier to criminal prosecution.
MARCH-22-2022
Signature U Date PRESIDENT
TAMER KHALIL
Print Name Title
ANEEN CONSTRUCTION,INC.
Contractor Name
C-21