HomeMy WebLinkAboutAneen Construction PWCA Camino Del Norte Guardrail Project 04-12-2022DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
Agreement No.
AGREEMENT FOR PUBLIC WORKS CONSTRUCTION
Aneen Construction, Inc.
Forthe
Camino Del Norte
Guardrail Project
CIP PROJECT NO. Z10030
This Agreement for Public Works Construction ("Agreement") is made and entered into as
of April 12, 2022 by and between the City of Lake Elsinore, a municipal corporation ("City") and
Aneen Construction Inc. a Corporation ("Contractor").
The City and Contractor, in consideration 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:
Camino Del Norte Guardrail Prosect (the "Project")
The City -approved plans for the construction of the Project, which are incorporated
herein by reference and prepared by the City of Lake Elsinore, are identified as:
Camino Del Norte Guardrail Plans
The Project Documents include this Agreement and all of the following: (1) the Notice
Inviting Bids, Instructions to Bidders, Bid Documents including Bidder's Proposal as submitted
by the Contractor, Contract Documents, General Specifications, Special Provisions, and all
attachments and appendices; (2) everything referenced in such documents, 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 two -hundred fifty two thousand, four
hundred -ninety dollars ($252,490.00).
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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.
C. Contractor agrees to receive and accept the prices set forth in the Bidder's
Proposal as 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 prior to 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 perform and complete all work within Thirty -Five (35)
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 Agreement as
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 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 act or 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 omission
preventing 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 be in the amount of Five Hundred
dollars ($500.00) 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.
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4. Changes to 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 claim against the City nor be the basis for a liquidated damage claim
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:
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 City Engineer 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. Contractor shall provide, before commencing work, a Faithful Performance
Bond and a Labor and Material Bond, each for one -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 Agreement nor any rights, title, interest, duties or
obligations under this Agreement may be assigned, transferred, conveyed or otherwise
disposed of by Contractor without the prior written consent of City.
7. Licenses. Contractor represents 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. Contractor represents and warrants to City that Contractor shall, 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 Contractor to 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, the County and Board Supervisors, 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
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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.
9. 1 nsurance 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.
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iv. Builder's Risk Coverage. Prior to the commencement of any
construction of the Project, Design -Builder shall 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).
V. Professional Liability Coverage Contractor shall maintain
professional errors and omissions liability insurance appropriate for Contractor's
profession for protection against claims alleging negligent acts, errors or omissions which
may arise from Contractor's services under this Agreement, whether such services are
provided by the Contractor or by its employees, subcontractors, or sub consultants.
The amount of this insurance shall not be less than one million dollars ($1,000,000)
on a claims -made annual aggregate basis, or a combined single limit per occurrence
basis.
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:
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 elected or 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 deductibles or 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
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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
If to Contractor: Aneen Construction Inc.
Attn: Tamer Khalil
9860 Indiana Ave. # 18
Riverside, Ca 92503
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 in total 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 for 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.
N.
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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 a good 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 Agreement and 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 this Agreement 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 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 City Engineer 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, layoff
ortermination.
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.
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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 paid are 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, Contractor and its subcontractors must furnish
electronic certified payroll records to the Labor Commissioner. Beginning January 1, 2016,
Contractor and its subcontractors must furnish electronic certified payroll records to the Labor
Commissioner without regard to when the 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
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. Execution. This Agreement may be executed in several counterparts, each of
which shall constitute 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]
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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
CONTRACTOR"
insert Contractor name], a [insert entity type]
0—w9gucd by:
Docu5ignvd by:
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4/23/2022 1 6:08 PM PDT
By: Tamer Khalil
Its: President
ATTEST:
FDocuSfgned by:
4/25/2022 1 8:45 AM PDT
I y er By:
APPROVED AS TO FORM
Its:
FZU ftnee by:
1, loa 4/23/2022 1 5:57 PM PDT
Clty Drney
rS
oocusigned by:
V,4/19/2022 1 8:46 AM PDT
Director of Administrative Services
9
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
EXHIBITA
CONTRACTOR'S PROPOSAL
ATTACHED]
DocuSign Envelope ID: OBBCB6BA-D163-4086-A2DB-5296B162005A
CITY OF LAKE ELSINORE
CI Project No. Z10030
SECTION C
BID DOCUMENTS
W.
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Company:
CITY OF LAKE ELSINORE
CIP Project No. 210030
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
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
NO. DESCRIPTION UNIT QTY
UNIT
COST
TOTAL
COST
1 MOBILIZATION, DEMOBILIZATION AND CLEANUP LS 1 20,000 20,000
2 CLEARING AND GRUBBING LS 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 11 B STEEL POST LF 1948 53.50 104,218
8 MIDWEST GUARDRAIL SYSTEM- TYPE 11 E 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% SF8200 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
v
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 REJEQTED IF TOTAL IS NOT SHOWN FOR BOTH FIGURES AND WORDS.
C-7
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CITY OF LAKE ELSINORE
CI 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.
Date:
MARCH -22-2022
By:
Contractor's State License No.. 1004775
Class: CLASS A
Department of Industrial Relations Registration No:
Registration Date:
Address:
Phone:
FAX:
DEC -30-2020
ANEEN CONSTRUCTION, INC.
Contractor
TAMER KHALIL
1000033880
Expiration Date:
9860 INDIANAAVE. #18 RIVERSIDE, CA 92503
909-913-3024
C-8
JUN -30-2022
DocuSign Envelope ID: OBBCB68A-D163-4086-A2DB-5296B162005A
CITY OF LAKE ELSINORE
CIP Project No. Z10030
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.
r
Bidder's Signature
TAMER KHALIL
Print Name
C-9
MARCH -22-2022
Date
PRESIDENT
Title
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
CITY OF LAKE ELSINORE
CIP Project No. Z10030
Me "INGNMEORK-3
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
STATE OF CALIFORNIA )
jCOUNTYOF
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 theBidderhasnotinanymanner, directly or indirectly sought by agreement, communication, or
conference with anyone to rix 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: 9660INDIANAAVE.016 RIVERSIDE, CA 92503
Telephone No.: 909-913-3024
Print (dame: J
TAI)EA KHALIL
Signature:
Title: PRESIDENT
Date: MARCHO 2022
Non -Collusion Affidavit must be accompanied by notary certificates for signature. Note
the description of the document on the notary certificate.
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
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT
A notarydlpublic or other officer completing this certificate verifies only the identity of
the in who sfgned the document to which this certificate is attached, and not
the truthfulness, accuracv. or validity aif that document.
State of Calif I r 'a }
County of117 A
On i/" t'`" before me,
L It
There assert nam a ir, o thr ir+Cer)
personally appeared!/
who proved to me on the basis of satisfactory evidence to be the pej59jjW whose names is/are subscribed to
the within instrument and acknowledged to me that hese/they executer the same in er/their
authorized capacitles that by his/her/their signatures on the instrument the ryeso), or the entity
upon behalf of which the arson s) accr, —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 and and official seal.
Signature
c}sw H. DUNN
COMM. #2290617 zz
Notary Public - California o
Riverside County
t M Ccmm, E : Tres June 24, 2023
Seal)
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
unauthoiized document and may prove useful to persons relying on the attached document
Description of Attached Document
The preceding Certificate of Acknowledgment is attached to a document
titled/for the purpose of
containing pages, and dated
The signer(s) capacity or authority is/are as:
Individual(s)
f Attorney -in -t=act
Corporate Officer(s) 4
l
Guardian/Conservator
Partner- Limited/General
Trustee(s)
wi. Other:
representing: _
Name(;1 ur Pers-(,: ur a (,T r,os1 Sipnei i rte rc.entinq
Method of Signer Identification
Proved to me on the basis of satisfactory evidence:
0, form(s) of identification U credible witness(es)
Notarial event is detailed in notary journal on:
Page # Entry N
Notary contact:
Other
AdditionalSignerb) Signer(s)Thumbprint(s)
l: play ri hi M%1-41 IN N.t,,y Rrn ark P() 41400, DI, MI[.II1.'t IA 01W; All Ri,)hr p-, veli .rani iNon,ho, r.,! y:'1_ Plea,e 7,)nra C: yo Il Authorized Reseller tc, purchase -opic, of rhii fJrr-
DocuSign Envelope ID: OBBCB6BA-D163-4086-A2DB-5296B162005A
CITY OF LIKE ELSINORE
CiP Project No. 210030
BOND N4. NIA
DIQDFR'S BOHh
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
KNOW ALL MEN OR WOMEN BY THESE PRESENTS-
Th'at we Aneen ens ction Inc, as PRINCIPAL.
here nOm teerfed to as "contrador", and -AM i -can Cant ctors Indemnity Company
a duty authorized corporate as "Surety.- are held and firmly bound unto the City of take Elsinore inthepenalsurraofTENPERCENT (10%) OF THE TOTAL AMOUNT OF THE 910 of the Contractor
above nand, 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 tobemade, to the City of Lake Elsinore to which said bid was submitted, we hind ourselves, our heirs,
executors, administrators and successors, joilltiy and severally, rtm)ly 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:
Thai 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 farms 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 pefibrmance 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
Certiffeate{s} in accordance with said Contract docurnents, then this obligation shall be null and
void; Werwise, It small be and remain in full force and effect until execution of the Agreemenl ar
forlehure 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 theCourt.
SIGNATURE PAGE FOLLOWS)i
C-11
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
tW;4;-9.4;Mot ia P.W,:
a DEL NORTEM •;s
C1P PROJECT NO. Z10030
CITY OF LAKE ELSINORE
CIF Project No. 210030
IN WITNESS WHEREOF, we have Hereunto set our Hands and seals on
this 22n -d day of March .2o22
BIDDER,.
CwtnXlor Name: APeen Canstruckn, Inc.
Address: 2§UIndiana 8
Etivers de QA
Telephone No,: i909) 913,30pA_
Print flamc.
Sa r+atdte: -
Date: —t,i A" . tl- 24 -z-"2_
CORPORATE SURETY,
Company Name: American Contractors Indemnity Company
Address: 801_ figuerca St__ Suite 700
1Q
Telephone No.: (3101649-4990
Print Name: Patncia Zengo .---
Tilte' Attorney -in -Fact
Signature:414--
Dale.,Plsr22. 2D2
StQN!NG lsTRUCTIQNS TQ 1141 CONT ACTOR
8idder's Bond must be accompanied by notary certificates for EACH signature. Note the
description of the document on the notary certificate. Attach ROTH notary certl11ca%e5
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 cartificates.
If the Bidder falls to properly sign or omits the required signatures, the bid will be considered
non-responsive and will be rejected.
C-12
DocuSign Envelope ID: OBBCB6BA-D163-4086-A2DB-5296B162005A
CITY OF LAKE ELSINORE
CIP Project No. Z1003
07 :1.i =TiNFOW ICI : 1
CIP PROJECT NO. Z10030
IN WITNESS WHEREOF, we havO hereunto set our hands and seals on
this 22nd day of March
4
Contractor Nance: Aneen Construction, Inc.
Addre-SS: is A 1
Telephow No.: soa)g1.3, Q24
Print Name: _ !1 E 0- I _.1
Title; pace, tir 1, —
Sttatt re:
I
Dai: 11 4 - 7 a z -1--
CORPORATE SURETY:
Company Dame: American Contractors Inderni
Address: 86'1 S--Eiguaron St._ Suite 700
Tetephone Na.; (310) 649-0990
Print Name, Patricia Zenizo
TrHe: Attorney -In -Fad
signature:
Date: rch 22 2022
SIGNIh1GMTRl1CTION5TOTHE CONTRACT013
Bidder's Bond must be accompanied by notary cartlflcates for EACH signature. Note the
description of the document on the notary certificate. Attract BOTH notary certificates
immediately fallowing this page.
Corporate Seel may be affixed Hereto.
The attorney-in-fac# for corporate surety must be registered, as such, in at least ane county
In the State of California. Attach one original Power of Attorney Irnmediatety fottowing the
notary certificates,
If the Bidder fails to properly sign or omits the requ[red signatures, the bid will be considered
non-responsive and will be rejected.
C-12
DocuSign Envelope ID: 0B8CB6BA-D163-4086-AWB-52966162005A
or
CALUF010" ALL-PURMW ACKN0WLgUX=NT CML COBE § 1189
A artery pu6lltD or Other dkw oompieft ft oereiicete venfles only the klerrtity of the Indivlcfual who signed thedomWdtowhichthisoatlliceleisattached, and riot the truthfulness, accu 1 a4y or vaf de y Of that docu w#.
State of California
County of _ Los Anaeies r
On MAR 2 2 L022 before Me._—ELSE to Salazar Nat Public
DatehtM kmt.Abme and Twe of the Offrc r
filly appeared __i'atri is .nizo _
Name(s) of &gner(s)
who proved to me on the basis of satisfactory evidence to be the person($) whose name() Waft¢
subscribed to the within instrument and acknoWkKk d to me that da/shelft executed the same in
t79t h Alyffir authorized capacity(IM). and that by Ws/herWr signature(p) on the instrument the person(g), or the entity upon behalf of which the person(s) acted, executed the Instrument.
EUSABETE WA20
Hptatr Publk - CaRfarnta
LbsAng*W Canary
Comrrdigan 12342511
MX Comm. fgim 31n 19, 2025
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hard and official seal.
940e, xWNiArt 2
Mace Afotaty Sea! Above
OMONAL
i t
Though rhrs section is optional, compleitng this Informal'ion calirll-deferaneration of the document or
fraudulent reattachment of this forrn to an urlfntended document.
Description of Attached Document
Title or Type of Document; Document Date:
Number of Pages: _- _ _ Signer(s) Other Than Named Above:
CapacftOes) Clainwd by Signor(s)
Signer's Name:
Corporate Officer — Title(s):
Partner -- F Limited i i General
Individual f_] Attorney in Fact
Trustee Guardian or Conservator
r m hv.r-
Signer Is Representing:
Signer's Dame:
C Corporate Officer — Titie(sj:
Partner -- :.I Urn4ted LI General
1-7 Individual 11 Attorney in Fact
L) 'Trustee f-] Guardian or Conservator
El Other:
Signer is RepresentlrQg:
014 National Notary Association , www.NationalNotaiy.org • i -8D4 -US NOTARY (1.804-876-6827) ltem #5907
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
roKIOMARiNE
Il, NCC
0 POWER OF ATTORNEY
AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS SONINNO COMPANY
1NITEO STATES SURETY COMPANY U.S, SPECIALTY INSURANCE COMPANY
KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company, a California corporation, "texas BondingCompany, an assumed name of American Contractors Indemnity Company, United States Surely Company, a M alyland ca"talionandU.S specialty Insurance Company, a Texas cofparstion (Collectively, the "Campanies'), do by "se presents make, comlifuleandappoint
PATRICIA Z£NIZO, PIETRO MICCICHE, ELISASETE SALAZ4R Of GLENDALE, CALIFORNK
its true and lawful AttorneY4sHn tact, each In their separate capacity if mare than one is named above, with full power and authodly4erebyconferredin "sts name, place and stead, to execrate, acknowledge and deliver any and all bonds, recognkances, undertakings Of outer Instrument or contracts of suretyship to Include riders, amendments, and consents of surety, prGridtng the bond penalty does not exceed -Five Million... - Dollarsfl6 • This Poftr of Aitomey shah expire witft ul further action on April 23:4, 2022 This Power ot.A4MO itedunderandbyasrortyofthefoWrlgrllttiionsadoptedbytheBoardsofDiredorsofthecompanies: that the PrhCSidesri, an ViCe•A .•.•••-_'
rested , luu y residenl, any Assistant vice•Presidem, any Secretary or any Assistant Secrelary shah be and Is herebyPower
fol awing p to appoint any onti3 r mare suitable persons as Atlomey(s)-In.Fact to represent and act far and an behalt of theCampareyaubcti0ritefollowingprayssions:
A;tr,mMi4rh-Fact may be given hull power and authority roc and In the name of and on behalf 0r the Company, to oxerule. aeknowiedge and dellyer, anyWallbands. recopt anew, corrlracis. agreements or indemnity and other conditional or obligatory undodakings, including any and all consentsforOnratetseofmininedperaeniageaendlorfinalestimatesoneng{n"riq and construction contrdcls, and any and all notices and documentsCWK*kQ or larminatnp the Company's habGity thereunder, and any such instruments so executed by any such Attorneydn-Fact shell be binding upont}1rt CbffVNW as if signed by the President and sealed and effected by the Corperata Secretary.
lb&Dkvd that the slanalwe of any authorized otfrcer and seal of the Company hereto M or heranner affixed to any power of attomey or any
vW 'he M tkg thereto by facsimile, and any power orattorney or certificate bearing facsimfte signature or facsimlte seal shat[ he valid and bindingWIwithreapedtoanybondorundertakingInwhichitisattached.
IN WITNESS WHEREOF, The Companies have caused this instrument to be signed and Iheir corporate sea is to be he rete affixed, this111dayofdune. 2018
AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING OMPANY
tlhiITE0Cie, SUIt>=T'- _#.PANY ECTAL lH URANCt CpNipgNYn
dyecC 4 • t 7xSt' ate of Calffomia '! N°
r
County of Los Angelesms's i1T.
B ~—
Daniel P, Agullar, Vice President
A Notary Prafilie oro ther ofircer completing (his cerfdreafe vigrifies.only the tdenaty or fhe individual who signed the dr =menf to
wlrkh this aertficafe 158 Rdhed, and not the truflifulnes$ &Xumc , or wilklitV oflha( document
On tars i" day of June, 2018, before roe, Sonia O. Caere}a, a notary public, personally appeared Daniel R Aguilar, Vico President ofArrtefk= Convectors Intiesmiity Company, Texas Bonding Company, United States Surely Company and U.S. Specialty InsuranceCompanywitioprovedtocreonthebasisofsatisfactoryevidanc;a to be the person whose name is subscribed to the within instrument
and acW to coir gyral he eKeculed the same In his authorixad Capacity, and that by his algnatum on the Instrument
PWWL Of rbrtitty Capon behalf of which the person acted, executed the Instrument
I certify under PENALTY OF PERJURY under the lawis of the State of Calilomis that ilia foregoing paragraplh is true and correct.
WITNESS my hand and ofireiat Seal. 1Pr4 Aa q
I.wrkyHn [w.Y _
SignatureI {
Seatj wor..f+whirisr
1, Elio Lo, Assistant Secretary American Contractors Indemnity Company, Texas Bonding Company, United States Surety
Company and U.S. Spedalty Insurance Company, do hereby Wily that the above and foregoing is a true and correct copy of a Power
of Attorney exeevted by sotd Comp anles. whlch is Still In furl force and effect; furthermore, the resolutions of the Boards of Directors,
set out in the Power of Alto mey are in full force and effect.
InWitne$s Where , I have hereunto set my, hand and affixed the seals of said Companies at Los Angeles, California this
L2 day of ,rCk
iµct. rail 7y LA vrw_ y 4 CorporateSealsf .. •,q- . e4 y_ rF Band
No. Vii'_ '' f' ,{ y + l
i "
Agency
N9. $ $7 r` 1 r' K10 Lo. Asel Socrotary 9Y06n,. osit
trnhcc.cornlsurety for more inforinatiori
DocuSign Envelope ID: OB8CB68A-D163-4086-A2DB-5296B162005A
CITY OF LAKE ELSINORE
CIP Project No. Z10030
BOND NO. 1001148682
PREMIUM $4.545.00
FAITHFUL PERFORMANCE BOND Premium Based on
Final Conlracl Amount
100% of Total Contract Amount)
WHEREAS, the City Council of the City of Lake Elsinore, State of California, has awarded to and entered
into an Agreement with Aneen Construction, Inc. (hereinafter designated as "Principal")
whereby Principal agrees to construct or install and complete certain designated public improvements,
which said Agreement, effective on the date signed by the City Manager, and identified as
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
is hereby referred to and made a part hereof; and
WHEREAS, said Principal is required under the terms of said Agreement to furnish a bond guaranteeing
the faithful performance of said Agreement.
NOW THEREFORE, we the undersigned Principal and American Contractors Indemnity Company
as Surety, are held and firmly bound unto the City of Lake Elsinore (hereinafter designated as "City") in
the penal sum ofF,nrIwpandNW100 dollars ($252.490 00 ), lawful money of the United
States, for which payment of which sum well and truly to be made, we bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH, that if the above bounded Principal, his or her or its
heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well
and truly keep and perform the covenants, conditions and provisions in said Agreement and any
alterations thereof made as therein provided, on his or her or their part, to be kept and performed at the
time and in the manner therein specified, and in all respects according to their true intent and meaning,
and shall indemnify and save harmless the City, its officers, agents and employees, as therein stipulated,
then this obligation shall become null and void; otherwise it shall be and remain in full force and effect.
As a part of the obligation secured hereby and in addition to the face amount specified therefor, there
shall be included costs and reasonable expenses and fees, including reasonable attorneys' fees, incurred
by City in successfully enforcing such obligation, all to be taxed as costs and included in any judgment
rendered.
The Surety hereby stipulates and agrees that no change, extension of time, alteration, or addition to the
terms of the Agreement or to the work to be performed thereunder, or the specifications accompanying
the same shall in any way affect its obligations on this bond, and it does hereby waive notice of any such
change, extension of time, alteration or addition to the terms of the Agreement or to'the work or the
specifications.
SIGNATURE PAGE FOLLOWS)
D-34
DocuSign Envelope ID: 0B8CB6BA-D163-4086-A2DB-5296B162005A
CITY OF LAKE ELSINORE
CIP Project No. Z10030
BOND NO.1001148682
SIGNATURE PAGE TO FAITHFUL PERFORMANCE BOND
IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and Surety above
named and we have hereunto set our hands, and seals on this 22nd day
of April 2022 .
BIDDER/PRINCIPAL-
Principal Name: Aneen Construction, Inc.
Address: 9860 Indiana Ave., #18
Riverside, CA 92503
Telephone No.: (909) 913-3024
SURETY:
Name: American Contractors Indemnity Company
Address: 801 S. Figueroa St., Suite 700
Los Angeles, CA 90017
Telephone No.- (310) 649-0990
Print Name:
Tamer khalil
Print Name: Pietro Micciche
Attorney- in-Fa
Signature: Signatur _ '^
Approved as to Form this
day of 20
City Attorney
City of Lake Elsinore
NOTE: This bond must be executed by both parties. Corporate seal may be affixed hereto. All
si natures must be acknowledged before a notaEy public attach acknowledgments). The
attorney-in-fact for the corporate surety must be registered, as such, in at least one county in
the State of California. (Attach one original Power of Attorney sheet for each bond).
D-35
DocuSign Envelope ID: 0B8CB6BA-D163-4086-AMB-529613162005A
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CML CODE § 1189
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 _LOS-Allaeles
On before me, Elisabete Salazar, Notary Public —
Date Here Insert Name and Title of the Officer
personally appeared Pietro Micciche
Names) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(!) whose narnei is/ajlte
subscribed to the within instrument and acknowledged to me that hefjMp* executed the same in
his/y(O""authorized capacitygW, and that by hi-){e Ml(signatureM on the instrument the personK,
or the entity upon behalf of which the personoQ acted, executed the Instrument.
0my
EUSABUE SALAIM
Notary Public - Callfornla
Los Angeles County
Commission N 2]42511
Comm. Expim Jan 19, 2025
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature _ —-
r
g
t?ign rre ofNotary
Place Notary Seal Above
0MONAL
Though this section is optional, compieting 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:
Number of Pages: Signer(s)
Document Date:
Other Than Named Above:
Capecity(ies) Claimed by Signer(s)
Signer's Name:
Corporate Officer — Title(s):
Partner — __ Limited J General
Individual F1 Attorney in Fact
Trustee LJ Guardian or Conservator
Other:
Signer Is Representing:
Signer's Name: _
Corporate Officer — Title(s):
L Partner — 1 Limited 1 General
l Individual Attorney in Fact
I Trustee i Guardian or Conservator
Other:
Signer Is Representing:
3M
02014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) ttem #5907
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
f .
TOKIOMAKINE
HCC
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 Maryland 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 or ELISABETE SALAZAR of GLENDALE, CALIORNIA
its true and lawful Attomey(s)-in-fact, each in their separate capacity if more than one is named above, with full power and authority
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***** Dollars
5,000,000.00*** ). This Power of Attorney shall expire without further action on January 3191, 2024. This Power of Attorney is
granted under and by authority of the following resolutions 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 Attorney(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
23rd day of September, 2021.
AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY
UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY
1s b% O 9rStateofCalifornia
J aCountyofLosAngeles _4 a ' By:
Daniel P. Aguilar, Vice President
A Notary Public or other ofcer 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 23rd day of September, 2021, before me, D. Littlefield, 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 S ate of California that the foregoing paragraph is true and correct.
a. >rr EFuro
WITNESS my hand and offi ' I seal. _ - :--
Signature
nur'AuOrk-c.ura,,,,,
ios,v.u. raeisty
f COnl11710707
Signature p- (
seal) ' =
p "`'r"'"" "" 7t• xat
I, Kio Lo, Assistant Secretary op 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 Witness Whereof, I have hereunto set,:ny h, nd' and affixed the seals of said Companies at Los Angeles, California this
Z n` day of ,, i [ _ __ _ `—, "1L & Z e -
Corporate Seals
Bond No.
Kjo Lo.
HCCSMANPOA09/2021
Visit tmhcc.com/surety for more information
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
CITY OF LAKE ELSINORE
CIP Project No. Z10030
BOND NO. 1001148682
PREMIUM $Included in Performance Bond
LABOR AND MATERIALS BOND
100% of Total Contract Amount)
WHEREAS, the City Council of the City of Lake Elsinore, State of California, has awarded to and
entered into an Agreement with Aneen Construction. Inc. (hereinafter designated as "Principal")
whereby the Principal agrees to construct or install and complete certain designated public
improvements, which said Agreement, effective on the date signed by the City Manager, and
identified as
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
is hereby referred to and made a part hereof; and
WHEREAS, under the terms of the Agreement, said Principal is required before entering upon the
performance of the work, to file a good and sufficient payment bond with the City of Lake Elsinore to
secure the payment of claims to which reference is made in Title 3 (commencing with Section 9000)
of Part 6 of Division 4 of the Civil Code.
NOW, THEREFORE, we the undersigned Principal and American Contractors Indemnity Company , as Surety
are held and firmly bound unto the City of Lake Elsinore (hereinafter designated as "City") and all
contractors, subcontractors, laborers, material suppliers, and other persons employed in the
performance of the Agreement as referred to in Title 3 (commencing with Section 9000) of Part 6 of
Division 4 of the California Civil Code, In the sum of Two Hundred Fifty Two Thousand Four Hundred Ninety and Nol100
dollars ($252,490.00 J, lawful money of the United States, for materials furnished or labor thereon
of any kind, or for amounts due under the Unemployment Insurance Code with respect to such work
and labor, that the Surety will pay for the same in an amount not exceeding the sum specified in this
bond. In the event suit is brought upon this bond, the Surety shall pay in addition to the face amount
thereof, all costs and reasonable expenses and fees, including reasonable attorney's fees, incurred
by the City in successfully enforcing this obligation, to be awarded fixed by the court, and to be taxed
as costs and to be included in the judgment therein rendered
It is expressly stipulated and agreed that this bond shall inure to the benefit of any of the persons,
companies, and corporations entitled to file claims under Title 3 (commencing with Section 9000) of
Part 6 of Division 4 of the California Civil Code, to give a right of action to such persons or their
assigns in any suit brought upon this bond.
Should the condition of this bond be fully performed, then this obligation shall become null and void,
otherwise it shall be and remain in full force and effect.
The surety hereby stipulates and agrees that no change, extension of time, alteration, or addition to
the terms of the agreement or the specifications accompanying the same shall in any manner affect
its obligation on this bond, and it does hereby waive notice of any such change, extension, alteration,
or addition.
SIGNATURE PAGE FOLLOWS)
D-36
DocuSign Envelope ID: 0138C136BA-D163-4086-AMB-529613162005A
CITY OF LAKE ELSINORE
CIP Project No. Z10030
BOND NO. 1001148682
SIGNATURE PAGE TO LABOR AND MATERIALS BOND
IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and Surety above
named and we have hereunto set our hands, and seals on this22nd day
of April 2022.
BIDDER/PRINCIPAL:
Principal Name: Aneen Construction, Inc
Address: 9860 Indiana Ave., #18
Riverside, CA 92503
Telephone No.: (909) 913-3024
Print Name
Signature:
Approved a
day of
City Attorney
City of Lake Elsinore
20_
SURETY:
Name: American Contractors Indemnity Company
Address: 801 S. Figueroa St., Suite 700
Los Angeles, CA 90017
Telephone No.: (310) 649-0990
Print Name: Pietro Micciche
Attacciay-in-Fact
Signature 0;r L
NOTE: This bond must be executed by both parties. Corporate seal may be affixed hereto. All
signatures must be acknowledged before a notary public attach acknowledgments). The
attorney-in-fact for the corporate surety must be registered, as such, in at least one county in
the State of California. (Attach one original Power of Attorney sheet for each bond).
D-37
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CML CODE § 1189
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 --COs Anae1eji.___.
On _APR 22 2022 before me, _ _Elisabete Salazar, Notary Public
Date Here Insert Name and Tide of the Officer
personally appeared Pietro Micciche
Names) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the personQQ whose name% is/4)(0
subscribed to the within instrument and acknowledged to me that he/)MW executed the same In
hislp(otj, )(authorized capacityQW, and that by hisi)(O(MMsignal urepQ on the instrument the person¢Q,
or the entity upon behalf of which the person( acted, executed the Instrument.
01.
EUSAU7E SAIAZO
Notary Public - California
n Los ArWies County
Commission/2342511
my Comm. Expires Jan 19, 2025
Place Notary Seal Above
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature,
Signaturpf of Nof 'Ou
OPTlOAML
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:
Number of Pages:
Document Date.
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
Corporate Officer — Title(s):
Partner — _ Limited _J General
Individual Attorney in Fact
Trustee IJ Guardian or Conservator
Other:
Signer Is Representing:
Signer's Name:
Corporate Officer — Title(s):
I_ Partner — I Limited F General
11 Individual ! Attorney in Fact
Trustee Guardian or Conservator
Other:
Signer Is Representing:
cwzc aac:csd
02014 National Notary Association - www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
TOKIOMARINE
HCC
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 Maryland 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 or ELISABETE SALAZAR of GLENDALE, CALIORNIA
its true and lawful Attorney(s)-in-fact, each in their separate capacity if more than one is named above, with full power and authority
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***"* Dollars
15,000,000-00— 00.0,000.00"** ). This Power of Attorney shall expire without further action on January 3131, 2024. This Power of Attorney is
granted under and by authority of the following resolutions 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 Aftorney(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
23,d day of September, 2021.
AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY
UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY
Sy,Cippy roiHac su1
State of California °
r`
t, 41
County of Los Angeles .$d " a By:
T+43 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 fo
which this certificate is attached and not the truthfulness, accuracy, or validity of that document
On this 23rd day of September, 2021, before me, D. Littlefield, 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.
D. lrrTtEriEr,O
WITNESS my hand and offi I seal. 1+c[!ry, Public . Cely,ys
Cm "los COunry6.CorRn Ision 1 2.}7'0307
uY COMM- Gans An 11, 2024Signature (seal)
I, Kio Lo, Assistant Secretary o 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, whirtl is MA in full force and effect; furthermore, the resolutions of the Boards of Directors,
set out in the Power of Attorney are irr f ill lomrt;p and of vt.
In Witnigss Whereof, I have heratirtc, set my hand &nd affixed the seals of said Companies at Los Angeles, California this
t' day of n6_
Corporate Seals 0o?1pt"Qca tiwiu r r(.*", IBondNo. I ( 1 `I LP '6 7 1 1 }
xv
k
Agency No. 3057 ; ;,r, `,,::a• ' *
io o, si etre ary
HCCSMANPOA09/2021
visit tmhcc.com/surety for more information
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
CITY OF LAKE ELSINORE
CIP Project No. Z10030
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:
DIR NO 1000001966
License Number: 122954 EXP. FEB -26-2022
Address of Office, Mill or Shop:
ALCORN FENCE COMPANY
6445 PEDLEY ROAD, RIVERSIDE, CA 92509
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:
Name Under Which Subcontractor is Licensed:
License Number:
Address of Office, Mill or Shop: _
Specific Description of Sub -Contract: and Bid Items of Work:
GUARDRAIL, LINE ITEMS 7-10
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
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
1
2
3
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:
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
Name (Firm/Agency) CITY OF RIVERSIDE PUBLIC WORKS
Address 3900 MAIN ST, RIVERSIDE, CA, 92522
Project Title
Project Location
Type of Work
Project Manager Contact
Dated Completed JUL-2021
Name (Firm/Agency)
WILLIAM ST IMPROVEMENTS
CITY OF RIVERSIDE
STREET IMPROVEMENTS
DAVID HATCH Phone
Contract Amount
CITY OF CORONA
Address 400 SOUTH VICENTIAAVE., CORONA, CA, 92879
Project Title
Project Location
Type of Work .
Project Manager Contact
Dated Completed DEC -2020
ONTARIO AVE.
CITY OF CORONA
STREET IMPROVEMENT
PETER RAMEY
Phone
Contract Amount
C-14
951-288-3633
320,00
909-855-1720
780,000
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
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
5
Name (Firm/Agency)
Address
Project Title
Project Location
Type of Work
Project Manager Contact
Dated Completed
Name (Firm/Agency)
Address
Project Title
Project Location
Type of Work
Project Manager Contact
Dated Completed
Name (Firm/Agency)
Address
Project Title
Project Location
Type of Work
Project Manager Contact
Dated Completed
Phone
Contract Amount
Phone
Contract Amount
Phone
Contract Amount
C-15
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
CITY OF LAKE ELSINORE
CIP Project No. Z10030
CONTRACTOR INFORMATION
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
Contractor's License No.: 1004775 Class: CLASS
a. Date first obtained: JUN -26-2015 Expiration
b. Has Bidder's License ever been suspended or revoked?
If yes, describe when and why:
c. Any current claims against License or Bond?
If yes, describe claims:
NO
NO
JUN -30-2023
Principals in Company (List all — attach additional sheets if necessary):
NAME TITLE LICENSE NO.
If Applicable)
TAMER KHALIL PRESIDENT
C-16
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
CITY OF LAKE ELSINORE
CIP Project No. Z10030
VIQLATIONS OF FEDERAL STATE OR LOCAL LAW
CAMINO DEL NORTE GUARDRAIL PROJECT
CIP PROJECT NO. Z10030
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 40 (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 NO (cit0e 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?
YESNO (circle one)
If "yes,' ase explain: _
4. Has Bidder been cited more than twice for failure to pay prevailing wages in the last five (5)
years?
YESNO (circle one)
If "yes," ase explain:
C-17
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
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 therepf shall also constitute signature of this Certification.
Al .. .. MARCH -22-2022
Signature Date
TAMER KHALIL
Print Name
ANEEN CONSTRUCTION, INC
Contractor Name
C-18
PRESIDENT
Title
DocuSign Envelope ID: 01218C66BA-D163-4086-A2D13-529613162005A
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:
Location
Reason:
Entity:
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
Signatur 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
DocuSign Envelope ID: 0 BBC B6BA-D 1 63-4086-A2 DB -5296B 1 62005A
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.
k"
Signature
By.
TAMER KHALIL
Name
PRESIDENT
Title
ANEEN CONSTRUCTION, INC
Contractor Name
C-20
DocuSign Envelope ID: OB8CB6BA-D163-4086-A2DB-5296B162005A
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 aJalse certification may subject the certifier to criminal prosecution-
11... MARCH -22-2022
Signature Date
PRESIDENT
TAMER KHALIL
Print Name Title
ANEEN CONSTRUCTION, INC
Contractor Name
C-21
DocuSign Envelope ID: OBBCB6BA-D163-4086-A2DB-5296B162005A
ACaRl70
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
4/16/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONIAU1
NAME: Chubb Customer Service Center
KRAFT LAKE INSURANCE AGENCY INC 7M;;: Ext : 866-972-2727 A/C. No):
ADDRESS: chubbcscLchubb.comPOBOX1426
INSURER(S) AFFORDING COVERAGE NAIC #
EACH OCCURRENCE $ 1,000,000
GRAND RAPIDS MI 49501 INSURER A : ACE Property And Casualty Insurance Company 20699
INSURED
INSURER B
ANEEN CONSTRUCTION INC. INSURER C :
9860 Indiana Ave Ste 18 INSURER D:
INSURER E:
LIABILITY
ANY AUTO
SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY K AUTOS ONLY
RIVERSIDE CA 92503-0203 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE iINSD WVD POLICY NUMBER MM/DD/YYYY) 1MM/DDIYYYY) LIMITS
A
A COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE DKOCCUR
SERCAD962083273N 06/11/2021 06/11/2022
EACH OCCURRENCE $ 1,000,000
PREMISES (Ea occurrence) $ 1,000,000
MED EXP (Any one person) $ 5,000
PERSONAL &ADV INJURY $ Included
GEN'L AGGREGATE LIMIT APPLIES PER:
h POLICY F—]PEQ ILOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 21000,000
AOWNED
AUTOMOBILE
X
LIABILITY
ANY AUTO
SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY K AUTOS ONLY
SERCAD962083273N 06/11/2021 06/11/2022
Ee accident $
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
per acddent) $
Occurrence/Aggregate $ Incl Win GL Limits
UMBRELLA LIABOCCUR
EXCESS LIAR HCLAIMS-MADE
EACH OCCURRENCE $
AGGREGATE $
DED I RETENTION $
NORKFRS COMPENSATION
NO EMPLOYERS' LIABILITY Y / N
NY PROPRIETOR/PARTNER/EXECUTIVE
DFFICER/MEMBER EXCLUDED?
Mandatory in NH)
f yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
I STATUTE I ER
E L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the
coverage afforded by the policies above. The insurance afforded by the policies described herein is subject to all terms, exclusions and conditions of such
policies
ER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Lake Elsinore ACCORDANCE WITH THE POLICY PROVISIONS.
130 south Main Street AUTHORIZED REPRESENTATIVE
LaXe hismore, W&",O a Rvak,i,ek
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
DocuSign Envelope ID: 0B8CB6BA-D163-4086-A21313-529613162005A
ACC)REX CERTIFICATE OF LIABILITY INSURANCE
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
04/18/
2022YYYY
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME:
BIBERK PHONE 84472-09674
P.O. Box 113247
WC
203-
654-3613
N
EE -MAIL customersery ce@IbiBERK.com
Stamford, CT 06911
INSURER S AFFORDING COVERAGE NAC*
MED PCP (Any oneperson) $ 0
Berkshire Hathaway Dlmd Insurance CompanyINSURERA:
INSURER B: NSUREDA0eien Construction, inc.
INSURER C'
9860 indiana ave 18 INSURER D: -
Riverside, CA 92503
INSURER E:
INSURER F
COVFRAGFS CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR NSUBRI
MOLPOLICY
EXP
DICDY
FF .
mAlymLIMITSLTRTYPEOFINSURANCEISDWVDPOLICYNUMBER
P
COMMERCIALGENERALLIABILITY
AUTHORIZED REPRESENTATIVE f
Ilk
EACH OCCURRENCE $ 0
CLAIMS -MADE El OCCUR SES !Ea o $
0
MED PCP (Any oneperson) $ 0
PERSONAL & ADV INJURY $ 0
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 0
PRODUCTS - COMP/OP AGG $ 0
POLICY (BET ::1 LOC
OTHER:
AUTOMOBILE LIABILITY Ea act
ccidED
SINGLE LIMIT $
Ea aent) _
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
BODILY INJURY (Per accident) $
PROPER-YDAMAGE $
Per a ciden
UMBRELLA LIABOCCURHCLAIMS-MADE
EACH OCCURRENCE $
AGGREGATE $ EXCESS LIAB
DED I I RETENTION $
WORKERS COMPENSATION X PER OTH-
A
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
Mandatory in NH)
NIA N9WC562902 04/19/2022 04/19/2023 E.L EACH ACCIDENT $
1,000,000
F -L DISEASE- EA EMPLOYEE $1,000,000
E.L DISEASE- POLICY LIMIT $1,000,()00IFyes, describe under
DESCRIPTION OF OPERATIONS below
Professional Liability (Errors & Per Occurrence/
Omissions): Claims -Made
I
Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
Contractor License #:1004775
Exclusions:
Tamer Khalil;
C'FRTIFIC'ATF HOLDER CANCELLATION
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Lake Elsinore
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
130 S Main street
Lake Elsinore, CA 92530 AUTHORIZED REPRESENTATIVE f
Ilk
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
DocuSign Envelope ID: OBBCB6BA-D163-4086-A2DB-5296B162005A
BUSINESS LICENSE
This business license is issued for revenue purposes only and does not grant authorization
to operate a business, This business license is issued without verification that the holder is
subject to or exempted from licensing by the state, county, federal government, or any
other governmental agency.
Business Name: ANEEN CONSTRUCTION, INC.
Business Location: 9860 INDIANA AVE UNIT 18
RIVERSIDE, CA 92503-5515
Owner Name(s): ANEEN CONSTRUCTION, INC
ANEEN CONSTRUCTION, INC
9860 INDIANA AVE UNIT 18
RIVERSIDE, CA 92503-5515
CITY OF LAKE ELSINORE
Administrative Services - Licensing
130 South Main Street, Lake Elsinore, CA 92530
PH (951) 674-3124
BUSINESS LICENSE NO. 026788
Business Type: GENERAL ENGINEERING CONTRACTOR
Issue Date: 4/15/2022 Expiration Date: 4/30/2023
Starting January 1, 2021, Assembly Bill 1607 requires the prevention of gender-based discrimination of business establishments A full notice is available in English or other
languages by going to: https://www dca ca gov/publications/
TO BE POSTED IN A CONSPICUOUS PLACE THIS IS YOUR LICENSE • NOT TRANSFERABLE