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HomeMy WebLinkAboutItem No. 10 - Lake Community Center Change Order No. 2 - SRCity Council Agenda Report City of Lake Elsinore 130 South Main Street Lake Elsinore, CA 92530 www.lake-elsinore.org File Number: ID# 22-219 Agenda Date: 6/14/2022 Status: Approval FinalVersion: 1 File Type: Council Consent Calendar In Control: City Council / Successor Agency Agenda Number: 10) Change Order No. 2 to Public Works’ Construction Agreement to Unique Builders of California for the Lake Community Center Rehabilitation Project (CIP Project #Z20021) Approve and authorize the City Manager to execute Change Order No. 2 for the not-to-exceed amount of $21,990.00 with Unique Builders of California for the Lake Community Center Rehabilitation Project (CIP Project #Z20021), in final form as approved by the City Attorney. Page 1 City of Lake Elsinore Printed on 6/9/2022 Page 1 of 2 REPORT TO CITY COUNCIL To: Honorable Mayor and Members of the City Council From: Jason Simpson, City Manager Prepared by: Shannon Buckley, Assistant City Manager Date: June 14, 2022 Subject: Change Order No. 2 to Public Works’ Construction Agreement to Unique Builders of California for the Lake Community Center Rehabilitation Project Recommendation Approve and authorize the City Manager to execute Change Order No. 2 for $21,990.00 for the not-to-exceed contract amount of $624,295.00 with Unique Builders of California for the Lake Community Center Rehabilitation Project (CIP Project #Z20021), in final form as approved by the City Attorney. Background Construction bid documents were prepared and the project was advertised for bid per the requirements outlined in the California Public Contract Code. On September 8, 2021, the City posted on PlanetBids the notice inviting bids for the Lake Community Center Rehabilitation Project (CIP Project #Z20021). On December 14, 2021, a construction agreement was awarded to Unique Builders of California for rehabilitating the Lake Community Center located at 310 W. Graham Ave. On June 1, 2022, Change Order No. 1 in the contingency amount of $54,775 was approved to cover various improvements. Discussion The scope of additional work contained in this Change Order is needed to complete several additional enhanced construction elements. It has been determined cost-effective to have Unique Builders of California complete additional elements in conjunction with the current contracted scope of work elements. The Change Order contains the following key elements to complete the construction of this project:  Additional roofing drainage and rebuilding existing roof drains to better remove stormwater from the roof.  Install stucco wall coating and wall leveler throughout the gymnasium  Prep and paint gymnasium interior wall and soundboard CIP Project #Z20021 Change Order No. 2 Page 2 of 2 Fiscal Impact The cost of this Change Order No. 2 to the Public Work’s Office Building Project is included in the Fiscal Year 21/22 – 25/26 Capital Improvement Plan (CIP) budget. Exhibits A – Change Order No. 2 B – Original Construction Agreement C – Change Order No. 1 2 DATE: QUANTITY UNIT Lump Sum 1.00 Lump Sum 1.00 $13,340.00 TOTAL SUM OF 2 Review by:Initials Date Date PRIOR TO THIS CHANGE ORDER CONTRACTOR IS AUTHORIZED TO MAKE THE FOLLOWING CHANGES: City Manager $13,340.00 UNIT PRICE EXTENSIONITEM Remove and install new roof drains ITEM QUANTITIES DECREASED $8,650.00$8,650.00 Install two prep coats of wall leveler and one coat of acrylic wall texture and paint UNIT PRICE CITY PROJECT # December 14, 2021DATE AWARDED: PROJECT TITLE:Lake Community Center Unique Builders of California #Z20021 Authorized by:Jason Simpson TOTAL AMOUNT OF CONTRACT $547,550.00 QUANTITIES INCREASED CITY OF LAKE ELSINORE 130 S. MAIN STREET LAKE ELSINORE, CA 92530 (951) 674-3124 June 14, 2022 PROJECT CHANGE ORDER CHANGE ORDER # THIS CHANGE ORDER IS APPLICABLE TO: CONTRACT AWARDED TO: City Manager: $21,990.00 Approved by: Contractor Change Order No. Assistant City Manager EXTENSION THE AMOUNT OF THE CONTRACT WILL BE (INCREASED) BY THE $21,990.00 None QUANTITY DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 Agreement No.Click or tap here to enter text. AGREEMENT FOR PUBLIC WORKS CONSTRUCTION Unique Builders of CA, Inc. Forthe CIP PROJECT NO. Z20021 Lake Community Center Rehabilitation This Agreement for Public Works Construction ("Agreement") is made and entered into as of December 14, 2021, by and between the City of Lake Elsinore, a municipal corporation ("City") and Unique Builders of CA, Inc. ("Contractor"). The City and Contractor, in consideration of the mutual promises and covenants set forth herein, agree as follows: 1. The Prosect and Prosect Documents. Contractor agrees to construct the following public improvements ("work") identified as: CIP PROJECT NO. Z20021 The City -approved plans for the construction of the Project, which are incorporated herein by reference and prepared by STK Architecture are identified as: Lake Community Center Renovation 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 Five Hundred Forty -Seven Thousand Five Hundred Fifty Dollars and no cents 547,550.00). 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 DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 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 all work within Sixty -Five (65) orking days from the date of commencement specified in the Notice to Proceed and shall complete all work within Sixty -Five (651 working days, 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 Director of Public Works, the City Engineer, a City inspector, or a representative of any of them, unless such act or omission actually prevents the Contractor from fully complying with the requirements of the Project Documents, and unless the Contractor protests at the time of such alleged prevention that the 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 Fifteen Hundred Dollars ($1.500) per calendar day, and that the Contractor will pay to the City, or City may retain from amounts otherwise payable to Contractor, such amount for each calendar day by which the Contractor fails to complete the work, including corrective items of work, under this Agreement within the time hereinabove specified and as adjusted by any changes to the work. 4. 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 claims against the Contractor. Any change to the work shall be by way of a written instrument ("change order") signed by the City and the Contractor, stating their agreement to the following: a. The scope of the change in the work; b. The amount of the adjustment to the contract price; and c. The extent of the adjustment to the Schedule of Performance. The Director of Public Works is authorized to sign any change order provided that sufficient contingency funds are available in the City's approved budget for the Project. All change in the work authorized by the change order shall be performed under the applicable conditions of the Project 2 DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 Documents. City and Contractor shall negotiate in good faith and as expeditiously as possible the appropriate adjustments for such changes. 5. Special Federal Requirements a. Contractor and Owner do hereby acknowledge that this project will be partially or fully funded with Community Development Block Grant (CDBG) funds [24 CFR 5701 and is therefore subject to applicable Federal procurement, labor, environmental, equal opportunity, and other regulations. b. Contractor shall maintain and keep books and records on a current basis, recording all transactions pertaining to this agreement in a form in accordance with generally acceptable accounting principles. Said books and records shall be made available to the County, the State of California, the Federal government, and to any authorized representative thereof for the purposes of audit at all reasonable times and places. All such books and records shall be retained for such periods of time as required by law, provided, however, notwithstanding any shorter periods of retention, all books, records, and supporting detail shall be retained for a period of at least four (4) years after the expiration of the term of this Agreement. c. Contractor shall comply with the Davis -Bacon Fair Labor Standards Act (40 USC a-276, a-5) and the implementation regulations thereof. Contractor shall comply with the U.S. Department of Housing and Urban Development's Federal Labor Standards Provisions HUD 4010). d. Contractor acknowledges that work under this contract is subject to the payment of prevailing wages pursuant to Section 1770 and 1773 et seq. of the Labor Code of the State of California, the Director of Industrial Relations (State Prevailing Wages), and the U.S. Department of Housing and Urban Development's Federal Labor Standards Provisions (Davis -Bacon Act Prevailing Wages). The Contractor to whom the contract is awarded, and all subcontractors under him, shall pay the higher of the Federal or State prevailing wage rate for any given classification employed in the performance of this contract. e. Contractor acknowledges that the applicable Wage Determination for this project is: General Decision Number: CA20210025 Modification Number: 11 Date: 10/1/21 6. Section 3 Compliance: The Contractor hereby acknowledges that this federally funded project is subject to Section 3 of the Housing and Urban Development Act of 1968 [12 U.S.C. 1701 u and 24 CFR Part 135] and agrees to the following: a. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD -assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing. 3 DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 b. The parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the Part 135 regulations. c. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the contractor's commitments under this Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. d. The contractor agrees to include this Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this Section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR Part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR Part 135. e. The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR Part 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CFR Part 135. Noncompliance with HUD's regulations in 24 CFR Part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. g. With respect to work performed in connection with Section 3 covered Indian housing assistance, Section 7(b) of the Indian Self -Determination and Education Assistance Act 25 U.S.C. 450e) also applies to the work to be performed under this contract. Section 7(b) requires that to the greatest extent feasible (i) preference and opportunities for training and employment shall be given to Indians, and (ii) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises. Parties to this contract that are subject to the provisions of Section 3 and Section 7(b) agree to comply with Section 3 to the maximum extent feasible, but not in derogation of compliance with Section7(b). 7. Additional Federal Requirements Whereas, the work under this Agreement is subject to applicable Federal, State, and local laws and regulations, including but not limited to the regulations pertaining to the Community Development Block Grant program (24 CFR Part 570) and 2 CFR Part 200. Contractor, sub -contractors, Consultants, and sub -consultants agree to comply with, and are subject to, all applicable requirements as follows: 51 DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 a. Equal Employment Opportunity - Compliance with Executive Order 11246 of September 24, 1965, entitled "Equal Employment Opportunity", as amended by Executive Order 11375 of October 13, 1967, and as supplemented in Department of Labor regulations (41 CFR chapter 60). The Contractor/Consultant will not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. Contractor/Consultant will ensure that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex or national origin. The Contractor/Consultant will take affirmative action to ensure that applicants are employed, and the employees are treated during employment, without regard to their race color, religion, sex, or national origin. Such actions shall include, but are not limited to, the following: employment, up -grading, demotion, or transfer; recruitment or recruitment advertising; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Contractor/Consultant agrees to post in a conspicuous place, available to employees and applicants for employment, notices to be provided by the County setting forth the provisions of this non -discriminating clause. b. Copeland "Anti -Kickback" Act (18 U.S.C. 874 and 40 U.S.C. 276c: All contracts and subgrants in excess of $2,000 for construction or repair awarded by recipients and subrecipients shall include a provision for compliance with the Copeland "Anti -Kickback" Act (18 U.S.C. 874), as supplemented by Department of Labor regulations (29 CFR part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States"). The Act provides that each contractor or subrecipient shall be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he is otherwise entitled. The recipient shall report all suspected or reported violations to HUD. c. Davis -Bacon Act, as amended (40 U.S.C. 276a to a-7: When required by Federal program legislation, all construction contracts awarded by the recipients and subrecipients of more than $2000 shall include a provision for compliance with the Davis - Bacon Act (40 U.S.C. 276a to a-7) and as supplemented by Department of Labor regulations (29 CFR part 5, "Labor Standards Provisions Applicable to Contracts Governing Federally Financed and Assisted Construction"). Under this Act, contractors shall be required to pay wages to laborers and mechanics at a rate not less than the minimum wages specified in a wage determination made by the Secretary of Labor. In addition, contractors shall be required to pay wages not less than once a week. The recipient shall place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation and the award of a contract shall be conditioned upon the acceptance of the wage determination. The recipient shall report all suspected or reported violations to HUD. d. Contract Work Hours and Safety Standards Act (40 U.S.C. 327 through 333: Where applicable, all contracts awarded by recipients in excess of $2000 for construction contracts and in excess of $2500 for other contracts that involve the employment of mechanics or laborers shall include a provision for compliance with Sections 102 and 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-333), as supplemented by Department of Labor regulations (29 CFR part 5). Under Section 102 of the Act, each contractor shall be required to compute the wages of every mechanic and laborer on the basis of a standard workweek of 40 hours. Work in excess of the standard workweek is permissible provided that the worker is compensated at a rate of not less than 1 1/2 times the basic rate of pay for all hours worked in excess of 40 hours in the workweek. Section 107 of the Act is applicable to construction work and provides that no laborer or mechanic shall be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not 5 DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. e. Rights to Inventions Made Under a Contract or Agreement— Contracts or agreements for the performance of experimental, developmental, or research work shall provide for the rights of the Federal Government and the recipient in any resulting invention in accordance with 37 CFR part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by HUD. Rights to Data and Copyrights – Contractors and consultants agree to comply with all applicable provisions pertaining to the use of data and copyrights pursuant to 48 CFR Part 27.4, Federal Acquisition Regulations (FAR). g. Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act (33 U.S.C. 1251 et seq.), as amended Contracts and subgrants of amounts in excess of 100,000 shall contain a provision that requires the recipient to agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251 et seq.). Violations shall be reported to HUD and the Regional Office of the Environmental Protection Agency (EPA). h. Byrd Anti -Lobbying Amendment (31 U.S.C. 1352)— Contractors who apply or bid for an award of $100,000 or more shall file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier shall also disclose any lobbying with non - Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the recipient. Debarment and Suspension (E.O.s 12549 and 12689)—No contract shall be made to parties listed on the General Services Administration's List of Parties Excluded from Federal Procurement or Nonprocurement Programs in accordance with E.O.s 12549 and 12689, "Debarment and Suspension," as set forth at 24 CFR part 24. This list contains the names of parties debarred, suspended, or otherwise excluded by agencies, and contractors declared ineligible under statutory or regulatory authority other than E.O. 12549. Contractors with awards that exceed the small purchase threshold shall provide the required certification regarding its exclusion status and that of its principal employees. Drug -Free Workplace Requirements—The Drug -Free Workplace Act of 1988 (42 U.S.C. 701) requires grantees (including individuals) of federal agencies, as a prior condition of being awarded a grant, to certify that they will provide drug-free workplaces. Each potential recipient must certify that it will comply with drug-free workplace requirements in accordance with the Act and with HUD's rules at 24 CFR part 24, subpart F. k. Access to Records and Records Retention: The Consultant or Contractor, and any sub - consultants or sub -contractors, shall allow all duly authorized Federal, State, and/or County officials or authorized representatives access to the work area, as well as all books, documents, materials, papers, and records of the Consultant or Contractor, and any sub -consultants or sub -contractors, that are directly pertinent to a specific program for the purpose of making audits, examinations, excerpts, and transcriptions. The L DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 Consultant or Contractor, and any sub -consultants or sub -contractors, further agree to maintain and keep such books, documents, materials, papers, and records, on a current basis, recording all transactions pertaining to this agreement in a form in accordance with generally acceptable accounting principles. All such books and records shall be retained for such periods of time as required by law, provided, however, notwithstanding any shorter periods of retention, all books, records, and supporting detail shall be retained for a period of at least four (4) years after the expiration of the term of this Agreement. Federal Employee Benefit Clause: No member of or delegate to the congress of the United States, and no Resident Commissioner shall be admitted to any share or part of this agreement or to any benefit to arise from the same. m. Energy Efficiency: Mandatory standards and policies relating to energy efficiency which are contained in the State energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94A 163, 89 Stat. 871). n. Procurement of Recovered Materials (2 CFR 200.322.) A non -Federal entity that is a state agency or agency of a political subdivision of a state and its contractors must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired by the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. 8. 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. 9. 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. 10. 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 as of March 1, 2015, 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. 11. Indemnity. Contractor shall indemnify, defend, and hold harmless the City and Riverside County and its officials, officers, employees, agents, and volunteers from and against any and all losses, liability, claims, suits, actions, damages, and causes of action arising out of any personal injury, bodily injury, loss of life, or damage to property, or any violation of any federal, state, or municipal law or ordinance, to the extent caused, in whole or in part, by the willful misconduct or negligent acts or omissions of Contractor or its employees, subcontractors, or agents, by acts for which they could be held strictly liable, or by the quality or character of their work. The foregoing obligation of Contractor shall not apply when (1) the injury, loss of life, damage to property, or violation 7 DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 of law arises from the sole negligence or willful misconduct of the City or its officers, employees, agents, or volunteers and (2) the actions of Contractor or its employees, subcontractor, or agents have contributed in no part to the injury, loss of life, damage to property, or violation of law. It is understood that the duty of Contractor to indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil Code. Acceptance by City of insurance certificates and endorsements required under this Agreement does not relieve Contractor from liability under this indemnification and hold harmless clause. This indemnification and hold harmless clause shall apply to any damages or claims for damages whether or not such insurance policies shall have been determined to apply. By execution of this Agreement, Contractor acknowledges and agrees to the provisions of this Section and that it is a material element of consideration. 12. Insurance Requirements. a. Insurance. Contractor, at Contractor's own cost and expense, shall procure and maintain, for the duration of the Agreement, unless modified by the City's Risk Manager, the following insurance policies. i. Workers' Compensation Coverage. Contractor shall maintain Workers' Compensation Insurance and Employer's Liability Insurance for his/her employees in accordance with the laws of the State of California. In addition, Contractor shall require each subcontractor to similarly maintain Workers' Compensation Insurance and Employer's Liability Insurance in accordance with the laws of the State of California for all of the subcontractor's employees. Any notice of cancellation or non -renewal of all Workers' Compensation policies must be received by the City at least thirty (30) days prior to such change. The insurer shall agree to waive all rights of subrogation against City, its officers, agents, employees and volunteers for losses arising from work performed by Contractor for City. In the event that Contractor is exempt from Worker's Compensation Insurance and Employer's Liability Insurance for his/her employees in accordance with the laws of the State of California, Contractor shall submit to the City a Certificate of Exemption from Workers Compensation Insurance in a form approved by the City Attorney. ii. General Liability Coverage. Contractor shall maintain commercial general liability insurance in an amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If a commercial general liability insurance form or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit. Required commercial general liability coverage shall be at least as broad as Insurance Services Office Commercial General Liability occurrence form CG 0001 (ed. 11/88) or Insurance Services Office form number GL 0002 (ed. 1/73) covering comprehensive General Liability and Insurance Services Office form number GL 0404 covering Broad Form Comprehensive General Liability. No endorsement may be attached limiting the coverage. iii. Automobile Liability Coverage. Contractor shall maintain automobile liability insurance covering bodily injury and property damage for all activities of the Contractor arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and non -owned vehicles, in an amount of not less than one million dollars 1,000,000) combined single limit for each occurrence. Automobile liability coverage must be at least as broad as Insurance Services Office Automobile Liability form CA 0001 (ed. 12/90) Code 1 ("any auto"). No endorsement may be attached limiting the coverage. iv. Professional Liability Coverage fif applicablel. 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 L DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 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 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 and Riverside County, 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 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. 13. 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. 14. If to City: City of Lake Elsinore with a copy to: City of Lake Elsinore Attn: City Manager Attn: City Clerk 130 South Main Street 130 South Main Street Lake Elsinore, CA 92530 Lake Elsinore, CA 92530 RE DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 to Contractor: Unique Builders of CA, Inc. Attn: David Carter 33175 Temecula Parkway, Suite A747 Temecula, CA 92992 15. 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 thisAgreement. 16. 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. 17. Assignment and Subcontracting. Contractor shall be fully responsible to City for all acts or omissions of any subcontractors. Assignments of any or all rights, duties or obligations of the Contractor under this Agreement will be permitted only with the express consent of the City. Nothing in this Agreement shall create any contractual relationship between City and any subcontractor nor shall it create any obligation on the part of the City to pay or to see to the payment of any monies due to any such subcontractor other than as otherwise is required by law. 18. 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. 19. 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. 20. 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. 21. 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. 22. 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. 23. 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 Director of Public Works shall act as the Project administrator on behalf of the City. 10 DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 24. 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. 25. 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 or termination. 26. Prevailing Wages. a. Contractor and all subcontractors shall adhere to the general prevailing rate of per diem wages as determined and as published by the State Director of the Department of Industrial Relations pursuant to Labor Code Sections 1770, 1773, and 1773.2. Copies of these rates and the latest revisions thereto are on file in the office of the City Clerk of the City of Lake Elsinore and are available for review upon request. b. Contractor's attention is directed to the provisions of Labor Code Sections 1774, 1775, 1776, 1777.5 and 1777.6. Contractor shall comply with the provisions of these Sections. The statutory provisions for penalties for failure to comply with the State's wage and the hours laws will be enforced. c. Labor Code Sections 1774 and 1775 require the Contractor and all subcontractors to pay not less than the prevailing wage rates to all workmen employed in the execution of the contract and specify forfeitures and penalties for failure to do so. The minimum wages to be 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. 11 DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 e. Eight hours labor constitutes a legal day's work, as set forth in Labor Code Section 1810. 27. 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. 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 Docu Signed by: asaw S I4kp oln. City Manager ATTEST: LDocuSigned by: City Clerk APPROVED AS TO FORM: Doc ueeSig ned by: cs2iwL FP City Attorney rS DocuSigned hy: ew Director of Administrative Services CONTRACTOR" Unique Builders of CA, Inc. DacuSig_ned by: By: David Carter Its: Secretary 12 DocuSign Envelope IR A2513331-AO4A45A8-A3E9-OBA4117891B1 BIDDER'S PROPOSAL CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REHABILITATION DOCUMENTS Company: UBCA, INC dba Unique Builder of California Honorable Mayor Members of the Council: In accordance with the Notice Inviting Bids pertaining to the receiving of sealed proposals by the City Clerk of the City of Lake Elsinore for the above titled improvement, the undersigned hereby proposes to fumish 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: BID SCHEDULE A — Item No. I Description Unit Price Total Bid [S] 1 Mobilization & Demobilization Including Construction Schedules of Total Bid1 5,000.00 2 Demolition 21,000.00 3 Framing 16,000.00 4 Windows and Doors 61,000.00 5 Painting 85,000.00 6 Flooring 8,500.00 7 Concrete 12,500.00 8 Built-up Roofing Sheet Metal Flashing and Trim 200,040.00 9 Cement Plaster g 5,000.00 10 Cabinets 46,000.00 11 Ceiling and lighting 42,000.00 12 Interior and Exterior Miscellaneous 9,050.00 13 Aluminum Trellis 33,500.00 14 SCHEDULE A Total Bid: $547,550.00 Figures') SCHEDULE A Total BId: Five hundred forty Seven thousand five hundred fifty and no cents Words'} GRAND Total (SCHEDULES Ay Bid: $547,550.00 Figures*) GRAND Total (SCHEDULES A) Bid: Five hundred forty seven thousand five hundred fifty and no cents Words*) BID MAY BE REJECTED IF TOTAL IS NOT SHOWN FOR BOTH FIGURES AND WORDS. DocuSign Envelope IR A2513331-AO4A45A8-A3E9-OBA4117891B1 ACKNOWLEDGMENT OF ADDENDA RECEIVED CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REHABILITATION DOCUMENTS The Bidder shall acknowledge the receipt of addenda by placing an "X" by each addendum received. Addendum No. 1 ,0" Addendum No. 2 P --- 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. 7- i Bidder's Signature Date DocuSign Envelope IR A2513331-AO4A45A8-A3E9-OBA4117891B1 NON -COLLUSION AFFIDAVIT CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REHABILITATION DOCUMENTS j SS COUNTY OF ) PIVCrs, do l NAME) ( 73 0 C G r1 1'9.ov&)t 1ery d s U V lr Affiant being firit. duly sworn, deposes ands s: That he or she is SeC 1-ekf 5 plc] CIA . r v— of Solb 6wner, partnEiW other proper title) g e G 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 7105) Address: Df 1 Ti Telephone No.: 6?0— q _( 1—V:33Q Print Name: Imo-? u, (Y {' rr Signature:= fid / Title. Q- Date: 10 5 i`(_ A - 7 LI SIGNING INSTRUCTIONS TO THE CONTRACTOR Non -Collusion Affidavit must be accompanied by notary certificates for signature. Nate the description of the document on the notary certificate. Attach notary certificate immediate) 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. J -ca DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of ct. } County of On before me; Til IY r 1 ora insert name and t t o o t e o cer personally appeared my d cw w who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islare subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. j ' `y. ASHtI;YM+aRrE9ucxAtew-' WITNESS my hand and official seal. COMM, 02364724 NOTARY PUBLIC • CALIFORNIA IC yCC" StDEGOiJNTYOL...... AtXCurtrn i•Cuti ASI 7, hT75 Notary Public Signat re (Notary Public Seal) INSTRUCTIONS FOR COMPLETING THIS FORM ADDITIONAL OPTIONAL INFORMATION This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT TIle or description of attached document) Title or description of attached document continued) Number of Pages Document Date CAPACITY CLAIMED BY THE SIGNER Individual (s) Corporate Officer Title) Partner(s) Attorney -in -Fact Trustee(s) Other wwwl. otaryClasses.eom 800-873-9865 f needed, should he completed and attached to the document Acknowledgments from other slates may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary Law State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). Print the name(s) of document signer(s) who personally appear at the time of notarization. Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. helshelgl ey, is lace ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-scal if a sufficient arca permits, otherwise complete a different acknowledgment form. Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). Securely attach this document to the signed document with a staple. C DocuSign Envelope IR A2513331-AO4A45A8-A3E9-OBA4117891B1 BIDDER'S BOND 4s]I9l 10101-ino V-706 CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REHABILITATION DOCUMENTS KNOW ALL MEN OR WOMEN BY THESE PRESENTS: That we U BCA, Inc. as PRINCIPAL, hereinafter referred to as "Contractor', and Merchants Bonding Company (Mutual) a duly authorized corporate as "Surety," are held and firmly bound unto the City of Lake Elsinore in the penal sum of TEN PERCENT (10%) OF THE TOTAL AMOUNT OF THE BID of the Contractor above named, submitted by said Contractor to the City of Lake Elsinore for the work for said project entitled above, for the payment of which sum in lawful money of the United States, well and truly to be made, to the City of Lake Elsinore to which said bid was submitted, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. In no case shall the liability of the surety hereunder exceed the amount of TEN PERCENT OF THE TOTAL AMOUNT BID (10%). 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 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 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) RocuSign Envelope V A2513331-AO4A45A8-A3E9-OBA4197891B1 BIDDER'S BOND SIGNATURE PAGE CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REHABILITATION DOCUMENTS IN WITNESS WHEREOF, we have hereunto set our hands and seals on this 21st day of October .21 BIDDER: Contractor Name: UBCA. Inc. Address: 33175 Temecula Pkwy, Ste. A 747 Temecula. CA 92992 Telephone No.: Print Name: Title: Signature: Date: CORPORATE SURETY: Company Name: Merchants Bonding Company (Mutual) Address: 3120 139th Ave SE. Suite 500 Bellevue. WA 98005 Telephone No.: (800) 678-8171 Print Name: Christina Rogers 4: RPO,Qq yy: Title: Attorney -in -Fact : _ : 1933 y; J C- Signature - Date: October 21 st, 2021 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, 1n 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. DocuSign Envelope ID: A2513331 -A04A-45A8-A3EMBA4117891 81 CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Orange On OCT 2 2021 , before me, Olivia Catherine Turman . Notary Public. personally appeared Christina Rogers who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of State of California that the foregoing paragraph is true and correct. 2, y 0_IY ACATHERM TURMAN Notary Public - California range County Commission d 2370441 WITNESS my hand and official seal. Comm. Expires Aug 11, 2025 SIGNATURL PLACE NOTARY SEAL ABOVE Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of attached document Title or type of document: Document Date: Signer(s) Other than Named Above: umber of Pages: DocuSign Envelope Ip: A2513331-A04A45A8-A3E9-OBA4ll789lB1 MERCHANTS BONDING COMPANY, POWER OF ATTORNEY Know All Persons By These Pres ents• that MERCHANTS BANDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING. INC., both being corporations of the State of Iowa (herein oollectively called the °Companies'] do hereby make, constitute and appoint, individually, Christina Johnson; Chrisline Rogers; Erik Johansson; Fra nres Lefler; James W Johnson; Jennifer Anaya; Melissa Lopez their true and lawful Attomey(s)-in-Fact, to sign Its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranleetng bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power•of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc.. on October 16, 2015. The President, Secretary. Treasurer. or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authonty to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto• bonds and undertakings, recognlzances, contracts of indemnity and other writings abIIgatory In the nature thereof.' The slgnalure of any authorized officer and the seal of the Company may be affixed by facsimil le or alecironlc transmission to any Power of Attomey or Certification thereof authorizing the execution and delivery of any band• undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shaft have the some force and effect as though manually fixed.' In connection with abligationa in favor of the Florida Daparbnent of Transportation anly, it is agreed that the power and aut horny hereby given to the Attomey-in-Fact includes any and all consents for the release of retained percentages andlor final estimates on engineering and construction contracts required by the State of Florida Department of Trans portali o n. It Is fully understood that consenting to the Slate of Florida Department of Transportalion making payment of the final estimate to the Contractor and/or its assignee, shall not felleve this surety company of any of its obligations under its bond. In connection with obllgations in favor of the Kentucky Department of Highways arty, It Is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked untess prior written personal notice of such intent has been given to the Commissioner - De parlmenl of Highways of the Commonwealth of Kentucky at least thirty (3 0) days prior to the modification c revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 26th day of January 2021 ONkG cop ........ • °°' 4' RpaR O %: 0' • (iP 0 MERCHANTS BONDING COMPANY (MUTUAL) b 9% : f : • MERCHANTS NATIONAL BONDING, INC. 2003 _ 1933 'y ' By d.. ` . ted; . •;c . STATE OF IOWA '"......' •''' COUNTY OF DALLAS ss. On this 26th day of January 2021 before me appeared Larry Taylor• to me personally known, who being by me duty sworn did say that he Is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said Instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. P JA4 s POLLY MASON Op Commission Number 750576 My Commission Expires A ° January 07, 2023 Notary Aublrc Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr„ Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, wfrch is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 21st day of October 2021 gP0/r+,Q. 4 . 744y4. S,q' 01 x 2003 : st: . y' 1933 c. secretary PDA 0018 (1120) ..""' DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 MERCHANTS BONDING COMPANY. MERCHANTS BONDING COMPANY (MUTUAL) • P.O. BOX 14498 -DFS MOINES, IOWA 50306-3498 l'1-IDNE.- (840) 678-8171 • FAIL: (515) 243-3854 ADDENDUM TO BOND This Addendum is in reference to the bond(s) to which it is attached. Merchants Bonding Company (Mutual) ("Merchants") deems the digital or electronic image of Merchants' corporate seal below affixed to the bond(s) to the same extent as if a raised corporate seal was physically stamped or impressed upon the bond(s). The digital or electronic seal below shall have the same force and effect as though manually fixed to the bond(s). All terms of the bond(s) remain the same. Signed and effective March 23, 2020. MERCHANTS BONDING COMPANY (MUTUAL) DING , coy . Oa.Q P4. a9. y 1933 :• , By: Larry Taylor, President DocuSign Envelope IR A2513331-AO4A45A8-A3E9-OBA4117891B1 LIST OF SUBCONTRACTORS CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REHABILITATION DOCUMENTS 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: Distinctive Colors Painting License Number: 826624 Address of Office, Mill or Shop: 33125 Sweetwater Canyon Rd., Menifee, CA 92584 Specific Description of Sub -Contract: and Bid Items of Work: Interior and Exterior Painting Name Under Which Subcontractor is Licensed: Pursuit Electric, Inc License Number: 1444091 Address of Office, Mill or Shop: 1831 McCormack Lane, Placentia, CA 92870 Specific Description of Sub -Contract: and Bid Items of Work Electrical and Lighting Name Under Which Subcontractor is Licensed: Right Way Roof, Corp. License Number: 661941 Address of Office, Mill or Shop: 15425 Arrow Rt., Fontana, CA 92335 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 fist alternate subcontractors for the same work. DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REHABILITATION DOCUMENTS 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 jor are currently working on) in the past three (3) years, provide the following required information: 1. Name Firm/Agency): City of Lake Elsinore Address: 1.30 South Main St., Lake Elsinore, CA 92530 Contact Person: Gus Papagolos Telephone No.: 951-674-3124 Title of Project: Homeless Shelter- State Homekey 1 Project Location: 215 W Graham, Lake Elsinore, CA 92530 Date of Completion: 112421 Contract Amount: 275,500.00 2. Name Firm/Agency): City of Lake Elsinore Address: 130 South Main St., Lake Elsinore, CA 92530 Contact Person: Gus Papagolos Telephone No_: 951-674-3124 Title of Project: Emergency Repairs CDN Project Location: Camino Del Norte Rd. - Between Main & Franklin Date of Completion: 916120 Contract Amount: 375,470.00 3. Name Firm/Agency): Maples & Associates, Inc Address: 24977 Washington Ave. Ste. J., Murrieta, CA 92562 Contact Person: Mike Maples Telephone No.: 951491-9562 Title of Project: PW Carp Yard - Building Cap Repair Project Location: 522 Poe St., Lake Elsinore, CA 92530 Date of Completion: 612021 Contract Amount: 322,820.00 DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 4. Name Firm/Agency): City of Lake Elsinore Address: 130 South Main St., Lake Elsinore, CA 92530 Contact Person: Gus Papagolos Telephone No.: 951-674-3124 Title of Project: fencing Repairs - City Parking Project location: 160 S. Langstaff, Lake Elsinore, CA 92530 Date of Completion: 1/2020 Contract Amount: 27,435.00 5. Name Firm/Agency): Maples & Associates Address: 24977 Washington Ave. Ste. J, Murrieta, CA 92562 Contact Person: Mike Maples Telephone No.: 951-491-9562 Title of Project: Diamond Stadium Capital Repair Wall Project Location: 500 Diamond Dr., Lake Elsinore, CA 92530 Date of Completion: 112020 Contract Amount: 53,100.00 6. Name Firm/Agency): Maples & Assoicates Address: 24977 Washington Ave. Ste. J, Murrieta, CA 92562 Contact Person: Mike Maples Telephone No.: 951491-9562 Title of Project: ADA Access Deck Project Location: 32040 Riverside Dr., Lake Elsinore, CA 92530 Date of Completion: 612020 Contract Amount: 147,718.00 7. Name Firm/Agency): Calvary Chapel Bible Fellowship Address: 34180 Rancho California Rd., Temecula, CA 92592 Contact Person: Clark Van wick Telephone No.. 951-694-5809 Title of Project: Baptismal Remodel Project Location. 34180 Rancho California Rd., Temecula, CA 92592 Date of Completion: 512020 Contract Amount: 188,786.80 DocuSign Envelope IR A2513331-AO4A45A8-A3E9-OBA4117891B1 CONTRACTOR'S INFORMATION CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REHABILITATION DOCUMENTS Contractor's License No.: 920943 a. Date first obtained. 2008 Class: b. Has License ever been suspended or revoked? rio If yes, describe when and why: c. Any current claims against License or Bond? NO If yes, describe claims: B Expiration 9/30/2022 Principals in Company (List all -- attach additional sheets if necessary): NAME David Carter Keri Carter TITLE Secretary President LICENSE NO. If Applicable) Q 42 0 V3 DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 EXHIBIT B4 Required Bid Form CERTIFICATION OF BIDDER REGARDING NONSEGREGATED FACILITIES Project Name: Lake Community Hall Renovation Name of Bidder: UBCA, WC dba Unique Builders of CA The above named Bidder hereby certifies that: I do not maintain or provide for my employees any segregated facilities at any of my establishments, and that I do not permit my employees to perforin their services at any location, under my control, where segregated facilities are maintained. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, rest rooms, wash rooms, restaurants and other eating areas, time clocks, locker rooms or other dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, national origin, or because of habits, local customs, or otherwise. I further agree to obtain identical certifications from all proposed subcontractors prior to the award of subcontracts exceeding $14,000. Signature: oC Name (Print): David Carter Title: Secretary Date: 10/21/21 Docusign Envelope ID: A2513331-A04A-45A8-A3E9-08A411789181 EXHIBIT B-6 Page 1 of 3 Required Bid Form for bids 100,000 or more BIDDER CERTIFICATION FOR SECTION 3 COMPLIANCE Housing and Community Development Act of 1968) Project Title: Lake Community Hall Renovation Amount of Bid: $547,550-00 The undersigned hereby certifies that he/she has read and understands Riverside County's Section 3 Affirmative Action Program as well as Section 3 of the Housing and Community Development Act of 1965, and further certifies adoption of, and adherence to, said program, and certifies understanding of the following for all construction contracts over $200,000. 1. Employment Opportunities I understand and agree that in the event that I am awarded this contract, and in the event that any new employment opportunities are created as a result of this CDBG-- funded project, I will: a. Contact the U.S. Department of Housing and Urban Development (HUD) Section 3 website at 1 xvw.iiud.govisection.3 to review the list of certified Section 3 persons, within Riverside County, to be considered for available employment opportunities; and Initial Hare b. Forward to the Department of Housing Homelessness Prevention & Workforce Solutions all detailed job descriptions for new employment opportunities and Section 3 reports, in a form, at a place, and at a time as directed by the Department of Housing Homelessness Prevention & Workforce Solutions. 0 Initial Here DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 Complete your proposed workforce plan for this project below: 0=== -- InitialInitial Here JOB CATEGORY CURRENT NUMBER OF NUMBER OF NEN HIRES OF NEW HIRES TO BE PROPOSED TO BE POSITIONS NEW HIRES SECTION 3 RESIDENTS SECTION 3 IF AWARDED BID PROFESSIONALS 7 0 0 0 TECHNICIANS OFFICEICLERICAL 2 0 4 0 CONSTRUCTION BY TRADE TRADE TRADE TRADE TRADE TRADE TRADE APPRENTICE TRAINING OTHER TOTAL Page 2 of 3 DocuSign Envelope ID: A2513331-A04A-45A8-A3E9-08A411789181 EXHIBIT B-6 Page 3 of 3 BIDDER CERTIFICATION FOR SECTION 3 COMPLIANCE IL Subcontracting Opportunities a. I understand and agree that for any and all subcontracting opportunities that may result from this CDBG-funded project, I will contact the U.S. Department of Housing and Urban Development (HUD) Section 3 website at WVVW.hUd.vovisection , to review the list of certified Section 3 Businesses, within Riverside County, to be considered for available subcontracting opportunities prior to selecting any subcontractor for my bid submittal. Initial Here b. I understand and agree that any and ,all sub -contracts and sub -tier agreements resulting from this CDBG-funded project are also subject to Section 3 compliance, and therefore, as the General/Prime Contractor, I am responsible to ensure compliance from all subcontractors. Initial Here Complete your Subcontractine Plan for this proiect below: TRADE AMOUNT OF SUBCONTRACT($) IS THE SUBCONTRACTOR SECTION 3 ELIGIBLE? YES OR NO IF SUBCONTRACTOR IS SECTION 3, INDICATE ELIGIBLE STATUS. 51% OWNER l 30% EMPLOYEE DC Painting 47,000.04 No Pursuit Electric 24,000.00 No Right Way Roof 204,000.00 No Add additional sheets if necessary Bidder (Company) Name: g 9C4 Authorized Representative (Type Name): Signature: r Date: 10/21/21 David Carter DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 EXHIBIT B-7 Required Bid Foran COUNTY OF RIVERSIDE CDBG PROGRAM BIDDER CERTIFICATION ON FEDERAL CONTRACT REQUIREMENTS PROJECT NAME: Lake Community Hall Renovation CERTIFICATION: I hereby certify that I have reviewed and understand the diversified Federal construction contract related requirements imposed on the Contractor(s) of HUD -funded construction projects, including but not limited to the following: 1. The subject project is being financed with Community Development Block Grant funds (24 CFR Part 570; 2. This project and all related construction contracts are subject to the U.S. Department of Housing and Urban Development's Federal Labor Standards Provisions (HUD 4010 — revised 0612009); and 1. This project is subject to all applicable laws and regulations as listed in the General Summary of these Special Federal Provisions; and 2. If my bid is $200,000 or more, this project and all related contracts will subject to Section 3 requirements (12 U.S.C. 1701u). CONTRACTOR'S NAME: UBCA, INC CONTRACTOR'S LICENSE NO.: 920943 ADDRESS: 33175 Temecula Pkwy Ste A # 747, Temecula, CA 92592 AUTHORIZED REPRESENTATIVE: SIGNATURE: DATE: J U, Z i - -Z-ti David Carter Type Name) DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 EXHIBIT B-8 Required Bid Form QUESTIONNAIRE REGARDING BIDDERS Bidder has been engaged in the contracting business under the present name of UBCA, INC dba Unique Builders of California Present business address is: Federal Tag ID: 82-54700 since 2008 33175 Temecula Pkwy Ste A #747, Temecula, CA 92592 Amount of Bid S 547,550.00 California Contractor's License No. -92M3 DUNS Number: Expiration Date: 9/30/2022 or CAGE Code: Date). Because this project is Federally -funded, it is necessary to obtain information concerning minority and other group participation for statistical purposes. The U.S. Department of Housing and Urban Development (HUD) uses this information to determine the degree to which its programs are beingutilizedbyminoritybusinessenterprisesandtargetedgroupcontractors. A minority enterprise is defined by the Federal Government as a business that is fifty -one -one percent (51 %) ar more "minority -Owned` . Please check applicable box concerning the ownership of your business: American Indian or Native Alaskan Asian or Pacific IslanderJNative Hawaiian Black/African American Hispanic White Hasidic Jews Other A woman -owned enterprise is defined -by the Federal Government as a business that is fifty - percent (5411/6) or more woman -owned. Please check applicable box concerning the Ownershipofyourbusiness: Woman/Female owned ® Male owned A Section 3 Contractor or Subcontractor is a business concern that is more than fifty-one percent (51%) owned by a low or very low-income person, or a business concern that provides economic opportunities to low and very low-income residents. Please check applicable box concerning the ownership of yourbusiness: Section 3 Business concern ® Non -Section 3 Business concern The United States Department of Housing and Urban Development (HUD) is authorized to solicit the information requested in this form by virtue of Title 12, United&ates Code, Section 1701 e7 seq., and other regulations. It will not bedisclosedorreleasedoutsideofHUDwithoutyourconsent, except as required or permitted by law. DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 IL u d U 6 - m II II II II II II C? b r Q Q r G DU C Cdd V] yy U 5 r M c M U z Q U 04 G C U L Q U p z 0 p vi V b C Cjap Q c m y 2 0 r- 0 W N T N V U Q oapaaC U ri w V a kn Lr-) Q u 6 - m II II II II II II DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 SECTION 3 SUMMARY REPORT EXHIBIT PA -5 ECONOMIC OPPORTUNITIES FOR LOW AND VERY LOW-INCOME PERSONS PROJECT NAME: 220021 Lake Community Center Rehabilitation DATE_ CONTRACTOR: UBCA, INC dba Unique Builders of California SUBCONTRACTOR: JOB CATEGORY NUMBER OF NEW HIRES NUMBER OF NEW HIRES THAT ARE SECTION 3 RESIDENTS OF AGGREGATE NUMBER OF STAFF HOURS OF NEW HIRES THAT ARE SECTION 3 OF TOTAL STAFF HOURS FOR SECTION 3 EMPLOYEES PROFESSIONALS 0 0 0 0 TECHNICIANS 0 0 0 0 OFFICE 1 CLERICAL 0 0 0 0 CONSTRUCTION BY TRADE 0 0 0 0 TRADE TRADE TRADE TRADE TRADE OTHERS 0 0 0 TOTAL 0 0 0 NAME OF PERSON COMPLETING FORM: K.Qr I ec, I:p- SIGNATURE: Section 3 "New Hires" refers to a person who is not on the Contractor's payroll for employment at the time of Contract award. Recipients and contractors subject to Section 3 requirements must maintain appropriate documentation to establish that HUD financial assistance for CABG -funded projects was directed to low-income and very low-income persons. Low-income persons means families (including single people) whose incomes do not exceed 84% of the area median household income, as established by ffUD, with adjustments for family size. Very low-income persons means families (including single people) whose incomes do not exceed 50% of the area median household income, as established by HUD, with adjustments for family size. 117 DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 EXHIBIT PA -6 CDBG PROJECT LABOR CLASSIFICATION SURVEY PROJECT NAME: Lake Comm Center Rehab CONTRACTOR: [IBCA, INC PROJECT NUMBER: 220021 SUBCONTRACTOR: RL] CLASSIFICATIONS BRICKLAYER LABORERS: GROUP 1 2 CARPENTERS 7 GROUP 2 CEMENT MASONS 3 GROUP 3 DRYWALL HANGERS 3 GROUP 4 ELECTRICIANS GROUPS IRON WORKERS POWER EQUIPMENT OPERATORS PAINTERS GROUPS I — 21 PLUMBERS 2 ROOFERS SHEET METAL WORKERS TRUCK DRIVERS GROUPS I A I _ SOFT FLOOR LAYERS 2 TILE LAYERS 2 LANDSCAPE I IRRIGATION FITTERS ADDITIONAL CLASSIFICATIONS Must be approved by HUD and DOL) LABORERS — STRIPPING CLASSIFICATIONS PLASTERER 2 Please note, our employees do multiple trades OTHERS therefore a carpenter may do drywall. No new hirestemployees will be needed for this ,job S:ICDBGLCONSTRUCfIOMConbmctor.Sub ChecUstTI)BG PROJECT LABOR CLASSICFICATION SURVEY.doc RL] DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 PA -6 (Continued) PROJECT NAME: Lake Community Center Rehabilitation WAGE DECiSiON NUMBERIMODIFICATION NUMBER: PROJECT NUMBER: 220021 PROJECT COUNTY: Riverside WORK CLASSIFICATION BASIC HOURLY RATE BHR FRINGE BENEFITS TOTAL HOURLY WAGE RATE LABORERS FRINGE BENEFITS: 24.60 Bricklayers GROUP# BHR TOTAL WAGE Carpenters 44.69 23.88 68.57 1 62.03 Cement Masons 40.30 26.80 67.10 Drywall Hangers 44.44 24.21 68.65 Electricians Iron Workers Painters OPERATORS FRINGE BENEFITS: Plumbers 53.83 26.75 80.58 GROUP # BHR TOTAL WAGE Roofers Sheet Metal Workers Soft Floor Layers 38.75 14.31 53.06 Japers file Setters 43.09 18.69 61.78 TRUCK DRiYERS FRINGE BENEFITS: OTHER CLASSIFICATIONS GROUP# BHR TOTAL WAGE ADDmoKAL CLASSIFICATIONS HUD Form 4230 - WORK CLASSIFICATION BASIC HOURLY RATE FRINGE BENEFITS TOTAL HOURLY WAGE RATE DATE OF HUD SUBMISSION TO DOL DATE OF DOL APPROVAL DocuSign Envelope IR A2513331-AO4A45A8-A3E9-OBA4117891B1 VIOLATIONS OF FEDERAL. STATE OR LOCAL LAWS CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REMODEL DOCUMENTS 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? YEINQ (circle one) Federal I 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? YE INO (circle one) Code/Laws: Section/Article: If "yes," identify and describe, (including agency and status): 120 DocuSign Envelope IR A2513331-AO4A45A8-A3E9-08A411789161 DISQUALIFICATION OR DEBARMENT CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REMODEL DOCUMENTS 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? Y s ! (circle one) ND 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? Y -F -S_ (circle one) r/ 121 DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 I:n•:- LHKE L4I [YC]!ZF 111.1 ..., I Yf ', _ NOTICE INVITING BIDS NOTICE IS HEREBY GIVEN that sealed bids will be received by the City of Lake Elsinore for the work generally described as: LAKE COMMUNITY CENTER REHABILITATION DOCUMENTS FILE NO. 1.LE.73-20 C I P PROJECT NO. 7-20021 Bids will be publicly opened, examined and declared in the City Hail Conference Room A, 130 South Main Street, Lake Elsinore, California, at the hour of 2:00 p.m. on October 21, 2021. A mandatory lob -walk at the project site wi ll be held at 10:00a.m. October 6, 2021 - The City of Lake Elsinore utilizes Planet Bids, Inc. to administer its Online Bidding System. PlanetBids requires potential vendors and bidders to register of htips://www. planetbids.com/portal/poria I.c fm? Company i D_ 14272#) in order to download contract and bid proposal documents, thereby assuring a means of no- tifying vendors and bidders are identified as "Planholders" of all subsequent information and addenda issued by the City. Only the electronic documents downloaded directly from PlanetBids will be considered tube official documents of the City of Lake Elsinore. Purpose: The City of Lake Elsinore is remodel the Lake Community Center located at 310 W. Graham Ave., Lake Elsinore Co. 92530. In short, the some of the molar elements of the remodel project will include adding office spaces upstairs, adding a front entry a bathroom, and interior walls to make improved use of the interior space. Also the project will include an ADA accessible sidewalk ;ending up to the building from the street. The purpose of this proposal is to seek a contractor for the remodeling construction of the Lake Community Center project according to plans contained herein. Scope: The Contractor will furnish a proposal and price for all materials, labor and equip- ment to complete the lob and deliver the entire site. The contractor must familiarize him- self with the site, all details of the work required, and existing conditions. The contractor must be a going entity for at least 3 years, produce a valid certificate of liability insurance, which must be on hand before work begins. All work will be permitted and inspected through the City of Loke Elsinore Building Department. General Requirements: Demolition Framing Windows and Doors Roofing Sheet Metal Flashing & Trim Painting Flooring Concrete Cement Plaster Ceiling and lighting Cabinets Interior and Exterior Miscellaneous Aluminum Trellis Federal Funding: This project is being financed with Community Development Block Grant funds from the U.S. Department of Housing and Urban Development (24 CFR Part 570) and subiect to certain requirements including: compliance with Section 3 (24 CFR Part 135) Economic Opportunities requirements; payment of Federal Davis -Bacon prevailing wages; Federal Labor Standards Provisions (HUD 4010); Executive Order #112x6; and oth- ers. Information pertaining to the Federal requirements is on file with the County of River- side Hausing, Homelessness Prevention. and Workforce Solutions. Prevailing Wages: The Federal minimum wage rate requirements, as predetermined by the Secretary of Labor. are set forth in the books issued for bidding purposes, referred to herein as Project Bid Documents (Special Federal Provisions), and in copies of this book which may be examined at the office described above where the proiect plans, special pro- visions, and proposal forms may be seen. Addenda to modify the minimum wage rates, if necessary, wlll be issued to holders of the Proiect Bid Documents. Qualifications: All bidders must be licensed, qualified, and understand haw to identify the most effective and efficient construction methods to complete the project. Pre -Construction Meeting: After award, selected contractor will attend a pre - construction meeting on a date to be determined. ANTICIPATED CONTRACT TIME: 65 WORKING DAYS FROM NOTICE TO PROCEED Bidding documents may be obtained online: For technical information relating to the details of the Specifications and/or bidding requirements, please contact Gus Popagolos of 951-764 2417. Candice Alvarez. City Clerk Published: Monday, September 20, 2021 Press -Enterprise DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-0BA4117891 81 THE PRESS -ENTERPRISE 1825 Chicago Ave, Suite 100 Riverside, CA 92507 951-684-1200 951-368-9018 FAX PROOF OF PUBLICATION 2010, 2015.5 C.C.P) Publication(s): The Press -Enterprise PROOF OF PUBLICATION OF Ad Desc.: 1 I am a citizen of the United States. I am over the age of eighteen years and not a party to or interested in the above entitled matter. I am an authorized representative of THE PRESS -ENTERPRISE, a newspaper in general circulation, printed and published daily in the County of Riverside, and which newspaper has been adjudicated a newspaper of general circulation by the Superior Court of She County of Riverside, State of California, under date of April 25, 1952, Case Number 54446, under date of March 29, 1957, Case Number 65673, under date of August 25, 1995, Case Number 267864, and under date of September 16, 2013, Case Number RIC 1309013: that the notice, of which the annexed is a printed copy, has been published in said newspaper in accordance with the instructions of the person(s) requesting publication, and not in any supplement thereof on the following dates, to wit: 09/20/2021 I certify (or declare) under penalty of perjury that the foregoing is true and correct. Date: September 20, 2021 At: Riverside, California Legal Advertising Representative, The Press -Enterprise LAKE ELSINORE, CITY OF 130 S MAIN ST ATTN: CITY CLERKS OFFICE LAKE ELSINORE, CA 92530 Ad Number 0011488875-01 P.D. Number: Ad Copy: DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 CITY OF ^,-, LASE LSIRORJE 1)REAM EXT RLM1'ry NOTICE INVITING BIDS NOTICE IS HEREBY GIVEN that sealed bids will be received by the City of Lake Elsinore for the work generally described as: LAKE COMMUNITY CENTER REHABILITATION DOCUMENTS FILE NO. 1.LE.73-241 CIP PROJECT NO. Z20021 Bids will be publicly opened, examined and declared in the City Hall Conference Room A, 130 South Main Street, Lake Elsinore, California, at the hour of 2:04 p.m. on October 7, 2021. A mandatory job -walk at the project site will be held at 10:00a_m. September 22, 2021. The City of Lake Elsinore utilizes PlanetBids, Inc. to administer its Online Bidding System. PlanetBids requires potential vendors and bidders to register at hftps://www.planetbids.com/portallportal.cfm?CompanylD=14272#) in order to download contract and bid proposal documents, thereby assuring a means of notifying vendors and bidders are identified as "Planholders" of all subsequent information and addenda issued by the City. Only the electronic documents downloaded directly from PlanetBids will be considered to be official documents of the City of Lake Elsinore. Purpose: The City of Lake Elsinore is remodel the Lake Community Center located at 310 W. Graham Ave., Lake Elsinore Ca. 92530. In short, the some of the major elements of the remodel project will include adding office spaces upstairs, adding a front entry a bathroom, and interior walls to make improved use of the interior space. Also the project will include an ADA accessible sidewalk leading up to the building from the street. The purpose of this proposal is to seek a contractor for the remodeling construction of the Lake Community Center project according to plans contained herein. Scope: The contractor will furnish a proposal and price for all materials, labor and equipment to complete the job and deliver the entire site. The contractor must familiarize himself with the site, all details of the work required, and existing conditions. The contractor must be a going entity for at least 3 years, produce a valid certificate of liability insurance, which must be on hand before work begins. All work will be permitted and inspected through the City of Lake Elsinore Building Department. General Requirements: Demolition Windows and Doors Painting Concrete Ceiling and lighting Interior and Exterior Miscellaneous Framing Roofing Sheet Metal Flashing & Trim Flooring Cement Plaster Cabinets Aluminum Trellis Federal Funding: This project is being financed with Community Development Block Grant funds from the U.S. Department of Housing and Urban Development (24 CFR Part 570) and subject to certain requirements including: compliance with Section 3 (24 CFR Part 135) Economic Docusign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 Opportunities requirements; payment of Federal Davis -Bacon prevailing wages; Federal Labor Standards Provisions (HUD 4010); Executive Order #11245; and others. Information pertaining to the Federal requirements is on file with the County of Riverside Housing, Homelessness Prevention, and Workforce Solutions. Prevailing Wages: The Federal minimum wage rate requirements, as predetermined by the Secretary of Labor, are set forth in the books issued for bidding purposes, referred to herein as Project Bid Documents (Special Federal Provisions), and in copies of this book which may be examined at the office described above where the project plans, special provisions, and proposal forms may be seen. Addenda to modify the minimum wage rates, if necessary, will be issued to holders of the Project Bid Documents. Qualifications: All bidders must be licensed, qualified, and understand how to identify the most effective and efficient construction methods to complete the project. Pre -Construction Meeting: After award, selected contractor will attend a pre -construction meeting on a date to be determined. ANTICIPATED CONTRACT TIME: 65 WORKING DAYS FROM NOTICE TO PROCEED Bidding documents may be obtained online: For technical information relating to the details of the Specifications and/or bidding requirements, please contact Gus Papagolos at 951-764 2417. Jason Simpson City Manager Candice Alvarez, City Clerk 811 nitro] Posted at City Hall on: DocuSign Envelope IR A2513331-AO4A45A8-A3E9-08A411789161 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 Contract Documents 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 Specifications, and Contract Documents, and has investigated the site of the work and is familiar with the conditions thereon. USCA, INC Contractor Date: l .0 1,Z 1 , Z l By: 1 _- Contractor's State License No.: 420493 Class: ]s Address: 33175 Temecula Pkwy Ste A 4747 Temecula, CA 92592 Phone: 909-851-4330 FAX: 951-303-0075 DocuSign Envelope ID: A2513331-A04A-45A8-A3E9-08A411789181 EXHIBIT PA -3 SUBCONTRACTOR QUESTIONNAIRE Subcontrator has been engaged in the co.Qtracting bjsiness under the present name of: L 0_L `t , since -iii- M (Date). Present business address ism Jj SoC . t 4"r , Federal Tax ED: g_ I 9 9 qq Amount of Subcontract $ QC's State of California Contractor's License No.: 211 t t._ Le, Expiration Date: 4 Because this project is Federally -funded, it is necessary to obtain information concerning minority and other group participation for statistical purposes. The U.S. Department of Housing and Cuban Development (HUD) uses this information to determine the degree to which its programs are being utilized by minority business enterprises and targeted group contractors. A minority enterprise is defined by the Federal Government as a business that is fifty-one percent (51 %) or more "minority-owned". Please check applicable box concerning the ownership of your business: U American Indian or Native Alaskan 0 Asian or Pacific Islander/Native Hawaiian Black/African American Ok Hispanic White Hasidic Jews Other A woman -owned enterprise is defined by the Federal Government as a business that is fifty - percent (501/o) or more woman -owned. Please check applicable box concerning the ownership of your business: Woman/Female owned Male owned A Section 3 Contractor or Subcontractor is a business concern that is more than fifty -percent (50°/Q) owned by a low or very low-income person, or a business concern that provides economic opportunities to low and very low-income residents. Please check applicable box concerning the ownership of your business: Section 3 Business concern 1' Non -Section 3 Business concern The United States Department of Housing and Urban Development (HUD) is authorized to solicit the information requested in this form by virtue of Title 12, United States Code, Section 170! et seq., and other regulations. It will not be disclosed or released outside of HUD without your consent, except as required or permitted by law. DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 do V a v tCdd n a7 O r Ov 7 L a N CO a C U o rn 0 2 1 owz V7 b C a u9 0 w H0 v Q E u v', 00 o kE Uvr do DocuSign Envelope ID: A2513331-A04A-45A8-A3E9-08A411789181 EXHIBIT PA4 CERTIFICATION OF SUBCONTRACTOR REGARDING NONSEGREGATED FACILITIES ProjectName: Name of Subcontractor: Name of General Contractor: k3 J- ck S --DI [ The above named Subcontractor hereby certifies that: I do not maintain or provide for my employees any segregated facilities at any of my establishments, and that I do not permit my employees to perforin their services at any location, under my control, where segregates) facilities are maintained. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, rest rooms, wash rooms, restaurants and other eating areas, time clocks, locker rooms or other dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, national origin, or because of habits, local customs, or otherwise. Signature' k Name (Print): r NL— k--Vj_ Title: 91'\ i 41MI Date: 116 DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 SECTION 3 SUMMARY REPORT EXHIBIT PA -5 ECONOMIC OPPORTUNITIES FOR LOW AND VERY LOW-INCOME PERSONS 2j-- PROJECTPROJECT NAME: L L'1 DATE: CONTRACTOR: ' • r JOB CATEGORY NUMBER OF NEW HIRES NUMBER OF NEW HIRES THAT ARE SECTION 3 RESIDENTS OF AGGREGATE NUMBER OF STAFF HOURS OF NEW HIRES THAT ARE SECTION 3 OF TOTAL STAFF HOURS FOR SECTION 3 EMPLOYEES PROFESSIONALS TECHNICIANS OFFICE 1 CLERICAL CONSTRUCTION BY TRADE TRADE fd S V11I1r5 TRADE TRADE TRADE TRADE OTHERS TOTAL NAME OF PERSON COMPLETING FORM: SIGNATURE: Section 3 "New Hires" refers to a person who is not on the Contractor's payroll for employment at the time of Contract award. Recipients and contractors subject to Section 3 requirements must maintain appropriate documentation to establish that HUD financial assistance for CDBG-funded projects was directed to low-income and very low-income persons. Low-income persons means families (including single people) whose incomes do not exceed 80% of the area median household income, as established by HUD, with adjustments for family size. Very low-income persons means families (including single people) whose incomes do not exceed 54°/a of the area median household income, as established by HUD, with adjustments for family size. 117 DocuSign Envelope ID: A2513331-A04A-45A8-A3E9-08A411789181 EXHIBIT PA -6 CDBG PROJECT LABOR CLASSIFICATION SURVEY PROJECT NAME: -- L'x runur CONTRACTOR: PROJECT NUMBER: SUBCONTRACTOR YY-# 1 V' _ . -n• S:ICDBOCONSTRUCTIONICentrwc or -Sub Check1is6CDBG PROJECT LABOR CLASSIMCA7IGN SURVEY.duc 118 CLASSIFICATIONS BRICKLAYER LABORERS: GROUP I CARPENTERS GROUP 2 CEMENT MASONS GROUP 3 DRYWALL HANGERS GROUP 4 ELECTRICIANS GROUP 5 IRON WORKERS POWER EQUIPMENT OPERATORS PAINTERS GROUPS i — 21 _ PLUMBERS ROOFERS SHEET METAL WORKERS TRUCK DRIVERS GROUPS 1-I1 SOFT FLOOR LAYERS TILE LAYERS LANDSCAPE 1 IRRIGATION FITTERS ADDITIONAL CLASSIFICATIONS Must be approved by HUD and DOL) LABORERS — STRIPPING CLASSIFICATIONS PLASTERER OTHERS S:ICDBOCONSTRUCTIONICentrwc or -Sub Check1is6CDBG PROJECT LABOR CLASSIMCA7IGN SURVEY.duc 118 DocuSign Envelope ID: A2513331-AO4A45A8-A3Eg-OBA4197891B1 PA -6 (Continued) PROJECT H E: W iC E DECISION NUMBERIMODIFICATION NUMBER: PROJECT NUMBER: Z a -` c) PROJECT U^NT,Y: Y, ,1- -2 i WORK CLASSIFICATION BASIC HOURLY RATE BHR FRINGE BENEFITS TOTAL HOURLY WAGE RATE LABORERS FRINGE BENEFITS: Bricicla ers CsROUP # BHR TOTAL WAGE Carpenters Cement Masons Drywall Hangers Electricians S Iron Wor} ers Painters 1 OPERATORS FRINGE BENEFITS: Plumbers GROUP # BHR TOTAL WAGE Roofers Sheet Metal Workers Soft Floor Layers 1$ Tapers Tile Setters TRUCK DRIVERS FRINGE BENEFITS: OTHER CLASSIFICATIONS GROUP # BHR TOTAL WAGE ADDmoNAL CLANFICATtONS HUD Form 4230 - WORK CLASSIFICATION BASIC HOURLY RATE FRINGE BENEFITS TOTAL HOURLY WAGE RATE DATE OF HUD SUBMISSION TO Dot. DATE OF DOL APPROVAL RocuSign Envelope V A2513331-AO4A45A8-A3Eg-OBA419789161 VIOLATIONS OF FEDERAL STATE OR LOCAL LAWS CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REMODEL DOCUMENTS 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? YES11\10 (circle one) Federal 1 State / Local (circle one) If "yes," identify and describe, (including agency and status): T d - h (4 - .VL. I iZ,) Have the penalties been paid? I SINO (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(O. (circle one) Code/Laws: Section/Article: If "yes," identify and describe, (including agency and status): 120 RocuSign Envelope V A2513331-AO4A45A8-A3Eg-OBA419789161 DISQUALIFICATION DR DEBARMENT CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REMODEL DOCUMENTS 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 ! (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 ! (circle one) NO 121 mc&FEnvelope OA2ywS9wA45AaGk*es« 9e,W DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 SUBCONTRACTOR QUESTIONNAIRE Subcontrator has been engaged in the contracting business under the present name of - Rite -Way Roof Corporation . since Aug. 15, 2001 Present business address is: 15425 Arrow Route, Fontana, CA 92335 Federal Tax ID: 33-0978921 Amount of Subcontract S 145,710.00 State of California Contractor's License No.: 1361941 Expiration Date: 01/31/2022 EXHIBIT PA -3 Date). Because this project is Federally -funded, it is necessary to obtain information concerning minority and other group participation for statistical purposes. The U.S. Department of Housing and Urban Development (HUD) uses this information to determine the degree to which its programs are being utilized by ininori ty business enterprises and targeted group contractors. A minority enterprise is defined by the Federal Goverrunent as a business that is fifty-one percent (5l%) or more "minority-owned". Please check applicable box concerning the ownership of your business: American Indian or Native Alaskan Asian or Pacific Islander/Native Hawaiian Black/African American Hispanic White Hasidic Jews Other A woman -owned enterprise is defined by the Federal Government as a business that is fifty - percent (50%) or more woman -owned. Please check applicable box concerning the ownership of your business: Woman/Female owned 10 Male owned A Section 3 Contractor or Subcontractor is a business concern that is more than fifty -percent (501/0) owned by a low or very low-income person, or a business concern that provides economic opportunities to low and very low-income residents. Please check applicable box concerning the ownership of your business: Section 3 Business concern 10 Non -Section 3 Business concern The United States Department of Housing and Urban Development (HUD) is authorised to solicit the information requested in this form by virtue of Title 11, United States Cade, Section 1701 et seq., and other regulations. It will not be disclosed or released outside of 11UD without your consent, exec pt as required or permitted by law. DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 O 10 as+ Q. V, A w W m y 4 nO R m a SW iV CD O CL D 4. CI'a @ O 7O L7 s n mas°Fi mro m Q Oz 0 C 0 F e o t Z o w fa 3m N N 1 m Z o D0 n D 0 os N n O NLSI Q a o x c N a 3 R n NWWrs nO R m a SW iV CD O CL D RocuSign Envelope V A2513331-AO4A45A8-A3E9-OBA419789161 EXHIBIT PA -4 CERTIFICATION OF SUBCONTRACTOR REGARDING NONSEGREGATED FACILITIES Project Name: City of Lake Elsinore -Lake Community Center Remodel Name of Subcontractor: Rite -Way Roof Corporation Narne of General Contractor: Unique Builders of CA The above named Subcontractor hereby certifies that: I do not maintain or provide for my employees any segregated facilities at any of my establishments, and that I do not permit my employees to perform their services at any location, under my control, where segregated facilities are maintained. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, rest rooms, wash rooms, restaurants and other eating areas, time clocks, locker rooms or other dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, color, religio,ata al origin, or because of hallits, local customs, or otherwise. Signature: Name (Print): ,Jeff Hughes Title: President Mile: October 26, 2021 116 DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 SECTION 3 SUMMARY REPORT EXHIBIT PA -S ECONOMIC OPPORTUNITIES FOR LOW AND VERY LOW-INCOME PERSONS PROJECT NAME: City of Lake Elsinore -Lake Community Center Remodel DATE: October 26, 2021 CONTRACTOR: Unique Builders of CA SUBCONTRACTOR: Rite -Way Roof Corporation JOS CATEGORY NUMBER OF NEW HIRES NUMBER OF NEW HIRES THAT ARE SECTION 3 RESIDENTS OF AGGREGATE NUMBER OF STAFF HOURS OF NEIN HIRES THAT ARE SECTION 3 OF TOTAL STAFF HOURS FOR SECTION 3 EMPLOYEES PROFESSIONALS TECHNICIANS OFFICE 1 CLERICAL CONSTRUCTION BY TRADE TRADE Roofing 0 0 0 0 TRADE TRADE TRADE TRADE OTHERS TOTAL NAME OF PERSON COMPLETING FORM: SIGNATURE' Lisa S. Mora Section w Hires" refers to a person who is not on the Contractor's payroll for employment at the time of Contract award. Recipients and contractors subject to Section 3 requirements must maintain appropriate documentation to establish that HUD financial assistance for CDBG-funded projects was directed to low-income and very low-income persons. Low-income persons means families (including single people) whose incomes do not exceed 80% of the area median household income, as established by HUD, with adjustments for family size. Very low-income persons means families (including single people) whose incomes do not exceed 54% of the area median household income, as established by HUD, with adjustments for family size. 117 DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 EXHIBIT PA -5 CDBG PROJECT LABOR CLASSIFICATION SURVEY City of Lake Elsinore - PROJECT NAME: Lake Community Center Remodel CONTRACTOR: Unique Builders of CA PROJECT NUMBER: 220021 SUBCONTRACTOR: Rite -Way Roof Corporation BRICKLAYER CARPENTERS CEMENT MASONS DRYWALL HANGERS ELECTRICIANS IRON WORKERS PAINTERS PLUMBERS ROOFERS 28 SHEET METAL WORKERS SOFT FLOOR LAYERS TILE LAYERS LANDSCAPE 1 IRRIGATION FITTERS LABORERS — STRIPPING PLASTERER OTHERS CLASSIFICATIONS LABORERS: GROUP I GROUP2 GROUP3 GROUP 4 GROUP5 POWER EQUIPMENT OPERATORS GROUPS 1-21 TRUCK DRIVERS GROUPS I -I l ADDITIONAL CLASSIFICATIONS Must be approved by HUD and DOL) CLASSIFICATIONS sx.oni coNS'rRUCTSONkCowmdor.Suh ChecklistTDBG PROJECT LABOR CLASS ICFI CATION SUR VBYdK 118 DocuSign Envelope [D: A2513331-AO4A45A8-A3E9-OBA4117891B1 PA -6 (Continued) PROJECT NAME: Lake Communtiy Center Rehabiitation WAGE DECISION NUMBERIMODIFICATION NUMBER: PROJECT NUMBER: Z20021 PROJECT COUNTY: Riverside WORK CLASSIFICATION BASIC HOURLY RATE BHR FRINGE BENEFITS i TOTAL HOURLY WAGE RATE LABORERS FRINGE BENEFITS: Brickia ers GROUP # BHR TOTAL WAGE Carpenters S Cement Masons Drywall Hangers Electricians Iron Workers Painters OPERATORS FRINGE BENEFITS: 1 $ Plumbers GROUP # BHR TOTAL WAGE Roofers Foreman 47.75 19.55 sQ7.3Q$ S Sheet Metal Workers Soft Floor Layers Tapers Tile Setters TRUCK DRIVERS FRINGE BENEFITS: OTHER CLASSIFICATIONS GROUP # SHR TOTAL WAGE Journeyman 42,07 19.55 61.62$ Apprentice 7th Period 16.70 54.97$ S Apprentice 6th Period 34.47 15.70 51.17$ 1 ADDITIONAL CLASSIFICATIONS HUD Form 4230•A WORK CLASSIFICATION BAsiC HOURLY RATE FRINGE BENEFITS TOTAL HOURLY WAGE RATE DATE OF HUD SUBMISSION TO DOL DATE OF DOL APPROVAL Apprentice 5th Period 30.67 16.45 Apprentice 4th Period 28.77 16.45 Apprentice 3rd Period 26.87 16.45 43.32 3 Apprentice 2nd Period 24.97 16.45 41.42 $ Apprentice 1st Period $23.06 $16.45 $39.51 DocuSign Envelope IR A2513331-AO4A45A8-A3E9-08A411789161 VIOLATIONS OF FEDERAL. STATE OR LOCAL CIR PROJECT NO. Z20021 LAKE COMMUNITY CENTER REMODEL DOCUMENTS 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? YE ND (circle one) Federal 1 State 1 Local (circle one) If "yes," identify and describe, (including agency and status): N/A 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? YEEECD (circle one) Code/Laws: NIA Section/Article: If "yes," identify and describe, (including agency and status): 120 DocuSign Envelope IR A2513331-AO4A45A8-A3E9-OBA4117891B1 DISQUALIFICATION OR DEBARMENT CIP PROJECT NO. Z20021 LAKE COMMUNITY CENTER REMODEL DOCUMENTS 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? S 1 (circle one) ND If yes, provide the following information (if more than once, use separate sheets): Date: Entity: Location: N/A Reason: Provide Status and any Supplemental Statement: NIA Has your firm been reinstated by this entity? I (circle one) 121 DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 EXHIBIT B-9 Required Biel Form LIST OF SUBCONTRACTORS SUBCONTRACTOR FED. I. D.# AMOUNT ADDRESSIPHONE NO. Distinctive Colors Painting % 3 _ q i $47,000.00 33125 Sweetwater Canyon, Menifee, 92584 Pursuit Electric 24,W0.00 1831 McCormack Ln, Placentia, 92870 Right Way Roof ;3- v 01'1 $200,000.00 15425 Arrow Rd. Fontana, 92335 SUPPLIERS NAME OF SUPPLIER ADDRESS/PHONE NO. CONTRACT AMOUNT This form is to be completed and submitted with the bid package. DocuSign Envelope ID: A2513331-A04A-45A8-A3E9-08A411789181 Page 1 of 2 EXHIBIT 13-10 Required Bid Farm for bids 100,000 or more SUBCONTRACTOR CERTIFICATION FOR SECTION 3 COMPLIANCE MUST BE COMPLETED BY ALL SUBCONTRACTORS Housing and Community Development Act of 1958) Project Title: Subcontractor: Lake Community Hail Renovation Contractor/Bidder: UBCA, INC The undersigned hereby certifies that he/she has read and understands Riverside County's Section 3 Affirmative Action Program as well as Section 3 of the Housing and Community Development Act n. f 1968, and further certifies adoption of, and adherence to, said program, and certifies understanding of the following for all prime construction contracts over $200,000: a. I understand and agree that in the event that I am awarded a subcontract, and in the event that any new employment opportunities are created as a result of this CDBG-funded project, I will contact the U.S. Department of Housing and Urban Development (HUD) Section 3 website at www.hud.gov/sec_tio113 to review the list of certified Section 3 persons, within Riverside County, to be considered for available employment opportunities; lnitW Here b. I will forward to the Department of Housing Homelessness Prevention & Workforce Solutions all detailed job descriptions and Section 3 reports, in a form, at a place, and at a time as directed by the Department of Housing Homelessness Prevention & Workforce Solutions. Page 2 of 2 EXHIBIT s-ln Complete your proposed workforce plan for this project below: a initial Here DocuSign Envelope ID: A2513331-A04A-45A8-A3E9-08A411789181 Subcontractor (Company) Authorized Representative (Type Name):— Signature: Date: t NUMBER OF NUMBER OF NEW HIRES JOB CATEGORY CURRENT NEW HIRES PROPOSED TO BE NEW HIRES TO BE POSITIONS IF AWARDED SECTION 3 SECTION 3 RESIDENTS BID PROFESSIONALS TECHNICIANS OFFICEICLERICAL CONSTRUCTION BY TRADE TRADE, P ,n r.' a TRADE TRADE TRADE TRADE TRADE APPRENTICE TRAINING OTHER TOTAL Subcontractor (Company) Authorized Representative (Type Name):— Signature: Date: t DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 Page 1 of 2 EXHIBIT B-10 Required Bid Farm f©r bids 100,000 or more SUBCONTRACTOR CERTIFICATION FOR SECTION 3 COMPLIANCE Project Title: MUST BE COMPLETED BY ALL SUBCONTRACTORS Housing and Community Development Act of 196$) Lake Community Hall Renovation Subcontractor: Rite -Way Roof Corporation Contractor/Bidder: UBCA, INC The undersigned hereby certifies that he/she has read and understands Riverside County's Section 3 Affirmative Action Program as well as Section 3 of the (lousing and Community Development Act of 1968, and further certifies adoption of, and adherence to, said program, and certifies understanding of the following for all prime construction contracts over $200,000: a. I understand and agree that in the event that I am awarded a subcontract, and in the event that any new employment opportunities are created as a result of this CDBO-funded project, I will contact the U.S. Department of Housing and Urban Development (HUD) Section 3 website at ww-w.hud.gov/section3 to review the list of certified Section 3 persons, within Riverside County, to be considered for available employment opportunities; 061 ifi,] Here b. I will forward to the Department of Housing Homelessness Prevention & Workforce Solutions all detailed job descriptions and Section 3 reports, in a form, at a place, and at a time as directed by the Department of Housing Homelessness Prevention & Workforce Solutions. Initial Here Page 2 of 2 EXHIBIT B-10 Complete your proposed workforce plan for this project below: DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 Subcontractor (Company) Name: Rite -Way Roof Corporation Authorized Representative (Type Name): Jeff Hughes Signature: Date: Onto er W21, 2021 NUMBER OF NUMBER OF NEW HIRES CURRENT NEW HIRES OF NEW FARES TO BE JOB CATEGORY POSITIONS IF AWARDED PROPOSED TO BE SECTION 3 SECTION 3 RESIDENTS BID PROFESSIONALS TECHNICIANS OFFICEICLERICAL B 0 0 0 CONSTRUCTION BY TRADE ROOFER TRADE Journeyman 20 0 0 0 TRADE TRADE TRADE TRADE TRADE APPRENTICE 8 0 0 0 TRAINING OTHER TOTAL 134 0 0 0 Subcontractor (Company) Name: Rite -Way Roof Corporation Authorized Representative (Type Name): Jeff Hughes Signature: Date: Onto er W21, 2021 DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 Page 1 of Z EXHIBIT 8-10 Required Bid Form for bids 100,000 or more SUBCONTRACTOR CERTIFICATION FOR SECTION 3 COMPLIANCE Project Title: MUST BE COINPLETED BY ALL SUBCONTRACTORS Housing and Community Development Act of 1968) Lake Community Hall Renovation Subcontractor: _NNV; 819C- c [AC, Contractor/Bidder: UBCA, INC The undersigned hereby certifies that he/she has read and understands Riverside County's Section 3 Affirmative Action Program as well as Section 3 of the Housing and Community Development Act of 1968, and further certifies adoption of, and adherence to, said program, and certifies understanding of the following for all prime construction contracts over $200,400: a. I understand and agree that in the event that I am awarded a subcontract, and in the event that any new employment opportunities are created as a result of this CDBG-funded project, I will contact the U.S. Department of Housing and Urban Development (HUD) Section 3 website at www .hud. ov/section3 to review the list of certified Section 3 persons, within Riverside County, to be considered for available employment opportunities; Initial dere b. I will forward to the Department of Housing Homelessness .Prevention & Workforce Solutions all detailed job descriptions and Section 3 reports, in a form, at a place, and at a time as directed by the Department of Housing Homelessness Prevention & Workforce Solutions. z_M Initial lie= Page 2 of 2 EXHIBIT B-10 Complete your proposed workforce plan for this project below: DocuSign Envelope ID: A2513331 -A04A-45A8-A3E9-OBA4117891 81 Subcontractor (Company) Name: Authorized Representative (Type Name): Signature: Date: i d[ L1 III NUMBER OF CURRENT NEW HIRES NUMBER OF NEW HIRES OF NEW HIRES TO BEEJOBICATEGORY POSITIONS IF AWARDED PROPOSED TO BE SECTION 3 SECTION 3 RESIDENTS BID PROFESSIONALS C' C7 Q Q TECHNICIANS a v v n OFFICEMLERICAL Q v v o CONSTRUCTION BY TRADE TRADE te Y+.i1 TRADE D G o TRADE Q 0 d 8 TRADE o a TRADE a 0 d TRADE 0 4 APPRENTICE v C3 G CJ TRAINING C C) d OTHER p Q 0 TOTAL T d k d Subcontractor (Company) Name: Authorized Representative (Type Name): Signature: Date: i d[ L1 III DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 ACC?R1:y CERTIFICATE OF LIABILITY INSURANCE MMfDDlYYYY} 73/16/2021 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: Ferrante Insurance Services, Inc. W"c°,., [925]674.1755 AF Ko: 925674-1663 1401 Willow Pass Road, Ste 880 L :_ ai@ferranteinsurance.com Concord, CA 94520 INSURERS} AFFORDING COVERAGE MAIC Y ID91034 INSURER A_ Lloyd's Synd 1991 AA1120142 INSURED INSURER B: Navigators Insurance Company 42307 UBCA Inc 412/2022 PERSONAL & ADV INJURY S 1,000 000 INSURER C: GENERAL AGGREGATE S INSURER 0: 41070 Via Del Toronjo INSURER E: Temecula CA 92592 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. AUTHORIZED REPRESENTATIVE POLIC FFITRTYPEOFINSURANCE SUBR POLICY NUMBER MMIOD YM PLIY EXPOrDDCtYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,00Q,000 X UAMAG—ETORYN—FED CLAIMS•MAD£ OCCUR PREMISES [Ea occurrence) - S 1100000 MED EXP (Any one Person) S 51000 A _ _ Y CISDTW100972 21 41212021 412/2022 PERSONAL & ADV INJURY S 1,000 000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 X POLICY _ JEQ _ LOC PRODUCTS_ COMPIOPAGG S 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT StEaacradentl ANY AUTO BODILY INJURY (Per Penson) S OWNED SCHEDULED AUTOS ONLY AUTOS e001LY INJURY (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per_a-cudent] 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE AGGREGATE S DED RETENTIONS 5 WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER__ ANY PROPRIETOWPARTNEWEXECUTIVE E.L. EACH ACCIDENT_ S OFFICERIMEMOER EXCLUDED? F] NIA Mandatory in NH] E.L. DISEASE - EA EMPLOYEE $ It describes, desbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S INLAND MARINE RenredlLeased Equip. 100,000 E 04-IM032496 2/2/2021 2/2/2022 DESCRIPTION OF OPERATIONS; LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached if more space is required) Certificate holder is named as additional insured per attached endorsement. I CERTIFICATE HOLDER CANCELLATION City of Lake Elsionore SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 130 South Main St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lake Elsionore, CA 92530 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE p 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and Toga are registered marks of ACORD DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 T ) ARE) CERTIFICATE OF LIABILITY INSURANCE DATE (MMID01YYYYI 12117!2021 THIS CERTIFICATE IS ISSUED ASA 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(Sy, 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 NAME_ T Gloria Black Hatter, Williams & Purdy Insurance PH NN Ext [760] 795-2002 we Ne (760) 929-0534 WC, 2230 E-MAIL gbL3Ck hw inSurancem ADDRESS. p .COfaradayAve INSURERISI AFFORDING COVERAGE NAIL Y INSURER A : Am Guard Insurance Company 42390CarlsbadCA92008 INSURED INSURER B Unique Builders of California INSURER C INSURER D: 33175 Temecula Pkwy INSURER ESteA4747 INSURER F: Temecula CA 92592 COVERAGES CERTIFICATE NUMBER: 21.22 Master 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE I NS URANCE 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 I LTR TYPE OF INSURANCE AUIJL1hUtIK INS -0 WVD POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MMIDDIYYI'Y LIMITS COM M ERC IAL G ENERAL LIA BILITY EACH OCCURRENCE 5 DAMAGE TO RENTE CLAIMS -MADE FIOCCUR PREMISES Ea occurrence 5 MED EXP {Any one persons 5 PERSONAL&ADV INJURY 5 GEN'LAGGREGATE UMITAPPLIESPER GENERALAGGREGA7E 5 POLICY PRGJECT LDC PRODUCTS - COMPrOP AGG 5 5OTHER AUTOMOBILE LIABILITY COM 01NED SINGLE LIMIT S 1 000.000Enaccidam) BODILY INJURY (Per persan) 5ANYAUTO A OWNED SCHEDULED AUTOSONLY X AUTOS UBAU208334 09/28/2021 09128/2022 aODILY INJURY (Per acode o S PROPERTY DAMAGE $ Per acaden! HIRED NON -OWNEDXAUTOSONLYXAUTOSONLY Uninsured motont BI- s 1,000,000 UMBRELLA LUIB HCLAIMS•MADE OCCUR EACH OCCURRENCE 5 AGGREGATE $ EXCESS UAB DED I I RETENTION $ 5 WORKERS COM PENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER ANY PROPRIETORPARTNER)EXECUTIVE OF FICERIM EM BER EXC LUDED7 N rA E L. EACH ACCIDENT 5 Mandatory In NH] E.L. DISEASE - EA EMPLOYEE S If yes, descnbe under DESCRIPTION OF OPERATIONS beroN E L DISEASE - POLICY LIMIT S DESCRiPT1ON OF OPERATIONS f LOCATIONS I VEHICLES (AGGRO 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Halder is named Additional Insured as required by a written contract. 30 days notice of cancellation except 10 days notice for nonpayment of premium f CGT1rIC'ATC une nCR rAMrFI I ATIC11N O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION HATE THEREOF, NOTICE WILL BE DELIVERED IN City of Lake Elsinore ACCORDANCE WITH THE POLICY PROVISIONS. 130 South Main St AUTHORIZED REPRESENTATIVE r O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 w UNIOBUI.01 KELLY ACv eo CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYYI 6/30/2021 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: It the certificate holder is an ADDITIONAL INSURED, the pollcy(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 0 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CO Goodman Insurance Services, Inc. PHONE FAX 27842 Towne Centre Drive, Suite 120 tArc, No. Ertl: (949) 769-3100 (AIC. No):(949) 769.3930 Foothill Ranch, CA 92518 EMAILeUDAESs: - INSURED UBCA. Inc 33175 Temecula PKWY, Suite A #747 Temecula, CA 92592 INSURER 17 INSURER E INSURER F: 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. lNSR AOOL SUBR POLICY EFF POLICY EXP LIMITSIroTYPEOFINSURANCElocowvnPOLICYNUMBERrMAuonrVYmrmwowYYn COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GEf1'L AGGREGATE LIMIT APPLIES PER: POLICY J%RLPT LOC AUTOMOBILE LIABILITY 5 ANY AUTO OWNED SCHEDULED AUTOS ONLY _ _ AUTOSS% IAUTOSONLY — NO pSE UMBRELLA LIAR OCCUR EXCESSLIAS CLAIMS -MADE DED f ^ RETENTION S A WORKERS AND EMPLOYERS' COMPENSATION Y/-N. CST5827832 ANY IPROP ERIMEIMTgOERE%CLUpEd ECLITIVE Y NIA Mandsmry in NH) If ves, descnha undef EACH OCCURRENCE 5 PREM ISESAEaEoccurrrrence)- 5 MED EXP, one.person]. ._ S PERSONAL&ADViNJURY S GENERAL AGGREGATE 5 T PRODUCTS - COMPIOP AGG S LIMIT BODILYINJURY(Per D0DILY. j1t URY [Pp PROPERTY DAMAGE Peraccderd] EACH OCCURRENCE S AGGREGATE S X STATUTE ERS , 7/1/2021 7f112022 E -L- EACH ACCIDENT _$ F I nIAF)LSF - FA FMFK r]VFF5 DESCRIPTION of OPERATIONS) LOCATIONS) VEHICLES (ACORD 1{11, Additional Remarks Schedule. may be attached if more space is regviredy Proof of Insurance 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 S. Main Street Lake Elsinore. CA 92530 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) 0 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: A2513331-AO4A-45A8-A3E9-OBA4117891B1 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: UBCA, INC Business Location: 33175 TEMECULA PKWY STE A747 TEMECULA, CA 92592-7300 Owner Name(s): DAVID CARTER UBCA, INC 33175 TEMECULA PKWY STE A747 TEMECULA, CA 92592-7300 CITY OF LAKE ELSINORE Administrative Services - Licensing 130 South Main Street, Lake Elsinore, CA 92530 PH (951) 674-3124 BUSINESS LICENSE NO. 024935 Business Type: GENERAL BUILDING CONTRACTOR Issue Date: 4/1/2021 Expiration Date: 3/31/2022 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 CITY OF LAKE ELSINORE 130 S. MAIN STREET LAKE ELSINORE, CA 92530 (951) 674-3124 PROJECT CHANGE ORDER CHANGE ORDER # 1 DATE: June 1, 2022 THIS CHANGE ORDER IS APPLICABLE TO: CITY PROJECT # #Z20021 PROJECT TITLE: Lake Community Center CONTRACT AWARDED TO: Unique Builders of California DATE AWARDED December 14. 2021 Authorized by: Jason Simpson TOTAL AMOUNT OF CONTRACT City Manager PRIOR TO THIS CHANGE ORDER $547,550.00 CONTRACTOR IS AUTHORIZED TO MAKE THE FOLLOWING CHANGES: QUANTITIES INCREASED ITEM QUANTITY UNIT UNIT PRICE EXTENSION See Attached Proposal Dated 2/14/2022 Lump Sum 1.00 $54,755.00 $54,755.00 QUANTITIES DECREASED ITEM QUANTITY UNIT PRIC­IE____T EXTENSION None 7 THE AMOUNT OF THE CONTRACT WILL BE (INCREASED) BY THE SUM OF $54,755.00 Change Order No. 1 Review by: Initials Date Approved by: Assistant City Manager City Manager: I U 1 AL "4, /55.UU Date 6/1 /22 Contractor UBCA, Inc. Unique Builders of California 33175 Temecula Pkwy Ste A #747 Phone: 909-851-4330 Fax 951-303-0075 Email: uniquebuildersofca@gmail.com Quote #: 00000681 Date: 2/14/22 Page: 1 Bill 1 To. Cily of Lake Elsinore 130 South Main St. Lake Elsinore, CA 9253 Description QUOTE UNIQUE BUILDERS O CALIFORNIA LicenwN B-920943 909.851.4330 Ship To: :,ity of Lake Elsinore 130 South Main St. -ake Elsinore, CA 92530 Amount * LAKE COMMUNITY HALL RENOVATION" Frame new wall in conference room Frame new ceiling in conference room Drywall, tape, and texture new walls Sand, patch, smooth coat then texture walls in ballet room Sand, patch, smooth coat then texture upstairs walls except storage rooms Purchase and install LVT flooring in lobby including 4" vinyl base Remove closet and hallway walls and re frame to make existing office bigger. Drywalll and texture office and hallway Remove and replace four doors upstairs with new commercial handles Remove exterior door and air conditioner in upper office, patch drywall and stucco as needed Extra drywal patching due two late changes for IT, HVAC, and electrical Extra electical work for new ac and offices !Extra flooring and base in two downstairs offices Epoxy on bathroom floors Extra paint in gym, office ceiling, and patches I $5,780.00 $4,320.00 $6,470.00 $11,025.00 $5,760.00 $3,800.00 $1, 750.00 $2,500.00 $3,300.00 $3,750.00 $900.00 $5,400.00 Total Amount: $54,755.00