HomeMy WebLinkAboutItem No. 13 Black Rock Construction SB 821City Council Agenda Report
City of Lake Elsinore 130 South Main Street
Lake Elsinore, CA 92530
www.lake-elsinore.org
File Number: ID# 19-148
Agenda Date: 5/14/2019 Status: PassedVersion: 1
File Type: Council Consent
Calendar
In Control: City Council / Successor Agency
Agenda Number: 13)
Construction Contract Award to Black Rock ConstructionSB 821 Project No. Z10010
1. Award the Public Works Construction Agreement to Black Rock Construction; and,
2. Authorize the City Manager to execute the Agreement in the amount of $249,000, in such final form
as approved by the City Attorney; and,
3. Authorize the City Manager to execute change orders not to exceed the 10 percent contingency
amount of $24,900; and,
4. Authorize the City Engineer to record the Notice of Completion once it is determined the work is
complete and the improvements are accepted into the City maintained roadway network.
Page 1 City of Lake Elsinore Printed on 5/9/2023
Page 1 of 2
REPORT TO CITY COUNCIL
To:Honorable Mayorand Members of the City Council
From:Grant Yates, City Manager
Prepared By: Nicole McCalmont, Senior EngineerTechnician
Date:May 14, 2019
Subject:Construction Contract Award for SB821 Sumner, Davis, and Mohr Street
Curb, Gutter, and Sidewalk Project CIP Project No. Z10010
Recommendation
1.Award the Public Works Construction Agreement for the SB821 Sumner, Davis, and
Mohr Street Curb, Gutter andSidewalk Project to Black Rock Construction.
2.Authorize the City Manager to executethe Agreement in the amount of $249,000 to
Black Rock Construction, in substantially the form attached and in such final form as
approved by the City Attorney.
3.Authorize the City Manager to execute change orders not to exceed the 10%
contingency amount of $24,900.
4.Authorize the City Engineer to record the Notice of Completion once it is determined
the work is complete and the improvements are accepted into the City maintained
roadway network.
Background
On June 26, 2017, City received confirmation from Riverside County Transportation
Commission (RCTC), that certain proposed project as part of SB 821 Grant were approved for
funding. SB 821 Sumner, Davis and Mohr Street Curb, Gutter and Sidewalkwas one of them.
On March 29, 2019, the project was advertised via Planetbids.
On April 30, 2019, the bids were opened.
Discussion
Contractor bids were opened publicly on April 30, 2019, at 2:30p.m. The City received five(5)
bidsfrom qualified contractors.Staffrecommends the selection of the apparent low bidder
Black Rock Construction. The bid results are summarized below:
Award SB821 Sumner, Davis, and Mohr SidewalkProject
May 14, 2019
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Page 2 of 2
Contractor (Bidder) Bid Amount _
Black Rock Construction $249,000.00
Hardy & Harper $261,001.50
All American Asphalt $315,654.50
Aramexx Construction $413,965.50
EBS General Engineering $581,790.28
Fiscal Impact
Funding for this project has been allocated via SB 821 Grant and General Fund and Gas Tax.
Exhibits
A –Agreement
B –Proposal
C-Vicinity Map
AGREEMENTFOR PUBLICWORKSCONSTRUCTION
BlackRockConstructionCompany
SB821Sumner, Davis, andMohrStreet –Curb, Gutter andSidewalkProject
CIPNo. Z10010
ThisAgreementforPublicWorksConstruction(“Agreement”)ismadeandenteredintoas
ofMay14,2019,byandbetweentheCityofLakeElsinore,amunicipalcorporation(‘‘City")and
BlackRockConstructionCompany,aCaliforniacorporation("Contractor").
The CityandContractor, inconsiderationofthemutualpromisesandcovenantssetforth
herein,agreeasfollows:
1.The ProjectandProjectDocuments.Contractor agreesto constructthefollowing
publicimprovements(“work”)identifiedas:
SB821Sumner, Davis, andMohr–Curb, GutterandSidewalkProject(the
“Project”).
TheCity-approvedplansfortheconstructionoftheProject,whichareincorporatedherein
byreference,areidentifiedas:
SB821Sumner, Davis, andMohr–Curb, GutterandSidewalkProject
CIP Project No. Z10010
TheProjectDocumentsincludethisAgreementandallofthefollowing:(1)theNotice
InvitingBids,InstructionstoBidders,BidDocumentsincludingBidder’sProposalassubmittedby
theContractor,ContractDocuments,GeneralSpecifications,SpecialProvisions,andall
attachmentsandappendices;(2)everythingreferencedinsuchdocuments,suchas
specifications, details, standardplansordrawingsandappendices,includingallapplicableState
andFederalrequirements;(3)allrequiredbonds,insurancecertificates,permits,notices,and
affidavits;and(4)anyandalladdendaorsupplementalagreementsclarifying,amendingor
extendingtheworkcontemplatedasmayberequiredtoinsurecompletioninanacceptable
manner.Alloftheprovisionsoftheabove-listeddocumentsaremadeapartofthisAgreement
asthoughfullysetforthherein.
2.Compensation.
a.For andinconsiderationofthepayments andagreementstobemadeand
performedbyCity,ContractoragreestoconstructtheProject,includingfurnishingallmaterials
andperformingallworkrequiredfortheProject,andtofulfillallotherobligationsassetforthin
theBidder’sProposal,suchcontractpricebeing TwoHundredFortyNineThousanddollars
($249,000).
b.Cityherebypromisesandagreestoemploy,anddoesherebyemploy,
Contractor to providethematerials,dothe work, andfulfillthe obligationsaccordingtothe terms
andconditionshereincontainedandreferredto,forthepricessetforth,andherebycontractsto
paythesameatthetime,inthemanner,andupontheconditionssetforthintheProject
Documents.
ExhibitA-Agreement.docx Page1
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c.Contractoragreestoreceive andacceptthepricessetforthintheBidder’s
Proposalasfullcompensationforfurnishingallmaterials,performingallwork,andfulfillingall
obligationshereunder.Suchcompensationshallcoverallexpenses,losses,damages,and
consequencesarisingoutofthenatureofworkduringitsprogressorpriortoitsacceptance
includingthoseforwellandfaithfullycompletingtheworkandthewholethereofinthemanner
andtimespecifiedintheProjectDocuments;andalsoincludingthosearisingfromactionsofthe
elements,unforeseendifficultiesorobstructionsencounteredintheprosecutionofthework,
suspensionordiscontinuanceofthework,andallotherunknownsorrisksofanydescription
connectedwiththe work.
3.CompletionofWork.
a.Contractorshallperformandcompleteallworkwithin Forty(40)working
daysfromthedateofcommencementspecifiedintheNoticetoProceed,andshallprovide,
furnishandpayforallthelabor,materials,necessarytools,expendableequipment,andalltaxes,
utilityandtransportationservicesrequiredforconstructionofthe Project.
b.Allworkshallbeperformedandcompletedinagoodworkmanlikemanner
instrictaccordancewiththedrawings,specificationsandallprovisionsofthisAgreementas
hereinabovedefinedandinaccordancewithapplicablelaws,codes,regulations,ordinancesand
anyotherlegalrequirementsgoverningthe Project.
c.Contractorshallnot beexcusedwithrespect tothefailuretoso complyby
anyactoromissionoftheCity,theDirectorofPublic Works,theCityEngineer,aCityinspector,
orarepresentativeofanyofthem,unlesssuchactoromissionactuallypreventstheContractor
fromfullycomplyingwiththerequirementsoftheProjectDocuments,andunlesstheContractor
protestsatthetimeofsuchallegedpreventionthattheactoromissionispreventingtheContractor
fromfullycomplyingwiththeProjectDocuments.Suchprotestshallnotbeeffectiveunless
reducedtowritingandfiledwiththeCitywithinthree(3)workingdaysofthedateofoccurrence
oftheactoromissionpreventingtheContractorfromfullycomplyingwiththeProjectDocuments.
d.CityandContractorrecognizethattimeisoftheessenceinthe
performanceofthisAgreementandfurtheragreethatifthe workcalledforunderthe Agreement
isnotcompletedwithinthetimehereinabovespecified,damageswillbesustainedbytheCityand
that,itisandwillbeimpracticableorextremelydifficulttoascertainanddeterminetheactual
amountofdamagestheCitywillsustainintheeventof,andbyreasonof,suchdelay.Itis,
therefore,agreedthatsuchdamagesshallbepresumedtobeintheamountofFiveHundred
dollars($500)percalendarday,andthattheContractorwillpaytotheCity,orCitymayretain
fromamountsotherwisepayableto Contractor,suchamount foreachcalendardaybywhichthe
Contractorfailstocompletethework,includingcorrectiveitemsofwork,underthisAgreement
withinthetimehereinabovespecifiedandasadjustedbyanychangestothework.
4.ChangestoWork.CityandContractoragreethattheCitymaymakechangesto
thework, orsuspendthework,andnomatter howmanychanges,suchchangesorsuspensions
arewithin thecontemplationoftheContractor andCityandwillnot beabasisforacompensable
delayclaimagainsttheCitynorbethebasisforaliquidateddamagesclaimsagainstthe
Contractor.
Anychangetotheworkshallbebywayofawritteninstrument(“changeorder”)signed
bythe Cityandthe Contractor,statingtheir agreement tothefollowing:
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a.Thescopeofthechangeinthework;
b.Theamountoftheadjustment tothecontractprice;and
c.Theextentoftheadjustment totheScheduleofPerformance.
TheDirectorofPublicWorksisauthorizedtosignanychangeorderprovidedthatsufficient
contingencyfundsareavailableintheCity’sapprovedbudgetfortheProject.Allchangeinthe
workauthorizedbythechangeordershallbeperformedundertheapplicableconditionsofthe
ProjectDocuments.CityandContractorshallnegotiateingoodfaithandasexpeditiouslyas
possiblethe appropriateadjustmentsforsuchchanges.
5.Bonds.Contractorshallprovide,beforecommencingwork,aFaithfulPerformance
BondandaLabor andMaterialBond, eachforone-hundredpercent(100%) ofthecontract price
intheform thatcomplieswiththe ProjectDocumentsandissatisfactorytothe CityAttorney.
6.Non-Assignability.NeitherthisAgreementnoranyrights,title,interest,dutiesor
obligationsunderthisAgreement maybeassigned,transferred, conveyedor otherwisedisposed
ofbyContractorwithout theprior writtenconsentofCity.
7.Licenses.ContractorrepresentsandwarrantstoCitythat itholdsthecontractor’s
licenseorlicensessetforthintheProjectDocuments,isregisteredwiththeDepartmentof
IndustrialRelationspursuanttoLaborCodeSection1725.5,andholdssuchotherlicenses,
permits,qualifications,insuranceandapprovalsofwhatsoevernaturewhicharelegallyrequired
ofContractor.ContractorrepresentsandwarrantstoCitythatContractorshall,atitssolecost
andexpense,keepineffectorobtainatalltimesduringthetermofthisAgreement,anylicenses,
permits,insuranceandapprovalswhicharelegallyrequiredofContractortopracticeits
profession.Contractorshallmaintaina CityofLakeElsinorebusinesslicense.
8.Indemnity.Contractorshallindemnify,defend,andholdharmlessthe Cityandits
officials,officers,employees,agents,andvolunteersfromandagainstanyandalllosses,liability,
claims,suits,actions,damages,andcausesofactionarisingoutofanypersonalinjury,bodily
injury,lossoflife,ordamagetoproperty,oranyviolationofanyfederal,state,ormunicipallaw
orordinance, tothe extentcaused,inwholeorinpart,bythewillfulmisconductornegligentacts
oromissionsofContractororitsemployees,subcontractors,oragents,byactsforwhichthey
couldbeheldstrictlyliable,orbythe qualityorcharacteroftheirwork.Theforegoingobligation
ofContractorshallnotapplywhen(1)theinjury,lossoflife,damagetoproperty,orviolationof
lawarisesfromthesolenegligenceorwillfulmisconductoftheCityoritsofficers,employees,
agents,orvolunteersand(2)theactionsofContractororitsemployees,subcontractor,oragents
havecontributedinnopartto theinjury,lossoflife,damagetoproperty,orviolationoflaw.Itis
understoodthatthedutyofContractortoindemnifyandholdharmlessincludesthedutytodefend
assetforthinSection2778oftheCaliforniaCivilCode.AcceptancebyCityofinsurance
certificatesandendorsementsrequiredunderthisAgreementdoesnotrelieveContractorfrom
liabilityunderthisindemnificationandholdharmlessclause.Thisindemnificationandhold
harmlessclauseshallapplytoanydamagesorclaimsfordamageswhetherornotsuchinsurance
policiesshallhavebeendeterminedtoapply.ByexecutionofthisAgreement,Contractor
acknowledgesandagreestotheprovisionsofthisSectionandthatitisamaterialelementof
consideration.
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9.InsuranceRequirements.
a.Insurance.Contractor,atContractor’sowncostandexpense,shall
procureandmaintain,forthedurationoftheAgreement,unlessmodifiedbytheCity’sRisk
Manager, thefollowinginsurancepolicies.
i.Workers’CompensationCoverage.Contractorshallmaintain
Workers’CompensationInsuranceandEmployer’sLiabilityInsuranceforhis/her
employeesinaccordancewiththelawsoftheStateofCalifornia.Inaddition,Contractor
shallrequireeachsubcontractortosimilarlymaintainWorkers’CompensationInsurance
andEmployer’sLiabilityInsuranceinaccordancewiththelawsoftheStateofCalifornia
forallofthesubcontractor’semployees.Anynoticeofcancellationornon-renewalofall
Workers’CompensationpoliciesmustbereceivedbytheCityatleastthirty(30)daysprior
tosuchchange.TheinsurershallagreetowaiveallrightsofsubrogationagainstCity, its
officers,agents,employeesandvolunteersforlossesarisingfromworkperformedby
ContractorforCity.IntheeventthatContractorisexemptfromWorker’sCompensation
InsuranceandEmployer’sLiabilityInsuranceforhis/heremployeesinaccordancewith
thelawsoftheStateofCalifornia,ContractorshallsubmittotheCityaCertificateof
ExemptionfromWorkersCompensationInsuranceinaformapprovedbytheCity
Attorney.
ii.CommercialGeneralLiabilityCoverage.Contractorshallmaintain
commercialgeneralliabilityinsuranceinanamountnotlessthanonemilliondollars
($1,000,000)peroccurrenceforbodilyinjury,personalinjuryandpropertydamage.Ifa
commercialgeneralliabilityinsuranceformorotherformwitha generalaggregatelimit is
used,eitherthegeneralaggregatelimitshallapplyseparatelytotheworktobeperformed
underthisAgreementorthegeneralaggregatelimitshallbeatleasttwicetherequired
occurrencelimit.Requiredcommercialgeneralliabilitycoverageshallbeatleastasbroad
asInsuranceServicesOfficeCommercialGeneralLiabilityoccurrenceformCG0001(ed.
11/88)orInsuranceServicesOfficeformnumberGL0002(ed.1/73)covering
comprehensiveGeneralLiabilityandInsuranceServicesOfficeformnumberGL0404
coveringBroadFormComprehensiveGeneralLiability.Noendorsementmaybeattached
limitingthecoverage.
iii.Automobile Liability Coverage.Contractor shall maintain
automobileliabilityinsurancecoveringbodilyinjuryandpropertydamageforallactivities
oftheContractorarisingoutoforinconnectionwiththeworktobeperformedunderthis
Agreement,includingcoverageforowned,hiredandnon-ownedvehicles,inanamount
ofnotlessthanonemilliondollars($1,000,000)combinedsinglelimitforeachoccurrence.
AutomobileliabilitycoveragemustbeatleastasbroadasInsuranceServicesOffice
AutomobileLiabilityformCA0001(ed.12/90)Code1(“anyauto”).Noendorsementmay
beattachedlimitingthecoverage.
iv.Builder’sRiskCoverage.Priortothecommencementofany
constructionoftheProject,Contractorshallobtain(orcausetobeobtained)andkeepin
forceduringthetermofanyconstruction,builder’sriskinsuranceinsuringforallrisksof
physicallossofor damage(excludingthe perilsofearthquakeandflood).
b.Endorsements.Eachgeneralcommercialliabilityandautomobileliability
insurancepolicyshallbewithinsurerspossessingaBest’sratingofnolessthanA:VIIand
shallbeendorsedwiththefollowingspecificlanguage:
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i.TheCity,itselectedorappointedofficers,officials,employees,
agentsandvolunteersaretobecoveredasadditionalinsuredwithrespecttoliability
arisingoutofworkperformedbyoronbehalfoftheContractor,includingmaterials,parts
orequipment furnishedinconnectionwithsuchworkoroperations.
ii.Thispolicyshallbeconsideredprimaryinsuranceasrespectsthe
City,itselectedorappointedofficers,officials,employees,agentsandvolunteers.
AnyinsurancemaintainedbytheCity,includinganyself-insuredretentiontheCitymay
have,shallbeconsideredexcessinsuranceonlyandshallnot contributewithit.
iii.Thisinsuranceshallactforeachinsuredandadditionalinsuredas
thoughaseparatepolicyhadbeenwrittenforeach,exceptwithrespecttothelimitsof
liabilityoftheinsuringcompany.
iv.TheinsurerwaivesallrightsofsubrogationagainsttheCity,its
electedor appointedofficers, officials,employeesor agents.
v.Anyfailuretocomplywithreportingprovisionsofthepoliciesshall
notaffectcoverageprovidedtotheCity,its electedorappointedofficers,officials,
employees,agentsorvolunteers.
vi.TheinsuranceprovidedbythisPolicyshallnotbesuspended,
voided,canceled,orreducedincoverageorinlimitsexceptafterthirty(30)dayswritten
noticehasbeenreceivedbythe City.
c.DeductiblesandSelf-InsuredRetentions.Anydeductiblesorself-insured
retentionsmustbedeclaredtoandapprovedbytheCity.AttheCity’soption,Contractorshall
demonstratefinancialcapabilityforpayment ofsuchdeductiblesorself-insuredretentions.
d.CertificatesofInsurance.Contractorshallprovide certificatesofinsurance
withoriginalendorsementstoCityasevidenceoftheinsurancecoveragerequiredherein.
CertificatesofsuchinsuranceshallbefiledwiththeCityonor beforecommencementof
performanceofthisAgreement.Currentcertificationofinsuranceshallbekeptonfilewiththe
Cityatalltimesduringtheterm ofthisAgreement.
10.Notices.AnynoticerequiredtobegivenunderthisAgreementshallbeinwriting
andeitherservedpersonallyorsentprepaid,firstclassmail.Anysuchnoticeshallbeaddressed
totheotherpartyattheaddresssetforthbelow.Noticeshallbedeemedcommunicatedwithin
48hoursfromthetime ofmailingifmailedasprovidedinthissection.
IftoCity:CityofLakeElsinore
Attn:CityManager
130SouthMainStreet
LakeElsinore, CA92530
Withacopyto:CityofLakeElsinore
Attn:CityClerk
130SouthMainStreet
LakeElsinore, CA92530
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IftoContractor:BlackRockConstructionCompany
Attn:BillGoshen
929MarinerStreet
Brea,CA92821
11.EntireAgreement.ThisAgreementconstitutesthecompleteandexclusive
statementofagreementbetweentheCityandContractor.Allpriorwrittenandoral
communications,includingcorrespondence,drafts,memoranda,andrepresentations,are
supersededintotalbythisAgreement.
12.Amendments.ThisAgreementmaybemodifiedoramendedonlybyawritten
document executedbybothContractor andCityandapprovedastoformby the CityAttorney.
13.AssignmentandSubcontracting.ContractorshallbefullyresponsibletoCityfor
allactsoromissionsofanysubcontractors.Assignmentsofanyorallrights,dutiesorobligations
oftheContractorunderthisAgreementwillbepermittedonlywiththeexpressconsentoftheCity.
NothinginthisAgreementshallcreateanycontractualrelationshipbetweenCityandany
subcontractornorshallitcreateanyobligationonthepartoftheCitytopayortoseetothe
paymentofanymoniesduetoanysuchsubcontractorotherthanasotherwiseisrequiredbylaw.
14.Waiver.Waiverofabreachor defaultunderthisAgreementshallnotconstitutea
continuingwaiverofasubsequentbreachofthesameorany otherprovisionunderthis
Agreement.
15.Severability.IfanytermorportionofthisAgreementisheldtobeinvalid,illegal,
orotherwiseunenforceablebyacourtofcompetentjurisdiction,theremainingprovisionsofthis
Agreementshallcontinueinfullforceandeffect.
16.ControllingLawVenue.ThisAgreementandallmattersrelatingtoitshallbe
governedbythelawsoftheStateofCaliforniaandanyactionbrought relatingtothisAgreement
shallbeheldexclusivelyina statecourtintheCountyofRiverside.
17.LitigationExpensesandAttorneys’Fees.IfeitherpartytothisAgreement
commencesanylegalactionagainsttheotherpartyarisingoutofthisAgreement,theprevailing
partyshallbeentitledtorecoveritsreasonablelitigationexpenses,includingcourtcosts,expert
witnessfees, discoveryexpenses,andattorneys’fees.
18.Mediation.Thepartiesagreetomakeagoodfaithattempttoresolveanydisputes
arisingoutofthisAgreementthroughmediationpriorto commencinglitigation.The partiesshall
mutuallyagreeuponthemediatorandsharethecostsofmediationequally.Ifthepartiesare
unabletoagreeuponamediator,thedisputeshallbesubmittedtoJAMSoritssuccessorin
interest.JAMSshallprovidethepartieswiththenamesoffivequalifiedmediators.Eachparty
shallhavetheoptiontostriketwoofthefivemediatorsselectedbyJAMSandthereafterthe
mediatorremainingshallhearthedispute.Ifthedisputeremainsunresolvedaftermediation,
eitherpartymaycommencelitigation.
19.AuthoritytoEnterAgreementandAdministration.Contractorhasallrequisite
powerandauthorityto conduct itsbusinessandtoexecute, deliver,andperform theAgreement.
EachpartywarrantsthattheindividualswhohavesignedthisAgreementhavethelegalpower,
right,andauthoritytomakethisAgreementandtobindeachrespectiveparty.TheCityManager
isauthorizedtoenterintoanamendmentorotherwisetakeactiononbehalfoftheCitytomake
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thefollowingmodificationstotheAgreement:(a)anamechange;(b)grantextensionsoftime;
(c)non-monetarychangesinthescopeofservices;and/or(d)suspendorterminatethe
Agreement.TheDirectorofPublicWorksshallactastheProjectadministratoronbehalfofthe
City.
20.ProhibitedInterests.Contractormaintainsandwarrantsthatithasnotemployed
norretainedanycompanyorperson,otherthanabonafideemployeeworkingsolelyfor
Contractor,tosolicitorsecurethisAgreement.Further,Contractorwarrantsthatithasnotpaid
nor hasitagreedtopayanycompanyor person,otherthanabonafideemployee workingsolely
forContractor,anyfee,commission,percentage,brokeragefee,giftorotherconsideration
contingentuponorresultingfromtheawardormakingofthisAgreement.Forbreachorviolation
ofthiswarranty,Cityshallhavetherightto rescindthisAgreementwithoutliability.Forthe term
ofthisAgreement,nomember,officeroremployeeofCity,duringthetermofhisorherservice
withCity,shallhaveanydirectinterestinthisAgreement,orobtainanypresentoranticipated
materialbenefit arisingtherefrom.
21.EqualOpportunityEmployment.Contractorrepresentsthatitisanequal
opportunityemployeranditshallnotdiscriminateagainstanysubcontractor,employeeor
applicantforemploymentbecauseofrace,religion,color,nationalorigin,handicap,ancestry,sex
orage.Suchnon-discriminationshallinclude,butnotbelimitedto,allactivitiesrelatedtoinitial
employment,upgrading,demotion,transfer,recruitmentorrecruitmentadvertising,layoffor
termination.
22.PrevailingWages.
a.Contractorandallsubcontractorsshalladheretothegeneralprevailingrate
ofperdiemwagesasdeterminedandaspublishedbytheStateDirectoroftheDepartmentof
IndustrialRelationspursuanttoLaborCodeSections1770,1773,and1773.2.Copiesofthese
ratesandthelatestrevisionstheretoareonfileintheofficeoftheCityClerkoftheCityofLake
Elsinoreandareavailableforreviewuponrequest.
b.Contractor'sattentionisdirectedto theprovisionsofLaborCodeSections
1774,1775,1776,1777.5and1777.6.Contractorshallcomplywiththeprovisionsofthese
Sections.ThestatutoryprovisionsforpenaltiesforfailuretocomplywiththeState'swageandthe
hourslawswillbeenforced.
c.LaborCodeSections1774and1775requiretheContractorandall
subcontractorstopaynotlessthantheprevailingwageratestoallworkmenemployedinthe
executionofthecontractandspecifyforfeituresandpenaltiesforfailuretodoso.Theminimum
wagestobepaidarethosedeterminedbytheStateDirectoroftheDepartmentofIndustrial
Relations.LaborCodeSection1776requirestheContractorandallsubcontractorstokeep
accuratepayrollrecords,specifiesthecontentsthereof,theirinspectionandduplication
proceduresandcertainnoticesrequiredoftheContractorpertainingtotheirlocation.The
statutorypenaltiesforfailuretopayprevailingwageswillbeenforced.IftheProjecthasbeen
awardedtoContractoronorafterApril1,2015,Contractoranditssubcontractorsmustfurnish
electroniccertifiedpayrollrecordstotheLaborCommissioner.BeginningJanuary1,2016,
ContractoranditssubcontractorsmustfurnishelectroniccertifiedpayrollrecordstotheLabor
Commissionerwithoutregardto whentheProjectwasawardedto Contractor.
d.LaborCodeSection1777.5requiresContractororsubcontractor
employingtradesmeninanyapprenticeableoccupationtoapplytotheJointApprenticeship
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Committeenearestthesiteofthepublicworksproject,whichadministerstheapprenticeship
programinthattradeforacertificateofapproval.Thecertificatewillalsofixtheratioof
apprenticestojourneymentobeusedintheperformanceoftheAgreement.TheContractoris
requiredtomakecontributionstofundsestablishedfortheadministrationofapprenticeship
programsiftheContractoremploysregisteredapprenticesorjourneymeninanyapprenticeable
tradeandifothercontractorsonthepublicworkssite aremakingsuchcontributions. Information
relativeto apprenticeshipstandards, contributions,wageschedulesandotherrequirementsmay
beobtainedfromthe StateDirectorofIndustrialRelationsorfromtheDivisionofApprenticeship
Standards.LaborCodeSection1777.6providesthatitshallbeunlawfultorefusetoaccept
otherwisequalifiedemployeesasregisteredapprenticessolelyonthegroundsofrace,religious
creed, color,nationalorigin, ancestry,sex, or age.
Section1810.
e.Eighthourslaborconstitutesalegalday'swork,as setforthinLaborCode
23.Termination.
(a)CitymaycancelthisAgreementatanytimeuponseven(7)dayswritten
noticeto Contractor.Contractoragreesto ceaseallworkunder thisAgreementonorbeforethe
effectivedateofsuchnotice.
(b)IntheeventofterminationorcancellationofthisAgreementbyCity,dueto
nofaultorfailureofperformancebyContractor, Contractor shallbepaidfullcompensationforall
servicesperformedbyContractor,inanamounttobedeterminedasfollows:Forworkdonein
accordancewithallofthetermsandprovisionsofthisAgreement,Contractorshallbepaidan
amountequaltotheamountofservicesperformedpriortotheeffectivedateofterminationor
cancellation;provided,innoeventshalltheamountofmoneypaidundertheforegoingprovisions
ofthisparagraphexceedtheamountwhichwouldbepaidContractorforthefullperformanceof
the servicesrequiredbythisAgreement.
24.Execution.ThisAgreementmaybeexecutedinseveralcounterparts,eachof
whichshallconstituteoneandthesameinstrumentandshallbecomebindingupontheparties
whenatleastonecopyhereofshallhavebeensignedbybothpartieshereto.Inapprovingthis
Agreement, itshallnotbenecessaryto produceoraccount formorethanonesuchcounterpart.
[Signaturesonnextpage]
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INWITNESSWHEREOF,the partieshavecausedthisAgreementto beexecutedonthe
datefirst writtenabove.
“CITY”
CITYOFLAKEELSINORE,amunicipal
corporation
“CONTRACTOR”
BlackRockConstructionCompany,a
Californiacorporation
GrantYates, CityManager
ATTEST:
By:
Its:
DeputyCityClerk
APPROVEDASTOFORM:
By:
Its:
CityAttorney
BIDDER'S PROPOSAL
CITY OF LAKE ELSINORE
CIP Project No. Z10010
SB 821 SUMNER, DAVIS AND MOHR STREET
CURB, GUTTER AND SIDEWALK PROJECT
CIP PROJECT NO. Z10010
Company: _ ..... G....._l _a._...l _J_c __ VC_o_l_l_t ___ C_o_.l"l_t"_h_r_"-_'-_h _P._Y'"'_
Honorable Mayor, Members of the Council :
In accordance with the Notice Inviting Bids pertaining to the receiving of sealed proposals by the
City Clerk of the City of Lake Elsinore for the above titled improvement, the undersigned hereby
proposes to furnish all Work to be performed in accordance with the Specifications, Standard
Drawings, and the Contract Documents, for the unit price or lump sum set forth in the following
schedule:
Time of Completion: Forty (40) Working Days from Issuance of Notice to Proceed (NTP)
by City to Contractor.
BID SCHEDULE A (SB 821)
ITEM TOTAL
NO. DESCRIPTION UNIT QUANTrTY UNIT COST COST
1 MOBILIZATION AND PROJECT INFORMATION SIGN LS 1 ) D. (I 19,f~ l..O ~f()SG
2 TRAFFIC CONTROL PLAN & IMPLEMENTATION LS 1 1...\. ()() v z__ (.)(J 0
3 CONSTRUCTION SURVEY AND STAKING LS 1 G, <f) o u (o , t)()O
STORM/NON STORM WATER POLLUTION CONTROL AND
4 IMPLEMENTATION LS 1 I l 0 co (r CJO()
5 CLEARING & GRUBBING LS 1 '1, C> OQ '(, 0 0 Q
6 SAWCUT EXI STING A.C. PAVEMENT LF 734 L..-00 /,i.f i 8
7 SAWCUT PCC LF 18 >-~ 0 ~'(
8 REMOVE A.C. PAVEMENT AND BASE MATERIAL SF 2,964 '2.. £..,) ti 66 '1
9 RELOCATE MAILBOX EA 4 t <:>D 'l.o o
10 REMOVE PCC SF 802 lt , t,) 1 1.tt?·S. ;-,,
11 GRIND A.C. IN PLACE (0.1 ') SF 1,460 1 . )'D ~{f O
12 MINOR GRADING/ EX CAVATION LS 1 / 'i '""
{') ,)f)t>
13 CONSTRUCT 611 AGG . BASE CLASS II CY 30 ~) L ~.)o
14 CONSTRUCT 4" ASPHALT CONCRETE TON 36.9 I )o >53)
15 CONSTRUCT 3" ASPHALT CONCRETE TON 1.8 2,-0 't ("7J
16 ASPHALT OVERLAY (0 .1') TON 10.3 z... 7-.S-?.3 0. fo
17 REMOVE TREE COMPLETELY EA 8 tl <;/:> t 0, oo o
18 CONSTRUCT CURB & GUlTER (TYP E 6) 18" WIDE LF 514 -z_ 7 ' t s)[)
19 CONSTRUCT CURB & GUTTER (TYPE 6) 24" WIDE LF 148 ·1 ~ l( 'l <'.1 .)..
C-1
20 CONSTRUCT PCC SID EWALK SF 4,111 S"-.00 UJ,~5S
21 RELOCATE FIRE HYDRANT EA 1 ).~oo J f""'D 0
22 ADJUST WATER VALVE TO GRADE EA 2 l f)l;l ? C> l)
23 ADJUST WATER MET ER TO GRADE EA 2 {\o 3 00
24 RELOCATE SIGN EA 5 "L S-o l 1.-J17
25 CONSTRUCT PCC DRIVEWAY APPROACH RAMPS SF 140 <6 -oo L { <..-o
26 CON STR UCT A.C. BERM AND TRANSITION Lf 10 t ') ') l Z.,'.)'O
CONSTRUCT ADA CURB RAMP AND TRUNCATED DOMES
27 STD . NO. 214.A EA 2 "].... oO"V 't [)()1)
CONSTRUCT ADA CURB RAMP AND TRUNCATED DOMES
28 STD. NO. 403 EA 2 '1-t:> 0 1b "( oCJv
29 CONSTRUCT PCC ALLEY DRIVEWAY Sf 465 ~-.VV 3 7 ~:D
30 CONSTRUCTION PCC RESIDENTIAL DRIVEWAY APPROACH SF 735 ~ .v-? ~'!( 0
31 CONSTRUCT PCC DRIVEWAY SF 321 i -PV 'l <" b<?
SUBTOTAL BID SCHEDULE A ( ')5'. ~ ~t
BID SCHEDULE B (DRAINAGE)
ITEM
NO. DESCRIPTION UNIT QUANTITY UNIT COST TOTAL COST
32 SAWCUT EX ISTING A.C. PAVEMENT LF 225 3 _ () 0 '7 I)"
33 REMOVE A.C. PAVEMENT AND BAS E MATERIAL SF 3,970 o°><"' 3 7 7(,)i>
34 RELOCATE MAILBOX EA 1 '1...~ D LOt>
35 REMOVE PCC SF 233 5-oo l t ks
36 GRIND A.C. IN PLACE {0.1') SF 437 ] .J O I )2 C.. ')-o
37 CONSTRUCT 3" ASPHALT CONCRET E TON 63 .8 l )o c; )7'0
38 ASPHALT OVERLAY (0.1') TON 3.2 L..1...:S'" 7 20
39 CONSTRUCT CUR B & GUTIER (TYP E 6) 18" WIDE LF 32 1o °'J h O
40 CONSTRUCT PCC SIDEWALK SF 185 lo .{) o 1 1 / tJ
CONSTRUCT CROSS GUTIER PER COUNTY OF RIVERSIDE
41 STD. NO. 209 (MODIFIED ) SF 500 {CJ. {)() S:. ooO
42 STRIPING AN D PAV EMENT MARKING LS 1 /~$)0 I ,,~0 0
SUBTOTAL BID SCHEDULE B 1 {., t-o / -I
BID SCHEDULE C (PAVEMENT)
ITEM
NO. DESCRIPTION UNIT QUANTITY UNIT COST TOTAL COST
43 SAW CUT EXI STING A.C. PAV EMENT Lf 66 Y O D 2 6Y
44 REMOVE A.C. PAVEMENT AND BASE MATERIAL SF 19,550 _7 ) ' '<. (,~t....f o
45 GRIND A.C. IN PLAC E (0.1 ') SF 132 \."7 l/.0 1-
46 CON STR UCT 3" ASPHALT CONCRETE TON --355 .0 l 4-o 'IG /DO .
47 ASPHALT OV ER LAY (0.1') TON 1.0 L... '1.-) "2 °L )
48 STRIPING AND PAVEMENT MARKIN G LS 1 I )O D f )DO
SUBTOTAL BID SCHEDULE C 6 b ~(L/
C-2
TOTAL BID PRICE OF A, B, & C:
TOTAL BID PRICE BASED ON BID SCHEDULE TOTAL OF UNIT PRICES FOR
SB 821 SUMNER , DAVIS AND MOHR STREET
CURB, GUTIER, AND SIDEWALK PROJECT
$---'r'--tvt:>-=--=La..c....;h'-"-=-_&~'/"'--+=+-r----'-/l-'-'-;......:;.;~=--J--'----=L'--.... ...;;_s <=? ......... j__=------><-y_·~---'~=--0
Total Bid Price in Written Form
In case of discrepancy between the written price and the num e rical price, the written price
shall prevail.
Note:
Estimated quantities are for the purpose of Bid comparison only; payments will be made on the basis of
actual measurement of Work completed, except for lump sum (LS) and final pay (F) quantities.
(S} denotes a specialty item. The Bid Price shall include, but not be limit ed to, sales tax and all other
applicable taxes and fees .
All work described on the plans and in the specifi cat ions and other incidental s necessary to complete th e
project shall be paid under items above. No add itio nal payments will be allowed.
*BID MAY BE REJECTED IF TOTAL I S NOT SHOWN FOR BOTH FIGURES ANP WORDS.
C-3
CITY OF LAKE ELSINORE
GIP Project No. Z10010
T he 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 th e reon shall be forfeited
th ereby to and remain the property of the City of Lake Elsinore.
The above unit prices include all work appurtenant to the various items as outlined in the
Specifications and all work or expense required for the satisfactory completion of said items. In
case of discrepancies between unit prices and totals, the unit prices shall govern.
Th e undersigned declares that it has carefully examined the Plans, Specifications, and Contract
Documents, and has investigated the site of the work and is familiar with the conditions thereon.
Contractor
-__.__s_y :_z_~ __ dr_ x;71 'o.>L .-. J"\.
Contractor's State License No.: ~ Y J ] 0 g ~
Date: lf -3 0 -{ ~
C!ass: ___ __.__.A..___
1
_-=L...._-_...<l _______ _
Department of Industrial Relations Registration No: -~/_D_~_0_0_0_5~'1~'1_o _____ _
Registration Date: __ )..;;._._-_l_l _-_{_~----Expiration Date: __ b_-_J_a_··-_{_~---
Address : 9 2 'l /Vic. r~rvt::r sr-
Phone :
FAX:
C-4
CITY OF LAKE ELSINORE
CIP Project No. Z10010
ACKNOWLEDGMENT OF AQDENPA RECEIVED
SB 821 SUMNER, DAVIS AND MOHR STREET
CURB, GUTTER AND SIDEWALK PROJECT
CIP PROJECT NO. Z10010
The B idder shall acknowledge the receipt of addenda by placing an "X " by each addendum
received.
Adde ndum No. 1 __ _
Addendum No. 2 --
Addendum No. 3 ---
Addendum No. 4 __ _
If an addendum or addenda have been issued by the City and not noted above as being
received by the Bidder, the Bid Proposal may be rejected.
Bidder's Signature
lf-3o-r 7
Date
Print Name Title
C-5
. '
NON-COLLUSION AFFIDAVIT
CITY OF LAKE ELSINORE
CIP Project No. Z10010
SB 821 SUMNER, DA VIS ANO MOHR STREET
CURB, GUTTER AND SIDEWALK PROJECT
CIP PROJECT NO. Z10010
STATE OF CALIFORNIA
COUNTY OF ORANGE
)
) SS
)
(NAME) Black Rock Construction Company
affiant being first duly sworn, deposes and says:
That he or she is Bill Goshen, Jr. of
(sole owner, partner or other proper title)
Black Rock Construction Company the party making the foregoing Bid,
that the Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership,
company, association, organization, or corporation; that the Bid is genuine and not collusive or
sham; that the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a
false or sham Bid, and has not directly or indirectly colluded, conspired, connived, or agreed with
any Bidder or anyone else to put in a sham Bid, or that anyone shall refrain from bidding; that the
Bidder has not in any manner, directly or indirectly sought by agreement, communication, or
conference with anyone to fix the bid price of the Bidder or any other Bidder, or to fix any overhead,
profit, or cost element of the bid price, or of that of any other Bidder, or to secure any advantage
against the public body awarding the Contract of anyone interested in the proposed Contract; that
all statements contained in the Bid are true; and, further, thatthe Bidder has not, directly or indirectly,
submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged
information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership,
company associations, organization, bid depository, or to any member or agent thereof to effectuate
a collusive or sham Bid. (Public Contract Code Section 7106)
Address: 929 Mariner St., Brea , CA 92821
Telephone No .: _(7_1_4~) 2_6_4_-6_29_7 ____________________ _
Print Name : Bill Goshen , Jr.
Title: Vice President Date: April 30, 2019
SIGNING INSTRUCTIONS TO THE CONTRACTOR
Non-Collusion Affidavit must be accompanied by notary certificates for signature. Note
the description of the document on the notary certificate. Attach notary certjfi c ate
jmmedjately fol!owjog thjs page. If the Bidder fails to properly sign or omits the required
signature, the bid will be considered non~responsive and will be rejected.
C-6
ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or validity of that document.
State of California }
Countyof _O_r_a_ng~e _______ _ }
On APRIL 30, 2019 before me, ~~~~~~~.,,.,-'~~~4-~~~~~~~~~-
p er son a II y appeared _B_il_I G_os_h_e_n_, _J_r. ________________ _
who proved to me on the basis of satisfactory evidence to be the persontst whose
nametst is/are subscribed to the within instrument and acknowledged to me that
helshelthey executed the same in his/I 1e1ftl1ei1 authorized capacity~). and that by
his,it:ier/il=leir signature~ on the instrument the person(s;, or the entity upon behalf of
which the person(€;-) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
(Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
NON-COLLUSION AFFIDAVIT
(Title or description of attached document)
Black Rock Construction Company
(Title or description of attached document continued)
Number of Pages _l_ Document Date 4 I 30 /19
CAPACITY CLAIMED BY THE SIGNER
D Individual {s)
0 Corporate Officer
Vice President
(Title)
D Partner(s)
D Attorney-in-Fact
o Trustee(s) o Other _________ _
2015 Version www.NotaryClasses .com 800-873-9865
INSTRUCTIONS FOR COMPLETING THlS FORM
This form complies wi1h current Culijomia statutes regarding notary wording and,
if needed. should be completed and attached to the documenl. Acknolwedgcnts from
other states may be completed.for documents heing sent to that scate so long as the
wo.-ding does not require the California nolary to violate Calijumia notary law.
• State and CoWlty information must be the Slate and County where the document
signet(s) personally appeared before the notary public for acknowledgment .
• Date ofnolarization must be the date that the signer(s) perwnally appeared which
must also be the same date lhe acknowledgment is complt:ted.
• The notary public must print his or her name as it appears wilhin hi~ or ht:r
commission followed by a comma and then your title (notary public).
• Print the name(s) of document signer(s) who personally appear at the timt: of
notarization .
• Indicate the com:ct singular or plural fonns by crossing off incorrect fonns (i .e.
he/she/~ is /afe) or circling the correct limns. Failure to correctly indicate this
infonnation may lead to rejection of document rt:>1:ording.
• The notary seal impression must be clear and photographically reproducible .
Impression must not cover text or lines. If st:al impression smudges, re-seal if a
sufficient urea pennits, otheiwise complete a different acknowledgment IOnn .
• Signature ot'thc notary public must match the signatur1: on file with the office of
the county clerk .
•!• Additional infonnation is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
•) Indicate title or type of atulched document, number of pages and date.
•!• Indicate the capacity claimed by the signcc. If the claimed capacily is a
corporate officer, indicate the title (i .e. CEO, CFO, Secrelary)
• Securely attnch this document to the signed document with a staple.
BIDDER'S BOND
CITY OF LAKE ELSINORE
CIP Project No. Z10010
BOND NO. _N_IA ____ _
SB 821 SUMNER, DAVIS AND MOHR STREET
CURB, GUTTER AND SIDEWALK PROJECT
CIP PROJECTNO.Z10010
KNOW ALL MEN OR WOMEN BY THESE PRESENTS:
That we Black Rock Construction Company as PRINCIPAL,
hereinafter referred to as "Contractor", and Philadelphia Indemnity Insurance Company
a duly authorized corporate as "Surety," are held and firmly bound unto the City of Lake Elsinore in
the penal sum of TEN PERCENT (10%) OF THE TOTAL AMOUNT OF THE BID of the Contractor
above named, submitted by said Contractor to the City of Lake Elsinore for the V'.K>rk for said project
entitled above, for the payment of which sum in la\J'Aul 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 10% of the Bid
THE CONDITION OF THIS OBLIGATION IS SUCH :
That whereas the Contractor has submitted the above-mentioned Bid to the City of Lake Elsinore
as aforesaid for the work for said project entitled above.
NOW, THEREFORE, if the aforesaid Contractor is awarded the Contract and, within the time and
manner required under the Contract documents, after the prescribed forms are presented to him or
her for signature, enters into a written Agreement in the prescribed form and in accordance with
the Contract documents, and files tvvo 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 2017 4 of the Public Contract Code.
In the event suit is brought upon this bond by the City and judgment is recovered, the Surety shall
pay all costs incurred by the City in such suit, including a reasonable attorney fee to be fixed by the
court.
(SIGNATURE PAGE FOLLOWS)
C-7
CITY OF LAKE ELSINORE
CI P P roj ect No. 21 0 01 0
BIDDER'S BOND SIGNATURE PAGE
SB 821 SUMNER, DAVIS AND MOHR STREET
CURB, GUTTER AND SIDEWALK PROJECT
CIP PROJECT NO. Z10010
IN WITNESS WHEREO F . we hav e hereunto set ou r hand s a nd sea ls on
t h is 30 t h day of.April _2019
BIDDER: CORPORATE SURETY:
Contractor Name: Black Rock Const ruction Company Company Name: Philadelphia Indemni ty Insurance Company
Address: 92 9 Mar iner St., Brea. CA 9282 1 Address: 251 S. Lake Ave .. Suite 360 Pasadena , CA 91101
T ele phone No .: _7_14_-_2_64_-_6_29_7 _____ _ Te lephone No.: 626-639-1323
Print Name: Bill Go shen, Jr. Print Name: Shane Wo lf
~----------
T itle : Vice President Title: Attorney-in-Fact
Date : April 30, 2019 Date : April 30, 2019
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 c ertificate. Attach BOTH notary certificates
immediately following this page.
Corporate Seal may be affixed hereto.
The attorney·in·fact for corporate surety must be registered, as such, in at least one county
in the State of California. Attach one original Power of Attorney immediately following the
notary certificates.
If the Bidder fails to properly sign or omits the required signatures , the bid will be considered
non-responsive and will be rejected.
C-8
' I
ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or validity of that document.
State of California }
County of _O_r_a ~ng~e _______ _ }
On APRIL 30, 2019
personally appeared _B_il_I G_o_sh_e_n__:_._J_r. ________________ _
who proved to me on the basis of satisfactory evidence to be the persontst whose
namets1 isfare subscribed to the within instrument and acknowledged to me that
he/shefthey executed the same in hisil1e1ftl1ei1 authorized capacity(tes-), and that by
hisJl-'leFftf:teir signaturets1 on the instrument the personts1, or the entity upon behalf of
which the person(&-) acted, executed the instrument.
I certify under PENAL TY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
(Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE A TT ACHED DOCUMENT
BIDDER'S BOND FOR CIP PROJECT
(Title or clescription of attached document) N 0 • Z 10 0 1 0
Black Rock Construction Company
(Title or description of attached documeot oonlinued)
Number of Pages _2_ Document Date 4/30I19
CAPACITY CLAIMED BY THE SIGNER
D Individual (s)
0 Corporate Officer
Vice President
(Title)
0 Partner(s)
0 Attorney-in-Fact
D Trustee(s)
D Other _________ _
2015 Version www .NotaryClasses.com 800-873-9865
INSTRUCTIONS FOR COMPLETING THIS FORM
This.form r:omplies with current California stal!ltes regarding notary wording and,
if needed. should be complered a11d al/ached to the documenr. Aclomlwedgenrs from
other states may be cumpleted./or ducume11ts being sent to that stale so long as the
wording doev not require the California notary to violate California notary law.
• State and County infonnation must be the State and County where the document
signer(s) personally appeared before the notary puhlic for acknowli:dgment.
• 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 hi:r
commission followed by a comma and then your title (nowry public).
• Print thi: name(s) of document signer(s) who personally appear at the time of
notarization .
• Indicate the correct 8ingular or plur,d fonns by crossing off incorrect tbnns (i .e.
ke/shefll:iey, is /a£$) or circling the correct limns . Failuri: to correctly indicate this
information may lead lo rejection of document recording .
• The notary seal impression must be clear and photographically reproducible .
Impression must nol cover text or lines. tr seal impres8ion smudges, re-seal if a
sufficient ari:a permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the 8ignature on file with the office of
the county clerk .
+:-Additional infonnation is not required but could help to ensure this
acknowledgment is not misused or auached to a different document.
(• lndicak title or type of attached document, number of pages and dale .
(• Indicate the capacity claimed by the signer . If the claimed capacity is a
corporate officer, indicate the title (i .e. CEO, CFO, Secretary).
• Securdy attach this document lo the signed document with a staple.
...
ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate
is attached , and not the truthfulness, accuracy, or validity of that document.
State of California }
County of _o_r_a_ng __ e _______ _ }
On APRIL 29, 2019
personally appeared _S_h_a_ne_W_o_l_f ------------------
who proved to me on the basis of satisfactory evidence to be the person~ whose
name~ is/ere subscribed to the within instrument and acknowledged to me that
he/sl"le/tliey executed the same in hislt 1eiltl 1ei1 authorized capacity(ies'), and that by
his/hefftl'leir signature~ on the instrument the personts}, or the entity upon behalf of
which the person(&) acted, executed the instrument.
I certify under PENAL TY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
r no n no no n no n n no nno ;nnono $1 v uuv a '"'' wr w v rsavav& F ~
•
SU SAN E. MORALE S
... COMM .# 2279182 z ~ NOTARY PUB LIC -CALIFORNIAS:
-ORANGE CO UNTY ~ J ft.t.own -l_ · (!)_ID~
Notary Public Signature (Notary Public Seal) la a an a ..... ~! c~.~~·. ~:?~r,e s M ar.c~ ~8, ~.~~~ J v v<Wa <WWW v u suwawuwv;
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM
ThL~ form complies with c urrent Califomiu s tutule.~ regarding notary wnrding and,
DESCRIPTION OF THE ATTACHED DOCUMENT if needed. should beco111ph!1edt111dauach ed 10 the document. Acknotwedge111sfrom
BIDDER'S BOND FOR BLA CK ROCK
(TiU e or description of attached document)
CONSTRU CTION COMPANY
(Tille or description of attached document continued)
Number of Pages _2_ DocumentDate 4/30/19
CAPACITY CLAIMED BY THE SIGNER
O Individual (s)
0 Corporate Officer
(Title)
0 Partner(s)
0 Attorney-in-Fact
o Trustee(s )
o Other ~~~~~~~~~~~
2015 Version www .NotaryClasses.com 800·873·9865
oth er stotes may be completed for dncum ent.s bei11g sent to that state st> lo11g as th e
wording does 1101 req11ire the California notary to vinlate California notary law.
• State and County information must be lhe State and County where the document
signer(s) personally appeared before the notary publi c for acknowledgmen t.
• Date ofnotarization must be the date that the signer(s) personally appeared which
must also be the sam e date the ackn owledgment is completed.
• The notary public must print his or Iler name as it appears within his or her
commission foll owed by a comma and then yo ur title (notary public).
• Print the nam c(s) or document signcr(s) who penmn ally appear at the tim e of
notar izat ion..
• Indicate the correct si ngular or pl ural forms by cr~;ng off incorrect forms (i .e.
ke/shc/!l!ey;-ts /are) or circling the correct forms . Failure to correctly indicate this
infonnauon may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproduci ble .
Impression must not cover texl or lines . If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a di fferent acknowlcdgmenl form .
• Signature orthe notary public must match the s ignalure on file with the offi ce or
the county cle rk.
0:-/\ddit ional informati on is nol req uired but coul d he lp to ensure this
acknowledgment is not mis~ or attached to a different document.
.;. Ind icate title or type of attac hed document, num ber of pages and date .
~ indicate tlte capacity claimed by the signer. Jf the claimed ca pacity is a
corporate officer, indicate the Litl e (i .e CEO, CFO, Secretary).
• Securely attach thi s document to the signed docu ment with a staple.
PHILADELPHIA INDEMNITY INSURA~CE COMPANY
One Bala Plaza, Suite 100
Bala Cynwyd, PA 19004-0950
Power of Attorney
855
KNOW ALL PERSONS BY THESE PRESENTS: That PHILADEL~HIA INDEMNITY INSURANCF. COMPA'.'IY (the Company), a corporation organized and
existing under the laWl> of the Commonwealth or Pennsylvania, does hereby constitute and appoint Todd M. Rohm, Shane Wolf, Cheryl L. ThomAs and Bea la A.
Sensi of Rohm lnsur11ncc Agency, its trui: and lawful Attorney-in-fact with lull authority to execute on its behalf bonds, undertakings, recognizances and other
contra1;t8 of indemnity and writings obligatory in the narurc thereof, issued in the course of its business and to bind the Company thereby, in an amount not to exceed
s s o.000.000 .00.
This Power of Attorney is granted and is s igned and sealed by fac8 imil e under and hy the authority of the following Resolution adopted hy the Board of Directors or
PHILADELPHIA INDEMNITY INSU RANCE COMPANY on the 14'h o f November, 2016 .
RESOLVED:
fURTHf.R
RESOLVED:
That the l.loard of Director8 hen:by authorizes thi: President or any Vice President of the
Company: (I) Appoint Attorney(s) in Fact and authorize the Attomey(s) in !'act to
execute on behalf of' the Company bonds and undertakings, contracts of indemnity and
other writings obligatoiy in the narure thereof and to attach the seal of the Company
thereto; and (2) to remove, at any time, any such Attorney-in-Fact and revoke the
authority given . And, be it
That the signatures of such officers and the seal of the Company may be affixed to any
such Power of Attorney or certificate relating thereto by facsimile, and any such Power of
Attorney so executed and certified hy facsimile signatures and facsimile seal shall be
valid and binding upon the Comp1my in the futuri: with respect to any bond or
undertaking to whicn it is attached .
IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSF.n THIS INSTRUMENT TO RE SIGNED ANO ITS
CORPORATP. SF.Al.TO RF. AFFIXF.O BY ITS AUTHORIZED OFFICE THIS 27111 DAY OFOCTOUER, 2017.
(Seal)
Robert D. O'Leaty Jr., President & CEO
Philadelphia Indemnity Insurance Company
On this 27lh day of October, 2017, belore me came the individual who executed the preceding instrument, to me personally known, and being by me duly sworn said
that he is the therein described and authorized officer of the PHILAJlF.l.PHIA INDF.M;>.llTY INSLllANCF. COMPANY; that the seal amxed to said instrumenl is
the Corporate seal of said Company; that the said Corporate Seal and his signature were duly affixed .
Notary Public:
residing at: Uala Cymwd. PA
(Notary Seal)
My commission expires: September 2S 2021
I, Edward Sayago, Corpora1e Sec retary of PM I LADE LP! ll A IND EMN ITY INS URANCE COM PANY , do he reby certify that the fort-going r~solu tion of thi: Board of
[)ircctors and the Power of Attorney issued pursuant !h ereto on the 27~' day ofOc1obc r, 2017 are true and correc1 and are still in IUll force and e ffect I do furth er cert ify
that Robert D. O'Leary Jr., who executed the Power of Attorney as President, wa.' on the date of exe1,:ution of the atw..:hed Power or Attorney the duly elected President
of PHILADELPHIA INDEMNITY INSURANCE COMPANY .
In Testimony Whereof! have subscribed my name and affixed the facsimile seal of each Comp-.my this 30th day of APRIL 20 19 -' --·-
F.dw.ird Sayago, Corporate Secretary
PIIILADl!:LPlllA INDt:MNITY INSURANC~ COMPANY
LIST Of SUBCONTRACTORS
CITY OF LAKE ELSINORE
CIP Project No. Z10010
SB 821 SUMNER, DAVIS AND MOHR STREET
CURB, GUTTER AND SIDEWALK PROJECT
CIP PROJECT NO. Z10010
The bidder is required to fill in the following blanks in accordance with the provisions of the
Subletting and Subcontracting Fair Practices Act (Chapter 2 of Division 5, Title 1 of the
Government Code of the State of California) and should familiarize itself with Sections 2-3 of the
Standard Specifications.
Name Under Which Subcontractor is Licensed: __ &,-'-/l_ .... +/->"--~-c_(li"'--'01 ________ _ I ~
License Number: '-3 0 3 (;,O
Address of Office, Mill or Shop: L fCi 0 !£. Lt, Cft 5f-.c.. /lv(. An ~,~ ,. CG,.
Specific Description of Sub-Contract: and Bid Items of Work:_..../t,_,<-r/-4 ...... <:..._C"'""J-_______ _
t1= u , / 't . / ' , l l , 'L rr, 1 3 c 1 J), ] Yr L( r , lf '1 4 7
Name Under Which Subcontractor is Licensed: (_ ~ d~( (.<>Xe...~
License Number: 3 7 4f 6D O
Address of Office, Mill or Shop: L (...go .! ' Lr I(. ( A (/-1. < I.) I oo vt...~7 )-,-", ( <\.
Specific Description of Sub-Contract: and Bid Items of Work __ s._1-..,,._r .... r-'"'~• o...._..~~------
.J:t 1... '11 '-Cl I '-( 't
Name Under Which Subcontractor is Licensed: __ ...::;.S ..... J-'--<t"L----4/-'-~ ~"""'L..-.r __ ...c;>'""'"vv,,___~-+-....:..<P_/f~t'P..--
License Number: ((JoOfJt7 I tt n r
Address of Office, Mill or Shop: I ) c; s-.> 'SI:. 7 Pc.r &. c.·.~t:l-r; flt.r I 'JJ../V J ~, L"c.
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 Californ ia for the type of work that they are to perform. Do not list
alternate subcontractors for th e same work.
C-9
REFERENCES
CITY OF LAKE ELSINORE
Cl P Project No. Z1001 O
SB 821 SUMNER, DAVIS AND MOHR STREET
CURB, GUTI'ER AND SIDEWALK PROJECT
CIP PROJECT NO . Z10010
Failure to demonstrate adequate experience may result in rejection of the bid.
For all public agency projects with a similar scope of work which you have worked on (or are
currently working on) in the past three (3) years, provide the following required information:
1 . Name (Firm/ Agency) ___ <-____., -~__,,,'--......;6);.....;;J-_ __,_/...:,c._{V{._,,_ __ IZ-_f.-'-5......;)(vi, __ ~ __ _
Address _______ _._1'1_.:..;;o'""''"""---=S_f .;.... ~--"'l....::c,_<~__;;::;,.__;;~-~-'' ~ __ --<... __ _
7
Project Tit le ------=L _c_~_c. _5 _ko_-c~------------
Project Location. ____ __..L--=-' _{ t _c =..>-~--=--~--;--=l-=<.c..:Jl<....,__.,<..."'--\f-=--{-_s._~ __ V'"'C__.._ __
Type of Work ____ L-_1....-=,.-J..~c>-~(,,_ .. _,_f...;,--1-v--=....,.., _ ___...O'"--Ac,~e:.....1,_. _.LA=.1..-..i!...s,.1-/_l......:c.~t_I-__ _
Project Manager Contact /I),), o ( c.. Phone _______ _
Dated Completed 0-c(-) 0( 'if Contract Amount __ Y___,.r9'--L_vv__;o:...,_ __
2 . Na me (Firm/ Agency) __ ......;(,=-"-'--:-~--t'--...::.()......;C-__ ...;;_l....;;.<-_l_'-<-::...__....,./fr:;..:.,,_I"""~ =-; ~_;;;,_v--<-:,__::..._ __
Address ------~,/?--=c...;...' '.;...;.,..,_~5T.'-'''-'l'---L_,t._r_.:«:.:...,____.,JS,'---t !_, ~--'-.:......;:;....._ __ _
Project Title ------"/.J.'-'.e..:;__c._l e_,,{_--'r..___P_-c._t/_L~1,,_/'-"'.L..1 _l,_."--y __ f_,--=-J-_. __ _
Project Location. ____ ~///l.__"'"""e-....... ~_ ..... ).-_ _,fi_.c"'-"'-'-£.~-L-=-~-t._'---=c::...;;___/(_( <_1 '-~-~~
Type of Work ____ ?!<:::....:l.s -'-r """'b14)=:........=W...::...v.<..-J-l-l/___:;._,_,__,.$"-/!-iv~, __,/k.~q..;?_l_c_· l_)-__ _
Project Manager Contact ,;f/iZ oCc_ Phone. _______ _
Dated Completed &:t1 1-~ JOt9 Contract Amount t l °' 0 D 'i>
3. Name (Firm/Agency) /.. ;-t y o E-Co s J-s A..:> ~
Address f-'t,'/ fJ r ., &osl-s A..> S
Project Title ,,4-( l /' e,.,... ,ero i... -c:->-< a f;s.
Project Location tJ~· .r1l> t. f
Type of Work (L }:f2-~~l 4/f: ).--ff<~ , l>.~ ~cf--c
Project Manager Contact lb: c. s h Phone. _______ _
Dated Completed 5'1 Li l,,.::>t'j Contract Amount /,Io a.. o t:>o
C-10
CITY OF LAKE ELSINORE
CIP Project No. Z10010
List any other projects (private, older than three (3) years, etc .) that may represent qualifying or
similar exp erience:
4 . Name (Firm/Agency) ___ l _,--1=+---o-"'--J-___ /-'-f.c-~ _ _,_1= _____ _
Address _______ S~~-<-~_-<_>_r_. ,.,.___.l ...... k ...... ~ __ }-_____ _
Proj ect Title ----~A-~I (.~s~< ""'----~k~"-~s_t_ .. ___ f.<-_· _h_c::_· s ____ _
Proj ect Location ____ __,_/+=~l _-'(~.f..,...f_t;..y;~k-P _ _,.t'-~(~k-~ __ J-______ _
'"' I . {
Type of Work _____ l.----'~·r-'-J.---"-}=_Cc-_vt-=r~t'--v...::____,__(_,_1 _rk_-=-v....::...._~_:_(_rt _,_1 _,_/h.J-+,~a'--~'-L,,-J-
Project Manager Contact Phone ________ _
Dated Completed J1v-<-l or( Contract Amount I !>¥> e.Ot>
5 . Name (Firm/Agency) --------------------
Address -------------------------
Project Title ------------------------
Proj ect Locatio n ______________________ _
Type of Work -----------------------
Project Manager Contact _________ Phone ________ _
Dated Completed _____ _ Contract Amo unt ________ _
6. Name {Firm/Agency) --------------------
Address -------------------------
Proj ect Title ------------------------
Project Location ______________________ _
Type of Work -----------------------
Project Manager Contact _________ Phone ________ _
Dated Completed _____ _ Contract Amou nt ---------
C-11
CONTRACTOR INFORMATION
CITY OF LAKE ELSINORE
CIP Proj e ct No. 210010
SB 821 SUMNER, DAVIS ANO MOHR STREET
CURB, GUTTER AND SIDEWALK PROJECT
CIP PROJECT NO. Z10010
Contractor's License No.: --$-+-Y""-']'"'-=]'"--0~8 ___ Class: __ A:~(--(_---~---
a. Date first obtained: ---=-/_2._-_l.._o_0_S..____ Expiration 2..,,.. LC, --Z.."i>
b. Has License ever been suspended or revoked? _ __,
1
.,_/V-"---=O __ _
If yes, describe when and why: -------------------
c. Any current claims against License or Bond? --__,.,.,_;t/_o __ _
If yes, describe claims: ---------------------
Principals in Company (List all -attach additional sheets if necessary):
NAME
v. I',
C-12
LICENSE NO.
(If Applicable)
CITY OF LAKE ELSINORE
CIP Proj ect No. Zl 0010
VIOLATIONS OF FEDERAL. STATE OR LOCAL LAWS
SB 821 SUMNER, DAVIS AND MOHR STREET
CURB, GUTTER AND SIDEWALK PROJECT
CIP PROJECT NO. Z10010
Has your firm or its officers been assessed any penalties by an agency for noncompliance
or violations of Federal, State or Local labor laws and/or business or licensing regulations
within the past five (5) y ears rel ati ng to your construction projects?
YES I ~ (circle one)
Federal I State I Local (circle one)
If "YES," identify and describe, (including agency and status): ---------
Have the penalties been paid? YES I NO (circle one)
2 . Does your firm or its officers have any ongoing investigations by any public agency
regarding violations of the State Labor Code, California Business and Professions Code or
State Licensing Laws?
YES I @) (circle one)
Code/Laws:
Section/ Article:
If "yes," identify and describe, (including agency and status): ----------
-J D -(~
Sign Date
Print Name Title
Contractor Name
C-13
PISQUALIFICAJ!ON OB DEBARMENT
CITY OF LAKE ELSINORE
CIP Proj ec t No. Z10010
SB 821 SUMNER, DAVIS AND MOHR STREET
CURB, GUITER AND SIDEWALK PROJECT
CIP PROJECT NO. Z10010
Has your firm, any officer of your firm, or any employee who has a proprietary interest in your firm
ever been disqualified, removed, or otherwise prevented from bidding on, performing work on, or
completing a federal, state or local project because of a violation of law or a safety regulation?
YES I @ (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 I NO (circle one)
Notes: Providing false information may result in criminal prosecution or administrative sanctions .
The above certification is part of the Proposal. Signing this Proposal on the signature
portion thereof shall also constitute sign tu re of this Certification.
Date
J~C..
Print Name Title
Contractor Nam e
C-14
If the Bidder fails to properly sign or omits the required signature, the bid will be considered
non-responsive and will be rejected.
UTILITY AGREEMENT
SB 821 SUMNER, DAVIS AND MOHR STREET
CURB, GUTTER AND SIDEWALK PROJECT
CIP PROJECT NO. Z10010
HONORABLE MAYOR AND CITY COUNCIL
CITY OF LAKE ELSINORE, CALIFORNIA
The undersigned hereby promises and agrees that in the performance of the work specified
in this contract for Project No. Z10010 Cultural Center Parking Lot Improvements, (I) (we)
(it) will employ and utilize only qualified persons , as hereinafte r defined, to work in proximity
to any electrical secondary, primary or transmission facilities. The term "Qualified person" is
defined in Title 8, California Administrative code , Section 2700, as follows:
Qualified Person : A person who by reason of experience or instruction , is familiar
with the operation to be performed and the hazards involved."
The undersigned also promises and agrees that all such work shall be performed in
accordance with all applicable electrical utility company's requirements, Public Utility
Commission orders, and State of California Cal -O SHA requirements.
The undersigned furth er promises and agrees that the provisions herein shall be and are
binding upon any su bcontractor or subcontractors that may be retained or employed by the
undersigned, and that the undersigned shall take steps as are necessary to assure
compliance by any said subcontractor or subcontractors with the requirements contained
herein .
Name
U · /'.
Title
/J(e-t_/<.. kft: {,e::>())~
Contractor Name
C-15
PUBLIC CONTRACT CODE
SB 821 SUMNER, DAVIS AND MOHR STREET
CURB, GUTIER AND SIDEWALK PROJECT
CIP PROJECT NO. Z10010
Public Contract Code Section 10285.1 Statement
In accordance with Public Contract Code Section 10285. 1 (Chapter 376, State. 1985), the bidder
hereby declares under pe:? of perjury under the laws of the State of California that the bidder has
_____ ,has not A-been convicted within the preceding three years of any offenses
referred to in that section, including any charge of fraud , bribery, collusion conspiracy, or any other
act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or
performance of, any public works contract, as defined in Public Contract Code Section 1101, with
any public entity, as defined in Public Contract Code Section 1100, including the Regents of the
University of California or the Trustees of the California State University. The term "bidder" is
understood to include any partner, member, officer, director, responsible managing officer, or
responsible managing employee thereof, as referred to in Section 10285.1.
Note : The bidder must place a check mark after "has" or "has nof' in one of the blank spaces
provided. The above Statement is part of the Proposal. Signing this Proposal on the
signature portion thereof shall also constitute signature of this Statement. Bidders are
cautioned that making a false certification may subject the certifier to criminal prosecution.
Public Contract Code Section 10162 Questionnaire
In accordance with Public Contract Code Section 10162, the Bidder shall complete, under penalty
of perjury, the following questionnaire:
Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest
in the bidder, ever been disqualified, removed , or otherwise prevented from bidding on, or
completing a federal, state, or local government project because of a violation of law or a safety
regulation: , /
Yes_ No.A
If the answer is yes, explain the circumstances in the following space.
Public Contract Code 10232 Statement
In accordance with Public Contract Code Section 10232, the Contractor, hereby states under penalty
of perjury , that no more than one final unappealable fin ding of contempt of court by a federal
court has been issu ed against the Contractor within the immediate preceding two-year period
because of the Contractor's failure to comply with an order of federal court which orders the
Contractor to comply with an order of the National Labor Relations Board.
Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the
signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders
are cautioned that making a false ce tification may subject the certifier to criminal prosecution .
0 -(
Date
Title
Contractor Nam e
C-16
TEST I
TEST TITLE SHEET
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