HomeMy WebLinkAboutKANA PIPELINE BID DOCUMENTS AVENUES MASTER SD CITY OF LAKE ELSINORE
CIP Project No. Z10032
SECTION C
BID DOCUMENTS
B-6
CITY OF LAKE ELSINORE
CIP Project No. Z10032
BIDDER'S PROPEL
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO.Z10032
Company: Lef 1D' I►-A `11J6..
Honorable Mayor, Members of the Council:
In accordance with the Notice Inviting Bids pertaining to the receiving of bid proposals by the City of
Lake Elsinore for the above titled improvement, the undersigned hereby proposes to furnish all Work
to be performed in accordance with the Specifications, Standard Drawings, and the Contract
Documents, for the unit price or lump sum set forth in the following schedule:
Time of Completion: One Hundred Twenty (120) Working Days from Issuance of Notice to
Proceed (NTP) by City to Contractor.
1. BID SCHEDULE A
ITEM
NO. ITEM DESCRIPTION T UNIT QUANTITY UNIT COST TOTAL COST
GENERAL ITEMS
1. Mobilization&Demobilization I Not to Exceed 5%of Bidl IS
2, Site Maintenance and Best Management Practice LS 1 OI pl
3 Traffic Control and Public Convenience. LS 1 7 DOO`A 7 OaD eii
4. Construction Survey and Re-Establishing Centerline Toes and
Monuments. LS
1 ppw %
SITE DEMOLITION
5, Sawcut, Remove and Dispose of Existing AC Pavement SF 28,460 --� p
e. Remove And Dispose of ExistingAC Berm LF 505 p p
7. Remove And Dispose of Existing Concrete Headwall w/ 11
Precautionary Measures Taken to Protect the Two LS 1 mow! / CPO
Existing 36"Fiberglass Pipes In-Place for Reuse #
8. Sawcut,Remove and Dispose of Existing Concrete Curb LF 355 2 q0� 7 y Sa
&Gutter
9. Sawcut,Remove and Dispose of Existing Concrete Curb LF 75 rJ `! O o�
Only
10. Sawcut, Remove and Dispose of Existing Concrete SF 440 I 0
Sidewalk
11. Sawcut. Remove and Dispose of Existing Concrete SF 1,085 �y 60
Cross-Gutter&Curb at T-Intersection
12 Remove Existing Gabion Wall for Reuse (59 LF). 1 �r,�� ao
Dispose of ExistingFilter Fabric Material. LS 7[�
Remove And Dispose of Existing T Wide Curb Opening
13 Catch Basin wl Precautionary Measures Taken to
Protect the Existing 15"And 24" Storm Drain Pipes In- EA i
Place for Reuse 7 f
UNCLASSIFIED EXCAVATION,SOIL EXPORT AND GRADING
14. Earthwork Trenching&Stockpiling,Cut-Volume CY 4850 'y$ 0
15. Earthwork Backfill and Roadway Grading,Fill-Volume CY 2,700
16. Off-site Hauling and Disposal of Surplus Soil Material CY 2,150 - ) c0
As-Needed
STREET IMPROVEMENTS
17. Construct 8" Hot Mix Asphalt Dike Per City of Lake
Elsinore Std. No.207 LF 616
18. Construct 4" AC Paving Over 95% Compacted Native TON 387
Soils Per Soil Engineers Recommendations
19 Construct 6"Thick PCC Residential Driveway Approach SF 340
Per City of Lake Elsinore Std. No.207 Width Per Plan
20 Construct 8" Curb Only, Type 8A Per City of Lake LF 56
Elsinore Std. No.203
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CITY OF LAKE ELSINORE
C!P Project No. Z10032
Construct 6' Wide Concrete Cross Gutter Only Per
21 Section A-A Of City of Lake Elsinore Std. No. 209A and
Detail 26 On Sheet 2.Construct Weakened Plane Joints 5F 1,425 7�
for Gutter Eve 10'
22 Construct 4'Wide Concrete Ribbon Gutter Per Detail 27
on Sheet 2 SF 2,580 ?lp°s 77 c�ad
23.
Construct 8"Concrete Integral Curb&Gutter Type 8 Per tl
LF 80
Citv of Lake Elsinore Std No.201
Cold Mill 2"Min Of Existing AC Pavement, Crack Seal
24. 1/4" Or Larger, And Construct 2" M n. AC Overlay Per SF 1800 $ c 1� .��
Detail on Sheet 2
25. Construct 3'Long 0"Curb to Full Height Curb Transition LF 6
26 Construct Full Depth AC Paving. Paving To Match SF 415 �� �QO�
Existing Pavement Section. 4-Min.
27 Construct 4"Thick Concrete Sidewalk Per City of Lake SF 575 .�`�
Elsinore Std No.210
Ji. Ilk
Reinstall Gabion Wall Using Salvaged Materials with
oi
28. New Mirafi 140N Filter Fabric(or Approved Equal) Per LS 1 $opl
Plan 59 LF
Traffic Striping & Markers, and Pavement Legends (4"
Double Yellow Striping per Caltrans STD. A20A, DOW �i
2Y. 22; 4" White Edge of Traveled Way Line per Caltrans L5 1 �
"r
STD. 276; Stop Pavement Marking and 12" Limit Line 7,4o 10"
Striping)
Re-install Salvaged Traffic Signs with Mounting per City 30. STD. No.406A. EA 1 Ov (p+llea'
Install MUTCD Warning Sign W3-1 (CA)With Mounting 1111:4. a1
31. Per City of Lake Elsinore Stop Sign Installation Detail EA 1
Std. Dwq.406A
32 Construct 2' AC (4"AC at Storm Drain Trench) Paving ,qQ�
Per Detail on Sheet 2 TON 565 Zf�Z I�s'�?Jp
STORM DRAINAGE IMPROVEMENTS
33. Install 15"RCP(D-LOAD Per Profile). Trench And Pipe �o p�
BeddingPer RCFC&WCD Std. .No.M815 LF 88 }Or O.�p
34. Install 18" RCP (d-load per profile). Trench and pipe ,
Bedding Per RCFC&WCD Std.DArg.No. M815 LF 570 �rOO'-� �G "7'W'0 �
35. Install 24" RCP (D-Load Per Profile)_Trench And Pipe
Bedding Per RCFC&WCD Std.Dwg.No.M815 LF 37
36. Install 36" RCP (D-Load Per Profile). Trench And Pipe
Bedding Per RCFC&WCD Std.Dwg.No.M815 LF 896 �
37. Install 48' RCP (D-Load Per Profile). Trench And Pipe
Bedding Per RCFC&WCD Std.D No. M815 LF 723
38. Construct Concrete Collar Per RCFC&WCD Std. Dwg. EA 1 3 �.y2 ? b�
No. M803
i
39. Construct Catch Basin No.1 Per RCFC&WCD Std.Dwg.
No.C8100-10'C.B. EA 3 O`er S }011)`-
40. Construct Catch Basin No. 1 Per RCFC&WCD Std.Dwg. EA 3 g ���
No.CB100-14'C.B. b0
41. Construct Catch Basin No.1 Per RCFC&WCD Std.Dwg. EA 4 s0
No.CB100-21'C.B. 015
42. Construct Catch Basin with Grate Inlets Per SPPWC Std. EA 1 bats
Plan No. 301-4-14'C.B. 20 irb`b
43. Construct Catch Basin with Grate Inlets Per SPPWC Std.
Plan No.301-4-21'C.B. EA
44. Construct Manhole No. 2 Per RCFC&WCD Std. Dwg. EA
M.H.252 sl Ia
4S. Construct Junction Structure No.2 Per RCFC&WCD Std. EA 1 00 00�
Dw .JS227
46. Construct Junction Structure-Pipe to Pipe Per SPPWC EA 4 tr
Std. Plan No.332-2 !
47. Install Precast Jensen 24"X36" Catch Basin Model No.
D1243660 With Bolted Down Traffic-Rated Trax Plate
Steel Cover,Slip Resistant and Painted Black Per Detail EA 1
No. 15 On Sheet 13
48, Install Trash Rack(Inclined)Per SPPWC Std.Dwg.361- EA 1 ca Gi Cl (0pP3
49. Install 18"CMP Pipe by Cutting Existing 18" CMP and
Weldin 18"CMP Tee Per Detail 18 on Sheet 13 EA
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
50. Install 24"CMP Riser Per Detail 13 On Sheet 15(CMP
Shall Be Polymer Lined Per ASTM Std.A762,AASHTO EA 1 �'�O�m Q`�b��
Std.M245 Inside and Out _`
51. Construct Concrete Headwall and Wingwalls Per
Caltrans Std.Plan D90 With Concrete Cutoff Wall-4.0' EA 1 �,�
Deep, 12"Wide w/#4 @Q 12"E.W.
52. Construct Grouted 1/4 Ton Rip-Rap, 2.7 Deep w/Mirafi
00
110ON Filter Fabric Per Detail No. 16 on Sheet 13(3,100 LS 1 f 61 00b— 191,
SF i'
53. Construct Local Depression No.2 Per RCFC&WCD Std.
D�.v .No.LD201 and Per Detail on Sheet 3 EA 11 d6� 4S I co
54. Connect RCP Pipe to Catch Basin or Manhole Structure
Per Plan.Apply Non-Shrink Grout to Form a Water Tight EA 56 �� }�
Seal �i
55. Install 36"x72' Precast Reinforced Concrete Box Per LF 554
CALTRANS Std.No. D83A D83B
56. Construct Transition Structure for RCB to Pipe per
SPPWC Std Plan No.342-2 EA 1 10 47C jb
57 Construct Junction Structure to Connect Pipe to RCB per EA 4 7�k��
SPPWC Std.Plan No. 333-2
58. Construct manhole Structure per SPPWC Std.Plan No.
323-4 EA 2 /51 D0� $ $CV�
59. Install (Modified) Cast-in-Place Reinforced Concrete �
Junction Structure per CALTRANS Std. Plan No.D91A EA 1 2Rb� `,
60. Install 24'Flap Gale(Hydrogate or Approved Equal) EA
61. Remove interfering Portion of Exist. 30"Water Line and
Cap Ends.Install 48"Steel Casing per EVMWD Std.Plan LF 20
W-6 'Casing Only for Future Use).Cap Ends.
62 Install Bio-Clean FuV Capture Filter with 21' Trough
24stem Curb Open rig Catch Basin Model No.CIF-Full- EA a ,;pp°�
b3 Install Bio-Clean Full Capture Filter with 14' Trough
System Curb Opening Catch Basin Model No. CIF-Full- EA 2 �,5��
24. 1 !7
64. Install Bio-Clean Full Capture Filter with 10' Trough
System Curb Opening Catch Basin Model No.CIF-Full- EA 3 24. 7�`SDo�
65. Install Bio-Clean's Connector Pipe Screen(CPS)Model EA z �D�
No. U 4.7 x 24.
TOTAL BID PRICE:
TOTAL BID PRICE BASED ON BID SCHEDULE TOTAL OF UNIT PRICES FOR
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
$ 3 ,337
�1
Total Bid Price in Numbers
rt�41Z M 1 t.1�1 ca tis #'R
Total Bid Price in Written Form
In case of discrepancy between the written price and the numerical price, the written price
shall prevail.
Note: Estimated quantities are for the purpose of Bid comparison only; payments will be made on the basis of actual measurement
of Work completed, except for lump sum(LS) and final pay (F)quantities. (S) denotes a specialty item. The Bid Price shall include,
but not be limited to, sales tax and all other applicable taxes and fees.
All work described on the plans and in the specifications and other incidentals necessary to complete the project shall be paid under
items above. No additional payments will be allowed.
*BID MAY BE REJECTED IF TOTAL IS NOT SHOWN FOR BOTH FIGURES AND WORDS.
C-9
CITY OF LAKE ELSINORE
CIP Project No. Z10032
The undersigned agrees to enter into and execute a contract, with necessary bonds, at the unit
prices set forth herein and in case of default in executing such contract, with necessary bonds,
the check or bond accompanying this bid and the money payable thereon shall be forfeited
thereby to and remain the property of the City of Lake Elsinore.
The above unit prices include all work appurtenant to the various items as outlined in the
Specifications and all work or expense required for the satisfactory completion of said items. in
case of discrepancies between unit prices and totals, the unit prices shall govern.
The undersigned declares that it has carefully examined the Plans, Specifications, and Contract
Documents, and has investigated the site of the work and is familiar with the conditions thereon.
K40ch-2 ee L-ti,a� '. w�-
Contractor
Date: By: Aan0
Contractor's State License No.: (ol 7
Class:
Department of Industrial Relations Registration No:
Registration Date: 7 rf 11I.:gj Expiration Date: _ 'So
Address: 1262a Ms�►Kc1.1�. by6�u6
Phone: (;2 l4) 1400
FAX: l 419 6. 1407
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO.Z10032
The Bidder shall acknowledge the receipt of addenda by placing an"X" by each addendum
received.
Addendum No. 1 X
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.
Bi er's Signature Date
Print Name Title
C-11
CITY QE
LAKE , LSI1`�O�E
DREAM EXTREME
Y
ADDENDUM NUMBER 1
CIP Project No. Z10032
PROJECT: The Avenues Master Plan Storm Drain Improvement Project
DATE: March 19, 2024
The attached ADDENDUM is added to the contract documents for the above referenced project.
1. Avenues Storm Drain Delta Revisions: Line A - Alignment and corresponding laterals were
revised to accommodate future utility improvements. Please see the detailed descriptions below:
• Within Mill Street, Line A moved 4' southerly.
• Laterals A-11, A-10, A-9 length increased by 4'
• Within Avenue 1 - Line A moved 8' easterly.
• Laterals A-8, A-7, A-6 length increased by 8' Laterals A-5, A-4 length decreased by 23'
• Lateral A-4.1 length decreased by 8'
• Within Park Way Alley, Line A moved 2.5' northerly.
• Lateral A-3 length increased by 2'. Lateral A-2 length decreased by 3'
• Contractor is responsible to verify all changes from original plan set and specifications.
2. Bidder's Proposal Bid Schedule— Quantity changes due to the above details.
3. Online Q&A Open until: March 26, 2024, at 3:00 P.M.
3. New Bid Opening Date: April 9, 2024, at 2:00 P.M.
Prospective bidders are required to acknowledge receipt of this addendum to the contract on the bid
proposal form. Failure to acknowledge the addendum and/or include the revised Bidders Proposal
will consider your bid as non-responsive.
Sincerely,
Remon Habib
City Engineer
951-674-3124
130 S.MAIN STREET
LAKE ELSINORE,CA 92530
WWW.LAKE-ELSINORE.ORG
CITY OF LAKE ELSINORE
CiP Project No. Z10032
NON-COLLUSION AFFIDAVIT
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO.Z10032
STATE OF CALIFORNIA )
) SS
COUNTY OF -I�16�S10� )
(NAME) 4—OSEly-A
affiant being first duly sworn, deposes and says:
That he or she is —t1+y V 6ow- 1i'R_-G�Ipci=q of
(sole owner, partner or other proper title)
ke.►�e. ?+t>lprU► tw-' 1tJ6, • the party making the foregoing Bid,
that the Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership,
company, association, organization, or corporation; that the Bid is genuine and not collusive or
sham; that the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a
false or sham Bid, and has not directly or indirectly colluded, conspired, connived, or agreed with
any Bidder or anyone else to put in a sham Bid, or that anyone shall refrain from bidding; that the
Bidder has not in any manner, directly or indirectly sought by agreement, communication, or
conference with anyone to fix the bid price of the Bidder or any other Bidder, or to fix any overhead,
profit, or cost element of the bid price, or of that of any other Bidder, or to secure any advantage
against the public body awarding the Contract of anyone interested in the proposed Contract; that
all statements contained in the Bid are true;and,further, that the Bidder has not, directly or indirectly,
submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged
information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership,
company associations, organization, bid depository, or to any member or agent thereof to effectuate
a collusive or sham Bid. (Public Contract Code Section 7106)
Address: 2620 hO%&44POL1a A-VWPua F �2.�y s14� Gam. d12S��
Telephone No.: C_Iuij g%6-1 q4=
Print Name:
Signature: r
Title: Date:
SIGNING INSTRUCTIONS TO THE CONTRACTOR
Non-Collusion Affidavit must be accompanied by notary certificates for signature. Note
the description of the document on the notary certificate. Attach notary certificate
immediately Wlowona this 12age. If the Bidder fails to properly sign or omits the required
signature, the bid will be considered non-responsive and will be rejected.
C-12
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 Riverside
On 27, before me, Hernes Salvador-Tabadero, Notary Public _
personally appeared MV2_r
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 Iaws of State of California that the foregoing
paragraph is true and correct.
A0jkMM BAL MW TMAM
COMM. 02403404
NWARY C-CALS40FAM WITNESS my hand and official seal.
Can.Op Gw 3%2M
SIGNAT[1RE
PtACFNOIARNSMI ABOVI
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:.. _ _Number of Pages:
Signer(s) Other than Named Above:
CITY OF LAKE ELSINORE
CIP Project No. Z10032
LIST OF SUBCONTRAQTORS
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO.Z10032
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: 4lywrz
License Number: -72CC>110
Address of Office, Mill or Shop:� �
Specific Description of Sub-Contract: and Bid Items of Work:
ps?-NW"J01 c4of-$`�UTil g f Ccy-�� �196�✓DtT�>;' C_ytoss 6aUgVF.
Name Under Which Subcontractor is Licensed:
License Number: 2.15wt '52.
Address of Office, Mill or Shop:
Specific Description of Sub-Contract: and Bid Items of Work
'��N1c7.1� b.rrf� C��ht1 l.t� �fed�-i.a►� 1�•G �btSV �
Name Under Which Subcontractor is Licensed: C > !-� v
License Number: 31?c>
Address of Office, Mill or Shop: 370 &i6_� JN. SF.. T-,4y(.PP3:)_S
Specific Description of Sub-Contract: and Bid Items of Work:
Name Under Which Subcontractor is Licensed: _>(JFb*4L-F
License Number: 'j 7 630(0
Address of Office, Mill or Shop: 53A2 4�iQpeo,3
Specific Description of Sub-Contract: and Bid Items of Work:
Subcontractors listed in accordance with the provisions of Section 2-3 must be properly licensed
under the laws of the State of California for the type of work that they are to perform. Do not list
alternate subcontractors for the same work.
C-15
CITY OF LAKE ELSINORE
CIP Project No. Z10032
` .
THE AVENUES MASTEIR PLAN STORM DRAIN IMPROVE'r=NT PROJECT
4
CIP PROJECT NO.Z10032
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: _- --'Vy 1 - 6g0
uIr
License Number: O — --
Address of Office, Mill or Shop;
Specific Description of Sub-Contract: and Bid Items of Work:
Name Under Which`Subcontractor is Licensed:
License Number:
Address of Office, Mill or Shop:
Specific Description of Sub-Contract: and Bid Items of Work
Name Under Which Subcontractor is Licensed:
License Number: _
Address of Office, Mill or Shop:
Specific Description of Sub-Contract: and Bid Items of Work:
Name Under Which Subcontractor is Licensed:
License Number: — --
Address of Office, Mill or Shop:
Specific Description of Sub-Contract: and Bid items of Work:
Subcontractors listed in accordance with the provisions of Section 2-3 must be properly licensed
under the laws of the State of California for the type of work that they are to perform. Do not list
alternate subcontractors for the same work.
C-15
CITY OF LAKE ELSINORE
CIP Project No. Z10032
REFERENCES
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO.Z10032
Failure to demonstrate adequate experience may result in rejection of the bid.
For all public agency projects with a similar scope of work which you have worked on (or are
currently working on) in the past two (2) years, provide the following required information:
1. Name (Firm/Agency) M141;g A
Address 3601 Strc►Na yl?t-1> . 1�5 tIS C. gca7lo
Project Title k,4ggF.la bgtj• -_W1011+4
Project LocationMzONS N6 , M UL bud. e VT4 qF GVkI40
Type of Work 1,,mT sl o'r r;d'o yea $WP6 ?PoNac loo , 13"'R4t'Y"Vr> w6rw'
Project Manager Contact_Vo%jzg" Ji44� _ Phone "77 2z2.- Sz4-S-2-
Dated Completed "1 3l FA47A Contract Amount _`�S,+qY G32
2. Name (Firm/Agency) C>PXW-,,O
Address 4Lbb Mo<b.�1 8W Q. �'[' S3 * C.Q.
Project Title C'>--'TDp t0 W6t y.1 � Q46 Y4.t
Project Location
Type of Work 4
Project Manager Contact Phone
Dated Completed 05 Contract Amount , 061. 1�4i5
3. Name (Firm/Agency) VZOL-0 ►1:P!
Address 34'V416 4eXXdtR:�- 9U2wifrT 501T& 160
Project Title N TTDF-M_
Project Location C-Nn Gq O}-'%gzAt7
i
Type of Work ?pq' 0i= la�Ky�'rzc�, . - �i31 �� 3eYX-T ST> S t�eS
Project Manager Contact k??-Ac- NytWsV- Phone �1�°1) '`f2 k�r- 14aca
Dated Completed CL T' ContractAmount AL .0t37,evoOk-IL
C-16
CITY OF LAKE ELSINORE
CIP Project No. Z10032
List any other projects (private, older than three (3)years, etc.)that may represent qualifying or
similar experience:
4. Name (Firm/Agency)
Address l'52.5 t4Zgj
Project Title L G STbgbA
Project Location Gwt( ofo►aj`yr s,/�
Type of Work V%(Z4?} b(>.�zc`Q} �` .3► }u� `�'��l�P S Z
Project Manager Contact %J )41r=� Phonememe 60 •2-5 D
Dated Completed Contract Amount
5. Name (Firm/Agency) )�70M�S
Address 00o MOB tm 29 . &urM 3ey
Project Title
Project LocationLATI aAn > ti
Type of Work 4e" Vc-T -
Project Manager Contact Phone '1 l) B t7
Dated Completed lib Contract Amount
6. Name (Firm/Agency)
Address
Project Title
Project Location
Type of Work
Project Manager Contact Phone
Dated Completed Contract Amount
C-17
CITY OF LAKE ELSINORE
CIP Project No. Z10032
CONTRACTORINFORMAjION
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO. Z10032
Contractor's License No.: 'AL 1 !J& Class:
a. Date first obtained: �,o� n8+ Expiration 3 a 62.E
b. Has Bidder's License ever been suspended or revoked? Ho
If yes, describe when and why: ,ir
c. Any current claims against License or Bond? "VHo
If yes, describe claims: P 1p�
Principals in Comoanv (List all—attach additional sheets if necessary):
NAME FILE LICENSE NO.
(If Applicable)
17�N��L Loc.K� �R�y�►sT
_apt-a L�cue V1� PR.e�tps�T
C-1 s
CITY OF LAKE ELSINORE
CIP Project No. Z10032
VIOLATIONS 0 :FEDERAL_ STATE OR LOCAL i Awc
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO.Z10032
1. Has your firm or its officers been assessed any penalties by an agency for noncompliance
or violations of Federal, State or Local labor laws and/or business or licensing regulations
within the past five (5)years relating to your construction projects?
YES'V' (circle one)
Federal / State/ Local (circle one) }}
If"YES," identify and describe, (including agency and status): N/b-
Have the penalties been paid? YES/ NO (circle one)
2. Does your firm or its officers have any ongoing investigations by any public agency
regarding violations of the State Labor Code, California Business and Professions Code or
State Licensing Laws?
YES NO (circle one)
Code/Laws: ��—
Section/Article:
If"yes," identify and describe, (including agency and status):
P ld--
3. Has Bidder been "default terminated" by an owner (other than for convenience), or has a
Surety completed a contract for Bidder within the last five (5) years?
YES /W (circle one)
If"yes," please explain: 1� ��-
4. Has Bidder been cited more than twice for failure to pay prevailing wages in the last five (5)
years?
YES / 1 ) (circle one)
If"yes," please explain:
C-19
CITY OF LAKE ELSINORE
CIP Project No. Z10032
Notes: Providing false information may result in criminal prosecution or administrative sanctions.
The above certification is part of the Proposal. Signing this Proposal on the signature
portion thereof shall also constitute signature of this Certification.
nature date
.&Uv"i►.." Ill PW2,qgMPr
Print Name Title
Contractor Name
C-20
CITY OF LAKE ELSINORE
CIP Project No. Z10032
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO.Z10032
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 / F (circle one)
If yes, provide the following information (if more than once, use separate sheets):
Date: Entity: !p.
Location: P 1a
Reason: N Ibr
Provide Status and any Supplemental Statement: N f
Has your firm been reinstated by this entity?
YES / NO (circle one)
Notes: Providing false information may result in criminal prosecution or administrative sanctions.
The above certification is part of the Proposal. Signing this Proposal on the signature
portion thereof shall also constitute signature of this Certification.
4 LP11 101-4
gnature Date
PQ&� WC 4G%--
Print Name Title
Contractor Name
C-21
CITY O1'LAKE ELSINORE
CIP Project No. Z10032
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
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO.Z10032
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. Z10032, THE AVENUES MASTER PLAN STORM DRAIN
IMPROVEMENT PROJECT, (1) (we) (it) will employ and utilize only qualified persons, as
hereinafter defined, to work in proximity to any electrical secondary, primary or transmission
facilities. The term "Qualified person" is defined in Title 8, California Administrative code,
Section 2700, as follows:
Qualified Person: A person who by reason of experience or instruction, is familiar
with the operation to be performed and the hazards involved."
The undersigned also promises and agrees that all such work shall be performed in
accordance with all applicable electrical utility company's requirements, Public Utility
Commission orders, and State of California Cal-OSHA requirements.
The undersigned further promises and agrees that the provisions herein shall be and are
binding upon any subcontractor or subcontractors that may be retained or employed by the
undersigned, and that the undersigned shall take steps as are necessary to assure
compliance by any said subcontractor or subcontractors with the requirements contained
herein.
Signature
By: �
Name
\!k GA-�F
Title
P i P E; ,
Contractor Name
C-22
CITY OF LAKE ELSINORE
CIP Project No. Z10032
PUBLIC CONTRACT CODE
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO.Z10032
Public Contract Code Section 10285.1 Statement
In accordance with Public Contract Code Section 10285.1 (Chapter 376, State. 1985), the bidder
hereby declares under penalty of perjury under the laws of the State of California that the bidder has
, has not _y_ been convicted within the preceding three years of any offenses
referred to in that section, including any charge of fraud, bribery, collusion conspiracy, or any other
act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or
performance of, any public works contract, as defined in Public Contract Code Section 1101, with
any public entity, as defined in Public Contract Code Section 1100, including the Regents of the
University of California or the Trustees of the California State University. The term "bidder' is
understood to include any partner, member, officer, director, responsible managing officer, or
responsible managing employee thereof, as referred to in Section 10285.1.
Note: The bidder must place a check mark after"has"or"has not"in one of the blank spaces
provided. The above Statement is part of the Proposal. Signing this Proposal on the
signature portion thereof shall also constitute signature of this Statement. Bidders are
cautioned that making a false certification may subject the certifier to criminal prosecution.
Public Contract Code Section 10162 Questionnaire
In accordance with Public Contract Code Section 10162, the Bidder shall complete, under penalty
of perjury, the following questionnaire:
Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest
in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or
completing a federal, state, or local government project because of a violation of law or a safety
regulation:
Yes_ No 1�
If the answer is yes, explain the circumstances in the following space.
Public Contract Code 10232 Statement
In accordance with Public Contract Code Section 10232,the Contractor, hereby states under penalty
of perjury, that no more than one final unappealable finding of contempt of court by a federal
court has been issued against the Contractor within the immediate preceding two-year period
because of the Contractor's failure to comply with an order of federal court which orders the
Contractor to comply with an order of the National Labor Relations Board.
Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the
signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders
are cautioned that making a false certification may subject the certifier to criminal prosecution.
mature Date
s�1t4 LQ c44m= 1'P
Print Name Title
Contractor Name
C-23