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HomeMy WebLinkAboutAGREEMENT DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 Agreement No. AGREEMENT FOR PUBLIC WORKS CONSTRUCTION SAS Construction For the City Hall Concrete Footings and Foundation, Bid Set 'A' CIP PROJECT NO. Z20006 This Agreement for Public Works Construction ("Agreement") is made and entered into as of March 26, 2024 by and between the City of Lake Elsinore, a municipal corporation ("City") and SAS Construction ("Contractor"). The City and Contractor, in consideration of the mutual promises and covenants set forth herein, agree as follows: 1. The Project and Project Documents. Contractor agrees to construct the following public improvements("work") identified as: City Hall Concrete Footings and Foundation, Bid Set 'A'(the"Project") The City-approved plans for the construction of the Project, which are incorporated herein by reference and prepared by Staff, are identified as: Bid Set 'A', Concrete Footings and Foundation The Project Documents include this Agreement and all of the following: (1) the Notice Inviting Bids, Instructions to Bidders, Bid Documents including Bidder's Proposal as submitted by the Contractor, Contract Documents, General Specifications, Special Provisions, and all attachments and appendices; (2) everything referenced in such documents, such as specifications, details, standard plans or drawings and appendices, including all applicable State and Federal requirements; (3) all required bonds, insurance certificates, permits, notices, and affidavits; and (4) any and all addenda or supplemental agreements clarifying, amending or extending the work contemplated as may be required to insure completion in an acceptable manner. All of the provisions of the above-listed documents are made a part of this Agreement as though fully set forth herein. 2. Compensation. a. For and in consideration of the payments and agreements to be made and performed by City, Contractor agrees to construct the Project, including furnishing all materials and performing all work required for the Project, and to fulfill all other obligations as set forth in the Bidder's Proposal, such contract price being two million six hundred ninety thousand dollars and no cents ($2,690,000.00). 1 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 b. City hereby promises and agrees to employ, and does hereby employ, Contractor to provide the materials, do the work, and fulfill the obligations according to the terms and conditions herein contained and referred to, for the prices set forth, and hereby contracts to pay the same at the time, in the manner, and upon the conditions set forth in the Project Documents. C. Contractor agrees to receive and accept the prices set forth in the Bidder's Proposal as full compensation for furnishing all materials, performing all work, and fulfilling all obligations hereunder. Such compensation shall cover all expenses, losses, damages, and consequences arising out of the nature of work during its progress or prior to its acceptance including those for well and faithfully completing the work and the whole thereof in the manner and time specified in the Project Documents; and also including those arising from actions of the elements, unforeseen difficulties or obstructions encountered in the prosecution of the work, suspension or discontinuance of the work, and all other unknowns or risks of any description connected with the work. 3. Completion of Work. a. Contractor shall perform and complete all work within 45 working days from the date of commencement specified in the Notice to Proceed, and shall provide, furnish and pay for all the labor, materials, necessary tools, expendable equipment, and all taxes, utility and transportation services required for construction of the Project. b. All work shall be performed and completed in a good workmanlike manner in strict accordance with the drawings, specifications and all provisions of this Agreement as hereinabove defined and in accordance with applicable laws, codes, regulations, ordinances and any other legal requirements governing the Project. C. Contractor shall not be excused with respect to the failure to so comply by any act or omission of the City, the City Engineer, a City inspector, or a representative of any of them, unless such act or omission actually prevents the Contractor from fully complying with the requirements of the Project Documents, and unless the Contractor protests at the time of such alleged prevention that the act or omission is preventing the Contractor from fully complying with the Project Documents. Such protest shall not be effective unless reduced to writing and filed with the City within three (3) working days of the date of occurrence of the act or omission preventing the Contractor from fully complying with the Project Documents. d. City and Contractor recognize that time is of the essence in the performance of this Agreement and further agree that if the work called for under the Agreement is not completed within the time hereinabove specified, damages will be sustained by the City and that, it is and will be impracticable or extremely difficult to ascertain and determine the actual amount of damages the City will sustain in the event of, and by reason of, such delay. It is, therefore, agreed that such damages shall be presumed to be in the amount of $1,000 per calendar day, and that the Contractor will pay to the City, or City may retain from amounts otherwise payable to Contractor, such amount for each calendar day by which the Contractor fails to complete the work, including corrective items of work, under this Agreement within the time hereinabove specified and as adjusted by any changes to the work. 2 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 4. Changes to Work. City and Contractor agree that the City may make changes to the work, or suspend the work, and no matter how many changes, such changes or suspensions are within the contemplation of the Contractor and City and will not be a basis for a compensable delay claim against the City nor be the basis for a liquidated damage claim against the Contractor. Any change to the work shall be by way of a written instrument ("change order") signed by the City and the Contractor, stating their agreement to the following: a. The scope of the change in the work; b. The amount of the adjustment to the contract price; and c. The extent of the adjustment to the Schedule of Performance. The City Engineer is authorized to sign any change order provided that sufficient contingency funds are available in the City's approved budget for the Project. All change in the work authorized by the change order shall be performed under the applicable conditions of the Project Documents. City and Contractor shall negotiate in good faith and as expeditiously as possible the appropriate adjustments for such changes. 5. Bonds. Contractor shall provide, before commencing work, a Faithful Performance Bond and a Labor and Material Bond, each for one-hundred percent (100%) of the contract price in the form that complies with the Project Documents and is satisfactory to the City Attorney. 6. Non-Assignability. Neither this Agreement nor any rights, title, interest, duties or obligations under this Agreement may be assigned, transferred, conveyed or otherwise disposed of by Contractor without the prior written consent of City. 7. Licenses. Contractor represents and warrants to City that it holds the contractor's license or licenses set forth in the Project Documents, is registered with the Department of Industrial Relations pursuant to Labor Code Section 1725.5, and holds such other licenses, permits, qualifications, insurance and approvals of whatsoever nature which are legally required of Contractor. Contractor represents and warrants to City that Contractor shall, at its sole cost and expense, keep in effect or obtain at all times during the term of this Agreement, any licenses, permits, insurance and approvals which are legally required of Contractor to practice its profession. Contractor shall maintain a City of Lake Elsinore business license. 8. Indemnity. Contractor shall indemnify, defend, and hold harmless the City and its officials, officers, employees, agents, the County and Board Supervisors, and volunteers from and against any and all losses, liability, claims, suits, actions, damages, and causes of action arising out of any personal injury, bodily injury, loss of life, or damage to property, or any violation of any federal, state, or municipal law or ordinance, to the extent caused, in whole or in part, by the willful misconduct or negligent acts or omissions of Contractor or its employees, subcontractors, or agents, by acts for which they could be held strictly liable, or by the quality or character of their work. The foregoing obligation of Contractor shall not apply when (1) the injury, loss of life, damage to property, or violation of law arises from the sole negligence or willful misconduct of the City or its officers, employees, agents, or volunteers and (2) the actions of Contractor or its employees, subcontractor, or agents have contributed in no part to the injury, loss of life, damage to 3 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 property, or violation of law. It is understood that the duty of Contractor to indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil Code. Acceptance by City of insurance certificates and endorsements required under this Agreement does not relieve Contractor from liability under this indemnification and hold harmless clause. This indemnification and hold harmless clause shall apply to any damages or claims for damages whether or not such insurance policies shall have been determined to apply. By execution of this Agreement, Contractor acknowledges and agrees to the provisions of this Section and that it is a material element of consideration. 9. Insurance Requirements. a. Insurance. Contractor, at Contractor's own cost and expense, shall procure and maintain, for the duration of the Agreement, unless modified by the City's Risk Manager, the following insurance policies. i. Workers' Compensation Coverage. Contractor shall maintain Workers' Compensation Insurance and Employer's Liability Insurance for his/her employees in accordance with the laws of the State of California. In addition, Contractor shall require each subcontractor to similarly maintain Workers' Compensation Insurance and Employer's Liability Insurance in accordance with the laws of the State of California for all of the subcontractor's employees. Any notice of cancellation or non-renewal of all Workers' Compensation policies must be received by the City at least thirty (30) days prior to such change. The insurer shall agree to waive all rights of subrogation against City, its officers, agents, employees and volunteers for losses arising from work performed by Contractor for City. In the event that Contractor is exempt from Worker's Compensation Insurance and Employer's Liability Insurance for his/her employees in accordance with the laws of the State of California, Contractor shall submit to the City a Certificate of Exemption from Workers Compensation Insurance in a form approved by the City Attorney. ii. Commercial General Liability Coverage. Contractor shall maintain commercial general liability insurance in an amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If a commercial general liability insurance form or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit. Required commercial general liability coverage shall be at least as broad as Insurance Services Office Commercial General Liability occurrence form CG 0001 (ed. 11/88) or Insurance Services Office form number GL 0002 (ed. 1/73) covering comprehensive General Liability and Insurance Services Office form number GL 0404 covering Broad Form Comprehensive General Liability. No endorsement may be attached limiting the coverage. iii. Automobile Liability Coverage. Contractor shall maintain automobile liability insurance covering bodily injury and property damage for all activities of the Contractor arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and non-owned vehicles, in an amount of not less than one million dollars ($1,000,000) combined single limit for each occurrence. Automobile liability coverage must be at least as broad as Insurance Services Office Automobile Liability form CA 0001 (ed. 12/90) Code 1 ("any auto"). No endorsement may be attached limiting the coverage. 4 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 iv. Builder's Risk Coverage. Prior to the commencement of any construction of the Project, Design-Builder shall obtain (or cause to be obtained) and keep in force during the term of any construction, builder's risk insurance insuring for all risks of physical loss of or damage (excluding the perils of earthquake and flood). V. Professional Liability Coverage. Contractor shall maintain professional errors and omissions liability insurance appropriate for Contractor's profession for protection against claims alleging negligent acts, errors or omissions which may arise from Contractor's services under this Agreement, whether such services are provided by the Contractor or by its employees, subcontractors, or sub consultants. The amount of this insurance shall not be less than one million dollars ($1,000,000) on a claims-made annual aggregate basis, or a combined single limit per occurrence basis. b. Endorsements. Each general commercial liability and automobile liability insurance policy shall be with insurers possessing a Best's rating of no less than A:VII and shall be endorsed with the following specific language: i. The City, its elected or appointed officers, officials, employees, agents and volunteers are to be covered as additional insured with respect to liability arising out of work performed by or on behalf of the Contractor, including materials, parts or equipment furnished in connection with such work or operations. ii. This policy shall be considered primary insurance as respects the City, its elected or appointed officers, officials, employees, agents and volunteers. Any insurance maintained by the City, including any self-insured retention the City may have, shall be considered excess insurance only and shall not contribute with it. iii. This insurance shall act for each insured and additional insured as though a separate policy had been written for each, except with respect to the limits of liability of the insuring company. iv. The insurer waives all rights of subrogation against the City, its elected or appointed officers, officials, employees or agents. V. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its elected or appointed officers, officials, employees, agents or volunteers. vi. The insurance provided by this Policy shall not be suspended, voided, canceled, or reduced in coverage or in limits except after thirty (30) days written notice has been received by the City. C. Deductibles and Self-Insured Retentions. Any deductibles or self-insured retentions must be declared to and approved by the City. At the City's option, Contractor shall demonstrate financial capability for payment of such deductibles or self-insured retentions. d. Certificates of Insurance. Contractor shall provide certificates of insurance with original endorsements to City as evidence of the insurance coverage required herein. Certificates of such insurance shall be filed with the City on or before commencement of 5 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 performance of this Agreement. Current certification of insurance shall be kept on file with the City at all times during the term of this Agreement. 10. Notices. Any notice required to be given under this Agreement shall be in writing and either served personally or sent prepaid, first class mail. Any such notice shall be addressed to the other party at the address set forth below. Notice shall be deemed communicated within 48 hours from the time of mailing if mailed as provided in this section. If to City: City of Lake Elsinore Attn: City Manager 130 South Main Street Lake Elsinore, CA 92530 With a copy to: City of Lake Elsinore Attn: City Clerk 130 South Main Street Lake Elsinore, CA 92530 If to Contractor: SAS Construction Attn: Seyed Mohammad Ali Shahabi 301 West Dryer Rd Unit D Santa Ana CA 92707 11. Entire Agreement. This Agreement constitutes the complete and exclusive statement of agreement between the City and Contractor. All prior written and oral communications, including correspondence, drafts, memoranda, and representations, are superseded in total by this Agreement. 12. Amendments. This Agreement may be modified or amended only by a written document executed by both Contractor and City and approved as to form by the City Attorney. 13. Assignment and Subcontracting. Contractor shall be fully responsible to City for all acts or omissions of any subcontractors. Assignments of any or all rights, duties for obligations of the Contractor under this Agreement will be permitted only with the express consent of the City. Nothing in this Agreement shall create any contractual relationship between City and any subcontractor nor shall it create any obligation on the part of the City to pay or to see to the payment of any monies due to any such subcontractor other than as otherwise is required by law. 14. Waiver. Waiver of a breach or default under this Agreement shall not constitute a continuing waiver of a subsequent breach of the same or any other provision under this Agreement. 15. Severability. If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect. 16. Controlling Law Venue. This Agreement and all matters relating to it shall be governed by the laws of the State of California and any action brought relating to this Agreement shall be held exclusively in a state court in the County of Riverside. 6 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 17. Litigation Expenses and Attorneys' Fees. If either party to this Agreement commences any legal action against the other party arising out of this Agreement, the prevailing party shall be entitled to recover its reasonable litigation expenses, including court costs, expert witness fees, discovery expenses, and attorneys'fees. 18. Mediation. The parties agree to make a good faith attempt to resolve any disputes arising out of this Agreement through mediation prior to commencing litigation. The parties shall mutually agree upon the mediator and share the costs of mediation equally. If the parties are unable to agree upon a mediator, the dispute shall be submitted to JAMS or its successor in interest. JAMS shall provide the parties with the names of five qualified mediators. Each party shall have the option to strike two of the five mediators selected by JAMS and thereafter the mediator remaining shall hear the dispute. If the dispute remains unresolved after mediation, either party may commence litigation. 19. Authority to Enter Agreement and Administration. Contractor has all requisite power and authority to conduct its business and to execute, deliver, and perform the Agreement. Each party warrants that the individuals who have signed this Agreement have the legal power, right, and authority to make this Agreement and to bind each respective party. The City Manager is authorized to enter into an amendment or otherwise take action on behalf of the City to make the following modifications to the Agreement: (a) a name change; (b) grant extensions of time; (c) non-monetary changes in the scope of services; and/or (d) suspend or terminate the Agreement. The City Engineer shall act as the Project administrator on behalf of the City. 20. Prohibited Interests. Contractor maintains and warrants that it has not employed nor retained any company or person, other than a bona fide employee working solely for Contractor, to solicit or secure this Agreement. Further, Contractor warrants that it has not paid nor has it agreed to pay any company or person, other than a bona fide employee working solely for Contractor, any fee, commission, percentage, brokerage fee, gift or other consideration contingent upon or resulting from the award or making of this Agreement. For breach or violation of this warranty, City shall have the right to rescind this Agreement without liability. For the term of this Agreement, no member, officer or employee of City, during the term of his or her service with City, shall have any direct interest in this Agreement, or obtain any present or anticipated material benefit arising therefrom. 21. Equal Opportunity Employment. Contractor represents that it is an equal opportunity employer and it shall not discriminate against any subcontractor, employee or applicant for employment because of race, religion, color, national origin, handicap, ancestry, sex or age. Such non-discrimination shall include, but not be limited to, all activities related to initial employment, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff or termination. 22. Prevailing Wages. a. Contractor and all subcontractors shall adhere to the general prevailing rate of per diem wages as determined and as published by the State Director of the Department of Industrial Relations pursuant to Labor Code Sections 1770, 1773, and 1773.2. Copies of these rates and the latest revisions thereto are on file in the office of the City Clerk of the City of Lake Elsinore and are available for review upon request. 7 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 b. Contractor's attention is directed to the provisions of Labor Code Sections 1774, 1775, 1776, 1777.5 and 1777.6. Contractor shall comply with the provisions of these Sections. The statutory provisions for penalties for failure to comply with the State's wage and the hours laws will be enforced. C. Labor Code Sections 1774 and 1775 require the Contractor and all subcontractors to pay not less than the prevailing wage rates to all workmen employed in the execution of the contract and specify forfeitures and penalties for failure to do so. The minimum wages to be paid are those determined by the State Director of the Department of Industrial Relations. Labor Code Section 1776 requires the Contractor and all subcontractors to keep accurate payroll records, specifies the contents thereof, their inspection and duplication procedures and certain notices required of the Contractor pertaining to their location. The statutory penalties for failure to pay prevailing wages will be enforced. If the Project has been awarded to Contractor on or after April 1, 2015, Contractor and its subcontractors must furnish electronic certified payroll records to the Labor Commissioner. Beginning January 1, 2016, Contractor and its subcontractors must furnish electronic certified payroll records to the Labor Commissioner without regard to when the Project was awarded to Contractor. d. Labor Code Section 1777.5 requires Contractor or subcontractor employing tradesmen in any apprenticeable occupation to apply to the Joint Apprenticeship Committee nearest the site of the public works project, which administers the apprenticeship program in that trade for a certificate of approval. The certificate will also fix the ratio of apprentices to journeymen to be used in the performance of the Agreement. The Contractor is required to make contributions to funds established for the administration of apprenticeship programs if the Contractor employs registered apprentices or journeymen in any apprenticeable trade and if other contractors on the public works site are making such contributions. Information relative to apprenticeship standards, contributions, wage schedules and other requirements maybe obtained from the State Director of Industrial Relations or from the Division of Apprenticeship Standards. Labor Code Section 1777.6 provides that it shall be unlawful to refuse to accept otherwise qualified employees as registered apprentices solely on the grounds of race, religious creed, color, national origin, ancestry, sex, or age. e. Eight hours labor constitutes a legal day's work, as set forth in Labor Code Section 1810. 23. Execution. This Agreement may be executed in several counterparts, each of which shall constitute one and the same instrument and shall become binding upon the parties when at least one copy hereof shall have been signed by both parties hereto. In approving this Agreement, it shall not be necessary to produce or account for more than one such counterpart. [Signatures on next page] 8 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 IN WITNESS WHEREOF, the parties have caused this Agreement to be executed on the date first written above. "CITY" "CONTRACTOR" CITY OF LAKE ELSINORE, a municipal SAS Construction corporation DocuSigned by: DocuSigned by: ,�aSbin, S��pSbw Fs LyJ ItiLbLA*K#J ab S66la1 City Manager By: Seyed Mohammad Ali Shahabi Its: Owner ATTEST: LDocuSigned by: -'; � City Clerk By: Click or tap here to enter text. APPROVED AS TO FORM: Its: Click or tap here to enter text. LD SSigned by: GiL® j-.ri460G� City Attorney DocuSigned by: Sew 1°&(" Assistant City Manager 9 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 EXHIBITA CONTRACTOR'S PROPOSAL [ATTACHED] DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 EXHIBIT B LIST OF SUBCONTRACTORS [ATTACHED] DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 BIDDER'S PROPOSAL CITY HALL BUIDLING CIP PROJECT NO. Z20006 SAS CONSTRUCTION Company: _ 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: BID SCHEDULE A— Item No. Unit Total Bid Description Quantity Units Price ($) ($) Mobilization & Demobilization Including 1 Project 1 75,000.0 1 Construction Schedules $ $ Not To Exceed 3% of Total Bid 2 Labor, Material and Performance Bonds 1 Project $425000 $425,000.0 3 Concrete, Footing, Grade Beams & Slab 1400 CY $500 $700,000.0 4 Steel Rebar 1 Project $750000 $750,000.0 5 Light Weight Concrete Flooring 750 CY $500 $375,000.0 6 Backfill and Compact 500 CY $250 $125,000.0 7 125 Loads $ 1200 $150,000.0 Spoils Removal estimated 2000 yards) 8 Water Proofing 18000 SF $5 $90,000.00 F . $ 1 $ $ $ SCHEDULE A Total Bid: $2490,000.00 Fi ures* SCHEDULE A Total Bid: 1�/O ILLION SIX HUNDRED NINTY _ THOUSAND DOLLARS (Words*) *BID MAY BE REJECTED IF TOTAL IS NOT SHOWtJJ30R BOTH FIGURES AND WORDS. DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 The undersigned agrees to enter into and execute a contract, with necessary bonds, at the unit prices set forth herein and in case of default in executing such contract, with necessary bonds, the check or bond accompanying this bid and the money payable thereon shall be forfeited thereby to and remain the property of the City of Lake Elsinore. The above unit prices include all work appurtenant to the various items as outlined in the Contract Documents and all work or expense required for the satisfactory completion of said items. In case of discrepancies between unit prices and totals, the unit prices shall govern. The undersigned declares that it has carefully examined the Specifications, and Contract Documents, and has investigated the site of the work and is familiar with the conditions thereon. SAS CONSTRUCTION Contractor Date: 03/11/2024 By: Contractor's State License No.: 1045038 Class: B, C10 Address: 301 WEST DYER RD UNIT D SANTA ANA CA 92707 Phone: 949-800-9247 FAX: C-3 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 ACKNOWLEDGMENT OF ADDENDA RECEIVED CITY HALL BUIDLING CIP PROJECT NO. Z20006 CONCRETE The Bidder shall acknowledge the receipt of addenda by placing an "X" by each addendum received. Addendum No. 1 X ACKNOWLEDGED ON 03/11/2024 Addendum No. 2 Addendum No. 3 Addendum No. 4 If an addendum or addenda has been issued by the City and not noted above as being received by the Bidder, the Bid Proposal may be rejected. - 03/11/2024 Bidder s Signature Date C-4 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 ADDENDUM No. 1 CITY HALL BUILDING CIP PROJECT NO. Z20006 CONCRETE CITY OF LAKE ELSINORE 130 South Main Street Lake Elsinore, CA 92530 March 4, 2024 The following changes and/or additions shall be made to the Notice Inviting Bid. All other requirements of the contract documents shall remain the same. The bidder shall acknowledge receipt of the addendum by inserting its number and date in the Bid Submittal. Foundation Concrete PSI: The compressive strength of the foundation concrete has been updated to 5000psi with maximum water cement ratio of 0.40. * "- 03/11/2024 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 NON-COLLUSION AFFIDAVIT CITY HALL BUIDLING CIP PROJECT NO. Z20006 CONCRETE STATE OF CALIFORNIA ) COUNTY OF 0 SS (NAME) SEYED MOHAMMAD ALI SHAHABi Affiant being first duly sworn, deposes and says: That he or she is SOLE OWNER of (Sole owner, partner or other proper title) SAS CONSTRUCTION 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: 301 WEST DYER RD UNIT D SANTA ANA CA 92707 Telephone No.: 949-500-9247 Print Name: S YED OHAM A ALI SHAHABI Signature: Title. OWNER 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 following this page. If the Bidder fails to properly sign or omits the required signature, the bid will be considered non- responsive and will be rejected. 4 a n C-5 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT F notary public or other officer completing this certificate verifies only the identity of he individual who signed the document to which this certificate is attached,and not he truthfulness,accuracy,or validity of that document. State of California ) County of U � ) On MoycC . 11 t 26 2"t before me, I uIJVAV(A &Vld- ius o u l�yyH l` (here insect n me an-d title of the offic ) personally appeared t_t !A � M Uh(A�III CA a Mill O hUY`` Abl �-- 1 who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s)acted,executed the instrument. I certify under PENALTY OF PERJURY under the laws of the AIOtIDRA ZENDEIAS State of California that the foregoing paragraph is true and correct. 60MM. 02477914 z 0 Notary Public•California p = orange County WITNESS my hand and official seal J Comm.Ex ire$Dec.30,2027 Signature (Seal) Optional Information ' t y Although the information in this section is not required by law,it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document. Description of Attached Document Additional Information The preceding Certificate of Acknowledgment is attached to a document Method of Signer Identification titled/for the purpose of Mon- G U 1(U S i on Mb o t Proved me on the basis satisfactory evidence: Q form(s) m(s)of identification Q credible witness(es) Notarial event is detailed in notary journal on: containing _ pages,and dated R1AYC'h• 1 II U2,LI Page# Entry#__ The signer(s)capacity or authority is/are as: Notary contact: ❑ Individual(s) Other ❑ Attorney-in-Fact ❑ AdditionalSigner(s) ❑ Signer(s)Thumbprint(s) ❑ Corporate Officer(s) ❑ Titles) ❑ Guardian/Conservator ❑ Partner-Limited/General the ❑Trustee(s) ❑ Other: e t !1.+. representing: A✓i Name(s)of Person(s)or Entlty(ies)Signer is Representing o copyright 2007-2017 Notary Rotary,PO Box 41400,Des Moines,IA 50311-0507. All Rights Reserved. Item Number 101772. Please contact your Authorized Reseller to purchase copies of this form. DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 BOND NO. BIDDER'S BOND CITY HALL BUIDLING CIP PROJECT NO.Z20006 CONCRETE KNOW ALL MEN OR WOMEN BY THESE PRESENTS: That we SAS Construction as PRINCIPAL, The Ohio.Casualty Insurance Company hereinafter referred to as"Contractor",and 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°!a) OF THE TOTAL AMOUNT OF THE BID of the Contractor above named, submitted by said Contractor to the City of take Elsinore for the work for said project entitled above, for the payment of which sum in lawful money of the United States, well and truly to be made, to the City of Lake Elsinore to which said bid was submitted, we bind ourselves, our heirs, executors, administrators and successors,jointly and severally,firmly by these presents. In no case shall the liability of the surety hereunder exceed the amount of 10%of Bid Amount THE CONDITION OF THIS OBLIGATION IS SUCH: That whereas the Contractor has submitted the above-mentioned Bid to the City of Lake Elsinore as aforesaid for the work for said project entitled above. NOW, THEREFORE, if the aforesaid Contractor is awarded the Contract and, within the time and manner required under the Contract documents, after the prescribed forms are presented to him or her for signature, enters into a written Agreement in the prescribed form and in accordance with the Contract documents, and files two bonds with the City of Lake Elsinore,one to guarantee faithful performance and the other to guarantee payment for labor and materials,in accordance with said Contract documents,and as required by law,and files the required insurance certificate(s)in accordance with said Contract documents, then this obligation shall be null and void; otherwise, it shall be and remain in full force and effect until execution of the Agreement or forfeiture pursuant to the Provisions of Sections 20172 and 20174 of the Public Contract Code. In the event suit is brought upon this bond by the City and judgment is recovered,the Surety shall pay all costs incurred by the City in such suit,including a reasonable attorney fee to be fixed by the court. (SIGNATURE PAGE FOLLOWS) C-6 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 BIDDER'S BOND SIGNATURE PAGE CITY HALL BUIDLING CIP PROJECT NO.Z20006 CONCRETE IN WITNESS WHEREOF, we have hereunto set our hands and seals on this i l"I day of H diCk- 201,q BIDDER: CORPORATE SURETY: The Ohio Casualty Contractor Name: SAS Construction Company Name: Insurance Company Address: 301 WEST DYER RD UNIT D Address: 175 Berkeley Street, SANTA ANA, CA 92705 Boston, MA 02116 Telephone No.: (949) 800-9247 Telephone No.: 1-866-255-5530 Print Name: SEYED MOHAMMAD SHAHABI Print Name: Kevin Harvey Title: SOLE OWN Title: Power of Attorney Signature: Signature: Date: sC Q Date: �ar I�4 SIGNING INSTRUCTIONS TO THE CONTRACTOR Bidder's Bond must be accompanied by notary certificates for EACH signature. Note the description of the document on the notary certificate. Attach BOTH notary certificates immediately following this page. Corporate Seal may be affixed hereto. The attorney-in-fact for corporate surety must be registered, as such, in at least one county in the State of California. Attach one original Power of Attorney immediately following the notary certificates. If the Bidder fails to properly sign or omits the required signatures, the bid will be considered non- responsive and will be rejected. II4S4, GoRPop. 0 1919 NAMPg�\,d3' + C-7 Seal No.9507 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 This Powerof Attorney Ifmits theacly of those named herein,and they have no author;tyto y bind the Company except in the manner and to the extent herein stated, L1Ue1" Liberty Mutual insurance Company mutuA.l. The Ohio Casualty insurance Company Certificate No: 8210823-992782 SURETY West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Caeuely Insurance,Company is a corporation duly organized under the taws of the State of New Hampshire that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duty organized under the laws of the Slate of indians{herein collectively called the'CompardeslLpwSuaat to and by authority herein set forth,does hereby name,constitute and appoint,Aaron Ohier,Erie Verkou6xen,Kevin Harvey all of the city of 7 en MBe state of OR each individually if there be more than one named,it true and lawful aftomeyin-fact to matte, SA execute,s acknowledge and derive,torand on t1s behalf as surely and as its act and deed,any and OR undertakings,bonds,recognizances and other surely obtigatfons,in pursuance of these presents and shelf be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of The Companies in their own proper petsons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized offiow or official of the Companies and the corporate seals of the Companies have been Axed theretothfs 29th dayof September 2023 . Liberty Mutuat Insurance Company tt+SUqq qV INBU tNsuq The Ohio Casualty tnsuramosCompany tiJ cAaPDa+* a il QpP0/c+r y .c� �oAP9R+9ye, West Ameriew Insurance Company ei �1912 0 0 1919�a 1991 0 rd3 ,e �a ° e�r�s�'a vts �irrn�tN� da �y` " m`State of PENN5YLVAMA * 1 * David M.Carey,Assistant Secretory C 5 SS 42 County of MONTGOMERY o E oOn this 29th day of September 2023 before me parsonally appeared David M,Carey,who acknowledged himselfto betheAssistant Secretary of Liberty Mutual insurance� to Cmpany,Te Ohio Casually Company,and WesfAmerfpn Insurance Company,and that h&as such,being authorized so to do,execute the foregoing instrument for the purposes therein contained by signing on behaifofthe corporations by himselfas a duty authorized of err, > 01 jor a iN WITNESS WHEREOF,f have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written, a C.F ni PA Al, r`{. �tNFartaay{yexdt-Nowy. "S O W Ettg t� TOmm_agak NoWy O t6 C OF My=MM*4vVkesMe029.202a Ely: O ru oil ya � u acr+owN, eresaPastelle,NotatyPublic o p O °� This Power of Attorney is made and executed pursuant to and by authority of the following Hy-laws and Authorizations of The Ohio Casually insurance Company,tilerty Mat °�� O•S Insurance Company,and Wa*Ameiican insurance Company which resolutions are now in full force and effect reading as follows: o cv a) ARTICLE IV—OFFICERS:Section 12 PowerofAttorney. ° Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President and subject to such limitation as the Chairman or the ° President may prescribe,shall appoint such attorneys�ndact as may be necessary to act in behalf of the Corporation to make,exomte,seal,acknowledge and deliver as surely m CC m any and all undertakings,bonds,recognizances and other surety obligations.Such atkxna%40act Subject to the limitations set forth In their respective powers of attorney,shalt v S0 o- have full power to bind fhe Corporation by their signature and execution Of any such instruments and to aftach thereto the sea)ot the Corporation.When so executed,such m 0 v instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or aftomey4n4ad under the provisions of this article may be revoked at anytime by the Band,the Chalrman,the President or by fhe officer orcifice+s grenti g such power or authority. o`m ARTICLE All-Execution of Coptraft Section S.Surely Bonds and Undadakings. Any officer of the Company authorized for that purpose in wdit by the chairman or the prssident,and subject to such limitations as the chairman or the president may prescribe shall appoint such attomeys in-fad,as may be necessary to act in behalf of the Company to make,execute,seat acknowledge and deliver as surety any and all undertakings, bonds,recognizames and ether surely obligations,Such altorneys-in-fact subject to the timn'fations set forth in their resp active powers of attorney,shalt have full power to bind the Company by Their signature and execution of any such instruments and to attach therelc the seat of the Company.Whan so executed such ifshuments shall be as binding as ff signed by the president and attested by the secretary. Certificate of Designation—The President ofthe Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such atbrneys4a. fact as may be necessary to ad on behalf of the Company to make,execute,seat,acknowledge and deliver as surely any and all undertakings,bonds,recognizances and other surety obligations. Authorization—By unanimous consent of the Comparys hoard of Directors,The Company cormsenfs that facade or mechanically mprodkucod signature of any assistant secrebw of the Company,wherever appearing upon a certified copy of any power of stioiney Rued by the Company In connection with surely bonds,shalt be valid and binding upon the Company with the sane face and effect as though manually affixed. t Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty khsurern Company,Liberty Mutual insurance Company,and West American Insurance Company do hereby oertily that the original power of attorney ofwhich the foregoing Is a full,he and coned copy of the Power of Attorney executed by said Companies,is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,i have hereunto set my hand and affixed the seals of sold Companies this day of 1912 n ° 1919 ° i 1991 a ��+a tcxu+ Jac ° purr Q 'ddrAN� b0 Ely- 8iT w i•� �yt * tot+ # Renee C.Llewellyn,Assistant Secretary LUS-12M LMIC OCIC WAuc Mule Co 0221 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 AL1F. .ALL-.PURPOSE of�i,�►ndlv�dual rho slg�rtea�l � uir��#y`.�rlti�i=�hls +�r�ficate.xs attactu��, ;:ind tttat`tl'ae�utii�lis��tk'sya�rvalld lur��i�t. We d C1050wel. } CQUT1t Of Riverside on o�r�s+o�.� �`��, Aaron Telex older,Notary Public penomllyappearlid 10VIN SNOW u+ +ri pr tit mme tin t�c �y' rrd+ ce pn� s� GIs} It GIs:u ## lrst` Ir ariwde8f tit tirr+a ttlt heta e��hey xe #sd the sal le.kvhWherAheirA h zi csMci yQss),srid:�ha� i i�lsrlfihl�rr:sigr�€t�r��s��� �rrb#�u�nt�t�s�p+ n�s��orer�ifiy.�pt�rt l�ehallf�of 7 Wch the 0 00W4.�sll�Vi!_�VY 1 cerMy uruier,PENALTY OF PENURY;i�d�r, s:lafn�pf'#ha Stag of Galifivrnia that ,the or%olrlg paragraph is.fie and Barra ct, WNM my hand:and-oOiidatseal: MONTYLER(�iLER� l COS,#24=7 C NOTARY PUBLIC CALIFORMA •• W. RNERSIdE COUNTY =���. My Caen,E�iresAug f5,2Q27__@ Notary Pubtic89mature I�vfer!►I�i+�G; !}. 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Tha, idi xiR fiiq�t ar phut t#X u�i�hi uun�stm�mart ��test sk ruses tt �� ��re il'a --��--- eurAeia�tcau�irermits.nrtt� pteiea'air<c�nt�kttUag�n�l�r: © gt�u0T omway?fihe s+ h Yt i situui�on rrh+�h a to of Parl��(a) I Ati r»li�-sec# aa� o gun ma rat as b*�! ='his oi ,geoRid [rarra �: rraalt. r . aporate4lt'aki, tt tk#o.�,i �9 + �tdek�snr.�il��ttM�t�icia�►a�htrnhes'dgiC�.• DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 LIST OF SUBCONTRACTORS CITY HALL BUIDLING CIP PROJECT NO. Z20006 CONCRETE 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: 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: 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. NO SUB CONTRACTOR C-8 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 REFERENCES CITY HALL BUIDLING CIP PROJECT NO. Z20006 CONCRETE 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 OCEANSIDE UNIFIED SCHOOL DISTRICT (Firm/Agency): Address: 2111 Mission Avenue OceansideCA92058 USA Contact Person: Fred Parker Senior Director. Strategy and Growth Telephone No.: (949) 679-9439 (424) 333-2841 Title of Project: Playgrounds & Shade Structures—Camp Pendleton Sites Project Location: CAMP PENDLTON OCEANSIDE Date of Completion: 12/31/2023 NOTE:THERE WERE OVER$3M OF VARIOUS DE UNIFIED Contract Amount: 1.3M SCHOOL DISTRICT DURING 2023 WHICH ALL CONCRETE WHICH WE CHOOSE BNOT TO INCLUDE IN ORDER TO 2. Name OCEANSIDE UNIFIED SCHOOL DISTRICT PROVIDE ADDITIONAL REFERENCES. (Firm/Agency): Address: 2111 Mission Avenue OceansideCA92058 USA Contact Person: James McGrane Project Engineer Telephone No.: T: (760) 966-4068 C: (732) 670-3553 Title of Projec£ONCRETE PLACEMENT FOR PLAY & SHADE — COASTAL AND VALLEY SITES Project Location: OCENSIDE UNIFIED SCHOOL DOSTRICT Date of Completion: 12/31/2023 Contract Amount: 670K 3. Name (Firm/Agency): MIRACOSTA COLLEGE Address: 1 Barnard Drive Oceanside, CA 92056 Contact Person: Tracy Gibson Pronouns: He/ Him/ His Interim Director Of Facilities lgibs�r`� Telephone No.: 760-415-0 17 Title of Project: HORTICULTURE GREENHOUSE INSTALLATION,AND INSTALLATION OF PROPOGATION HOUSE Project Location: Mira Costa college Date of Completion: JAN 03,2023 Contract Amount: MULTIPLE CONTRACTS SUM 350K NOTE: SAS HAS COMPLETED MULTIPLE PROJECTS FOR MIRA OCSTA COLLEGE WHICH IS NOT LISTED HERE C-9 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 4. Name (Firm/Agency): Long beach unified school district Address: Mr.SherrV Turner Assistant Pro'ect Manager Long Beach U D—Facilities Development&Planning Contact Person: 2425 Webster Ave Long Beach, Ca 90810 Email:sturner1@lbschools.net Telephone No.: Phone:562-997-7550 ext. 1330 Title of Project: INSTALLATION OF WATER FOUNTAIN SYSTEMS Project Location: Long beach unified school district Date of Completion: MARCH 2O24 NOTE: SAS HAS COMPLETED A SIMILAR PROJECT IN SUMMER OF 2023 WITH CH UNIFIED Contract Amount: $2.35M SCHOOL DISTRICT WITH THE SAME TEAM 5. Name San Diego County Office of Education (SDCOE) (Firm/Agency): Address: 6401 Linda Vista Rd San Diego, CA 92111 United States Contact Person: Eric Berg Coordinator- Facilities, Maintenance & Operations Telephone No.: Phone: 858-295-6896 Title of Project: SDCOE Various Projects 2022 2023 Project Location: San Diego County Juristiction Date of Completion: 06/06/2023 NOTE:SAS HAS COMPLETED MULTIPLE PROJECTS WITH SDCOE FROM 2021 TO 2023 AND IS ALWAYS Contract Amount: Various projects adding to 750K INa I IDFD AS A PRFFFRFD CONTRACTOR FOR MULTITUDE OF PROJECTS 6. Name (Firm/Agency): MISSION VIEJO CITY HALL Address: 200 Civic Center Mission Viejo California 92691 Contact Person: DANNY WALSH Telephone No.: (949) 470-3031 (562) 343-0332 Title of Project: OSO CREEK GOLF COURSE AND NEW BARNYARD BUILDING Project Location: 200 CIVIC CENTER MISSION VIEJO Date of Completion: 9/21/2022 Nate: T-heFe weFe-tvv&-pF&jects that was eempleted Contract Amount: 250K for Mission yejo city hall, One was the construction of metal 5800SF of building for cityhall 7. Name REDLANDS UNIFIED SCHOOL DISTRICT (Firm/Agency): Address: 20 West Lugonia RedlandsCA92374 Contact Person: Joe Williamson Director of Maintenance & Operations Telephone No.: Redlands Unified School District +1 (909) 725-8870 Title of Project: Various projects, including hydration system installation Project Location: 27 Schools in Redlands unified school District Date of Completion: JAN 03, 2023 Contract Amount: 300K C-10 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 List any other projects (private, older than three (3) years, etc.)that may represent qualifying similar experience: 1. Name (Firm/Agency): LAX PROUD BIRD PROJECT Address: 11022 Aviation Boulevard Los Angeles, CA 90045 Contact Person: John Tallichet President & CEO I Specialty Restaurants Corporation Telephone No.: - - 6101 Title of Project: Concrete work and improvements Project Location: 11022 Aviation Boulevard Los Angeles, CA 90045 Date of Completion: 2020 Contract Amount: 780K 2. Name (Firm/Agency): Address: Contact Person: Telephone No.: Title of Project: Project Location: Date of Completion: Contract Amount: 3. Name (Firm/Agency): Address: Contact Person: Telephone No.: Title of Project: Project Location: Date of Completion: Contract Amount: C-11 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 CONTRACTOR'S INFORMATION CITY HALL BUIDLING CIP PROJECT NO. Z20006 CONCRETE Contractor's License No.: 1045038 Class: B,C10 a. Date first obtained: 10/01/2018 Expiration 10/31/2024 b. Has License ever been suspended or revoked? NO If yes, describe when and why: c. Any current claims against License or Bond? NO CLAIMS If yes, describe claims: Principals in Company (List all —attach additional sheets if necessary): NAME TITLE LICENSE NO. (If Applicable) SEYED MOHAMMAD ALI SHAHABI OWNER 1045038 C-12 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 VIOLATIONS OF FEDERAL, STATE OR LOCAL LAWS CITY HALL BUIDLING CIP PROJECT NO. Z20006 CONCRETE 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® (circle one) Federal /State/ Local (circle one) NOT APPLICABLE If"yes," identify and describe, (including agency and status): Have the penalties been paid? YESf Mcircle one) NOT APPLICABLE 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/® (circle one) Code/Laws: Section/Article: If"yes," identify and describe, (including agency and status): C-13 DocuSign Envelope ID:OADCE614-COAD-4C2B-A24C-119E2D79E6E9 DISQUALIFICATION OR DEBARMENT CITY HALL BUIDLING CIP PROJECT NO. Z20006 CONCRETE 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? ®l (circle one) If yes, provide the following information (if more than once, use separate sheets): Date: Entity: Location: Reason: Provide Status and any Supplemental Statement: Has your firm been reinstated by this entity? YES / (circle one) rM C-14