HomeMy WebLinkAbout25B - SANTA ANA BLVD GRADE SEPARATION_ Exhibit A_ColorREQUEST FOR PROPOSAL
PROJECT STUDY REPORT EQUIVALENT
AND CONCEPTUAL ENGINEERING PLANS
FOR SANTA ANA BOULEVARD GRADE SEPARATION PROJECT
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CITY OF SANTA ANA
PUBLIC WORKS AGENCY
20 CIVIC CENTER PLAZA
SANTA ANA, CALIFORNIA 92702
Issued by:
Souri Amirani, Deputy City Engineer
City of Santa Ana
REQUEST FOR PROPOSAL
PROJECT STUDY REPORT EQUIVALENT AND CONCEPTUAL ENGINEERING
PLANS
FOR SANTA ANA BOULEVARD GRADE SEPARATION PROJECT
TABLE OF CONTENTS
I.
INTRODUCTION ...................................................................... ............................... 3
II.
PROJECT BACKGROUND ..................................................... ............................... 3
III.
CONTENT OF PROPOSAL ..................................................... ............................... 4
IV.
SCOPE OF WORK .................................................................. ............................... 5
V.
GENERAL REQUIREMENTS ................................................ ...............................
14
VI.
PROJECT BUDGET .............................................................. ...............................
15
VII.
PERFORMANCE PERIOD .................................................... ...............................
15
VIII.
CONSULTANT SELECTION COMMITTEE ........................... ...............................
16
IX.
ESTABLISHING OF FEES .................................................... ...............................
16
X.
PROFESSIONAL SERVICES AGREEMENT ........................ ...............................
16
XI.
INSURANCE REQUIREMENTS ............................................ ...............................
16
XII.
CITY RESPONSIBILITY ........................................................ ...............................
16
XIII.
EXAMINATION OF SITE PRIOR TO SUBMITTING PROPOSAL ........................
17
XIV.
RIGHT TO REJECT PROPOSALS ........................................ ...............................
17
XV.
SCHEDULE ........................................................................... ...............................
17
XVI.
PROPOSAL SUBMITTAL DEADLINE .................................. ...............................
18
XVII.
ISSUING OFFICE .................................................................. ...............................
18
XVIII.
ADDENDA ............................................................................. ...............................
18
XIX.
CLARIFICATIONS ................................................................... .............................18
XX.
JOINT VENTURES ................................................................ ...............................
19
XXI.
PRIME CONSULTANT RESPONSIBILITIES ........................ ...............................
19
XXII.
DELAYS ................................................................................. ...............................
19
XXIII.
PROJECT CONTROL ............................................................ ...............................
19
XXIV.
RULES FOR PROPOSALS ................................................... ...............................
19
XXV.
METHOD OF PAYMENT ....................................................... ...............................
19
XXVI.
REGULATIONS ..................................................................... ...............................
20
XXVII.
THE CITY'S AFFIRMATIVE ACTION PROGRAM ................ ...............................
20
XXVIII.
DBE GOAL ............................................................................ ...............................
20
XXIX.
WAGE RATES ....................................................................... ...............................
20
APPENDICES
APPENDIX A - LOCATION MAP
APPENDIX B - PROPOSED SANTA ANA BOULEVARD GRADE SEPARATION
APPENDIX C - SAMPLE PROFESSIONAL SERVICES AGREEMENT
APPENDIX D - SAMPLE CERTIFICATION OF INSURANCE
APPENDIX E - CERTIFICATION OF NON - DISCRIMINATION BY CONSULTANT
APPENDIX F - FEDERAL REQUIREMENTS
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REQUEST FOR PROPOSAL
PROJECT STUDY REPORT EQUIVALENT AND CONCEPTUAL ENGINEERING
PLANS FOR SANTA ANA BOULEVARD GRADE SEPARATION PROJECT
I. INTRODUCTION
The City of Santa Ana Public Works Agency (City) desires to enter into an
agreement with a qualified consulting engineering firm for the preparation of
Project Study Report Equivalent (PSRE) for the Santa Ana Boulevard Grade
Separation project at the LOSSAN Corridor crossing. The proposed grade
separation is adjacent to the Santa Ana Regional Transportation Center
(SARTC). The major elements of the PROJECT's PSRE are:
• Environmental evaluation documents
• Cost Estimates for construction and right -of -way
• Conceptual engineering plans
• Evaluation of right -of -way impacts
• Evaluate traffic detour routes for Santa Ana Blvd. and trains during
construction.
The PSRE and conceptual engineering plans of the grade separation shall
address land use and impacts associate with future improvements. For all
questions, requests for clarification, and comments on this Request for Proposal
(RFP), see section XIX. Clarifications.
II. PROJECT BACKGROUND
The proposed grade separation at Santa Ana Boulevard is in conjunction with the
City's Santa Ana Regional Transportation Center (SARTC) Master Plan located
at 1100 East Santa Ana Boulevard, which entails new station areas, additional
parking and improved pedestrian and bicycle access to accommodate the
expansion of Metrolink services, Santa Ana's Fixed Guideway Project and the
addition of the Bus Rapid Transit (BRT).
Santa Ana Boulevard is a six -lane east -west principal arterial and currently
carries in excess of 20,000 vehicles per day. Within the City, OCTA Metrolink
RR is a north -south two -track railroad. At SARTC, this railroad serves Metrolink,
Amtrak, Union Pacific (UP) and Burlington Northern Santa Fe (BNSF), which
connects freight and residents of central Orange County with the outlying areas
of nearby regions, including Los Angeles, Inland Empire, San Diego and beyond.
Due to increasing demand for inter and intra- county rail services resulting from
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growth in population and employment in the surrounding areas, the City
proposes the grade separation to alleviate the current and potential traffic
impacts and hazards posed by the existing at -grade rail crossing at Santa Ana
Boulevard and OCTA Metrolink RR. Based on the land use and the proximity of
the Interstate 5 (1 -5) ramps to the east and Santiago Street to the west, the
proposed PROJECT will likely depress Santa Ana Boulevard under the railroad
tracks to provide uninterrupted flow of roadway and rail traffic, which will improve
freight movement, corridor crossing safety, and air quality.
CONTENT OF PROPOSAL
In order to maintain uniformity with all proposals furnished by the Consultants, all
proposals are limited to a maximum of 30 pages (excluding front and back
covers, section dividers and resumes) and shall include the following:
A. Cover letter highlighting the Prime Consultant's qualifications and the primary
location where the PROJECT work will be performed. There shall be
indication that the proposal will be valid for 90 days and must be signed by an
officer that has authority to bind the Consultant.
B. Project understanding and approach discussing the PROJECT, key issues,
and any suggestions or special concerns that the City should be made aware
of. This section should demonstrate experience and expertise in all areas
required to perform work described in the Scope of Work.
C. A detailed scope of work identifying each required task for the preparation of
PSRE in accordance with the City, OCTA, Southern California Regional Rail
Authority (SCRRA), Federal Highway Administration (FHWA), Federal
Railroad Administration (FRA), BNSF, California Department of
Transportation (Caltrans) and other involved agencies' policies and
requirements, along with any additional tasks not currently identified in this
RFP, but are necessary for the successful completion of the PROJECT.
D. Project schedule, project management plan (PMP) and quality
assurance /quality control (QA/QC) plan to be implemented on the PROJECT
that will ensure the required services to complete in a timely manner and a
quality acceptable to the City. The QA/QC shall ensure that reports, plans,
estimates, and other documents are complete, accurate, proofread, and
checked to meet professional engineering and environmental practices prior
to submitting for review. The Consultants shall provide the firm's workload
and the ability to perform the work requested, specifically as it relates to the
Project Manager and key personnel.
E. Project team organizational chart identifying the Project Manager and those
who will be performing the work along with a brief resume of each team
member, including similar type of projects in which he /she has been directly
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involved in. A minimum of three references for similar size and type projects,
including contact name, organization, and phone number, shall be provided
for the Project Manager. The Project Manager will be the primary contact
person to represent the firm and will be the person to conduct the
presentation, if invited for an interview. Sub - consultants, if any, shall be
identified with the same requirements as for the prime consultant.
F. List of similar projects which your firm completed within the last five (5) years.
Project information shall include project description, agency, client name
along with contact information, year completed, project construction and
design costs, and team members that worked on the projects.
G. Five (5) bound copies and one electronic copy in PDF format on a Compact
Disc (CD) of a complete responsive proposal shall be submitted.
IV. SCOPE OF WORK
The Consultant shall be responsible for the preparation and submittal of the
PSRE through completion, with the approval from the City and other involved
agencies. The PROJECT is federally funded and Caltrans retains stewardship
responsibility for project development documents to be reviewed by Federal
Highway Administration (FHWA), the Consultant shall prepare the PSRE in
accordance with the Caltrans Preparation Guidelines for Project Study Report in
the Caltrans Project Development Procedures Manual (PDPM). All necessary
documentation, studies, estimates, conceptual engineering plans and exhibits
shall be in accordance with the compliance documentation for California
Environmental Quality Act (CEQA) and National Environmental Protection Act
(NEPA), unless otherwise noted, under the direction of a California registered
Civil Engineer. The following is the breakdown of the scope of work for the
PROJECT as well as the minimum deliverables required. Any additional tasks or
deliverables deemed necessary by the Consultant shall be clearly identified in the
proposal.
A. Management and Administration
The Consultant is fully responsible for the overall project management,
administration and coordination of the PROJECT, including but not limited to
the following:
1. Management and Coordination — The Consultant shall be the liaison with
responsible /cooperating agencies and other stakeholders, monitor project
progress and maintain project files. Other responsibilities of the
Consultant include supervising sub - consultants, coordinating, monitoring
and reviewing design for conformance with the standards, policies and
procedures of all affected agencies, including but not limited to the
following:
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a. City of Santa Ana
b. Southern California Regional Rail Authority
c. OCTA Metrolink
d. Amtrak
e. Burlington Northern Santa Fe Rail
f. California Public Utilities Commission (CPUC)
g. Federal Highway Administration (FHWA)
h. Federal Railroad Administration (FRA)
i. Santa Ana Regional Water Quality Control Board (SARWQCB)
j. Southern California Air Quality Management District (SCAQMD)
k. California Department of Transportation (Caltrans)
I. US Environmental Protection Agency (EPA)
2. Project Schedule — Within two (2) weeks of the Notice to Proceed, the
Consultant shall prepare a project schedule in Microsoft Project 2003
format utilizing the Work Breakdown Structure (WBS) to be approved by
the City. The project schedule shall clearly identify the critical path and
include the required tasks and subtasks of the Consultant, sub - consultants
and all involved agencies to complete the PROJECT. All deliverables
shall clearly be identified. The project schedule shall be updated on a
regular basis reflecting the actual progress and distributed at the PDT
meetings. Any change to the project schedule must be approved by the
City. Additionally, the Consultant shall develop the project schedule for
the design, right -of -way, and construction phases of the PROJECT for
both design -build and design- bid -build options.
Deliverable — Project Master Schedule with biweekly updates and status
tracking
3. Meetings — Project Development Team (PDT) meetings shall occur
monthly with all stakeholders and shall be held at the City of Santa Ana.
The Consultant shall prepare and send out the agenda and any necessary
communication documents a minimum of five (5) business days in
advance, prepare and distribute meeting minutes, new action /decision
items and disposition of previous action /decision items and other
communication documents within five (5) business days after the meeting
to all attendees and invitees. The Consultant shall identify any additional
meetings, including agency coordination and technical workshop
meetings, as they deem necessary.
Deliverables — Agendas, minutes and action items; attendance at monthly
PDT meetings.
4. Progress Reporting - Progress reports shall be submitted at monthly
intervals, indicating progress achieved during the reporting period in
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relation to the progress scheduled. The progress report shall discuss
significant issues and present proposed corrective action, show status of
major changes, and identify next month's activities. The Consultant shall
provide the City with two (2) copies of the progress report.
Deliverables — Monthly Progress Reports submitted in both hard copy and
electronic format.
B. Permits
The Consultant shall be responsible for securing all necessary encroachment
permits for field studies and work related to document preparation, such as
surveying and geotechnical activities. Additionally, the Consultant shall
submit any required traffic control plan to the City for review and concurrence
prior to beginning any field study. The Consultant shall obtain necessary
training including applicable rail safety program prior to performing field study.
The Consultant shall identify all potential project - related permit requirements
in the PSRE and include the cost in the cost estimate.
Deliverables — Documentation of all potential project- related permit
requirements.
C. Research & Data Collection
The Consultant shall thoroughly research and collect information related to
the PROJECT, including existing field conditions, as -built plans, studies,
encumbrances and record drawings (including utilities), reports, agreements,
right -of -way data, and all future improvement plans adjacent to or affecting
the project site. The Consultant shall review and document the collected
data, physical constraints, and deficiencies and include the cost estimate for
design solutions.
Deliverables — Documentation of pertinent project information including
photographs, mapping, schematics, field notes, existing studies and any study
findings.
D. Utility Survey
The proposed grade separation will greatly impact public services and utilities.
The Consultant shall conduct a survey that identifies all impacts to these
facilities and is solely responsible to conduct all necessary research to
complete this task. City staff will be available to answer questions and
provide guidance. At a minimum, the Consultant shall consult with Public
Works Agency staff and the following service and utility providers:
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1. Sewer /waste water (Santa Ana PWA)
2. Water /water well replacement (Santa Ana PWA)
3. Solid waste /refuse (Santa Ana PWA)
4. Fire service /paramedics /fire alarm system (Santa Ana FD)
5. Police services (Santa Ana PD)
6. Recreational Facilities (Santa Ana Parks, Recreation &Community
Services Agency)
7. Street and site drainage (Santa Ana PWA)
8. Electricity (Southern California Edison)
9. Natural gas (Southern California Gas Company)
10. Communication services (AT &T)
11. Cable T.V. (Time Warner)
12. Bus Services (OCTA)
As part of this survey, the Consultant shall include both a field review as well
as a review of available as -built drawings, encroachment permits, and utility
franchise agreements for the projects areas. The results of this review shall
be a database of utility records indicating type of utility, owner, drawing
number, and other relevant information. Consultant shall also prepare a utility
base map of the PROJECT area showing locations of all existing utilities.
Deliverables - Utility Database and Base Map.
E. Field Survey /Topography
The Consultant shall perform all surveys and aerial mapping necessary to
complete the requested scope of services. The Consultant shall prepare an
aerial topographic survey map at a scale of 1" = 20' of the PROJECT site and
surrounding area to provide all necessary information for horizontal and
vertical controls. Survey of the PROJECT site shall be prepared in US
Customary English units by a California licensed Land Surveyor in
Microstation V8 format. The horizontal datum shall be NAD 83 and the
vertical datum shall be NAVD 88. Survey shall be done to cover at least 100
feet beyond the PROJECT's ultimate right -of -way and shall include locating
building foot prints, utilities, trees, sidewalks, fences, poles, meters, vaults,
structures, street furniture, curb and gutters, etc.
Deliverables — All electronic files and field notes for field survey /topography
data collection.
F. Traffic Studies
The Consultant shall perform the traffic analysis in accordance to the PSRE
development. The analysis shall support the preparation of the traffic impact
section of the required environmental evaluation documents. The Consultant
shall analyze travel- demand model and prepare future traffic projections for
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impacted roadways and intersections. A traffic analysis for each developed
alternative (mentioned in Conceptual Engineering Plans) is required. The
Consultant shall identify all unavoidable adverse traffic - related impacts and
the mitigation measures.
The Consultant shall develop a Transportation Management Plan (TMP) for
each developed alternative to provide continuous traffic circulation and
access, with adequate space for safe and efficient construction. The TMP
shall include construction handling practices, including lane closures, detour
routes, accommodation for bicycle and pedestrian traffic, mass transit, work -
hour restrictions, and others. The Consultant shall include the associated
cost for each developed alternative along with the mitigation solutions for
TMP in the cost estimate section.
Deliverables — Traffic analysis and TMP for each developed alternative.
G. Preliminary Geotechnical Investigation
The Consultant shall prepare a preliminary geotechnical review of the projects
areas. Existing subsurface information for the projects areas shall be
collected, including geologic maps published by the California Division of
Mines and Geology, geologic maps published by the United States Geological
Survey, and ground water well information. The Consultant shall provide
seismic and geological hazards that may have a significant impact on the
design and construction of the projects.
Deliverables — Geotechnical Analysis.
H. Conceptual Hydraulics and Hydrology Study
The Consultant shall analyze existing drainage systems for their ability to
accommodate future design flows in accordance with applicable agency
standards including proposed improvements. A Preliminary Hydraulics and
Hydrology Study shall be prepared summarizing potential storm water quality
impacts and develop options to avoid, reduce, or minimize the potential for
storm water quality impacts. These results shall be coordinated with the
City's existing Master Plan of Drainage. The Consultant shall ensure that the
PROJECT includes sufficient right -of -way and budget for required storm
water controls and identify PROJECT specific permanent and temporary
measures that may be required to mitigate anticipated impacts. Drainage
areas and total disturbed area will be defined, as will climatic conditions,
existing drainage site conditions, site permeability, soil texture, existing
vegetation (if any), and groundwater.
Deliverables — Hydraulics and Hydrology Study.
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I. Constraints Analysis
The Consultant shall prepare an evaluation of site constraints that may limit
PROJECT design options, including the need to maintain ongoing freight and
passenger rail operations, and the need to maintain adequate vehicle and
transit access on affected arterials. All constraints developed by all studies
and investigations carried out for this PSRE shall be considered in this
analysis.
Deliverables — Site Constraints Analysis.
J. Alternatives Analysis and Structural Type Selection
The Consultant shall develop a minimum of three (3) viable alternatives for
the grade separation and develop initial screening criteria. Based on the land
use and the proximity of the 1 -5 ramps to the east and Santiago Street to the
west, Santa Ana Boulevard will likely be lowered to cross the existing railroad
tracks in an undercrossing configuration. Consideration of alternatives and
criteria should be given to unique construction requirements such as "shoofly"
track, California PUC vertical and horizontal track clearances, Metrolink and
OCTA requirements and criteria, construction staging requirements and the
TMP. Each alternative must efficiently accommodate the existing platform at
SARTC and limit the construction cost and right -of -way impacts.
Based on the screening criteria, the Consultant shall work with City and
stakeholder staff to reach consensus on the alternatives to be carried forward.
The Consultant shall then develop criteria for evaluating the remaining
alternatives and shall consider construction impacts as one factor. The
remaining alternatives shall be further refined and evaluated using the
evaluation criteria and the results of all studies and investigations carried out
for this PSRE. To assist in the documentation of comparisons between
alternatives, the Consultant shall prepare a matrix of selection criteria and
evaluation results for each alternative. Based on the evaluation, the
Consultant shall recommend one or more alternatives and include an
assessment of potential risks and strategies to mitigate, minimize, or
eliminate risks as the recommended PROJECT proceeds through design and
construction.
Deliverables — Alternatives recommendation, criteria for evaluation, refined
alternatives, matrix of selection criteria, and assessment of alternative risks.
K. Conceptual Engineering Plans
The plan development shall include two (2) milestone deliverables —Draft
Conceptual Engineering Design and Final Conceptual Engineering Design. A
plan set shall be prepared for each alternative. The Consultant shall prepare
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five (5) sets of half -size (11" x 17 ") engineering plans and preliminary
quantities and estimates plus electronic files for each conceptual engineering
plan submittal to the City. Additionally, the Consultant shall provide the
necessary number of copies of engineering plans to participating agencies
and other interested parties for review and comment. Plans shall be prepared
in conformance with the latest City Computer -Aided Design and Drafting
(CADD) standard. The Consultant shall coordinate review and approval of rail
realignment and shoofly design with appropriate agencies. The conceptual
engineering plans shall be at a scale of 1 " = 20' and shall include, but not be
limited to, the following:
1. Existing and proposed centerlines and right -of -way lines, curb lines,
easements, medians, sidewalks and join lines on public and private
properties.
2. Topographic survey for the PROJECT area to facilitate the preparation
of engineering drawings, right -of -way maps and itemized cost
estimates for traffic handling, construction and right -of -way acquisition.
3. Plans for Santa Ana Boulevard and OCTA Metrolink RR (proposed
track and shoofly) including profiles and superelevation diagrams.
4. Plans and details for railroad bridge to accommodate the existing two
tracks and an additional future track (including Advanced Planning
Study level of detail).
5. Plans for retaining wall(s) and soundwall(s) (if necessary).
6. Plans for existing utilities and drainage, including relocation of existing
utilities and assessment of a pump station for the sump condition
resulting from the proposed depressed roadway (if necessary).
7. Plans and details for access modifications, including creating cul -de-
sacs at affected intersections as needed.
8. Street approaches for all legs of the intersections at Interstate 5 (I -5)
ramps, Santiago Street, and Santa Ana Boulevard to ensure
appropriate lane transitions.
9. Plans for necessary preliminary grading.
10. Plans for channelization and signal modification.
11. Plans for stage construction, traffic handling, and detour (including
detour layouts, profiles and superelevation diagrams, construction area
signs, etc...).
Deliverables — Conceptual Drawings.
L. Right -of -way
The Consultant shall determine the right -of -way required and the right -of -way
data sheet estimates for each PROJECT's alternative. The Consultant shall
prepare right of -way maps on the scale of 1" = 20'. Right -of -way map shall
include existing and new street centerlines, existing and proposed right -of-
way lines, property lines, agency boundaries, all adjacent parcels and cross
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streets, topography, building foot prints (including set -back to proposed right -
of -way lines), parcel numbers, addresses, indication of full or partial take of
each property and amount of right -of -way needed per parcel for each
alternative. The Consultant shall identify in detail any loss of on -site parking
for each parcel affected by the PROJECT. The Consultant shall submit the
right -of -way map to the City and participating agencies for review and
approval. Final maps shall be delivered on mylar and electronically as both
.PDF and .DGN files. All electronic files related to the right -of -way maps shall
become property of the City.
Following approval of the right -of -way map, the Consultant shall prepare a
cost estimate for acquiring right -of -way. The Consultant shall provide
sufficient information to the City to facilitate the preparation of cost estimates
for land acquisition, structure demolition, relocation, administration and other
miscellaneous costs. The Consultant shall identify the public improvements
cost per parcel for the purpose of right -of -way dedication in exchange for
public improvements for all partial takes. The Consultant shall utilize a
California licensed land surveyor to prepare legal descriptions and exhibits for
all partial and full takes as well as a plan for the reuse of remnant parcels of
the partial takes.
Deliverables — Right -of -Way survey.
M. Cost Estimates
The Consultant shall prepare a cost estimate for final design, shoofly,
permitting, right -of -way acquisition, TMP, construction, utilities relocation, and
potential mitigation measures. The construction estimate shall include details
of estimated quantities and unit costs for major items of work based on
current prices. The Consultant shall verify current prices with manufacturers,
material suppliers and contractors. The cost estimates shall be prepared for
each alternative and submitted at each milestone along with the conceptual
engineering plans.
Deliverables —Cost Estimates.
N. Environmental Evaluation
The Consultant shall prepare the environmental evaluation documents for the
PROJECT in accordance with CEQA and NEPA guidelines. The procedures
shall include the City of Santa Ana adopted environmental rules for the
implementation of CEQA and NEPA. The Consultant shall prepare the
Preliminary Environmental Analysis Report (PEAR) in accordance to Caltrans
PEAR Handbook to comply with the requirement of the PSRE.
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The environmental analysis and documentation activities required by the
CEQA and NEPA shall include, but not be limited to, the following specific
requirements:
1. The Consultant shall research and review previous studies and
environmental documentation applicable to the PROJECT. The
Consultant shall prepare a technical memorandum summarizing the
review of pertinent documents.
2. The Consultant shall submit five (5) copies and participant agencies'
required number of copies of the environmental evaluation documents
plus electronic files for City and participant agencies to review. After
the review, the Consultant shall incorporate revisions to the document
and submit the required number of revised copies plus electronic files
for review and approval. The Consultant shall be responsible for re-
submittals until all City and participant agencies' comments have been
addressed to the satisfaction of all stakeholders.
Deliverables — Environmental Checklist , PEAR and ISA.
O. PSRE Submittal
The Consultant shall submit ten (10) copies of the Draft PSRE plus electronic
files for review and comment. The Consultant shall also provide a sufficient
number of copies for all stakeholders. In addition of the requirements of
Caltrans' PSRE, the Consultant shall analyze, describe, and evaluate all
potential environmental impacts of the proposed PROJECT, provide any
necessary and available mitigation measure, and compare the relative
impacts for each alternative and indicate the level of impacts after mitigation.
After the review, the Consultant shall incorporate revisions to the document
and submit the required number (same number as Draft PSRE) of Final
PSRE plus electronic files for review and approval. The Consultant shall be
responsible for re- submittals until all City and participant agencies' comments
have been addressed
The Consultant shall draft the Resolution of Certification with the required
findings. The City Council will review and approve the Draft Resolution and
City staff will prepare the Final Resolution.
Deliverables — Draft and Final PSRE.
P. Submittal Format At Completion
The Consultant shall maintain PROJECT files using the City's specified filing
system. The Consultant shall be responsible for obtaining information on the
filing system, file naming convention, and CADD standard at the beginning of
the PROJECT. At the PROJECT closing, the Consultant shall submit all
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drawings, reports, estimates, letters, exhibits, and other project - related
documents in the correct filing and on a CD or Digital Video Disc (DVD). The
submitted files' format shall be:
1. Drawings shall be prepared in Microstation V8 format based on the
latest City CADD standard. All final conceptual plans shall also be
submitted in PDF format.
2. Electronic copies of the environmental reports shall be submitted in
Microsoft Word 2007 format, the exhibits of the environmental reports
shall be in PDF format, and the cost estimates shall be in Microsoft
Excel 2007 format.
V. GENERAL REQUIREMENTS
A. All work shall be performed in conformance with the latest City of Santa Ana,
Caltrans, and other involved agencies' policies, procedures and standards.
B. The Consultant shall carry out the instructions received from the City of Santa
Ana and shall cooperate with the City and other involved agencies.
C. The Consultant has total responsibility for the accuracy and completeness of
all documents and plans prepared and shall check all such materials
accordingly. The documents and plans will be reviewed by the City for
conformity with the requirements of the Agreement. Reviews by the City do
NOT include detailed review or checking of environmental reports and
designs or the accuracy with which such reports and designs as depicted in
the documents and the plans. The responsibility for accuracy and
completeness of such items remains solely that of Consultant.
D. The documents and plans furnished under the Agreement shall be of a quality
acceptable to the City of Santa Ana. The criteria for acceptance shall be a
product of neat appearance, well organized, technically and grammatically
correct, checked, and dated and having the maker and checker identified.
The minimum standard of appearance, organization and content of the
documents shall be that of similar types produced by the City and set forth in
related City of Santa Ana and other involved agencies' manuals. The
Consultant shall modify its work as necessary to meet the level of
acceptability defined by the criteria above.
E. The Consultant shall have a QA/QC plan in effect during the entire time work
is being performed under the Agreement. The QA/QC plan shall establish a
process which includes checking procedures for report preparation, a
discipline and interdisciplinary check of the environmental reports and
conceptual engineering plans, correcting and back checking procedures, and
all job related correspondence and memoranda dated and received by
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affected persons and then bound in appropriate job files. The City of Santa
Ana reserves the right to request proof of said documentation.
F. Manuals /Standards - Where applicable, engineering design of all PROJECT
improvements shall be compatible and in accordance with the following, but
not limited to:
• A Policy on Geometric Design of Highways and Streets (AASHTO)
• CPUC General Orders Requirements
• California Regional Water Quality Control Board Requirements
• Manual of Uniform Traffic Control Devices (MUTCD)
• Standard Specifications for Public Works Construction (SSPWC)
• Caltrans Project Development Procedures Manual (PDPM)
• Caltrans Highway Design Manual
• Caltrans Guidelines for Preparing a Preliminary Environmental Analysis
Report (PEAR)
• Caltrans Standard Environmental Reference
• OCTA Right of Way Manual
• BNSF Design Guidelines for Industrial Track Projects
• BNSF Utility Accommodation Policy
• SCRRA Grade Separation Guidelines
• City of Santa Ana Standard Plans and Specifications
It shall be the responsibility of the Consultant to verify that the latest version
and /or update of these documents are obtained.
G. The Consultant's work will be subject to inspections by representatives of the
City of Santa Ana and other involved agencies.
VI. PROJECT BUDGET
The maximum project budget for performing all tasks defined in the scope of
work is $1.3 million.
VII. PERFORMANCE PERIOD
A. The contract shall begin upon approval by the City Council, and the
Consultant shall commence work after notification to proceed by the City.
Unless extended by contract amendment, the contract shall terminate upon
acceptance by the City of Santa Ana of the PROJECT and upon completion
of the terms of this agreement by the Consultant.
B. The Consultant is advised that any recommendation for contract award is not
binding on the City until the Agreement and all pertinent paperwork are fully
executed and approved by the City Council.
15
VIII. CONSULTANT SELECTION COMMITTEE
The City has established a Consultant Selection Committee to evaluate each
consultant's proposals. The evaluation of each proposal will be based on
technical criteria and qualifications listed in the RFP, reference checks, and other
information which will be gathered independently. A final listing of the most
qualified consultants will then be established for possible interview.
IX. ESTABLISHING OF FEES
A fee proposal is to be submitted separately in a sealed envelope plainly labeled
"Fee Proposal ". The fee proposal shall include a not -to- exceed fee and a
detailed labor hour breakdown by task and classifications. Include all incidental
costs estimated to accrue during the life of the contract. Include a billing rate
schedule for the prime consultant and any sub consultants with an hourly billing
rate by classification. The hourly rate shall remain in effect during the life of the
PROJECT.
The fee proposal will not be opened until the consultants have been evaluated by
the proposal selection committee. In conformance with the Brooks Act, the City
will select the consultant based on qualifications, and then negotiate a contract
price based on available funding and a further breakdown of the not -to- exceed
cost submitted in the fee proposal. The City will retain 10% of the final contract
until final delivery of the deliverables.
X. PROFESSIONAL SERVICES AGREEMENT
A sample Professional Services Agreement is enclosed for your review, as
Appendix C. The RFP and the consultant's proposal will be attached and
become part of the agreement as exhibits.
XI. INSURANCE REQUIREMENTS
A certificate of insurance is enclosed for your reference as Appendix D. Please
refer to the sample agreement for the necessary amounts of general liability,
automotive, worker's compensation and professional liability insurance. The
appropriate endorsements are also shown within the sample contract agreement.
The certificate shall include the Cities of Santa Ana and Irvine, Caltrans and their
officers and employees as insured or additional insured.
XII. CITY RESPONSIBILITY
The City of Santa Ana will be responsible for the following:
16
A. Making available existing City plans and records. The Consultant shall be
responsible for researching available records and paying for copies of
records.
B. Boiler plate of the City of Santa Ana general provisions and specifications.
C. City of Santa Ana Standard Plans.
XIII. EXAMINATION OF SITE PRIOR TO SUBMITTING PROPOSAL
Each consultant must inform himself /herself fully of the conditions relating to the
PROJECT and the employment of labor thereon. Failure to do so will not relieve
a successful consultant of the obligation to carry out the provisions of the
contract.
XIV. RIGHT TO REJECT PROPOSALS
A. The City of Santa Ana reserves the right to reject any or all proposals
submitted and no representation made hereby that any contract will be
awarded pursuant to this RFP or otherwise.
B. All costs incurred in the preparation of the proposal, the submission of
additional information and /or any aspect of a proposal prior to award of a
written contract will be borne by the respondent. The City of Santa Ana will
provide only the staff assistance and documentation specifically referred to
herein and will not be responsible for any other cost or obligation of any kind,
which may be incurred by the respondent. All proposals submitted to the City
of Santa Ana become the property of the City.
XV. SCHEDULE
The City's tentative schedule for this PROJECT is as follows:
RFP Issued:
Pre - Proposal Meeting:
Question Due Date:
Proposal Due Date:
Interview Date:
Contract Award:
March 2, 2010
March 16, 2010
March 31, 2010
April 6, 2010
April 22, 2010
May 17, 2010
Upon issuance of Notice to Proceed, the Consultant shall submit a detailed
schedule for the PROJECT.
17
XVI. PROPOSAL SUBMITTAL DEADLINE
Proposals are due in the office of the Executive Director of the Public Works
Agency at 20 Civic Center Plaza — Ross Annex (M -36), 3rd Floor, Santa Ana, CA
92701 Attn: Souri Amirani on or before 5:00 p.m.,Tuesday, April 6, 2010.
XVII. ISSUING OFFICE
Santa Ana Public Works Agency, office of the Executive Director.
1AVAIIW_1QQ=I'1'711
Any subsequent changes in the RFP from the date of issuance to date of
submittal will result in an addendum by the issuing office. Any written addenda
issued pertaining to this RFP shall be incorporated into the terms and conditions
of any resulting Agreement. Consultants shall acknowledge receipt of addenda
in their proposals.
XIX. CLARIFICATIONS
A. Examination of Documents
If the Consultant requires clarification to any part of this RFP, the Consultant
shall notify the City in writing as described below. If the City feels a
clarification is warranted, the City will issue a written addendum clarifying the
matter, which will be sent to all firms in receipt of this RFP.
B. Submitting Requests
1. All questions, including questions that could not be specifically
answered at the pre - proposal conference must be put in writing and
must be received by the City no later than 5:00 p.m., March 31, 2010.
2. Requests for clarifications, questions and comments must be clearly
labeled, "Written Questions" and reference the RFP in question. The
City is not responsible for failure to respond to a request that has not
been labeled as such.
3. Any of the following methods of delivering written questions are
acceptable as long as the questions are received no later than the date
and time specified above:
a. U.S. Mail /Personal Courier:
City of Santa Ana
Attn: Jason Gabriel
20 Civic Center Plaza
Ross Annex (M -36)
Santa Ana, CA 92701.
b. Facsimile: (714) 647 -5635
W
c. E -Mail: Submit questions by email to both Souri Amirani, Deputy
City Engineer at samirani(o-),santa- ana.orq and Jason Gabriel, Senior
Civil Engineer at i
C. City Responses
Responses from the City will be emailed to all Consultants in receipt of this
RFP no later than April 2, 2010. Consultants may also request responses
be sent via U.S. Mail by e- mailing or faxing the request to Jason Gabriel,
Senior Civil Engineer.
Inquiries received after March 31, 2010, will not be responded to.
XX. JOINT VENTURES
The City intends to contract with a single firm and not with multiple firms doing
business as a joint venture. All responses to this RFP shall be on a prime —
subcontractor basis.
XXI. PRIME CONSULTANT RESPONSIBILITIES
The selected consultant will be required to assume responsibilities for all services
offered in his /her proposal. The selected consultant will be the sole point of
contact with regard to contractual matters, including payment of any and all
charges resulting from the contract.
XXI 1. D E LAYS
The City reserves the right to delay scheduled dates if it is to the advantage of
the City of Santa Ana.
XX111. PROJECT CONTROL
Control of the PROJECT shall remain the total responsibility of the City of Santa
Ana.
XXIV. RULES FOR PROPOSALS
The signer of the proposal must declare in writing that the only person, persons,
company or parties interested in the proposal as principals are named therein;
that the proposal is made without collusion with any other person, persons,
company, or parties submitting a proposal; that it is in all respects fair and in
good faith without collusion or fraud; and, that the signer of the proposal has full
authority to bind the principal proposer.
XXV. METHOD OF PAYMENT
The consultant shall submit invoices to the City of Santa Ana. The invoice shall
include a detailed breakdown of the services, the tasks, the hours, and hourly
19
rates. It should be noted that no more than 90 percent of the total payment
amount will be made prior to the final completion and approval of all work and
delivery of final products.
XXVI. REGULATIONS
The selected consultant shall be expected to comply with all applicable federal
and state regulations, and contract provisions. The ensuing contract shall
contain such contractual provisions and conditions necessary to define a sound
and complete agreement.
XXVII. THE CITY'S AFFIRMATIVE ACTION PROGRAM
The City has an affirmative action program. The purpose of the affirmative action
program is to encourage certified minority business enterprises and women
business enterprises. All Submitting firms must have established affirmative
action programs approvable by the City. The attached Appendix E, "Certification
of Non - Discrimination by Contractors" shall be completed by each submitting firm
and included in the proposal.
XXVIII. DBE GOAL
The Disadvantage Business Enterprise (DBE) goal for this PROJECT is 1.67 %.
The Underutilized Disadvantage Business Enterprise (UDBE) goal for this
PROJECT is 2.22 %. This information may be submitted with your proposal. If it
is not, it must be submitted and received by the administering agency no later
than the time specified in the federal requirements attached (Appendix F).
XXIX. WAGE RATES
Because this PROJECT is federally funded, the rate of wages for each craft or
type of worker or mechanic employed under this contract shall be specified under
the current determinations of the Department of Labor as required under the
Davis -Bacon Act. The current wage determination can be obtained at the
following location:
http: / /frwebgate.access.gpo gov/cgi-bin/getdoc.cgi ?dbname= Davis-
Bacon &docid= CA20080035
Notwithstanding the conditions hereinabove, the California Labor Code stipulated
that not less than the general prevailing rate of per diem wages for each craft or
type of worker or mechanic needed to execute the contract in the locality in which
the work is to be performed, and not less than the general prevailing rate of per
diem wages for holiday and overtime work as determined by the Director of
Industrial Relations of the State of California shall be paid to all workers
employed. A copy of the prevailing rate of per diem wages is on file at the City of
20
Santa Ana Public Works Agency — Construction Division, and is available on
request to any interested party.
Where a discrepancy exists between federal and state prevailing wage rates, the
policy of the California Department of Labor is to require that the higher of the
two prevailing wage rates shall apply.
21
APPENDIX A
LOCATION MAP
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APPENDIX C
SAMPLE PROFESSIONAL SERVICES AGREEMENT
CONSULTANT AGREEMENT
RECITALS
B. Consultant represents that Consultant I �
� ..... € , t . ../
No 00
00 00 0
MEN NONE MEN
NONE No MEN
city. 0 MEN No No
MEME Ek
C. In undertaking the performance Agreemen sultant represWhat it is
knowledgeable in its field d that ices ed by Consultant under this
Agreement will be per comp uch standards as may reasonably be
expected from a professi ulting the field.
NOW THEREFORE, in considerate
terms and conditions luweinafter set f
Consultant shall pe
i ancsq
agree
ctive promises, and subject to the
Vows:
set forth in Exhibit A to this Agreement.
Con'Wnt agrees to accept as total payment for its services,
kwhibit A. The total sum to be expended under this
during the term of this Agreement.
y City shall be made within thirty (30) days following receipt of proper
V k- performed, subject to City accounting procedures. Payment need not
fails to meet the standards of performance set forth in the Recitals
e expected by City.
Agreement shall commence on the date first written above and terminate on
200 ,unless terminated earlier in accordance with Section 12, below. The term of
this Agreement may be extended upon a writing executed by the Executive Director of N( AME
OF RELEVANT AGENCY) and the City Attorney.
1
Prior to undertaking performance of
maintain and shall require its subcontracto
a. Commercial General Li
general liability insurance naming t
urance, or equivalent form, with a combined single
ence. Such insurance shall include coverage for
Compensation Insurance. In accordance with the provisions of Section 3300
nsultant, if Consultant has any employees, is required to be insured against
.e mpensation or to undertake self - insurance. Prior to commencing the
.ie k under this Agreement, Consultant agrees to obtain and maintain any
ity insurance with limits not less than $1,000,000 per accident.
r onsultant is or employs a licensed professional such as an architect or engineer:
bility (errors and omissions) insurance, with a combined single limit of not less
00,000 per claim.
2
e. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section: _
f. If Consultant fails or refuses to produce or maintalq
section or fails or refuses to furnish the City with required proo
and is in force and paid for, the City shall have the e
terminate this Agreement. Such termination sha
time and materials expended prior to notificat'
receive compensation and agrees to inde
of insurance by the City.
Consultant agrees to and shal
employees, consultants, special couns
injury, damages, just c ensation, r(
urance required
MIMM
IMMMMI
Lnsurance has been •
0'1�*I,,ction, to • �
tight to be • its
tork perfoom . •
less the City, its officers, agents,
m liability: (1) for personal
Ole relief arising out of claims
for personal injury, ealth, and s t erty dmage, which may arise from the
direct or indirect ope onsult r its c tors, subcontractors, agents,
employees, or other per t1 it if whic relates to the services described in
section 1 of this Agreemen (2) 'm that personal injury, damages, just
compen,Q40Mg,restitution, ju equita f is due by reason of the terms of or effects
this Agreeme�
iici auita
nsultant receives from the City information which due to the nature of such
info Wation is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own information of
CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has n
or indirect, which would conflict in any manner
this Agreement.
Any notice, tender, deman
Agreement shall be in writing and
mailed by first class or certified mail,
telegraphic communication in the ma
FRunication pursuant to this
roperly given if delivered in person or
W by telefacsimile or other
on, to the following persons:
Executive Director of (NAME OF RELEVANT AGENCY)
City of Santa Ana
0 Civic Center Plaza (M -_)
.O. Box 1988
Santa Ana, California 92702
telefacsimile (714)
4
City Attorney
City of Santa Ana
20 Civic Center Plaza (M -29)
Santa Ana, California 92702
telefacsimile (714) 647 -6515
INSERT NAME, ADDRESS,
state, County or City
er, d , delivery, or other
en three (3) days after it has been
ire ified, with postage prepaid, and
imile, tice, tender, demand, delivery, or
to hav given twenty -four (24) hours
ed by nsmitting facsimile machine,
1.1 these time frames, weekends, federal,
uch as this Agreement is intended to secure the specialized services of Consultant,
CO ant may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the City and any such assignment, transfer, delegation or subcontract without
the City's prior written consent shall be considered null and void. Nothing in this Agreement
5
shall be construed to limit the City's ability to have any of the services which are the subject to
this Agreement performed by City personnel or by other consultants retained by City.,A&6
This Agreement may be terminated by the City upon thirty (30) da
termination. In such event, Consultant shall be entitled to receive and the Cit
compensation for all services performed by Consultant prior to receipt of such no
subject to the following conditions:
a. As a condition of such payment, the Executive Dir may require Consultan
to the City all work product completed as of such date, and in se such work product s
the property of the City unless prohibited by law, and Consultant is to the City's use there
for such purposes as the City deems appropriate. AL
b. Payment need not be made for wor
specified in the Recitals of this Agreement.
Consultant shall not discrim ause o color, creed, religion, sex, marital
i
status, sexual orientation, age, nation ncest 'sability, as defined and prohibited
by applicable law, in the recruitment, tl ining, tion, promotion, termination or
other employment rela activities. Co tan s that n equal opportunity employer
and shall comply w' ' cable fede tate cal laws and regulations.
Wd vered in the State of California and the
I enforc ment of any of the clauses of this Agreement
�ws of the State of California. Both parties further
be the venue for any action or proceeding that may
with or by reason of this Agreement.
16. MISCELLANEOUS PROVISIONS
G
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreemene
shall
indemnify City fully, including reasonable costs and attorney's fees, for any injuries ges tc
City in the event that such authority or power is not, in fact, held by the signatory awn.
All Exhibits referenced herein and attached hereto shall be incorp
forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date
JOSEPH W. FLETCHER
City Attorney
By:
Name of Attorney
city
7
Employer ID # or Individual SS #
APPENDIX D
SAMPLE CERTIFICATE OF INSURANCE
ACORDTm CERTIFICATE OF LIABILITY INSURANCE
DATE {M 00�
0113112001Y}
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx_]OCCUR
X 1 1 1 1 1 1 1 1 1
01/01/2001
0 1 10 1 12002
EACH OCCURRENCE
$ 1;000;000
FIRE DAMAGE (Anyone fire)
$ 50,000
MED EXP (Any one person)
$5,000
PERSONAL & ADV INJURY
$ 1;000;000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
PRODUCTS - COMP /OP AGG
$ 2,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
X222222222 01/01/2001 0 1 10 1 12002
SEE A ADDITIONAL
INSURED ENDORSEMENT
COVERAGES DEPEND ON TYPE
OF AGREEMENT/CONTRACT
COMBINED SINGLE LIMIT
(Ea accident)
$ � ��������
X
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
Per accident)
$
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESS LIABILITY
OCCUR EICLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
XXX333333333
01/01/2001
0 1 10 1 12002
TORY L IM OER
E.L. EACH ACCIDENT
$ 1;000;000
E.L. DISEASE - EA EMPLOYEE
$ 1;000;000
E.L. DISEASE - POLICY LIMIT
$ 1;000;000
OTHER
Professional Liability
PL444444
01/01/2001
0 1 10 1 12002
Each Occurrence 1;000;000
DESCRIPTION OF OPERATIONS /LOCATIONSIVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
Certificate Holder is additional insured per attached.
Project No.
CERTIFICATE HI)LDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Santa Ana DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN
29 Civic Center Plaza - Ross Annex (M— NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Santa Ana, CA 92791
AUTHORIZED REPRESENTATIVE
ACORD 25 -S (7197) O ACORD CORPORATION 1988
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by
# relating to the following:
1. The City of Santa Ana, 20 Civic Cen
officers, employees, agents, volunteers and repre
( "additional insureds ") with regard to liability
and uses performed by or on behalf of the in;
2. With respect to claims
behalf of the named insured, such
additional to or contributing with a
additional insureds.
3. This ins
suit is brought exce
person or organizatio
would have as a claima
material
given to
(Completio
effective.)
fective
Policv.
III I
Waal
NEI
1
provisions of Policy
• , mmi
IF
�i
ME
•• •
ids
HER 0
Iffy- ,� •
''.. 101M, w
ns and uses perf6rmed by or on
this policy is primary and is not
ed by or for the benefit of the
i s g ainst whom claim is made or
of ility. The inclusion of any
ht which such person or organization
ds, this insurance shall not be cancelled, or
:cept ter thirty (30) days written notice has been
enter Plaza, Santa Ana, California 92701.
g countersignature, is required to make this endorsement
this endorsement form as a part of
Named Insured
Countersigned by
0
Authorized Representative
APPENDIX E
CERTIFICATION OF NON - DISCRIMINATION BY CONSULTANTS
CITY OF SANTA ANA
PROJECT STUDY REPORT EQUIVALENT AND CONCEPTUAL ENGINEERING PLANS
FOR SANTA ANA BOULEVARD GRADE SEPARATION PROJECT
PROPOSAL AND CONTRACT AGREEMENT
CERTIFICATION OF NONDISCRIMINATION BY CONTRACTOR
The undersigned contractor or corporate officer, during the performance of this contract, certifies
as follows:
1. The Contractor shall not discriminate against any employee or applicant for employment
because of race, color, religion, sex, or national origin. The Contractor shall take affirmative
action to ensure that applicants are employed, and that employees are treated during employment
without, regard to their race, color, religion, sex, or national origin. Such action shall include,
but not be limited to, the following: employment, upgrading, demotion, or transfer; recruitment
or recruitment advertising; layoff or termination; rates of pay or other forms of compensation;
and selection for training, including apprenticeship. The Contractor agrees to post in
conspicuous places, available to employees and applicants for employment, notices to be
provided setting forth the provisions of this nondiscrimination clause.
2. The Contractor shall, in all solicitations or advertisements for employees placed by or on
behalf of the Contractor, state that all qualified applicants will receive consideration for
employment without regard to race, color, religion, sex, or national origin.
3. The Contractor shall send to each labor union or representative of workers with which
he /she has a collective bargaining agreement or other contract or understanding, a notice to be
provided advising the said labor union or workers' representatives of the Contractor's
commitments under this section, and shall post copies of the notice in conspicuous places
available to employees and applicants for employment.
4. The Contractor shall comply with all provisions of Executive Order 11246 of September
241 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor.
5. The Contractor shall furnish all information and reports required by Executive Order
11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or
pursuant thereto, and will permit access to his /her books, records, and accounts by the
administering agency and the Secretary of Labor for purposes of investigation, to ascertain
compliance with such rules, regulations, and orders.
6. In the event of the Contractor's non - compliance with the nondiscrimination clauses of
this contract or with any of the said rules, regulations, or orders, the contract may be canceled,
terminated, or suspended in whole or in part and the Contractor may be declared ineligible for
further Government contracts or federally assisted construction contracts in accordance with
procedures authorized in Execution Order 11246 of September 24, 1965, and such other
sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of
September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise
provided by law.
CITY OF SANTA ANA
PROJECT STUDY REPORT EQUIVALENT AND CONCEPTUAL ENGINEERING PLANS
FOR SANTA ANA BOULEVARD GRADE SEPARATION PROJECT
PROPOSAL AND CONTRACT AGREEMENT
CERTIFICATION OF NONDISCRIMINATION BY CONTRACTOR (continued
7. The Contractor shall include the portion of the sentence immediately preceding paragraph
(1) and the provisions of paragraphs (1) through (7) in every subcontract or purchase order
unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to
Section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be
binding upon each subcontract or purchase order as the administering agency may direct as
means of enforcing such provisions, including sanctions for noncompliance; provided, however,
that in the event the Contractor becomes involved in, or is threatened with, litigation with a
subcontractor or vendor as a result of such direction by the administering agency, the Contractor
may request that the United States enter into such litigation to protect the interests of the United
States.
8. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939,
and as amended,
No discrimination shall be made in the employment of persons upon public works because of
race, religious creed, color, national origin, ancestry, physical handicaps, mental condition,
marital status, or sex of such persons, except as provided in Section 1420, and any contractor of
public works violating this Section is subject to all the penalties imposed for a violation of the
Chapter.
Signed
Title
Firm
Date
APPENDIX F
FEDERAL REQUIREMENTS
Certification of Consultant ............................................. ............................... Exhibit 10 -F
Certification of Local Agency ....................................... ............................... Exhibit 10 -G
Local Agency Proposer UDBE Commitment (Consultant Contracts) .... Exhibit 10 -01
Local Agency Proposer DBE Information (Consultant Contracts) ......... Exhibit 10 -02
Nonlobbying Certification for Federal Aid Contracts .. ............................... Exhibit 10 -P
Disclosure of Lobbying Activities ................................ ............................... Exhibit 10 -Q
Equal Employment Opportunity Certification .....................Exhibit 12 -E Attachment C
Non - Collusion Affidavit .. ............................... ........................Exhibit 12 -E Attachment D
Debarment and Suspension Certification ............................ Exhibit 12 -E Attachment E
Local Assistance Procedures Manual
EXHIBIT 10 -F
Certification of Consultant, Commissions & Fees
Exhibit 10 -F Certification of Consultant, Commissions & Fees
CERTIFICATION OF CONSULTANT
I HEREBY CERTIFY that I am the
, and duly authorized
representative of the firm of , whose address is
, and that, except as hereby
expressly stated, neither I nor the above firm that I represent have:
(a) employed or retained for a commission, percentage, brokerage, contingent fee, or other consideration,
any firm or person (other than a bona fide employee working solely for me or the above consultant) to
solicit or secure this agreement; nor
(b) agreed, as an express or implied condition for obtaining this contract, to employ or retain the services
of any firm or person in connection with carrying out the agreement; nor
(c) paid, or agreed to pay, to any firm, organization or person (other than a bona fide employee working
solely for me or the above consultant) any fee, contribution, donation, or consideration of any kind, foror
in connection with, procuring or carrying out this agreement.
I acknowledge that this Certificate is to be made available to the California Department of Transportation
(Caltrans) in connection with this agreement involving participation of Federal -aid Highway funds, and is subject
to applicable state and federal laws, both criminal and civil.
(Date)
(Signature)
Page 10 -43
LPP 06 -02 May 1, 2006
Local Assistance Procedures Manual
Exhibit 10 -G Certification of Local Agency
CERTIFICATION OF LOCAL AGENCY
I HEREBY CERTIFY that I am the
EXHIBIT 10 -G
Certification of Local Agency
of the
(local agency) I , and that the consulting firm of
,or its representative has not been required (except
as herein expressly stated), directly or indirectly, as an express or implied condition in connection
with obtaining or carrying out this Agreement to:
(a) employ, retain, agree to employ or retain, any firm or person, or
(b) pay or agree to pay, to any firm, person or organization, any fee, contribution, donation, or
consideration of any kind.
I acknowledge that this Certificate is to be made available to the California Department of Transportation
(Caltrans) in connection with this Agreement involving participation of federal-aid highway funds, and is
subject to applicable state and federal laws, both criminal and civil.
(Date)
(Signature)
Page 10 -45
LPP 06 -02 May 1, 2006
Local Assistance Procedures Manual EXHIBIT 10 -01
Local Agency Proposer UDBE Commitment (Consultant Contracts)
EXHIBIT 10 -01 Local Agency Proposer UDBE Commitment (Consultant Contracts)
NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM
LOCAL AGENCY: LOCATION:
PROJECT DESCRIPTION:
PROPOSAL DATE:
PROPOSER' S NAME:
CONTRACT UDBE GOAL ( %):
WORK
ITEM NO.
DESCRIPTION OR SERVICES TO BE
SUBCONTRACTED (or contracted if
the proposer is a UDBE)
UDBE CERT NO.
AND EXPIRATION
DATE
NAME OF EACH UDBE
(Must be certified at the time
proposals are due - include UDBE
address and phone number)
PERCENT
PARTICIPATION
OF EACH UDBE
For Local Agency to Complete:
Local Agency Proposal Number:
Federal -Aid Project Number:
Federal Share:
Total Claimed UDBE
Commitment
Proposal Date:
Local Agency certifies that the UDBE certifications have been verified and all
information is complete and accurate /unless noted otherwise.
Print Name Signature Date
Local Agenc Representative
(Area Code) Telephone Number:
Signature of Proposer
Date (Area Code) Tel. No.
Person to Contact (Please Type or Print)
Local Agency Proposer UDBE Commitment (Consultant Contracts)
(Rev 6/27/09)
Distribution: (1) Original - Local agency files
Page10 -73
LPP 09 -02 July 31, 2009
EXHIBIT 10 -01 Local Assistance Procedures Manual
Local Agency Proposer UDBE Commitment (Consultant Contracts)
INSTRUCTIONS —LOCAL AGENCY PROPOSER UDBE COMMITMENT
(CONSULTANT CONTRACTS)
ALL PROPOSERS:
PLEASE NOTE: It is the proposer's responsibility to verify that the UDBE(s) falls into one of the
following groups in order to count towards the UDBE contract goal: 1) African Americans; 2) Asian-
Pacific Americans; 3) Native Americans; 4) Women. This information must be submitted with your
proposal. Failure to submit the required UDBE commitment will be grounds for finding the proposal
nonresponsive.
A "UDBE" is a firm meeting the definition of a DBE as specified in 49 CFR and is one of the following groups:
African Americans, Native Americans, Asian - Pacific Americans, or Women.
The form requires specific information regarding the consultant contract: Local Agency, Location, Project
Description, Proposal Date, Proposer's Name, and Contract UDBE Goal.
The form has a column for the Work Item Number and Description or Services to be subcontracted to UDBEs (or
performed if the proposer is a UDBE). The UDBE prime contractors shall indicate all work to be performed by
UDBEs including work to be performed by its own forces, if a UDBE. The UDBE shall provide a certification
number to the Consultant and notify the Consultant in writing with the date of decertification if their status should
change during the course of the contract. Enter UDBE prime consultant and subconsultant certification
numbers.The form has a column for the Names of certified UDBEs to perform the work (must be certified on the
date proposals are due and include UDBE address and phone number).
There is a column for the percent participation of each UDBE. Enter the Total Claimed UDBE Participation
percentage of items of work submitted with proposal pursuant to the Special Provisions. (If 100% of item is not to
be performed or furnished by the UDBE, describe exact portion of time to be performed or furnished by the
UDBE.) See "Notice to Proposers Disadvantaged Business Enterprise Information," (Exhibit 10 -I) to determine
how to count the participation of UDBE firms. Note: If the proposer has not met the contract goal, the local
agency must evaluate the proposer's good faith efforts to meet the goal in order to be considered for award of the
contract.
Exhibit 10 -01 must be signed and dated by the consultant submitting the proposal. Also list a phone number in
the space provided and print the name of the person to contact.
For the Successful Proposer only, local agencies should complete the Proposal Number, Federal -
aid Project Number, Federal Share, and Proposal Date fields and verify that all information is complete and
accurate before filing.
Page 10 -74
July 31, 2009 LPP 09 -02
Local Assistance Procedures Manual EXHIBIT 10 -02
Local Agency Proposer DBE Information (Consultant Contracts)
EXHIBIT 10 -02 Local Agency Proposer DBE Information (Consultant Contracts)
NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM
LOCAL AGENCY: LOCATION:
PROJECT DESCRIPTION:
TOTAL CONTRACT AMOUNT ($):
PROPOSER' S NAME:
WORK
ITEM NO.
DESCRIPTION OR SERVICES TO BE
SUBCONTRACTED (or contracted if
the proposer is a DBE)
DBE CERT NO.
AND EXPIRATION
DATE
NAME OF EACH DBE
(Must be certified at the time
proposals are due - include DBE
address and phone number)
DOLLAR AMOUN T OF
EACH DBE
For Local Agency to Complete:
Local Agency Contract Number:
Federal -Aid Project Number:
Federal Share:
Total Claimed DBE
Participation
%
Contarct Award:
Local Agency certifies that the DBE certifications have been verified and all
informations is complete and accurate.
Print Name Signature Date
Local Agency Representative
(Area Code) Telephone Number:
Signature of Proposer
Date (Area Code) Tel. No.
Person to Contact (Please Type or Print)
Local Agency Proposer DBE Information (Consultant Conttarcts)
(Rev 6/27/09)
For Caltrans Review:
Print Name Signature Date
Caltrans District Local Assistance Engineer
Distribution: (1) Copy - Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within 15 days after contract execution.
Failure to send a copy to the DLAE within 15 days after contract execution may result in deobligation of funds for this project.
(2) Original - Local agency files
Page 10 -74a
LPP 09 -02 July 31, 2009
EXHIBIT 10 -02 Local Assistance Procedures Manual
Local Agency Proposer DBE Information (Consultant Contracts)
INSTRUCTIONS -LOCAL AGENCY PROPOSER DBE INFORMATION
(CONSULTANT CONTRACTS)
SUCCESSFUL PROPOSER:
The form requires specific information regarding the consultant or other contract: Local Agency, Location,
Project Description, Total Contract Amount, Proposal Date, and successful Proposer's Name.
The form has a column for the Work Item Number and Description or Services to be Subcontracted to DBEs. The
prime consultant shall indicate all work to be performed by DBEs including, if the prime consultant is a DBE,
work performed by its own forces, if a DBE. The DBE shall provide a certification number to the prime
consultant. Enter DBE prime consultant's and subconsultant's certification number. The form has a column for
the Names of DBE certified contractors to perform the work (must be certified on or before the proposals are due
and include DBE address and phone number).
Enter the Total Claimed DBE Participation dollar amount of items of work in the total DBE Dollar Amount
column. (If 100% of item is not to be performed by the DBE, describe exact portion of time to be performed by
the DBE.) See "Notice to Proposers Disadvantaged Business Enterprise Information," ( Exhibit 10 -I) to
determine how to count the participation of DBE firms.
Exhibit 10 -02 must be signed and dated by the successful proposer at contract execution. Also list a phone
number in the space provided and print the name of the person to contact.
Local agencies should complete the Contract Number, Federal -aid Project Number, Federal Share, and
Contarct Award fields and verify that all information is complete and accurate before signing and sending a copy
of the form to the District Local Assistance Engineer within 15 days of contract execution. Failure to submit a
completed and accurate form within the 15 -day time period may result in the deobligation of funds on this project.
District DBE Coordinator should verify that all information is complete and accurate. Once the
information has been verified, the District Local Assistance Engineer signs and dates the form.
Page 10 -74b
July 31, 2009 LPP 09 -02
Local Assistance Procedures Manual
EXHIBIT 10 -P
Nonlobbying Certification for Federal -aid Contracts
Exhibit 10 -P Nonlobbying Certification For Federal -Aid Contracts
The prospective participant certifies by signing and submitting this proposal /bid to the best of his or her
knowledge and belief that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of any federal agency, a Member
of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection
with the awarding of any federal contract, the making of any federal grant, the making of any federal
loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of any federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any federal agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection
with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and
submit Standard Form -LLL, "Disclosure of Lobbying Activities," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction
imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
The prospective participant also agrees by submitting his /her proposal /bid that he /she shall require that the
language of this certification be included in all lower -tier subcontracts which exceed $100,000 and that all such
sub - recipients shall certify and disclose accordingly.
Page 10 -75
LPP 09 -02 July 31, 2009
Local Assistance Procedures Manual
EXHBIT 10 -R
Disclosure of Lobbying Activities
Exhibit 10 -Q Disclosure of Lobbying Activities
DISCLOSURE OF LOBBYING ACTIVITIES
COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
❑ a. contract ❑ a. bid /offer /a pp lication ❑ a. initial
b. grant b. initial award b. material change
c. cooperative agreement c. post -award
d. loan For Material Change Only:
e. loan guarantee year quarter
f. loan insurance date of last report
4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee,
Enter Name and Address of Prime:
FiPrime FISubawardee
Tier , if known
Congressional District, if known
6. Federal Department /Agency:
8. Federal Action Number, if known:
10. a. Name and Address of Lobby Entity
(If individual, last name, first name, MI)
11.
12.
14.
Congressional District, if known
7. Federal Program Name /Description:
CFDA Number, if applicable
9. Award Amount, if known:
b. Individuals Performing Services (including
address if different from No. l0a)
(last name, first name, MI)
(attach Continuation Sheet(s) if necessary)
Amount of Payment (check all that apply) 13. Type of Payment (check all that apply)
$ ❑ actual ❑ planned ❑ a. retainer
b. one -time fee
Form of Payment (check all that apply): c. commission
a. cash d. contingent fee
b. in -kind; specify: nature e deferred
Value f. other, specify
Brief Description of Services Performed or to be performed and Date(s) of Service, including
officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11:
(attach Continuation Sheet(s) if necessary)
15. Continuation Sheet(s) attached: Yes ❑ No ❑
16. Information requested through this form is authorized by Title
31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature:
was placed by the tier above when his transaction was made or
entered into. This disclosure is required pursuant to 31 U.S.C. print Name:
1352. This information will be reported to Congress
semiannually and will be available for public inspection. Any
person who fails to file the required disclosure shall be subject Title:
to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure. Telephone No.: Date:
Authorized for Local Reproduction
Federal Use Only:
Standard Form LLL Rev. 04 -28 -06
Standard Form - LLL
Page 10 -77
LPP 06 -02 May 1, 2006
EXHIBIT 10 -Q Local Assistance Procedures Manual
Disclosure of Lobbying Activities
INSTRUCTIONS FOR COMPLETION OF SF -LLL,
DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient at the initiation or receipt of
covered federal action or a material change to previous filing pursuant to title 31 U.S.C. Section 1352. The filing of a form is required for
such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered
federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply
for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and
Budget for additional information.
1. Identify the type of covered federal action for which lobbying activity is and /or has been secured to influence, the outcome of a
covered federal action.
2. Identify the status of the covered federal action.
3. Identify the appropriate classification of this report. If this is a follow -up report caused by a material change to the information
previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted
report by this reporting entity for this covered federal action.
4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if known. Check the
appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the
tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to
subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in Item 4. checks " Subawardee" then enter the full name, address, city, State and zip code of
the prime federal recipient. Include Congressional District, if known.
6. Enter the name of the federal agency making the award or loan commitment. Include at least one organization level below
agency name, if known. For example, Department of Transportation, United States Coast Guard.
7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the full Catalog of Federal
Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.
8. Enter the most appropriate federal identifying number available for the federal action identification in item 1 (e.g., Request for
Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number,
the application /proposal control number assigned by the federal agency). Include prefixes, e.g., "RFP -DE -90 -001."
9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter the federal amount
of the award /loan commitments for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in Item
4. to influenced the covered federal action.
(b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last
Name, First Name and Middle Initial (Ml).
11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (Item 4) to the lobbying entity
(Item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is
a material change report, enter the cumulative amount of payment made or planned to be made.
12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in -kind contribution, specify the
nature and value of the in -kind payment.
13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.
14.Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the
date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with federal
officials. Identify the federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that
were contacted.
15. Check whether or not a continuation sheet(s) is attached.
16. The certifying official shall sign and date the form, print his /her name title and telephone number.
Public reporting burden for this collection of information is estimated to average 30- minutes per response, including time for reviewing
instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348- 0046), Washington, D.C. 20503.
SF- LLL - Instructions Rev.06- 04- 90«ENDIF»
Page 10 -78
May 1, 2006 LPP 06 -02
Local Assistance Procedures Manual
PS &E Checklist Instructions
EXHIBIT 12 -E
Attachment C
(THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL
SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE
CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL)
EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION
The bidder , proposed
subcontractor , hereby certifies that he has ,
has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required
by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting
Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or
administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due
under the applicable filling requirements.
Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of
Labor (41 CFR 60- 1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in
connection with contracts and subcontracts, which are subject to the equal opportunity clause. Contracts
and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60 -1.5.
(Generally only contracts or subcontracts of $10,000 or under are exempt.)
Currently, Standard Form 100 (EEO -1) is the only report required by the Executive Orders or their
implementing regulations.
Proposed prime contractors and subcontractors who have participated in a previous contract or
subcontract subject to the Executive Orders and have not filed the required reports should note that 41
CFR 60- 1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a
report covering the delinquent period or such other period specified by the Federal Highway
Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor.
Page 12 -79
LPP 01 -04 March 15, 2001
Local Assistance Procedures Manual
PS &E Checklist Instructions
EXHIBIT 12 -E
Attachment D
Noncollusion Affidavit
(Title 23 United States Code Section 112 and
Public Contract Code Section 7106)
To the CITY / COUNTY of
DEPARTMENT OF PUBLIC WORKS.
In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares
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 association, organization, bid depository, or to
any member or agent thereof to effectuate a collusive or sham bid.
Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature
portion thereof shall also constitute signature of this Noncollusion Affidavit.
Bidders are cautioned that making a false certification may subject the certifier to criminal
prosecution.
Page 12 -81
LPP 01 -04 March 15, 2001
Local Assistance Procedures Manual
PS &E Checklist Instructions
DEBARMENT AND SUSPENSION CERTIFICATION
TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29
EXHIBIT 12 -E
Attachment E
The bidder, under penalty of perjury, certifies that, except as noted below, he /she or any other person associated
therewith in the capacity of owner, partner, director, officer, and manager:
• Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by
any federal agency;
• Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency
within the past 3 years;
• Does not have a proposed debarment pending; and
• Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent
jurisdiction in any matter involving fraud or official misconduct within the past 3 years.
If there are any exceptions to this certification, insert the exceptions in the following space.
Exceptions will not necessarily result in denial of award, but will be considered in determining bidder
responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of
action.
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.
Page 12 -83
LPP 01 -04 March 15, 2001