Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
SIGNATURE CONTRACTORS
Recording Requested By, And When Recorded Mail To: Clerk of the Council, City of Santa Ana 20 Civic Center Plaza, P.O. Box 1988 Santa Ana, CA 92702 r� c.: d Recorded in Official Records, Orange County Tom Daly, Clerk- Recorder IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII NO FEE *$ R 0 0 0 4 7 7 7 7 0 5 S* 2012000252921 2:00 pm 05/02/12 63 4'14 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THIS SPACE FOR COUNTY RECORDERS USE ONLY ,��:, �� ,,� .., — i5'� — , �. NOTICE OF COMPLETION NOTICE IS HEREBY GIVEN that the undersigned City of Santa Ana, California, a municipal corporation, with the address of City Hall, 20 Civic Center Plaza, Santa Ana, California, 92701, is the owner of the property hereinafter described, that said owner has caused construction of CENTENNIAL PARK RESTROOM ROOF REPLACEMENT under contract °w entered into on MAY 2. 2011, with SIGNATURE CONTRACTORS, on which contract a o WESTERN INSURANCE COMPANY is surety. The property on which such work � w improvement was placed is in the City of Santa Ana, County of Orange, State of California, and � o described as Project No. 10 -7558 located at: CENTENNIAL PARK. The work improvement on m F said property was accepted as completed on MARCH 30. 2012. o z c z CITY SANTA NA, A MUNICIPAL CORPORATION � � m o by 1 n�4/Vl 1 /1 ll M t � � Dated: 2� Z City Engineer w o � E. TITLE C z z a --------------------------------------- caa ---------------------------------------------------- z � S a VERIFICATION x I, the undersigned, say: I am the City Engineer of the City of Santa Ana, California; I executed the foregoing Notice of Completion acting on behalf of the owner of the property therein described; I make this verification on behalf of said corporation by authorization of the City Council of the City of Santa Ana; I have read said notice and know the contents thereof; and I declare under penalty of perjury that the facts therein stated are true. Executed on y (2 � �% Z at Santa Ana, Califomia (Signature of individual swearing that the contents of Notice of Completion are true.) THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN (10) DAYS AFTER COMPLETION REQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: MAY 2, 2011 TITLE: CONTRACT AWARD FOR CENTENNIAL PARK RESTROOM ROOF REPLACEMENT (PROJECT NO. 107558) �.(..t� MANAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED S Z — I f L� ,qs Recommended � As Amended � Ordinance on � �` Reading 0 Ordinance on 2ntl Reading � Implementing Resolution Q Set Public Hearing For_ CONTINUED TO FILE NUMBER Award a contract to Signature Contractors, the lowest responsible bidder, in accordance with unit bid prices in the estimated amount of $113,677.20 for replacement of the Centennial Park Restroom Roof_ 2. Approve a Funding Analysis with a total estimated construction cost of $138,071 . DISCUSSION The existing restroom facilities at Centennial Park were constructed over 25 years ago and have slowly deteriorated due to the adverse effect of weather and age (Exhibit 1 ). Funding is now available to renovate the exterior of the facilities, which will include removing the existing wood roof and columns and replacing them with a new metal roof and concrete columns, and installation of new exterior security lighting. Once completed, the new restroom metal roof and concrete columns will match the picnic shelters throughout Centennial Park and the added lighting will increase the safety of the area. The Notice Inviting Bids was advertised on March 25 and 26, 2011 and bids were opened on April 12, 2011. A summary of the bid invitations mailed, the bids received, and the bid results follows. Santa Ana Contractors receiving notices: 12 Contractors requesting bidding documents: 10 Bids received: 6 Bids received from Santa Ana Contractors: O Contract Award For Centennial Park Restroom Roof Replacement May 2, 2011 Page 2 NAME OF RESPONSIVE BIDDER CITY BID AMOUNT 1 . Signature Contractors Laguna Niguel $113,677.20 2. Lehman Construction, Inc_ Tustin $123,497.00 3. Fleming Environmental, Inc. Fullerton $128,340.00 4. Vido Samarzich, Inc. Alta Loma $130,400.00 5. Best Contracting Services, Inc. Gardena $133,595.20 6. Unique Performance Construction, Inc. Costa Mesa $135,400.00 While the City sent out the Notice Inviting Bids to Santa Ana contractors, no contractors from Santa Ana submitted bids. A survey was taken from randomly selected contractors. These companies did not submit a bid because they are currently busy with too many projects or because they can't get bonds. Six bids were received and all were responsive. The lowest bid was submitted by Signature Contractors for $1 13,677.20, which is below the Engineer's estimate of $123,500. ENVIRONMENTAL IMPACT In accordance with the California Environmental Quality Act, the proposed project is exempt from future review. Categorical Exemption Environmental Review No. 2010 -49 will be filed for the project. In addition, a Certification of Categorical Exclusion and Statutory Worksheet have been prepared in accordance with the National Environmental Policy Act. FISCAL IMPACT The funding analysis shows a total estimated construction cost of $138,071 for the project (Exhibit 2). Funds are available in the Community Development Block Grant Funds (accounting unit 13518783- 66220). ���� ��� Raul Godinez II Gerardo Mouet ' Executive Direct r Executive Director Public Works Agency Parks, Recreation and Community Services Contract Award For Centennial Park Restroom Roof Replacement May 2, 2011 Page 3 Nancy T. E ards Interim Executive Director Community Development Agency RG/WA Exhibit 1: Project Location Map 2: Funding Analysis APPROVED AS TO FUNDS AND ACCOUNTS: Francisco Gutierrez r���� Executive Director Finance & Management Services Agency I� J� —, � � — _ -- � -- EDINGER AVE. - - -- --- �norrtTrrL\ �rnirrm�t rnrrrrrrrlTrrr m � � —_ -. -.- �uluuiaiiwlLLr � _ L.1_I � �rirwluLr(( -i uiuiurulwiwul((\\ 1rnnTrfTTTnTIII1lTR J � �� ll mlTlinll111 L� �IIIIInrTfrfTfrini�frf�� \rllLI111LLllIRWllfll lf� � � � LWJ1111111LLLLLLLLLLI11 �1� /Z1L11llW11 LLllLlllllLLLllLLll VIrrrrmTrrr-tm nnrmrm _ �n� ��mrurmTrm nniurlrrrr{� lmnnrrrrrrrrrmrrnrrrrrrrnmr� �llll1L uuuLUUUiiuiu �T � - u�ynulru 011111 uLUiuw� � _ iii a LI u � __ — — _ — i� �_� /\ll\VVVI t \ � �> „ - j� _ % � � _ � /%/ `�� r` �' c�� �� = =� � ,_ , s - — L_ _ 1 � _ _ __r - - -- �. � / -- - LAKE � f -� _� _� � i �._ -�,,� �� -�� [[i 3 i \ �- �� . CENTENNIAL PARK � ,/ �, Q LAKE � ��-��. NTS [L� � f� ��� � ��� ����G�� � i - _ � -- . �� � __ CENTENNIAL RD % -- - i -� -_ -- ___ �/ � .- I� �0 � ��- -- � RESTROOM LOCATION SANTA ANA `� AGENDAOUNCIL V -V /-� DATE: P�a��= woaKS �E� =r MAY 2, 201 1 PROJECT 107558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT .NN ORAN6@ ? C �� � "�' i 0 0 K � 7 FUNDING ANALYSIS PROJECT NO. 107558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT Construction Contract Inspection and Testing Contingencies $1 13,677 $3,934 $20,460 TOTAL ESTIMATED CONSTRUCTION COSTS $138.071 Exhibit 2 1'I Ijll II llul IIIIII'I1 .1 I II I'll State bf Goal FoYnla 11' N ht 4-q.Qw4 SANTA county, of O ji: ck—lation s" defined Ill 4 ti N Me 1111 I , j I'I, III IIIIIIIIIIIIllll111 If111 ,r 1 Illllli!f + If �I,I r 11 1 )1111 1 II it IIII' j ill y'.Oo -jl ix? Pf ec, ;Ilillll rE IMP ; 111,1 ',I 111111 111'1111 lilll ll1J'1111 I;;�'►Ilj4Ij � }Il Ill {Iljililllllllll�II�II1111IjIll !!111 +�11I1 {Il�li' 11 I,� Ii, I I +li I 1, I I 1 ,1 1 1111 1 j 11' 111 ill ail' I II j;ll�jll1!; ►;;; I, 11; t; I' il,; lill11h11tlllllljllll 'llli�llt,ltli I','''ll,; J _, �_ N cC V ..� z �� � a �I N 0 � � 00 �� N 00 V w GC � � Vi C� c �' w f-� CV NM O\ e � � ^� � `� � M ♦� i� O U �. .--. a� •Tr���IA c��l o �/L N rL. cT � e� .:.::.�. �.� 4��= [ ' q �a_3 C'V �- C.J 1 ...Li <.. CG <._ i`�J as a� O 0 0 A zs .... ^.r C� G� r..� f�7 a� v CL a� cF.. 0 0 0 0 s.. .:� �i r..� a �..� �..� a� a a� V v .� ..� O N eet V GEC -� i CITY OF SANTA ANA / PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL &z CONTRACT AGREEMENT BID. "PROPOSAL x TO: CITY COUNCIL. `OF THE CITY OF SANTA ANA FROM: c- �l � /� A��C�CZ..Vs � d rJ� �G� (Z. � . REQUIREMENT: The undersigned declares that he/she has carefully examined the location of the proposed work, that he /she has examined the Plans and "Specifications and read the accompanying instruction to BIDDERS, and hereby proposes to furnish all material and do all the work required to complete the said work in accordance with said plans, specifications and special provisions, for the unit prices) or lump sums) set forth in the following schedule: Item # Bid Item Unit Quantity Unit Price Amount PROJECT 10 -7558 Centennial Park Restroom Roof Shelter 1. Demolition and Dispose LS 1 $ � +�� aa� � $ � � �.�� 2. 24'x24' Shade Structure EA 2 $ �� �� � ' $ 6 �a/� 3. Concrete Sonatube Columns EA 8 $ �� ' $ G �7 � 4. Concrete Sonatube Footings EA 8 $ % l $ S, yG� 8 5. Welded Wire Mesh LF 120 $� ®� � $ %o�L L 7 L 6. Electrical per structure (J -Box, flood � /3(fa � � a lights with wire vandal proof cover, EA 2 $ $ electrical wire, and conduits) 7. Emergency Work On Time and LS 1 $ 10.000 $ 10.000 Material Basis TO BE INCLUDED IN BID PACKAGE BP 1 of 29 CITY OF SANTA ANA PROJECT NO. 10.7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL CONTRACT AGREEMENT BID PROPOSAL continued TOTAL BID - - - -- PROJECT NO. 10.7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT -------------------- - - - - -- $ / �3, � Z? BIDDER ^ w - Firm �c fL�f �o�,,��s Address Phone may%`' � �� � —� / ��^��`- Fax ��! s �� � - �,yy Email �1��51q�c:�� ,� ��./f,� BIDDER Signature TO BE INCLUDED IN BID PACKAGE BP 2 of 29 MAYOR Miguel A. Pulido MAYOR PRO TEM Claudia C. Alvarez COUNCILMEMBERS David Benavides Carlos Bustamante Michele Martinez Vincent F. Sarmiento Sal Tinajero April 5, 2011 CITY OF SANTA ANA PUBLIC WORKS AGENCY M -36 P.O. Box '19H8 Santa Ana, California 92702 CITY MANAGER David N. Ream CITY ATTORNEY Joseph W. Fletcher CLERK OF THE COUNCIL Maria D. Huizar ADDENDUM No. ONE SUBJECT: PROJECT No. 107558: Centennial Park Restroom Roof Replacement The following change has been made to specifications of the subject project: Specifications 1. Page v, Notice Inviting Bids; Revise the Contractor's license sentence to read as follows: "The successful BIDDER must possess or obtain a valid California Class A or B Contractor's license prior to the schedule award date of this contract." 2. Page 16, Section 2.09; Delete the words, "and shall provide anti - graffiti coating." from the first paragraph of section 2.09 Shade Structure and Sonatube &footing. All other terms and conditions remain the same. FOR THE CITY OF SANTA ANA �_ � George Alvarez U� City Engineer 2� � \�� �` S �,� ccrs���� AIA Document A310T"' - 2010 _,,,, This document has important legal consequences. Consultation with an attorney is encouraged with respect to its completion or modification. Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR: (Name, /ega/ status and address) SIGNATURE CONTRACTORS 2824'1 CROWN VALLEY PARKWAY F293 LAGUNA NIGUEL, CA 92677 SURETY: (Name, legal status and principal p /ace of business) WESTERN INSURANCE COMPANY P.O. BOX 2 � 030 RENO, NV 895'15 OWNER: (Name, legal status and address) CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA, CA 9270'1 BOND AMOUNT: TEN AND 00 /t 00 PERCENT, t O% OF BID AMOUNT. PROJECT: (Name, location or address and Project number, if any) CENTENNIAL PARK RESTROOM ROOF REPLACEMENT (REBID). II iPROJECT NO. '107558 The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to pertorm the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an eMension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemetl to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. Signed d sealed "Ith d ofA ", 201. IG ATUR CONTOR WESTERN ! CE CO (P ipal) v`�' (Sea /) (S y) r r le) (Tit /e) YUN .MULL /CK, at! CAUTION: You should sign an original AIA Contract Document, on which this text a,�p6ars in RED. An original assures thatc hangers will not be obscured. �/ AIA Document A370 T"" — 20'10. Co pyHght U '1963, '1970 and 20'1 O by The America nstltute oT Architects. All rights reserved. WARNINGc This AIACJ Document is protected by U.S. Copyright Law and International Treaties. Un thorized reproduction or distribution of this AIA® Document, or any portion of it, may result in severe civil and criminal penalties, and will prosecuted to the maximum extent possible under the law. Purchasers are permitted to reprotluce ten (t O) copies of this document when completed. To report copyright violations of AIA Contract Documents, a -mail The American Institute of Architects' legal counsel, copyright @aia.org. 06� t 1 O ACKNOWLEDGMENT State of California County of Orange ) On April 11, 2011 before me, Peter Austin Neff, Notary Public (insert name and title of the officer) personally appeared Yune T. Mullick , who proved to me on the basis of satisfactory evidence to be the personO whose nameO is /aD+ac subscribed to the within instrument and acknowledged to me that heft executed the same in hisbttec#h�x authorized capacity���, and that by his/iaa9x/xlx� signatures) on the instrument the person(), or the entity upon behalf of which the person() acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. PETER AUSTIN NEB F � '{ COMM. f 1799369 � s � NOTARY PUBUC.CAUFORNU► — ORANGE COUNTY N (1,N{ Mr coff.R F, RAY Z7, sots Signature � (Seal) WESTERN INSURANCE COMPANY POWER OF ATTORNEY 1 1 3 9 9 KNOW ALL MEN BY THESE PRESENTS: That WESTERN INSURANCE COMPANY a corporation organized and existing under the Taws of the State of Utah and having its principal office at the City of Sandy, in the State of Utah, does hereby constitute and appoint Yung T. Mullick, James W. Moilanen, Jennifer C. Giboney P. Austin Neff Of the STATE OF UTAH its true and lawful Attomey(s) -in -Fact, each in their separate capacity if more than one is named above, to sign its name as surety to, and to execute, seal and acknowledge any. and all bonds, undertakings, contracts and other written instruments in the nature thereof on behalf of the Company in its business of guaranteeing the fidelity pf persons; guaranteeing the performance of contracts; and executing or guaranteeing bonds and undertakings' required or permitted in any actions or proceedings allowed by law. In Witness Whereof, [he said WESTERN INSURANCE COMPANY has caused this instrument to�be sealed with its corporate seal, duly attested by the signatures of its President and Secretary, this 6th day of December, 201 O. WESTERN INSURANCE COMPANY On this 6th day of December, 201 O, before me personally came DICK �TTMAN, PRESIDENT of the WESTERN INSURANCE COMPANY and ALICE A. MOLASKY ARMAN, SECRET 1��5 §id Company, with both of whom 1 am personally acquainted, who being by me severally duly sworn, said, [hgt a said D�I�C?K� L. ROTTMAN and ALICE A. MOLASKY ARMAN were respectively the PRESIDENT and tltpy�R ARY of `Yy"' WESTERN INSURANCE COMPANY, the corporation described in which executed the foregoing PoL�r Attomey, t�tach knew the seal of said corporation; that the seal affixed to said Power of Attomey was such�q �gra1`e seal, that i av���,'b a axed by orr�Qe��f. the Board of Directors of said corporation, and that they signed their namesip�6y like order a67P�IDENT and SEY"1t�1''ARY, respectively, of the Company. My Commission expires thg�t�. h April, 20 4� ±Y.1 �(�11``�►�s/� .._....__ .......... ....._..................`....., ,��� �YZ� PATRICIA A. LEt50N +� / 1 i8ry R«sry weu��smuw Rwutle �'�i�n�d) LA. `O�i'�_�+ --- -- NO PUb1iC s ,,,a..,.�,,.dd.,.,...,s�a.., 71� �` i...... ............................... y.....g.....: �t%n This Power of Attome is rant�e�h� d by authority of the following Resolutions adopted by the Board of Directors of the WESTERN INSURANCE COMPA� on December 6, 2010. RESOLVED, that in connection with the fidelity and surety insurance business pf the Company, all bonds, undertakings, contracts and other instruments relating to said business may be signed, executed, and acknowledged by person or entities appointed as Attomey(s) -in -Fact pursuant toa Power or Attomey issued in accordance with these resolutions. Said Powers) of Attomey for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman, or the President, or a Vice President, jointly with the Secretary, under their respective designations. The signature of such officers maybe engraved, printed or lithographed. The signature of each of the foregoing officers and the seal of the Company may be affixed by facsimile to any Power of Attomey or to any certificate relating thereto appointing Attomey(s) -in -Fact for purposes only of executing end attesting bonds and undertakings and other writings obligatory in the nature thereof, and ,unless subsequently revoked and subject [o any limitations set forth therein, any such Power of Attomey or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is validly attached. RESOLVED, that Attomey(s) -in -Fact shall have the power and authority, unless subsequently revoked end, in any case, subject to the terns and limitations of the Power of Attomey issued to them, to execute and deliver on behalf of the Company and to attach the seal of the Company to any and all bonds and undertakings, and other writings obligatory in the nature thereof, and any such instrument executed by such Attomey(s) -in -Fact shall be as binding upon the Company as if signed by an Executive OfFicer and sealed and attested to by the Secretary of the Company. 1 ALICE A. MOLASKY ARMAN, Secretary of the WESTERN INSURANCE COMPANY, do hereby certify that the foregoing is a true excerpt fromthe Resolution of the said Company as adopted by its Board of Directors on December 6, 2010 end that this resolution is in full force effect. (, the undersigned Secretary of the WESTERN INSURANCE COMPAN V do hereby certify that the foregoing Power of Attomey is in full force and effect and has not been revoked. In Testimony Vyhere9t; I have hereunto set my hand and the seal of the WESTERN INSURANCE COMPANY on this 1 ! tYi day of A -a�r�i , 2011 �y�� Secretary SEAL tugs _ • (Signed) By SEAL President twa (Signed) By sv Secretary STATE OF UTAH On this 6th day of December, 201 O, before me personally came DICK �TTMAN, PRESIDENT of the WESTERN INSURANCE COMPANY and ALICE A. MOLASKY ARMAN, SECRET 1��5 §id Company, with both of whom 1 am personally acquainted, who being by me severally duly sworn, said, [hgt a said D�I�C?K� L. ROTTMAN and ALICE A. MOLASKY ARMAN were respectively the PRESIDENT and tltpy�R ARY of `Yy"' WESTERN INSURANCE COMPANY, the corporation described in which executed the foregoing PoL�r Attomey, t�tach knew the seal of said corporation; that the seal affixed to said Power of Attomey was such�q �gra1`e seal, that i av���,'b a axed by orr�Qe��f. the Board of Directors of said corporation, and that they signed their namesip�6y like order a67P�IDENT and SEY"1t�1''ARY, respectively, of the Company. My Commission expires thg�t�. h April, 20 4� ±Y.1 �(�11``�►�s/� .._....__ .......... ....._..................`....., ,��� �YZ� PATRICIA A. LEt50N +� / 1 i8ry R«sry weu��smuw Rwutle �'�i�n�d) LA. `O�i'�_�+ --- -- NO PUb1iC s ,,,a..,.�,,.dd.,.,...,s�a.., 71� �` i...... ............................... y.....g.....: �t%n This Power of Attome is rant�e�h� d by authority of the following Resolutions adopted by the Board of Directors of the WESTERN INSURANCE COMPA� on December 6, 2010. RESOLVED, that in connection with the fidelity and surety insurance business pf the Company, all bonds, undertakings, contracts and other instruments relating to said business may be signed, executed, and acknowledged by person or entities appointed as Attomey(s) -in -Fact pursuant toa Power or Attomey issued in accordance with these resolutions. Said Powers) of Attomey for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman, or the President, or a Vice President, jointly with the Secretary, under their respective designations. The signature of such officers maybe engraved, printed or lithographed. The signature of each of the foregoing officers and the seal of the Company may be affixed by facsimile to any Power of Attomey or to any certificate relating thereto appointing Attomey(s) -in -Fact for purposes only of executing end attesting bonds and undertakings and other writings obligatory in the nature thereof, and ,unless subsequently revoked and subject [o any limitations set forth therein, any such Power of Attomey or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is validly attached. RESOLVED, that Attomey(s) -in -Fact shall have the power and authority, unless subsequently revoked end, in any case, subject to the terns and limitations of the Power of Attomey issued to them, to execute and deliver on behalf of the Company and to attach the seal of the Company to any and all bonds and undertakings, and other writings obligatory in the nature thereof, and any such instrument executed by such Attomey(s) -in -Fact shall be as binding upon the Company as if signed by an Executive OfFicer and sealed and attested to by the Secretary of the Company. 1 ALICE A. MOLASKY ARMAN, Secretary of the WESTERN INSURANCE COMPANY, do hereby certify that the foregoing is a true excerpt fromthe Resolution of the said Company as adopted by its Board of Directors on December 6, 2010 end that this resolution is in full force effect. (, the undersigned Secretary of the WESTERN INSURANCE COMPAN V do hereby certify that the foregoing Power of Attomey is in full force and effect and has not been revoked. In Testimony Vyhere9t; I have hereunto set my hand and the seal of the WESTERN INSURANCE COMPANY on this 1 ! tYi day of A -a�r�i , 2011 �y�� Secretary SEAL tugs Company Profile Company Profile Company Search Company Search Results Company Information Old Company Names Agent for Service Reference Information NAIL Group List Lines of Business Financial Statements PDF's Annual Statements Quarterly Statements CA Supplements Company Complaint Company Pertormance & Comparison Data Company Enforcement Action Composite Complaints Studies Additional Info Find A Company Representative In Your Area View Financial Disclaimer COMPANY PROFILE Company Information WESTERN INSURANCE COMPANY 9065 SOUTH 1300 EAST SALT LAKE CITY, UT 84094 Old Company Names back to top Agent For Service SARGE KLIMOW 11023 EUCALYPTUS STREET SUITE 104 RANCHO CUCAMONGA CA 91730 bacK to top Reference Information Effectiv¢ Dat¢ NAIC #: 10008 California Company ID #: 4750 -6 Date Authorized in California: 09/20/2002 License Status: UNLIMITED- NORMAL Company Type: Property &Casualty State of Domicile: UTAH back to top NAIC Group List NAIL Group #: 4641 D & ]Rottman Grp back to top Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. SURETY back to top © 2008 California Department of Insurance Page 1 of 1 http: // interactive. web. insurance. ca. gov /companyprofile /companyprofile ?event= companyPr... 4/ 14/201 1 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT LIST OF SUB- CONTRACTORS Section 4100 et. seq. of the Public Contract Code requires listing of all subcontractors with the bid for all subcontract work exceeding the following amount: - Streets, highways including bridge projects; 1/z% of the bid or $10,000, whichever is greater - Buildings, parks, or other projects: 1 /s% of the bid BIDDER proposes to subcontract certain portions of the work to the firms listed below: NAME �ja�� SDK -� C`�'�'si LOCATION �� � ���.� CJ's PHONE l�s 0 - �— L 6 0 TYPE OF WORK $ NAME C�1 -� Tt'O.J LOCATION Lq l�q�OC�! PHONE `")/ S%- So'!'S= �'�' TYPE OF WORK. !'1Rtsi�\ $ OT i�� NAME �..�tgs iTlAciCi�li�t� LOCATION �qia '�„^� +'p PHONE (�— �� -3 TYPE OF WORK � $ ' (ff6d'- NAME LOCATION _ PHONE TYPE OF WORK NAME LOCATION _ PHONE TYPE OF WORK NAME LOCATION _ PHONE TYPE OF WORK NAME NAME LOCATION LOCATION _ PHONE PHONE TYPE OF WORK $ TYPE OF WORK NAME LOCATION PHONE T PE OF WORK $ ^�wri3� -t4�- (1�r��iR of F' S mitting Bid ignature of BIDDER NAME LOCATION _ PHONE TYPE OF WORK TO BE INCLUDED IN BID PACKAGE BP 3 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL 8r. CONTRACT AGREEMENT BIDDER'S STATEMENT BIDDER understands and agrees that this written proposal (or any part thereof specifically designated and accepted by the City of Santa Ana, hereinafter .AGENCY) shall constitute the entire agreement between BIDDER and the AGENCY only after it has been accepted by the City Council, endorsed by the Clerk of the Council with her signature and official seal noting hereon the action of approval of the Council, signed by the Public Works Agency Executive Director or his duly authorized agent, and signed by the City Attorney, denoting his approval of the form of this document, and its execution, and when it or an exact copy of it has been either delivered to BIDDER or deposited with the United States Postal Service properly addressed to the BIDDER with the correct postage affixed thereto. BIDDER further agrees that upon delivery (as defined above) of the accepted agreement he /she will furnish AGENCY all required bonds and certificate of liability insurance within ten (10) days (excluding Saturdays, .Sundays and AGENCY'S legal holidays), or the funds, check, draft, or BIDDERS bond substituted in lieu thereof accompanying this proposal shall become the property of the AGENCY and shall be considered as payment of damages due to the delay and other causes suffered by AGENCY because of the failure to furnish the necessary bonds and because it is distinctly agreed that the proof of damages actually suffered is difficult to ascertain.; otherwise said funds, check, drafts, or BIDDER'S bond substituted in lieu thereof shall be returned to the undersigned. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the bid schedule are solely for the purpose of comparing bids, and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. All terms contained in the Specifications, the Certification of Non - Discrimination by Contractors, and the Workers' Compensation Insurance Certificate are to be incorporated by reference into this Agreement and are made specifically as part of this bid. \ - Name of Firm �] � J�j A�VL/L� C�a�V �C�'�C�j1 Signature of BIDDER Title ©�� N +�iZ� V �iy�i ✓: cQ �-t�` (if an individual, so state) TO BE INCLUDED IN BID PACKAGE BP 4 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT continued (If a firm or co- partnership, state the firm name and give the names of all individual co- partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) Awarded tO��tirvf,,, ���„ f�r�_ ACTION OF COUNCII.: on the basis of t responsible and regponsjye bidder in the amount of s // 3 , l �'�/ � '� � �.� ^Date [;1L Q� 20 �� APPROVED AS TO FORM: _� r ` �— - - � ACCEPTED FOR THE CITY OF SANTA ANA: r EXECUTIVE D TOR PUBLIC WORKS GENCY _ ����) TO BE INCLUDED iN BID PACKAGE CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT (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 �) �i /�ff�i T a.-t iL � t✓C��1 �4C� .S , 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, 1 1114, or 1 1246, 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 Com**�+ttee 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 $1 0,000 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. TO BE INCLUDED IN BID PACKAGE BP 6 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT 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 1 1246. of September 24, 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. TO BE INCLUDED IN BID PACKAGE BP 7 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT 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 bject� all th�n 'es i posed for a violation of the Chapter. Signed Title � C.,.S/�(� t %L— Firm S J 6S ,�- /e9�/!� (� -'�c Date y�l! TO BE INCLUDED IN BID PACKAGE BP 8 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT WORKERS' COMPENSATION INSURANCE CERTIFICATION As required by Califonia Labor Code Section 1860 and 1861, the Contractor certifies as follows: I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for worker's compensation or to undertake self- insurance in accordance with the provisions of the Code, and I will comply with such provisions before commencing the performance of the work of this contract. If I, as the Contractor, now or at any time during the course of this agreement, qualify as an employer under California Labor Code Section 3300, unless the hired empioyee(s) is (are) persons excluded by said Labor Code, I shall furnish the City of Santa Ana with an insurance certificate from my workers' compensation insurance carrier certifying that I carry such insurance and that the policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior written notice to the City of Santa Ana. Signed � � �.�� Title � s/S �i�- Firm �"�� CQu (}1C ��� Date � — � l _ l TO BE INCLUDED IN BID PACKAGE BP 9 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL. PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT The following are the names, addresses, and telephone numbers for three public agencies for which BIDDER has performed similar work within the past two years. Name d Addr s of Owner. Name and Tele hone Number of rson f liar with project. macs d6� c` �.s- ���.�,.i �- �� Contract Amount Type of Work Date Completed Name and Address of owner. ��—�- ./�u� �'S/C— 5.33 — Z yJZ� Name and Telephon umber of person familiar with project. Contract Amount Type of Work Date Completed Name a�itl Address of owner. Name and Telephorie Number of person familiar with project. ,�,��, S<3,6�d '11�9c:a�a — l�.c�.c,.�� /a— � d Contract Amount Type of Work .Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. i �i� for �P ��.1� .� .� � (�. S S ► w �T , e� CJ� 1�c�.s�'� � � � �eSl — 7 dU� TO BE INCLUDED IN BID PACKAGE BP 10 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING APPRENTICESHIP REQUIREMENTS The undersigned BIDDER is familiar with the requirements of Section 1777.5 of the State Labor Code regarding employment of apprentices, and understands that contractors on contracts exceeding $30,000 or 20 working days shall: 1. Apply to the joint apprenticeship committee administering the apprenticeship standards of the craft or trade in the area of the site of the public work for a certificate approving the contractor under the apprenticeship standards for the employment and training of apprentices in the area or industry affected. 2. Employ the number of apprentices or the ratio of apprentices to journeymen stipulated in the apprenticeship standards. 3. Contribute to the fund or funds in each craft or trade in which he /she employs journeymen or apprentices on the public work, in the same amount or upon the same basis and in the same manner as the other contractors, except contractors not signatory to the trust agreement shall pay a like amount to - the Californiaenticeship Council. Signed �� �� Title �� Firm ��� /�/?� �.5�� Date �- Cl _ `� TO BE INCLUDED IN BID PACKAGE BP 1 1 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT NON - COLLUSION AFFIDAVIT (Title 23 United States Code Section 1 12 and Public Contract Code Section 7106) To the CITY OF SANTA ANA 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 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 Non - collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non - collusion Affidavit. BIDDERS are caution hat � ng a false certification may subject the certifier to criminal prosecution. Signed State of California County of C�..s,��� Subscribed and sworn to (or affirmed) before me on this day of 20_, by proved to me on the basis of satisfactory evidence to be the persons) who appeared before me. Notary Public Signature Notary Public Seal TO BE INCLUDED IN BID PACKAGE BP 12 of 29 ACKNOWLEDGMENT State of California County of Orange ) On April 12, 201 1 before me, Peter Austin Neff, Notary Public (insert name and title of the officer) personally appeared Louis T. Gabriel who proved to me on the basis of satisfactory evidence to be the person() whose name() is /appec subscribed to the within instrument and acknowledged to me that he%� executed the same in hisbtrer#ln�ic authorized capacity(i��, and that by his /iaoex/�btetix signatures) on the instrument the person(), or the entity upon behalf of which the person(�j acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m hand and official seal. cm PETER COMM. * 179 NEFF y � COMM. � 7799389 � tXnAW KE C Fa 4? N ORANO UNTY MY Coarn LVM W1Y 71, 2072 Signature (Seal) CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING "ANTI- KICKBACK" REOUII2EMENTS The undersigned is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the Copeland "Anti- Kickback" Act (18 USC 74) as supplemented in the Department of Labor regulations (29 CFR, Part 3). This act provides that each contractor or subcontractor shall be prohibited from inducing, by any means, any person employed in the construction or repair of public work, to give up any part of the compensation to which he /she is otherwise entitled. Signed � �. � ��' Title �. W.i-t -��` i Firm S� /j �� /�l`�`� -�Q� �Q.j�tj��11�.� Date 7� — L TO BE INCLUDED IN BID PACKAGE BP 13 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT CONTRACTOR'S LICENSING STATEMENT The undersigned contractor, or corporate officer, declares under penalty of perjury that the following is true and correct. � _ ��.,� Contractor's Name: � J �j �(��l1�_ �.�p.�v' ��L 7 Business Address: ��{ `�-,��� C (� y „� V�IA��4� �� � 3 �• �/� �a� Z C Telephone: ��Jr r `�6 �� ��� %' State Contractor's License No. and w ��� Class: V Expiration � � f Date: Signed: � � �% Title: Q �3N��_ TO BE INCLUDED IN BID PACKAGE BP 14 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNTAI .PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT CLAUSES SECTION 3 - CONTRACT CLAUSES A. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD - assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low- and very low- income persons, particularly persons who are recipients of HUD assistance for housing. B. The parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the part 135 regulations. C. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the contractor's comm;tments under __ this Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the persons) taking applications for each of the positions; and the anticipated date the work shall begin. D. - The contractor agrees to include the Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this Section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR Part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge of that the subcontractor has been found in violation of the regulations in 24 CFR Part 135. TO BE INCLUDED IN BID PACKAGE BP 1 S of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT SECTION 3 - CONTRACT CLAUSE continued E. The Contractor will certify that any vacant employment positions, including training positions, that are filled (1) after. the contractor is selected, but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR Part 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CRR Part 135. F. Noncompliance with HUD's regulations in 24 CFR part 35 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. G. With respect to work performed in connection with Section 3 covered Indian housing assistance, Section (7) b of the Indian Self - Determination and Education Assistance Act (25 U.S.C. 450e) also applies to the work to be performed under this contract. Section 7(b) requires that to the greatest extent feasible (I) preference and opportunities for training and employment subcontracts shall be given to Indians, and (ii) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises. Parties to this contract that are subject to the provisions of Section 3 and Section 7 (b) agree to __ comply with Section 3 to the maximum extent feasible, but not in derogation of compliance with Section 7(b). For the purpose of training and employment the primary Section 3 covered project area is the area in closest proximity to the actual construction work site within the U.S. Census Tract in which the project is located. It is understood that priority for employment opportunity is to be given to residents residing within the primary Section 3 area as defined. A Section 3 area resident is any lower income individual residing within the Section 3 area, whose total family income does not exceed 80% of the median income of the metropolitan statistical area in which the project is located (Orange County). A public housing resident is defined by regulations as Section 3 resident, regardless of income. The contractor and each subcontractor certifies that they will provide, to the greatest extent feasible, opportunities for employment to lower income residents (local residents) and job opportunities in connection with projects in their neighborhoods. For fiscal year 1996 -97, minimum goal for each project is 30 %. TO BE INCLUDED IN BID PACKAGE BP 16 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT SECTION 3 - CONTRACT CLAUSE continued The Contractor /Sub- contractor /Service Provider by the signature affixed hereto declares under penalty of perjury: Contractor /Sub - contractor /Service Provider has read Section 3 requirements and accepts all its requirements contained therein for all of his/her operations within the City of Santa Ana. S' nature' Signature Signature Lcsu�� � �L�� Print Name and Title Print Name and Title Print Name and Title Date TO BE INCLUDED IN BID PACKAGE BP 17 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT FEDERAL REQUIREMENTS FOR FEDERAL -AID CONSTRUCTION PROJECTS GIIV�2AL —The wait hs�r plaposcd wffi be fmaned irr while Q ar pat wtitt Fedaal fiIItds, and Thaefae aIl of the sus, rules ad tegtilatiorts pornilgated by the Feda-al Govarattalt and applicable b wodc fmaroed ur wlnle Q in pat with Federal fiterlt wiII apply b such wQic. The `Y2aclraed Cotrt-xxpkovi�ts, Fedaal- Aid Corsontclierr Canocac7s, `i" (Iirr FHWA 1273, ate included irr this Battier 14. Wher>eva in said mgtmad crnn-acx povisims ma�a>ees ate made � `SIIA Cor�-acting offioa;" "SE3A teeaiidaY enguria'" Q • altt®ad tell -eti� cff ttte SHA," such tefaertoes shaIl be mrt�trad � meat `Fi>gjrteez" as defined in Section 1 -1.18 oftlre Stallard Speci6c�tiats OF PREVIOiJ6 COI�TIRACT - In addman � the ptwivots in Sactirn II, "Norrdi�aimration." and Sacticn VII, "- a+,�:•,.g Q Assgvrtg the Correct;' c�'the raquaed mt�-acx povisiars, the Carlrtacoor shaII oQnply wuh lire fnIIowing i •�•'•• ra • • •• •• u•a.�r �•••I• -r•c•c c• • =i -•.r .�•.�v -r�• Iv�- •7' I • ter, a•`�• . •• - - .r a• • ^`i -`•. •••v• � •••. ru - ••i✓.0 - u.l •• .rt a •c• •• .rt • .•a • -r• •a •. • crti Title 23, Un�.d Slaw Code, Secnon 112, tagtaes aS a eordmnsr pemdat liD apptorval by the Fadaal Ffighw•ay Ad<rarrisa-� of the mrr-act f� flris w�odc � each BIDDER fle a swcan sr�tra* exeared by, Q on belralfe� the pasorr, ftan, assocaatirn, ar oapaatian b whom sudr c�aact is to be a�vadtd, oelfidying that such paean, fiat,, a�ociatiat, Q cap�ation has not, eidra d'¢adly Q utduecdy, � m6o cry a paticipe�d in cry ca1>u5irn Q otlrawi� halarn cry acuortintestiamtaf& eeeompbiddmginootaractionwilhthesittrtit8�dbid. A ftIItr m trHl� the tron- oo>l�otr afirkdvu �nar tagtt6ad by Section 112 as a oatifraiorr urda patchy ofpeijtiy ratlra that as a swtan St�i77aY as parrumad by 28, USC, Sec 1746, is irtc�.rded in theptaposal PARTICIPATION BY D16ADVANI'A® Bid II�i•IERPRISES IN SUBOOI�TI'RACI7L�iG- Pact 26, Title 49, Code ofFeda-al �PP� m � Federalsdd project. Patutent sa�otts of said Code ae urootpaaB-�d in patorin its etritety wdtrQr aura sactiarsofthere spacial povi9Qs Af>rdanalt I•S�l�A -b3t1 8-07A7 (This form need not be filled in if all joint venture firms ate minority owned J 1. Name of joint venture 2. Address of join venture 3. Phone number of joint venture 4. Identify the firms which cottrprise the joint venture. (The DBE partrrer must complete Schedule A) a Describe the role of the DBE firm in this joint venture. b. Describe very briefly the experience and :+»�irtPCC qualifications of each non -VIBE joint venhme: 5. Nahne of the joint ventrtre's business 6- Provide a copy of the joint venture agreement 7. Whaz is tbe claimed percentage of DBE ownership? 8. Ownership of joint venture: (This need not be filled in if described in the joint venture agreettrent, provided by question (6). a Profit and loss sharing b. Capital contributions, including equipment c. Other applicable OWIleP5171p 1nteIeSiS TO BE INCLUDED IN BID PACKAGE BP 18 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT 9. Comol of and peroac in this c�acz ]derrify by araR>e, lace, sex, and `Yani' those individuals (and they tides) who ace aespocstble Lor day�rday and policy dacison mal�cg, i�luding. b� nat lirrci�d �, those wtlh prirrcetesporsibility far. a Finartcaal decisiocs Name ofFarn Name ofFam b. Marragecrcer8decisiocs, suc$r as: Name 1. F�+:r.ctl;no c 2 Maiceling and sales 3- � and � �� 4. i?iadrascrg ofmajor mars or supplies c S�tpavcsocroffieldopa-ahors Nom: � sties fling this Sd,erh dP B and before the mmple6ono�Fthe joint. verchae's vwrk an the oor>tractcovaed by this regulaborc, drae is any sigr>'dr�a drange in the inforrr»t sibmit�d, the jot tae rust infocrn the gcarnee, eulra daectly Q thcwglr the pcirrce oo�-acoor ifthe joint �mae is a sccboormac�or. `Tire tmdasigrced swear that the foregoing shdanats ace coaect and inc�tde aD mat®al iccfuncatiou cry to idaffiy and explaQr the tans and operation of otr join ventue acd the intended P b'Y eadr joint v� in the �,.,.tP.,st<;n�, Fuctt� the ta�dasgned acd agme m provide m mot, « and aoaa-� u£arr�n receding acutal join vennae w�ic acd the paycrieatttliaefrae and acry proposed � in acry of the joat vamae arrerts and m paatit the audit and ezaam�aSoac of the books, reoorciq and Sles of the joint vettuce, by autlrolimd repesataaves of the gartee or the Federal funding �-7'• �Y rrca�al will be gcaatds far �rrtmamrtg any whiclt may be awmded and for irrir:zn;n� action LmdetFedaal or Sra� laws ooctoarrircg false s °, at�tr FSd>�A -FR2 8�Or7A7 Title _�.� �. Name On dcis day of 20 before me appeacad (rce<rce; m me pasoraally lmown, who, being duly swum, did eacect>oe the focegoszcg affidavit acd did sm�ue that he or she was pm�perly audrQized by (Name of Sari to execs the atSdavit and did so as his or her flee act acd deed. Nosy R>blic Con>�an expo [S�] Dam SYa�� COY � Qrc this _ day of 20 before me appeared (Name) to me pasorrally larown, who being sw+urt, did execcme ttre finegoucg at£davit and did starve that he Q she was pcopady acttto<iaed by (Name of fan% to exea� the afidavitard did so as his or ha flee act acd deed Notay Public Cnnartission expires [�� TO BE INCLUDED IN BID PACKAGE BP 19 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 DEBARMENT AND SUSPENSION CERTIFICATION The BIDDER under penalty of perjury, certifies that except as noted below, he /she or any person associated therewith in the capacity of owner, partner, director, officer, manager: is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; has not suspended, debarred, voluntarily excluded, or determined ineligible by any federal agency within past three years; 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 determ;n;ng BIDDERS responsibility. For any exception noted above, indicate below to whom it applies, initialing agency, and dates of action. Note: 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. — Name of BIDDER Signature of BIDDER w`� Date � FED.8 -22 -88 TO BE INCLUDED IN BID PACKAGE BP 20 of 29 -- Exhibit 15 -G1 Local Agency Bidder UDBE Commitment (Construction Contracts) N(7TE: PT RFFFR T(7 iNSTRi7CTinNS nN T)=TF REVERSE SIDE (7F THiS FORM \,FASFp GENCY: �)d E1 VT �Ars� �/��! LOCATION: �CA�K�Zt— e- V"'�"ie� ROJECT DESCRIPTION: PROJECT NO. 10- PARK REST1200M ROOF REPLACEMENT /7558�CENTENlNIIP.L OTAL CONTRACT AMOUNT: $ ! /J' �w ID DATE: �– l�' I� - IDDER'S NAME: J 1 SN.1J9V e-r/[.�' ONTRACT UDBE GOAL:' � /�7L ONTRACT ITEM NO. EM OF WORK AND DESCRIPTION R SERVICES TO BE No. of UDBE D EXPIRATION AME OF UDBEs Must be certified on the date bids LLAR AMOUNT DBE UBCONTRACTED OR MATERIALS ATE opened - include UDBE addtcss O BE PROVIDED d hone number ..� - ai _ / / rd+<sd � o ctr L — - or Local Agency to Complete: al Agency Contract Number: Total Claimed Participation ederal Aid Project Number: ederal Share: ontract Award Date: al Agency certifies that all information is complete and accurate. 'n[ Name Signature: Date ignamre of Bidder al Agency Representative Area Code Tele hone Number: � L ���G / ��� ���_' ��� Date (Area Code) Tel. No. or Caltrans Review: Print Name Signature Date Caltrans District Local Assistance Engineer Local Agency Bidder -UDBE Commitment (Rev 3/09) - Liau��uuaiii: �i/ �.upy — raz or scan a copy [O me t- ;alvans lll5[rtC[ lACal As515tareee Crlg[neer (IJL.Ab) Wlmin 11 OayS or award. t'allure to send a copy to the DLAE within 15 days of award rosy result in de- obligation of funds for this project. (2) Copy -- Include in award package to Caltrans District Local Assistance (3) Original –Local agency files TO BE INCLUDED IN BID PACKAGE BP 21 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT NONLOBBYING CERTIFICATION FOR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, 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 influence or attempting to influence 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 appropriate 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 sub,}ect 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 or her bid or proposal that he or 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. �� C /� B DER's Signature L Firm �� -�r Date • Standard Form LLL may be obtained from Calvans and FHWA offices TO BE INCLUDED IN BID PACKAGE BP 22 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT DISCLOSURE OF LOBBYING ACTIYITIE.S Complete thin fnrm in rtiaclnae lnhhvino aMiviNec .� r.r rr• Z t i T C !` l'i CO 1. Type of Federal Action 2. Status of Federal Action 3. Report Type: � a_ Contract � a. Bid/offer /application 0 a. initial b. Grant b. initial award b. material change c. Corporate Agreement c, post -award d. Ban For Material Change only: e. Loan Guarantee Year y„�rt,� f. Loan Insurance date of last re _ 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Q Prime � Subwardce Tier , Iflalown Con Tonal District, i /otolvrl Con 'opal District, i lotown 6. Federal Department/Agency: 7. Federal Program Name /Description CFDA Number, If livable 8. Federal Action Number, 1f'IOlOTNIt 9. Award Amount, if/ozown a. Name and Address of Lobbying Entity b. Individual Performing Services (uicbtding addr+"cr�differaufiarnNo. T�rd�.d'� �TYrlC7t�,J69,MI) IQa) (1a�+i�. fvszr�ti� 11�1I) attach Continuation Sheets) if neces ) 11. Amount of Payment (check all that apply): l 3. Type of Payment (check all that apply) $ Q Actual � Planned � a. retainer � b. one -time fee � c. commission 12. Form of Payment (check all that apply): a- cash Q d. contingent fee b. in -kind; specify: nattse Q e. deferred value Q f. other, 14. Brief Description of Services Performed or to be performed and Dates) of Service, including officer(s), employee(s), or members) contacted, for Payment indicated in item 1 L• (attach Continuation Shee s) i cessa ) 15. Continuation Shee s attached: Yes No 16. Lduniationnad thiougli this foan is aalio<iadbylitie 31 USC Section 1352 Tlrisdivclau= eoflobbymga�vitiesisarr�lione £factupon Signature whichreliarlce was placedby the Zia above whal the he�aaroit was madeorer�ied into. Thisdisclos:eistecgmedr.��*m31 U.S.C.1352 Thsiirtoarradonwlllbe Print Name n;xitdd to the Congas sar>ia�xraIly atld wl-Il be available forpublic u>Spection. Anypasonwilofalsk�flethexeqt maddisclnA: eshaIIbesti�jacxtioacavilpataltye�f' Title not less than $IQOOOard rtotmore Iliarl $100;000 fiaeac}i S»Ch falli:e. Tel hone No. Date Feda'al Use �Y• AutlTOiiaed fa Local Reptoducuon Standeid Foiin —I1d. TO BE INCLUDED IN BID PACKAGE BP 23 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING REQUIRED FEDERAL CONTRACT PROVISIONS CForm FHWA -1273) The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the required Federal Contract Provision (Form FHWA -1273) as shown in the appendix of the specii�proy�isions of this project. w Signed /� ( r Title �� Vw`'�- Firm � ! �S i✓� /� �F7�.S�� Date �— < TO BE INCLUDED IN BID PACKAGE BP 24 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION FOR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, 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 an Federal contract, grant, loan, or cooperative agreement. (2) If any funds other 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 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 malting 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 or her proposal that he or 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 c�fyQand disclose accordingly. �� r'v- B R Signature Firm l/� !/ Date TO BE INCLUDED IN BID PACKAGE BP 25 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT BIDDER'S CERTIFICATE OF COMPLIANCE REGARDING "BUY AMERICA" REQUIREMENTS FOR STEEL OR MANUFACTURED PRODUCTS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the "Buy America" requirements of Section 165 of the Surface Transportation Assistance Act of�1982Q and as shown in the special provisions of this project. Signed (� �� � /w" Title ��.al,�'�. Firm ,l� S N�a -a..�� Date �— (� TO BE INCLUDED IN BID PACKAGE BP 26 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the BIDDER hereby declares under penalty of perjury under the laws of the State of California that the BIDDER has _ ,has not been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1 100, including the Regents of the University of California or the Trustees of the California State University. The term "BIDDER" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The BIDDER must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed � �` Title Firm � i � �/ya� Date � L � '- L TO BE INCLUDED IN BID PACKAGE BP 27 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10162 OUESTIONAIRE In conformance with Public Contract Code Section 10162, the BIDDER shall complete, under penalty of perjury, the following questionnaire: Has the BIDDER, any officer of the BIDDER, or any employee of the BIDDER who has a proprietary interest in the BIDDER, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation? - Yes No /�' If the answer is yes, explain the circumstances in the following space. TO BE INCLUDED IN BID PACKAGE BP 28 of 29 CITY OF SANTA ANA PROJECT NO. 10 -7558 CENTENNIAL PARK RESTROOM ROOF REPLACEMENT PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10232 STATEMENT In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor to comply with an order of the National Labor Relations Board. Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed � �� � �-^-' Title V � t�� -�C�_ ^ Firm � i� ,.r��� -ate �r�-� Date �— L� — � TO BE INCLUDED IN BID PACKAGE BP 29 of 29