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HomeMy WebLinkAboutBEN'S ASPHALT, INC. (2)Clerk of the Council, City of Santa Ana 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 Recorded in Official Records, Orange County Tom Daly, Clerk-Recorder IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiIIIIIIIIIIIIIIIIIIIIIIINO FEE + I R 0 0 0 4 8 2 7 8 5 9 I. 2012000290787 9:22 am 05/22/12 62 417 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 zSrr I.. 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 SANTA ANA ZOO WALKWAY IMPROVEMENTS under contract entered °w into on MARCH 5, 2012, with BEN'S ASPHALT INC., on which contract FIDELITY AND o DEPOSIT COMPANY OF MARYLAND 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 U C described as Project No. 12-2621 located at: SANTA ANA ZOO. The work improvement on M F said property was accepted as completed on MAY 15, 2012. Fz o? Z p CITY SANTA A MUNICIPAL CORPORATION 0 m c7 Dated: 5121 A City Engineer W - W E TITLE V Z a VERIFICATION a 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 ? (2 7i at Santa Ana, California (Signature of individual swearing that the contents of Notice of Completion are true.) i THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN (10) DAYS AFTER COMPLETION REQUEST FOR w' COUNCIL ACTION CITY COUNCIL MEETING DATE: CLERK OF COUNCIL USE ONLY: MARCH 5, 2012 TITLE: APPROVED 3 CONTRACT AWARD FOR SANTA ANA 0? "As Recommended CA36 ZOO WALKWAY IMPROVEMENTS ? As Amended PROJECT NO. 122621 ? Ordinance on 15t Reading ) ? Ordinance on 2nd Reading ? Implementing Resolution ? Set Public Hearing For CONTINUED TO FILE NUMBER CITY MANAGER RECOMMENDED ACTION 1. Award a contract to Ben's Asphalt, Inc., the lowest responsible bidder, in accordance with unit bid prices for the base bid plus alternate one in the estimated amount of $62,675 for construction of the Santa Ana Zoo walkway improvements. 2. Approve a funding analysis with a total estimated construction cost of $75,000. DISCUSSION In September 2011, the Friends of Santa Ana Zoo received a donation of $75,000 from the McBeth Foundation to refurbish the asphalt and decomposed granite walkways and service roads throughout the Santa Ana Zoo at Prentice Park (Exhibit 1). The walkways and service roads have been maintained over the past 20 years with temporary patches and fixes. Replacement or permanent repairs are needed to provide safe access to the zoo for the public and staff. This project provides for the reconstruction of the walkways and service road. The Notice Inviting Bids was advertised on January 18 and 19, 2012, with outreach efforts to 17 Santa Ana contractors. Bids were opened on February 7, 2012. A summary of the bid notices and the bid results follows: Contractors requesting bid documents: 32 Santa Ana contractors sent bid notices: 17 Total bids received: 10 Bids received from Santa Ana contractors: 2 Contract Award for Santa Ana Zoo Walkway Improvements March 5, 2012 Page 2 NAME OF RESPONSIVE BIDDER CITY BASE BID AMOUNT 1. Ben's Asphalt, Inc. Santa Ana $62,675 2 Excel Paving Company Long Beach $66,693 3. Newcon Development Santa Ana $73,800 4. Green Giant Landscape, Inc. La Habra $74,800 5. Super Technical, Inc. Anaheim $75,388 6. Oliver Mahon Asphalt, Inc. Costa Mesa $79,780 7. Century Paving, Inc. La Mirada $82,210 8. Ted Enterprises San Clemente $85,610 The engineer's estimate was $57,000. A total of 10 bids were received with eight being responsive. Ruiz Engineering, Inc. and EBS General Engineering submitted incomplete bids that were deemed nonresponsive. The bid documents require the contractor be selected by the lowest base bid. The lowest bid was submitted by Ben's Asphalt, Inc. in the amount of $62,175. Therefore, staff recommends awarding base bid plus alternate one in the total amount of $62,675. ENVIRONMENTAL IMPACT Environmental Review #ER-2012-02 is completed and a Negative Declaration is filed pursuant to the California Environmental Quality Act. FISCAL IMPACT The funding analysis shows a total estimated construction cost of $75,000 for the project (Exhibit 2). Funds are available in the State Contract Services Fund (accounting unit 02213200- 62300). APPROVED AS TO FUNDS AND ACCOUNTS: Raul Godinez II Francisco Gutierrez Executive Director Executive Director Public Works Agency Finance & Management Services Agency V "-t n Gerardo Mouet Executive Director Parks, Recreation, and Community Services Agency RG/ET Exhibits: 1. Project Location Map 2. Funding Analysis FIRST STREET 0 C::3 P 0 O ~ 0 X92 O O '9 U) o 0 0 0~ J O I SANTA ANA ZOO O CHESTNUT AV Ln n D mm z fn EXHIBIT 1 SANTA ANA TITLE: CIE! DCOUNCIL A DATE: CONTRACT AWARD FOR f 1 LWA AGENDA DATE: March s, 2012 SANTA ANA ZOO AC WALKWAY IMPROVEMENTS ~.[..~..tr (PROJECT 12-2621) Exhibit 2 FUNDING ANALYSIS PROJECT NO. 122621 SANTA ANA ZOO WALKWAY IMPROVEMENTS Construction Contract $62,675 Contract Administration $1,000 Inspection and Testing $2,800 Survey Staking $1,000 Contingencies $7,525 TOTAL ESTIMATED CONSTRUCTION COSTS 75 000 THE REGISTER This space for filing stamp only 625 N GRAND AVE, SANTA ANA, CA 92701 Telephone (714) 796-7000 / Fax (714) 796-6059 CNS#: 2243661 NOTICE INVITING BIDS phone (7141 647-5680._ The Plans end pacification are NOTICE IS HEREBY GIVEN now available in portable that the City of Santa Ana, document format (PDF) on a California will receive at the compact disk (CD) only. City Hall-Ross Annex, (M- There is no charge for the 43), 20 Civic Center Plaza, Plans and Specifications on Santa Ana, California 92701, Co. To request a CD by mail, the Public Works A enc the Contractor must submit Fourt oor ec t on st, an email request to on or be ore the hour o 2:00 sarmour®santa-ana.org and PROOF OF PUBLICATION saalon February 2012 provide the following scaled tads and/or proposals information: Company name, for mailing address, phone number, FedEx account, and PROJECT 12-2621 email Subject heading: CD (2015.5 C.C.P.) SANTA ANA ZOO Request for PROJECT 12- WALKWAY 2621 SANTA ANA ZOO IMPROVEMENTS WALKWAY State of California ) IMPROVEMENTS. Checks Notice is hereby given are no longer accepted. Any County of ORANGE ) SS BIDDERS that in accordance addenda will be issued by with the provisions of the email to those who received California Labor Code, not CDs directly from the Public Notice Type: BID - NOTICE INVITING BIDS less h n t wares evailrate ingeach Works Agency. for of per craft or type of worker and DO NOT CALL mechanic needed to execute PURCHASING DIVISION the contract in the locality in REGARDING Ad Description: which the work is to be AVAILABILITY OF PLANS perf ormed, and not less than AND SPECIFICATIONS. Santa Ana Zoo Walkway Imprv the general prevailing rate of 1/18,1/19/12 per diem wages for holiday CNS-2243661# and overtime work as THE REGISTER determined by the Director of Industrial Relations of the State of California shall be I am a citizen of the United States and a resident of the State of California; I am paid to all workers employed. over the age of eighteen years, and not a party to or interested in the above Each bid shall be entitled matter. I am the principal clerk of the printer and publisher of the THE accompanied by cash, a REGISTER, a newspaper published in the English language in the city p of payaya ablle e or certified check to the City of Santa SANTA ANA, county of ORANGE, and adjudged a newspaper of general Ana, or bid bond issued by a corporate surety, for an circulation as defined by the laws of the State of California by the Superior amount not less than ten Court of the County of ORANGE, State of California, under date 11/19/1905, percent (10i) of the of as Case No. A21046. That the notice, of which the annexed is a printed copy, has guarantee that aggregate guarantee the the bid, D a BIDDER been published in each regular and entire issue of said newspaper and not in will treanter if tot the sproposed con any supplement thereof on the following dates, to-wit: awarded to him. The signature of the BIDDER on the bid bond MUST be notarized. The City Council reserves the right to reject any or all bids. The successful BIDDER must possess or obtain a valid California Class A or C12 Contractor's license 01/18/2012, 01/19/2012 prior to the scheduled award date of this contract. Substitution of securities for Executed on: 01/19/2012 any monies withheld by the City of Santa Ana to ensure At SANTA ANA, California performance is allowed in accordance with the Public Contract Code. I certify (or declare) under penalty of perjury that the foregoing is true and correct. ~~ppm__ppgI t?g__ tr m t of the Decifications will be furnished upon application to the Public Works A gy counter . First Floor 20 ivi Center Plaza, Santa Ana California 92701. Sig lure I IIIIIII IIII VIII VIII I IIII VIII VIII III VIII II VIII IIII IIII * A 0 0 09 0 1 4 9 4 5 { ! t"' FS A 1 _ BID ASPHALT, INC. MAINTENANCE DIVISION 2200 S. Yale Street Tel: 714-540-1700 Santa Ana CA 92704 Fax: 714-540-1 709 SEALED BID FOR: Project 12-2621 *Santa Ana Zoo Walkway Improvements In the city of Santa Ana *Do not open with regular mail* CITY OF SANTA ANA ADDENDUM NO. TWO PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS PROPOSAL & CONTRACT AGREEMENT BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: IN`s C~~IPNAL-C~ ~/VC. 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 (if any), specifications and special provisions, for the unit price(s) or lump sum(s) set forth in the following schedule: Item # Bid Item Unit Quantity Unit Price Amount 1. Unclassified Excavation * CY 5 $ $ ~J 2. AC Pavement * TN 240 $ ~J $ ~ol~, 3. Cold Mill Base Material* SF 25,000 $ $ ~CS, OOO~ 4. Dispose Excess Base Material * CY 40 $ LAO $ t 'Qs -b0 5. Root Shave LS 1 $ c~•,5co $ `a rj00 6. Decomposed Granite * TN 5 $ d '~)o $ CID 0 7. Adjust Sewer Manhole to Grade EA 3 $ $ q p0 8. Adjust Sewer Cleanout to Grade EA 3 $ I co 5a(J), 9. Adjust Water Meter to Grade EA 2 $ -i $ 3rzIc oa o• 10. Adjust Drain Grate to Grade EA 2 $ r.7 $ 11. Furnish & Install New Sewer Cleanout* EA 1 $ l 000 $ Q0~ 12. 1'x1' PCC footing for benches EA 12 $ -i cJ•~ $ TO BE INCLUDED IN BID PACKAGE BP I of 13 CITY OF SANTA ANA ADDENDUM NO. TWO PROJECT 12-2621: SANTA ANA ZOO WALKWAY IMPROVEMENTS PROPOSAL & CONTRACT AGREEMENT BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA 00 TOTAL BASE BID---------------------------------------------------------------------------- $ ADD ALTERNATE ONE: L 00 oe 12. Recycle Solid Plastic Lumber Edging LF 100 $ J $ (include steel stakes placed at 4' o.c.) * TOTAL ADD ALTERNATE ONE----------------------------------------------------- CJ ADD ALTERNATE TWO: a-5 13. Form Edge of AC Walkway LF 1,000 $ $ 450 TOTAL ADD ALTERNATE TWO----------------------------------------------------- $ S o The lowest responsible bidder shall be selected based on the TOTAL BASE BID for PROJECT 12- 2621, SANTA ANA ZOO WALKWAY IMPROVEMENTS. The City reserves the right to award the Base Bid and any, all, or none of the Add Alternate Bid items. * The quantity for this bid item is shown for bid comparison only. This bid item shall not be subject to the "25%" limit as stated in Section 3-2 of the Standard Specifications. The actual amount for this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. BIDDER PROJECT 12-2621 SANTA ANA ZOO WALKWAY Firm N ` ~~p 4{qL-( -co C. IMPROVEMENTS Address c~.~40 SovTf1 ~jAL.~ Phone `-1 p ` oo Fax 'c4 k L; Syc '4 cot Email BIDDER Signature TO BE INCLUDED IN BID PACKAGE BP2of13 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS 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; ''/z% of the bid or $10,000, whichever is greater - Buildings, parks, or other projects: ''/z% of the bid BIDDER proposes to subcontract certain portions of the work to the firms listed below: NAME rr' rIKS WF-9- pluml btvv V NAME LOCATION (a NA HAM LOCATION PHONE y _ ~y 3 00~ 3 PHONE TYPE OF WORK EwzL $ 1 U~- TYPE OF WORK $ NAME Qm.?-X(,o I ~ P a, So N$ NAME LOCATION (4ZQ c,,p LOCATION PHONE C ~'i - PHONE TYPE OF WORK TooT tE $ '3, ooh TYPE OF WORK $ 1= ooT'trti c,s NAME NAME LOCATION LOCATION PHONE PHONE TYPE OF WORK $ TYPE OF WORK $ NAME NAME LOCATION LOCATION PHONE PHONE TYPE OF WORK $ TYPE OF WORK $ NAME NAME LOCATION LOCATION PHONE PHONE TYPE OF WORK TYPE OF WORK $ vzvp-pNq~cl c.. Name of Firm,S mitting Bid Si ature TO BE INCLUDED IN BID PACKAGE BP3of13 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS PROPOSAL & 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 g 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. )6v= r Name of Firm Signature of BIDDER Title %.U (if an individual, so state) TO BE INCLUDED IN BID PACKAGE BP 4 of 13 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS 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.) WzL T.Rrn Sk~~~' NGTc~iJ C N CJ J -t. ) To IJ t~ a; t uQLT, mac_. ACTION OF COUNCIL: Awarded to on the basis of lowest responsib and responsive bidder in the amount of Date 20 ~o ATTEST: CLERK OF THE COUNQJL APPROVED AS TO FORM: ACCEPTED FOR THE CITY OF SANTA ANA: CITY ATTORNEY EX TIVE DIREC R PUBLIC WORKS AGE CY TO BE INCLUDED IN BID PACKAGE BP5of13 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS 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 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5. The Contractor shall furnish all infonnation 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 BP6of13 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS 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 i - U Firm -r&N (a ~QLT Date `a- TO BE INCLUDED IN BID PACKAGE BP7of13 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS PROPOSAL AND CONTRACT AGREEMENT WORKERS' COMPENSATION INSURANCE CERTIFICATION As required by California 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 1, 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 employee(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 \VK 6 ' . F. Firm 1 N~ll~ 71"C, c Date TO BE INCLUDED IN BID PACKAGE BP8of13 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS PROPOSAL AND CONTRACT AGREEMENT REFERENCES 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. 1. Z-- A Vac-NE D Name and Address of Owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed 2. Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed 3. Name and Address of owner. Name and Telephone Number of person familiar with project. 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. SV-- 7-- Q -tr(lc r n I CU 1 Q>E t 5o r-3 S ,y SU P'V~ NC£ Q c Eg , .Z~c ~Sc~o E ~p CANya?~ Q-D SvsrE I Ca-NC~NEZr~~ CA ~'~t41°lal~as"So ~acv~ gac- ao~~ TO BE INCLUDED IN BID PACKAGE BP9of13 ~ rl ASPHALT, INC. LICENSE # 668417 REFERENCE LIST City of Mission Viejo 949-470-3092 27204 La Paz Rd. Mission Viejo, CA 92692 Chris Robinson Annual Routine Maintenance in 2009-2010 for $262,000.00 City of Brea 714-990-7691 Number One Civic Center Circle Brea, CA 92621-5758 Jerry Mestas Annual Maintenance in 2009-2010 for $200,000.00 Innovative Technical Solutions 925-946-3100 2730 Shadelands Dr., Ste 100 Walnut Creek, CA 94598 Pave Perimeter Road US Air Force in 2009-2010 for $1,045,000.00 HBI, Inc. 949-851-2211 4921 Birch St., Ste. One Newport Beach, CA 92660 Bob Braido Trench patching at Various Wal-mart Locations in 2010 for $30,000.00 Santa Ana U.S.D. 714-558-5743 1601 E. Chestnut St. Santa Ana, CA 92701 Dave Woosley Patching at several school locations in 2008 for $325,000.00 in 2009 for $682,000.00 2200 S. Yale Street, Santa Ana, CA 92704 Phone 714-540-1700 fax 714-540-1709 ~n ASPHALT, INC. LICENSE # 668417 PUBLIC WORKS / CITY JOBS CITY JOB NAME City of Santa Ana V&5 1h St. Rehab 20 Civic Center Plaza Shelton St. Santa Ana, CA 92702 Fairview Str. Rehabilitation Edward Torres (714) 647-5018 Fairview/Edinger Ave. Intersection Widening Warner Ave. Improvements Warner Ave. Rehabilitation Westminster Ave. Widening City of Huntington Beach Warner/Newland Improvements 2000 Main St. Huntington Beach, ca 92648 Eric Charlonne (714) 536-5430 City of Anaheim Broadway Str. Improvements 200 S. Anaheim Blvd. Anaheim Blvd. Anaheim, CA 92805 La Palma Ave. Str. Improvements Mike Woods (714) 765-5176 La Palma Ave. Str. Rehab Magnolia Ave. City of Westminster Bushard Str. Improvements 8200 Westminster Blvd. Westminster, CA 92683 Kevin Sin (714) 898-3311 City of Tustin Tustin Ranch Rd. 300 Centennial Way Tustin, CA 92780 Benny Tenkean (714) 573-3161 City of Lynwood San Jose, Platt & Carlin 11330 Bullis Rd. Lynwood, CA 90262 Elias Saikaky (310) 603-0220 City of Placentia Placentia Ave. Rehabilitation 401 E. Chapman Ave. Placentia, CA 92870 Art Burgner (714) 993-8245 City of Garden Grove Garden Grove Str Rehab 11222 Acacia Parkway Garden Grove, CA 92842 (714) 741-5000 City of Corona 2002/2003 Pavement Rehab 730 Corporation Yard Way Corona, CA 92880 Scott Briggs (909) 736-2454 City of Mission Viejo Cabot Road Pavement Rehab 200 Civic Cneter Mission Viejo, CA 92692 (949) 470-3000 2200 S. Yale St., Santa Ana, CA 92704-4427 Phone (714) 540-1700 Fax (714) 540-1709 1 ASPHALT, INC. LICENSE # 668417 CITY JOB NAME City of La Puente Temple Ave. Reconstruction 15900 East Main St. Francisquito & Nelson Aves La Puente, CA 91744 (626) 855-1500 City of Newport Beach Monrovia Ave. 3300 Newport Blvd. Newport Heights Pavement Overlay P.O. Box 1768 Newport Beach, CA 92658-8915 (949)644-3311 City of Westminster Bushard & Magnolia Aves Civic Center 8200 Westminster Blvd. Westminster. CA 92683 (714) 898-3311 City of Villa Park Collins Ave./Wanda Rd. 17855 Santiago Blvd. Villa Park, CA 92861-4187 (714) 998-1500 City of Chino 2003-04 Str. Rehab 13220 Central Ave. Chino, CA 91710 (909) 464-8367 County of San Bernardino Various Roads - Chino Area Engineering Department 825 East Third St. San Bernardino, CA 92415-0835 (909) 387-8104 2200 S. Yale St., Santa Ana, CA 92704-4427 Phone (714) 540-1700 Fax (714) 540-1709 2 in rn ASPHALT, INC. LICENSE # 668417 CITY REFERENCE LIST City of Santa Ana City of Anaheim 1St & 5th Street/ Shelton Street Broadway Street Improvements 20 Civic Center Plaza 200 S. Anaheim Blvd. Santa Ana, CA 92702 Anaheim, CA 92805 Edward Torres (714) 647-5018 Mike Woods (714) 765-5176 City of La Puente City of Santa Ana Temple Ave. Reconstruction Shelton Street 15900 E. Main Street 200 Civic Center Plaza, La Puente, CA 91744 Santa Ana, CA 92702 Joe Boada (626) 855-1500 Edward Torres (714) 647-5018 City of Huntington Beach City of Santa Ana Warner/ Newland Improvements Fairview / Edinger Ave. Intersection Widing 2000 Main Street 20 Civic Center Plaza Huntington Beach, CA 92648 Santa Ana, CA 92702 Eric Charlonne (714) 536-5430 Ed Torres (714) 647-5018 City of Anaheim City of Placentia Anaheim Blvd. Placentia Ave Rehabilitation 200 S. Anaheim Blvd. 401 E. Chapman Avenue Anaheim, CA 92805 Placentia, CA 92870 Mike Woods (714) 765-5176 Art Burgner (714) 993-8245 City of Santa Ana City of Tustin Warner Avenue Improvements Tustin Ranch Road 200 Civic Center Drive 300 Centennial Way Santa Ana, CA 92702 Tustin, CA 92780 Ed Torres (714) 647-5018 Benny Tenkean (714) 573-3161 City of Westminster City of Anaheim Bushard Street Improvements La Palma Avenue Street Improvements 8200 Westminster Blvd. 200 S. Anaheim Blvd. Westminster, CA 92683 Anaheim, CA 92805 Kevin Sin (714) 898-3311 Daryl Lopez (714) 765-5126 City of Santa Ana City of Lynwood Fairview Street Rehabilitation San Jose, Platt & Carlin 20 Civic Center Plaza 11330 Bullis Road Santa Ana, CA 92702 Lynwood, CA 90262 Ed Torres (714) 647-5018 Elias Saikaly (310) 603-0220 2200 S. Yale Street, Santa Ana, CA 92704 Phone 714-540-1700 fax 714-540-1709 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS 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: I. 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 California Appre ticeship Council. Signed Title i . Firm N~ \Q1, V, Date a 13 TO BE INCLUDED IN BID PACKAGE BP 10 of 13 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS PROPOSAL AND CONTRACT AGREEMENT NON-COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 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 cautioned tha aking a false certification may subject the certifier to criminal prosecution. Signed State of Cali mia County of Subscribed and sworn to (or affirmed) before me on this fl\ day of Fe. lj 2011 by h in proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. TERI BRADEN Commission #t 1924994 Notary Public California orange County M Comm. Ex ires Feb 10, 2015 ry Public Signature Notary Public Seal TO BE INCLUDED IN BID PACKAGE BP 11 of 13 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING "ANTI-KICKBACK" REQUIREMENTS 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 Firm Date TO BE INCLUDED IN BID PACKAGE BP 12 of 13 CITY OF SANTA ANA PROJECT 12-2621 SANTA ANA ZOO WALKWAY IMPROVEMENTS 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: \bF I-) 1H ( L-T `t NC-. Business Address: 319-00 SdU -C M R B Telephone: ( q `-i 4bli 0 - ~ 140 0 State Contractor's License No. and Class: Expiration Date: Signed: Title: -O• TO BE INCLUDED IN BID PACKAGE BP 13 of 13 Jeremy Taylor From: Jeremy Taylor Sent: Tuesday, February 07, 2012 12:28 PM To: 'Ly, Mindy' Subject: RE: Zoo Walkway Improvements Addendum Mindy, I have received the addendums and this email serves as confirmation that I did receive them Jeremy Taylor Project Manager 2200 S. Yale Street Santa Ana, CA 92704 Tel: 714-540-1700 Mobile: 714-231-9487 Fax: 714-540-1709 Email: jeremy.taylorCa~bensasohalt.com (Check us out in the Orange County Register!) "Celebrating 50 Years of Service" From: Ly, Mindy rmailto:MLy(absanta-ana.orcal Sent: Monday, February 06, 2012 4:25 PM To: Jeremy Taylor Subject: Zoo Walkway Improvements Addendum Jeremy, Per request, attached are addenda one and two. Please reply to this email to confirm the receipt of the addenda. Mindy 1 MAYOR CITY MANAGER Miguel A. Pulido David N. Ream MAYOR PRO TEM CITY ATTORNEY Claudia C. Alvarez Joseph W. Fletcher COUNCILMEMBERS CLERK OF THE COUNCIL David Benavides Maria D. Huizar Carlos Bustamante Michele Martinez CITY OF SANTA ANA Vincent F. Sarmiento Sal Tinaiero PUBLIC WORKS AGENCY M-36 P.O. Box 1988 Santa Ana, California 92702 January 23, 2012 ADDENDUM No. ONE SUBJECT: PROJECT No. 12-2621: Santa Ana Zoo Walkway Improvements The following change has been made to specifications of the subject project: Specifications 1. Page iii, Notice Inviting Bids; Add the following paragraph to the Notice Inviting Bids: "There will be a PRE-BID JOB WALK at Santa Ana Zoo, 1801 E. Chestnut Avenue on Tuesday, January 31, 2012 at 10:00am." Note: the bid date shall remain the same. All other terms and conditions remain the same. FOR THE CITY OF SANTA ANA JAI Souri Amirani City Engineer a. AI MAYOR CITY MANAGER Miguel A. Pulido David N. Ream MAYOR PRO TEM CITY ATTORNEY Claudia C. Alvarez Joseph W. Fletcher COUNCILMEMBERS CLERK OF THE COUNCIL David Benavides Maria D. Huizar Carlos Bustamante Michele Martinez CITY OF SANTA ANA Vincent F. Sarmiento Sal Tinajero PUBLIC WORKS AGENCY M-36 P.O. Box 1988 Santa Ana, California 92702 February 2, 2012 ADDENDUM No. TWO SUBJECT: PROJECT No. 12-2621: Santa Ana Zoo Walkway Improvements The following changes have been made to specifications of the subject project: Specifications 1. Page BP 1 and 2 of 13; Replace pages BP 1 and 2 of 13 with the attached BP 1 and 2 of 13. 2. Page 1, Section 1.03 Time of Completion; Revise Section 1.03 with the following: The Contractor shall complete all work under the contract within 24 working days from the date of the Notice to Proceed issued by the Engineer. Additionally, contractor shall complete the main zoo walkway (PRIORITY 1 per plan) within the first 14 calendar days. Work is authorized on weekends as needed to accommodate the additional 4 calendar days for PRIORITY 1 work. Contract time shall begin on a designated Monday at the preconstruction meeting. The area of the zoo in the construction area will be closed starting on this designated Monday for two weeks and re-open on the 3rd Monday. All work must be completed and cleared by 5 pm on the Sunday prior to the zoo reopening to the public. Liquidated damages shall be assessed if contractor exceeds the 14 calendar days of work on the PRIORITY 1 areas. Contractor shall move on to the zoo keeper's area (PRIORITY 2 per plan) immediately after work has been completed in the main zoo. No weekend work is authorized for PRIORITY 2 work. Contractor shall provide liability insurance, business license, submittals, and all required documents immediately after execution of the contract. Preconstruction meeting shall take place within two weeks of awarding and notice to proceed shall be issued on April 16." 3. Appendix E, Construction Plan; Replace construction plan in appendix E with the attached construction plan. February 2, 2012 ADDENDUM No. TWO PROJECT No. 12-2621 Page 2 4. Page 18, Section 2.10 Root Shaving; Add the following sentence to the end of the first paragraph: "Where tree roots exist, contractor shall remove the existing AC to expose the roots for Tree Maintenance Supervisor's inspection. Tree roots shall be shaved and removed prior to cold milling the AC." All other terms and conditions remain the same. FOR THE CITY OF SANTA ANA ~11r11`, Souri Amirani City Engineer r i i 1 I 08739254 Bond No._-- - Fidelity and Deposit Company POST OFFICE BOX 1227 OF MARYLAND BALTIMORE, MD 21203 i I ~ BID BOND KNOW ALL MEN BY THESE PRESENTS: Asphalt, Inc . - That we, Ben-------'--s - - ' as Principal, (hereinafter called the "Principal"), and !the FIDELITY AND DE osrr COMPANY OF MARYLAND, P.O. Box 1227, Baltimore, Maryland 21203, a corporation f . duly organized under the laws of the State of Maryland, as Surety, (hereinafter called the "Surety"), are held and { fcrmty bound unto__ CitY_ofwSanta Ana - - - - - Obligee, (hereinafter called the "Obligee"), in the sum of____.ten percent of _amou_nt_ bid Dollars 10 ° 4 for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, f executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for.-122621- -Santa-Ana-Zoo AC Walkway _ Improvements r - - - - - - - - - - - - - - NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the principal shall enter into a contract with the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or contract documents with good and sufficient surety for the faithful performance of such contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter into such contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. 3rd -----day of_ - February br_u...a_ r- y- 20 12 Signed and sealed --------------------A.D., E 4 Ben's As halt, Inc. (SEAL) Principal - - - Vitness BY: C _ Title FIDELITY AND DE C PANY OF YLAND Sur - By--- - - - -------------------(SEAL) Witness AT EY -FACT Title c370-50M, 7.91 - Charles L. Flake C-roans W Am"imn Wtitute or Ardtitow u«ument A-310- - Fobmry 1970 Edition. k F CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA County of Orange On 2-3-12 before me, Lexie Sherwood Notary Public Date Here Insert Name and Title of the Officer personally appeared Charles L. Flake Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the LEXIE SHERWOOD person(s), or the entity upon behalf of which the person(s) COMM. #1856389 3 acted, executed the instrument. 0 NOTARY PUBLIC • CALIFORNIA A ORANGE COUNTY I certify under PENALTY OF PERJURY under the laws of Comm. Exp. JULY 27, 2013 the State of California that the foregoing paragraph is true and correct. Witness my hand and fficial seal. Signature Place Notary Seal Above Signature of Not ry Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ? Individual ? Individual ? Corporate Officer - Title(s): ? Corporate Officer - Title(s): ? Partner - ? Limited ? General ? Partner - ? Limited ? General ? Attorney in Fact .1 M. ? Attorney in Fact ? Trustee ? Trustee ? Guardian or Conservator Top of thumb here ? Guardian or Conservator 7Topofumb here ? Other: ? Other: Signer Is Representing: Signer Is Representing: 02007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • www.NationaiNotary.org Item #5907 Reorder: Call Toll-Free 1-800-876-6827 Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation of the State of Maryland, by WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary, in pursuance of authority granted by Article VI, Section 2, of the By-Laws of said CompHS are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date h e s by nominate, constitute and appoint Richard A. COON, Charles L. FLAKE, David L. CULB n OOD, all of Anaheim, California, EACH its true and lawful agent and U ,9 d deliver, for, and on its behalf as surety, and as its act and deed: any an o si ~n e . xecution of such bonds or undertakings in pursuance of these prese ~1 as fully and amply, to all intents and purposes, as if they had been d e.' t a th gularly elected officers of the Company at its office in Baltimore Md. 91 , p er attorney revokes that issued on behalf of Richard A. COON, Charles L. FLAKE, ew P. FLAKE, Lexie SHERWOOD, dated November 7, 2005. The said Assistant ease eby certify that the extract set forth on the reverse side hereof is a true copy of Article VI, Section 2, of the By-L s said Company, and is now in force. IN WITNESS WHEREOF, the said Vice-President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 15th day of November, A.D. 2006. ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND 'gyp DEPOS _ O G By: Eric D. Barnes Assistant Secretary William J. Mills Vice President State of Maryland City of Baltimore ss. On this 15th day of November, A.D. 2006, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, came WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. Constance A. Dunn Notary Public My Commission Expires: July 14, 2015 POA-F 012-4150H EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND "Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice-President, or any of the Senior Vice-Presidents or Vice-Presidents specially authorized so to do by the Board of Directors or by the Executive Committee, shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident Vice-Presidents, Assistant Vice-Presidents and Attorneys-in-Fact as the business of the Company may require, or to authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations, policies, contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages and to affix the seal of the Company thereto." CERTIFICATE I, the undersigned, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that the Vice-President who executed the said Power of Attorney was one of the additional Vice-Presidents specially authorized by the Board of Directors to appoint any Attorney-in-Fact as provided in Article VI, Section 2, of the By-Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed." IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said Company, this 3RD day of FEBRUARY 2012 Assistant Secretary CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California ss. County of ll z°l~ `~(Ll - - / before me, M On Name and Tile of Officer (e.g., "Jane Doe, Nof~ry Public") Date _y personally appeared I'{Z Name(s) of Signer(s) personally known to me ? proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that TEr~ RI BR OEN he/she/they executed the same in his/her/their Commission # 1924994 authorized capacity(ies), and that by his/her/their aI. Notary Public California z signature(s) on the instrument the person(s), or the = g... D Orange County entity upon behalf of which the person(s) acted, M Comm.. Expires Feb 10, 2015• executed the instrument. WITNESS m and and off' ' seal C ~ Place Notary Seal Above Signature of Notary Public OPTIONAL document Though the prevent fraudulent removal law, it my prove and reattachment of this form to another document. and could Description of Attached Document Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ? Individual ? Individual ? Corporate Officer - Title(s): ? Corporate Officer - Title(s): ? Partner - ? Limited ? General - ? Partner - ? Limited ? General ? Attorney in Fact Top of thumb here El Attorney in Fact Top of thumb here ? Trustee El Trustee ? Guardian or Conservator ? Guardian or Conservator ? Other: ? Other: Signer Is Representing: Signer Is Representing: 0 2004 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 Item No. 5907 Reorder: Call Toll-Free 1-600-676-6827