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GREENLAND CONSTRUCTION, INC.
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 Offlclal Records, Orange County Tom Daly, Clerk- Recorder IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIII NO FEE * s R o 0 o s z z z s e a s 2012000612598 3:27 pm 10/09/12 276 4'19 N'12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THIS SPACE FOR COUNTY RECORDERS USE ONLY 0 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 PLAZA SANTA ANA IMPROVEMENTS under contract entered into on MAY °w 7. 201 1, with GREENLAND CONSTRUCTION, on which contract AMERICAN SAFTEY CASUALTY INSURANCE COMPANY is surety. The property on which such work wimprovement was placed is in the City of Santa Ana, County of Orange, State of California, and � c described as Project No. 12 -7532 located at: 325 FOURTH STREET. The work improvement m H on said property was accepted as completed on OCTOBER 5. 2012. p z o �' CITY SANTA AMC7NICIPAL CORPORATION .� � - m � by � � � v Dated: t 0 /9 / O t City Engineer r� o t� E'^ TITLE F ___________________________ _______________________________ D rn C4 C S � 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 10/9/2012 at Santa Ana, California (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 i Z ?t� REQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: MAY 7, 2012 TITLE: CONTRACT AWARD WITH GREENLAND CONSTRUCTION, INC. FOR PLAZA SANTA ANA (PROJECT NO. 127532, NON - GENERAL FUND) � p�L� "' CITY MANAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVEDS - ?'- /2 Q As Recommended) oP`3� 0 As Amended 0 Ordinance on 'Ise Reading � Ordinance on 2n° Reading � Implementing Resolution � Set Public Hearing For CONTINUED TO FILE NUMBER Award a contract to Greenland Construction, Inc., the lowest responsible bidder, in the estimated amount of $180,967 for construction of the Plaza Santa Ana project. 2. Approve a Funding Analysis with a total estimated construction cost of $226,165. DISCUSSION The Plaza Santa Ana project is an 8,785 square -foot open -air plaza located at the northwest corner of 4th and French Streets in downtown Santa Ana (Exhibit 1 ). The City acquired the property in 1984 and licensed the site for use by EI Faison Mercado from 1984 to 2005. In 2010, the site was cleared and has been available as public open space for the surrounding neighborhoods. A concept plan was prepared by the Parks, Recreation and Community Services Agency (PRCSA) to provide improvements that will enhance the location and provide better use as neighborhood open space. Improvements include additional lighting, ADA enhancements, raised planters, landscaping and irrigation, and repair and replacement of the existing concrete and bricks. On November 28, 201 1 , this concept plan was presented to a three - member Council Subcommittee on Parks, Recreation, Education and Youth (PREY), that reviewed the plan and recommended it for approval by the City Council. On March 5, 2012, in response to concerns brought forth to the City Council, staff reviewed the concept again with the PREY Councif subcommittee and made minor revisions. Contract Award For Plaza Santa Ana May 7, 2012 Page 2 The Notice Inviting Bids was advertised on March 23 and 24, 2012 and bids were opened on April 1 1 , 2012. A summary of the bid invitations mailed, the bids received, and the bid results are as follows: Santa Ana Contractors receiving notices: 15 Contractors requesting bidding documents: 8 Bids received: 3 Bids received from Santa Ana Contractors: 1 NAME OF RESPONSIVE BIDDER CITY BID AMOUNT 1. Greenland Construction, Inc. Canoga Park $180,967 2. Hondo Company, Inc. Santa Ana $222,656 3. STL Landscape Los Angeles $400,000 A total of three bids were received and all were responsive_ The lowest bid was submitted by Greenland Construction, Inc., for $180,967. The Engineer's estimate was $120,000. The additional cost is primarily due to the additional work needed for ADA compliance and additional lighting improvements that were not in the original scope of work. ENVIRONMENTAL IMPACT Environmental Review #ER- 2011 -85 has been completed and a Notice of Exemption has been filed pursuant to the California Environmental Quality Act. In addition, a Certificate of Categorical Exclusion has been prepared in accordance with the National Environmental Policy Act (N EPA). FISCAL IMPACT The Funding Analysis shows a total estimated construction cost of $226,165 for the project (Exhibit 2). Funds are available in the Community Development Block Grant Fund (accounting unit 13518783- 66220). � — Raul Godinez II Executive Director Public Works Agency /���� Gerardo Mouet Executive Director Parks, Recreation, and Community Services Agency RG /SA Exhibit 1: Project Location Map 2: Funding Analysis APPROVED AS TO FUNDS AND ACCOUNTS: t�c�cc�c.. � r �� ��_ Francisco Gutierrez �,� Executive Director Finance &Management Services Agency Nancy T_ Ecj ards Interim Executive Director Community Development Agency �� � '1 __., �._._- __.___._.__� �__.__.__._,__.__J i_ ._� — _ - -��� LVD (6TH ST) if' 1 111 i e i I• � �.__.._.._._.._.._.._._._._ 5TH ST �..— "-- - - - - -- N N j1 � o � f � m � � .�_.. .._. __._.._- .,_._. � e! � _�._� _. _._.J � _,� W SANTA -._ 1 ___.Y. � �_._�_.. ii 4TH ST C�. . ... __ _ w U � Z W � Q' g LL (6TH ��"�r 1 PROJECT LOCATION N75 O�Y ORANOC SANTA ANA C 1 TY COUNC 1 L 3 =� �� ' c'z `P^ AGENpw PROJECT 1 2 - 7532 � � ���: DATE. PLAZA SANTA ANA ��� -MAY 7. 2012 FUNDING ANALYSIS PROJECT NO. 12 -7532 PLAZA SANTA ANA Construction Contract $180,967 Contract Administration $9,050 Inspection and Testing $10,851 Survey $7,200 Contingencies $18,097 TOTAL ESTIMATED CONSTRUCTION COSTS $226.165 Exhibit 2 1 • I . THE REGISTER 625 N GRAND AVE, SANTA ANA, CA 92701 Telephone (714) 796-7000 / Fax (714) 796-6059 (2015.5 C.C.P.) State of California County of ORANGE ss Notice Type: BID - NOTICE INVITING BIDS Ad Description: Plaza Park Impry I am a citizen of the United States and a resident of the State of California; I am over the age of eighteen years, and not a party to or interested in the above entitled matter. I am the principal clerk of the printer and publisher of the THE REGISTER, a newspaper published in the English language in the city of SANTA ANA, county of ORANGE, and adjudged a newspaper of general circulation as defined by the laws of the State of California by the Superior Court of the County of ORANGE, State of California, under date 11/19/1905, Case No. A21046, That the notice, of which the annexed is a printed copy, has been published in each regular and entire issue of said newspaper and not in any supplement thereof on the following dates, to-wit: 03/23/2012, 03/24/2012 Executed on: 03124/2012 At SANTA ANA, California I certify (or declare) under of perjury that t /e fore ing is true and correct. i J!'51'grialure A 54* CNS#: 2283114 NOTICE INVITING BIDS NOTICE IS HEREBY GIVEN that the City of Santa Ana, California will receive at the City Hall-Ross Annex, (M- 43), PO CIO,- Inter Plaza, Santa Ana, Inter 92701, the Public Works Agen- t7Fourt Floor Recep- ..Ist, Fourth or before the hour of 2:00 p.m, on Wed- nesday, April 11, 2012 sealed bids and/or pro ,S.osals for PROJECT .12-7S32t PLAZA SANTA ANA Notice is hereby given BID- DERS that this project is funded with Federal Com- munity Development Block Grant money, and that the rate of wages for each craft or type of work or mechanic employed under this con- tract shall be as specified under the current determina- tions of the Department of Labor as required under the Davis•Bacon Act. Where a discrepancy exists between Federal and State prevailing wage rate the higher of the two prevail- ing wage rates shall apply. Each bid shall be accompa- nied by cash, a cashier's or certified check payable to the Gfty of Santa Ana, or bid bond issued by a corporate surety, for an amount not less than ten percent (10%) of the aggregate of the bid, as a guarantee that the BID- DER will enter into the pro- posed contract if the same is awarded to him The sig . nature of the BIDDER on the bid bond must be notarized The City Council reserves the right to reject any or ail bids. The successful BIDDER must possess or obtain a valid California Class A Con- tractor's prior to the sched- uled award date of this con- tract. The work to be performed under this contract is subject to the requirements of Sec- tion 3 of the Housing and Ur- ban Development Act of 1968, as amended, 12 U.S.C. 170lu (Section 3), The City of Santa Ana has established an Annual Antici- pated DBE Participation Lev- el (AADPL) of 15.91 (7,14'/ Race Neutral and B,77% Race Conscious) for projects constructed this fiscal year. This project has a spe. offic UDBE Contract goal of 8.77%.This per- centage shall apply to the i cost of the entire pro l . ect. The UDBE cam itment for Exhibit 15-GI may be submit- led with the bid proposal, If This space for filing scamp only the UDBE form is not submit -1 ted with the bid, the appa- rent low bidder, the second low bidder, and the third low bidder must complete and submit the form, to the City. The Form must be received i by the City no later than the time specifie d in �fie Fed eral Requirement of PP.od x F of the Special Provisions. Substitution of for l any monies withheld by the. City of Santa Ana to ensure performance is allowed in accordance with the Public Contract Code, lete electronic sets of he � fare and Specifications: will be furnished upon appli- 1 cation at the Public Works' Agency counter, First Floor, 20 Civic Center Plaza, Ross Annex. Santa Ana, 92701 Plans and Specifi- cations are available in', portable document for-' mat PDF) on a com. act disk (CD) only. here is no charge for the Plans and Specifications on CID. PWA Counter Business Hours are 9:00am to 4:00pm, Monday thru Thurs- day. Call the PWA Proj- ects Information Line at 714.647-5680 for avaitabliff"t of CDs. To 71CD by mail, the Contractor must submit an email request to sarmour@santa-ano.orQ and provide following fiffor- Company name, mailing address, phone number, FedEx account, and CD i jema*IS b ' A heading: . lli EC NO.. PLA. ZA SANTA" M Checks are, no ' onr ac- cepted, Addenda will be is- sued by email twOose who received CDs directly ,from the Pubfi W ksA"' . c 'raU".n , 0. NOT PUR- CHASING DIVISH)N RE-1 CARDING PUBLIC! WORKS AGENCY PROJ-J ECTS. 3/23, 3/24/12 CHS-2283111 THE REGISTER RAW 9463288 CITY OF SANTA ANA PROJECT NO_ 12 -7532: PLAZA SANTA ANA PROPOSAL 8r CONTRACT AGREEMENT BID PROPOSAL TO: CITY COUNCIL /O�'F TH /E CITY OF SAN "fA ANA FROM: G.��,� GOiriSGr�J�iO� 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 Quantit Unit Price Amount 1. Unclassified Excavation CY 50 $ � Q $��QIQ 2. PCC Pavement SF 1,000 $ �.r(� $ �,�. Qlp 3. Brick Pavement SF 200 $ lQ p� $ Z�.Q�Q 4. Root Shaving EA 1 $2� ,�� $2FjQ,(� 5. Tree Grates EA 8 $ � � � $ ,, � �pQ 6. Exterior Hardscape Treatment and LS 1 $ rj�� /,SOO $ S,,S %5� Repair 7. Electrical Service and Lighting LS l $7�Jr��O..c� $.G� 8. Landscaping LS 1 $.2 Q pp $���Q2,a� 9. Irrigation System LS 1 $��,5.�3�0 $16,� -��1� 1 O. ADA Ramp LS 1 $ /0,,010_ o� $ /O p /� >..rX7 1 1 . Site Amenities (trash receptacles, bike LS 1 $ �� $ � 5$7.,{p racks) 12. Raised Planters LS I $Z��O.00 $�.� TO BE INCLUDED IN BID PACKAGE BP 1 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA PROPOSAL 8r CONTRACT AGREEMENT BID PROPOSAL, continued Item # Bid Item Unit Unit Price Amount 13. Cast Aluminum Letters EA 20 $ <30,� $ �OO.�p 14. Pull Boxes EA 4 $Z>CQ,�Ip $ /�Q� pp 15. Emergency Work On Time and LS I $ 10.000 $ 10.000 Material Basis 16. 20- working day Landscaping 8z I_S 1 $SGI�G� $ 5G�0.� Irrigation Maintenance Period TOTAL BIDS/ �11dti� !�'���✓5���!rI11f4�i���o:J $ I 9� .�� PROJECT NO. 12 -7532: PLAZA SANTA ANA /+ BIDDER / j Firm Vl����s' /rJ /..GiAw �C� R�r �wen6.�+ou� .���,, cS..�viZ+rSJ Address �^����,cA 3��3 Phone CS/8� 963- 807/ Fax ��✓8�9��- -C��77 Email /p�¢Rroc�LJ !¢�.��COrz. c.Om BIDDER � _ Signature TO BE INCLUDED IN BID PACKAGE BP 2 of 30 CITY OF SANTA ANA PRO:IECT NO. 12 -7532: PLAZA SANTA ANA PROPOSAL AND CONTRACT AGKEEMENT 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; %% of the bid or $1 0,000, 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 Y T � %�rie�f L�i�.. LOCATION R,�9 LJ_9fL._Sl -l�,/ � 9/786 PHONE rqm� nst� _riS�T� TYPE OF WORK � /o��� $��r7�pCJC> NAME LOCATION _ PHON E TYPE OF WORK NAME LOCATION PHONE TYPE OF WORK $ NAME LOCATION PHONE TYPE OF WORK $_ NAME LOCATION PHONE TYPE OF � /7�//O�RK/ � $ G�QV'�d L.orK�sv ioc-�G' t..1J� Narpe o ��tting Bid Signature of BIDDER li`I_�u 1 LOCATION PHON E TYPE OF WORK $ NAME LOCATION PHONE TYPE OF WORK $ NAME LOCATION PHONE TYPE OF WORK $ NAME LOCATION PHONE TYPE OF WORK $ NAME LOCATION _ PHONE TYPE OF WORK $ TO BE INCLUDED [N B[D PACKAGE BP 3 of 30 CITY OF SANTA ANA PROJECT NO. 12- '7532: PLAZA SANTA ANA PROPOSAL 8c 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 herein 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 (1 O) 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 GjrQ����t�pj���iz��w�N �,, . Signature of BIDDER Title (if an in ivi ual, so TO BE INCLUDED IN BID PACKAGE BP 4 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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.) ACTION OF COUNCIL: Awarded tor./' 1nc�m0irm� /w- ,o� /2..n�iE =_p�j . qn the basis of west responsible and responsive bidder in the amount of � ,� $ / g� , 9� /�' Date � y 20 /o?i ATTEST: �., CL RK OF THE COUNCIL APPROVED AS TO FORM: �2 (� C TY ATTORNEY ACCEPTED FOR THE CITY OF SANTA ANA: r EXECUTIVE DIR OR PUBLIC WORKS AGENCY BP 5 of 30 TO BE INCLUDED [N BID PACKAGE CI'T'Y OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICHARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The BIDDER Li�Q.n,(�ss VO Iry t proposed subcontractor (/%- _ o� /,J j� hereby certifies that he has _, has not �C participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 1 1 1 14, 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 Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by tke Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60 -1 .7(b) (1)), and must be submitted by BIDDERS and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60 -1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form ]00 (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 tiled 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 [N BID PACKAGE 8P 6 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA PROPOSAL AND CONTRACT AGREF_MENT 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 information and reports required by Executive Order ] 7246 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 1 1 246 of September 24, 1 965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 1 1246 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 30 CITY OF SANTA ANA PROJECT NO. 12- '7532: PLAZA SANTA ANA PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION OF NONDISCRIMINATION BY CONTRACTOR (continued 7. The Contractor shal I 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 t 11 the penal ies imposed for a violation of the Chapter. Signed _ Title �� ��A�cr�.no,Ltm��rtl / lwno�fLiizc/ L /i�-ec�l� Firm �TI'�otw� �►�SL /!/�iCCIJV. �• Date �y ��• �Z TO BE INCLUDED IN BID PACKAGE I3P 8 of 30 CI "fY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 employees) is (are) persons excluded by said Labor Code, 1 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 _� ��� ? /��i..— Title Firm Date Q� �lJ �2 TO BE INCLUDED 1N BID PACKAGE BP 9 of 30 C[TY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA PROPOSAL AND CONTRACT AGREEMENT REFERENCES The following are the names, addresses, and telephone numbers for three public agencies for which BIDD/'ER hasp formed similar work within the past two years. Na a and Address of Owner. _ v Nam[[e /man- d//- Te�le /phyo�ne Number �' / �/. /E_lll. Cpl Contract Amount 2. with project. J �� � `"(�+� L L /�h, �t�/�1: / ®K V/fn1�lA�V�/'lf1T YU GC iiJlL.. Wor Date Completed 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. _ � � _ 1J TO BE INCLUDED IN BID PACKAGE BP 1 O of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 California Apprenticeship Council. Signed �[ ) ��� Title �[yA!/,A�s ..�e�mdrl�c�3 %��f,n��K,...� [ // ✓�i11� Firm � -e���� ,i�� -! �'-'�; Date CAL% ��_ � Z TO BE INCLUDED IN BID PACKAGE BP I I of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 1 12 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 th t making a false certification may subject the certifier to criminal prosecution. Signed �_ �_ State of California County of Q/= -1NN6� Subscribed and sworn to (or affirmed) before me on this �l� day of /r/ -/�/L 20J�, by a/LASN f�AG/i /l�H/ MEIi ff4FN0�/PN ,proved to me on the basis of satisfactory evidence to be the person(sj who appeared before me. Notary Public Signature MARK A. PALAZUELOS F "� COMM. # 1891197 � 3 NOTARY PUBLIC CALIFORNIA � ORANGE COUNTY My Comm. expires May 27, 2014 t Notary Public Seal BP 12 of 30 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 (l8 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 /J 1 Title �IJa tL. /11I/lse�_- ..�Uav�av�nJ.,_..�/ �n•. �,. I /lyd�7I�0I'��i- � � v v 7 / Firm ��i�L � iYi /r��lli1. JJl!'.. Date .f7�,/ �!J_ %% TO BE INCLUDED IN BID PACKAGE BP 13 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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: Greer+/�yto/ Z�o`„ , .��� _ Business Address: 7Q�l���P.,.� �, �� ���,� ,� ?������_ � y/,�j2� Telephone: L f� /$,Z9�S3 -�Q�/ State Contractor's License No. and Class: % Z��.� ���j Expiration Date: Signed: Title: TO BE INCLUDED IN BID PACKAGE BP 14 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 1 968, as amended, 12 U.S.C. 1 701 u (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 1 35 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 commitments 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 5 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 CFR 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 (1) 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 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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. • �(��LI�L� 1F�2•IY7 +3 LZn A 1/L3' }� �6i12QR� M�/�Q',t�✓ Signatu a Print N e nd Title Signature Signature Print Name and Title Print Name and Title 04/.0. /2 Date TO BE INCLUDED IN BID PACKAGE BP 17 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA PROPOSAL AND CONTRACT AGREEMENT FEDERAL REQUIREMENTS FOR FEDERAL -AID CONSTRUCTION PROJECTS GENERAL —The work haeui proposod will be ftrtartoed in whole or vt pat with Feda-al finids, � theefue all ofthe s�d�s, rules aryl rt�rlabcxs Rtxntil�maci try' the Feda-al Ciovararrab: and applicable to work firr�ioed in whole or in pat with Fala-al fiords will apply 10 suds wait. 'Ihe `Y2uqurtcr3 Conirad Provtsicxx� Pcdv -al- Aid C_oraVUCtion ContracL� `Y-'orm F•7 -IWA 1273, an' indcd©d in dvs Section 14. Whar�er in said ragtmed oonlracY provisicxs rc9aa>as � n-racie � "SIiA Ca�-actirtg otlica" "SI -IA nsiderri '," or `�tnitixiad represtntativc of tlx SI -IA,,, suds n °taea� shall be ea>��l k� rr� "F�>gm�ea" as ciclinoci m Suction 1 -1.18 oftlie Startdad Specifications PERFORMANCE OF PREVIOUS CONT'RAC'T - In addition � the provisions vi Section Il, "IVordisQmvrtatior�" and Satiori VII, "Subleyting or Assignvtg the Contract,' of the regtmed conArad. provisiorts, the Ccxitracax� shall wild the tallow�irig: The BIDDER shall ��+m° the CERTIFICATION WI'1"FI RF?.C:ARD TO THE PII2FORMANCE OF PREVIOUS COMRACIS OR SCJBCONI RAC"IS SlJB1I� i' 'PO THE EQUAL OPPOR'Tl_JN1TY CLAUSE AND THE FILING OF REQUIRED F2EP( )RTS kxatc�i in tlx: pioposal. No nom. for sublettirig ex assignrrig arty pcxtion of the mntl-aY vi � of$10000 will be cnruidar =d tutda� the provisiors ofSection VII ofthe regtmed oaataR provisiors tml� suds recprsl. is aaxxrq�aiied by the CERTIFICATION refened b above, exen�d by the proposed subctxm- ac�x�. NON�70LLUSION PROVISIONS -The provisioris vi this sectimr are applicable m all mr�-acls exocpt oonttacts tix Fedaal Aid Saoa�tday projects Title 23, United States Code, Section 112, talrmes as a ooriditicm pti3oedcin � approval by the Federal Highway Administr -for of the oa�tr-acY, for this wc>tic tl�c�, each BIDDER file a sv\om statanari exeaned by, or on bdialfof, the p ©�orr, fum associatiori, or mrporation b whom such oam-act is to be awanJod. cz3lifymg that suds priori, fmn, a�ociatioit a oorpcx-�on has rto> -, eitlxr d'uaxly or intiuocfly, aVHl3d into arty aigeaitart, paticipaecl in any collusion err otherwise 1akc3i any action m rem- aitrtof fiee mmpc�tilive bidd'mg in ooratactiort with the subntitLC�d bici A term to rr>iike the rionoolltaion affidavit aart +*Y+,r ragtmed by Section I l2 as a oatitiration rnxJa' pantlty ofpajury rather than as a sworn slatariait as pemvtlai by 28, USC, Sea 1746, is included in the proposal. PARTICIPATION BY �ISAUVANTAGED BUSINESS ENTERPRISES IN SUBCON7fRACTING - Pat 26, Title 49, Cade otTedaal Regulaborts supplies to this FedaaFeid project 1'atiriari �ctiorts of said Code are uinxpa-azed'vi parlor m its aVU�y witlrvr ortia� sectiorsoflhese special pmviticas cchadulP B - Inforrriation fu Detanvning Joir4 Vc�mae Gigbility. At�mtTt F.,cf.i,�A - FRI 807A7 (This farm netxi not be filled in ifall joint venture firms are minority owned.) I .Name ofjoint venture 2. Address ofjoin venture 3. Phone number ol;joint venture 4. Identify the firms which comprise the joint venture. (The DBE partrier must complete Schedule A) a. Describe the role of the DBE firm in this joint venture. b. Describe very brietly the experience and business qualifications of each non -MBE joint venture: 5. Nature oY the joint venture's business 6. Provide a copy of the joint venture agreement. 7. Whaz is the claimed percentage of DBE ownership? 8. Ownership ofjoint venture: (This need not be filled in if described in the joint venture agreement, provided by question (6). a. Profit and loss sharing b. Capital contributions, including equipment. c. Other applicable ownership interests TO BE INCLUDED IN BID PACKAGE BP 1 8 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA PROPOSAL AND CONTRACT AGREEMENT 9. Ca�ritc�l of and participation in this oontracL Idermiy by Warne, race, sec, and "firrrt" thou irdividuals (and their titles) who ate responsble for dayfir }day t»�gc3naR and policy dc�c-ision making, induding, but rtot limitiad 1v, U�ose with prime nspxsbility for. a Finarx;ial decisions h. Martagerrtertt decisions, such as: 1. F.�irrrating 2. Maricebng and sales 3. Hiring and tiring of n»iagerrrent 4. F'rndmsingofmajoritems or supplies a Supervision offield opa-alions LT G�b�rd�iou N ieotF`�Cl NameofFim� Sigrratrae�Sig>atiue ������i� /����r�i2�i� N�Name ,t r ��_ Title TNe State of Canty of On this day of 20� before me appeared (Warne) to me personally known, who, being duly swum, did execat[e the forc�aoing affidavit anti did state Uiat tie or she was pnpaiy arnixxizad by (Name of fine) to c�cecaIIe the affidavit and did so as hisor her tine act and deed. Note: I f affEr tiling this Scl�le B and before the completion ofthe Notary Public joirrt venhae's vwric on the contract covered by this regulation, these is Commission ea�uts any signific�it d'tartge in the intin-r»ation submitted, the jovrt va'rhue must infonn the grantee, eilha� directly or ttacxtg}t the pine ��� oontrac�tor- ifihejoint venhue is a s�bcvntr- acTrn�. I?ate j ii "llle UIYler3gne(f SwLB' that the faF�R)Ing STc�RMil(5 ale mrtect and 'include all material infon-rraticxr necv�svy to identify a,xl e�lain the tams and operation ofot u-joint ventrne and the intendrd participation by eactr joint ventrua' in the tardatakirtg. Further•, the undasignad cavaiarrt and ague in provide to g -arrtee amerV, wmplete and amu-ame intom»on te�vding acaral joint venhue wait and the payment therefae and any propc>�d cliarrges in :my of the joint verr[tae arr-��tgemer�ts anti to pc3rnit the audit arrd examination of the books, reoortis, and tiles of the joint vertlrue, try arehoria�d repesa�ves of the gaVee or the Federal fiud'uig agency. Any material misrq�reseritabcm will be grorurds for laminating any mrmarx which may be awanjed and for initialing actia�t ttrtder Federal or Shale laws wricarring lake shalartertts." Atl�dunart F.Yh:.s A- F'R2 7307A7 State of On this _ day of 2n befixe me appeared ( Name) fv rr-ie personally known, who being sworn, did exaaIIe the tixe�xting affidavit arrct did state that he or she �� properly arlliioriaed by (Name of frrm) fv esccectrte the aiiiclavit and diet so as his or her fn.� act and dead. Notary Public Commission c 1�] BP 1 9 of 30 TO BF, INCLUDED IN B[D PACKAGE CITY OF SANTA ANA PROPOSAL AND CONTRACT AGREEMENT PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 determining 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. FED.8 -22 -88 Name of BIDDERG,��j�Gpr�[�-y��pr�l�y�. Signature of BIDDER Date �y l2, /L TO BE INCLUDED IN BID PACKAGE BP 20 of 30 Exhibit 15 -G1 Local Agency Bidder UDBE Commitment (Construction Contracts) NnOTE: PLEASE REFER TO INSTRUCTIONS IN APPENDIX GENCY: ��1/OT �Cw�'Lt�Q.�.�Q� LOCATION:�I� ��y�f ��/�j ��-yC i'/J -sew /J `_ /7 / PROJECT DESCRIPTION: PROJECT NO. � /-� /(�,Z�L� J��� ar. �� � /OY6GG N� %7 - / %'� OTAL FEDERAL CONTRACT AMOUNT: $�� ���� BID DATE: /� � ./ /� BIDDER'S NAME: C11'rG�1/ C�CJ��µ. ��- . ONTRACT UDBE GOAL: ONTRACT ITEM OF WORK AND DESCRIPTION ert. No. of UDBE AME OF UDBEs DOLLAR AMOUNT ITEM NO. R SERV[C ES TO BE ND EXPIRA "LION Must be certified on [he date bids UBE SUBCONTRACTED OR MA7�ERIA LS DATE re opened - include UDBE address O BE PROVIDED nd hone number) /CQ. � � 1./. %�' V � i or Local Agency to Complete: Total Claimed $� ��� �� ocal Agency Contract Number _ Participation Federal Aid Project Number: Federal Share: �3;�% ontract Award Date: Local Agency certifies chat all information is completes and accurate. Pri n[ Name Signature Datc Signature of Bidder ocal Agency Representative Area Code) Tele hone Number ^,/ f �p [� -10. /Z �Uf 8 � %fL -%;��� Date (Area Code) Tel. No. or Caltrans Review: Print Name Signature Datc Caltrans District Local Assistance Engineer focal Agency Bidder -UDBE Commitment (Rev i /09) vlscnounon: (�) copy - rax or scan a copy [o me Caltrans u�stne[ Local Ass�stanee Engineer (DLA t:) within 1 5 days of award. Failure to send a copy [o the DLAE within I S days of award may result in de- obligation of funds }or this project. (2) Copy -- Include in award package to Caltrans District Local Assistance (3) Original -Local agency tiles TO BE INCLUDED IN BID PACKAGE BP 21 of 30 Exhibit 15 -G2 Local Agency Bidder DBE Information (Construction Contracts) (Inclusive of all DBEs including the UDBEs listed at bid proposal) NOTE: PLEASE REFER TO INSTRUCTIONS IN APPENDIX //�� � \l L ��a�///�///1 GENCV: ����� /liLY/��_ LOCAT ON:_ �l�i/L�/I�IL�L,IJtL(/'IJYI�!!J� _ L 9 ROJECT DESCRIPTION: PROJ ECT N0 �1ia77 �91�d,� lJA1i ��/\//J t/� —� Z p�/ OTAL FEDERAL CONTRACT' AMOUNT: $ �� �O /'�Q BID DATE: O //��2 ' IDDER'S NAME: C_JY�/sl� � /Ow � _ ONTRACT ITEM OF WORK AND DESC RIPT'ION ert. No. of DBE AME OF DBEs DOLLAR AMOUNT ITEM NO. R SERVICES TO BE ND EXPIRATION Must be certified on [he date bids BE SUBCONTRACTED OR MATERIALS DATF_ re opened - include DBE address O BE PROVIDED nd hone number) i - ►�i�s .. �. YTE W. or Local Agency to Complete: -/y�� _ $ Local Agency Contract Number: _ Patrtlic patioo � " ����� Federal Aid Project Number: Federal Share: l� —]���% ontract Award Date: ocal Agency certi Fies [hat all information is complete and accurate. B� J %/ Print Name Signature Date Signature of Bidder Local Agency Representative Area Code Tele hone Number: ��/ �/�����z (SIB)963 -807/ Daft- (Ama Code) "rel. No. or Caltrans Review: Print Name Signature Date Caltrans District Local Assistance Engineer Local Agency Bidder - DBG Information (Rev 3/09) Distribution: (1) Copy —Fax or scan a copy to the Caltrans District Local Assistance Engineer (DEAF) within 1 5 days of award_ Failure to send a copy to the DEAF: within 15 days of award may result in de- obligation of funds for this project. (2) Copy -- Include in award package to Caltrans District Local Assistance TO BE INCLI;DED [N BID PACKAGE BP 22 of 30 (3) Original —Local agency Fles CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA PROPOSAL AND CONTRACT AGREEMENT NONLOBBY lNG CERTIFICATION FOR FEDERAL A[D 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 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 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. BIDDY >Ignature F ^ir!m /� Date � Standard Form LLL may be obtained from Caltrans and FF:VVA otT�ces_ TO BE INCLUDED IN BID PACKAGE BP 23 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA PROPOSAL AND CONTRACT AGREEMENT DISCLOSL7RE OF LOBBYING ACTIVITIES Complete [his form [o disclose lobbvine activ irics pursuant fn '� 1 1 I C C 1452 1. Type of Federal Ac -lion 2. Status of Federal Ac-[ion 3. Report Type: Q a. Contract Q a. Bid/otier/ lication app � a. initial b. Grant b. initial award b. material change c. Corporate Agreement c, post -award d. Ban Por Material Change only - e. Loan Guarantee Year quarter f. Loan Insurance date of last re rt 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Prime Q Subwardee Tier , ljknown Con ssional District, i known Con essional District, r lozown 6. Federal DepartrnendAgency: 7. Federal Program Name/Description CFDA Number, If• livable S. Federal Action Number, fknown 9. Award Amount, if/orown O. a. Name and Address of Lobbying Entity b. Individual Performing Services (arlrrfag acfias�a6,�rv�tfrp�nNo. (rfrrfttir�{lz�rrm :fvs; Mj 1(kz) (/e�ramr�.�"5t tzmten �i (attac;h Continuation Shoet(s) ifnece� ) 1 l . Amount of Paymen[ (check all that apply): 13. 'type of Payment (check all that apply) $ � Actual � Planned � a. retainer b. one -time fee � c. commission 12. Forth of Payment (check all that apply): Q a. cash � d. contingent tee Q b. in -kind; specify: nature � e. deferred value � t: other, s i ' 14. Brief Description of Services Performed or to be performed and Dates) oi'Service, including oiiicer(s), employee(s), or members) contacted, for Payment indicated in item 1 1 : (attach Continuation Sheets) i necessa 15. Continuation Sheets) attached: Yes � No 16. Infcxrrramorl tegr�ed through this tixm is ar8l�i�t by TNe 31 USC SeL�DII - 1352. " Ihisd�9el osraeof' lobbyingactivitiesisarrr�aialtepcscxnationofiactupon Signature. wliidi reliarrcewas placed by the tiaabove wtrar tl-letr-arsaction was rrrade or aNaod vVO. Thisdiscbs<aeis regtritad��r -r!�t to31 U.S.C.1352. 'ibis infianialion will be Print Name . , report+ adtatheCongrc�sani�rnuallyanciwillbeavailabletorpublicirtgraction. � � f7 / � Anypc�sa�whofailsroSleUieralrmeddiscl m- taeshallbesubjecttoacivilparaltyof' Title Iw7a1�IHyT /t ✓G�-d r-� rot less than $10,000 and rotnlore than $100,(X701ar®d� such tallrue Dy /l7•%L Tele honeNo.lr / Date TO BE INCLUDED IN BID PACKAGE BP 24 of 30 FEi'ia'al U�Only: Authorised for Local Aeproduc[ ion Standard Forth — LLL CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING REQUIRED FEDERAL CONTRACT PROVISIONS CForm FHWA -12731 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 o the special provisions of this project. Signed �v�L/1: ice_ Title Firm Date Q!� gyp. /Z TO BE INCLUDED IN BID PACKAGE BP 25 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his 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 a ®ll such sub - recipients shall certify and disclose accordingly. ca.Gc,. -- BIDD_E / Signature ��Clf�l�'/�/c/� /Oyt, �- Firm O�/.1a0 /Z Date ., l�'� ":: .. »t�:trane� ar F,'tA''ol�+�es ,.. , r .' ` � ,.. �- „,�„ TO BE INCLUDED IN BID PACKAGE BP 26 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 �,A� ssi/�s�tance Act of 1 982 and as shown in the special provisions of this project. Signed - %'S�7� >a��i�� Date i � � ; � - i. � „� _s,... i TO BE INCLUDED 1N BID PACKAGE BP 27 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285. I (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 1 1 Ol, with any public entity, as defined in Public Contract Code Section 1 1 00, 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 1 0285.1 . Note S i gnec Title Firm 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. Date � /��Z TO BE INCLUDED iN BID PACKAGE BP 28 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 29 of 30 CITY OF SANTA ANA PROJECT NO. 12 -7532: PLAZA SANTA ANA 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 tinding of contempt of court by a federal court has been issued against the C',ontractor 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. S ignec Title Firm 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. Date �� � _ / ?� TO BE INCLUDED IN BID PACKAGE BP 30 of 30 THE AMERICAN INSTITUTE OF ARCHITECTS �� l�1�1��1 i f - _� CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT �,�c<<:�t;�i'`� _ = � _- _ - - = �c�:�5c2^�,�ti�az: Sri; �cc: �e���ii� ;�:^�i^�c'�.�s��Ci��^��>�%a;�^e STATE OF CALIFORNIA County of Oran e } On `� ,, ` before me, Irene Luong, Notary Public Da a Here Insert Name and Title of the Officer ' personally appeared Stephanie Hoang Names) 01 Slgner(s) ��' IRENE LUONG Commission # 1883838 i -�,���- � � Notary Public - California z a' � Orange County My Comm. Expires Mar 22. 2014' Plato Notary Seal Atwvc who proved to me on the basis of satisfactory evidence to be the persons) whose names) is /al=e subscribed to the within instrument and acknowledged to me that #3e /she /itaay executed the same in-hts /her /tHeir authorized capacity(ies), and that by Fitts /her /their signatures) on the instrument the person(sj, or the entity upon behalf of which the persons) 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 d an ci s al. Signature Signature of Nol ry Public OPT /ONAL Though the information below is not required by /a w, it may prove valuable to persons relying on the document and could prevent fraudulent remove/ and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Signers) Other Than Named Above: Capacity(ies) Claimed by Signers) Signer's Name: Stephanie Hoang � Individual O Corporate Officer Title(s): � Partner Q Limited � General ® Attorney in Fact - c - � Trustee • � Guardian or Conservator Top of thumb here 0 Other: Signer Is Representing: Number of Pages: Signer's Name: � Individual 0 Corporate Officer Title(s):_ � Partner � Limitetl � General � Attorney in Fact � Trustee � Guardian or Conservator D Other: Signer Is Representing: RIGHTTHUMBPRINT OF SIGNER .. - - ��G` �C) ��` ��. ��G-`. 2:` G_` �C 7: ��' �` �C._ �'"_ �L" C;` Z_ �C- �Z_`_, C-' Z�C^ �x1Zr�Cit? `- '�L��.`�"�C."�`�C.`ZtG.` ` �i� `��S+�S�;C;�T`rCi`L�'`ii =�C.` CAS."' ��C:` C` �C> ��G>" Pi% U` F,' 4: F <..`Z`_JCZ.'�"L�C:�C%L�'— `:{��G (p 2001 National Notary Avxoriation • 9350 De Soto Avo.. PO. Boa 2a02 •Chatsworth. CA 9Y 3t 3 -2902 • www.NationalNOla ry.or0 I[em 46901 ncordcr: Call Toll -Froe 1- BOO - 676- EiN'L� SBAB00322 PC�iIVER QF ATTORNEY CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT State of California County of � On � �- before me, o to � _ personally appeared who proved to me on the basis of satisfactory evidence to be the persons) whose names) 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 STEPHANIE HOANG his /her /their signatures) on the instrument the Commlaalon s 1907943 person(s), or the entity upon behalf of which the � -� Notary Public - California persons) acted, executed the instrument. � Oranpe CouMtr M Comm. Ex Tres Nov 9. 2014 + I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS myhand off'cial seal. Signature: Place Notary Seal Above 51 etur of Notary blic OPT /ONAL Though the information be /ow is not required by law, it may prove valuable to persons rely' g on th document and could prevent fraudulent removal and reattachment of this form to another ocument. Description of Attached Document Title or Type of Document: Document Date: Signers) Other Than Named Above: Capacity(ies) Claimed by Signers) Signer's Name: O Corporate Officer — Title(s): D Individual � Partner — O Limited D General Top of thumb here � Attorney in Fact � Trustee O Guardian or Conservator O Other: Signer Is Representing Number of Pages: Signer's Name: D Corporate Officer — Title(s): O Individual - � Partner — O Limited O General Top of thumb here D Attorney in Fact � Trustee O Guardian or Conservator O Other: Signer Is Representing i l41 eVV`! rvanonal rvo[ary ASSOCIa[IOn • Na[IOnalNOtarY.Or9 • 1- tl00 -US NOTARY (l- BOO -B]6 -662]) ILBm #590] Company Profile Company Profile Company Search Company Search Results Company Information Old Company Names Agent for Service Reference Information NAIC Group List Lines of Business Workers' Compensation Complaint and Request for Action /Appeals Contact Information Financial Statements PDF's Annual Statements Quarterly Statements Company Complaint Company Performance & Comparison Data Company Enforcement Action Composite Complaints Studies Additional Info Find A Company Representative In Your Area View Financial Disclaimer COMPANY PROFILE Company Information AMERICAN SAFETY CASUALTY INSURANCE COMPANY 39969 100 GALLE RIA PKWY, S.E., SUITE 700 2860 -5 ATLANTA, GA 30339 Old Company Names Effective Date TIC INDEMNITY COMPANY 05/23/1995 TICOR INDEMNITY COMPANY 01/14/1992 Agent For Service TE RRENCE WAITROVICH 523 WEST SIXTH STREET SUITE 544 LOS ANGELES CA 90014 Reference Information NAIC #: 39969 California Company ID #: 2860 -5 Date Authorized in California: 01/12/1983 License Status: UNLIMITED - NORMAL Company Type: Property 8� Casualty State of Domicile: OKLAHOMA back to top NAIL Group List NAIC Group #: 1346 AMERICAN SAFETY HOLDING GRP 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. AUTOMOBILE BOILER AND MACHINERY BURGLARY FIRE LIA BI Lri Y MARINE SURETY WORKERS' COMPENSATION back to top Workers' Compensation Complaint and Requests for Action Contact Information Page 1 of 2 http: // interactive. web. insurance. ca. gov /companyprofile /companyprofile ?event= companyPr... 4/ 19/2012 ! � � ! �� �� SANTA ANA BLVD (6TH ST) i � r.._.._.._.._.._.._.._ E I i _._� ? I _._.. 5TH ST 4 VJ i Z 1�� 1�� .. y � � � � N � �r11 � � �_ i m � a a W 0 1 =n � � _.,� _� i _..� _� ��"�r 1 F-'KVJCC: 1 LU�;H I IUN NTS �� ORq �O@ SANTA ANA � CITY COUNCIL 3r g o° � � W � � wceNOw PROJECT 1 2 - 7532 � v� � °� DATE• PLAZA SANTA ANA ��_ ,� �K• MAY 7. 2012