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HomeMy WebLinkAboutPALP INC. DBA EXCEL PAVING COMPANY (3) 90 Recording Requested By, Recorded in Official Records, Orange County And When Recorded Mail To: Hugh Nguyen, Clerk-Recorder Clerk of the Council, City of Santa Ana III II �I �Ilillll I IIIII II� I II NO FEE 20 Civic Center Plaza,P.O.Box 1988 I Santa Ana,CA 92702 * $ R 0 0 0 7 7 3 8 4 7 1 $ 2015000406063 11:03 am 08105/15 90 413 NI 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THIS SPACE FOR COUNTY RECORDERS USE ONLY a 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 MAPLE BIKE TRAIL SAFETY ENHANCEMENTS AT OCCIDENTAL A STREET, ST. ANDR.EW PLACE AND ST. GERTRUDE PLACE under contract entered into on o OCTOBER 21, 2014, with EXCEL PAVING COMPANY, on which contract FEDERAL a INSURANCE COMPANY is surety. The property on which such work improvement was cplaced is in the City of Santa Ana, County of Orange, State of California, and described as 0 F Project No. 13-6797 located at: MAPLE STREET. The work improvement on said property c w was accepted as completed on APRIL 9, 2015. Z A CITY A,A MUNICIPAL CORPORATION O by rA Dated: � � � Princi l Civil Engineer-Tyrone Chesanek Z TITLE ------------------------------------------------------------------------------------------- W ° VERIFICATION a I, the undersigned, say: I am the City Engineer - Edwin "William" Galvez 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 one}1 �� , at Santa Ana, California (Signature of ind idual swearing that the contents of Notice of Completion are true.) THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10)DAYS AFTER COMPLETION REQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: OCTOBER 21, 2014 TITLE: AWARD CONTRACT FOR MAPLE BIKE TRAIL SAFETY ENHANCEMENTS AT OCCIDENTAL STREET, SAINT ANDREW PLACE, AND SAINT GERTRUDE PLACE (PROJECT 186797) (STRATEGIC PLAN NO. 6, 1,B&G) CITY MANAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED OCT 2 1 2014 ® As Recommended 0l 3 ❑ As Amended ❑ Ordinance on 15' Reading ❑ Ordinance on 2nd Reading ❑ Implementing Resolution ❑ Set Public Hearing For CONTINUED TO FILE NUMBER Award a contract to Palp, Inc., dba Excel Paving Company, the lowest responsible bidder, in accordance with the base bid, in the amount of $224,887, for the construction of the Maple Bike Trail Safety Enhancements at Occidental Street, Saint Andrew Place, and Saint Gertrude Place. 2. Approve the Cost Analysis for a total estimated project delivery cost of $262,754. DISCUSSION The recommended action will allow the City to enter into a contract with Palp, Inc., dba Excel Paving Company, and proceed with construction of the Maple Bike Trail Safety Enhancements. The project has received budget and funding approval as part of the City's Capital Improvement Program. Project design is complete and bid procedures have been followed as established by the City's Municipal Code, and in adherence to the Public Contracts Code. The Maple Bike Trail Safety Enhancement project at Occidental Street, Saint Andrew Place, and Saint Gertrude Place consists of constructing bulb -outs within the existing public right-of-way at the three bike trail street crossings (Exhibit 1). The existing bike trail serves hundreds of bicyclists and pedestrians every day, in addition to heavy use by students walking or biking to Edison Elementary School. Once completed, these improvements will enhance safety at the bike trail crossings by shortening the crossing distance for all pedestrians and bicyclists. The Notice of Inviting Bids was advertised on August 18 and 19, 2014, and bids were opened on September 9, 2014. The following is a summary of the bid invitations mailed and received, and bid results: Contract Award For Maple Bike Trail Safety Enhancements at Occidental Street, St. Andrew Place and St. Gertrude Place October 21, 2014 Page 2 Contractor Participation Data Santa Ana contractors receiving notices 16 Contractors requesting bidding documents 19 Bids received 6 Bids received from Santa Ana contractors 0 Bid Results Summary RANK BIDDERS NAME LOCATION BID 1 Palp, Inc., dba Excel Paving Company Long Beach $224,887 2 Naka Engineering Contractors Laguna Hills $225,390 3 CPO Enterprises Inc. Covina $232,460 4 Hillcrest Contracting, Inc. Corona $240,650 5 Beador Construction, Inc. Corona $255,300 6 All American Asphalt Corona $294,900 Six bids were received and considered responsive, with Palp, Inc. dba Excel Paving Company submitting the lowest responsive bid. The bid amount of $224,887 is comparable to the Engineer's Estimate of $203,800. Based on the bids received, staff recommends award of this contract to Palp, Inc., dba Excel Paving Company. STRATEGIC PLAN ALIGNMENT Approval of this item supports the City's efforts to meet Goal #6 Community Facilities & Infrastructure, Objective #1 (establish and maintain a Community Investment Plan for all City assets), Strategy B (equitably maintain existing streets and associated assets in a state of good repair so they are clean, safe, and aesthetically pleasing for all users), and Strategy G (develop and implement the City's Capital Improvement Program in coordination with the Community Investment (e.g., neighborhood streets, traffic improvements, park facilities, bike master plan, etc.). ENVIRONMENTAL IMPACT In accordance with the California Environmental Quality Act, the recommended actions are exempt from further review. Categorical Exemption Environmental Review No. 2012-36 was filed for this project. Contract Award For Maple Bike Trail Safety Enhancements at Occidental Street, St. Andrew Place and St. Gertrude Place October 21, 2014 Page 3 FISCAL IMPACT The estimated total delivery cost of this project is $262,754, which includes construction, contract administration, inspection, testing, surveying, and contingencies (Exhibit 2). Funding is available in the Select Street Construction Fund (Accounts 05917663-66220 and 05917660-66220, Project 13- 6797). rr a iviousavipour Ex cutive Director Public Works Agency FM/EWG/ET Exhibits: 1. Location Map 2. Cost Analysis 3. Project Bid Package APPROVED AS TO FUNDS AND ACCOUNTS: Francisco Gutierrez -- Executive Director Finance & Management Services Agency Contract Award For Maple Bike Trail Safety Enhancements at Occidental Street, St. Andrew Place and St. Gertrude Place October 21, 2014 to 120 5T QERTRUD �i W)JECT LGCAMO N IM: R EXHW 1 0A R SANTA ANA PFIOJECT'13-, T 141 ��� �pi � � MAPLE FAKE TRAIL SAFETY ENHANCEMENTS PW A AGENDA OA78 AT OC CIDENTAL S f, ET. ANDF9EW PLACE 02108M Z. Ana AND ST. GERMUDE PL ruga emns r PAYEE 1 OF 1 COST ANALYSIS PROJECT 13-6797 MAPLE BIKE TRAIL SAFETY ENCHANCEMENTS AT OCCIDENTAL STREET, ST. ANDREW PLACE AND ST. GERTRUDE PLACE Construction Contract $224,887 Contract Administration $7,107 Inspection and Testing $9,079 Survey Staking $3,238 Contingencies $22,489 TOTAL ESTIMATED CONSTRUCTION COSTS $266,800 EXHIBIT 2 A 17"t £-ZID wIll �NM ,-V Q THE REGISTER 625 N GRAND AVE, SANTA ANA, CA 92701 Telephone (714) 796-7000 I Fax (714) 796-6059 PROOF OF PUBLICATION (2015.5 C.C.P.) Stain of California ) County Of ORANGE j s5 Notice type: BID- NOTICE INVITING BIDS Ad Description: Maple Bike Trail Safety Enhancements I am a citizen of the United Slates and a resident of the Slate of California; I am over the age of eighteen years, and not a party to or interested in the above entitled mailer. 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, Stale of California, under dale 1 1119M905, 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: 08118/2014, 081191'2014 Executed on: 08/19/2914 At SANTA ANA, California I certify (or Rectum) undor penalty, of perjury that the mrogohlg is True and corrnLl. )nln �I,,,,,. nn Irlrn,) vrrr�il„iray of proMnt fa•6767 Ynp4 ■Ikw 7rtll RWlrty gnDaneemenh Dealaintrl .twat, at. Androw veno a any at, frertnWo Sumer; DY. lobos Is hereby giv BID )ERs that this pro t L ended with Conaasdan MIg a told @hell be FEDERAL FUNDING: Proud No. 133797 Maple Size fore"" Sa/nly Enhancements Occi. dental $hast. St, Andrew Placa, and St. Gertrude Piece 010-50331149) will be funded In part byy federal fund., All bidder. stall meet all required federal rcq l'.. menta, included In hese Spacial Prov,.k s. The DOE eentreot goal 1.4,62% at aomI n or the I of the aggregate of file bid; Aag.arena. that the BID- To requ el a Co by mail, in ER will anler Into the pro- Contractor must submit a I posod cenlraet If the same is @mall request Ir rewarded to him. TM aly asomougUharen-ars.wg em ,helm/ o/ thr DIDDaiI provide the lollowing Inlol len thr old bond moot motion: Company nems be WeWlaad. r. moiling address, phos number, FedEx account, am The City Council reeonee email $ublscl heading: the right to /elect any or It bids. DD pr ua l for Pro'rot The auccceaful BIDDER T1.11 SafettyrClMr+noi• must pposses. r obtain o mrW4 -valid Celifarnla flags A Con- rRector's error to the 40ed Choekv are no 1.q or w oed award dote of tha cam corned. Addenda will be It tract ''vt,od pV small to those wb Signature DO NOT CALL PURCHAS. ING DIVISION REGARDING PUBLIC WORKS AGENCY PROJECT$. 3/18 8,10114 THE NlamyrLp R -t343 9955880 11111111111 II 1111111111 II Il l VI I 11111111 I II * A 0 0 0 0 0 3 5 1 4 4 1 a From the Requirements of the California Environmental Quality Act (CEQA) To: COUNTY CLERK From: Cityof Santa Ana County of Orange Planning & Building Agency P.O. Box 238 20 Civic Center Plaza M-20 Santa Ana, CA 92702 Santa Ana, CA 92702 Project Title: Maple Bike Trail Crossing Enha Data of Approval: 04116/2012 Project Number(s): PWA-2012-358-GAPP Project Location: 1 Citywide (Partial) City: Santa Ana County: Orange ER Number: ER -2012-36 Project Description: Currently, Class I Maple bike Trail crosses several residential streets, Using BTA funding, this project will enhance safety by constructing bulb outs to narrow the scree crossings. This segment Is part of the City of Santa Ana Bikeway Master Plan. This is a grant application. Applicant Name: Souri Amirani, Public Works Applicant Address: City of Santa Ana Ross Annex,20 Civic Center Plaza SANTA ANA, CA 92701 Name of Public Agency Approving Project: City Council Name of Person or Agency Carrying Out Project: Amirani, Souri Exempt Status: ❑ Ministerial (Sec. 15268) ❑ Declared Emergency (Sec. 15269 (a)) ❑ Emergency Project (Sec. 15269 (b through e)) ❑ General Rule (Sec. 15061(b)(3)/(5)) ❑ Statutory Exemption: ❑ Categorical Exemption: 15378 Reason(s) Why Project is Exempt From CEQA: Grant application is not a project per Section 15378. City Contac II Sob ke ice..= "` _� Telephone: (714) 647-5842 Signatur Title: azfc - pto t�� Date: o4r IT I_r_Iz MAYORtr Miguel A. Pulido CITY MANAGER David N. Roam MAYOR PRO TEM Claudia C. Alvarez CITYATTORNEY Joseph W. Fletcher COUNCIL MEMBERS 7i1 CLERK OF THE COUNCIL P. David Benavides Marla D. Huizar Carlos Buslamente Michele Martinez Vincent F. Sarmlento Sal Tinaiero CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza (M-20) P.O. BOX 1968 • Santa Ana, California 92702 (714) 667-2700 • Fax (714) 973.7461 www.snnto-ane.org NOTICE OF EXEMPTION From the Requirements of the California Environmental Quality Act (CEQA) To: COUNTY CLERK From: Cityof Santa Ana County of Orange Planning & Building Agency P.O. Box 238 20 Civic Center Plaza M-20 Santa Ana, CA 92702 Santa Ana, CA 92702 Project Title: Maple Bike Trail Crossing Enha Data of Approval: 04116/2012 Project Number(s): PWA-2012-358-GAPP Project Location: 1 Citywide (Partial) City: Santa Ana County: Orange ER Number: ER -2012-36 Project Description: Currently, Class I Maple bike Trail crosses several residential streets, Using BTA funding, this project will enhance safety by constructing bulb outs to narrow the scree crossings. This segment Is part of the City of Santa Ana Bikeway Master Plan. This is a grant application. Applicant Name: Souri Amirani, Public Works Applicant Address: City of Santa Ana Ross Annex,20 Civic Center Plaza SANTA ANA, CA 92701 Name of Public Agency Approving Project: City Council Name of Person or Agency Carrying Out Project: Amirani, Souri Exempt Status: ❑ Ministerial (Sec. 15268) ❑ Declared Emergency (Sec. 15269 (a)) ❑ Emergency Project (Sec. 15269 (b through e)) ❑ General Rule (Sec. 15061(b)(3)/(5)) ❑ Statutory Exemption: ❑ Categorical Exemption: 15378 Reason(s) Why Project is Exempt From CEQA: Grant application is not a project per Section 15378. City Contac II Sob ke ice..= "` _� Telephone: (714) 647-5842 Signatur Title: azfc - pto t�� Date: o4r IT I_r_Iz P13-6797; MAPLE BIKE TRAIL SAFETY ENHANCEMENTS AT OCCIDENTAL STREET, ST. ANDREW PLACE, AND ST. GERTRUDE PLACE; CM -5063(149) Attached please find the following documents: 1) ORIGINAL CONTRACT FROM EXCEL PAVING 2) ENVELOPE WITH DATE STAMP 3) PROJECTABSTRACT 4) PROOF OF PUBLICATION 5) EIR- NOTICE OF EXEMPTION MAYOR Miguel A, Pulido. MAYOR PRO TEM Sal Tinaloro COUNCILMEMBERS Angelica Amezooa P.. David Senavldes Michele, Martinez Roman Rayne Vincent F. Sarmiento September 2, 2014 ADDENDUM No. ONE CITY OF SANTA ANA 20 Civic Center Plaza . P.O. Box 1988 M-21 Santa Ana, California 82702 WMAt.Santa-$Marto CITY MANAGER David Cavazos CITY ATTORNEY Sohla: R. Carvalho. CLERK of THE COUNCIL Maria A. Hulzar SUBJECT: PROJECT NO. 13-6797, MAPLE BIKE TRAIL SAFETY ENHANCEMENTS AT OCCIDENTAL STREET, ST. ANDREW PLACE, AND ST, GERTRUDE PLACE, CM -6063(149) The following changes and clarifications have been made to Specifications for the subject project: Specifications 1. Appendix G: Replace entire Appendix G with attached Appendix G. 2. Page 30, Section 4.01 Traffic Control: Add the following after paragraph 1; "Contractor shall phase construction so that no two adjacent intersections are closed simultaneously." Clarifications Below are answers to questions received concerning the project: 1, This project has a DBE goal of 4.52%. Is this a mandatory goal (the bidder must meet or exceed this goal)? • No, this is a goal that each bidder must try to meet or exceed. 2, if the goal is not mandatory, is a Good Faith Effort (GFE) required? If a GFE is required, what form (15-H) or format should bidders use to demonstrate the GFE? The typical Form 15-H (see attached copy) is not in the specs. • If you have not met the DBE goal, complete and submit the DBE information— Good Faith Efforts, Ex 15-H form with the bid showing that you have made adequate good faith efforts to most the goal as stipulated in Appendix F, Exhibit 12-E, Section 2-1.02 of the special provisions. SANTA ANA CITY COUNCIL Mimi A•Mid 3141 0 M nrtF.samala l M10 In Ma,d,. Anwa Na ZW RDavd U001as P lnsdRy a M yor Mey,va Tam WAw6 94W Wa12 W,d3 W dA Wads magd I®eaa Silnale/dbxtlnl-9na oro y3 orylon ol@Xendad.d, I (gym Waaaaa,da exa.a, 93e,dv1d1Dn.,—wn flR m0,,dh..... ADDENDUM No. ONE I Page 2 3. Page IV states that this project"is implementing the new Race Conscious DBE Program". Based on what we've read, this RC DBE means UDBE (underutilized DBE): Is the DBE goal for DBE or UDBE? UDBE does not exist anymore. It is just DBE now. 4. The specs do not have the forms called, "Bidder's List of Subcontractors Parts I or II" (see attached copy from another bid).. iso bidders have to submit these forms with the bid? For subcontracting, use forms found on page BP -3 and BP -18. All other terms and conditions remain the same. FOR THE CITY Q SAj4TA ANA Acting City Engineer SANTA ANA CITY COUNM MIBJHk Polft 5Winpjem W.1 E Saz,nl6ldo MloW. MAJineYMpNiza Amnxu P.GAd Sea Ids ftR P nRayFln M4yIN MaW Pf im; WxYd6 W.1dI W41d2 WWW Wmd/ Ma aoaam a. Sfinvl ® eom V6arndanl@®MW-an Mhi MnoziIDaenm,;pryq�yg hGm asBma vnnnro Ivs., lJ nfiavnre�ann Wa US rm CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) PROPOSAL & CONTRACT AGREEMENT BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: P U � )CJXIAI 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 price(s) or lump sum(s) set forth in the following schedule: Item # Bid Item Unit Quantity Unit Price Amount 1. Unclassified Excavation* CY 610 $—(A-- _ $ Ao� 2. AC Pavement* IN 400 $Aam0f_ $ 5UdD .- 3. PCC Curb and Gutter (Type A-2-6) LF 800 $ 7�0,� $ 2,4000- 4. PCC Sidewalk (4") SF 6,400 $ 5. PCC Curb Ramp SF 1,800 $ 6. PCC Curb and Gutter (Type B-1) LF 80 $ $_2�_ 7. Adjust Water Valve Frame and Cover EA 7 $ q00 . mjgo).� to Finished Grade 8. Adjust Sewer and Drainage Manhole EA 5 $ $ to Finished Grade 9. Adjust Survey Monument to Finished EA 2 $ t w $ �. Grade 10. Remove Existing Fire Hydrant EA 1 BP 1 of 26 TO BE INCLUDED EQ BID PACKAGE 11. Furnish and Install Fire Hydrant EA 12. Signing and Striping LS 13. Furnish and Install 3X4' Truncated EA Dome Panel TOTAL $ )4000- $ 1 $—I $ 1= The lowest responsible bidder shall be selected based on the low total bid. The City reserves the right to award the Base Bid, and any, all or none of the 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. t This bid item is considered a Specialty Item per Section 2-3.2 of the Standard Specifications. PROJECT 13-6797 MAPLE BIKE TRAIL SAFETY ENHANCEMENTS AT Firm OCCIDENTAL STREET, ST. ANDREW PLACE, AND ST. GERTRUDE PLACE: CM -5063(149) Address Phone BIDDER LEMON. LCNG BEACH, CA 90806 (562)599-5941 Fax FAX ("a82l B'411465 Email "X"YJY—C� Pa i ��11��i" BIDDER 11 Signature�f1 BP 2 of 26 TO BE INCLUDED IN BID PACKAGE CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County Of L sAngeles; On 5Et before me, C.. Phillips, Notary Public (nae insist name and hue of the omem) personally appeared who proved to me on the basis of satisfactory evidence to be the personl&s(1 whose nameW is/ale subscribed to the within instrument and acknowledged to me that he/shakbagefexecuted the same in his&zdibeir authorized capacityQ20, and that by his4wvWa* signature(e) on the instrument the person(fi), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages _ Document Date (Additional information) CAPACITY CLAIMED BYTHE SIGNER WITNESS my hand and official seal. c Pill LIPS' s Corporate Officer COMM 461996177 a ❑ n NotaeY Public California N ❑ LOS ANCLLC'y (N ,Seal) Si ofNotary Public Mycomm, COUNTY ispiros Oct, 20, 2016 ❑ Other ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages _ Document Date (Additional information) CAPACITY CLAIMED BYTHE SIGNER ❑ Individual (s) ❑ Corporate Officer (1YUe) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other 2QQ1 .version.CAPAvl2,10,078.00_-873.9865 wwwNoteryClas es, in _ INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California mnel canmin verbiage exactly err appears above m the rosy section or a separate aeknawledgmerrr form must be properly complered and nitached to that daarmew. She only escepNan is f a docvmew is to be recorded owside ofCahforwa In anch imamx; any alternative aefrwwledgmenr verbiage as may. be printed on such a dawmew so tang as she verbiage does not require the notary to do something that is alsgal far a .nary M Cnl(forrrra (i.e. certffyrng the atdhorized c"do, of the signer). piease check the locum ew earefollyfor proper wm*d wording and arrach threform(fropired • State and County information must be Ute Slate and County where the document sigoer(s) personally appeared before the Canny pubticteraeknowledgment. • Date of notarization must be the date that the signer(s) persorway appeared which must also Who same date the acknowledgment Is completed. • The tsotary Public must print his or her name as it appears within his or her comndssion followed by a comma and Wen your title(notery public). • Print the naine(a) at document sdgiher(s) who Personally appear at the time of Canalization. • Indicate the Carred singular or plural farms by crossing off incorrect forms (i.e. haisheli ho) -is./are) or circling the correct forms. Foliate to correctly indicate this information nay lead to re)eotion of document recording.• • Tire notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, "4eal if Sufficient area Permits, otherwise complete a different admowledgmeat form. • Signature of the notary public must match the signature on ale with the office of the county clerk. h Additional hd'onmtion is not requited but could help to ensure this acdmowledgment is not misused or attached to a different document. Indicate title or type of attaphed doctmaent, number of pages and dale. V Indicate the capacity Claimed by the signer. If the claimed capsoity is a corporate officer, indloam the Ute (i.e. CBO,.CFO, Secretary). • Securely attach this documentlo the signed document CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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; '/2% of the bid or $10,000, whichever is greater - Buildings, parks, or other projects: %2% of the bid BIDDER proposes to subcontract certain portions of the work to the £inns listed below: NAMEd LOCATIONN PHONE 1 '� TYPE OF WO i $ 2q 0. LICENSE#b3)p NAME LOCATI, PHONE TYPE Of LICENSI I LOCATION' WS _ PHONE 24K - TYPE OF WO C1' U A D10W_ LICENSE # 0 fpr 3 NAME LOCATION _ PHONE TYPE OF WORK [' IgtB (uIr, BnAICENSE # [,'yr'iI E 3"NVIr6P'��+`' 1CMITIFlN'VIaTT Name of Firm Submit' B' Signature of BIDDER P. P, 1-39OWN, PRESIDENT NAME 6& LOCATION 1 u3 vtr G PHONE TYPE OF WORKj1Qj%c $ Z LICENSE # OFTILVIM LOCATI( PHONE TYPE OF LICENSE NAME LOCATION PHONE TYPE OF WORK LICENSE # LOCATION PHONE TYPE OF WORK LICENSE # TO BE INCLUDED IN BID PACKAGE BP 3 of 26 CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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; '/2% of the bid or $10,000, whichever is greater - Buildings, parks, or other projects: '/z% of the bid BIDDER proposes to subcontract certain portions of the work to the firms listed below: NAME LOCATION PHONE TYPE OF WORIC LICENSE # NAME LOCATION PHONE TYPE OF WORK LICENSE # NAME LOCATION PHONE TYPE OF WORK LICENSE # NAME LOCATION _ PHONE TYPE OF WORK H(+jS,IDWCENSE # _ Z4 Name of Firm Sub mjtti g i$ d Signature of BIDDER C. p, Ft&-0t�lM I RC :WENf 20= LOCATION PHONE TYPE OF WORK LICENSE # NAME LOCATION _ PHONE TYPE OF WORK LICENSE # NAME LOCATION PHONE TYPE OF WORK $ LICENSE # NAME LOCATION PHONE TYPE OF WORK $ LICENSE # BP 3 of 26 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) PROPOSAL & CONTRACT AGREEMENT I: 1 1 X&S31003V10211 BIDDER understands and agrees that this written proposal (or any part thereof specifically designated and accepted by the City of Santa Ana, hereinafter AGENCY) shall constitute the entire agreement between BIDDER and the AGENCY only after it has been accepted by the City Council, endorsed by the Clerk of the Council with her signature and official seal noting hereon the action of approval of the Council, signed by the Public Works Agency Executive Director or his duly authorized agent, and signed by the City Attorney, denoting his approval of the form of this document, and its execution, and when it or an exact copy of it has been either delivered to BIDDER or deposited with the United States Postal Service properly addressed to the BIDDER with the correct postage affixed thereto. BIDDER further agrees that upon delivery (as defined above) of the accepted agreement he/she will furnish AGENCY all required bonds and certificate of liability insurance within ten (10) business days, 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 secifically as part of this bid. 8�t�.k � 86 a s Name of Firm ZX£°EL (lA"t6NS COMPA�J �' Signature of BIDDER Title C. P. HQVtN, PIIESltiENT (if an individual, so state) BP 4 of 26 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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.) DUR 1,1CS)BA ua tl �� f V,4071 C MR -1 MY Curtis P. Drown President and Chief Executive owwr Curtis P. urown in vice res ent: and ChiefparatirrgfSFlreer CAllPO RATION Bruce E. Flatt Vice President and Chief FlnamcWg#Lrav Marcia S. Miller Secretary Michele E. Drakulich Assistant Secretase �/ CTION OF COUNCIL: Awarded to� (/� � eioc^ o12 IK l"nen on the basis of lowAt responsible and responsive bidder in the amount of / .�� $ 7� L�. !� Date S2G 20 /e5 ATTEST: zS �l1 � >.. r �P /V 7 `-7 CLERK OFTHE CQUNCIL CITY OF SANTA ANA: WORKS AGENCY TO BE INCLUDED IN BID PACKAGE BP 5 of 26 CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) (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 proposed subcon actor hereby certifies that he has , has not _, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by BIDDERS and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO -1) is the only report required by the Executive Orders or their implementing regulations. Proposed Prime Contractors and Subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. BP 6 of 26 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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 information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with such rules, regulations, and orders. 6. In the event of the Contractor's non-compliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole or in part and the Contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Execution Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies involved 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. BP 7 of 26 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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 , i l ^'u' Title Ca F. 0MV, N, PIYFSIDENT Finn1$�rbyi3„r f° El?F:R9 Date CEO - 8 2014 TO BE INCLUDED IN BID PACI{AGE BP 8 of 26 CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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 I, as the Contractor, now or at any time during the course of this agreement, qualify as an employer under California Labor Code Section 3300, unless the hired 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 C,F. U K1WN, P9ESW94T a Finn 1 x t f'IwLahln r -num Date SP a A 7014 TO BE INCLUDED IN BID PACKAGE BP 9 of 26 CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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. Name and Address of Owner. I® el y Name and Telephone Number of rson farnil'ar with project. t'J l;, 091 !1 >v» 12I Zn17 Contract Amount Type of Work Date Completed 2. &1 V, TNO cls kJ Name and Address of7kner. Vi Name and Telephone Number of person f m iar wi ro ect. qm = e Contract Amount Type of Work Date Completed 3. CL(7 SPY UI 6AAVIGJ �AJ-k AA1g14A f�o Name and A dress of owner. A S C lQ2Ea� 3 0 6 ?'fav Name and Telephone Number of persofi familiar with project. L r)l 1 TIL L KJ /4. e -ZOL4 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. 1111 V�elfif Aw, Wo Vim Ca BP 10 of 26 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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 (I F, OHOVIN, MESIDENT Firm Date BP 11 of 26 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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 that malting a false certification may subject the certifier to criminal prosecution. Signed State of California County of LOS ANGELES c ""' Subscribed and sworn to (or affmned) before me on this _day ofo��' 20_, C.P. DROWN proved to me on the basis of satisfactory evidence to be the persons) appeared before me. 44 - Notary PubliA 44griature AJ C. Phillips, Notary Public Notary Public Seal ,," 7_� by who TO BE INCLUDED IN BID PACKAGE BP 12 of 26 1L4�t p1.pllc-�,CS____res oct. 29, 2016 by who TO BE INCLUDED IN BID PACKAGE BP 12 of 26 CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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 C -P- BROINK MESIDENT taw e` i? WOMA Finn Date SEP 0 201" BP 13 of 26 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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: PAQ INC. DBA EXCEL PAVING COMP AW 29�36 LEMON SUE Business Address: LONG BEAU, GA POO Telephone: (562) 599-5641 State Contractor's License No. and STATE LI6o 6608659 *A' °' Expiration Date: Signed: Title: C. P• ER0HN,PRESIDENT TO BE INCLUDED IN BID PACKAGE BP 14 of 26 Project 13-6797 Maple Bike Trail Safety Enhancements At 1� Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) Q 1 PROPOSAL AND CONTRACT AGREEMENT FEDERAL REQUIREMENTS FOR FEDERAL -AID CONSTRUCTION PROJECTS GENERAL—The woklmpgmosedwillbefumucedjnwholeorjnpat v& Federal fiords, and therefore all of the swans, rules and regtatias pro milgded by the Federal Gainnrent and amicable to wait financed in whole a m pat will Federal finds will apply to such wait 'lire `Requited CnilartPurvisias, Fedgal Aid Co struljon Caitract%"Four FHWA 1273, are included in i1 s Section 14, w4zrvcr in saidrequued contract provisions refaar<es ere made tti "SHA CarMacuig off;" "SHA resicknt erhgurea;" or "artraized represantative of fie SMI" such rcEre noes shall be ocashmed to mean`J nghnea"asdeGnadin Section 1-1.18 of l eStax}ardSpecificatiaas. PERFORMANCE OF PREVIOUS CONTRACT - In addition in the pwisiaes in Section Il, `Naxlisc imina hoe,,' and Secdon VII, "Subletting or Assign the Cantor;" of the required axnhact }xovisia>s, the Contractor sball co plyVahtelollowiog. ' 't I'. I •I w I' V I GIII ' I' l 'J I 1 : 11' I I - II I - I:.�• '� 1111 I -Ir .I. :I iu I r.I :III I I 1 :I :I Ir I • . r I w� � .I :, III 'u :I I I- %' I • II I I- a I 1 I NONCOId USION PROVRONS -'Ile provisions in this section am ap,mlenblet3allmntatsao4tomtadsferFed2alAidS=on pgwN Tice 23, Unkil States Code, Section 112, requires as a condition prcoaknt to approval bytreFededI3ighwayAdm n shatoofthemutat*fori iiswoicllnt each BIDDER file a swam slatermentacmrtedby, oronbeli fof,,tlop rson, IjnA assadrtcr4 or cotpaahm to whom such contact is to be awarded, ontitymgtetsrrhlaasor,firm, ass iafian,o•mrpaationhasnol;eiflierdirectly or md'uaily, ordered job any ages ur pmbcpW jn arty mllruion or otherwise tArm any aur jnrestmd offine omTpe ftwbjddiug m connection wee the ahnited bid A form m peke the noncotusim affidavit shatonent ragarodbySection 112 as acertification urderpaialtyofpajoyrather t tan as a swan slatementaspormAtodby28,USC, Sec. 1746,ismdrdediriftprq»a al. PARTICIPATION BY DISADVANTAGED BUSINESS ENTERPRISES IN SUBCONTRACIING - Fart 26, Tike 49, Code of FedcdReglatjcm WljestodnisFed�d-mdpoject Pevinantsectio ns ofsaid OD&miroWo atedmpadorinilse ntndywifinotnersw&mofdmVocW 1 SdoduleB-hnfammhmforDdtaminmg7ont Vett=Etgbky. Athndmhont ExhHA-FRI 8-07.97 (This form need notbe filled in if all jointventure firms are minority owned) 1. Nano ofjoint venture 2. Address ofjoin venture 3. Phone number ofjoint ventare 4. Identify the firms which comprise thejointventure. (TbeDBE parhiermust complete Schedule A) a. Describe the role ofthe DBE firm in "joint venture. b. Describe very briefly the experience and business qualifications of each non -MBE joint venture: 5. Natureofthejointventure'sbusiness 6. Provide a copy ofthejoint venture agreement 7. What 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 BP 15 of 26 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) PROPOSAL AND CONTRACT AGREEMENT 9. C kel of and putic*c n in flys wnhact Identify by name, (Name) to me personally lhurwq who bang sworn, did exeaate the and eplaun fine tans and cpaatim of our joint ventre and dr lava, sex, and '*if' Aim L1dMduafs (ato fim Wes) who are intended parftopatim by ewb joint vanhm� in fine unndertalcung kwgo pope Y by (N ) affidavit t and did slake fiat } e or she was 1 aullxxiz d an of fun respcanble fu � day -today nxanapmr: and policy damon NaraeofFiun NaneofFimn mating mdedmg but not bur d to, flnose wide prirre vent= work and thepa}nnnrtfinaefineandaiypmposedcbmW NotayPubhc reslronabrldyfor sulakne Sg alae aFivancialdecis m audimzed represcriabrocs of the grantee cr the Feded Inndnag 1W agawy Any rnstaial numpresantation wM be grounds fcr Name Name h Marnern>entdedscrA sachas: T fle Tide 1. Estimating Dffie Date 2. Mai<etiugandsales I* Shteof 3. Flirmga d fningo&nnanageanxirt Connntyof 4.Pmdv nngofi*orifecmorsupphm On the — day of 20� before me appeared (nanr) ID me p 19AY lmown, who, being duly sworn, did execute the foregoing affidavit and did slate drat be or she was Mperiy auffnized by (Name cf fun) c. Supervnenoffieldopaations bo ecutetbeaf'idavitaddidso ashisorherfrceadanddwI NotayRblic Note: Ii; aka ft dus Sdiodrde B and before fine completion of Corin ssleo Whcs flnejoutvailurCswmm1hemitadcwaedb ftregrl M4 diene is any sign6 mt &mw m die infemn om abivftzd, the � ) jointved= must mfwmdnegrarFee,adud¢edlycrduu#the Duro lxvnecamacfm ifdnejouitver#= isasubw nVactor Sta(eof Af"" Camiyof 'Tv undersigned swear float flee f -eg* statnern s are On dos — da of 20_, befae me appeared coned and include all rnabe ial irdiximbon neczssay to iderofy (Name) to me personally lhurwq who bang sworn, did exeaate the and eplaun fine tans and cpaatim of our joint ventre and dr intended parftopatim by ewb joint vanhm� in fine unndertalcung kwgo pope Y by (N ) affidavit t and did slake fiat } e or she was 1 aullxxiz d an of fun Findma, the umda9gned covenant and agree to provide to grantee tnexec&the afidavitanddidso as his orherfieeadand deed amart, amynlete and aca;unate mfomstion regarding a&" joint vent= work and thepa}nnnrtfinaefineandaiypmposedcbmW NotayPubhc in any ofdnejointventareananganenisand topamrtdie auditand Coirnnmonexpires e nmiatim of ff ebooks, uecads, and files ofthe jointve n6se,by audimzed represcriabrocs of the grantee cr the Feded Inndnag 1W agawy Any rnstaial numpresantation wM be grounds fcr tarnirrating ary omaid whidn may be awarded ad for initiating action underFederal or Stak laws carcerning false slcaneriW' Attachment ExhHA FR2 8-07-9"/ BP 16 of 26 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA PROPOSAL AND CONTRACT AGREEMENT Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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.$t fa4 L: M1,. FtBi se'P rS n s Name of BIDDER MLIII Signature of BIDDER C P MOWN FED.8-22-88 Date , p - 8 2014 t NIESll)CNT BP 17 of 26 TO BE INCLUDED IN BID PACKAGE Exhibit 15-G2 Local Agency Bidder DBE Information (Construction Contracts) (Inclusive of all DBEs at bid proposal) NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX F AGENCY: LOCATION: PROJECT DESCRIPTION: PROJECT NO. 13-679T Maple Bike Trail Safety Enhancements Occidental Street St Andrew Place St. Gertrude Place CM -5063(149 TOTAL FEDERAL CONTRACT AMOUNT: $ 261.322 BID DATE: SFI — 9 Ng11 "t BIDDER'S NAME: ° ' CONTRACT ITEM OF WORK AND DESCRIPTION Cert.No.ofDBE NAME OF DBEs DOLLAR AMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened - include DBE address O BE PROVIDED and phone number i 3 '11M�o t PWAIN Ao213 Tlhtioid VD) 6 Z0,1 w 2 M0 rYl1 I u M QPL 'L For Local Agency to Complete: S j Total Claimed $ 6v &— Local Agency Contract Number Participation —L `^' Federal Aid Project Number. Federal Share 0/0 Contract Award Date: Local Agency certifies that all information is complete and accurate. �q��' r✓t�✓" Signature of Bidder P. WN, PRESI EN Print Name Signature Date Local Agency Representative Area Code Tele hone Number — X914 gJ6i) "a99�5B4! dl d Date (Area Code) Tel, No. For Caltrans Review: Print Name Signature Date Caltrans District Local Assistance Engineer Local Agency Bidder - DBE Information (Rev 3/09) Distribution: (1)Copy—Pax or scan acopy to the Caltrans District Local Assistance Engineer(DLAE) within 15 days of award. Failure to send a copy to the DLAE 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 (3) Original—Local agency files BP 18 of 26 CITY OF SANTA ANA PROTECT TITLE & NO. # PROPOSAL AND CONTRACT AGREEMENT NONLOBBYING CERTIFICATION FOR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influence or attempting to influence an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriate funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction unposed 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. CIJI 1 °, p, BROWN, POEa ENT BIDDER'S Signature P'1- ( N�{ �.+elS•�� J rte u'�ab ^ 2 - u.. Firm J bate • Standard Form LLL may be obtained from Caltrans and FaWA offices. BP 19 of 26 PALP, 2g;Z L.3 CITY OF SANTA ANA PROJECT TITLE & NO. # PROPOSAL AND CONTRACT AGREEMENT DISCLOSURE OF LOBBYING ACTIVITIES ConeDlete this form to disclose lobbvine activities nuranant to 41 i i c r r e;I 1. Type of Federal Action 2 2. Status of Federal Action 33.. Report Type: a. Contract A] a. Bid/offer/application a, initial b. Grant b. initial award b, material change c. Corporate Agreement c, post -award d Ban For Material Change only: e. Loan Guarantee Year quarter_ f Loan Insurance date of last reort 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and uubb Address ofPrhne: BEACMAMMistrict,i known Congressional District i known 6. Federal Department/Agency: 7. Federal ProgranmNameMescription CFDA Nurnber, If a licable 8. Federal Action Number, f knoivn 9. Award Amount, y lWown 10. a. Name and Address of Lobbying Entity b. Individual Performing Services (rcW#g cxaussif ufromNa (�m6iddr id esn fn9M9 IQq) 4WWgf0VnWgAO (attach Continuation Sheets) ifnecess ) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply) $ ❑ Actual ❑ Planned ❑ a. retainer ❑ b. one-time fee ❑ c. commission 12. Form of Payment (check all that apply): ❑ a. cash ❑ d. contingent fee ❑ b. in-kind; specify: nature ❑ e. deferred value ❑ f other, specify 14. Brief Description of Services Performed or to be performed and Dates) of Service, including officer(s), employee(s), or member(s) contacted, for Payment indicated in item 11: attach Continuation Sheet(s) i ess 15. Continuation Shee s attached: ❑ Yes o 16.hmfommadonrogrsleddia0diisfonnis attflmai,edbyTdle31 USCsec im 1352TlisdisclmoofkbbyngauMesisanrktigmpw moffadupam Signature__. C. v#dlrelumwwasplaadbyktuabovewhamtetmsadionwasnideoret"d. C. P. B¢t°)A,PHERDENT lila ltilsdisclwmneismegrmedpr antto31U.SC1352. Thisinbunationwillbe Print Name reportedtodrCmgess.ani,imLally"wiUbeavalablebTtbli mTedion kVMsanwdmo&lstofledmemagiieddiselosmshallbea4cdloaadpaaltyof Title artless dmam$10,000"notirmdmam$100,000faeach Rich lailtne (562) 599-5541 SEP - s 2014 Tel hone No. Date Fed®alUse0nly: Audlo izedforLoM Reproduction Standard Form—LLL BP 20 of 26 TO BE USED FOR FEDERALLY FUNDED PROJECTS ONLY CITY OF SANTA ANA PROJECT TITLE & NO. # PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING REQUIRED FEDERAL CONTRACT PROVISIONS (Form FHWA-1273) The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the required Federal Contract Provision (Form FHWA-1273) as shown in the appendix of the special provisions of this project. Signed Title Finn Date BP 21 of 26 Code MWN, PRENDEN CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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 $100,000 and that all such sub-recipientsshall certify and disclose accordingI �.� C1 C.M,PRESIDENT BIDDE i MR. 1G : a Firm SGP .- 9 2014 Date *Sndard,FomtLLL maybe o'litawed fon Cal'aus or�iw� offices +� i't k"'"", r�„x-.' ' ," +,�.� �; ..Ea`,,:a H y m... ,•••�•• ••• .. 4 . �.._ L< m.v,ak,.ts.: s£ V L.< [ Jt' BP 22 of 26 CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) PROPOSAL AND CONTRACT AGREEMENT BIDDER'S CERTIFICATE OF COMPLIANCE REGARDING `BUY AMERICA" REQUIREMENTS FOR STEEL OR MANUFACTURED PRODUCTS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the `Buy America" requirements of Section 165 of the Surface Transportation Assistance Act of 1982 and as shown in the special provisions of this project. Signed Title 6®psUROWi't,pilEwlDC-NI 16IR Firm,$s.r Date w d 9 201 CITY OF SANTA ANA BP 23 of 26 Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the BIDDER hereby declares under penalty of perjury under the laws of the State of California that the BIDDER has e , has not ,/ been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "BIDDER" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The BIDDER must place a check mark after "has" or "has not' in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed C.P. CROWN, PEIESIDENI Title R WIL FMr,a LiAQ.V& V aA `+F T31 (10.,4 V °�;'1 Yf Firm Date BP 24 of 26 CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) 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 Noz If the answer is yes, explain the circumstances in the following space. BP 25 of 26 CITY OF SANTA ANA Project 13-6797 Maple Bike Trail Safety Enhancements At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10232 STATEMENT In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor to comply with an order of the National Labor Relations Board. Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed C, P, BROW I, PHcSIDENT Title Firm DatgF,P - q 2014 BP 26 of 26 Bond No. The American Institute of Architects, AIA Document No. A310 (February, 1970 Edition) Bid Bond KNOW ALL MEN BY THESE PRESENTS, that we PALP Inc. dba Excel Paving Company as Principal hereinafter called the Principal, and Federal Insurance Company a, corporation duly organized under the laws of the state of Indiana as Surety, hereinafter called the Surety, are held and firmly bound unto City of Santa Ana as Obligee, hereinafter called the Obligee, in the sum of Ten percent of the total amount of the bid Dollars ($ 10% ), for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for Maple Bike Trail Safety Enhancements 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 famished in the prosecution thereof, or in the event of the failure of the Principal to enter 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. Signed and sealed this 26th day of August , 2014 PALP Inc, dba Excel Paving Company Witness ,pp Principal (Seal) By: C,� , P DROWN, PIIUMENT Name/Title Witness ORSC 21328 (5/97) Federal Insurance Company Surety (Seal) By: 0. A Dougl s A. Rapp Attorney -in -Fact ACKNOWLEDGMENT State of California County of Orange ) On 8/26/2014 before me, Debra Swanson, Notary Public (insert name and title of the officer) personally appeared Douglas A. Rapp who proved to me on the basis of satisfactory evidence to be the person(A) whose name($) is/are subscribed to the within instrument and acknowledged to me that helel-iefEHey executed the same in hisAeNtheir authorized capacity(4*, and that by hisAeFAhalt signature($) on the instrument the person(st), or the entity upon behalf of which the person(o) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.DEBRA SWANSON Eni nr rw N COMM. #1997119 X r NOTARY PUBLIC-CALIFORNIA� ue CC ORANGE COUNTY + N Signature IL.A . �-42r )J) MVN. (Seat) `4 o�M MYCOMM, EXP, NpV10, x016 Chubb POWER Federal Insurance Company Attn: Surety Department OF Vigilant Insurance Company 15 Mountain View Road _....__ Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Linda D. Coats, Matthew J. Coats, Douglas A. Rapp and Timothy D. Rapp of Laguna Hills, California ----------- each as their true and lawful Attorney- in- Fact to execute under such designation In their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed In the course of business, and any Instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to In said bonds or obligations. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 16th day of November, 2009. Kenneth G. Wendel, Assistant Secretary Norris, Jr., Vice Pled ant STATE OF NEW JERSEY as. County of Somerset On this 16th day of November, 2009 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he Is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Norris, Jr., subscribed to said Power of Attorney is In the genuine handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By - Lam and in deponents presence, Notarial Seat KATHERINE J. ADELAAR NOTARY PUBLIC OF NEW JERSEY ��N No 2316685 raOTARY Cammiaaieo ExpvesJuly 16, 2014 s.s-� Sr PUBLIC Notary Public a'JEPg� CERTIFICATION Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: "All powers of attorney for and on behalf of the Company may and shall be executed In the name and on behalf of the Company, either by the Chairman or the President or n Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President, any 5ecietary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any cerliflcate relating thereto appointing Assistant Secretaries or Attorneys in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate beading such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies") de hereby certify that (1) the foregoing extract of the By- Laws of the Companies Is true and correct, (I) the Companies are duly licensed and authorized to transact surety business In all 50 of the United Slates of America and the District of Columbia and are authorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (Ili) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this August 26, 2014 _. u1pMNn� a�'.Xrnr aSUsnbcF x xNeIAHP " nax` • 'sew WR�a /LtiLliyLf/G"lU Lt. Kenneth C. Wendol, Assistant t Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903- 3656 e-mail surely®chubb Qom FUrin 15-70-02250-U (Ed.5-03) CONSENT CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Los Angeles On SEP " 9 2014 before me, C. Phillips, Notary Public (Hae mean Cane and title of the omcer)- personally appeared who proved to me on the basis of satisfactory evidence to W the personW whose nameW is/Idse subscribed to the within instrument and acknowledged to me that he/sksitlwgecexecuted the same in hist authorized capacityi@gv), and that by his/ mrdhil Il; signature(3) on the instrument the person(fi), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. q( C PHILLIPS ld COMM 11996177 n WITNESS In hand and official seal. a 0 }' a �,_. Notary Pubpc Calrfornla � w LOS ANGELES COUNTYCAI u .o, My Comm. Expues Oct. 29, 2016 Si ofNoury public (NomrY Seal) T �- �� ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached doounsent) (Title or description of attacheddocument continued) Number of Pages _ Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer .(Tice) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other INSTRUCTIONS FOR COMPLETING THIS FORM Any aeknowledgmem complered in California marl conwin verbiage asnttly as appears above In the Notary section or a separare acinowledgmrm form aawt be properly. comi4cfed and attached to Char domomenr, rhe only avctpam is if a docvmew is ra be recorded o,aside of California In mch imrows. Cary alrernarive addnowledgmear verbiage as maybe printed an such a docamem m long our the verbiage does not require the nolwy to do something Cwt is dlegaf for a notary in Californk (s.e, eerfifyiag the mdborised apathy of rhe signer). pleat, Cheek The docawem CC?C1W1Yfwproper nerarlat wording and attach thleform ifnegafeed • Stare and County information must be dw Slate and County where the document Signor(* personally appeared before the notary, publicforacknowledgment. • Date of notarization must be the date that die signor(s) personally appeared which must else be the same date the acknowledgment Is completed. • The nobly public must print Ws or her name as it appears wiadn his or her commission followed by a comma and men your title (notary public). • Print the narne(s) of document signer(a) who personally appear at the tlme of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forts (i.o hwahe46eyr• Mere ) or cirelingvia correct forms. Failure to correctly indicate this Information may lead to rojemion of document recording.• • The notary real impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, rmenl if a sufficient area permits, otherwise complete a different acknowledgment term. • Signature of the salary public must match We signature on file with the office of the county clock. d Additional infornmtion is not required but could help to omure tlls acimowledgment is not mlsused or atached to a dtferont doaunmt. ? Indicate tide or type of ottarlhed docmtent, number of pages and date. r'• Indicate the capacity claimed by the signer, If the olahmod capacity b a corporate officer, indieatd the rte 0.e. CEO,.CFO, Secretary). • Socurely attach this documatitW the signed document _.__ ,200A. Vofsion CAP.A v12,16.0.78O_"73,•9ge5 www,NoteryClpsses,too APPENDIX F Federal Requirements & Requirements for Federal -Aid Construction Projects (Form FHWA-1273) Local Assistance Procedures Manual V~ EXHIBIT 12-E PS&E Checklist Instructions Attachment A ATTACHMENT A SECTION 14. FEDERAL REQUIREMENTS FOR FEDERAL -AH) CONSTRUCTION PROJECTS GENERAL.—The work herein proposed will be financed in whole or in part with Federal funds, and therefore all of the statutes, roles and regulations promulgated by the Federal Gov- emment and applicable to work financed in whole or in part with Federal fiords will apply to such work. The 'Required Contract Provisions, Federal -Aid Construction Contracts, "Form FHWA 1273, are included in this Section 14. Whenever in said required contract provisions references are made to "SHA contracting officer," "SHA resident engineer," or "authorized representative of the SHA," such references shall be construed to mean "Engineer" as defined in Section 1-1.18 of the Standard Specifications. PERFORMANCE OF PREVIOUS CONTRACT.—In ad- dition to the provisions in Section II, "Nondiscrimination," and Section VII, "Subletting or Assigning the Contract," of the re- quired contract provisions, the Contractor shall comply with the following: The bidder shall execute the CERTIFICATION WITH RE- GARD TO THE PERFORMANCE OF PREVIOUS CON- TRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND THE FILING OF REQUIRED REPORTS located in the proposal. No request for subletting or assigning any portion of the contract in excess of $10,000 will be considered under the provisions of Section VII of the required contract provisions unless such request is accompanied by the CERTIFICATION referred to above, executed by the proposed subcontractor. NON -COLLUSION PROVISION.—The provisions in this section are applicable to all contracts except contracts for Federal Aid Secondary projects. Title 23, United States Code, Section 112, requires as a condi- tion precedent to approval by the Federal Highway Administrator of the contract for this work that each bidder file a sworn statement executed by, or on behalf of, the person, fine, association, or corporation to whom such contract is to be awarded, certifying that such person, firm, association, or corporation has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive biddingin connection with the submitted bid. A form to make the non -collusion affidavit statement required by Section 112 as a certification under penalty of perjury rather than as a sworn statement as permitted by 28, USC, Sec. 1746, is included in the proposal. PARTICIPATION BY DISADVANTAGED BUSINESS EN- TERPRISES IN SUBCONTRACTING.—Part 26, Title 49, Code of Federal Regulations applies to this Federal -aid project. Pertinent sections of said Code are incorporated in part or in its entirety within other sections of these special provisions. Schedule B—Information for Determining Joint Venture Eli- gibility FR -1 (This form need not be filled in if all joint venture firms are DBE owned.) 1. Name ofjoint venture 2. Address ofjoint venture 3. Phone number ofjoint venture 4. Identify the frets which comprise the joint venture. (The DBE partner must complete Schedule A.) a. Describe the role of the DBE firm in the joint venture. b. Describe very briefly the experience and business qualifications of each non -DBE joint venturer: 5. Nature of the joint venture's business 6. Provide a copy of the joint venture agreement. 7. What 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.). Revised 3-95 0&M-95 Page 12-9 OR 12-04 June 29, 2012 "\Ir- EXHIBIT 12-E Local Assistance Procedures Manual Attachment A PS&E Checklist Instructions a. Profit and loss sharing. b. Capital contributions, including equipment. c. Other applicable ownership interests. 9. Control of and participation in this contract. Identify by time, race, sex, and "firm" those individuals (and their titles) who are responsible for day-to-day management andpolicy decision making, including, but not limited to, those with prime responsibility for: a. Financial decisions b. Management decisions, such as: 1. Estimating 2. Marketing and sales 3. Hiring and firing of management personnel 4. Purchasing of major items or supplies c. Supervision of field operations Note.—If, after filing this Schedule B and before the comple- tion of the joint venture's work on the contract covered by this regulation, there is any significant change in the information submitted, the joint venture must inform the grantee, either di- rectly or through the prime contractor if the joint venture is a subcontractor. Affidavit "The undersigned swear that the foregoing statements are cor- rect and include all material information necessary to identify and explain the terms and operation of ourjoint venture and the intended participation by each joint venturer in the undertaking. Further, the undersigned covenant and agree to provide to grantee current, complete and accurate information regarding actual joint venture work and the payment therefor and any pro- posed changes in any of the joint venture arrangements and to permit the audit and examination of the books, records and files of the joint venture, or those of each joint venturer relevant to the joint venture, by authorized representatives of the grantee or the Federal funding agency. Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initiating action under Federal or State laws concerning false statements." Revised 3-95 08-07-95 FR -2 ...................................................... Name of Finn Name of Pimm ................................................................ ...................... Signature Signature .......................................................................I.,........ Name Name ....:.............. .... .............. I ......... .............................I ...... . Title Title ................................................ ................ I .......... ....... Date Date Date State of County of On this _ day of 19 _, before me appeared (Name) to me personally known, who, being duly sworn, did execute the foregoing affi- davit, mid did state that he or she was properly authorized by (Name of firm) to execute the affidavit and did so as his or her free act and deed. Notary Public Commission expires [Seal] Date State of County of On this _ day of , 19 _, before me appeared (Name) to Inc personally known, who, being duly sworn, did execute the foregoing affidavit, and did state that he or she was properly authorized by (Name of firm) to execute the affidavit and did so as his or her free act and deed. Notary Public Commission expires [Seal] Page 12-10 June 29,2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B ATTACHMENT B REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS L General L Nundisrdmirmtion III. Nonsegregated Facilites IV. Dards-Bacon and Related ACL Provisions V. Contract Work Hours and Safety Standards Act Provisions M. Subletting to AmEgningthe Contract VII. Salety: Aceldent Prevention 'AIL False Statements Concerning Highway Pngeds IX Implementation of Clean Air Act and Federal Water Pollution Central Act X Comp1tance with Governmenhuids Suspension and Debarment!Requimmerrls XL Codification Regarding Use of Contract Funds for Lobbying ATTACHMENTS A Empoyment and Materials Preference for Appalachian Development Highway System or Appalachian Loral Access Road Contracts (included In Appalachian contracts only) L. GENERAL 1. Form FHWA-1273 must be p*imny incoWaM in each construction contract funded under llbe 23 (excluding emergmcyccnbctssolelyintandedfordebdsmmowat). The contractor (orsuhmntracax) must lused this farm in each subcordract and Turther require to Inclusion In an II her subcontracts (excluding purchase orders, rental agreements and other agmennerda for supplies a services).. The applicable requirements of Form FHWA-1273 are incorporated by reference far work done under my purchase order, rental agreement or agreement far other sentices. The prime consmctarshall be responsible for comptiance;by any subcontractor, lower -tier subcontractor orservice, provider. Form FHWA-1273 =af be included In afi Fedamt-aid dewgr- butd contracts, in all subcontracts and in Lower der subcontracts [excluding subcontracts W dasign services, Purchase orders; rental agreements and other agreements for suppliesor services). The tlesign-buffdershalt be responsible for compliance by any subcontractor, lawer-tiersubcontractor orservice provider. Contracting agencies may reference Form FHWAA273 in bid pmposal or request for proposal documents, however, fie Form FHWA-1273 must be phys[ca[ly hrcurporated (not referenced) In all contracts, subcontracts and lower-¢ier subcontracts tuc uding purchase ordem, rental agreements and other agreements Wsupplies or services misted to a construction contact). _ 2. Subject In the applicability cmena noted in ft following sectons, these contract provisions shall sop" all wok performed on the contract by the contractors own organization and with the assistance of workers under the commctofs Immediate superintendence and to all work performed on the contract by pacework, station work, a by subcontract OB 12-05 R FWA-1273— Revised May t, 2012 3. A breach of any of the stimletims contained in these Required Contract Provisions may be esu ffctentgrourds for withholding of progress paynuarts, withholding of frenal payment, lamination of the cantrad suspansian f deban m or any otheractbn determhad to be appropriate by the conlradng agency and FHW k 4. Selection of Labor. During the pedommnce of this comasL the contractor shall nut use convict labor for any purpose w" the limits of a 0011drucifiCa Pf0jecton a Fedemhald highway unless it is labor performed by convicts Who aro on parole, supervised mlesee, or pmbaton. The ten FocI xid highway noes not include madways functionally classified as local mads or WWI mirror collectors U. NONDISCRIMINATION The Pmvdsions of this MCUM mlalad to 23 CFR Part 230 am applicable to all Fedeml-aid construction contracts and to all related rwnsneUm subcortmcis of $10,000 or mom_ The pmvisions of 23 CFR Pat 230 am not applicable to material supply, engineering, or architectural servtra contracts. In adtlifiw, the contractor and al subcontractors must comply with the following policies: E ceadive Order 11246, 41 CFR 06, 29 CFR 1625-1527, Title 23 USC Section 140, the Reha a ita6on Act of 1973, as amended (29 USC 794), Tfite M of the Civil Rights Act of 1964, as amended, and muted regulatfons including 49 CFR Pads 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. The conaadarand all subcontractors must cs faywifh: the requirements of the Equal Opporturdy Clause in 41 CFR 50- 1-4b) and, farall construction cmimcts sneering $18,000, the Standard Federal Equal Employment Oppormnity Conshucton Contract Speclficalions In 41 CFR 684.3. Note: The U.S. Department of Labor has e,dmim authority fon determine, co"llancewith Executive Omer 11246 and the. Policies of the Secretary of Labor including 41 CFR 60, and 29 CFR 1625-1627. The contracting agency and the FHWA have the authority and the tesponslbllity to ensure comptianm with This 23 USC Section 148, the Rehabilitation Act of 1973, as amended (29 USC 794), and Two M of the Chill Rights Act of 1964, as amended, and related regulators including 49 CFR Pads 21,26 and 27; and 23 CFR Pads 200, 236, and 633. The following provision is adopted from 23 CFR 230, Appendix A with appmpdate misters to comb" to the U.S. Department of Labor (US DOL) and FHWA remamments. 1. Equal Employment Opportunity: Equal employment opportunity (EEO) requirements not to discriminate and to take albrnrative acban to assure equal opPohnty as set forth antler laws, executive orders'rules regulations (28 CFR 35 29 GFR 1638, 29 CFR 1625-1627, 41 CRR 60 and 49 CFR 276 and orders of the Secretary of Labor as modified by tie provisions prescribed herein, and imposed Pursuant to 23 U.S.G.140 Shari COM itum the EEO and specific atbmmadve action standards for the contractors project acbVUfes under Page 12-11 July 31, 2012 E%HIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions this contract The provisions of the Americans with Disalvlities Act of 1999 (42 U-S.C. 12101 et seq.) set Mirth under 26 CFR 35 and 29 CFR 16W are Incorporated by reference in this contract. In the execution of this contract, the eontmctor gees to comply with the following minimumspecific requirement activities of EEC]: a.. The contactorvnll work with the conlracGpg agency and the Federal Oovemme d to ensum that it has made every good faith effort to provide equal opportunity Mb respect to all of its terns and conditions of employment and in their review of activities undarthe contract K The ronlractorwtlll accept as its operating policy the following statement 'Itis the policy of this Comparnyto assure that applicants are employed, and that employees we treated during employment, without regard to their race, religion, sex, colo, national origin, age ordisability. Such action shall Include - employment upgrading, demotion, or transfer, recruitment of recruitment advertising; layoff atearmsfien; rates of pay OF other form of compensation.; and selection for training, Including apprenticeship, pre -apprenticeship, ancVoron-the- job training 2. EEO Officer: The contactor will designate and make known to the contracting officers an EEO Officerwhaw ill have the reslonsibiilityforand must be capable ofeffectively administering and promoting an active EEO program and who must be assigned adequate authority and responsibility to do so. 3. Dissemination of Policy: All membered the contractors staff who are atnhonzed to hire, supervise, promote, and discharge employees, orwbo recommend such action, or who am substantially involved in such action, will Ire made fully cognizant of, and will rrpiement, the contractors EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above agreementwiti Ire met, the following actions will be taken as a minimum: a. Periodic meetings of supervisory and personnel office employees will lis conducted before the start of work. and than not less often than once every six months, at which time the contractor's EEO policy and its implementation will be reviewed and explained. The meefirgs villi be conducted by the EEO Officer. b. All new supervisory or personnel office employees AN be given a thorough Indoctrination by the EEO Officer, covering all majoraspects of the contractors EEO obligations within thirty days fotlawing their reporting f irciuty with the contractor. c, All personnel who are engaged to direct monalmerd for the project will be instructed by the EEO Officer in the contractors procedures for locating and hiring minadOes and women. d_ Notices and posters setting form the contractors EEO policy will be placed in areas readily accessible to employees, applicants for employment and potential employees.. a. The contractors EEO policy and the procedures to implement such policy All be brought to the attenfion of employees by means of meetings, employee handlwnks, or other appropriate means. Page 12-12 July 31, 2012 d. Recruitment. When advorii rrg for employees, the contradorwill include in all advartisarrients forempdoyees the notation: An Equal Opportunity Enrplrayer." AM such advertisements will be placed in publications having a large circulation among minorities and women No the area from which the project worn force would nir raaty be derived. a. The contractor will, unless precluded by a valid bargaining agreement, conduct symeacetic and direct recmihment through public and private employee referral sources likely to yield qualified minaOfas and worsen. To meet this requirement, the contractor war identify sources of paleallal rrdncdty 910up employees, and establish with such identified sources procedures whereby minority and vonnen applicants may be referred to the contractor for employment consideration. b. In the event the contractor has a Wild bargaining agreement providing for exclusive hldrtg hall referrals, the contractor is expected to observe the provisions of that agamor itto the extent that the system meets the mntractar's compliance with EEO contract provisiarw. Where inpiementadan of such an agreement has the effect of discriminating against minorities or women, or obligates the contactor to do the same, such implementation violates Federal nondiscrimination provisions. c. The contractor will encourage its prmmntemployees to refer minorities and women as applicants foremplo}mnert. dnforrnation and procedures with regard to refining such applicants will be discussed with employees, S. Personnel Actions: Wages, working conditions, and employee benefits shall be established and administered, and personnel actions of every type, including hiring upgrading, Pronhogoa, transfer, demotion, layoff, and termination, shall be taken without regard to race, color, religion, sex, national origin, age or disability. The following procedures shall be followed: a. The contmUorwiII conductperiodic tnspedionsofpniject sites to imisthat working eondifiohs and employee fadkfies do not indicate discriminatory la sbnera of pmject site personnel. b. The connector will periodically evaluate the spread of wages Paid within each classification to rletemrfne any evidence of discriminatorywage practices. c. The contractor =11 periodically review selected personnel actions in depth to determine wthadea there is eAck ace of discrimination. W! Item evidence is found, the contractor will pmmptytake oormctive acficn. If the mviewinddcates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all affected persons. d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor in connection with its obligations undo this contract, will attempt to resolve such complaints, and All take appropriate corrective motion wthm a reasonable time. If the investigatlol indicates thatthe discrimination may affect persons other than the cgnplatnant, such corrective action shall include such other persons. Upon completion of each investigation, the contractor will Worm ovary tomplam2ntof all of thafr avenues of appeal - 6. Training and Promotion: a. The contractor will assist in foaling, qualifying, and increasing the skills of minorities and women who are OB 12-05 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B applicants faremploynuenl or current employers. Suchaforts should be aimed at developing full journey laves status employees in the type of trade or job classi8cabon Involved. b. Consistent will the contactors wort force regpirametds and as peanissible under Federal and State regulations, the contractor shall make full use o€training programs, i.e., apprenliceship, and on-titig-job training programs for Me geographical area of contract performance. In the evema special pravisbn for taring Is pmvided mderttris contact, this subparagraph will be superseded as indicated in the special provision. The cdntading agency may reserve banning positions for persons who receive welfare assistance in accordance with 23 U.S.C. f46(a). c. The contactor will advise emtployees and applicants for eagoymerd of available training programs and entrance requirements for each. it. The contractor will periodically raview:Um training and promotion polental ofemployees who are minorities and worsen and will encourage eligible employees to apply for such training and;prono6on. T. unions: If the contaulor renes in whole or in pad upon unions as a source of employees, the contractor vall use good' faith efforts to obtain the cooperation of such unions to Increase opportunities for minotfies and women. Actions by the contactor, either dteski9i or through a coatactaes association acting as agent, WN include the procedures set forth below a The contacrorw1l use good faith efforts to develop, in cooperation with the unions, joint training programs aimed toward qualifying mora minorities and woman for membership in the unions and Increasing the skills of minoritiesand women so that they may qualify for higher paying employment. b.. The celtachor will use good faith efforts to Incorporate an EEO clause into each union agreement to the end gnat such union will be contractually bound to refer applicant without regard to their race, color, religion, sax, national origin, age or dtsolnitity. c. The wrdmctex is to obtain information as to the referral practices and policies of the labor unon except that to the. extent such Information is within the exclusive possession of the labor union and such laboruni n refuses to furnish such information to the contractor, the contractor shall so cenffyto the contracting agency and shall set forth what efforts have been made to obtain suchinformation. d. In the event the union is unable to provide the contractor with a reasonable flaw of referrals withal the time Nmit set fnnh in the collective bargaining agreement, the contractor will, through Independent recruitment agorts, fill the employment vacancies without regard to race, color, religion, sere national origin, age a disabift, molting Irl efforts to obtain qualified andfor qualifiable minodtas and women. The failure of a union to provide suftciant refenais (even though it is obligated to provide exclusive refamals under the terms of a collective bargaining agreement) does not relieve We contractor from the requirements of this paragraph. len the avert the union referral practice prevents the contractor frown meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, men contactor shall immediatelynotify the contacting agency. 8. Reasonable Accommodation for Applicants Employees with Disabilities:. The contractor must be familiar OR 12-05 With the requirements for and comply with the Americans with Disabilities Act and all rules and regulations established there under. Employers must provide reasonable accommodation in all employment activities runless to do so would cause an undue hardship. 9. Selection of Subcontractors,: Procurement of Materials and Leasing of Equipment: The cnntmcOrshall nut dlsedminale on the grounds of race, color, reVgim, sex, national origin, age or disability in the selection and retention of subcontractors, including procurement of materials and teases of equipment The contractor shall take all necessary and reasonable steps b ensure nondiiscdmination in the administaton of this contract. a. The conhaclorshall ratify all potential submntactors and suppliers and lessors of their EEO obligations undarthis contact b. The conlractorwil use good faftn efforts to ensure subcontractor compliance vrith their EEO obligations_ I9. Assurance Required by 49 CFR 26.13(6): a The requirements of 49 CFR Pad 26 and the State DDT's U.S. DOT-2PPmved DBE program are incorporated by reference_ b. The crantacbr Orsubcontradorshali not ctiscrimmateon the basis of coca, color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of 49 CFR Pad 26 In the award and administration of DOT-assigued contracts. Failure by the contractor to carryout those requirements Is a material bmach of INS conimcl, which may result in the termination of tris contractor such other remedy as the contracting agency. deems appropriate. 11. Records and Reports: The contactor shall keep such records as necessary to document compliance with the EEO requirernehts. Such ireeods shall be retained for a padof of three years folllowing the date of the final payment to the C01542:101' for all contract weft. and Shall be available at reasonable Bross and places for inspection by authorized representatives of the contracting agency and Bre FTiNJA. a. The records kept bythe contaciorshail document the fallowing: (t) Trite number and work hours Of minotdy antl Son, 11111011Y group members and women employed In each work classification on the project; (2) The progress and efiods being made in cooperation with unions, when aWficable, to increase employment Opportunities for minontes and women; and (3) The progress and Mile being made in locating, hiring, training, qualibmil, and nupgredrng Maorites and women; b. The contactors and subcontractors wfN submitan annual reportto the contracting agency each July for the duratiorn sof the project, indicating the number of minority, woman, and norm-mirodly group eupleyees currently engaged in each work classification required by the cwdractwork. this Information is to be reported on Form FI -MA -1391 . The staffing data should represent the pmject work force an board in all or any pad of the last payroll peird preceding the and of July. if on-thejrtu training is being required by special provision, the contactor Page 12-13 July 31, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B IPS&E Checklist Instructions wOl be required to collect and report training data- The emptoymsnt data should reflect She work tome. on board during all Or any part of the test payroll period preceding the end of July - 111. NONSEGREGATED FACILITIES This provisicii is applicable to all Fedemt-aid construction contracts and to all related corstmetion subcontracts of $10,090 or more - The contractor must ensure that f rcisliliies provided fur employees are provided in such a manner that segregator on the ibasis of race, color, refigion� sex, or national origin cannot result The contractor may neither require such segrogated use by written or oral policies nor tolerate such use by employee custom. The contractor'sobiigadon extends further to ensure that its employees are not assigned to perform their services at any location under the contractors control, where the facilf ies are segregated. The term "facilities" includes waiting rooms, work areas, restaurants and other eating areas,. time clocks, reatments, washrooms, locker rooms, and other storage orrtressing areas, parsing lots, drinking fountains, recreation or entertainment areas, transportation, and housing pmvidedforemployess. The contractor shall provide separate or single -tater rest ems and necessary dressing or sleeping areas to assure privacy behvcen sewer IV. DAVIS-BACON AND RELATED ACT PROVISIONS This section is applicable to all Federal -aid ooistmetion projects exceeding $2,000 and be al[ related subcontracts and lower --tier subcontracts (regardless of subcontract size). The requirements applyto all projects located within the right-of- way of a roadway that is functionally classified as Federal -aid highway- This excludes roadways functionally classified as local reads or rare[ minor collectors, which are exempt Cordmdirg agencies may elect to aptly these requiremenis to other Projects. The folkawing praWshoms; are from the U -S- Department of Labor regulations in 29 CFR 5.5 'Contract provisions and related maters" with minor revisionsto conform to the FHWA- 1273 format and FHWA program requirements. 1. Minimum wages a. All laborers and mechanics employed orwodring upon the site of the work, will be (raid unconditionally and not less often than once a week, and withal subsequent deduction or rebate on any account (except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act (29 CFR pad 3)), the full amourd of wages and bona fide fringe benefits (or cash equivalents thereat) due at time of payment computed at rates not less duan those contained in the wage determination of the Sectary of Labor which is alrached hereto and made a. pard hereof, regardless of any contractual relationship which may be allegedto exist between the contractor and such laborers and mechaNce. Contributionsmade or rests reasonably anticipated for bona fide fringe benefits under section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions Page 12-14 July 31, 2012 Of Paragraph td. of this sGUM else, regularconfibutions made or costs incurred for more them a weekly pored (but not less often Phan quarterly) under purrs, funds, or programs which. cover the Particular weekly pe<ridd, are deemed to he constructively made or incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage delamtinadion for the classification of work actually performed, without regard to skill, except as provided in 29 CFR -9.5(a)(4). Laborers or mechanics performing work In more than one crasswcation may be compensated at the rate sPectfied for each class ficadon for the time actually wcgdked therein: Pmvicied, That the employers payrol€ records accurately set ford, the time spent in each classification in Which work is performed. The wage determination (including any additional chassigcation and wage rotes conformed Under paragraph t -b, of this section) and ft Davis-Bamn poster (WH -1321) shall be Posted at all times bythe contractor and its subcontractors of the site of the work in a prominent and accessible place where it can be easily seen by the workem- b.(1) The contracting officer shall require that any class of laborers or mechanics, including helpers, which is not flsfed in the wage determination and which Is to be employed under the contact shall be classified in conformance with the wage determination. The contracting Officer shall approve an additional classification and wage rate and fringe benefits therefore only when the following criteria have been met 0) The work to be performed by the classification requested is not Performed by a classification in the wage. deiemiinagon, and (ii) The clasaifiUnion is ufilVed in the area by the c:anstruoion industry, and (iii) The Proposed war9e fats, including any bona fide fringe benefits, bears a reasonable relationship bathe wage rates contained In the wage determination. (2) If the contractor and the laborers and mechanics to be employed in the classification (if known). or their representatives, and the contracting oificer:agree on the classification and wage rate (including Eke amount designated for fringe benefits where appropriate), a report of Me action taken shall be sent by the contracting officer to the AAdministrator of the Wage and Hour Division, Employment Standards Administration, U.S. Departmentof Labor, Washington, DC 20210. The Adiffir si etor, or an authorized representative, will approve, m O*, orolsappmve every additiorel classification action withhn 30 days of receipt and SO advise Che cordraeft oftcer Of Will notify the contracting officer within the 30 -day period that additional finis is necessary. (3) In the event the contractor, the laborers or mechanics to be employed in the classification or their representatives, antl the contracting officer do not agree or the proposed classification and wage rate Mc[udlrg the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions, including the views of all iriterested Partes and the racommendatkn of the contracting officer, to the Wage and your Administrator for determination. The Wage and HdurAdminist mier, or an authorized repfesentallve, will Issue a determination within 30 days of receipt and so advise the contracting officer or OR 12-05 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B will notify the contracting officer within the 30 -day period that additional time is necessary. (4) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs i.b.(2) or 1.b.(3) of this section, shall be paid to all workers performing work in the classification under this contract from the first day on which work is performed in the classificat7on. c- Whenever the mirumum vrsge rate prescribed In the contract for class of laborers or machanice Includes afringe benefit which is not expressed as an hourly rote, the contractor shag either pay the benefit as stated in the wage determination or shall pay another bona fade fringe benefit or an hourly cash equivalent Otereo€. d. Me cdntractordoes not make payments to a trustee or otherthird person, the contractor may consider as part atthe wages of any laborer or mechanic the amount of any casts reasonably anticipated In providing bona fide fringe benefits under a plan or program, Provided, That the Secretary of Labor has found, upon the written request of the contractor, that the explicable standards of the Davis -Bacon Act have been met. The Secretary of Labor may require the contactor to set aside In a separate account assets for the merefing at obligations under the plan or program. 2. Withholding The contracting agency shall upon its own action or upon written request of an authorized representative of the Depadment of Labor, withhold or cause to be withheld from the contractor under this contrast, a any other Federal contract with the same prime contractor, or any other fedemgy- asslsted cortmd subject to Danis -Bacon prevailing wage requirements, which is held by the same prime crnbador, so muds of the accrued payments or advances as may be camsideref necessary to pay laborers and mechanics, including apprentices, trainees, and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contact In the event of falure to pay any laborer ar mechanic, including any apprentice, trainee, or helper, employed or working on the site of the work, all or part of the wages required by the contact, the contracting agency may, after notice to the con rador, take such action as may be necessary to cause the suspension of any further paymeM, advance, or guarantee of hinds until such violations have ceased. 3. Payrolls and basic records a Payrdls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved fora period Mtinree years thereafter for an laborers and mechanics working at the site of the work. Such records shall contain the new, address, and soda€ security number of each such woker, his or her correct classification, hourly rates M wages paid (Including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the We described In section 1{b)(2y[l) of the Davis -Bacon Ad), daily and weekly number of hours worked, deductions made sand actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(x)(1 Xiv) that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in section 1(b)(2)(B)of the Davis- OB avin OB 12-05 Bacon Act, the canhactor shag maintain recants which show that Me commitment to provide such bM§ts is enforceable, that Me plan or program is financially responsible, and that the plan or Program has been communicated in writing to the laborers or mechanics akfectad, and records which show the costs anticipated or the anduai cost incurred In pmvidkng such benefits. Contractors employing apprentices orhainees under approved programs shall mairdain written evidence of the registration ofapprenticeship gams and celfificabon of trainee programs. the registration of the apprentices and trainees, and the redw and wage rates prescribed in the applicable programs. b.(1) The contractor shall submit YAWAYfor each week in v.fiWh any contract work is performed a copy of all paymgs to the contracting agency- The payrolls submitled shalt set out aocumteiy and comptately all of the information required to be maintained under 29 CFR 5.5(aH3}(0, except that full social security numbers and home addresses shag not be included on weekly tmnsmi tens. Instead the payrolls shag only need to include an individually Identifying number for each employee { e.g-, the last four digits Of the employees social security number)- The required weekly payroll Information may be submitted In any form deared. fiakorml Form WH -34p is available for this purpose from the wage and Hour Division Web site at htIP:Ihs .do[.govfiesarwirlrfomisfwh347h& hhn or its successor site. The prime contacts is responsible for the submission. of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the kill social security number and cumerd address of each covered worker, and shall provide them upon request to the contracting agency for transmission to the State DOT, the FHWA ar the wage and Hour Division of the Depadmentof Labor for purposes of an investigation or audit of compliance oath prevailing wage requirements. It is act a violation of this section for a prime contractor to require a subconhactorto provide addresses rad social secudtg numbers to the prime cottractarf r its own records, without weekly submission to the contacting agency.. (1) Each payroll submitted shall be accompanied by a 'Statement of Compliance," signed by the contractor 0 subcontractors his Or her agent who pays or supervises the Payment of the persons employed under the contract and shall certify the following:. () That the payroll for the payroll Period moraine the fMdnnabon required to be provided under §5.5 (a)(3j(hi) of Regulations, 29 CFR part 5, the appropriate information is being maintained under §55 (a)(3)(i) of Regulations, 29 CFR Part 5, and that such information is correct and complete; (11) That each laborer or helper, apprentice, and trzinee ticlayed on the each ptnyed on the centrad during time payroll period has been paid the full weekly wages earned, without rebels, either directly or Indirecty, and that no deductions have been made eiOrer directly or indirectly from the full wages eamK other than Permissible deductions as set forth in Regulations, 29 CFR part 3; 000 That each laboarar mechanic has been paid not less than Ore applicable wage rates and fringe heralds or cash equivalents for the classification of work performed, as specified in the applicable wage determination incorporated into the ceadecL Page 12-15 July 31, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions (3) The weekly submission of a property amculed certification set forth on the reverse side of Optional Farm WH, 347 shall satisfy the requirement for submission of the "Statement of Comptlance' required bypalegraph 3,1).(2) of this section. (4) The faleifiration of any of the above cedffIcations may. subject the comiractor or subcontractor to civil or criminal prosecution under section 1001 of Lige 18 and section 231 of title 31 of the United States Cale. c. The contractor or subcontractor shall make the records required under paragraph 3.a. of tits section available for Inspection, copying, or transcription by authorized representatives of the contracting agency, the Stale DOT, the FHWA, or the Depaninem of Labor, and shall penult such representatives to interview employees during working hours on the job. If the connector or subcontractor fails to submit the required records or to rake them available, the FHWA may', after "lien notice to the contractor, the contracting agency or the State DOT, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Fudhemiore, failure to submit the required records uponrequest or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. 4. Apprentices and trainees a Apprentices (programs of the USDOL). Apprentices wild be permitted to work at less than the predetermmined rate for the work they perfonned when they are employed pursuant to and individually registered fir a bona fide apprenticeships program registered with the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized lay the Office, or if a person is employed in his or her first 90 days of probationary employment as an apprentice In such anapprenticeship program, who is not individually registered in the program, but who has been coddled by the Office of Apprertiaeship Training, iEmployer and Labor Services or a State Apprenticeship Agency (where appropriate) to be eligible for probationary employment as an apprentice. The alknwable ratio of apprentices tojcumeymmen on the job site in any craft classification shall not be greater than the rade, pemritted to the contractor as to the entire wodx force under the registered program. Any worker listed on a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any apprentice perfoming wo* on the job site In excess of the ratio permitted under the registered program shall be paid not less than the appgceblewage rate on the wage determirration for the work actually performed. Where a contactor is performing construction on a project lin a locality other than that in which its program is registered, the relics and wage rates (expressed in peace cages of the journeyman's howdy rate) specified in the contractor's ar subcomractor5 registered program shall be observed. rate sprciped In the applicable wage daterminatton. Apprentices shall be paid fringe ben aft in accordance with the provisions of the apprenticeship program. if the appre itireshp program does net specify finge benefits, apprentices (must be paid the full an lountof fringe bernefds listed on the wage determination for the applicable classification. tithe Administrator destenni..m that a different Practice prevails for the applicable appointee classification, finger shall be paid in accordance vrffh that dateminagon. In file eventthe Office of ApprenticeshfpTraining, Employer and Labor Services, ar a State Apprenticeship Agency recognizedbythe Office,Wthdraws ;approvalol n apprenticeship program, the ccxotractorwill no kmger be permitted to utilize apprentices at fess than the applicable prexletemtined rate for the work perfommad unit an acceptable program is approved. b_ Trainees (programs of the USDDL). Except as provided in 29 CFR 51 fl, immes will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a program vnhfch has received prio approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The mile of trainees to jouraeyrnen car the job site shall not be greater than pemndted trader the plan approved by the Employment and Training Adminfstragon. Everytrainee must be paid at not less plan the rate specified in the approved program forthe trainee's level of progress, expressed as a percentage of the jaumayman hourly rate specified in the applicable wage determination. Trainees shalt be paid fringe benekts In accordance with the provisions of the trainee program. if the trainee program does not mention flings benefits, lratnees shall be paid the full amount of Rings benafits listed on thewage datemminagon unless the Administratoof the Wage and Hour Division determfrim that there is an apprenticeship program associated Wath the corresponding journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who is not registered and participating in a raining plan approved by the Employment and Training Administration shall be paid not less than the applicable wage nate on the wage detemminafionfix the classification of wort[ actually perfammed. In addition, anYbeirse perfoming work an the jab site in excess of the ratio permitted under the registered program shall be paid not less then the applicalyle wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a trainig program, the contractorwill no longer be pemrlfted to utilize trainees at less than the applicable predetermined rate for the work performedunfit an acceptable program is approved. C- Equal employment opportunity. The utilization of apprentices, trainees and journeymen underthis pad shall be in comarmrity with the equal employmentoppodunky Every apprentice must be paid at nut less then the rate requirements of Executive Ostler 11246, as amended, and 29 specified in the registered program for the apprerflice's level of CFR part 30. progross, expressed as a percentage of the journeymen hourly Page 12-16 July 31, 2012 OB 12-05 Local Assistance Procedures Manual PS&E Checklist Instructions d. Apprentices and Trainees (programs of the U.S. DOT). Apprentices and trainees working under appnernoesbip and skill training programs which have been certified by the Secretary of Transportation as promoting EFA lin correction with Federal -aid highway construclion program are not subject to the requirements of paragraph 4 of this Section IV. The straight time hourly wage rates forappren0rzs and tratness under such programs will be established by the particular pmgffam- The ratio of apprentices and trainees to journeymen shall nut be greaterthan permitted bythe terms of the particular program. 5. Compliance with Copeland Act requirements. The contractor shah comply with the requirements of 29 GFR part 3, which are incorporated by reference in this contrat 6.Subcoatracts, The contractor or subcantraclorshail insert Foran FHWA-1273 inany subroutmcis and also require the subcontractors to include Form F4WA-1273 in any law her subcnnlrads.. The prime conbadar shall he responsible for the compliance by any subcontractor or lower ter subcontractor with all the contract clauses In 29 CFR 5.5. 7. Contract termination: debarment. A breach of the contact dauses'in 29 CFR 5.5 nmy be gmurtds fortmdnation of the oon(md, and fordebarmed as a oontractrrard a subcontractor as provided in 29 CFR 5.12. 0. Compliance with Davis -Bacon and Related Act requirements. All ratings and interpretations of the Davts- Bacon and Related Ads contained in 29 OFR parts 1, 3, and 5 are herein incorporated by reference in this contact. 9. Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this rontraetshall act be subject to the general disputes clause of this contract Such disputas shall be resolved in accordance with the procedures of the Department of Labor set forth In 29 GFR parts 5, 6, and 7. Disputes within the meaning of this clause Include disputes between the contractor (or any of ifs subconlmdors) and tin contracting agency, the U.S. Department of Labor, or the empkryees ortheir representatives. 10. Certification of eligibility. a. By entedrg into this contract the comractor deNfied that neriber 0 (nor he or she) nor any person or firm who has an interest in ft contractors firm is a person or arm ineligible to be awarded Government contracts by virtue of section 3(a) of the Davis -Bacon Actor 29 GFR 5A2(a)(1). b. No pad of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract by vidue of section 3(a) of the Davis=Bacon Ad or 29 CFR 5.12(a)(1). c. The penalty Ear mating false statements Is prescribed in the LIZ. Criminal Code, 10 U3.C.1001. OB 12-05 EXHIBIT 12-E Attachment B V. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT The f0tWwing clauses aPply to any Feder"d construction contract to an amount in excess of $100,000 and sabject to the overtime provisions of the Contract Work Hauls and Safety Standards Act.. Theseclauses shal be Inserted to addition to the clauses required by29 CFR. 5.5(a) ar29CFR4.6. As used In this paragraph, the terms laborer and mechanics Include watehmen and guards. 1. Overtime requirements. Nocontrackrrorsubcor0mclor contracting for any Part of the contract work which may require or nvotm the employment of laborers ar mechanics shall require or permit any such laborer or mechanic to any workweek in which he or she is ergployed on such work to work an excess of forty harm in such warttweek unless such laborer or mechanic receives compensation at a, rate not fess than me and one-half times the basic rate of pay for all hours waited in excess of tarty hours In such workweek. 2. Violation; liability for unpaid wages; liquidated damages. In the event of any Violation of the clause set forth in paragraph (1.) of this se0011, the contractor and any subcomlrador responsible therefor shall be liable for the unpaid wages. th addition, such contractor arid subcontractor shall be Viable to the United States (In the rase of work done under contract for the District Of 0011.1m1>ra or a territory. to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mmschadc, includng watchmen and guards, employed in violation of the clause Set forth to Paragraph (1.) of this sector, in the sum of $19 for each calendar day on which such individual was required or Pe ri tted to work In excess of the standard workweek of forty hours without Payment of the overtime wages required by the clause set lamb in paragraph (1.) of this section. 3. Withholding for rgyaid wages and liquidated damages. The FHWA or the correcting agency shall upon its ohm action or upon wd0en request of an authorized repmsentative of the Department of Labor withhold or manse to be withheld, from any maneys payable an account of work Performed by the comractoror sutcantmdor under any such Contact or any other Federal contact with the same prime wrimcfar, or any other federally -assisted contract subject to the Contact Work Hours and Safety Standards Act, which is held by the same prime contactor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the cause set too h paragraph (2.) of this section. 4. Subcontracts. The cOalractrx or subcontractor shall insert In arty subcontracts the clauses set forth in Paragraph (1.) through (4.) of this section and also a clause requiring the subcontadas to include these changes in any lower tier subcootacts The Prime contactor shall be responsible for comPfance 'by any submrrtmctoror lower fie- subcontractor With the clauses set forth in paragraphs (1.) through (4.) ofthis section. Page 12-17 July 31, 2012 EXHIBIT 12-E Attachment B VI. SUBLETTING OR ASSIGNINGTHE CONTRACT This provision is applicable to all Fedacal-aid construction contracts on the National Highway System. 1. The contractor shall perform with Eta own organization contract work arnonting to not less than 30 percent (ora greater pemerrage if specified elsewhere in the contract) of the total original contract Woe, a dulling any specialty items designated by the contracting agency. Specialty Hems may be performed by subcontract and the amount of any such specialty items performed may be deducted from the total original contract price before computing the amount or walk required to be perormed by the conkactars own organization ('23 CFR 635.11fn). a. The tame "perform work with Its am organizatiarr refers tow orkers employed or leased by the prime contractor, and equipmerd rimed or rented by the prime connector, with or wiithoutoperators. Such term does not include employees or equipment da subcontractoror lower bar subcontractor, agents. at Me prime contractor, or y other assignees. The term imay include payments for the costs of hiring leased employees from an employee leasing firm meeting an relevant Federal and State regulatory requirements. Leased employees may only be included in this term If the gime contractor meets all of the following wrkdkfos: (1) the prime contractor maintains control over the supervision of time day4te-day activities of the leased employees; (2) the prince contractor remains responsible for the quality of the wars of the... leased employees; (3) the prime contractor retains all power 63 accept or exclude individual employees tram wart on the project; and (4) the prime contractor remains ultimately responsible for the payment of madetomined minimum wages, the submission of Payrolls, statements of compliance and all other Federal regulatory requirements. b. "Specialty Items" shall be construed to be limited to wok that requires highly special zed knogedge, abilities, or equipment not ordinarily available in the type of contracting organizations qualified and expected to bid or propose on the contract as a whole and in general are to be limited to minor components of the overall contract 2. The contract amount upon which the requirernems set forth in paragraph (1) of Section M Is computed includes the cost of material and manufactured products which are to be purchased or produced by the contractor underthe contract provisions. 3.. The contractor shall furnish (a) a competent superintendent or supervisor who is employed by the firm, has full authority bo direct performance of the work in accordance with the contract requirements, and is in charge of ail construction operations (regardless or who performs the wok) and (b) such other of its own organizational resources (supervision, manageme t, and engineering services) as the contacting officer determines is necessmyto assure the performance of the conkad, 4. No portion or the contract shall be sublet, assigned or otherwise disposed of except with the written consent of the contracting officer, or authorized representative, and such consent Men given shall not be construed to relieve the contractor of any responsibility for the fulfillment of this cootracL Written consentwirl be given onlyatertme Page 12-1.8 July 31, 2012 Local Assistance Procedures Manual PS&E Checklist Instructions couaaatiryg agency has assured that each subcontract is evidenced in vatting Wd that it oomAains all pertinent provisions and requirements of the prime contract, 5. The 30% self -performance requirement If paragraph (1) is not applicable to design -build conir.,.ycfs; however, contracting agencies may establish their own snif-perhom ane. requirements. VIL SAFETY: ACCIDENT PREVENTION This provision is applicable to all Federal -aid construction contracts and to all related subcantracts. 1_ In the performance otthis contrectths contractor shall comply with all applicable Federal, 6te, and local laws governing safety, health, and sanilation (23 CFR 635). The contractor shall provide all safeguards, safety devices and Protective equipment and take sly other needed actions as it determines, or as the contracting officer my to be reasonably necessary to protect the life and health of employees on the lob and the safety of the public and to protect property in connection with the performance of the workcovered by the contract 2 It is a condition of this contract, and shall be made a condition of each subcompact, Mich bye contractor eaters into pursuant to this contrail, that She contractor and any subcontractor shall not permit anyemplcyee, to perfennamm of the contract, to work in sunondings or under conditions which are unsanitay, hazardous or dangerous to his/her health or safety, as determined under construction safety and health standards (29 CFR 1926) Promulgated by Me Secretary of Labor, in accordance win Seckon 107 of the Contract Waik Homos and Safety Standards Act (40 U.S.C. 3704). 3. Pursuant to 29 CFR 1926.31 It is a condition of this contract that the Secretary of Labor or authorized representative thereof, shall have tight of erftto any she of contact performance to inspect or hrvastigate the matter of compliance with the construction safety and health standards and to carry out Me duties of the Secretary order Section 407 of the Contract Wok Hours and Safety Standards Act (40 U.S.G.3704)_ Vill, FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS This provision is applicable to all Fe leml-ald construction contracts and to all related subcontracts. In orderto assure high quality and durable oostmction in conformity with approved plans and specifications and a high degree of seliabf9tty on statements and representations made by engineers, contractors, suppliers, and workers on Federat- aid highway projects, it isessential that an persons concerned -- Win the project perform their functions as carefully, thoroughly, and honestly as possible. VwPlfiml falsification, distortion, or misraiese deliOn with respect to anytadis related to the projectile a violation of Federal law. To prevent any misunderstanding regarding the seriousness of these and similar acts, Form FHWA-1022 shall be pasted on each Federal -aid highway project (23 CFR 635) In one or more places Where it is readily available to all person cbri mmed with the project 18 U.S.C. 1020 mads as follows. OB 12-05 Local Assistance Procedures Manual PS&E Checklist Instructions "Whoever, being an officer, agent, or employee of the United States, or of any Stab or Territory, or whoever, Mather a person, assoclaiion, firm, or corporation, knowingly makes my false sttaternK ;false representation, or false report as to the characterr quality, quantity, or cost of the malarial used or to be used, or the quantity or quality of Iha work performed o to Le performaA or the cost thereof h connection with the submission of plans, maps, specifications, wnkacts,. or costs of const uctioa on any highway or related protect submitted for approval to the Serretagr of Transportation; or Whoever knowingly makes any false statement, false representation, false report or false claim With respect to the character, quality, quantity, or cost of any workperformed or to be performed, or materials famished or to be Nmishad, In connection with the construction of any highway or related project approved by the Secretary of Transportation; or Whoever knowingly makes any false statement or false representation as to material fact linany statement cedincate, or report submitted pursuant to provisions of the Federal -aid Loads Act approved July 1, 1916, (39 Stat 355), as amended and suppleme tad; Shall be fined under this the or imprisoned not more than 5 years orboflv." IX. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER, POLLUTION'. CONTROL ACT This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. By submission of this bolproposal or the execution of this contract, or subconhact, as appropriate, the bidder, proposer, Federal -aid construction contractor, or subcontractor, as appropriate, writ be deemed to have stipulated: as fellows: 1. That any person who is or will be utilized in the performance of this contract is not prohibited from receiving an award due to a, violation of Section 509 of the Clean Water Act or Section 306 of the Clean AirAct 2. That the contractor agrees to include or cause to be included the requirements of paragraph (1) of this Section X in every subcuntract, and furtheragrees to take such action as the contracting agency may direct as a means of enforcing such requirements. X. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION This provision is applicable to all Federal aid construction contracts, design -build contracts, subcontracts, lower -tier subcontracts„ purchase orders, lease agreements, consultant contracts or any other covered transaction requiring FHWA approval or that is estimated to cost $25,000 or more— as defined in 2 CFR Parts 100 and 12oa 1. Instructions for Certification —First Tier Participants: a. By signing and submitting this proposal, Me prospective first tier participant is providing the certification set out below. b. The inability of a person to provide the cer ithation set out below will not necessarily result in dental of participation in this OB 12-05 EXHIBIT 12-E Attachment B covered transaction. The prospective first tier partetpe nt shall submit an explahallm of why O'cannot provide 1110 carrication set out below. The cenitikation or explanation will be considered in connection with the department oragenco deterrnina6cor whether to enter into this transaction. However, failure of the prospective that tier participant to hurrdsh a certification or an explanation shall disgdalify such a person from participation in this transactor.. C. The mriftication In MIS; clause is a malarial representation of fact upon which reliancewas placed when the contracting agency determined to enter brio this tuonsacticin. If O is later determined that the prospective participant knowingly rendered an erroneous certification, in addition to other romecties available to the Federal Government, the contracting agency may terminate this transaction for cause of default. d. The pmspecbve first bar participant shall provide immediate written nollca to the censoring agency to whom this proposal is submitted If arty orae the prospective first tier participant learns that its raw'difcation was erroneous when submitted or hasbecome emaneous by mason of changed choumstancas. a. The tehms "covered transaction,." "debarred," "suspended, nheftgible,"",paddcpant,"'person," "principal," and "volunfadly exduded," as used in this clause, are defined in 2 CFR Parts 180 and 1200 `First Tier.Covered Transactions" refers to any covered transaction between a grantee ar subgrantee of Federal funds and a participant (such as the Prime argeneral contract)- °Lowei-TierCovered Transactions" refers to any covered transaction under a First Ther Covered Tmnmction(such as sruacantracts). 'First Tier Participant" refers to the participant who has entered into a cowered traneadtrn with a grantee or subgrantee of Federal funds (such as the prime or general contractor). 'Lower Tier P2111*2m"refers any Participant who has entered into a covered transaction Win a First Tier Participant or other Lower TiierPart[dPards (such as subcontractors and suppliers). f. The prospective first tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered kda, it shell not knowingly enterinto any Bower Ser covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authariwd by the department or agency entering into this transaction. g. The pmspm ive first far pal idpamt further agrees by subrat tog this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and voluntary Exclusloi-Lowrer Tae Covered Transactions,- praMed try the department or contracting agency, entering 1110 this covered transaction, without modification, in all lower tier covered hansactlons.. and In all sdtdtations for lower far covered transactions exceeding the $25,000 threshold. h- A participant In a covered transadiwr may mly upon a certification of a Prospective participant in a lower tier covered transaction that is notdebarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it krhowch that the certification is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility, of its prindgaals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (httns-INwww eaEs acv!), which is camp#ad by the General Services Administration, Page 12-19 July 31, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions I. Nothing contained in ft foregoing shall be con-strusd to require the establishment of a system orrecords in order to render in good faith the cerdficOon required by this clause. The knowledge and information of the prospective participant is not required In exceed Shat which is normally possessed by a prudent person in the ordinary course of business dealings - 1. Except for transactions authorized under paragraph (f) of these instructions, if a participant al a covered transaction knowingly enters into a lower tier covered transaction with a person Me is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause ordefault. 2. Certification Regarding Qabarmard, Suspension, Ineligibility, and Voluntary Exctuston — First Tier Participants: a. The prospective first Her participant certifies to the best of its knowledge and belief, that it and its principals; (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency; (2) Have not within a thnea-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a. criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public tmnsadioa, vlotabon of Federal or State anfiaust suedes or commission of'embemlament, that, forgery, bribery, falsification ordestmdion of records, making false statements, or receiving skrlen property; (0) Are not presently indicted for m otherwise criminally or civilly charged bya governmental entity (Federal, State or local with commission of any of the offenses enumerated in paragraph (a)(2) of this cartificatton; and (4) Have not within a thma-year period preceding this appllcaDonfproposal had one or more public transactions (Federal, State or local) terminated for cause or default b. Where the prospective participant is unable to cerfify to any of the stalemates in this certification, such prospective participant shall attach an explanation to this proposal. 2 Instructions for Certification - Lower Tier Participants: (Applicable to all subcommets, purchase orders and other lowerfiertramsacUmns requiring prior FHWA approval nor estimated to rust $25,000 or mom -2 CFR Parts 190 and 1200) a. By signing and submitting this proposal, the prospective lower der is providing the certification set out below. It. The cetification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If It Is later determined thatthe prospective lower Der participant knowingly rendered an emoneaus cenifimficn, in addition to other remedies available to the Federal Government, the department, or agency with which io Page 12-20 July 31, 2012 this transaction originated may pulli available remedies, including suspension andlor debarment. c. The prospective lower Derparttppant shall provide immediatewdtten notice to the person to which this proposal is submitted if at anytime the prospective lower Der participant teams that its certification was emameous by reason of changed circumstances. d. The teems "covered transaction."' "debarren,d;' "suspended; "fineligibfe," "participant ° ^perso"principal" and "Vduntadly excluded," as used inti this clause, are defined in 2 CFR Parts 100 and 1200. You rruay contactthe person to which this proposal is submified for assistance in obtaining a oopyofihoseregulations. "FfrstTier Coversd Transactions" l eters, to any covered transaction betVreen a gredea or subgrantee or Federal funds and a participant (such as the primeorgeneralconlmet). "LowerTrar Covered Tmnsacfions refers to any covered transaction undler2 First Tier Cowered Transaction (such as sur contrads). "First Tier ParficipaW refersth the participant who has entered into a covered transaction with a granteo or subgrantee of Fedand funds (such as the prime orgeneral contmctark "Lower per Pamolloanf'refras any Pargcill cilia has entered into covered transaction with a First Tiler Parttelpant or other Lower Ter Participants (such as subcontractors. and suppliers), e. The prospective lower Der participant agrees by submitting this proposal that should the proposed covered transaction be entered: into; it strait not knowingly erder into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from parlidpation in this covared transaction, unless authorized by the department or agency with which this transaction originated. E The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding 0ebarment, Suspension, Ineligfb lily and Voluntary Exclusion -Lower Tier Covered Transarficn," without modification, in all lower tier covered transactions and in all solciations for tower Der corseted transactions exceeding the $.25,000 threshold. g. A participant h a covered transaction imay rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, inefi9ibte, or voluntarily excluded from the covered transaction, unless it knows that the cenificatidn is erroneous. A. participant is responsible for ensuring that its prsndipals are net suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify five eligibility of its principals, as well as the eltgDmlftyofany lower tier prospective participants, each particlpant may, but is not required to, check the Excluded Parties List System websds (httos:ff .eels govt), whidh is compiled by the General Services Administration. h. Nothing contained in the foregoing shall be construed to require esta6fishment of a system of records in orderto render in good faith the certification required by this clause. The knowledge and information of padiapant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 1. Except for transactions authorized order paragraph a of these instructions, if a participant In a covered trarmcttun knowingly enters into a lower tier covered fransacikn with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Governmemi, the OB 12-05 Local Assistance Procedures Manual PS&E Checklist Instructions department or agency with which this transacbm originated may pursue available remedies, including suspension andfor debarment Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier participants: 1. The prospectiue lawertierpanitdpant oerlifles, by submission of this:timposa€, that nei0ner it nor He principals B presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transaoiions by any Federal department or agency. 2. Where ft prospective lowartierparicipant is unableta codify to arty ofthe statements In this cediFieatian, such prospective participant shall attach anertirianation to this proposal. 711. CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING This provision is applicable to all Federal aid construction contracts and to all related subcontracts which exceed $100,000 (49 CFR 20)- I . 0). 1. The prospective participant certifies, by signing and submitting We bid or proposal, to the best of his a her Knowledge and belief, that a. No Federal appropriatedfunds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officeror employee of any Federal agency, a Member of Coitress, an ofaceror employee of Congress, or an employee of a Member of Congress in connection vath the awarding of any Federal contract, the making of any Federal grant the making of any Federal loan, the entering irhb of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, faun, or cooperative agreement b. if any funds other than Federal appropriated funds have been paid or Wil be paid to arty perm fa influencing or adempfing to influence an officer or employee of any Fedemi agency, a Mendher of Congress, an officer or employee of Congress, oar employee of a Member of Congress in conneclion with this Federal contract, grant, loan, or cooperative agreement, the undersigned shag comylete and submit Standard ForntLLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 2. This certiflcaron is a material representation of fact upon which reliancewas 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 31 U.S.C. 1352 Any person who fails to file the required certi0caflon stall be subject to a civil penalty of not less than $10,000 and not more than $i00,00D for each such faikue. 3. The prospective participant also agrees by submhting its bid or proposal that the participant shall require that the language of this certification be included in all tower tier soticontracts, which exceed $1DO,000 and that all such recipients shall certify and discbse accordingly. 11 OB 12-05 EXHIBIT 12-E Attachment B Page 12-21 July 31, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B IPS&E Checklist Instructions ATTACHMENT A - EMPLOYMENT AND MATERIALS PREFERENCE FOR APPALACHIAN DEVELOPMENT HIGHWAY SYSTEM OR APPALACHIAN LOCAL ACCESS ROADCONTRACTS This provision is applicable to at Federaiaid projects funded under the Appalachian Regional Development Act of 1965. 1. During the performance of this contract the contractor undertaking to do work which is, or reasonably may be, dote as on-site work, shall give preference to qualified persons who regularly reside in the labor area as designated by the IOL wherein the contract work is situated, orthe subregion. or the Appalachian counties of the State wherein the contract work is situated, except a. To the extent mat qualified persons regularly residing In the area are not available. b. Forthe reasonable needs of the contractor to employ. supervisory of specially experienced Personnel necessary to assure an efficient execulon of the contract work. c. For the obligation of the contractor to after employment N present or former employees as the dasult of a lawful collective bargaining contract provided that the number of nonresident persons employed under this subparagraph (1 c) shall not exceed 20 percent. of Ilse foal number of employees employed by the contractor on the contract work, except as provided in subparagraph (4) below. 2_ The contractor shall place ajob order with the State Employment Service indicating (a) the classifications of the laborers, mechanics and other employeesrequired to pefonn the contract work, (b) the number of employees required in each classification, (c) the date on which the participant estimates such employees will be required, and (d) any other pertinent information required by the State Employment Service to complete the job order form. The job order may be placed with the State Employment Service in writing or by telephone_ Ifduring the course of the contract work, the Information SUbrnilted by the contractor in the original job order is substantially modified, the participant shall promptly notify the State Employment Service. 3_ The contractor shall give full consideration to all ,quatned jab applicants referred to him by the State Employment Service. The contractor 1. not required to grant emp"at to any job applicants who, in his opinion, are W qualified to perform the dassificadot of work required. 4. ff, within one went- following Ota placing of a job order by the contractor with the State Employment Service, the State Employment Service is unable to refer any qualftiedjob applicants to the contractor, or less than the number requested, the State Employment Service will forward a certificate to the contractor indicating the unavailability of applicants. Such certificate shall be made a part of the contractor's permanent project records. Upon receiptof this cardficate, the contractor may employ persons who do not normally reside in the labor area to fill positions covered by the certificate, notwithstanding the prunsfons of subparagraph( c) above. 5. The provisions of 23 CFR 633.207(e) allow the contracting agencyto provide a contractual preference forthe use of mineral resource materials native to the Appalachian region IN fi. The contractor shall Include the provfsfons of Sections 1 through 4 of this Attachment In e%%IY subcontract for werk which is, of reasons* may be, dme as on-site work. Page 12-22 July 31, 2012.OB 12-05 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B Female and Minority Goals To comply with Section Il, "Nondiscrimmatinn," of "Itt(Inied Contract Provisions Federal -Aid Construction Contracts," the following fence and minority utilization goals for Federal -aid coaslmchrio contracts and subcontracts that exceed $10,000. The nationwide goal for female utilization is 6.9 percent The goals for minority utilization [45 Fed Reg 65984 (101311981)] are as follxaw75: Iinnorit• Utilization Goals Economic Area toai (percent) 174 Redding CA: Nom SMSA Counties: 6.8 CA Lassen; CA Modoc; CA Plumas; CA Shasta, CA Siskiyow CA Tehema 175 Eureka, CA Non -SMSA Counties: 6,45 CA Del Norte; CA Humboldt; CA T*ty 176 San Francisco -Oakland -San Jose; CA: SMSA Counties - 717 -0 Salimas-Seaside-Monterey, CA 28.9 CA Monterey 7360 San Francisco-Oaklaad 7-5.6 CA Alameda; CA Contra. Costa; CA Marin; CA San Francisco; CA San Mateo 7400 San Jose, CA CA Santa. Clara, CA 19.6 7485 Santa Cruz, CA CA Santa Cruz 14.9 7500 Santa Rosa CA Sonoma 9.1 8720 Vallejo -Fairfield -Napa, CA CA Napa; CA Solano 17.1 Non -SMSA Counties: CA Lake; CA Mendocino; CA San Benito 212 177 Sacramento, CA: �SABA Counties: 6920 Sacramento, CA 16.1 CA Placer, CA Sacramento; CA Yolo Non -SMSA Counties 14.3 CA Butte; CA Colusa; CA EI Dorado; CA Glenn; CA Nevada; CA Sierra; CA. Sutter; CA Yuba 178 Stockton -Modesto, CA: SMSA Counties: 5170 Modesto, CA 12-3 CA Stannislauus 8120 Stockton, CA 24.3 CA 'San Joaquin Non -SMSA Counties 19.8 CA Alpine, CA Amador; CA Calaveras; CA N i osa; CA Merced; CA Toulunme 179 Fresno -Bakersfield, CA SMSA Counties, 0680 Bakersfield, CA 19.1 CA Kern 2840 Fresno, CA 26.1 CA Fresno Non -SMSA Counties: 23.6 Page 12-23 OB 12-05 July 31, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions For each July during which work is performed under the contract, you and each non -material -supplier subcontractor with a subcontract of $10,000 or more aunt complete FmmFHWA PR -1391 (Appendix C to 23 CFA 230). Submit the forms by August 15. Training This section applies if number of trainees or apprentices is specified ill the special provisions. As part of your equal opportoniiy affirmative action program, provide on thejob training to dee elop M jmune5mne7n in the types of trades or job classifications invoiced. You have primary responsibility for meeting this training requitement. if you subcontract a contact pout, determine how many trainees or apprentices are to be trained by the subcontractor. Include these training requirements in your subcontract. where feasible, 25 percent of apprentices or trainces in each occupation most be in their 1st year of apprenticeship or training,. Distribute the number of apprentices or trainees among the work classifications on the basis of your needs and the availability of joumeymen in the various classifications within a reasonable recruitment area. Before starting work-, submit to the City(Couuiy of 1. Number of apprentices or trainees to be trained for each classification 2. Training program to be used 3. Training staring date for each chssificatioa Obtain the City/County of 's approval for this submitted infatnsation before you start avotk The City/County of credits you for each apprentice or trainee you employ on the work who is cuneently enrolled or becomes enrolled aim approvedprogram The primary objective of this section is to train and upgrade minorities and women toward jua meymca status. Make every effort to enMH minority and women apprentices or tramem, such as conducting systematic and direct recmitneui through public andmvate sources likely to yield minority andwomen apprentices or trainees, lathe extent they are availableti iffiin a reasonable recruitment area. Shmv that you have made the efforts_ In heiakinpn these efforts, do not discrete against any applicant for training. Do not employ as an apprentice or trainee an employee: 14 Page 1.2-24 July 31, 2012 OB 12-05 CA Kings; CA hfidera; CA Tulare 190 Los Angeles, CA_ SMSA Counties: 0360 Ancheiur:Santa. Ana -Garden Grave, CA 11.9 CA Orange 4480 Los Angeles -Long Beach, CA 28.3 CA Los Angeles 6000 Oxnard -Simi ValleyVentura, CA 21.5 CA Ventua 6780 Riverside -San. Bernardino -Ontario, CA 19.0 CA Mverside; CA San Beaardmo 7480 Santa,Bar7wa.-Santa Maria Lompoc, CA. 19.7 CA Sawa, Barbara Aron -SMSA Counties 24.6 CA Inyc; CA Mono; CA San. Luis Obispo 181 San Diego, CA_ SMSA Counties 7320 San Diego, CA 16.9 CA San Diego Non -SMSA Counties 18.2 CA Impeiial For each July during which work is performed under the contract, you and each non -material -supplier subcontractor with a subcontract of $10,000 or more aunt complete FmmFHWA PR -1391 (Appendix C to 23 CFA 230). Submit the forms by August 15. Training This section applies if number of trainees or apprentices is specified ill the special provisions. As part of your equal opportoniiy affirmative action program, provide on thejob training to dee elop M jmune5mne7n in the types of trades or job classifications invoiced. You have primary responsibility for meeting this training requitement. if you subcontract a contact pout, determine how many trainees or apprentices are to be trained by the subcontractor. Include these training requirements in your subcontract. where feasible, 25 percent of apprentices or trainces in each occupation most be in their 1st year of apprenticeship or training,. Distribute the number of apprentices or trainees among the work classifications on the basis of your needs and the availability of joumeymen in the various classifications within a reasonable recruitment area. Before starting work-, submit to the City(Couuiy of 1. Number of apprentices or trainees to be trained for each classification 2. Training program to be used 3. Training staring date for each chssificatioa Obtain the City/County of 's approval for this submitted infatnsation before you start avotk The City/County of credits you for each apprentice or trainee you employ on the work who is cuneently enrolled or becomes enrolled aim approvedprogram The primary objective of this section is to train and upgrade minorities and women toward jua meymca status. Make every effort to enMH minority and women apprentices or tramem, such as conducting systematic and direct recmitneui through public andmvate sources likely to yield minority andwomen apprentices or trainees, lathe extent they are availableti iffiin a reasonable recruitment area. Shmv that you have made the efforts_ In heiakinpn these efforts, do not discrete against any applicant for training. Do not employ as an apprentice or trainee an employee: 14 Page 1.2-24 July 31, 2012 OB 12-05 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment B 1. In any classification in which the emplayee has successfully completed a training course 1 ading to journeyman status or in which: the employe has been employed as a joutmeyman 2. Who is not registered in a program approved by the US Department of Labor, Bureau of Apprenticeship and Training Ask the employee if the employee has successfidly completed a training course Heading to jourricynnia stains or has been employed as s journeyrum Your records must show the employees answem to the quegtioas- In your training program, establishthe +m+= m n, length and training type for each ,claamfncation. The City/County Of and FHWA approves aprogram if one of the following is met: 1. Itis calculated m: 1.1. Meet the your equal employment opportunity responsibilities 1.2. Qualify the average apprentice or trainee for journeyman status in. the classilication. involved by the endof rite traiuing period 2. It is, registered with the U.S_ Department of Labor, Bureau of Apprenticeship and Toining mid it is administered in a way consistent with the equal employment responsibilities of federal -aid highway constnuetioa contracts Obtain the State's approval for your nrammig program before you start work macivmg the classification covered by the program Provide training in the construction crafts, not in clerk -typist or secretarial -type positions. Training is allowed is lower level management positions such as office engiueers, estimators, and tanekeepers if the training is. oriented toward construction applicalious.'liaining is allowed in the laborer classification if siguifrcaut and meauingfud training is provided and appravedby the division office. Off-site training is allowed if the training is an integral part of an approvetl training programand does not makeup a sigadicampart of the overall training. The City(County of reimburses you 80 cents per -hour of training givenan employee on this contras under an approved training program 1. Forou-sitehaining 2. For off-site training if the apprentice or trainee is currently employed on a federal -aid project and you do at least one of the following: 2.1. Contribute to the cost of the training 2.2. Provide the instruction to the apprentice of trainee 2.3. Pay the apprentice's or trainee's wages during the off-site training period 3. If you comply with this section_ Each apprentice or trainee must: 1. Begin training on the project as soon as fi:asible after the start of work involving the apprentice's or trainee"s skill 2. Remain on theproject as long as training opportunities exist in the apprentice's or trainee's work classification or until the apprentice or trainee has completed the training program Finnish the apprentice or trainee. 1. Copy of the programyou will comply with in providing the training 2. Certification showing the type and length oftrainin.g satisfactorily completed Maintain records and submit reports documenting yo urperfonnanee under this section. 15 Page 12-25 OB 12-05 July 31, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment B PS&E Checklist Instructions Page 12-26 July 31, 2012 OB 12-05 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment C (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) ATTACHMENT C EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder ttTa ., I ltaeyik; F;I P`�}3 proposed subcontractor hereby certifies that he has ✓ , has not_, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due wider the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CPR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts, which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO -1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Page 12-27 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual PS&E Checldist Instructions Page 12-2S June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment D ATTACHMENT D NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 slid Public Contract Code Section 7106) To the CITY / COUNTY of DEPARTMENT OF PUBLIC WORKS. In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Page 12-29 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment D PS&E Checklist Instructions Page 12-30 June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment E ATTACHMENT E DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, and manager: • Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past 3 years; • Does not have a proposed debarment pending; and • Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Page 12-31 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment E PS&E Checklist Instructions Page 12-32 June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment F ATTACHMENT F NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his 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. Page 12-33 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment F FS&E Checklist Instructions Page 12-34 June 29, 2012 OB 12-04 Pap, un. Fie 2 1 LEMON LCM WCH Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment G ATTACHMENT G DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTWITTFR PURRTTANT Tn 11 TT c n , o 1. Type of Federal Action: Fla. contract b. grant c. cooperative agreement d. loan e. loan guarantee f. loan insurance 2. Status of Federal Action: ® a. bid/offer/application b. initial award c. post -award 3. Report Type: ® a. initial b. material change For Material Change Only: year_ quarter_ date of last report _ 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Prime n Subawardee EXCEL PAVWG COMPAW Tier , if known GA 9'08 Congressional District, if known 6. Federal Department/Agency: 8. Federal Action Number, if known: 10. a. Name and Address of Lobby Entity (If individual, last name, first name, MI) Congressional District, if known 7. Federal Program Name/Description: CFDA Number, if applicable 9. Award Amount, if known: b. Individuals Performing Services (including address if different from No. 10a) (last name, first time, MI) (attach Continuation Sheet(s) if necessary) 11. Amount of Payment (check all that apply) $ [] actual planned 12. Form of Payment (check all that apply): a. cash — b. in-kind; specify: nature 13. Type of Payment (check all that apply) a. retainer b. one-time fee c. commission d. contingent fee e deferred f, other, specify 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if ne ssary) 15. Continuation Sheet(s) attached: Yes 11 No 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance was placed by the Ger above when his transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only: OB 12-04 Signature: Q1,11 Print Name: L40^i1fd14 PREA ENT Telephone No.: (562) 599-5841 Date: SF�, 9 2 Authorized for Local Reproduction Standard Form - LLL Page 1.2-35 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment G PS&E Checldist Instructions INSTRUCTIONS FOR COMPLETION OF SF -LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient, at the initiation or receipt of covered federal action or a material change to previous filing pursuant to title 31 U.S.C. Section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additionalniformation. 1. Identify the type of covered federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered federal action. 2. Identify the status of the covered federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered federal action. 4. Enter the fall name, address, city, State and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "subawardee" then enter the full name, address, city, State and zip code of the prime federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency malting the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate federal identifying number available for the federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the federal agency). Include prefixes, e.g., 'RFP -DE -90-001." 9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter the federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10(a). Enter Last Name, First Name and Middle Initial (MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. Page 12-36 June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E P5&E Checklist Instructions Attachment G 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with federal officials. Identify the federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. SF -LLL -Instructions Rev. 06-04-90<<ENDIFn Page 12-37 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment G TS&E Checklist Instructions 04*4* vo\w Page 12-38 _ June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment H ATTACHMENT H SECTION 2. PROPOSAL REQUIREMENTS AND CONDITIONS 2-1.01 GENERAL The bidder's attention is directed to the provisions in Section 2, "Proposal Requirements and Conditions," of the Standard Specifications and these special provisions for the requirements and conditions which the bidder must observe in the preparation of and the submission of the bid. The bidder's bond shall conform to the bond form in the Bid book for the project and shall be properly filled out and executed. The bidder's bond form included in that book may be used. In conformance with Public Contract Code Section 7106, a Noncollusion Affidavit is included in the Bid book. Signing the Bid book shall also constitute signature of the Noncollusion Affidavit. The Contractor, sub -recipient or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of Title 49 CFR (Code of Federal Regulations), Part 26 in the award and administration of US DOT -assisted contracts. Failure by the Contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy, as the recipient deems appropriate. Each subcontract signed by the bidder must include this assurance. Failure of the bidder to fulfill the requirements of the Special Provisions for submittals required to be furnished after bid opening, including but not limited to escrowed bid documents, where applicable, may subject the bidder to a determination of the bidder's responsibility in the event it is the apparent low bidder on a future public works contracts. 2 -1.015 --FEDERAL LOBBYING RESTRICTIONS. --Section 1352, Title 31, United States Code prohibits Federal funds from being expended by the recipient or any lower -tier sub -recipient of a Federal -aid contract to pay for any person for influencing or attempting to influence a Federal agency or Congress in comiection with the awarding of any Federal -aid contract, the making of any Federal grant or loan, or the entering into of any cooperative agreement. If any funds other than Federal funds have been paid for the same purposes in connection with this Federal -aid contract, the recipient shall submit an executed certification and, if required, submit a completed disclosure form as part of the bid documents. A certification for Federal -aid contracts regarding payment of funds to lobby Congress or a Federal agency is included in the Bid book. Standard Form - LLL, "Disclosure of Lobbying Activities," with instructions for completion of the Standard Form is also included in the Bid book. Signing the Bid book shall constitute signature of the Certification. The above referenced certification and disclosure of lobbying activities shall be included in each subcontract and any lower -tier contracts exceeding $100,000. All disclosure forms, but not certifications, shall be forwarded from tier to tier until received by the Engineer. The Contractor, subcontractors and any lower -tier contractors shall file a disclosure form at the end of each calendar quarter in which there occurs any event that requires disclosure or that materially affects the accuracy of the information contained in any disclosure form previously filed by the Contractor, subcontractors and any lower -tier contractors. An event that materially affects the accuracy of the information reported includes: Page 12-39 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment H PS&E Cheeldist Instructions (1) A cumulative increase if $25,000 or more in the amount paid or expected to be paid for influencing or attempting to influence a covered federal action; or (2) A change in the person(s) or individual(s) influencing or attempting to influence a covered federal action; or (3) A change in the officer(s), employees(s), or member(s) contacted to influence or attempt to influence a covered Federal Action. 2-1.02 DISADVANTAGED BUSINESS ENTERPRISE (DBE). -This project is subject to Title 49 CFR 26.13(b): The Contractor, sub -recipient or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The Contractor shall carry out applicable requirements of 49 CFR, Part 26 in the award and administration of DOT -assisted contracts. Failure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as the recipient deems appropriate. Take necessary and reasonable steps to ensure that DBEs have opportunity to participate in the contract (49 CFR 26). To ensure there is equal participation of the DBE groups specified in 49 CFR 26.5, the Agency specifies a goal for Disadvantaged Business Enterprises (DBEs). DBE is a firm that meets the definition of DBE. Make work available to DBEs and select work parts consistent with available DBE subcontractors and suppliers. Meet the DBE goal shown in the Notice to Bidders or demonstrate that you made adequate good faith efforts to meet this goal. It is your responsibility to verify that the DBE firm is certified as DBE at date of bid opening. For a list of DBEs certified by the California Unified Certification Program, go to: http://www.dot.ca.gov/ho/ben/find certifled.htm All DBE participation will count toward the California Department of Transportation's federally mandated statewide overall DBE goal. Page 12-40 June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment I Credit for materials or supplies you purchase from DBEs counts towards the goal in the following manner: 1. 100 percent counts if the materials or supplies are obtained from a DBE manufacturer. 2. 60 percent counts if the materials or supplies are obtained from a DBE regular dealer. Only fees, commissions, and charges for assistance in the procurement and delivery of materials or supplies count if obtained from a DBE that is neither a manufacturer, nor a regular dealer. 49 CFR 26.55 defines "manufacturer" and "regular dealer." You receive credit towards the goal if you employ a DBE trucking company that performs a commercially useful function as defined in 49 CFR 26.55. DBE Commitment Submittal Submit DBE information on the Local Agency Bidder DBE Commitment (Construction Contracts), Exhibit 15-G form, included in the Bid book. If the form is not submitted with the bid, remove the form from the Bid book before submitting your bid. If the DBE Commitment form is not submitted with the bid, the apparent low bidder, the 2nd low bidder, and the 3rd low bidder must complete and submit the DBE Commitment form to the Agency. DBE Commitment form must be received by the Agency no later than 4:00 p.m. on the 4th business day after bid opening. Other bidders do not need to submit the DBE Commitment form unless the Agency requests it. If the Agency requests you to submit a DBE Commitment form, submit the completed form within 4 business days of the request. Submit written confirmation from each DBE stating that it is participating in the contract. Include confirmation with the DBE Commitment form. A copy of a DBE's quote will serve as written confirmation that the DBE is participating in the contract. If you do not submit the DBE Commitment form within the specified time, the Agency finds your bid nonresponsive. Good Faith Efforts Submittal If you have not met the DBE goal, complete and submit the DBE Information - Good Faith Efforts, Exhibit 15-H form with the bid showing that you made adequate good faith efforts to meet the goal. Only good faith efforts directed towards obtaining participation by DBEs will be considered. If good faith efforts documentation is not submitted with the bid, it must be received by the Agency no later than 4:00 p.m. on the 4th business day after bid opening. If your DBE Commitment form shows that you have met the DBE goal or if you are required to submit the DBE Commitment form, you must also submit good faith efforts documentation within the specified time to protect your eligibility for award of the contract in the event the Agency finds that the DBE goal has not been met. Page 12-41 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment I PS&E Checklist Instructions Good faith efforts documentation must include the following information and supporting documents, as necessary: 1. Items of work you have made available to DBE firms. Identify those items of work you might otherwise perform with its own forces and those items that have been broken down into economically feasible units to facilitate DBE participation. For each item listed, show the dollar value and percentage of the total contract. It is your responsibility to demonstrate that sufficient work to meet the goal was made available to DBE firms. 2. Names of certified DBEs and dates on which they were solicited to bid on the project. Include the items of work offered. Describe the methods used for following up initial solicitations to determine with certainty if the DBEs were interested, and the dates of the follow-up. Attach supporting documents such as copies of letters, memos, facsimiles sent, telephone logs, telephone billing statements, and other evidence of solicitation. You are reminded to solicit certified DBEs through all reasonable and available means and provide sufficient time to allow DBEs to respond. 3. Name of selected firm and its status as a DBE for each item of work made available. Include name, address, and telephone number of each DBE that provided a quote and their price quote. If the firm selected for the item is not a DBE, provide the reasons for the selection. 4. Name and date of each publication in which you requested DBE participation for the project. Attach copies of the published advertisements. 5. Names of agencies and dates on which they were contacted to provide assistance in contacting, recruiting, and using DBE firms. If the agencies were contacted in writing, provide copies of supporting documents. 6. List of efforts made to provide interested DBEs with adequate information about the plans, specifications, and requirements of the contract to assist them in responding to a solicitation. If you have provided information, identify the name of the DBE assisted, the nature of the information provided, and date of contact. Provide copies of supporting documents, as appropriate. 7. List of efforts made to assist interested DBEs in obtaining bonding, lines of credit, insurance, necessary equipment, supplies, and materials, excluding supplies and equipment that the DBE subcontractor purchases or leases from the prime contractor or its affiliate. If such assistance is provided by you, identify the name of the DBE assisted, nature of the assistance offered, and date. Provide copies of supporting documents, as appropriate. 8. Any additional data to support demonstration of good faith efforts. The agency may consider DBE commitments of the 2"d and 3`d bidders when determining whether the low bidder made good faith efforts to meet the goal. Page 12-42 June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment I ATTACHMENT I SECTION 3. AWARD AND EXECUTION OF CONTRACT The bidder's attention is directed to the provisions in Section 3, "Award and Execution of Contract," of the Standard Specifications and these special provisions for the requirements slid conditions concerning award and execution of contract. Bid protests are to be delivered to the following address: 1Agencv to provide informationl The award of the contract, if it be awarded, will be to the lowest responsible bidder whose bid complies with all the requirements prescribed. The contract shall be executed by the successful bidder and shall be returned together with the contract bonds, to the Agency so that it is received within 10 days, not including Saturdays, Sundays and legal holidays, after the bidder has received the contract for execution. Failure to do so shall be just cause for forfeiture of the proposal guaranty. The executed contract documents shall be delivered to the following address: fAeencv to provide detailed information if this paragraph is used] SECTION 4. BEGINNING OF WORK, TIME OF COMPLETION AND LIQUIDATED DAMAGES Attention is directed to the provisions in Section 8-1.03, `Beginning of Work" in Section 8-1.06 "Time of Completion," and in Section 8-1.07, "Liquidated Damages," of the Standard Specifications and these special provisions. The Contractor shall begin work within 15 calendar days after the contract has been approved by the attorney appointed and authorized to represent the City/County of This work shall be diligently prosecuted to completion before the expiration of WORKING DAYS beginning on the 15 calendar day after approval of the contract. (INSERT AMOUNT OF LIQUIDATED DAMAGES) The Contractor shall pay to the City/County of the sum of $ per day, for each and every calendar day's delay in finishing the work in excess of the number of working days prescribed above. Page 12-43 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment I PS&E Checklist Instructions Liquidated Damages Liquidated Damages are based on the estimated cost of field construction engineering. In special cases, liquidated damages greater than the estimated field construction engineering cost may be specified, provided detailed reasons are given to support the greater amount. In every case, show the calculations that support the recommended rate. Liquidated damages are not to be used as disincentives to encourage timely completion. Use the following formula for highway construction projects to avoid excessive liquidated damages: L% (See Table below) x Engineer's Estimate + RE Office Expenses * = Liq Dam/calendar day Working Days ** * Resident Engineer office expenses over the life of the contract should be added unless the cost is already included in the Engineer's Estimate. ** Working days used to calculate liquidated damages should not include water pollution establishment or plant establishment days. LIQUIDATED DAMAGES TABLE (L%) * Resurfacing projects include AC Surfacing, seal coats, slurry seals, and so on. The calculated liquidated damages should be rounded up in $100 increments to determine the amount to be specified. Page 12-44 June 29, 2012 OB 12-04 Project T e Project Estimate Resurfacing*/Rehab New Highway Realignment/ Widening Landscaping Soundwall Others Over $30 million 10% 10% 13% 15% 15% 15% $10 million to $30 million 10% $5 million to $10 million 10% 15% 15% 15% 15% 15% $7501Cto $5 million 15% Less Than $750k 15% 20 % 20% * Resurfacing projects include AC Surfacing, seal coats, slurry seals, and so on. The calculated liquidated damages should be rounded up in $100 increments to determine the amount to be specified. Page 12-44 June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment J ATTACHMENT J SUBCONTRACTOR AND DBE RECORDS Required for ALL construction contracts administered under the Caltrans Standard Specifications 5-1.—SUBCONTRACTOR AND DBE RECORDS Use each DBE subcontractor as listed on the List of Subcontractors form and the Local Agency Bidder DBE Commitment (Construction Contracts), Exhibit 15-G, forms unless you receive authorization for a substitution. The Agency requests the Contractor to: 1. Notify the Engineer of any changes to its anticipated DBE participation 2. Provide this notification before starting the affected work Maintain records including: 1. Name and business address of each I st-tier subcontractor 2. Name and business address of each DBE subcontractor, DBE vendor, and DBE trucking company, regardless of tier 3. Date of payment and total amount paid to each business If you are a DBE contractor, include the date of work performed by your own forces and the corresponding value of the work. Before the 15th of each month, submit a Monthly DBE Trucking Verification form. If a DBE is decertified before completing its work, the DBE must notify you in writing of the decertification date. If a business becomes a certified DBE before completing its work, the business must notify you in writing of the certification date. Submit the notifications. On work completion, complete a Disadvantaged Business Enterprises (DBE) Certification Status Change, Exhibit 17-0, form. Submit the form within 30 days of contract acceptance. Upon work completion, complete a Final Report — Utilization of Disadvantaged Business Enterprises (DBE), First -Tier Subcontractors, Exhibit 17-17, form. Submit it within 90 days of contract acceptance. The Agency withholds $10,000 until the form is submitted. The Agency releases the withhold upon submission of the completed form. Page 12-45 OB 12-04 June 29, 2012 E,YHIBIT 12-E Local Assistance Procedures Manual Attachment J PS&E Checklist Instructions a,0\a�y ��y Page 12-4G June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Cheeldist Instructions Attachment K ATTACHMENT K PERFORMANCE OF SUBCONTRACTORS 5-1. PERFORMANCE OF SUBCONTRACTORS DBEs must perform work or supply materials as listed in the Local Agency Bidder DBE Commitment (Construction Contracts), Exhibit 15-G, included in the Bid. Do not terminate or substitute a listed DBE for convenience and perforin the work with your own forces or obtain materials from other sources without authorization from the Agency. The Agency authorizes a request to use other forces or sources of materials if it shows any of the following justifications: 1. Listed DBE fails or refuses to execute a written contract based on plans and specifications for the project. 2. You stipulated that a bond is a condition of executing the subcontract and the listed DBE fails to meet your bond requirements. 3. Work requires a contractor's license and listed DBE does not have a valid license under Contractors License Law. 4. Listed DBE fails or refuses to perform the work or famish the listed materials. 5. Listed DBE's work is unsatisfactory and not in compliance with the contract. 6. Listed DBE is ineligible to work on the project because of suspension or debarment. 7. Listed DBE becomes bankrupt or insolvent. 8. Listed DBE voluntarily withdraws with written notice from the Contract 9. Listed DBE is ineligible to receive credit for the type of work required. 10. Listed DBE owner dies or becomes disabled resulting in the inability to perform the work on the Contract. 11. Agency determines other documented good cause. Notify the original DBE of your intent to use other forces or material sources and provide the reasons. Provide the DBE with 5 days to respond to your notice and advise you and the Agency of the reasons why the use of other forces or sources of materials should not occur. Your request to use other forces or material sources must include: 1. 1 or more of the reasons listed in the preceding paragraph 2. Notices from you to the DBE regarding the request 3. Notices from the DBEs to you regarding the request If a listed DBE is terminated, make good faith efforts to find another DBE to substitute for the original DBE. The substitute DBE must perform at least the same amount of work as the original DBE under the contract to the extent needed to meet the DBE goal. The substitute DBE must be certified as a DBE at the time of request for substitution. Unless the Agency authorizes (1) a request to use other forces or sources of materials or (2) a good faith effort for a substitution of a terminated DBE, the Agency does not pay for work listed on the Local Agency Bidder DBE Commitment (Construction Contracts), Exhibit 15-G, form unless it is performed or supplied by the listed DBE or an authorized substitute. Page 12-47 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment K PS&E Checldist Instructions Page 12-48 June 29,2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Cheeldist Instructions Attachment L ATTACHMENT L SUBCONTRACTING 5-1._ SUBCONTRACTING No subcontract releases the Contractor from the contract or relieves the Contractor of their responsibility for a subcontractor's work. If the Contractor violates Pub Cont Code § 4100 et seq., the City/County of may exercise the remedies provided under Pub Cont Code § 4110. The City/County of may refer the violation to the Contractors State License Board as provided under Pub Cont Code § 4111. The Contractor shall perform work equaling at least 30 percent of the value of the original total bid with the Contractor's own employees and equipment, owned or rented, with or without operators. Each subcontract must comply with the contract. Each subcontractor must have an active and valid State contractor's license with a classification appropriate for the work to be performed (Bus & Prof Code, § 7000 et seq.). Submit copies of subcontracts upon request by the Engineer. Before subcontracted work starts, submit a Subcontracting Request form. Do not use a debarred contractor; a current list of debarred contractors is available at the Department of Industrial Relations web site at: http://www.dir.ca.gov/dlse/debar.html Upon request by the Engineer, immediately remove and not again use a subcontractor who fails to prosecute the work satisfactorily. Each subcontract and any lower -tier subcontract that may in tum be made shall include the "Required Contract Provisions Federal -Aid Construction Contracts" in Section 14 of these special provisions. Noncompliance shall be corrected. Payment for subcontracted work involved will be withheld from progress payments due or to become due, until correction is made. Failure to comply may result in termination of the contract. 5-1. PROMPT PROGRESS PAYMENT TO SUBCONTRACTORS A prime contractor or subcontractor shall pay any subcontractor not later than 10 days of receipt of each progress payment in accordance with the provision in Section 7108.5 of the California Business and Professions Code concerning prompt payment to subcontractors. The 10 days is applicable unless a longer period is agreed to in writing. Any delay or postponement of payment over 30 days may take place only for good cause and with the agency's prior written approval. Any violation of Section 7108.5 shall subject the violating contractor or subcontractor to the penalties, sanctions and other remedies of that section. This requirement shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the contractor or subcontractor in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance, or noncompliance by a subcontractor. Page 12-49 OB 12-04 June 29, 2012 EXHIBIT 12-E Attachment L Local Assistance Procedures Manual PS&E Checklist Instructions 5-1._ PROMPT PAYMENT OF FUNDS WITHHELD TO SUBCONTRACTORS The local agency must include one of the following three provisions (if using Caltrans Standard Specification, modify or delete paragraphs 9-1.06 and 9-1.065) to ensure prompt and full payment of any retainage from the prime contractor, or subcontractor to a subcontractor. (EITHER) No retainage will be withheld by the agency from progress payments due the prime contractor. Retainage by the prime contractor or subcontractors is prohibited and no retainage will be held by the prime contractor from progress due subcontractors. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the California Business and Professions Code. This requirement shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcontractor, in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance or noncompliance by a subcontractor. (OR) No retainage will be held by the agency from progress payments due the prime contractor. Any retainage held by the prime contractors or subcontractors from progress payments due subcontractors shall be promptly paid in full to subcontractors within 30 days after the subcontractor's work is satisfactorily completed. Federal law (49 CFR 26.29) requires that any delay or postponement of payment over the 30 days may take place only for good cause and with the agency's prior written approval. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code. These requirements shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcontractor, in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance or noncompliance by a subcontractor. (OR) The agency shall hold retainage from the prime contractor and shall make prompt and regular incremental acceptances of portions, as determined by the agency, of the contract work and pay retainage to the prime contractor based on these acceptances. The prime contractor or subcontractor shall return all monies withheld in retention from a subcontractor within 30 days after receiving payment for work satisfactorily completed and accepted including incremental acceptances of portions of the contract work by the agency. Federal law (49 CFR 26.29) requires that any delay or postponement of payment over 30 days may take place only for good cause and with the agency's prior written approval. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code. These requirements shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcontractor, in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance or noncompliance by a subcontractor. Page 12-50 June 29, 2012 OB 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment L 5-1._ FEDERAL REQUIREMENTS (AMERICAN RECOVERY AND REINVESTMENT ACT) Under the American Recovery and Reinvestment Act (ARRA) of 2009, 9 USC § 902: SEC. 902. ACCESS OF GOVERNMENT ACCOUNTABILITY OFFICE. (a) ACCESS.—Each contract awarded using funds made available in this Act shall provide that the Comptroller General slid his representatives are authorized: (1) to examine any records of the contractor or airy of its subcontractors, or ally State or local agency administering such contract, that directly pertain to, and involve transactions relating to, the contract or subcontract; and (2) to interview any officer or employee of the contractor or any of its subcontractors, or of any State or local government agency administering the contract, regarding such transactions. (b) RELATIONSHIP TO EXISTING AUTHORITY. -Nothing in this section shall be interpreted to limit or restrict in any way any existing authority of the Comptroller General. Under ARRA of 2009, 9 USC § 1515(a): SEC. 1515. ACCESS OF OFFICES OF INSPECTOR GENERAL TO CERTAIN RECORDS AND EMPLOYEES. (a) ACCESS.—With respect to each contract or grant awarded using covered funds, any representative of an appropriate inspector general appointed under section 3 or 8G of the Inspector General Act of 1978 (5 U.S.C. App.), is authorized: (1) to examine any records of the contractor or grantee, any of its subcontractors or subgrantees, or any State or local agency administering such contract, that pertain to, and involve transactions relating to, the contract, subcontract, grant, or subgrant; and (2) to interview any officer or employee of the contractor, grantee, subgrantee, or agency regarding such transactions. (b) RELATIONSHIP TO EXISTING AUTHORITY. -Nothing in this section shall be interpreted to limit or restrict in any way any existing authority of an inspector general. Immediately notify the Engineer if you have been contacted by the U.S. Comptroller, Inspector General, or their representatives. Used in projects with ARRA Federal -aid funds. Used in projects with American Recovery and Reinvestment Act Federal -aid funds. 5-1._ MONTHLY EMPLOYMENT REPORT (AMERICAN RECOVERY AND REINVESTMENT ACT) For the purpose of complying with the American Recovery and Reinvestment Act of 2009, submit a completed Monthly Employment Report form by the fifth of each month for the previous month. For the form, go to: htti)://www.dot.ca.izov/hq/construe/forins/ceml2O4.pdf If you fail to submit a complete and accurate report, the Department withholds 2 percent of the monthly progress estimate. The Department does not withhold more than $10,000 or less than $1,000. The Department releases the withhold upon submission of the completed form. Page 12-51 OB 12-04 June 29, 2012 EXHIBIT 12-E Local Assistance Procedures Manual Attachment L PS&E Checklist Instructions Used in projects with American Recovery and Reinvestment Act Federal -aid funds 3-1.02 DATA UNIVERSAL NUMBERING SYSTEM (D -U -N -S) NUMBER For the purpose of complying with the American Recovery and Reinvestment Act of 2009, the successful bidder must provide the Department a D -U -N -S number. Complete and sign the Data Universal Numbering System (D -U -N -S) Number form included in the contract documents. This form must be submitted with the executed contract. If your company does not have a D -U -N -S number, you can obtain one by contacting Dun & Bradstreet at: htta://dnb.com/us/ If you fail to submit this information with the executed contract, the City/County of will not approve the contract. Page 12-52 June 29, 2012 08 12-04 Local Assistance Procedures Manual EXHIBIT 12-E PS&E Checklist Instructions Attachment M ATTACHMENT M BUY AMERICA REQUIREMENTS 5-1, BUY AMERICA REQUIREMENTS. -- Attention is directed to the `Buy America" requirements of the Title 23 United States Code, Section 313 and the regulations adopted pursuant thereto. In accordance with said law and regulations, all manufacturing processes for steel and iron materials furnished for incorporation into the work on this project shall occur in the United States; with the exception that pig iron and processed, pelletized and reduced iron ore manufactured outside of the United States may be used in the domestic manufacturing process for such steel and iron materials. The application of coatings, such as epoxy coating, galvanizing, painting, and any other coating that protects or enhances the value of such steel or iron materials shall be considered a manufacturing process subject to the `Buy America" requirements. A Certificate of Compliance, conforming to the provisions in Section 6-1.07, Certificates of Compliance, of the Standard Specifications, shall be furnished for steel and iron materials. The certificates, in addition to certifying that the materials comply with the specifications, shall also specifically certify that all manufacturing processes for the materials occurred in the United States, except for the exceptions allowed herein. The requirements imposed by said law and regulations do not prevent a minimal use of foreign steel and iron materials if the total combined cost of such materials used does not exceed one-tenth of one percent (0.1%) of the total contract cost or $2,500, whichever is greater. The Contractor shall famish the Engineer acceptable documentation of the quantity and value of any foreign steel and iron prior to incorporating such materials into the work. Page 12-53 OB 12-04 June 29, 2012 At€aclunent B Bond No. 8238-53-62 M.-01 1 VIVO KNOW ALL MEN BY rHESE PRESENT S THAT� WHEREAS, The City of Santa lana, Sime of (; difomia, and PALP Inc. dba Excel Paving Company complete certain desigaaated public improvements, which sand agreement,, dated ,(0%i, ------ Maple -- Maple Bike Trail is hereby rS"erred to and tun WHKREAS, said Principal is rexiuimd ander the terries of said agreement to peenash a Eland for Fasthrul Felformance of said agreement. NOW, `ff-FREFORE, we, the Principal and..... Federal Insurance Company asSuretyare geld and firmly bound unto tiro Cily of Santa Ann {hereina to called'City "), in the poral swu of Two hundred twenty four thousand eight hundred ei ht seven & 00100 OLLARS t,$___124 887 oo ) lawfW money of the United States, for the payment of, which son; well mad truly to be made, we bind onriselves; our heirs, successors, executors aid adnaitrtstrators, Jointly and severally, firmly by these presents. The condition of dais obligation is such dist if the above hounded Princ pul, has or its heirs, executors, udamnistratoas, sasecessors tar assigns, shalt ill all things stand to and abide fry, and well and truly ksep and r%rm the: covemnts, conditions and provisions to the said agreement and any Aeration thereof made as therein provided, on his or their part, to he kept and perrorikled at ihw-thuo axed in tha nwivier tboreir4 s}secific, and art all resppoovs according to their true intent and moiling, m>d MIAI indeautxify and save hormless City, Its officers, aEa nts and ermtoyers, as therein stipulated, then this obligation shat4l become null and void; othenvise it stall be and reniarn in fill) farce and effect, As part of tlw ohiieatr"an secured hereby and us addition to the face amount specified therefor, there shall be included COM and reasonable eXpcnses and tees, including reasonable attorvicy"s fees, incurred by City in succr:ss#'uily er>forcang such obligation, all to be gaged as casts and included to mgjudgment rendered. I The Snrcty hereby stipulates and agrees that no Change, voosiott of ;ime, alteration or addition to tht te°ztts of the agreement or to the work to be perfotoed th ounder. or fire specifications accompanyit s Oc sante steal) 4t anywviso affect its ohligatims on this Bond, and it does hereby naive nolice Qf any stac.h cha%l , emersion Of Yuroae, alteration or addition to the toms of 010 is Cemeni or to the vo'rk. or to tho sp�ciiicatzoxis. . IN. W TTvTSS WHERFOf. tius ensYst meat sxas been duly e-eputec3by The PraxsciVtii and S+arety .3hrn e t axncd, on November 3, 2014 PRINCIPAL PALP Inc. dba Excel Paving Company (Type Company Name) Title; C, N,iRi WaVKPRES10ENT By, 'IThIc SURETY: Federal Insurance Company (Type ComptwyNamo) (Attach acknowledgements of both Principul_and Surety sigma es) APPROVED AS TO TIt3.nt: City Attorney a B}. TII ttorney in Fact ouglas A. Rapp 'ride: CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of _Los Angples On 1 — (k.-' beforeme, C. Phillips, Notary Public (Nem iruat rwrc and sae of the officer) personally appeared C. P. Brown. who proved to me on the basis of satisfactory evidence to be the personw whose narl islOw subscribed to the within instrument and acknowledged to me that he/ahrexecuted the same in hist authorized capacityQ@O, and that by his/IkvAll signature(3) on the instrument the person(S), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Sigaeave Notery Mile My Comm.Ezpires Oct .?.9,2016 (Notary Seal) w"�'`^'��� ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Tide or description of attached document) (Tide or description of attached de cumeot continued) Number of Pages _ Document Date (Additional information) CAPACITY CLAIMED EYTHE SIGNER ❑ Individual (s) ❑ C. PHILLIPS (T(Ue) COM #1996177 m Partner(s) ❑ Notary Public -California e ❑ Trustee(s) LOS ANGELES COUNTY a My Comm.Ezpires Oct .?.9,2016 (Notary Seal) w"�'`^'��� ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Tide or description of attached document) (Tide or description of attached de cumeot continued) Number of Pages _ Document Date (Additional information) CAPACITY CLAIMED EYTHE SIGNER ❑ Individual (s) ❑ Corporate Officer (T(Ue) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appear, above in be wavy section or a separate acknowledgment form cost be properlycompleted and allackd to that document. The only exception is if a document is to be recorded otudde of Cal fornix. in such butanes, arty ahernaatve "Anowledgment verbiage as trey be prinfed on such a document so long as the verbiage Aces nM require rhe notary ro do something )hat is illegal for a notary in California it e, cerWfying the authorized capacity of Phe signe). Picase check Aha document carefullyfor proper not arfol warding and attach this form if requfred • stake and County infommtion must be the State and County where the document signer(s) personally appeared before the notary publiefor acknowledgment. • Date of notarization must be the date that die signers) personally appeared which must also be the same date Are acknowledgment is completed, • The notary public must -print his or her acme as it appears within his or her comaosion followed by a comma and (hen your title (notary public). • Print the m no(s) of document signers) who personally appear at the time of notatization • Indicate the correct singular or plum( forms by crossing off incorrect forms (i.e. Wsheldreyr is lore ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording., • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. if seal impression smudges, reseal if a sufficient mea permits, Otheivdse complete a different acknowledgment form. • Signature of the notary public must match the signature on ale with the office of the county clerk. Additional hnfonmtion is not required but could help to ensure this acknowledgment is not misused or attached to a different document. 5• Indicate title or type of i aapiwd docmae rt number of pages and date. Indicate the capacity claimed by Uwe signer. If die claimed capacity is a corpomte officor, Include the due (i. e. CEO, CFO, Secretary), • Securely attach this dmumentto the signed document 2008„Yersion CAPA v12 10,07 800_-873 9865 www NotetpClas@es wen, ACKNOWLEDGMENT State of California County of Orange j On 11/03/2014 before me, Debra Swanson, Notary Public (insert name and title of the officer) personally appeared Douglas A. Rapp who proved to me on the basis of satisfactory evidence to be the person(d) whose name(k islere subscribed to the within instrument and acknowledged to me that he/she" executed the same in hisRTerfth3Phr authorized capacity(ieaj, and that by hisAwAheir signature($) on the instrument the person(8), or the entity upon behalf of which the person(y) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature P`" r'e da8�E3FZ.A�1s°YLBNSti3d (Seal) ff`` N �<°',��%� RUTARYPU©LIC•CALIF01?NIA%® P 5R °: lsfta"1F9�•.�E C;('yUidTY �5 °O°""���"aa�a�, h7YCpMM F.•Xh.NC)V10,3016 Chubb POWER Federal Insurance Company Attn: Surety Department OF Vigilant Insurance Company 15 Mountain View Road Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY a Wisconsin corporation, do each hereby constitute and appoint Douglas A. Rapp and Timothy D. Rapp of Aliso Viejo, Callicirrila ---------------------------------------------------------- each as their true and lawful Attorney- In- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other writings obligatory In the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 11 day or December, 2011. Kenneth C. Wendel, Assistant Secretary Devil Norris. Jr.. Vice President STATE OF NEW JERSEY ss. County of Somerset On this 16th day of December, 2011 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Norris, Jr., subscribed to said Power of Attorney is in the genuine handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By - Laws and in deponent's presence. .Notarial Seala)- KATHERINE J. ADELAAR NOTARY pUBUC 76 NEW JFk5F1Na,2316665 Commission Expires July i6, 2024 Notary Public CERTIFICATION Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: 'All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations, The signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- in. Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any Lond or undertaking to which it is attached.' I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies") do hereby certify that (i) the foregoing extract of the By Laws of the Companies is true and correct, (ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (Ili) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 3rd day of November, 2014 �Ya� MN Y A�4e�eC�. i @ J,pVOM�Qh Ito= °cow e� • ,r s • ]]g •r , J � �J Keeinneth C. we el, Assistant Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903- 3656 e-mail: surety@chubb.com Form 15-10- 02258- U (Ed. 5- 03) CONSENT Attactunent A I :"inP R�:Y3tia.Y:a:Y_1 CONTRACTOR'S PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS, THAT: WHEREAS, the City of Santa Ana, State of California, and PALP Inc. dba Excel (hereinafter designated as "Principal") have entered into an agreement whereby Principal agrees to install and complete certain designated public improvements, which said agreement, dated Maple Bike Trail Safety Enhancements at Occidental Street, entitled " St. Andrew Place and St. Gertrude Place (Project No, 13-6797) is hereby referred to and made a part hereof; and WHEREAS, under the terms of said agreement, Principal is required before entering upon the performance of the work, to file a good and sufficient Contractor's Payment Bonin with the City of Santa Ana to secure the claims to which reference is made in Title 3, (cmunencing with Section 9000) of Part 6 of Division 4 of the Civil Code of the State of California, NOW THEREFORE, said Principal and the undersigned as corporate Surety, are held firmly bound unto the CITY OF SANTA ANA, and all contractors, subcontractors, laborers, nlaterialmen and other persons employed in the perfomlance of the aforesaid agreement and referred to in the aforesaid Civil Code, in the sum of Two hundred twenty four thousand eight hundred eighty seven & 00100 DOLLARS ($ 224,887.00 ), for materials furnished or labor thereon of any kind, or for amounts due under the Unemployment Insurance Act with respect to such work or labor or for any amounts required to be deducted, withheld and paid over to the Franchise Tax Board from the wages of employees of the Principal and his subcontractors pursuant to Section 18806 of the Revenue and Taxation Code, with respect to such work and labor; that said Surety will pay the same in an amount not exceeding the amount hereinabove set forth, and also in case stunt is brought upon this Bond, will pay, in addition to the face amount thereof, costs and reasonable expenses and fees, including reasonable attorney's fees, incurred by the City in successfully enforcing such obligation, to be awarded and fixed by the court, and to be taxed as costs and to be included in the judgment therein rendered. IT IS HEREBY EXPRESSLY STIPULATED AND AGREED that this Bond shall inure to the benefit of any and all persons, companies and corporations entitled to file claims Title 3, (conunencing with Section 9000) of Part 6 of Division 4 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this Bond. Should the condition of this bond be fully performed, then this obligation shall become null and void, otherwise it shall be and remain in fill force and effect. 1 The Surety hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of said agreement or the specifications accompanying the same shall in any nnarmer affect its obligations on flus Bond, and it does hereby waive notice of any such change, extension, alteration or addition. IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and Surety above named, on November 3rd , 2014 PRINCIPAL: PALE Inc. doe Excel Paving Company (Type Company Name) By: (C.p ZdL'Iu� I me! C. P. BROWN, FRLMENT La Title: (Attach Aclmowledgements of both Principal and Surety signatures) APPROVED AS TO FORM: City Attorney Payment Bond - P.W. (except subdivisions) 02/13 M SURETY: Federal Insurance Company (Type Company Name) By: C. Title: Alt ey in Fact Do las A. Rapp By: Title: CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California Countyof Los Angeles On /I—Z— 14 _ before me, C. Phillips, Notary Public (Here heart name and nae of the 0 lea) personally appeared who proved to me on the basis of satisfactory evidence to be the person(cv(1 whose name($) is/Aw subscribed to the within instrument and acknowledged to me that helakaAhoWexecuted the same in hist authorized capacity✓ gO, and that by his t>a>g signature(s) on the instrument the person(fi), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Tide or description of Attached document continued) Number of Pages _ Document Date (Additional information) CAPACITY CLAIMED EYTHE SIGNER ❑ Individual (s) ❑ C. PHILLIPS WITNESS my hand and official seal. Y, ❑ c COMM. #1996177 N ❑ an ❑ a Notary Public -California tt ❑ Other LOS ANGELES COUNTY a Notary Seal) •" My Comm. Expires Oct. 29, 2016 igoemreo Notuy Public ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Tide or description of Attached document continued) Number of Pages _ Document Date (Additional information) CAPACITY CLAIMED EYTHE SIGNER ❑ Individual (s) ❑ Corporate Officer (rite) ❑ Partner(s) ❑ Attomey-in-Fact ❑ Trustee(s) ❑ Other _ , .,_ 2008.yer@ion CAPA v12.10,0.7 800-R73 9RGi _www NotaryClassas cam. INSTRUCTIONS FOR COMPLETING THIS FORM Airy acknowledgment completed in California most comeen verbiage exactly as appears above in lie nolary section or a separate acknowledgment form must be properly. completed and attached to that dacumenq. rhe only rxception is or a domrment is to be recorded outside of Call%rnia In sack imfarees, airy aformarive acknowledgment verbiage as may be printed on such a dacameeu so long as the verbiage does not requirt rhe rotary to do something da it illegal far a notary in California 0.e. cerlWrig the authorized cegwctry of rhe signal. Please check the dacwmew eorefallyfor proper nmarial wording and attach thUform ifnequited • State and County information must be the State and County where the document signet($) personally appeared before the notary public far acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which most also be Me same date the acknowledgment b completed. • The notory public mostprinthis or her name as it dppew witdn his or her commission followed by a comma and then your lite (notary public). • Print the names) of document signer(i) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (Lo, harsher b tare ) or circling the correct fomrs. Failure to correctly indicate this information may lead to rejection of document recording., • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, rascal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. F Additional information is not required but could help to ensure tds acknowledgment is not misused or attached to a diflfercat document. 4 Indicate tide or type of attached docmnent, number of pages and date. v Indicate the capacity claimed by the signer, If the claimed capacity is a corporate officer, indicate the Noe (i, e. CEO, CFO, Secretary). • Securely atcom mus doeumentto the signed document ACKNOWLEDGMENT State of California County of Orange I ) On 11/03/2014 before me, Debra Swanson, Notary Public (insert name and title of the officer) personally appeared Douglas A. Rapp who proved to me on the basis of satisfactory evidence to be the person(jd) whose name(o) is/are• subscribed to the within instrument and acknowledged to me that he/chef' executed the same in hisl*eNti� w authorized capacity(ie*, and that by hisAaAheir signature($) on the instrument the person(d), or the entity upon behalf of which the person(09 acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. .�� COi1tlM, ff •19g7119 � � n W� "f _ N07ANYPlIBI.IC•CALIFORNI&� Signature (Seal)a Qr FahfE Cf�t9N rY '�hnrc4. MY CQMM. EkP. NOV 1Q; 2P16 Chubb POWER Federal Insurance Company Attn: Surety Department OF Vigilant Insurance Company 15 Mountain View Road Surety ATTORNEY pacific Indemnity Company Warren, NJ 07059 Know All by These Presents, That FI COMPANY, a New York corporation, and P appoint Douglas A. Rapp and Timothy an Indiana corporation, VIGILANT INSURANCE sconsin corporation, do each hereby constitute and --------------------------------------------------------- each as their true and lawful Attorney- In. Fact to execute under such designation In their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 16th day of December, 2011. Kenneth C. Wende, Assistant Secretary - . Norris, Jr., Vice President STATE OF NEW JERSEY County of Somerset as. On this 16th day of December, 2011 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Noris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Norris, Jr., subscribed to said Power of Attorney is in the genuine handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By. Laws and in deponent's presence. ,Notarial Seal -�Apc KATHERINE J. ADELAAR SAAY`�y NOTARY PUBLIC NEW JFk5F1 ✓7 � � No, 231616 665 Comfniledon Expires July 16, 2014 Notary Public CERTIFICATION Extractfrom the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY "All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fact for purposes only of executing and attesting bands and undertakings and other writings obligatory In the nature thereof, and any such power of attorney or certificate bearing such facsimlle signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.' I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies") do hereby certify that (i) the foregoing extract of the By- Laws of the Companies is true and correct, (ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Department: further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed In American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (iii) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 3rd day of November, 2014 *(Do Kenneth C. We el, Assistant Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3,493 Fax (908) 903- 3656 e-mail: surety@chubb.com Form 15-10- 02256- U (Ed. 5- 03) CONSENT To: From: David Cavazos City Manager Fred Mousavipour, Executive Director Public Works Agency Date: March 2, 2015 Project Nos. 13-6797; Maple Bike Trail Safety Enhancement At Occidental Stree t, St, -And rew Place, and St. Gertrude Place; CM -5063(149) Subject: Change Order No. 1 CONTRACTOR : Excel Paving Company = P.O. Box 16405 Long Beach, CA 90806-5195 PROJECT DESCRIPTION: Maple Bike Trail Safety Enhancement At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) CHANGE ORDER NUMBER: CHANGE ORDER AMOUNT: $ 34,756.00 ACCOUNTING UNIT-ACCOUNT-ACTIvITy NUMBERS: 05917663-66220-13679702028 05917663-66220-13679703028 JUSTIFICATION EXTRA WORK AT AGREED PRICE The Maple Bike Trail Safety Enhancement project at Occidental Street, Saint Andrew Place, and Saint Gertrude Place consists of constructing bulb -outs within the existing public right-of-way at the three bike trail street crossings. The existing bike trail services hundreds of bicyclists and pedestrians every day, in addition the heavy use by students walking or biking to Edison Elementary School completed, these improvements will enhance safety at the bike crossings by shortening the crossing distance for all pedestrians and bicyclists. The contract documents require the contractor to construct eight new bulb -outs which will narrow the street at the intersections and will include new curb ramps. However, in order to enhance the aesthetics of the surrounding areas, staff recommends replacing the concrete area with landscaping and irrigation. Hence, the contractor was directed to change the scope of work to instead include plants as noted in PCO No. 1. Agreed Cost = $34,756 Project 13-6797 Request for Approval of Change Order No. 1 March 2, 2015 Page 2 of 2 ORIGINAL CONTRACT BID ITEMS QUANTITY ADJUSTMENTS Preliminary Estimated Item # Item Unit Quantity Unit Price Amount 4. PCC Sidewalk SF (2800) $8.00 ($22,400.00) Estimated Total ($22,400.00) CONTRACT COST SUMMARY Original Contract Total Previous Change Orders Adjusted Contract Quantities Change Order #1 Amount Total Amount % of Contract $224,887 $-0- ($22,400) Decrease -9.96% $34,756 ✓` Increase 15.45% Adjusted Contract Total $237,243.00 SCHEDULEIMPACT Increase contract time by 7 working days for delays associated with this change order. APPROVED AS TO FUNDS AND ACCOUNTS: Fred �ous vipour, Executive Director Francisco Gutierrez, Executive Director Public Works Agency Finance & Management Services Agency K:Construction/Projects/13-6797/8.Change Orders/B/CO #01/13-6797 MEM RFA CCO#01 4 L F 1 4 A CONTRACT CHANGE ORDER Project Number Project No. 13-6797; Maple Street Bike Trail Safety Enhancements at Occidental Street, St Andrew PL & St Gertrude PL — CM - 5063(149) To Excel Paving Company Change Order Number 1 Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated, rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by PUBLIC WORKS AGENCY EXTRA WORK AT AGREED PRICES3 `..m Compensate the contractor to provide landscaping and irrigation per PCO #1. .dfi... Js. AGREED PRyI6E ='$P4,756 ORIGINAL CONTRACT BID ITEMS QUANTITY ADJUSTMENTS C'l Item # Contract Bid Item Quantity Adiustment 3. PCC Sidewalk (4") (2800) U/M Unit Price Total SF $8.00 ($22,400.00) Total ($22,400.00) CHANGE ORDER COST SUMMARY INCREASE $34,756 DECREASE 22 400 NET INCREASE TO CONTRACT 12 356 Page 1 of 2 MINIFUNMRIA a 0 9 . �. CONTRACT CHANGE ORDER Project Number Project No. 13-6797; Maple Street Bike Trail Safety Enhancements Change Order Number at Occidental Street, St Andrew PL & St Gertrude PL — CM - 5063(149) To Excel Paving Company Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated, rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by PUBLIC WORKS AGENCY The compensation both time and cost set forth in this change order comprises the total compensation due the Contractor, all Subcontractors, and all Suppliers for all work performed per this change order, including impact on unchanged work. By signing this change order, the Contractor acknowledges and agrees on behalf of himself, all Subcontractors, and all Suppliers, that the stipulated compensation includes payment for all work contained in this change order, plus all payment for interruption of schedules, extended field overhead, home office overhead, profit, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract. The signing of this change order constitutes full mutual accord and satisfaction for all changes and work performed on this project, and that the time and cost paid per this change order constitutes the total equitable adjustments owed the Contractor, all Subcontractors, and all Suppliers for all work performed on this project. The Contractor on behalf of himself, all Subcontractors, and all Suppliers agrees to waive all rights, without exception or reservation of any whatsoever to file any further claim related to this project. TOTAL COST THIS CHANGE ORDER: DECREASE $ _ _ „ _ _ INCREASE By reason of this order the CONTRACT TIME completion will be adjusted as follows: 7 working days $ 12,356 We the undersigned contractor have given careful consideration to the change proposed and hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials, except as may otherwise be noted above, and perforin all service necessary for the work above specified, and will accept as full payment therefor the prices shown above. Accepted, Date Contractor Excel Paving Company By _! Al J , Titl G . 81tOWfi q � EN7 Approval recommended by L � _ %� Date Approved by \ ! �--— Date � �— Page 2 of 2 MEMORANDUM To: David Cavazos City Manager Fred Mousavipour, Executive Director From: Public Works Agency Date: May 1, 2015 Project Nos. 13-6797; Maple Bike Trail Safety Enhancement At Occidental Street, St. Andrew Place, and St. Gertrude Place; CM -5063(149) Subject: Change Order No. 2 c ca y- CONTRACTOR : Excel Paving Company w = P.O. Box 16405 Long Beach, CA 90806-5195 PROJECT DESCRIPTION: Maple Bike Trail Safety Enhancement At Occidental Street,'` t Andrew Place, and St. Gertrude Place; CM -5063(149) '' = CHANGE ORDER NUMBER: 2 CHANGE ORDER AMOUNT: $ 14,032.00 ACCOUNTING UNIT -ACCOUNT -ACTIVITY NUMBERS: 05917663-66220-13679702028 05917660-66220-13679703028 JUSTIFICATION EXTRA WORK AT TIME & MATERIAL The Maple Bike Trail Safety Enhancement project at Occidental Street, Saint Andrew Place, and Saint Gertrude Place consists of constructing bulb -outs within the existing public right-of-way at the three bike trail street crossings. The existing bike trail services hundreds of bicyclists and pedestrians every day, in addition the heavy use by students walking or biking to Edison Elementary School completed, these improvements will enhance safety at the bike crossings by shortening the crossing distance for all pedestrians and bicyclists. The contract documents required the contractor to remove the existing street section and construct a 4 - inch section of asphalt pavement over compacted subgrade. However, when the contractor began removing the street, the section was asphalt over pcc concrete, which caused the subgrade to be 2 inches lower. As a result, import fill material needed to be imported, graded and compacted. This work was performed on a time and material basis. (PCO#02) FINAL COST = $14,032.00 Project 13-6797 Request for Approval of Change Order No. 2 May 1, 2015 Page 2 of 2 CONTRACT COST SUMMARY Amount Authorized by City Council Amount Total % of Amount Contract Construction Contract $224,887.00 Previous Approved COs Change Order #1 $12,356.00 Increase 5.49% Change Order #2 $14,032.00 Increase 6.24% Total Change Orders to Date $26,388.00 Increase 11.73% Adjusted Total $251,275 SCHEDULEIMPACT Increase contract time by 16 working days for delays associated with this change order. APPROVED AS TO FUNDS AND ACCOUNTS: Fred Mou avipour, Executive Director Francisco G ierrez, Executive Director Public Works Agency Finance & Management Services Agency K:Construction/Projects/13-6797/8.Change Orders/B/CO #01/13-6797 MEM RFA CCO#02 Ml M PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project No. 13-6797; Maple Street Bike Trail Safety Enhancements Change Order Number 2 at Occidental Street, St Andrew PL & St Gertrude PL — CM - 5063(149) To Excel Paving Company Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated, rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by EXTRA WORK AT TIME & MATERIAL PUBLIC WORKS Import fill material for subgrade and perform additional grading and compacting on a time and materials basis. (PCO #02) FINAL COST = $14,032.00 CHANGE ORDER COST SUMMARY _ INCREASE $14,032 DECREASE -$-0- NETINCREASE TO CONTRACT 14 032 Page 1 of 2 h,> A 1A PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project No. 13-6797; Maple Street Bike Trail Safety Enhancements Change Order Number at Occidental Street, St Andrew PL & St Gertrude PL — CM - 5063(149) To Excel Paving Company Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated, rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by PUBLIC WORKS AGENCY The compensation both time and cost set forth in this change order comprises the total compensation due the Contractor, all Subcontractors, and all Suppliers for all work performed per this change order, including impact on unchanged work. By signing this change order, the Contractor acknowledges and agrees on behalf of himself, all Subcontractors, and all Suppliers, that the stipulated compensation includes payment for all work contained in this change order, plus all payment for interruption of schedules, extended field overhead, home office overhead, profit, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract. The signing of this change order constitutes full mutual accord and satisfaction for all changes and work performed on this project, and that the time and cost paid per this change order constitutes the total equitable adjustments owed the Contractor, all Subcontractors, and all Suppliers for all work performed on this project. The Contractor on behalf of himself, all Subcontractors, and all Suppliers agrees to waive all rights, without exception or reservation of any whatsoever to file any further claim related to this project. TOTAL COST THIS CHANGE ORDER: DECREASE $ _ _ _ _ _ INCREASE $ 14,032.00 By reason of this order the CONTRACT TIME completion will be adjusted as fellows: 16 working days. We the undersigned contractor have given careful consideration to the change proposed and hereby agree, if this proposal is approved, that we. will provide all equipment, furnish all materials, except as may otherwise be noted above, and perform all service necessary for the work above specified, and will accept as full payment therefor the prices shown above. Accepted, DAe, 5/4/2015 Contractor Excel Paving Company By � T, 11 A i,Title Curt Brown, Sr., President Approval recommended by UBLIC 46RIL AGENCY EXECUTIVE DIRECTOR Approved by Page 2 of 2 Date Date 5- / 2Z{ / I '