HomeMy WebLinkAboutDAMON INC. Recorded in Official Records, Orange County
Retarding Requested By, Hugh Nguyen, Clerk-Recorder
And When Recorded Mail To: ]111� �11
II 11�II] 11111 II I IIIClerk of the Council,City of Santa Ana I NO FEE
20 Civic Center Plaza,P.O.Box 1988 * $ R 0 0 0 8 7 3 3 5 Z 7 $ *
Santa Ana,CA 92702 2016000477697 3:18 pm 09/30/16
37 414 N12 1
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.04
THIS SPACE FOR COUNTY RECORDERS USE ONLY
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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
a construction of 3RD AND BUSH RESTROOM under contract entered into on JUNE 21, 2016,
with DAMON, INC., on which contract NORTH AMERICAN SPECIALTY INSURANCE
z COMPANY is surety. The property on which such work improvement was placed is in the City
oof Santa Ana, County of Orange, State of California, and described as Project No. 16-1305
o located at: 3RD STREET AND BUSH STREET. The work improvement on said property was
a z accepted as completed on SEPTEMBER 19, 2016.
� Z
p CITY OF S ANA, A MUNICIPAL CORPORATION
� v
by
z Q Dated: 2`y Princi 1 Civil Engineer-Ty1one Chesanek
TITLE
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tX
Ua
VERIFICATION
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 on �' �(0 at Santa Ana, Califo
(Signature of indiv(fucompletion
al swearing that the
contents of Notice are true.)
THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10)DAYS AFTER COMPLETION
REQUEST FOR
COUNCIL ACTION
CITY COUNCIL MEETING DATE:
JUNE 21, 2016
TITLE:
AWARD CONTRACT TO DAMON INC. FOR
CONSTRUCTION OF NEW RESTROOM
FACILITY AT 3RD AND BUSH STREETS
(PROJECT: 16-1305)
{STRATEGIC PLAN NO. 6, 1G}
__ f
CITY MANAGEFU
CLERK OF COUNCIL USE ONLY:
APPROVEDJUN 2 1 2016, ar>6
Z As Recommended
❑ As Amended
❑ Ordinance on I" Reading
❑ Ordinance on 2nd Reading
❑ Implementing Resolution
❑ Set Public Hearing For
CONTINUED TO
FILE NUMBER
1. Reject the sole bid received on May 27, 2016 from Metro Builders & Engineers Group, Ltd. in
amount of $322,500, for construction of New Restroom Facility at 3rd and Bush Streets
Project.
2. Authorize the City Manager and Clerk of the Council to award and execute contract with
Damon Inc., the lowest responsible bidder, in accordance with the base bid in the amount of
$174,454 for the construction of a new restroom facility at 3RD and Bush Streets , subject to
non -substantive changes approved by the City Manager and City Attorney.
3. Approve the Project Cost Analysis for the total estimated project delivery cost of $235,514,
which includes the contract base amount, administration, inspection, testing, and an
authorized contingency of approximately 20 percent, in the amount of $34,892.
4. Approve an appropriation adjustment for Fiscal Year 2016-17 to recognize $235,514 from
prior year fund balance and appropriating $235,514 into the Downtown Enhancements
expense account.
DISCUSSION
As part of the Downtown Enhancements and Parking Modernization Plan, staff met with various
downtown stakeholders to discuss the amenities in the Downtown that would enhance guest
experience. The lack of public restrooms was prominent in the formation of the Plan. Staff has
been working on two separate public restroom projects; a restroom adjacent to Plaza Calle
Cuatro and the 3rd and Bush Streets Public Restroom. The Calle Cuatro restroom project is
being incorporated into a larger construction project and will be presented to the City Council later
this year.
Contract Award For Construction of
New Restroom at 3rd and Bush Streets
June 21, 2016
Page 2
The proposed project for consideration at 3rd and Bush Streets involves the construction of a new
permanent restroom facility, which will include two fully ADA/CBC accessible, uni-sex restrooms,
drinking fountain, water bottle filling station, and bench seating. The building's facades will
incorporate local street art and a vertical garden. Site improvements include extension of existing
landscaping and irrigation. Located at the northeast corner of 3rd and Bush Streets in the surface
parking lot (Exhibit 1), this public facility will support downtown activity and programming.
A Notice Inviting Bids was originally advertised for bid on April 11 and 18, 2016 and the bid was
opened on April 27, 2016. Due to the fact that only one bid was received, which was
unaffordable, the project was modified and re -advertised on May 2 and May 9, 2016. Bids were
opened on May 11, 2016; the following is a summary of the bid invitations made and the bids
received:
Contractor Participation Data
Santa Ana contractors receiving notices
18
Contractors requesting bidding documents
3
Bids received
4
Bids received from Santa Ana contractors
0
Bid Results Summary
RANK
BIDDER'S NAME
LOCATION
BASE BID AMT
1
Damon, Inc.
Downey
$174,454.00
2
Horizons Construction Co. Int'l, Inc.
Orange
$235,400.00
3
Lehman Construction, Inc.
Tustin
$247,900.00
4
Metro Builders & Engineers Group, Ltd.
Newport Beach
$307,860.00
A total of four bids were received and all four were considered responsive. Damon, Inc. submitted
the lowest responsive bid in the amount of $174,454 (Exhibit 2). Damon, Inc.'s bid is comparable
to the engineer's estimate of $180,000. Based on the bid analysis and a contractor's reference
check, staff recommends awarding the construction contract to Damon, Inc. (Exhibit 3).
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 G (develop and implement the City's Capital Improvement Program in
coordination with the Community Investment Plan (e.g., neighborhood streets, traffic
improvements, etc.).
Contract Award For Construction of
New Restroom at 3`d and Bush Streets
June 21, 2016
Page 3
ENVIRONMENTAL IMPACT
In accordance with the California Environmental Quality Act, the recommended actions are
exempt from further review. Categorical Exemption Environmental Review No. 2016-56 was filed
for this project.
FISCAL IMPACT
As indicated in the Cost Analysis (Exhibit 4), the estimated total delivery cost of this project is
$235,514, which includes construction, contract administration, inspection, testing, surveying and
contingencies. An appropriation adjustment for FY 16-17 will recognize prior year fund balance of
$235,514 into the Parking Fund Prior Year Carry Forward revenue account (no. 02710002-
50001) and appropriate $209,346 into the Downtown Enhancements Building Improvements
expense account (no. 02710133-66200) and $26,168 into the Downtown Enhancements Salaries
expense account (no. 02710133-61000).
Executive Director
Public Works Agency
FM/EWG/TC/MO
Exhibits: 1. Location Map
2. Bid
3. Construction Contract
4. Cost Analysis
APPROVED AS TO FUNDS AND ACCOUNTS:
Francisco Gutierrez
Executive Director
Finance & Management Services Agency
SANTAANA
City Council
Agenda Date
PUBLIC PUBLIC wonxa AGENCY June 21, 2016
Project No. 16-1305:
New Restroom at 3rd and Bush Streets
Exhibit 1
Eq
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: t6-1305
3'D AND BUSH RESTROOM
BID PROPOSAL
TO: CITY COUNCIL OF THE CITY OF SANTA ANA
FROM: 0A VNA 0 T~j
REQUIREMENT:
Me,g6um 1.r "mss
EXHIBIT 2
The undersigned bidder declares that they have carefully examined the location of the proposed
work, that they have examined the Contract Documents in its entirety and hereby proposes to
furnish all material and do all the work required to complete the said work in accordance with
said plans (if any) and the specifications for the unit price(s) or lump sutn(s) set forth in the
following schedule:
BASE BID:
Item
Description
Qty
Unit
Unit Price
Amount
I
Design -Build New Restroom
1
LS
$
$
Facility
i
_
2
New Water Service
1
LS
$
$
=
f1,O U
3
New Sewer
1
LS
$
$
=79
,
4
New Electrical Service
1
LS
$
5
Site Work
1
LS
$
$
6
Landscape & Irrigation
1
LS
$ u
$ -
Modifications
TOTAL BASE BID
S
_44;tf
ADD ALTERNATE BID:
7
Parking Lot Lighting Modifications
1
LS
$
$,
r
TOTAL ADA ALTERNATE BID
$
P-1 ofP-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3RD AND BUSH RESTROOM
Item Description
Qty
Un1C
Unit Prue
Amount
TOTAL ADD ALTERNATE BID
$ Jai Aja
TOTAL BASE RID
b
� N
It ')
The lowest responsible bidder shall be selected based on the total base bid. The City nese es"t e
right to award the Base Bid, and any, all, or none of the add -alternate bid items (if any).
* 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.
f This bid item is considered a Specialty Item per Section 2-3.2 of the Standard Specifications
TIME FOR COMPLETION OF IMPROVEMENTS AND LIOUIDATED DAMAGES
The undersigned bidder hereby proposes to complete the Work for the total base bid amount
shown above, within SIXTY (60) working days after the commencement date stated in the
Notice to Proceed.
The liquidated damages amount, in lion of the amount specified in Subsection 6-9 of the
Standard Specifications, shalt be $500 per calendar day.
NameofFirm 'DYiY 10y, t4yG—
Signature of BIDDER
Title k 1-L
(If an individual, so state. If a firm or cc -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.)
P-2 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 1.6-1305
3RD AND BUSH RESTROOM
BIDDER'S STATEMENT
BIDDER understands and agrees that this Bid Proposal, Contract Documents and subsequent
Construction Contract Agreement shall constitute the entire agreement between BIDDER and the
AGENCY only after it has been accepted by the City Council, endorsed by the Cleric 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/her 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 fiends, check, drafts, or
BID'DER'S bond substituted in lieu thereof shall be returned to the undersigned.
BIDDER understands that a bid is required for the entire work, 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. The
BIDDER also certifies that the bid is a balanced bid.
In accordance with Section 7028.15 of the California Business and Professions Code, the
undersigned certifies under penalty of perjury that the foregoing is true and correct.
Name of Firm A)AVIA o t-� l tJ C
Signature of BIDDER
Title Ui u'
(Iran individual, so state. If a firm or co -partnership, state the firm naine 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.)
P-3 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3"D AND BUSH RESTROOM
CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT
The undersigned contractor, or corporate officer, declares under penalty of perjuxy that lie/she
and all his/her subcontractors are registered with the State of California Department of Industrial
Relations (DIR), and that the following is true and correct.
Contractor's Name: DAM0, -" 1 N C
Business Address: _CA iQO tet.
dkM0 �' � � AJv
t)C)w'n e '-(
Uk '10 Zk4 C)
Business E -Mail Address:
q wl c� .
Ccs w�.
Telephone: 562— a . t',q I 0
State Contractor's License No. and Class: q,b S co 9
License Expiration Date:
State Dept. of Eidustrial Relations (DIR)
Registration No.:
State Dept. of
Registration E)
Signcd:
G
(D>R) 61 � 0 / 16
Title: G V(,6 P.
P-4 o'fP-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3RD AND BUSH RESTROOM
PREVAILING WAGE COMPLIANCE AND MONITORING STATEMENT
Contractor is aware of the requirements of California Labor Code Section 1720, et seq., as well
as California Code of Regulations, Title 8, Section 16,000, et seq., ("Prevailing Wage Laws"),
which require the payment of prevailing wage rates and the performance of other requirements
on "public works" and "maintenance" projects. Since the services are being performed as part of
an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws,
and since the total compensation is $1,000 or more, Contractor agrees to fully comply with such
Prevailing Wage Laws.
City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at
the commencement of this Agreement. Contractor shall make copies of the prevailing rates of
per diem wages for each craft, classification or type of worker needed to execute the services
available to interested parties upon request, and shall post copies at the Contractor's principal
place of business and at the project site.
Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees
and agents free and harmless from any claim or liability arising out of any failure or alleged
failure to comply with the Prevailing Wage Laws.
The undersigned certifies that the foregoing is true and correct.
Name of Finn PA 01 ° ' C
J ° '
Signature of BIDDER
Title tV6ce 11rc-"
(if an individual, so state)
P-5 of P-16
OWNERSHIP AFFIDAVIT
STATE OF CALIFORNIA
COUNTY OF ORANGE
CITY OF SANTA ANA
❑ INDIVIDUAL
❑ PARTNERSFIIP
XCORPORATiON
❑ SOINT VENTURE
that such a bid is
collusion to securt
proposed contra,,
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3R"AND BUSH RESTROOM
) SS
being duly sworn, deposes and says
That he/sho is the party malting the foregoing proposal _
That he/she is a member of the co -partnership firm designated as:
and who has been and is duly vested with the authority to male and execute instwi
fortheco-partnefshipby:\w\ei
who constitute the other members of Cha co -partnership.
Thatis of: �; v\"vr ( It C,
C'
R corporation which is making the foregoing proposal:
That he is of:
one of the parties malting the foregoing proposal as a joint ventrue, andthe he/she has
been and is duly vested with the authority to ox. -cute instruments for an on behalf of the
parties making said bid who are:
and not collusive or sham, and has not in any manner sought by
tntage against the City of Santa Ana or any person interested in the
If or any other person.
d i1
Subscribed4 d sworn to before me this f day of �l�— 20((-,
qa !L'Vtfe,.C.(n.Pr. -� ,�r�"tD'�llta.. juga
Signature of officer Administering Oath (Notary Public)
P-6 ofP-16
A notary public or other officer completing this certificate verifies only the identity of
the individual who signed the document to which this certificate is attached, and not
the truthfulness, accuracy, or validity of that document.
State of California
County of ULI;
Subscribed and sworn to (or affirmed) before me on this it�^ day of
20 t� by ( ofy
s
proved to me on the basis of satisfactory evidence to be the person(s) who appeared
before me.
Signature (Seal)
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
201E Version 800-873-9B6f,
RICARDO htAGNb••��
CpMM. #2123529 z
oma^, _ 'au -' Notary Putriic •California �
a � Los Angelas Cmmty
M�mm, Expire& Sep. 1), 2019
INSTRUCTIONS
The welding otall Jumts completed in California after January 1, 2015 must be in the form
as set forth within this Jurat. There are no exceptions. It a Jurat to he completed does not
follow this Pond, the notary must correct the verbiage by using ajurat stamp comaining the
correct wording or allaching a separate jurat form such as this one with does contain the
proper wording, in addition, the notary must require an oath or aftirmafton from the
document signer regarding the truthfulness of the contents of the document. The
document must be signed AFTER the oath or afrmallon. If the document was previously
signal if mustils re-signed in front ofthe notarypublic during thejurat process.
• State and county Information must be the state and county where the
document signer(s) personally appeared before the notary public.
• Date of notarization must be the date the signer(s) personally
appeared which must also be the same date the jurat process is
completed.
• Print the names) of the document mgner(s) who personally appear at
the time of notarization.
• Signature of the notary public must match the signature on file with the
office of the county clerk.
• The notary seal impression must be clear and photographically
reproducible. Impression must not cover text or lines. If seal impression
smudges, re -seal if a sufficient area permits, otherwise complete a
different jurat form.
t• Additional information Is not required but could help
to ensure this jurat is not misused or attached to a
different document.
Indicate title or type of attached document, number of
pages and date.
• Securely attach this document to the signed document with a staple.
Bond No.; DAMIN-084
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3 R AND BUSH RESTROOM
AID BOND
KNOW ALL PRESENT that,
Damon, Inc, , as BIDDER, and
North American Specialty Insaranue Company , as SURETY,
are held and firmly bound unto the CITY OF SANTA ANA, as AGENCY, in the penal sum of
Ten Percent of n,c'rotal An,own Bid; Bid *Dollars (gz7soo.00 ..... J, which is ten percent (10%)
of the total amount bid by AFD -MR -to AGENCY for the above -stated project, for the payment of
which sum. BIDDER and SURETY agree to be bound, jointly and severally, firmly by these
presents. 3Bond Penalty not to Execud Twenty -Seven Thousand Five Hundred and 00!100
THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas BIDDER is about to
submit a bid to AGENCY for the above -stated project, if said bid is rejected, or if said bid is
accepted and a contract is awarded and entered into by BIDDER in the manner and time
specified, then this obligation shall be null and void, otherwise it shall remain in full force and
effect in favor of AGENCY.
IN WITNESS NESS WHEREOF the parties hereto have set their names, titles, hands, and sea] this
lou, day of May 2016.
BIDDER'
9602 Samoline
North
Matthew R. Myns, Attorney -in -Fact
Subscribed and sworn to before me
20,_-'
Signature:
Notary Public in and for the County of
Tel: I (562) 606-3139
6 Hutton Centre Drive,
State of
Santa Ana, CA 92707
Tel: ] (714) 550-7799
this, day of
Provide BIDDER/ SURETY name, address. and telephone number and the name, title,
address, and telephone number of authorized representative.
P-7 of P-16
NAS SURETY GROUP
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
GENERAL POWER OE ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing tinder
laws of the State of New Hampshire, and having its principal office in the City of Manchester, Now Hampshire, and Washington International
Insurance Company, a corporation organized and existing under the laws of the State of Now Hampshire and having its principal office in the City of
Schaumburg, Illinois, each does hereby make, constitute and appoint:
RANDY SPOHN and MATTHEW R. DOBYNS
JOINTLY OR SEVERALLY
Its true and lawful Attorney(s)-hi-Foot, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of: FIFTY MILLION (S50,000,000,00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held
on the 9t1i of May, 2012:
"RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President',
the Secretary or any Assistant Secretary be, and such or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named
in the given Power of Attorney to execute on behalf of the Company heads, undertakings and all contracts of surety, and that each or any of them
hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; mid 1t is
FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any
eerdfieate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal, shall be
binding upon the Company when so affixed and in the Future with regard to any bond, undertaking or contract of surety to which it is attached,"
orlmmumnHi
By
�J\y�pVAtITY/ Idi� „�umuuPulund4r
o aR.BpMifk�''�yrySIQN:4I/H
SEAL 3 Stevm, senior Vlo Piosirryloc Pres idwlorwssl,inelun Ltlurnoiiunntmnronoo Cangsnm
W i%% 1979 &Senior Vleo erosNmq nYNarra Anmrlcan Npeolxl[ynrs,rtnnce Compnnv
Nj 1y yet p "tl
jllllli1111IIPPVI\\
BY
Won) M.lgnii„Via h.1daniol'wnhiaemn�NonM lnewnna Conspa,y ribnlw
5 \'incYrcsltleni ofNorre Ameelenn Specialty Lsvrvu¢e C.,,uny
IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International lusutanee Company have caused their
official seals to be hereunto affixed, and these presents to be signed by their authorized officers thls26tb day of dune , 2012
North American Specially Insurance Company
Washington International Insurance Company
State of Illinois
County of Cook ss:
On this 26tli day of June 2012 , before me, a Notary Public personally appeared Steven P. Anderson , Senim' Vlce PrnsidQlll of
Washington International Insurance Company and Senior Vice President of North Annericmn Specialty Insurance Company and David M• Layman,
Vice President of Washington International Insurance Company and Vice President of North Arnerleatr Specialty Insurance Company,
personally known to are, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and
acknowledged said instrument to be the voluntary act and deed of their respective companies. n
OP1nC1AH,S8AL”
DONNA D. SXLBN5
Notary Public, Slate bf liftola Donna D. Sklens, Notary Public
'Ady.Gontmissiog'i?K, free 1010512045
1, JeffreXGoldbere the duly elected Assistant Secretary of North American. Specialty Insurance Company and Washington
International Insurance Company, do hereby certify that [lie above and foregoing is a true mud correct copy of a.Power of Attorney given by said North
American Specialty Insurance Company and Washington International ,Insurance Company, which is still in fill] fin co and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 10th day of May
.20 16 .
SeFl}oykoltional Vicerlci of&Asci Nt ah An,ai aP
WarLingmu Ldenmtiona rnemrence Consrany & N'wth Amodann 9pacinhy iosm'nnar Cnmpeny
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only tine identity of the
individual who signed the document to which this certificate is attached, and not the truthfulness,
accuracy, or validity of that document.
State of CALIFORNIA__
County of ORANGE _
On �{ U � before me, ERIKA GUIDO, NOTARY PUBLIC,
personally appeared MATTHEW R. DOBYNS ®,
® who proved to me on the basis of satisfactory evidence to be the person(}
whose names} is/are subscribed to the within instrument and
acknowledged to me that he/she/t" executed the same in his/her/their
authorized capacity (ies), and that by his/herJtiieir signatureW on the
instrument the personN, or the entity upon behalf of which the personH
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.
ERiKAtiUIDO WITNESS official seal.
,::
COMM #! 2022671
NOTARY PUBLIC CALIFORNIA
oRANGECCUNrY�
jdand
My comm. expires May 6, 2017 )�
OPTIONAL ,
Though the data below is not required by law, it may prove valuable to persons relying on the document and
could prevent fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACKED DOCUMENT
❑ INDIVIDUAL
❑ CORPORATE OFFICER
❑ PARTNER(S) ❑ LIMITED
® ATTORNEY-IN-FACT
❑ TRUSTEE(S)
❑ GUARDIAN/CONSERVATOR
❑ OTHER: ^ �_
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 164305
3RDAND BUSH RESTROOM
LIST OF SUB -CONTRACTORS
Section 41.00 et. seq. of the Public Contract Code requires listing of all subcontractors with the bid for all
subcontract work exceeding the following amount:
o Streets, highways including bridge projects: ''/a% of the bid or 510,000, whichever is greater
o Buildings, parks, or other projects: i/z% of the bid
Section 1725.5 of the Public Contract Code requires all Subcontractors be registered with the State
Department of Industrial Relations (DIR).
BIDDER proposes to subcontract certain portions of the work to the firms listed below:
Name 6
License 4/Exp.
DIR Reg. -#/Exp.
Location
Phone
Type Of Work
Amount $
Name
License #/Exp.
DIR Reg. #/Exp.
License #
Location
Phone
Type Of Work
Amount $
Name
License #/Exp,
DIR Reg. #/Exp.
License # _
Location _
Phone
Type Of Work
Amount $
1p
JCULA
�1yrt1'.�
rvo
Name
License #/Exp.
DIR Reg. #/Exp.
Location
Phone
Type Of Work
Amount $
Name
License #/Exp.
DIR Reg. #/Exp.
License # _
Location
Phone
Type Of Work
Amount $
Name
License #/Exp.
DIR Reg.#/.Exp.
License #
Location
Phone
Type Of Work
Amount $
P-8 of P-16
CITY OF SANTA. ANA
PROPOSAL,
PROJECT NO.: 16-1305
3RO AND BUSH RESTROOM
REFERENCES
0 k-e:,.Cvve
The following are the names, addresses, and telephone munbers for THREE public agencies for
which the BIDDER has performed similar work within the past three years.
1.
2.
3.
Name and Address of Owner.
Name and Telephone Number of person familiar with project.
Contract Amount
Name and Address of owner.
Type of Work
Name and Telephone Number of person familiar with project.
Date Completed
Contract Amount Type of Work Date Completed
Name and Address of owner.
Name and Telephone Number of person familiar with project.
Contract Amount Type of Work
Date Completed
The following are the names, addresses, and telephone numbers of all brokers and sureties from
whom BIDDER intends to procure insurance and bonds.
P-9 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3P -D AND BUSH RESTROOM
ADDITIONAL REFERENCES
�, e 'Ark- ctd, eek
The following are the names, addresses, and telephone numbers for THREE public agencies for
which the BIDDER or Subcontractor has performed street improvement work in the past 5 years.
2.
3.
Name and Address of Owner.
Name and Telephone Number of person familiar with project.
Contract Amount Type of Work Date Compl
Name and Address of owner.
Name and Telephone Number of person familiar with project.
Contract Amount Type of Work
Name and Address of owner,
Name and Telephone Number of person familiar with project.
Contract Amount
Type of Work
Date Completed
Date Completed
The following are the names, addresses, and telephone nurnbers of all brokers and sureties from
whom BIDDER intends to procure insurance and bonds.
P-10 ofP-16
DAMON, Inc.
License: 463003
References for City of Santa Ana
3b and Bush Street Restrooms Project
1. Project Name: Boat Canyon and Alta Laguna Park Restroom Rehabilitation
Owner: Laguna Beach
Valuation $100,000
Description: Work consisted of upgrading men's/women's restrooms at both parks. ADA Upgrades,
partitions, painting, fixtures, plumbing.
Contact:
Kenneth Il
714.738.6845
303 W. Commonwealth Ave.
Fullerton, CA 923£324,
2, Project Name: Separate Gender Accommodation Fire Station 1
owner: City of Fullerton
Valuation: $180,000
Description: Fire station Remodel. Demolition, plumbing, paint, electrical, drywall, tile removal and
replacement to male restroom and converting one restroom in to a female restroom. Also remodeled
training room and storage room.
Contact:
Kenneth Il
714.738.6845
303 W. Commonwealth Ave.
Fullerton, CA 923824.
3. Project: Bellis Park Snack Shack improvements
Owner: City of Buena Park
Valuation: $155,300
Description: Tile removal and replacement, hot mop, pluming, restroom and kitchen renovation including
appliance installation, partitions, paint, stainless steel.
DAMON, Inc.
License: 463003
References for City of Santa Ana
310 and Bush Street Restrooms Project
1. Project Name: 31149 Front St. Renovation
Valuation: $218,000
Owner: City of Alhambra
Description: Remodel of SFR to include: Demo, plumbing, concrete, electrical, structural framing,
painting.
Contact:
Martin Flay
111 S. First St.
Alhambra CA, 90801
626.570.5007
2. Project Name: Movie'rheater Alley Improvements
Owner: City of Alhambra
Valuation: $45,000
Description: Alley improvements to include: pavers, lighting and demo.
Contact:
Patrick You ng
(760) 505.0700
111 S. First St.
Alhambra, CA 91801
3. Project Name: Fires station 1
Valuation: $30,000
Owner: City of Orange
Description: Upgrades to Fire station including, flooring, demo, electrical and framing.
Contact:
Majid Farhat
(714) 744-5562
300 C. Chapman
Orange, CA 92866
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 1.6-1305
3RD AND BUSH RESTROOM
NON -COLLUSION AFFIDAVIT
(Title 23 United States Code Section 112 and
Public Contract Code Section 7106)
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 share; 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 ortio thereof shall also constitute signature of this Non -collusion
Affidavit. BI E e cautioned that malting a false certification may subject the
certifier to tri nal osecution.
Signed
State of C�
County of
S bscribcd and sworn to (or affirmed) before me on this e) day oft—,, 2014, by
�*
bV10 DCMOLAI,K proved to me on the basis of satisfactory evidence to be the
person(s) who appeared before me
Notary Public Signature Notary Pablie Seal
P-11 of P-16
A notary public or other officer completing this certificate verifies only the identity of
the individual who signed the document to which this certificate is attached, and not
the truthfulness, accuracy, or validity of that document.
State of California
County of
Subscribed and sworn to (or affirmed) before me on this Id day of l
20 (G,' by
J0140, 1)(A0A0(AtbI _i,<�
proved to me on the basis of satisfactory evidence to be the person(,sfwho appeared
before me.
Signature (seal)
DESCRIPTION OF THE ATTACHED DOCUMENT
0V . Co1Iu"It,V-� ,(} w
(Tido or description of attached document)
(Tido or description of attached document continued)
Number of Pages _ Document Date
Additional information
20 1' Varsior. wr iv, f oit vr,le car, 800 5865
�. "'A"" MAGtd6 1
COMM, #2123529
rx; kw. Nctary Public California 71
z 3.,a Los Angeles County
My Comm. EIres 5e . I1, 2614
INSTRUCTIONS
The wording of all Jurats completed in California aflor January 1,2015 must be in the farm
as set forth within this Jurat, There are no exceptions. If a Jurat to be completed does not
follow this fon, the notary must correct the verbiage by using ajuror stamp containing the
correct wording or almishfng a separate past form such as tills one with does canlafn the
paper wording. In addition, the notary, must require an oath or affirmation from the
documerd signer regarding the truthfulness of the contents of the document. The
document must be signed AFTER the oath or affirmation. If the document was previously
signed, it must be resigned In front of the salary public during thejurat process
State and county information must be the state and county where the
document signer(s) personally appeared before the notary public.
Date of notarization must be the date the signers) personally
appeared which must also be the same date the jurat process is
completed.
Print the name(s) of the document signer(s) who personally appear at
the time of notarization.
Signature of the notary public must match the signature on file with the
office of the county clerk.
The notary seal Impression must be clear and photographically
reproducible. Impression must not cover text or lines. If seal impression
smudges, re -seal if a sufficient area permits, otherwise complete a
different jurat form.
. Additional information Is not required but could help
to ensure this jurat is not misused or attached to a
different document.
Indicate title or type of attached document, number of
pages and date.
Securely attach this document to the signed document with a staple.
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3RD AND BUSH RESTROOM
NON-DISCRIMINATION CERTIFICATE
The undersigned contractor or corporate officer, during the performance of this contract, certifies
as follows:
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-cornpliance 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.
P-12 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3 R1 AND BUSH RESTROOM
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 staters, 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 ter.
Signed: �
Title: AV2f-,,,7t'�l' l
Firm: wlo pr, t,eaC.
Date:J 1 I ,
P-13 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3an AND BUSH RESTROOM
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 Rind or fiords in each craft or trade in which he/she employs j ouuneymen 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 t .the California Apprenticeship Council.
Signed:
Title: V(Ce
Firm: UNMa4 kt'A'
Date: ;1,'1 16
P-14 ofP-t6
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1.305
3RD AND BUSH RESTROOM
STATEMENT RE,EGARDING "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 subcomra• or shall be prohibited from inducing, by any means, any person
employed in the construct' r repair of public work, to give up any part of the compensation to
which he/she is o(hexit i itled.
Signed: (% /of/ l/
Title: t l L q tc, \ &C o1
Firm: Nyvot+ u',)u
Date: 5 I `t II (I
P-15 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3R" AND BUSH RESTROOM
PUBLIC CONTRACT CODE SECTION 10162 OUESTIONNATRE
In conformance with Public Contract Code Section 10162, the BIDDER shall complete,
under penalty of perjury, the following questionnaire:
Has the BIDDER, any officer of the BIDDER, or any employee of the BIDDER who has a
proprietary interest in the BIDDER, ever been disqualified, removed, or otherwise prevented
from bidding on, or completing a federal, state, or local government project because of a
violation of law or a safety regulation?
Yes No
If the answer is yes, explain the circumstances in the following space
P-1.6 o:CP-16
Contact:
Jeff Townsend
714.562,3680
6650 Beach Blvd.
P.O. Box 5009
Buena Park, CA 9062.2
4. Project: Pedestrian Gate at the Community Center
Owner: City of Buena Park
Valuation: $46,454
Description: Tile removal and replacement, hot mop, pluming, restroom and kitchen renovation including
appliance installation., paint, stainless steel.
Contact:
.Jeff Townsend
714.562.3680
6650 Beach Blvd.
P,O. Box 5009
Buena Park, CA 90622
5. Project: Holly Ave. Ball Wall Replacement
Owner: Arcadia Unified School District
Valuation: $50,000
Description: Concrete, demolition, rebar and asphalt for engineering of new handball courts.
Contact:
Jaime Morales:
626,821.8300 EXT: 6620
150 S. 3rd Ave.
Arcadia, CA 91006
Exhibit 3
CITY OF SANTA ANA
CONSTRUCTION CONTRACT
PROJECT NO.16-1305
3RD AND BUSH RESTROOM
This CONSTRUCTION CONTRACT is made and entered into this 2t" day of June, 2016 , by
and between the CITY OF SANTA ANA, CALIFORNIA, a charter city and municipal
corporation organized and existing under the Constitution and laws of the State of California,
hereinafter referred to as "CITY" and Damon Inc., hereinafter referred to as "CONTRACTOR
WITNESSETII:
The CITY and the CONTRACTOR, for the consideration hereinafter named, mutually agree as
follows:
1. CONTRACTOR agrees to perform all the work and furnish all the materials at its own cost
and expense necessary to construct and complete in a good and workmanlike manner and to
the satisfaction of the City Engineer of the CITY, the 3`J and Bush Restroom Project,
hereinafter referred to as the "Work of Improvement" identified in and in accordance with
the Contract Documents prepared by the City's Public Works Agency and approved by the
City Council,
2. The complete Construction Contract consists of the "Contract Documents" as defined by the
Standard Specifications for Public Works Construction and which include the following:
• Notice Inviting Bids
• Information to Bidders
• Bid Proposal
• Bid Bond.
• Contract Form
• Contract Bonds
• General Provisions
• Special Provisions
• Technical Provisions and Project Plans
• Appendices
In case of conflict between the Contract Documents, the precedence of documents shall be as
established in the Standard Specifications for Public Works Construction.
3. CITY agrees to pay and CONTRACTOR agrees to accept in fill payment to complete the
Work of Improvement the sum total amount not to exceed $174,454.00 — One hundred
seventy-four thousand four hundred fifty-four dollars and no cents, as set forth and identified
in the BID PROPOSAL, which is attached hereto and incorporated herein as Exhibit "A."
Page 1 of 3
CITY OF SANTA ANA
CONSTRUCTION CONTRACT
PROJECT NO,16-1305
3RD AND BUSH RESTROOM
The BID PROPOSAL contains a schedule of unit price(s) or Jump sum(s) based on
approximate quantities only, and the City does not expressly or by implication agree that the
actual amount of work will correspond therewith, but reserves the right to increase or
decrease the amount of any class or portion of the work or to omit portions of the work as
may be deemed necessary or advisable.
4. CONTRACTOR agrees to complete the Work of Improvement within the time specified in
the Time for Completion of Improvements section of the BID PROPOSAL (Exhibit "A")
including commencing construction within the timeframe therein specified after issuance of a
Notice to Proceed.
5. The CONTRACTOR will pay, and will require all subcontractors to pay, all employees on
the Work of Improvement a salary or wage at least equal to the prevailing salary or wage
established for such work as set forth in the wage determinations for this work in accordance
with applicable State and Federal law.
6. CONTRACTOR shall, after award of this Contract, furnish two bonds to be approved by the
CITY, one in the amount of One Hundred Percent (100%) of the Contract price, to guarantee
the faithful performance of the work (Performance Bond), and one in the amount of One
Hundred Percent (100%) of the Contract price to guarantee payment of all claims for labor
and materials furnished (Payment Bond), This Contract shall not become effective until such
bonds are supplied to and approved by the CITY.
%. CONTRACTOR shall, prior to the release of the performance and payment bonds or the
retention payment, furnish a warranty performance and payment bond (Warranty Bond).
Said Warranty Bond shall also be required as a condition of project acceptance. For projects
up to $500,000, the Warranty Bond amount shall be the greater of $10,000 or 20% of the
final contract price. For projects above $500,000, the Warranty Bond amount shall be the
greater of $100,000 or 10% of the final contract price.
8. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability
Insurance and Worker's Compensation Insurance as outlined in the General Provisions, to be
approved by the CITY.
Page 2 of 3
CITY OF SANTA ANA
CONSTRUCTION CONTRACT
PROJECT NO.16-1305
3RD AND BUSH RESTROOM
IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract ori the
Clay and year first above written.
ATTEST:
MARIA D. HIJIZAR
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
BY
os Sandoval
ief Assistant City Attorney
CITY OF SANTA ANA:
DAVID CAVAZOS
City Manager
RECOMMENDED FOR APPROVAL:
Fred Mousavipour
Executive Director, Public Works Agency
CONTRACTOR:
By:
Page 3 of 3
COST ANALYSIS
PROJECT NO. 16-1305: 3RD AND BUSH STREETS PROJECT
Construction Contract
$ 174,454
Contract Administration
$ 10,662
Inspection and Testing
$ 15,506
Survey
$ 0
Contingencies
$ 34,892
TOTAL ESTIMATED CONSTRUCTION COSTS
$ 235,514
EXHIBIT 4
REQUEST FOR APPROPRIATION ADJUrSTMEN
Appropriation Adjustment No: 2017-03 / 7 1,2-61 t�? % .. C
Date: June 1, 2016 Council Action Date JUN 2016 G
r
Department: Finance & Management Services
Approved: Yes
TYPE OF ADJUSTMENT
Transfer of Funds (No Council Action Required)
X❑ Transfer of Funds (Council Action Required)
Froin rarsmg nnterprnse
Accounting Unit - Account # - Description Amount
02710002 50001 Prior Year Carry Forward 235,514
Total
14
of the
W
To: Downtown Enhancements
—,,,,tf.,,, t i.dt - Arrnnnt i! - Tlr-crrinti nn Amount
02710133 66200
02710133 61000
Total
Building Improvement 209,346
Salaries Regrdar 26,168
235,514
JUSTIFICATION FOR REQUEST:
Approve an appropriation adjustment, by appropriating prior year fund balance in order to provide funding for construction of a public restroom
at the 3rd & Bush St parking lot
Department Head
APPROVED ASffOfFUNDS AND ACCOUNTS:
Assistant Di'15"Tr of Finance
Accounting
APPROVED:
'Date City Manager"i
PREPARATION: v
Submit original with department head signature to Finance/Accounting M-17, and a control number will be assigned. Upon approval
from the Assistant Director of Finance and the City Manager, a photocopy of the signed original will be forwarded to the department.
Date
THE REGISTER
625 N GRAND AVE, SANTA ANA, CA 92701
Telephone (714) 796-7000 / Fax (714) 796-6059
PROOF OF PUBLICATION
(2015.5 C.C.P.)
State of California )
County of ORANGE ) ss
Notice Type: BID - NOTICE INVITING BIDS
Ad Description:
3rd and Bush St Restroom RE -BID
I am a citizen of the United States and a resident of the State of California; I am
over the age of eighteen years, and not a party to or interested In the above
entitled matter. I am the principal clerk of the printer and publisher of the THE
REGISTER, a newspaper published in the English language in the city of
SANTA ANA, county of ORANGE, and adjudged a newspaper of general
circulation as defined by the laws of the State of California by the Superior
Court of the County of ORANGE, State of California, under date 11/19/1905,
Case No. A21046. That the notice, of which the annexed is a printed copy, has
been published in each regular and entire issue of said newspaper and not in
any supplement thereof on the following dates, to -wit:
05/02/2016,05/09/2016
Executed on: 05/09/2016
At SANTA ANA ,CA
I certify (or declare) under penalty of perjury that the foregoing Is true and
correct.
r�
S' nature
II I II II II II II III I I III III III I I I I II
* A 0 0 0 0 0 4 0 8 5 9 8 4
This space for filing stamp only
CNS#: 2875892
OTICE INVITING BIDS
REBID
PROJECT NO. 16-1305
3rd and Bush st'nesim.n,
Icope.'of work includes
bid ooewna. Did,
In accordance with the. pravi-
siona of thn cal forma ['a
since
Code, prevailing wage rates
pIY
5/9/16
I ONS -2873892#
THE REGISTER 10160526
MAYOR
-
CITY MANAGER
Miguel A. Pulido
N
David Cavazos
MAYOR PRO TEM=-
s
CITY ATTORNEY
Vicente Sarmiento
Sonia R. Carvalho
COUNCIL MEMBERS^--,
CLERK OF THE COUNCIL
Angelica Amazcua
Maria D. Hulzar
P. David Benavides
Michele Martmez
Roman A. Reyna
Sal Tlnalerd
CITY OF SANTA ANA
PLANNING & BUILDING AGENCY
20 Civic Center Plaza (M-20)
P.O. BOX 1988 • Santa Ana, California 92702
(714) 667-2700 • Fax (714) 9731461
www.santa-ana.org
NOTICE OF EXEMPTION
From the Requirements of the California Environmental Quality Act (CEQA)
To: COUNTY CLERK From: City of 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: 3rd and Bush St Restroom Date of Approval: 06/07/2016
ProjectNumber(s): PWA -2016 -493 -CITY
Project Location: 1 CityWide (Partial)
City: Santa Ana County: Orange ER Number: ER -2016-56
Project Description: New construction or conversion of small structures
Applicant Name: Suzi Furjanic, Santa Ana Public Works Agency
Applicant Address: City of Santa Ana: 20 Civic Center Plaza M-36
SANTA ANA, CA 92701
Name of Public Agency Approving Project: City Council
Name of Person or Agency Carrying Out Project: Furjanic, Suzi
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:
0 Categorical Exemption: 15303 (e)
Reason(s) Why Project is Exempt From CEQA:
Building is an accessory structure and less than 2,500 sf.
City Contact: Suzi Furjanic Telephone: (714) 571-4241
Signature: ��// /;% Z L / Title: / �G' (//- ekk)lO� Date: 4
SANTA ANA CITY COUNCIL
Miguel A. Pulido Vincente Sarmiento Michele Martinez Angellca Amezcua P. ravld Benavides Roman Reyna Sal Tinalera
Mayor Mayor Pro Tem, Ward 1 Ward 2 Ward 3 Ward 4 Ward 6 Ward 6
MPulidoasanta-anaorg VSarm1entc0.santa-anaoro. MMadinezfaZ5anta-anaoro&Amezcua@santaana oro pBznavidesCoasanta-ona.om 3gey Lq2 ta-anaora 81-inaierofasanta-anaoro
j.AL 2 2 2016
Exhibit 3
CITY OF SANTA ANA
CONSTRUCTION CONTRACT
PROJECT NO, 16-1305
3 RD AND BUSH RESTROOM
This CONSTRUCTION CONTRACT is made and entered into this 21'r day of June, 2016 1 by
and between the CITY OF SANTA ANA, CALIFORNIA, a charter city and municipal
corporation organized and existing under the Constitution and laws of the State of California,
hereinafter referred to as, "CITY" and Damon Inc,, hereinafter referred to as, "CONTRACTOR".
WITNESSETH:
The CITY and the CONTRACTOR, for the consideration hereinafter named, mutually agree as
follows:
I, CONTRACTOR, agrees to perforin all the work and furnish all the materilts at its owli cost
and expense necessary to construct and complete in a good and worki-minlike manner and to
the satisfaction of the City Engineer of the CITY, the P and Bush Restroom Project,
hereinafter referred to as the "Work of Irnprovernont" identified in and in accordance with
the Contract Docunients prepared by the City's Public Works Agency and approved by the
City Council,
2, The complete Construction Contract consists of the "Contract Documents" as defined by the
Standard Specifications for Public Works Construction and which include the rollowing:
• Notice Inviting Bids
• fialbmiation to Bidders
• Bid proposal
• Bid Bond
• Contract Form
• Contract Bonds
• General Provisions
• Special Provisions
• Technical Provisions and Project Plans
• Appendices
In case of conflict between the Contract Documents, the precedence of documents shall be as
established in the Standard Specifications for Public Works Construction,
3. CITY agrees to pay and CONTRACTOR agrees to accept in full payment to complete the
Work of Improvement the sum total amount not to exceed S174,454.00 — One hundred
leve t r -four thousand I)ur hundred fifla-hour dollars and no cents, as set forth and identified
in the BID PROPOSAL, which is attached hereto and incorporated herein as Exhibit "A."
Page I of 3
CITY OF SANTA ANA
CONSTRUCTION CONTRACT
PROJECT NO, 16-1305
3RD
AND BUSH RESTROOM
The BID PROPOSAL contains a schedule of unit price(s) or himp sum(s) based on
approximate quantities only, and the City does not expressly or by implication agree that the
actual amount of work will correspond therewith, but reserves the right to increase or
decrease the amount of any class or portion of the work or to omit portions of the work as
may be deemed necessary or advisable.,
4. CONTRACTOR agrees to complete the Work of Improvement within the time specified in
the Time for Completion of Improvements section of the BID PROPOSAL (Exhibit "A")
including commencing construction within the timeframe therein specified after issuance of
Notice to Proceed.
5. The CONTRACTOR will pay, and will require all subcontractors to pay, all employees on
the Work of Improvement a salary or wage at least equal to the prevailing salary or wage
established for such work as set forth in the wage, determinations for this work, in accordance
with applicable State and Federal law.
6. CONTRACTOR shall, after award of this Contract, furnish two bonds to be approved by the
CITY, one in the amount of One Hundred percent (100%) of the Contract price, to guarantee
die faithful performance of the work (Performance Bond), and one in the amount of One
ITUndred Percent (100%) of the Contract price to guarantee payment of all claims for labor
and materials furnished (Payment Bond). This Contract shall not become effective until -inch
bonds are supplied to and approved by the CITY,
7, CONTRACTOR shall, prior to the release of the feiforniance and payment bonds or the
retention payment, Furnish a warranty performance and payment bond (Warranty Bond).
Said Warranty Bond shall also be required as a condition of project acceptance,. Por projects
up to $500,000, the Warranty Bond amount shall be the greater of $]Moo or 20% of the
final connact price. For projects above $500,000, the Warranty Bond amount shall be the
greater of $100,000 or 10% of the final contract price,
A. CONTRAC'FOK shall, after award of this Contract, furnish Certificates of Liability
Insurance and Worker's Compensation Insurance as outlined in the General Provisions;, to be
approved by the CITY.
H
Page 2 of 3
CITY OF SANTA ANA
CONSTRUCTION CONTRACT
PROJECT NO.16-1305
38u AND BUSH RESTROOM
1N Wl']'NESS WHF?REUP', the parties hereto have executed thiS Constrnetion Contract on the
day and year first above written.
A`fTBS"r: CITY OF SANTA ANA:
APPROVE3D AS TO FORM: Rl"COMMENDED FOR .APPROVAL:
SONIA R. CARVALFIO
City Attorney
t
"..._..��_...,........�...Y....
Jt>S Sandoval` q 4,d
Kusavi your
ClitefAssistant C ttylft�rney utive Director, Public Works Agency
Uwyl cry \ M C..
Hv:�`1x�"'uu�gllsS
Titic: VI;u �✓ f;Ap,;
Page 3 of 3
7—P 'I",Aj
NIARIA'D. I iiIZAR
DAVID CAVAZOS
Clark of the Council
City Manager
APPROVE3D AS TO FORM: Rl"COMMENDED FOR .APPROVAL:
SONIA R. CARVALFIO
City Attorney
t
"..._..��_...,........�...Y....
Jt>S Sandoval` q 4,d
Kusavi your
ClitefAssistant C ttylft�rney utive Director, Public Works Agency
Uwyl cry \ M C..
Hv:�`1x�"'uu�gllsS
Titic: VI;u �✓ f;Ap,;
Page 3 of 3
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
31iD AND BUSH RESTROOM
BID PROPOSAL
TO: CITY COUNCIL OF THE CITY OF SANTA ANA
FROM: 9Am r•7 r.1 -Tr,%C..
REQUIREMENT:
AMenJuM J- was
Exhibit A
The undersigned bidder declares that they have carefully examined the location of the proposed
work, that they have examined the Contract Documents in its entirety and hereby proposes to
furnish all material and do all the work required to complete the said work in accordance with
said plans (if any) and the specifications for the unit price(s) or lump sum(s) set forth in the
following schedule:
BASE BID:
Item
Description
Qty
Unit
Unit Price
Amount
1
Design -Build New Restroom
I
LS
$
$
Facility
�a
2
New Water Service
I
LS
$
$
3
New Sewer
I
LS
$
$
4
New Electrical Service
I
LS
$
$
5
Site Work
1
LS
$
$
�i
6
Landscape & Irrigation
I
LS
$
$
9
Modifications
TOTAL BASE 131D
1 a
ADD ALTERNATE BID:
7
Parking Lot Lighting Modifications
1
LS
$
$
TOTAL ADD ALTERNATE BID
$
P-1 of P-16
CITY OF SANTA ANA
PROPOSAL, Exhibit A
PROJECT NO,: 16-1305
3" AND BUSH RESTROOM
Item
Description
Qty
Unit
Unit Price
Amount
TOTAL ADD ALTERNATE BED
$ JCA
TOTAL BASE BID
$ Cel 5
41
The lowest responsible bidder shall be selected based on the total base bid. The City reset es the a
right to award the Base Bid, and any, all, or none of the add -alternate bid items (if any),
* 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
TIME FOR COMPLETION OF IMPROVEMENTS AND LIOUIDATED DAMAGES
The undersigned bidder hereby proposes to complete the Work for the total base bid amount
shown above, within sixTY (60) working days after the commencement date stated in the
Notice to Proceed.
The liquidated damages amount, in lieu of the amount specified in Subsection 6-9 of the
Standard Specifications, shall be $500 per calendar day.
Name of Firm A)YtA4c7Yi l &'c
Signature of BIDDER
Title U x'a Pre
(If an individual, so state. 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.)
P-2 of P -t6
Mepi_&,o -J- w's
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3' AND BUSH RESTROOM
BID PROPOSAL
TO: CITY COUNCIL OF THE CITY OF SANTA ANA
FROM: ON VVI v tJ ZnS�
REQUIREMENT:
The undersigned bidder declares that they have carefully examined the location of the proposed
work, that they have examined the Contract Documents in its entirety and hereby proposes to
furnish all material and do all the work required to complete the said work in accordance with
said plans (if any) and the specifications for the unit price(s) or lump sum(s) set forth in the
following schedule:
BASE BID:
Item
Description
Qty
Unit
Unit Price
Amount
1
Design -Build New Restroom
1
LS
$
$
Facility
2
New Water Service
1
LS
$
$
1
S'C1K3 U
3
New Sewer
1
LS
$
$
gs-bD 'Lo
4
New Electrical Service
I
LS
$
$
CL
5
Site Work
1
LS
$
$
6
Landscape & Irrigation
1
LS
$
$
Modifications
TOTAL BASE BID
$
ADD ALTERNATE BID:
7
Parking Lot Lighting Modifications
1
LS
$
$
i6z
TOTAL ADD ALTERNATE BID
$ ocy>
P-1 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3' AND BUSH RESTROOM
Item
Description
Qty
Unit
Unit Price
Amount
TOTAL ADD ALTERNATE BID
$
TOTAL BASE BID
$
The lowest responsible bidder shall be selected based on the total base bid. The City rese es t11e
right to award the Base Bid, and any, all, or none of the add -alternate bid items (if any).
* 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
TIME FOR COMPLETION OF IMPROVEMENTS AND LIOUiDATED DAMAGES
The undersigned bidder hereby proposes to complete the Work for the total base bid amount
shown above, within SIXTY (60) working days after the commencement date stated in the
Notice to Proceed.
The liquidated damages amount, in lieu of the amount specified in Subsection 6-9 of the
Standard Specifications, shall be $500 per calendar day.
NameofFinn Dywloyi lta/Ilc
Signature of ,BIDDER
Title pye5l :
(If an individual, so state. 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.)
P-2 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3RD AND BUSH RESTROOM
BIDDER'S STATEMENT
BIDDER understands and agrees that this Bid Proposal, Contract Documents and subsequent
Construction Contract Agreement 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/her 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, 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. The
BIDDER also certifies that the bid is a balanced bid.
In accordance with Section 7028.1.5 of the California ,Business and Professions Code, the
undersigned certifies under penalty of perjury that the foregoing is true and correct.
Name of Firm tiAY 0 N 1 �-J C -
Signature of BIDDER
Title Ih C'
(If an individual, so state. 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)
P-3 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3'm AND BUSH RESTROOM
CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT
The undersigned contractor, or corporate officer, declares tinder penalty of perjury that he/she
and all his/her subcontractors are registered with the State of California Department of Industrial
Relations (DIR), and that the following is true and correct.
Contractor's Name:
Business Address: CA lat> 2- Clt w c 1
t1 t IA -X-"
0out _
Business E -Mail Address: �oWr C!\o rn o
u Ic vC t S
c 1 Yvt c t i 1
C c r✓i
Telephone: S(.2 � G G. 2q i C)
State Contractor's License No. and Class: 616 v C)o 3 -- 6
License Expiration Date: f3l3/ll
State Dept. of Industrial Relations (DIR)
Registration No.:
State Dept. of Industrial�ielations (DIR)
Registration Expiration] ate: (.0 lqoli6
Signed:
Title: / Vf t e ��FG,t)64,7,-1-
P-4 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3'm AND BUSH RESTROOM
PREVAILING WAGE COMPLIANCE AND MONITORING STATEMENT
Contractor is aware of the requirements of California Labor Code Section 1720, et seq., as well
as California Code of Regulations, Title 8, Section 16,000, et seq., ("Prevailing Wage Laws"),
which require the payment of prevailing wage rates and the performance of other requirements
on "public works" and "maintenance" projects. Since the services are being performed as part of
an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws,
and since the total compensation is $1,000 or more, Contractor agrees to fully comply with such
Prevailing Wage Laws.
City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at
the commencement of this Agreement. Contractor shall make copies of the prevailing rates of
per diem wages for each craft, classification or type of worker needed to execute the services
available to interested parties upon request, and shall post copies at the Contractor's principal
place of business and at the project site.
Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees
and agents free and harmless from any claim or liability arising out of any failure or alleged
failure to comply with the Prevailing Wage Laws.
The undersigned certifies that the foregoing is true and correct.
Name of Pirm U A' M ° -.3 -3 C
Signature of BIDDER
Title V46e 11re,
(if an individual, so state)
P-5 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
31m AND BUSH RESTROOM
OWNERSHIP AFFIDAVIT
STATE OF CALIFORNIA )
COUNTY OF ORANGE ) SS:
CITY OF SANTA ANA )
r-�
�Mr ��`kr��"•'���s , being duly sworn, deposes and says:
[]INDIVIDUAL That he/she is the party malting the foregoing proposal:
I r'
❑ PARTNERSHIP That he/she is a member of the co -partnership firm designated as:
and who has been and is duly vested with the authority to make and execute instrut
for the co -partnership by: ,,vkc: Cs go,- ��\�-,�•{i 5u° \i-f<'SSC4:•-+-fit,\�
who constitute the other members of the co-parhlership.
J..CORPORATION Thatp is ' of: tiDVNM °`'c ( -k C
C
a corporation which is making the foregoing proposal:
❑ JOINT VENTURE That he is of: ' `l" ^-1
one of the parties making the foregoing proposal as a joint venture, and the he/she has
been and is duly vested with the authority to execute instruments for an on behalf of the
parties making said bid who are:
that such a bid is genuiri and not collusive or sham, and has not in any manner sought by
collusion to secure an, dvantage against the City of Santa Ana or any person interested in the
proposed contra self or any other person.
Signatur der
cp-
Subscribed nd sworn to before me this day Mirf-V 20 ��'
Signature of officer Administering Oath (Notary Public)
P-6 of P-16
J U RAT
A notary public or other officer completing this certificate verifies only the identity of
the individual who signed the document to which this certificate is attached, and not
the truthfulness, accuracy, or validity of that document.
State of California
County of 4S AUtil i
i&day Kitt
Subscribed and sworn to (or affirmed) before me on this of
20 L6 by �Jok'yt Nubftouk4kyb:
proved to me on the basis of satisfactory evidence to be the persono who appeared
before me.
A
e.• My Comm�� Expires se , 1i�iY2pt�
Signature ($eal)
OPTIONAL INFORMATION INSTRUCTIONS
The wording of all Jurats completed in California after January 1, 2015 must be in the form
as set forth within this Jurat. There are no exceptions. If a Jurat to be completed does not
follow this form, the notary must correct the verbiage by using ajurat stamp containing the
correct wording or attaching a separate jurat form such as this one with does contain the
proper wording, In addition, the notary must require an oath or affirmation from the
DESCRIPTION OF THE ATTACHED DOCUMENT document signer regarding the truthfulness of the contents of the document. The
y „' A - document must be signed AFTER the oath or affirmation. If the document was previously
DwAaVY Ft
l�- signed, it must be re-signed in front ofthe notary public during thejurafprocess.
(Title or descripfion of attached document)
• State and county information must be the state and county where the
document signer(s) personally appeared before the notary public.
(Title or descripfion of attached document continued)
• Date of notarization must be the date the signer(s) personally
appeared which must also be the same date the jurat process is
completed.
Number of Pages _Document Date • Print the name(s) of the document signers) who personally appear at
the time of notarization.
• Signature of the notary public must match the signature on file with the
Addifional information office of the county clerk.
• The notary seal impression must be clear and photographically
reproducible. Impression must not cover text or lines. If seal impression
smudges, re -seal if a sufficient area permits, otherwise complete a
different jurat form.
Additional information Is not required but could help
to ensure this jurat is not misused or attached to a
different document.
Indicate title or type of attached document, number of
pages and date.
• Securely attach this document to the signed document with a staple.
2015 Version www.NotaryCssses.com 800-873--9865
Bond No.: DAMIN-084
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1905
3Ro AND BUSH RESTROOM
KNOW ALL PRESENT that,
Damon, Inc. its BIDDER, and
North American Specialty Insurance Company , as SURETY,
are held and firmly bound unto the CITY OF SANTA ANA, as AGENCY, in the penal sum of _
Ten Percent of the Total Amount Bid; Bid Dollars ($27,500.00 ), whish. is ten percent (10%)
of the total amount bid by BIDDER to AGENCY for the above -stated project, for the payment of
which sum. BIDDER and SURETY agree to be bound, jointly and severally, firmly by these
presents, * Bond Penalty not to Exceed Twenty -Seven Thousand Five Hundred and 00/100
THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas BIDDER is about to
submit a bid to AGENCY for the above -stated project, if said bid is rejected, or if said bid is
accepted and a contract is awarded and entered into by BIDDER in the manner and time
specified, then this obligation shall be null and void, otherwise it shall remain in full force and
effect in favor of AGENCY.
IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and sea] this
lodr day of May , 201-1.
BIDDER*
Damon, Inc., 9602 Sainoline A, _venue, Downey, CA 90240, Tel: 1(562) 606-3139
By 4v.
SURETYii/
North American Specialty Insurance Company, 6 Hutton Centre Drive, Suite 850, Santa Ana, CA 92707
By: i��" Tel: 1(714) 550-7799
Matthew R. Dobyns, Attorney -in -Fact
Subscribed and sworn to before me this day of
,20_
Signature:
Notary Public in and for the County of State of
* Provide BIDDER/ SURETY name, address, and telephone number and the name, title,
address, and telephone number of authorized representative.
P-7 of P-16
NAS SURETY GROUP
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under
laws of the State of New Hampshire, and having its principal office in the City of Manchester, New Hampshire, and Washington International
Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and ]raving its principal office in the City of
Schaumburg, Illinois, each does hereby make, constitute and appoint:
RANDY SPOHN and MATTHEW R, DOBYNS
JOINTLY OR SEVERALLY
Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, counter or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of: FIFTY MILLION ($50,000.000.00) DOLLARS
This Power of Attorney is granted mud is sighed by facsimile Linder and by the authority of the following Resolutions adopted by the Boards of
Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held
on the 9" of May, 2012:
'RESOLVED, that any two of the Residents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President
the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named
in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them
hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any
certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be
binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached."
` \\\C\nlnnnul7/r/i.�
,yOQE tP.t1TV/,�, �i�
a 6 p%po 4. 6,
ay,'2P rm`:qr
lay
�i100q `uu
t/N
,
4,PopriJirS
SEAL tom=
Sa,enP.Anue..,nn,swim vice PicAdeia efwaNhinglan Intmnaannal ln,nnmoo CemPany
� SEAL
1879 �,�"13
OP &
&Senior Vice President of Norm Amerienn specialty Inti ane Cnmpntry
1_t m
ti n
K*S�:',pa
ynlynNs.nr
/I/llllll11110.\
••'
By
Nensat
UnAelM.Llymnn, Vice Pmsidmrt of W.0ioa.. L,hmaa ullloan, n,cCompmry
& Vice Premi1c.a of North Americom specialty htsurance congnmy
IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their
o(licial seals to be hereunto affixed, and these presents to be signed by their authorized officers this26th day of June 2012 •
North American Specialty Insurance Company
Washington International Insurance Company
State of Illinois
County of Cook ss:
On this 26th day of June , 2012 before ore, a Notary Public personally appeared Steven P. Anderson , Senir Vice President of
Washington International Insurance Company and Senior Vice President of Ninth American Specialty Insurance Company and David M. Layman ,
Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company,
personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and
acknowledged said instrument to be the voluntary act and deed of their respective companies.
"OFMCIALMAU'
1)ONNAD.SKLENS
Notary public, State ofItunois Donna D. Skiers, Notary Public
My Commission %plres IOIN2015
1, leffrev Goldberg The duly elected Assistant Secretary of North American Specialty Insurance Company and Washington
International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said Ninth
American Specialty Insurance Company and Washington International Insurance Company, which is still in full force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 1 oth day of May , 20 16 .
Terrey Goldberg, Vice President & Assistant Secretary cf
Washington hrtemanonel I as, Cr eny& NmiL American Specialty lmmnonoe Company
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the truthfulness,
accuracy, or validity of that document.
State of CALIFORNIA
County of (;�` RAjN�GE
On ✓ �V
37 u,�before me, ERIKA GUIDO. NOTARY PUBLIC.
personally appeared MATTHEW R. DOBYNS
® who proved to me on the basis of satisfactory evidence to be the person(s)
whose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/heF/theiF
authorized capacity (ies), and that by his/heF/th& signature(s) on the
instrument the person(s), or the entity upon behalf of which the person(s)
acted, executed the instrument.
Rte._..
ERIKAGUIDO jj
,,;;;;,,
N COMM. # 2022671 �
NOTARY PUBLIC CALIFORNIA a
"' - ORANGE COUNTY ^'
9�__,— wmm. expires May 5, 2017 t
I certify under PENALTY OF PERJURY under the laws of the State of
California that the foregoing paragraph is true and correct.
WITNESS "if h-Apd and official seal.
Though the data below is not required by law, it may prove valuable to persons relying on the document and
could prevent fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER
❑ INDIVIDUAL
❑ CORPORATE OFFICER
❑ PARTNER(S) ❑ LIMITED
® ATTORNEY-IN-FACT
❑ TRUSTEE(S)
❑ GUARDIAN/CONSERVATOR
❑ OTHER: _
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
DESCRIPTION OF ATTACHED DOCUMENT
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3RDAND BUSH RESTROOM
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:
o Streets, highways including bridge projects: ''/2% of the bid or $10,000, whichever is greater
o Buildings, parks, or other projects: ''/z% of the bid
Section 1725.5 of the Public Contract Code requires all Subcontractors be registered with the State
Department of Industrial Relations (DIR).
BIDDER proposes to subcontract certain portions of the work to the firms listed below:
Name C/ +0 n 6,JJc�Name
License #/Exp. Q-7- t9 4,r'3 1-504D License #/Exp.
DIR Reg. #/Exp. 0000 `S `- q (91 6 -So- &DIR Reg. #/Exp.
Location RJC4L0, Tav l- s C,A Location
Phone ]('I - -4-1-Lo - y r Phone
Type Of Work VAOAU'r Type Of Work
Amount $ 10,000 Amount $
Name
License #/Exp.
DIR Reg. #/Exp.
License #
Location
Phone
Type Of Work
Amount $
Name
License #/Exp.
DIR Reg. #/Exp.
License #
Location
Phone
Name
License #/Exp.
DTR Reg.#/Exp.
License #
Location _
Phone
Type Of Work
Amount $
Name
License #/Exp.
DIR Reg. #/Exp.
License # _
Location _
Phone
Type Of Work Type Of Work
Amount $ Amount $
P-8 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
San AND BUSH RESTROOM
REFERENCES
The following are the names, addresses, and telephone numbers for THREE public agencies for
which the BIDDER has performed similar work within the past three years.
1.
2.
3.
Name and Address of Owner.
Name and Telephone Number of person familiar with project.
Contract Amount
Name and Address of owner.
Type of Work
Name and Telephone Number of person familiar with project.
Contract Amount
Name and Address of owner.
Type of Work
Name and Telephone Number of person familiar with project.
Contract Amount Type of Work
Date Completed
Date Completed
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.
P-9 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3rm AND BUSH RESTROOM
ADDITIONAL REFERENCES Se 6tk--g6 erd�
The following are the names, addresses, and telephone numbers for THREE public agencies for
which the BIDDER or Subcontractor has performed street improvement work in the past 5 years.
Name and Address of Owner.
Name and Telephone Number of person familiar with project.
Contract Amount Type of Work Date Completed
2.
Name and Address of owner.
Name and Telephone Number of person familiar with project.
Contract Amount Type of Work Date Completed
3.
and Address of owner.
Name and Telephone Number of person familiar with project.
Contract Amount Type of Work Date Completed
The following are the names, addresses, and telephone numbers of all brokers and sureties from
whom BIDDER intends to procure insurance and bonds.
P-10 of P-16
DAMON, Inc.
License: 463003
References for City of Santa Ana
3,1 and Bush Street Restrooms Project
1. Project Name: Boat Canyon and Alta Laguna Park Restroom Rehabilitation
Owner: Laguna Beach
Valuation: $9.00,000
Description: Work consisted of upgrading men's/women's restrooms at both parks. ADA Upgrades,
partitions, painting, fixtures, plumbing.
Contact:
Kenneth Kwak:
714.738.6845
303 W. Commonwealth Ave.
Fullerton, CA 923824.
2. Project Name: Separate Gender Accommodation Fire Station 1
Owner: City of Fullerton
Valuation: $180,000
Description: Fire station Remodel. Demolition, plumbing, paint, electrical, drywall, tile removal and
replacement to male restroom and converting one restroom in to a female restroom. Also remodeled
training room and storage room.
Contact:
Kenneth Kwak:
714.738.6845
303 W. Commonwealth Ave.
Fullerton, CA 923824.
3. Project: Bellis Park Snack Shack Improvements
Owner: City of Buena Park
Valuation: $156,300
Description: Tile removal and replacement, hot mop, pluming, restroom and kitchen renovation including
appliance installation, partitions, paint, stainless steel.
DAMON, Inc.
License: 463003
References for City of Santa Ana
3rtl and Bush Street Restrooms Project
1. Project Name: 31149 Front St. Renovation
Valuation: $218,000
Owner: City of Alhambra
Description: Remodel of SFR to include: Demo, plumbing, concrete, electrical, structural framing,
painting.
Contact:
Martin Ray
111 S. First St.
Alhambra CA, 90801
62.6.570.5007
2. Project Name: Movie Theater Alley Improvements
Owner: City of Alhambra
Valuation: $45,000
Description: Alley improvements to include: pavers, lighting and demo.
Contact:
Patrick Young
(760)505-0700
111 S. First St.
Alhambra, CA 91801
3. Project Name: Fires station 1
Valuation: $30,000
Owner: City of Orange
Description: Upgrades to Fire station including, flooring, demo, electrical and framing.
Contact:
k4aiidFarhat
(714)744-5562
J00E.Chapman
Orange, CA9l806
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3RDAND BUSH RESTROOM
NON -COLLUSION AFFIDAVIT
(Title 23 United States Code Section 112 and
Public Contract Code Section 7106)
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 oEosecution.
thereof shall also constitute signature of this Non -collusion
Affidavit. BI , Ee cautioned that malting a false certification may subject the
certifier to pri n
Signed
State of C,
County of
Sbscribed and sworn to (or affirmed) before me on this � day of 60A 20/4, by
. Ve V) �G1MDLs�cV-l5 proved to me on the basis of satisfactory evidence to be the
person(g) who appeared before me
A��, Iy.re�
Notary Public Signature Notary Public Seal
P-11 of P-16
JURAT
A notary public or other officer completing this certificate verifies only the identity of
the individual who signed the document to which this certificate is attached, and not
the truthfulness, accuracy, or validity of that document.
State of California
County of 0S PYAOO 0-1<�'
Wil Subscribed and sworn to (or affirmed) before me on this �tday of
20 l.& by J06% J)AVKd(A(' e-ts
proved to me on the basis of satisfactory evidence to be the person(owho appeared
before me.
"IA"' NPAONO"~
CUMM. #2]23529 z
a> uv Notary Publlc - California
z '•a Los Angeles Cuuf a o
L My Corns Ex fires S'e r 11, 2019
'Signature (seal)
OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
V�- CotIus(av) 4+0a�j
(Title or description of attached document)
(Title or description of attached document continued)
Number of Pages _ Document Date
Additional information
2015 Version www.NotaryClasses.aom NO -873-6865
INSTRUCTIONS
The wording of all Jurats completed in California after January 1, 2015 must be in the form
as set forth within this Jurat There are no exceptions. If a Jurat to be completed does not
follow this form, the notary must correct the verbiage by using ajurat stamp containing the
correct wording or attaching a separate jurat form such as this one with does contain the
proper wording. In addition, the notary must require an oath or affirmation from the
document signer regarding the truthfulness of the contents of the document. The
document must be signed AFTER the oath or affirmation. If the document was previously
signed, it must be re-signed in front of the notary public during the jurat process.
• State and county information must be the state and county where the
document signer(s) personally appeared before the notary public.
• Date of notarization must be the date the signer(s) personally
appeared which must also be the same date the jurat process is
completed.
• Print the name(s) of the document signer(s) who personally appear at
the time of notarization.
• Signature of the notary public must match the signature on file with the
office of the county clerk.
• The notary seal impression must be clear and photographically
reproducible. Impression must not cover text or lines. If seal impression
smudges, re -seal if a sufficient area permits, otherwise complete a
different jurat form.
Additional information Is not required but could help
to ensure this jurat is not misused or attached to a
different document.
Indicate title or type of attached document, number of
pages and date.
• Securely attach this document to the signed document with a staple.
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3RD AND BUSH RESTROOM
NON-DISCRIMINATION CERTIFICATE
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 1.1246
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 Hiles, 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.
P-12 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3' AND BUSH RESTROOM
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 Ad ter.
f
Signed: ~-
Title: V ee, 1(2,ecj,-Ar,
Firm: JDA&k0 N C��E
Date: 'JI'l 1 11,
P-13 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3RDAND BUSH RESTROOM
STATEMENT REGARDING APPRENTICESHIP REQUIREMENTS
The undersigned BIDDER is familiar with the requirements of Section 1777.5 of the State Labor
Code regarding employment of apprentices, and understands that contractors on contracts
exceeding $30,000 or 20 working days shall:
I. Apply to the joint apprenticeship committee administering the apprenticeship standards of
the craft or trade in the area of the site of the public work for a certificate approving the
contractor under the apprenticeship standards for the employment and training of apprentices
in the area or industry affected.
2. Employ the number of apprentices or the ratio of apprentices to journeymen stipulated in the
apprenticeship standards.
3. Contribute to the find 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 he California Apprenticeship Council.
Signed:
Title: Vi (C ref iOuy I
Firm: %mo"I wt.
Date: ('��� IG
P-14 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3'm AND BUSH RESTROOM
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 subcontraclor shall be prohibited from inducing, by any means, any person
employed in the construct' r repair of public work, to give up any part of the compensation to
which he/she is othey*i itled.
Signed: (/ E (/
Title: 1 u, �t &e J�
Firm: NMON wc,
Date: (`
P-15 of P-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 16-1305
3RD AND BUSH RESTROOM
PUBLIC CONTRACT CODE SECTION 10162 OUESTTONNAIRE
In conformance with Public Contract Code Section 10162, the BIDDER shall complete,
under penalty of perjury, the following questionnaire:
Has the BIDDER, any officer of the BIDDER, or any employee of the BIDDER who has a
proprietary interest in the BIDDER, ever been disqualified, removed, or otherwise prevented
from bidding on, or completing a federal, state, or local government project because of a
violation of law or a safety regulation?
Yes No
If the answer is yes, explain the circumstances in the following space
P-16 of P-16
Contact:
Jeff Townsend
714.562.3680
6650 Beach Blvd.
P.O. Box 5009
Buena Park, CA 90622
4. Project: Pedestrian Gate at the Community Center
Owner: City of Buena Park
Valuation: $46,454
Description: Tile removal and replacement, hot mop, pluming, restroom and kitchen renovation including
appliance installation., paint, stainless steel.
Contact:
Jeff Townsend
714.562.3680
6650 Beach Blvd.
P.O. Box 5009
Buena Park, CA 90622
5. Project: Holly Ave. Ball Wall Replacement
Owner: Arcadia Unified School District
Valuation: $50,000
Description: Concrete, demolition, rebar and asphalt for engineering of new handball courts.
Contact:
Jaime Morales:
626.821.8300 EXT: 6620
150 S. 3rd Ave.
Arcadia, CA 91006
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