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HomeMy WebLinkAboutPALP INC. DBA EXCEL PAVING COMPANY (5) Recording Requested By, And When Recorded Mail To: Recorded in Official Records, Orange County Clerk of the Council,City of Santa Ana Hugh Nguyen, Clerk-Recorder 20Civic Center Plaza,P.O.Box 1988 +��++���111111111111111111111111111111Ell111IIl�I111111111ff NO FEE Santa Ana,CA 92702 III I I $ R 0 0 0 8 9 1 5 6 2 a $ * 2016000624899 2:57 pm 12109/16 9 416 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4 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 e construction ©f 3RD STREET TRAFFIC CALMING PROJECT under contract entered into on Q MAY 17, 2016, with EXCEL PAVING COMPANY, on which contract FEDERAL INSURANCE COMPANY is surety. The property on which such work improvement was o placed is in the City of Santa Ana, County of Orange, State of California, and described as CO c z Project No. 15-6606 FAID# U58DP005861 located at: 3RD ST. FROM BIRCH ST. TO Az SPURGEON ST. The work improvement on said property was accepted as completed on o OCTOBER 31, 2016. " v CITY OF AN MUNICIPAL CORPORATION O wF wF- j 1 zDated: l C ' 1 Princi Civil Engineer-Tyrone Chesanek A , !x TITLE --------------------- a 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; nid II declare under penalty of perjury that the facts therein stated are true. Executed on ' at Santa Ana, California (Signature of indiv dual sweming that the contents of Notice of Completion are true.) THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10) DAYS AFTER COMPLETION REQUEST COUNCIL � CITY COUNCIL MEETING DATE MAY 17, 2016 TITLE: AWARD CONTRACT TO EXCEL PAVING COMPANY FOR THE 3RD STREET TRAFFIC CALMING PROJECT (PROJECT: 15-6606) {STRATEGIC PLAN NO. 5, 4B} 1 -� _ CITY MANAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED 0101y 1 7 20I6 dAs Recommended, 23A 77 As Amended E7 Ordinance on 1®e Reading 1 Ordinance on 2m Reading © Implementing Resolution 171 Set Public Hearing For CONTINUED TO FILE NUMBER 1. Authorize the City Manager and Clerk of the Council to award and execute a construction contract to Excel Paving Company, the lowest responsible bidder, in accordance with the bid in the amount of $239,480, for the term beginning upon execution of the contract and ending upon project completion, for the 3`d Street Traffic Calming Project, subject to nonsubstantive changes approved by the City Manager and City Attorney. 2. Approve the Project Cost Analysis for a total estimated project delivery cost of $299,350, which includes the contract base amount, administration, inspection, testing, and a $23,948 contingency. DISCUSSION In an effort to increase pedestrian walkability in the downtown corridor and enhance intersection safety for all users, including pedestrians and bicyclists, the project will construct a landscaped traffic circle, curb ramps, and median islands within the existing public right-of-way along 3rd Street between Birch Street and Spurgeon Street (Exhibit 1). Funding is provided by the Orange County Partnership to Improve Community Health (OCPICH) grant intended to address the leading risk factors for the major causes of death and disability in the United States, including poor nutrition and physical inactivity. Once completed, these improvements will provide safety enhancements and improve mobility for all users. A Notice Inviting Bids was advertised on March 25 and 30, 2016, and bids were opened on April 11, 2016. The following is a summary of the bid invitations made and the bids received: Contract Award For 3rd Street Traffic Calming Project May 17, 2016 Page 2 Contractor Participation Data Santa Ana contractors receiving notices 16 Contractors requesting bidding documents 6 Bids received 1 Bids received from Santa Ana contractors 0 Bid Results Summary RANK BIDDER'S NAME LOCATION BID 1 Excel Paving Company Long Beach $239,480.00 One bid was received and considered responsive. Excel Paving Company submitted the lowest responsive bid in the amount of $239,480 (Exhibit 2). Based on a staff analysis of the bids received, staff recommends award of a construction contract to Excel Paving Company to address the safety concerns identified in the grant (Exhibit 3). STRATEGIC PLAN ALIGNMENT Approval of this item supports the City's efforts to meet Goal #5 Community Health, Livability, Engagement & Sustainability, Objective #4 (support neighborhood vitality and livability), Strategy B (Improve neighborhood quality by locating or providing access to complementary services and public facilities, including access to health food option in neighborhoods). ENVIRONMENTAL IMPACT In accordance with the California Environmental Quality Act, the recommended action is exempt from further review. Categorical Exemption Environmental Review No.2016-28 was filed for the project. Contract Award For 3`d Street Traffic Calming Project May 17, 2016 Page 3 FISCAL IMPACT The estimated total delivery cost of the project is $299,350, which includes construction, contract administration, inspection, testing and contingencies (Exhibit 4). Funds in the amount of $223,473.00 are available in the Emergency and Health Grants Fund (Account No. 12217600- 66220) and $75,877.00 in the Measure M2 Street Construction Fund (Account No. 03217662- 66220) for expenditure in Fiscal Year 2015-16. Fred Mousavipour Executive Director Public Works Agency FM/EWG/TC Exhibits: 1. Location Map 2. Bid 3, Construction Contract 4. Cost Analysis APPROVED AS TO FUNDS & ACCOUNTS: Francisco Gutierrez Executive Director Finance & Management Services Agency mmmwt l zlui AaU.s AUCIVOH8 e EXHIBIT 1 MAYOR Miguel A. Pulido MAYOR PRO TEM Vicente Sarmiento COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Sal Tinajero April 6, 2016 Da all ILI, liggs14 CITY OF SANTA ANA 20 Civic Center Plaza • P.O. Box 1988 M•36 Santa Ana, California 92702 (714)647.6013 nw santa'ana Dra EXHIBIT 2 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. HUizar SUBJECT: PROJECT NO. 15-6606: 3rd Street Traffic Calming from Birch Street to Spurgeon Street The following change has been made to Specifications for the subject project: Specifications 1. Page xvii, Bid Opening, paragraph 1. Replace with the following: The Agency publicly opens and reads bids at the time and place noted on the Notice Inviting Bids. Prior to Bid Opening, Contractors will be required to comply with the City's new security policy and sign -in with the receptionist on the first floor (policy attached). Contractors will sign -in under Bid opening for Project 15-6606 to receive elevator access to the 3rd floor lobby. Contractors should allow themselves additional time to register in order to avoid missing the time - stamp deadline as stated on the Notice Inviting Bids, Add new Appendix H, Proposed Downtown Street furniture Map: See Attachment. 3, Pages P-1 of P-18 and P-2 of p-18; Replace with the attached pages P-1 of P-18 and P-2 of P-18. All other terms and conditions remain the same. Cl`j, OF'�,SANT ANA William "Edwin" G� z City Engineer SANTA ANA CITY COUNCh- Miguel A. Polido Vicente Sarmlonlo Michele Marti@:Z Angelico ftearua P David Renavides Roman Reyna Sal iinajoro Mayor Mayor Pro Tam, Ward 1 Ward 2 Ward s Ward 4 Ward 5 Ward 6 mpulld.fiaonla-end 6Ye vaern Its 1 nlmnrlinCzrrllSdt C-a(J(Lllf ,ry9 rll'zt to lr+IlrYn -fl l0 gkaYdE6(i=4�atlaDrelteyna(e:6ana 8na Orn 610afk(,QLUIy�D-EII.,O� ADDENDUM NO, ONE CITY OF SANTA ANA PROJECT NO. 15-6606 PROPOSAL PROJECT" NO. 15-6606: 3"" STREET TRAFFIC CALMING (FAID# U58DP005861) BID PROPOSAL TO: CITY COUNCIL, OF THE CITY OF SANTA ANA FROM: NP, WCMA 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 (lie 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: Item P-1 Description Qty Unit Unit Price Amount 1 Unclassified Fxcavation Cy 80 $ $ 2 AC Pavement* TN 55 $ $ 9 3 Construct PCC Sidewalk (T=4")* SP 825 $ $ Z '2 Y 4 Constnwt PCG Curb Ramp* SF 1140 $ O "' $ r%f 5 Construct PCCDriveway (T=G")* 5F 55 $ I►oD 6 Construct PCC Curb only (B-1)* LF 260 $ $ 7 Construct PCC (7urb and Clutter (A-2-6)* LF SD $ $ B Construct AC DIIfF Traffic Circle(Ctub =G"}* LF 65 $ Face 9Construct aad Pravide BrickPaver Band* SF 70 $ $ IU Adjust Manhole Frame and Cover to Grade FA 1 X000® layao �. 11 Adjust water valve Frarne and Cover to Grade EA 1 $ tp 0 — $ 5W 12 Adjust Pull Box to Grade _ EA 1 $ (o0a ` $ (006 — 13 Landscaping LS 1 $ Doors" oODt�� 4 Landscape Maintenance (60 calendar _ days): LS I $ 199 $ 15 Funtish and Install Soil* CY 20 $ ��-, $1 16D— 0Dr P-1 ofP-18 CITY OF SANTA ANA ADDENDUM NO. ONE PROJECT NO. 15-6606 PROPOSAL PROJECT NO. 15-6606:3 RD STREETTRAFFIC CALMING (PAID# U58DP005861) Item Description Qty Unit Unit Price Amount 16 Signing and StriPhtg LS 1 $ ^ S1h0 �ij V $� ✓ 17 Temporary Consnuotion Sign* EA q $ r(70' ry�� $ LiUa� 18 Furnish and Install Bike Racks (Complete in Plate)* EA 64 $ Lf �"b � $ t ��(�AD 19 Furnish & Install Bench by Victor Stanley Model t1 CBF -10 jComplete in Place)* EA 9 $ 20 Install 'Free Urates (Complete in Place)* EA 25 $ $ 0 �IJly r 21 Furnish and Install Ceramic Way -Finding EA 50 $ $ Markers (Complete bi Plaec)* (I 6 DOD TOTAL BASE BID $ r) l Add Alternative Bid "A" I r•urmsu ano msrau bronze way-P'inding EA 50 $ Markers (Complete in Place)* wvb — TOTAL ADD ALTERNATIVE IIID "A" $,a Z1 TOTAL MASE BID + ADD ALTERNATIVE BID "A" $ OKA /3 a' L nu lowest responstnre bolder shall be selected based on the Total Base Bid. The City reserves the 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. TIME FOR COMPLETION OF IMPRC)VrMFNTS AND LIQUIDATED DAMAG The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, within r um er 30 workine days atter die commencement date stated in the Notice to Proceed. Preconstruction meeting shall take place one week after Council Award, Project 15-6606 shall be completed by August 15, 2016 and Laid Iters (18, 19, 20, 21) shall be completed by Ji.dy 5, 2016. The liquidated damages amount, in lieu of the amount Standard Specifications, shall be $1,000 per calendar day. NarneofFirm PALP Num Signature of BE specified in Subsection 6-9 of the Title C, P, ~"ROWN,PRESiCEN7 (If an individual, so state, if a firm or co -partnership, state the firm name and give the nares of all individual co-partners composing the flan. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof) P-2 of P-18 CALIFORNIA ALL-pURpOSE ACKNOWLEDGMENT CMIL CODE § 1189 � MT _,,.t4 l�.,M,"� 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 Los Angeles ) On before me, CPhillips Notary Public Date Here Insert Name and Title of the Officer personally appeared C. P. Brown Names) of Signer(s) who proved to me on the basis of satisfactory evidence to be the persons) whose name(o islilim subscribed to the within instrument and acknowledged to me that he/ststt(fty executed the some in hisibROW authorized capacity(les), and that by his4ilittIfthellir signature(s) on the Instrument the person(s), or the entity,upon behalf of which the person(s) acted, executed the instrument, m f/� c PH1LLI AN COMM.PIJ.'Y9017/ n t\' nl�,y(LOS ANI LC COUNTYyComm Pxmr sOs[ 79 9GS6� ..L.. .i .. vv ... ..a✓tiF.w- I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature. Signal of Notary Public Place Notary Seal Above OPTIONAL Though this section Is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signer(s) Document Date: Other Than Named Above: Capacity(les) Claimed by Signers) Signer's Name: ❑ Corporate Officer - Title(s): ❑ Partner — ❑ Limited 0 General ❑ Individual O Attorney in Fact El Trustee 0 Guardian or Conservator n Other: Signer Is Representing: Signer's Name: O Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General Gl Individual ❑ Attorney in Fact ❑ Trustee 0 Guardian or Conservator ❑ Other: Signer Is Representing: � xih^: Fes, n . ♦ N i, � V 4 JGL/r4_4\. . v ♦ .� ..� . �<\ . _- .'/,.. \ 4\ \ 4,Mh- r<�)PqqV,10MuW MV, CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3ru' STREET TRAFFIC CALMING (FAID# U58DP005861) 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 fiords, 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 fiords, 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 7028.15 of the California Business and Professions Code, the undersigned certifies under penalty of perjury that the foregoing is true and correct. Name of Firm g NANO t, MAPAW Signature of BIDDER (' Title C PBR( I.—--BE21DE-Ann (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 ofP-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3R' STREET TRAFFIC CALMING (SAID# U58DP00586I) CONTRACTOR'S LICENSING AND REGISTRATION STATEMF,NT The undersigned contractor, or corporate officer, declares under 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:taN6P Fit:. 08A CECIL MMU LghW= 1.EEMM AVENUE Business Address: iUNU BEACH, CA M8 Business E -Mail Address: Telephone: (561A) w,99-an#1 State Contractor's License: No. and Class: a P « « License Expiration Date:%o ?ep State Dept. of Industrial Relations (DIR) Registration No.: State Dept, of Industrial Relations (DIR) �} Registration Expiration Date: i L� U Signed: Title: c,p, opon,PnESEDENT P-4 ofP-1.8 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606; 3R' STREET TRAFFIC CALMING (FAID# U58DP005861) 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 haraless 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 Firm Irl Signature of BIDDER Title (if an C, P, so state) P-5 of P-18 CITY OF SANTA AIA PROPOSAL PROJECT NO, 15-6606: 3RD STREET TRAFFIC CALMING (FAIR# U58DP005861) OWNERSHIP AFFIDAVPI' STATE OF CALIFORNIA } COUNTY OF ORANGE ) SS: CITY OF SANTA ANA ) ^ p" 'R 'hl , being duly swom, deposes and says: ❑ INDIVIDUAL That he/she is the party making the foregoing proposal: ❑ 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 instruments for the co -partnership by: who constitute the othermembers oftho co -partnership. W. WDIA dCORPORATION That he is o£ EL ANG a corporation which is making the foregoing proposal: ❑ JOINT VENTURE 'That he is of: one of the parties making the foregoing proposalas a joint venture, and the he/;lie has been. and Is duly vested with the authority to execute instruments for an on behalf of the parties making said bird who are: that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion to secure any advantage against the City of Santa Ana or any person interested in the proposed contract, for himself or any other person. ' CSF,„ V1,0n, pflm!) w Signature of Bidder Subscribed and swo APR 11 2016 to before me this day of _ 20 — Signature o" o (icer A inistering Oath (Notary Public) fi tJc f hry Publk (. flfornia �y� �„�"�y" tAiS ANGi tL�CpLi�IY �• WIY Gomm. tx�hurb net. LTJ, 20t6 l ' o m ' CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606:3" STREET TRAFFIC CALMING (FAID# U58DP005861) Ell) BOND KNOW ALL PRESENT that, PALP Inc. dba Excel Paving Company as BIDDER, and Federal 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 of the bid _ Dollars ($ 10% ), which is ten percent (10%) of the total amount bid by BIDDER to AGENCY for the above -.stated project, for the payment of which stun, BIDDER and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCII 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 seat this 36th day of March 20 16, BIDDER* PALP Inc. db SURETY* D. Rapp, Attorney In Fact ed and swom to before me ,20—. Signature: Notary Public in and for the County of 2230 Lemon 562-599-5641 15 Mountain View Road, Warren. NJ 67059 , State of 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-18 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 _Orange County of On March 30, 2016 before me, Debra Swanson, Notary Public_ (insert name and title of the officer) personally appeared Timothy D. Rapp , who proved to me on the basis of satisfactory evidence to be the person(t) whose narle* is/afe subscribed to the within instrument and acknowledged to me that he/ehe lst" executed the same in his/ e4 authorized capacity{ e&), and that by histsignature(* on the instrument the person(M, or the entity upon behalf of which the person(,s!) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ca -r Ne IOR ,,� y�•� w cv ,� ' ""'IAS WAN30N CQ/iM, # 9997119 �7 R NOTARYPI 9LIC CALIFORNIA C 0RANGSCQUNTY MY CO69M, t^XP, NOV 90, 2998 (Seal) °� r6rvverc Chubb Federal insurance Company Attn: Surety Department OF Vigilant Insurance Company 15 Mountain View Road lu AMUIBL3 $Lu'®xy ATTORNEY pacific Indemnity Company Warren, NJ 07059 `Know All by These Presents, That FI COMPANY, a New York corporation, and P appoint Douglas A. Rapp and Timothy an Indiana corporation, VIGILANT INSURANCE accnsin corporation, do each hereby constitute and each as their true and lawful Attorney- In. Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety Instruments amending or altering the same, and consents to the modification or alteration of any Instrument referred to In said bonds or thereon or otherwise, bonds and undertakings and other writings Obligatory In the nature thereof (other than ball bonds) given or executed In the course of business, and any obliBatione, In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY hove each executed and attested those presents and affixed their corporate seals an this 16th day of December, 7011. Kenneth C. Wends, Assistant Secretary . Norde, Jr., Vlce President STATE OF NEW JERSEY County of Somerset ss. (/ On this 16th day of December, 2011 before me, a Notary Public of Now Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the sold Kenneth C, Wendel, being by we duly sworn, did depose and say that he Is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY. COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate Seals and were thereto affixed by authority of the By- Laws of said Companlea, and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he Is acquainted with David B. Norris, Jr., and knows him to be Vice Presldentof said Companies; and that the signature of David B. Norris, Jr., subscribed to said Power of Attorney Is In the genulne handwriting of David S. Norris, Jr., and was thereto subscribed by authority of said By. Laws and In deponent's presence. ,Notarial Seal D ! KATHERINE J. ADELAAR NOTARY PUBLIC NEW JFRSF\ N0.2316685 685 v 4NG COmmllrsfon Expires July 14S, 2014 �� ��Q,°w NOtety PubIIC CERTIFICATION Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, "AIL powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman orthe President or a Vice President or an Assistant Vice President, Jointly with the Secretary or an Assistant Secretary, under their respeGilve designations, The signature of Such officers may be engraved, printed or lithographed The signature of each of the following officers; Chairman, President, any Vice president, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any bens it relating thereto appointing Assistant Secretaries or Attorneys- In. Foot for purposes only of executing and attesting bonds and undertakings and other writings obligatory In the nature thereof, and any such power of attorney or certificate beating such facsimile slgnalura or facsimile coal shall be valid and binding upon the Company and any such power so executed and'cenlfed by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it Is attached." I, Kenneth 0. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the 'Companies') do hereby certily that (1) the foregoing extract of the BY, Laws of the Companies Is true and correct, (it) the Companies are duly licensed and authorized to transact surety business in ail 60 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Depadmeng further, Federal and Vigilant are licensed In Puerto Rico and the U,S. Virgin Islands, and Federal Is licensed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (III) the foregoing Powerof Attorney is true, correct and in full force and effect, Given under my hand and seals of said Companies at Warren. NJ this 30th day of March, 2016 n' ox MptANn brµ gas sat-µ ['—ti�a T.4 /.d-tiJ Kenneth C, We el, Assistant Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903- 3656 e-mail: surety2chubb,com Form 15-10-022613-U (Ed. 5-03) CONSENT 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 1 County of Los Angeles ) On _Pft) 1 lois before me, C Phillins Notary Fublic Date Here Insert Name and Title of the Officer personally appeared Ce P. Brown Name(s) at Signer(s) who proved to me on the basis of satisfactory evidence- to be the persons) whose name(s) isIaW subscribed to the within instrument and acknowledged to me that hs/aba(titley executed the same in hls> ft#he)f authorized capaelty(les), and that by his/hsignature(s) on the instrument the person(s), or the entity ppon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph Is true and correct. WITNESS my hand and official seal. 31 i (UMM 9 199617 vi Notary Fubhc-CNifnrnia v Signature,,,_ LOS Antes i ry GOO 1'y Sign t re of Note Public _..„i^My(nmm. ^nlres0it 29 aDtfi�} Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signer(s) Document Date: Other Than Named Above: ____ — Cepaoitypes) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer - Title(s): ❑ Partner — ❑ Limited © General ❑ individual C7 Attorney in Fact ❑ Trustee ❑ Guardian or Conservator n Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — TUIe(s): * Partner — ❑ Limited 0 General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: _ -.F.V1 G\Lh..G�...v.�4L.. v..\.. `.\.4\.n. L.R�....G\.�\. ..vi\.. .L..v rte. S t.. 'v<1 -\Y. �"_ ..v. .�.4\.•:4\ 1 i � CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) 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: Y/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 License #/Exp. G DIR Reg. #/Exp. Location f Z4 Phone �B? 2i�i4t4 Type 0£ Worl Amount $ VA 2l A Name 0A License #/Exp. 0 DIR Reg. #(Exp. License # Location VI Phone E . (f? Type Of Worlc Amount $ 2 Name _IfAh—I A0-A9f''-11Vt ° License #/Fxp.� DIR Reg. #/Exp, License # Location Phone(� 6 Type Of Work R d tM Amount $ A Inh Signature of Bidderr ,l. r ivr, R E,rDDIT Name License #/Exp. DIR Reg. #/Exp. Location Phone Type Of Work Amount $ ]rte License #/Exp. DIR Reg. #/Exp License # Location Phone Type Of Work Amount $ Name License #/Exp. BIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ P-8 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) 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. a. 3. Name and Address of Owner. Na e and Telephone Number of p rsou�fai 'liar withproject. Contract Amount Type of Work ➢ate Completed n\,, i�y 2)03 U). C tanit�wz,c+ L� and dress of owner. Name and Te ep&ne Number ofpe6ou familiar with project. N to �, Contract Amount Typ of Worms D to Completed Name and Address of owner. -IDUNAA b Jn. t&'M Name and Telephone Number of person familiar with project, kAAO 681-- 1 010t _....._ 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-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) ADDITIONAL REFERENCES 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. z. UtM i iUV�(e A, Name and Address of owner. Name and Telephone Number of person femiliar with project, Contract Amount Type of Work Oate Completed 3. 3� �a e� C�'1�1 a e and Address of owner. 2. L�1 �- Name and Telephone Number ofperson amiliar with project. 06 - P&M s i), 6 _ 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. t1Ye�a 40�1 45k�10 (Pilo P-10 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3 a STREET TRAFFIC CALMING (FAID# U58DP005861) 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 mariner, directly or 'indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. BIDDERS are cautioned that malting a false certification may subject the certifier to criminal prosecution. a a t> ii.91N, I'Sif S OSP#T Signed ' I --� — State of California County of LOS, { NrG'.r'.1E Subscribed and sworn to (or affirmed) before me on this day of �9 0, by to �qn proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me Notary Public 'nature Notary Public Seal C PrIILLIPs C<7�4M. N799f,7'77 M J ,Not 9ANGUi<SCOU TY a F'.wW LOS ANGE=LES COUNTY `A �.,�: My Comm. Explrr=s Oct, 2'.#. 20tn�1 P -1I of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) NON-DISCRIMINATION CERTIFICATE The undersigned contractor or corporate officer, daring 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. 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. The Contractor shall send to each labor union or representative of workers with which he/she has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 4. The Contractor shall comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5, The Contractor shall furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with such rules, regulations, and orders. 6. In the event of the Contractor's non-compliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole or in part and the Contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Execution Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law. P-12 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) 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. S. Pursuant to California Labor Code Section '1735, as added by Chapter 643 Stats. 1939, and as amended, no discrimination shall be made in the employment of persons upon public works because of race, religious creed, color, national origin, ancestry, physical handicaps, mental condition, marital status, or sex of such persons, except as provided in Section 1420, and any contractor of public works violating this Section is subject to all the penalties imposed for a violation of the Chapter. Signed: ' L Title: S'. �aF3�1k�Ji?,i'13r"„adll�4d1" Firm: Date: P-13 ofP-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAIR# U58DP005861) STATEMENT" REGARDING APPRENTICESHIP REQUIREMENTS The undersigned BIDDER is familiar with the requirements of Section 1777.5 of the State Labor Code regarding employment of apprentices, and understands that contractors on contracts exceeding $30,000 or 20 working days shall: I. Apply to the joint apprenticeship committee administering the apprenticeship standards of the craft or trade in the area of the site of the public work for a certificate approving the contractor under the apprenticeship standards for the employment and training of apprentices in the area or industry affected. 2. Employ the number of apprentices or the ratio of apprentices to journeymen stipulated in the apprenticeship standards. 3. Contribute to the fund or funds in each craft or trade in which lie/she employs journeymen or apprentices on the public work, in the same amount or upon the same basis and in the same manner as the other contractors, except contractors not signatory to the trust agreement shall pay a like amount to the California Apprenticeship Council. Signed: , Title: C. F, MO'VIU, PMiF`aeCian Firm: PMH%AW, Date: APR 112016 P-14 of P-1.8 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) STATEMENTREGARDING "ANTI-KICI{BACK" REQUIREMENTS The undersigned is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the Copeland "Anti -Kickback" Act (18 USC 74) as supplemented in the Department of Labor regulations (29 CFR, Part 3). This act provides that each contractor or subcontractor shall be prohibited from inducing, by any means, any person employed in the construction or repair of public work, to give up any part of the compensation to which he/she is otherwise entitled. Signed: C"I J Title: C.P, Pi341V"m, PPIE, 0F� )T R Date: •,181t' P-15 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAIR## U58DP005861) PUBLIC CONTRACT CODE SECTION 10285,1 STATEMENT In conformance with Public Contract Code Section 10285,1 (Chapter 376, Stats. 1985), the bidder hereby declares underprialty of perjury under the laws of the State of California that the bidder has _ , has not ,/ been convicted within the preceding three years of any offenses referred to in that section,, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Cade Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note, The bidder must place a checkmark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. P-16 ofP-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3'D STREET TRAFFIC CALMING (FAID# U58DP005861) PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE In conformance with Public Contract Code Section 10162, the 13IDDE, R 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 raguI t' n? Yes No If the answer is yes, explain the circiunstances in the following space. w P-17 of P-18 CITY OF SANTA ANA PROPOSAL, PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) PUBLIC CONTRACT CODE SECTION 10232 STATEMENT In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two-year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor to comply with an order of the National Labor Relations Board. Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that malting a false certification may subject the certifier to criminal prosecution. P-18 of P-18 (THE BIDDER'S EXECUTION ON ME SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE ANENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH AREA PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION TheW.:BJDDEJt t RANG CO PA proposed subcontractor _ __ f hereby certifies that he has, bas not _, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Dote: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which arc exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Forth 100 (EEO -1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager: • is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any Federal agency; • has not been suspended, debarred, vohmtarily excluded or determined ineligible by any Federal agency within the past 3 years; • does not have a proposed debarment pending; and • has not been indicted, convicted, or bad a civil judgment rendered against it by a court of competent jurisdiction in any, matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. IN Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the. signature portion thereof shall also constitute signature of this Certification. NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACT'S The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated Rinds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, 'Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failme. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subreeipients shall certify and disclose accordingly. ➢ P WC. 2. UMi LONG 0% DISCLOSURE OF LOBBYING ACTIVITIES I. Type of Federal Action: ® a. contract b. grant C. cooperative agreement d. loan e. loan guarantee £ loan insurance 2. Status of Federal Action: ® n. bid/offer/application b, initial award c. post -award 4. Name and Address of Reporting Entity Prime ® Subawardee MEL PANG COWAW Tier , if known :5 4 IfENUE �H' M Ligressional District, if known 6. Federal Department/Agency: & Federal Action Number, if known: 10. it. Name and Address of Lobby Entity (If individual, last name, first name, MI) 3. Report Type: ® a. initial b, material change For Material Change Only: year quarter date of last report 5. If Reporting Entity in No. 4 is Subawardce, Enter Name and Address of Prime: Congressional District, if known 7. Federal Program Name/Description: CFDA Number, if applicable p. Award Amount, if known; b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, Mn (attach Continuation Sheet(s) if necessary) 11. Amount of Payment (check all that apply) $ n actual ® planned 12. Form of Payment (clerk all that apply): a. cash b. in-kind; specify: nature 13. Type of Payment (clack all that apply) a. retainer b. one -thee fee c. commission d. contingent fee e deferred £ other, specify i_ _ 14. Brief Description of Services Performed or to be performed and Dato(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item It: (attach Continuation Sheet(s) if ne sary) 15. Continuation Sheet(s) attached: Yes IJ No 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance was placed by the tier above when his transaction was made or entered late. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $160,000 for each such failnrc. Federal Use Only, Print Name: Telephone No.: i�B21539 58$1 Authorized for Local Reproduction Standard Form - LLL INSTRUCTIONS FOR COAUILETION OF SF -LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of covered Federal action or a material change to previous fling pursuant to title 31 U.S.C, section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered Federal action. Attach a continuation sheet for additional information if the space on the fonn is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered. Federal action. 2. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report, if this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g, the first subawardee of the prime is the first tier. S ubawards include but are not limited to subconnnets, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency malting the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (iFB) number, grant announcement marcher, the contract grant. or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP -DE -90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered Federal action. (b) Enter the full names of the individual(s) performing services and include fall address if different from 10 (a). Enter Last Name, First Name and Middle initial (MI). 11. Enter the amotmt of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is'a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box. Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13, Check the appropriate box. Check all boxes that apply. If cdrer, specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with Federal officials. Identify the Federal officer(s) or employees) contacted or the officer(s) employees) or Member(s) of Congress that were contacted. _ 15. Check whether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. 5nLLL-r.=Wom R ,. o5.044 NSN0Ir» 9 a a tl F C I vW'110 o N :Q a 4 � 0 p ' ;r y 4 p� +964 v v oNN v Ffl v +A froCfl�£A v dNN� v v 64� n 64 v E9� v ONvts v Fns v �Ft3 v C�N'�F [FI (H 6H ❑❑❑❑ ❑❑ ® ❑ ❑ n ❑❑❑❑❑ v v v n� w �e N \"• � d N O1 N t7 L I P! H CITY OF SANTA ANA EXHIBIT 3 CONSTRUCTION CONTRACT AGREEMENT PROJECT NO, 15-6606; 3' STREET TRAFFIC CALMING (FAID# U58DP005861) This CONSTRUCTION CONTRACT is made and entered into this 17t" day of May, 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 Excel Paving Company, hereinafter referred to as "CONTRACTOR". WITNESSETH: 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 3d Street Traffic Calming 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 • Project Plans • Required Contract Provisions Federal -Aid Construction Contracts (Form FHWA 1273) • Davis -Bacon Act and Wages • 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. 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 $239,480.00, as set forth and identified in the BID PROPOSAL, which is attached hereto and incorporated herein as Exhibit "A". The BID PROPOSAL contains a schedule of unit priee(s) or hump 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. 1 of 3 CITY OF SANTA ANA CONSTRUCTION CONTRACT AGREEMENT PROJECT NO. 15-6606: 3"DSTREET TRAFFIC CALMING (FAID# U.58DP005861) 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. . 7. 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 project above $500,000, the Warranty Bond amount shall be the greater of $100,000 or 10% of the final contract price. . 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, H 2 o£3 CITY OF SANTA ANA CONSTRUCTION CONTRACT AGREEMENT PROJECT NO, 15-6606:3" STREET TRAFFIC CALMING (FAID# U58DP005861) IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: MARIA D. HU17AR, Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorne BY is Sandoval ief Assistant City Attorney 3 of 3 CITY OF SANTA ANA: DAVID CAVAZOS City Manager RECOMMENDED FOR APPROVAL: Fred Mousavipour Executive Director, Public Works Agency CONTRACTOR: Excel Paving Company Sy:_ Title: City project No.15-6606 REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS I. General II. Nondiscrimination III, Nonsegregated Facilities IV. Davis -Bacon and Related Act Provisions V. Contract Work Hours and Safety Standards Act Provisions VI. Subletting or Assigning the Contract VII. Safety: Accident Prevention VIII. False Statements Concerning Highway Projects X. Implementation of Clean Air Act and Federal Water Pollution Control Act X. Compliance with Governmentwide Suspension and Debarment Requirements XI. Certification Regarding Use of Contract Funds for Lobbying ATTACHMENTS A. Employment and Materials Preference for Appalachian Development Highway System or Appalachian Local Access Road Contracts (included in Appalachian contracts only) I. GENERAL 1, Form FHWA-1273 must be physically incorporated in each construction contract funded under Title 23 (excluding emergency contracts solely intended for debris removal). The contractor (or subcontractor) must insert this form in each subcontract and further require its inclusion in all lower tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services). The applicable requirements of Form FHWA-1273 are incorporated by reference for work done under any purchase order, rental agreement or agreement for other services. The prime contractor shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Form FHWA-1273 must be included in all Federal -aid design - build contracts, in all subcontracts and in lower tier subcontracts (excluding subcontracts for design services, purchase orders, rental agreements and other agreements for supplies or services). The design -builder shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Contracting agencies may reference Form FHWA-1273 in bid proposal or request for proposal documents, however, the Form FHWA-1273 must be physically incorporated (not referenced) in all contracts, subcontracts and lower -tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services related to a construction contract). 2. Subject to the applicability criteria noted in the following sections, these contract provisions shall apply to all work performed on the contract by the contractor's own organization and with the assistance of workers under the contractor's immediate superintendence and to all work performed on the contract by piecework, station work, or by subcontract. FAID#U58D005861 FHWA-1273 -- Revised May 1, 2012 3. A breach of any of the stipulations contained in these Required Contract Provisions may be sufficient grounds for withholding of progress payments, withholding of final payment, termination of the contract, suspension I debarment or any other action determined to be appropriate by the contracting agency and FHWA. 4. Selection of Labor: During the performance of this contract, the contractor shall not use convict labor for any purpose within the limits of a construction project on a Federal -aid highway unless it is labor performed by convicts who are on parole, supervised release, or probation. The term Federal -aid highway does not include roadways functionally classified as local roads or rural minor collectors. II. NONDISCRIMINATION The provisions of this section related to 23 CFR Part 230 are applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The provisions of 23 CFR Part 230 are not applicable to material supply, engineering, or architectural service contracts. In addition, the contractor and all subcontractors must comply with the following policies: Executive Order 11246, 41 CFR 60, 29 CFR 1625-1627, Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. The contractor and all subcontractors must comply with: the requirements of the Equal Opportunity Clause in 41 CFR 60- 1.4(b) and, for all construction contracts exceeding $10,000, the Standard Federal Equal Employment Opportunity Construction Contract Specifications in 41 CFR 60-4.3. Note: The U.S. Department of Labor has exclusive authority to determine compliance with Executive Order 11246 and the policies of the Secretary of Labor including 41 CFR 60, and 29 CFR 1625-1627. The contracting agency and the FHWA have the authority and the responsibility to ensure compliance with Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), and Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. The following provision is adopted from 23 CFR 230, Appendix A, with appropriate revisions to conform to the U.S. Department of Labor (US DOL) and FHWA requirements. 1. Equal Employment Opportunity: Equal employment opportunity (EEO) requirements not to discriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, rules, regulations (28 CFR 35, 29 CFR 1630, 29 CFR 1625-1627, 41 CFR 60 and 49 CFR 27) and orders of the Secretary of Labor as modified by the provisions prescribed herein, and imposed pursuant to 23 U.S.C. 140 shall constitute the EEO and specific affirmative action standards for the contractor's project activities under City project No. 15-6606 this contract. The provisions of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) set forth under 28 CFR 35 and 29 CFR 1630 are incorporated by reference in this contract. in the execution of this contract, the contractor agrees to comply with the following minimum specific requirement activities of EEO: a. The contractor will work with the contracting agency and the Federal Government to ensure that it has made every good faith effort to provide equal opportunity with respect to all of its terms and conditions of employment and in their review of activities under the contract. b. The contractor will accept as its operating policy the following statement: "It is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age or disability. Such action shall include: 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, pre -apprenticeship, and/or on-the- job training." 2. EEO Officer: The contractor will designate and make known to the contracting officers an EEO Officer who will have the responsibility for and must be capable of effectively administering and promoting an active EEO program and who must be assigned adequate authority and responsibility to do so. 3. Dissemination of Policy: All members of the contractor's staff who are authorized to hire, supervise, promote, and discharge employees, or who recommend such action, or who are substantially involved in such action, will be made fully cognizant of, and will implement, the contractor's EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above agreement will be met, the following actions will be taken as a minimum: a. Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and then not less often than once every six months, at which time the contractor's EEO policy and its implementation will be reviewed and explained. The meetings will be conducted by the EEO Officer. b. All new supervisory or personnel office employees will be given a thorough indoctrination by the EEO Officer, covering all major aspects of the contractor's EEO obligations within thirty days following their reporting for duty with the contractor. G. All personnel who are engaged in direct recruitment for the project will be instructed by the EEO Officer in the contractor's procedures for locating and hiring minorities and women. d. Notices and posters setting forth the contractor's EEO policy will be placed in areas readily accessible to employees, applicants for employment and potential employees. e. The contractor's EEO policy and the procedures to implement such policy will be brought to the attention of employees by means of meetings, employee handbooks, or other appropriate means. FAID#U58D005861 4. Recruitment: When advertising for employees, the contractor will include in all advertisements for employees the notation: "An Equal Opportunity Employer." All such advertisements will be placed in publications having a large circulation among minorities and women in the area from which the project work force would normally be derived. a. The contractor will, unless precluded by a valid bargaining agreement, conduct systematic and direct recruitment through public and private employee referral sources likely to yield qualified minorities and women. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such identified sources procedures whereby minority and women applicants may be referred to the contractor for employment consideration. b. In the event the contractor has a valid bargaining agreement providing for exclusive hiring hall referrals, the contractor is expected to observe the provisions of that agreement to the extent that the system meets the contractor's compliance with EEO contract provisions. Where implementation of such an agreement has the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Federal nondiscrimination provisions. c. The contractor will encourage its present employees to refer minorities and women as applicants for employment. Information and procedures with regard to referring such applicants will be discussed with employees. 5. Personnel Actions: Wages, working conditions, and employee benefits shall be established and administered, and personnel actions of every type, including hiring, upgrading, promotion, transfer, demotion, layoff, and termination, shall be taken without regard to race, color, religion, sex, national origin, age or disability. The following procedures shall be followed: a. The contractor will conduct periodic inspections of project sites to insure that working conditions and employee facilities do not indicate discriminatory treatment of project site personnel. b. The contractor will periodically evaluate the spread of wages paid within each classification to determine any evidence of discriminatory wage practices. c. The contractor will periodically review selected personnel actions in depth to determine whether there is evidence of discrimination. Where evidence is found, the contractor will promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all affected persons. d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor in connection with its obligations under this contract, will attempt to resolve such complaints, and will take appropriate corrective action within a reasonable time. If the investigation indicates that the discrimination may affect persons other than the complainant, such corrective action shall include such other persons. Upon completion of each investigation, the contractor will inform every complainant of all of their avenues of appeal. 6. Training and Promotion: a. The contractor will assist in locating, qualifying, and increasing the skills of minorities and women who are City project No. 15-6606 applicants for employment or current employees. Such efforts should be aimed at developing full journey level status employees in the type of trade or job classification involved. b. Consistent with the contractor's work force requirements and as permissible under Federal and State regulations, the contractor shall make full use of training programs, i.e., apprenticeship, and on-the-job training programs for the geographical area of contract performance. In the event a special provision for training is provided under this contract, this subparagraph will be superseded as indicated in the special provision. The contracting agency may reserve training positions for persons who receive welfare assistance in accordance with 23 U.S.C. 140(a). c. The contractor will advise employees and applicants for employment of available training programs and entrance requirements for each. d. The contractor will periodically review the training and promotion potential of employees who are minorities and women and will encourage eligible employees to apply for such training and promotion. 7. Unions: If the contractor relies in whole or in part upon unions as a source of employees, the contractor will use good faith efforts to obtain the cooperation of such unions to increase opportunities for minorities and women. Actions by the contractor, either directly or through a contractor's association acting as agent, will include the procedures set forth below: a. The contractor will use good faith efforts to develop, in cooperation with the unions, joint training programs aimed toward qualifying more minorities and women for membership in the unions and increasing the skills of minorities and women so that they may qualify for higher paying employment. b. The contractor will use good faith efforts to incorporate an EEO clause into each union agreement to the end that such union will be contractually bound to refer applicants without regard to their race, color, religion, sex, national origin, age or disability. c. The contractor is to obtain information as to the referral practices and policies of the labor union except that to the extent such information is within the exclusive possession of the labor union and such labor union refuses to furnish such information to the contractor, the contractor shall so certify to the contracting agency and shall set forth what efforts have been made to obtain such Information. d. In the event the union is unable to provide the contractor with a reasonable flow of referrals within the time limit set forth in the collective bargaining agreement, the contractor will, through independent recruitment efforts, fill the employment vacancies without regard to race, color, religion, sex, national origin, age or disability; making full efforts to obtain qualified and/or qualifiable minorities and women. The failure of a union to provide sufficient referrals (even though it is obligated to provide exclusive referrals under the terms of a collective bargaining agreement) does not relieve the contractor from the requirements of this paragraph. In the event the union referral practice prevents the contractor from meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, such contractor shall immediately notify the contracting agency. 8. Reasonable Accommodation for Applicants 1 Employees with Disabilities: The contractor must be familiar FAID#U58D005861 with the requirements for and comply with the Americans with Disabilities Act and all rules and regulations established there under. Employers must provide reasonable accommodation in all employment activities unless to do so would cause an undue hardship. 9. Selection of Subcontractors, Procurement of Materials and Leasing of Equipment: The contractor shall not discriminate on the grounds of race, color, religion, sex, national origin, age or disability in the selection and retention of subcontractors, including procurement of materials and leases of equipment. The contractor shall take all necessary and reasonable steps to ensure nondiscrimination in the administration of this contract. a. The contractor shall notify all potential subcontractors and suppliers and lessors of their EEO obligations under this contract. b. The contractor will use good faith efforts to ensure subcontractor compliance with their EEO obligations. 10. Assurance Required by 49 CFR 26.13(b): a. The requirements of 49 CFR Part 26 and the State DOT's U.S. DOT -approved USE program are incorporated by reference. b. The contractor or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of 49 CFR Part 26 in the award and administration of DOT -assisted contracts. Failure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as the contracting agency deems appropriate. 11. Records and Reports: The contractor shall keep such records as necessary to document compliance with the EEO requirements. Such records shall be retained for a period of three years following the date of the final payment to the contractor for all contract work and shall be available at reasonable times and places for inspection by authorized representatives of the contracting agency and the FHWA. a. The records kept by the contractor shall document the following: (1) The number and work hours of minority and non - minority group members and women employed in each work classification on the project; (2) The progress and efforts being made in cooperation with unions, when applicable, to increase employment opportunities for minorities and women; and (3) The progress and efforts being made in locating, hiring, training, qualifying, and upgrading minorities and women; b. The contractors and subcontractors will submit an annual report to the contracting agency each July for the duration of the project, indicating the number of minority, women, and non -minority group employees currently engaged in each work classification required by the contract work. This information is to be reported on Form FHWA-1391. The staffing data should represent the project work force on board in all or any part of the last payroll period preceding the end of July. If on-the-job training is being required by special provision, the contractor City project No. 15-6606 will be required to collect and report training data. The employment data should reflect the work force on board during all or any part of the last payroll period preceding the end of July. III. NONSEGREGATED FACILITIES This provision is applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The contractor must ensure that facilities provided for employees are provided in such a manner that segregation on the basis of race, color, religion, sex, or national origin cannot result. The contractor may neither require such segregated use by written or oral policies nor tolerate such use by employee custom. The contractor's obligation extends further to ensure that its employees are not assigned to perform their services at any location, under the contractor's control, where the facilities are segregated. The term "facilities" includes waiting rooms, work areas, restaurants and other eating areas, time clocks, restrooms, washrooms, locker rooms, and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing provided for employees. The contractor shall provide separate or single -user restrooms and necessary dressing or sleeping areas to assure privacy between sexes. IV. DAVIS-BACON AND RELATED ACT PROVISIONS This section is applicable to all Federal -aid construction projects exceeding $2,000 and to all related subcontracts and lower -tier subcontracts (regardless of subcontract size). The requirements apply to all projects located within the right-of- way of a roadway that is functionally classified as Federal -aid highway. This excludes roadways functionally classified as local roads or rural minor collectors, which are exempt. Contracting agencies may elect to apply these requirements to other projects. The following provisions are from the U.S. Department of Labor regulations in 29 CFR 5.5 "Contract provisions and related matters" with minor revisions to conform to the FHWA- 1273 format and FHWA program requirements. 1. Minimum wages a. All laborers and mechanics employed or working upon the site of the work, will be paid unconditionally and not less often than once a week, and without subsequent deduction or rebate on any account (except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act (29 CFR part 3)), the full amount of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment computed at rates not less than those contained in the wage determination of the Secretary of Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics. Contributions made or costs reasonably anticipated for bona fide fringe benefits under section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions FAID#U58D005861 of paragraph 1.d. of this section; also, regular contributions made or costs incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs which cover the particular weekly period, are deemed to be constructively made or incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to skill, except as provided in 29 CFR 5.5(a)(4). Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification forthe time actually worked therein: Provided, That the employer's payroll records accurately set forth the time spent in each classification in which work is performed. The wage determination (including any additional classification and wage rates conformed under paragraph 1.1b. of this section) and the Davis -Bacon poster (WH -1321) shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. b.(1) The contracting officer shall require that any class of laborers or mechanics, including helpers, which is not listed in the wage determination and which is to be employed under the contract shall be classified in conformance with the wage determination. The contracting officer shall approve an additional classification and wage rate and fringe benefits therefore only when the following criteria have been met: (i) The work to be performed by the classification requested is not performed by a classification in the wage determination; and (ii) The classification is utilized in the area by the construction industry; and (iii) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (2) If the contractor and the laborers and mechanics to be employed in the classification (if known), or their representatives, and the contracting officer agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate), a report of the action taken shall be sent by the contracting officer to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor, Washington, DC 20210. The Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30 -day period that additional time is necessary. (3) In the event the contractor, the laborers or mechanics to be employed in the classification or their representatives, and the contracting officer do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions, including the views of all interested parties and the recommendation of the contracting officer, to the Wage and Hour Administrator for determination. The Wage and Hour Administrator, or an authorized representative, will issue a determination within 30 days of receipt and so advise the contracting officer or City project No.15-6606 Will notify the contracting officer within the 30 -day period that additional time is necessary. (4) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs 1.b.(2) or 1.b.(3) of this section, shall be paid to all workers performing work in the classification under this contract from the first day on which work is performed in the classification. c. Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate, the contractor shall either pay the benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. d. If the contractor does not make payments to a trustee or other third person, the contractor may consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona fide fringe benefits under a plan or program, Provided, That the Secretary of Labor has found, upon the written request of the contractor, that the applicable standards of the Davis -Bacon Act have been met. The Secretary of Labor may require the contractor to set aside in a separate account assets for the meeting of obligations under the plan or program. 2. Withholding The contracting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor, withhold or cause to be withheld from the contractor under this contract, or any other Federal contract with the same prime contractor, or any other federally - assisted contract subject to Davis -Bacon prevailing wage requirements, which is held by the same prime contractor, so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees, and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, including any apprentice, trainee, or helper, employed or working on the site of the work, all or part of the wages required by the contract, the contracting agency may, after written notice to the contractor, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. 3. Payrolls and basic records a. Payrolls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all laborers and mechanics working at the site of the work. Such records shall contain the name, address, and social security number of each such worker, his or her correct classification, hourly rates of wages paid (Including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in section 1(b)(2)(B) of the Davis -Bacon Act), daily and weekly number of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv) that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in section 1(b)(2)(6) of the Davis- FAID#U58D005861 Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred in providing such benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs, the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. b.(1) The contractor shall submit weekly for each week in which any contract work is performed a copy of all payrolls to the contracting agency. The payrolls submitted shall set out accurately and completely all of the information required to be maintained under 29 CFR 5.5(a)(3)(i), except that full social security numbers and home addresses shall not be included on weekly transmittals. Instead the payrolls shall only need to include an individually identifying number for each employee e.g. , the last four digits of the employee's social security number). The required weekly payroll information may be submitted in any form desired. Optional Form WH -347 is available for this purpose from the Wage and Hour Division Web site at http://v w .dol.gov/esa/whd/forms/wh347instr.htm or its successor site. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the full social security number and current address of each covered worker, and shall provide them upon request to the contracting agency for transmission to the State DOT, the FHWA or the Wage and Hour Division of the Department of Labor for purposes of an investigation or audit of compliance with prevailing wage requirements. It is not a violation of this section for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for its own records, without weekly submission to the contracting agency.. (2) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (i) That the payroll for the payroll period contains the information required to be provided under §5.5 (a)(3)(ii) of Regulations, 29 CFR part 5, the appropriate information is being maintained under §5.5 (a)(3)(1) of Regulations, 29 CFR part 5, and that such information is correct and complete; (ii) That each laborer or mechanic (including each helper, apprentice, and trainee) employed on the contract during the payroll period has been paid the full weekly wages earned, without rebate, either directly or indirectly, and that no deductions have been made either directly or indirectly from the full wages earned, other than permissible deductions as set forth in Regulations, 29 CFR part 3; (iii) That each laborer or mechanic has been paid not less than the applicable wage rales and fringe benefits or cash equivalents for the classification of work performed, as specified in the applicable wage determination incorporated into the contract. City project No. 15-6606 (3) The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH -347 shall satisfy the requirement for submission of the "Statement of Compliance" required by paragraph 3.b.(2) of this section. (4) The falsification of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under section 1001 of title 18 and section 231 of title 31 of the United States Code. c. The contractor or subcontractor shall make the records required under paragraph 3.a. of this section available for inspection, copying, or transcription by authorized representatives of the contracting agency, the State DOT, the FHWA, or the Department of Labor, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records or to make them available, the FHWA may, after written notice to the contractor, the contracting agency or the State DOT, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. 4. Apprentices and trainees a. Apprentices (programs of the USDOL). Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or if a person is employed in his or her first 90 days of probationary employment as an apprentice in such an apprenticeship program, who is not individually registered in the program, but who has been certified by the Office of Apprenticeship Training, Employer and Labor Services or a Slate Apprenticeship Agency (where appropriate) to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices to journeymen on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any worker listed on a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rale on the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor is performing construction on a project in a locality other than that in which its program is registered, the ratios and wage rates (expressed in percentages of the journeyman's hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's level of progress, expressed as a percentage of the journeymen hourly FAID#U58D005861 rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with the provisions of the apprenticeship program. If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved. b. Trainees (programs of the USDOL). Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified in the approved program for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who is not registered and participating in a training plan approved by the Employment and Training Administration shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any trainee performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. c. Equal employment opportunity. The utilization of apprentices, trainees and journeymen under this part shall be in conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR part 30. City project No.15-6606 d. Apprentices and Trainees (programs of the U.S. DOT). Apprentices and trainees working under apprenticeship and skill training programs which have been certified by the Secretary of Transportation as promoting EEO in connection with Federal -aid highway construction programs are not subject to the requirements of paragraph 4 of this Section IV. The straight time hourly wage rates for apprentices and trainees under such programs will be established by the particular programs. The ratio of apprentices and trainees to journeymen shall not be greater than permitted by the terms of the particular program. 5. Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR part 3, which are incorporated by reference in this contract. 6. Subcontracts. The contractor or subcontractor shall insert Form FHWA-1273 in any subcontracts and also require the subcontractors to include Form FHWA-1273 in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR 5.5. 7. Contract termination: debarment. A breach of the contract clauses in 29 CFR 5.5 may be grounds for termination of the contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR 5.12. 8. Compliance with Davis -Bacon and Related Act requirements. Ail rulings and interpretations of the Davis - Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in this contract. 9. Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall not be subject to the general disputes clause of this contract. Such disputes shall be resolved in accordance with the procedures of the Department of Labor set forth in 29 CFR parts 5, 6, and 7, Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, the U.S. Department of Labor, or the employees or their representatives. 10. Certification of eligibility. a, By entering into this contract, the contractor certifies that neither it (nor he or she) nor any person or firm who has an interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). b. No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). c. The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. FAID#U58D005861 V. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT The following clauses apply to any Federal -aid construction contract in an amount in excess of $100,000 and subject to the overtime provisions of the Contract Work Hours and Safety Standards Act. These clauses shall be inserted in addition to the clauses required by 29 CFR 5.5(a) or 29 CFR 4.6. As used in this paragraph, the terms laborers and mechanics Include watchmen and guards. 1. Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rale not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek. 2. Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (1.) of this section, the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (1.) of this section, in the sum of $10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (1.) of this section. 3. Withholding for unpaid wages and liquidated damages. The FHWA or the contacting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph (2.) of this section. 4. Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (1.) through (4.) of this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (1.) through (4.) of this section. City project No. 15-6606 VI. SUBLETTING OR ASSIGNING THE CONTRACT This provision is applicable to ail Federal -aid construction contracts on the National Highway System. 1. The contractor shall perform with its own organization contract work amounting to not less than 30 percent (or a greater percentage if specified elsewhere in the contract) of the total original contract price, excluding any specialty items designated by the contracting agency. Specialty items may be performed by subcontract and the amount of any such specialty items performed may be deducted from the total original contract price before computing the amount of work required to be performed by the contractor's own organization (23 CFR 635.116). a. The term "perform work with its own organization" refers to workers employed or leased by the prime contractor, and equipment owned or rented by the prime contractor, with or without operators. Such term does not include employees or equipment of a subcontractor or lower tier subcontractor, agents of the prime contractor, or any other assignees. The term may include payments for the costs of hiring leased employees from an employee leasing firm meeting all relevant Federal and State regulatory requirements. Leased employees may only be included in this term if the prime contractor meets all of the following conditions: (1) the prime contractor maintains control over the supervision of the day-to-day activities of the leased employees; (2) the prime contractor remains responsible for the quality of the work of the leased employees; (3) the prime contractor retains all power to accept or exclude individual employees from work on the project; and (4) the prime contractor remains ultimately responsible for the payment of predetermined minimum wages, the submission of payrolls, statements of compliance and all -other Federal regulatory requirements. b. "Specialty Items" shall be construed to be limited to work that requires highly specialized knowledge, abilities, or equipment not ordinarily available in the type of contracting organizations qualified and expected to bid or propose on the contract as a whole and in general are to be limited to minor components of the overall contract. 2. The contract amount upon which the requirements set forth in paragraph (1) of Section VI is computed includes the cost of material and manufactured products which are to be purchased or produced by the contractor under the contract provisions. 3. The contractor shall furnish (a) a competent superintendent or supervisor who is employed by the firm, has full authority to direct performance of the work in accordance with the contract requirements, and is in charge of all construction operations (regardless of who performs the work) and (b) such other of its own organizational resources (supervision, management, and engineering services) as the contracting officer determines is necessary to assure the performance of the contract. 4. No portion of the contract shall be sublet, assigned or otherwise disposed of except with the written consent of the contracting officer, or authorized representative, and such consent when given shall not be construed to relieve the contractor of any responsibility for the fulfillment of the contract. Written consent will be given only after the contracting agency has assured that each subcontract is FAID#U58D005861 evidenced in writing and that it contains all pertinent provisions and requirements of the prime contract. 5. The 30% self -performance requirement of paragraph (1) is not applicable to design -build contracts; however, contracting agencies may establish their own self -performance requirements. VII. SAFETY: ACCIDENT PREVENTION T h i s p r o v i s i o n i s applicable to all Federal -aid construction contracts and to all related subcontracts. 1. In the performance of this contract the contractor shall comply with all applicable Federal, State, and local laws governing safety, health, and sanitation (23 CFR 635). The contractor shall provide all safeguards, safety devices and protective equipment and take any other needed actions as it determines, or as the contracting officer may determine, to be reasonably necessary to protect the life and health of employees on the job and the safety of the public and to protect property in connection with the performance of the work covered by the contract. 2. It is a condition of this contract, and shall be made a condition of each subcontract, which the contractor enters into pursuant to this contract, that the contractor and any subcontractor shall not permit any employee, in performance of the contract, to work in surroundings or under conditions which are unsanitary, hazardous or dangerous to his/her health or safety, as determined under construction safety and health standards (29 CFR 1926) promulgated by the Secretary of Labor, in accordance with Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 3704). 3. Pursuant to 29 CFR 1926.3, it is a condition of this contract that the Secretary of Labor or authorized representative thereof, shall have right of entry to any site of contract performance to inspect or investigate the matter of compliance with the construction safety and health standards and to carry out the duties of the Secretary under Section 107 of the Contract Work Hours and Safely Standards Act (40 U.S.C.3704). VIII. FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS T h i s p r o v i s i o n i s applicable to all Federal -aid construction contracts and to all related subcontracts. In order to assure high quality and durable construction in conformity with approved plans and specifications and a high degree of reliability on statements and representations made by engineers, contractors, suppliers, and workers on Federal - aid highway projects, it is essential that all persons concerned with the project perform their functions as carefully, thoroughly, and honestly as possible. Willful falsification, distortion, or misrepresentation with respect to any facts related to the project is a violation of Federal law. To prevent any misunderstanding regarding the seriousness of these and similar acts, Form FHWA-1022 shall be posted on each Federal -aid highway project (23 CFR 635) in one or more places where it is readily available to all persons concerned with the project: 18 U.S.C. 1020 reads as follows: City project No. 15-6606 "Whoever, being an officer, agent, or employee of the United States, or of any State or Territory, or whoever, whether a person, association, firm, or corporation, knowingly makes any false statement, false representation, or false report as to the character, quality, quantity, or cost of the material used or to be used, or the quantity or quality of the work performed or to be performed, or the cost thereof in connection with the submission of plans, maps, specifications, contracts, or costs of construction on any highway or related project submitted for approval to the Secretary of Transportation; or Whoever knowingly makes any false statement, false representation, false report or false claim with respect to the character, quality, quantity, or cost of any work performed or to be performed, or materials furnished or to be furnished, in connection with the construction of any highway or related project approved by the Secretary of Transportation; or Whoever knowingly makes any false statement or false representation as to material fact in any statement, certificate, or report submitted pursuant to provisions of the Federal -aid Roads Act approved July 1, 1916, (39 Stat. 355), as amended and supplemented; Shall be fined under this title or imprisoned not more than 5 years or both." IX. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. By submission of this bid/proposal or the execution of this contract, or subcontract, as appropriate, the bidder, proposer Federal -aid construction contractor, or subcontractor, as appropriate, will be deemed to have stipulated as follows: 1. That any person who is or will be utilized in the performance of this contract is not prohibited from receiving an award due to a violation of Section 508 of the Clean Water Act or Section 306 of the Clean Air Act. 2. That the contractor agrees to include or cause to be included the requirements of paragraph (1) of this Section X in every subcontract, and further agrees to take such action as the contracting agency may direct as a means of enforcing such requirements. X. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION This provision is applicable to all Federal -aid construction contracts, design -build contracts, subcontracts, lower -tier subcontracts, purchase orders, lease agreements, consultant contracts or any other covered transaction requiring FHWA approval or that is estimated to cost $25,000 or more — as defined in 2 CFR Parts 180 and 1200. 1. Instructions for Certification — First Tier Participants: a. By signing and submitting this proposal, the prospective first tier participant is providing the certification set out below. b. The inability of a person to provide the certification set out below will not necessarily result in denial of participation in this FAID#U58D005861 covered transaction. The prospective first tier participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective first tier participant to furnish a certification or an explanation shall disqualify such a person from participation in this transaction. c. The certification in this clause is a material representation of fact upon which reliance was placed when the contracting agency determined to enter into this transaction. If it is later determined that the prospective participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the contracting agency may terminate this transaction for cause of default. d. The prospective first tier participant shall provide immediate written notice to the contracting agency to whom this proposal is submitted if any time the prospective first tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. e. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200. "First Tier Covered Transactions' refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions' refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). f. The prospective first tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. g. The prospective first tier participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions," provided by the department or contracting agency, entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. h. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility, of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (https://www.epls,ciov/), which Is compiled by the General Services Administration. City project No.15-6606 i. Nothing contained in the foregoing shall be construed to require the establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of the prospective participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. j. Except for transactions authorized under paragraph (f) of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 2. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — First Tier Participants: a. The prospective first tier participant certifies to the best of its knowledge and belief, that it and its principals: (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency; (2) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or Slate antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (a)(2) of this certification; and (4) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, Slate or local) terminated for cause or default. b. Where the prospective participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. 2. Instructions for Certification - Lower Tier Participants: (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200) a. By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department, or agency with which ilB7 FAID#U58D005861 this transaction originated may pursue available remedies, including suspension and/or debarment. C. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended," "Ineligible," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. "First Tier Covered Transactions' refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). e. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. f. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. g. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (bapa://www.epts.gov/), which is compiled by the General Services Administration. h. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. i. Except for transactions authorized under paragraph a of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the City project No. 15-6606 department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion. -Lower Tier Participants: 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. XI. CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING This provision is applicable to all Federal -aid construction contracts and to all related subcontracts which exceed $100,000 (49 CFR 20). 1. The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: a. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering Into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying;' in accordance with its instructions. 2. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering Into this transaction imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 3. The prospective participant also agrees by submitting its bid or proposal that the participant shall require that the language of this certification be Included in all lower tier subcontracts, which exceed $100,000 and that all such recipients shall certify and disclose accordingly. 11 FAID#U58D005861 Local Assistance Procedures Manual EXHIBIT 16-11 Subcontracting Request STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION FRONT SUBCONTRACTING REQUEST DC -CEM -1201 (REV. 4/94) (OLD FIC -45) CT# 7541-3514-7 See Instructions On Back REQUEST NUMBER CONTRACTOR NAME L' 2. Specialty items (previously requested)................................................................. $ COUNTY ROUTE BUSINESS ADDRESS .............. 5. Contractor must perform with own forces ( lines 1 minus 4 x CONTRACT NO. CITY/STATE Z[P CODE FEDERAL AID PROJECT NO. (From Special $ S. Total (lines 6+7)................................................................................................... Provisions) SUBCONTRACTOR (Name, Bastaess Address, Phone) BID ITEM NUNIBER(S) % OF BID ITEM CHECK IF: DESCRIBE WORK WHEN $ AMOUNT (See Categories Below) LESS THAN 100% OF BASED ON SUBBED (1) 2 3) WORK IS SUBBED BID $AMOUNT Categories: 1) S eoialt 2 p Y ) tsted Under Fair Practices ALt.3) Certified DBE/MBE/WBE/DVBE I Certify That. • The Standard Provisions for labor set forth in the contract apply to the subcontracted work. • If applicable, (Federal Aid Projects only) Section 14 (Federal Requirements) of the Special Provisions have been inserted in the subcontracts and shall be incorporated in any lower -tier subcontract. Written contracts have been executed for the above noted subcontracted work. NOTE: This section is to be completed by the Resident Engineer 1. Total of bid items.................................................................................................................................................$ 2. Specialty items (previously requested)................................................................. $ 3. Specialty items (this request)............................................................................... $ 4. Total (lines 2+3).................................................................................... .............. 5. Contractor must perform with own forces ( lines 1 minus 4 x % .................. ............... $ 6. Bid items previously subcontracted..................................................................... S 7. Bid items subcontracted ( this request)................................................................ $ S. Total (lines 6+7)................................................................................................... $ 9. Balance of work Contractor to perform (lines 1 minus 8) .................................... $ $ o. copy- loea i agency Labor Complinme Officer 4. Contractors lnformton Copy Page 16-51 February 1, 1998 EXHIBIT 16-B Local Assistance Procedures Manual Subcontracting Request INSTRUCTIONS FOR COMPLETING SUBCONTRACTING REQUEST FORM All First-tier subcontractors must be included on a subcontracting request. Submit in accordance with Section 8-1.01 of the Caltrans Standard Specifications. Type or print requested information. Information copy is to be retained by the contractor. Submit other copies to project's Resident Engineer. After approval, the original will be returned to the contractor. When an entire item is subcontracted, the value to be shown is the contractor's bid price. When a portion of an item is subcontracted, describe the portion, and show the % of bid item and value. THIS FORM IS NOT TO BE USED FOR SUBSTITUTIONS. Prior to submittal of Form CEM -1201 involving a replacement Subcontractor, submit a separate written request for approval to substitute a listed subcontractor. Section 4107 of the Government Code covers the conditions for substitution. Submit a separate written request for approval of any DBE/MBE/WBE/DVBE substitution. Include appropriate backup information and state what efforts were made to accomplish the same dollar value of work by other certified DBE/MBE/WBE/DVBEs. NOTE: For contractors who will be performing work on railroad property, it is necessary for the contractor to complete and submit the Certificate of Insurance (State Form DH-OS-AIOA) naming the subcontractor as insured. No work shall be allowed which involves encroachment on railroad property until the specified insurance has been approved. Page 16-52 LPP 12-02 October 5, 2012 COST ANALYSIS PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING PROJECT Construction Contract $ 239,480.00 Contract Administration $ 17,715.00 Inspection and Testing $ 18,207.00 Survey $ 0.00 Contingencies $ 23,948.00 TOTAL ESTIMATED CONSTRUCTION COSTS $299,350.00 EXHIBIT 4 THE REGISTER 625 N GRAND AVE, SANTA ANA, CA 92701 Telephone (714) 796-7000 / Fax (714) 796.6059 NOTICE TO OONTNACTONS This space for filing stamp only PROOF OF -fcrnla Pkcm, M-22, foenaMa, Ca S:., PUBLICATION 2701 for: (2075.5 C.C.P.) PROJECT 00.163600 and St, Trafgo Calming from Birch St:to Sppurggeon St FWD#USS oP006861 State of California ) County of ORANGE ) SS Instruction on bid submis+� elan are included In the con... tract oocumante." Notice Type: BID -NOTICE INVITING BIDS Scope of work Indudaa rear Pim°anneal, en1 aldo near`.' aid. Ad Description: 3rd Street Traffic Calming form Birch to Spurgeon I am a citizen of the United States and a resident of the State of California: I am The contract documents'• over the age of eighteen. years, and. not a party to or Interested in the above and theaempiet... eieclrodicaet of the ' Ianv^ entitled matter. I am the principal clerk of the printer and publisher of the THE and specNGations are .avalia'l^ REGISTER, a newspaper published in the English language In the city of his et the Public Works^ A ency counter. First noor7' Plaza, Rua'Ma, SANTA ANA, county of ORANGE, and adjudged a newspaper of general 2� civic,Center Mnax, sante Cal ifmnla- circulation as defined by the laws of the State of California by the Superior ez7a1. Court of the County of ORANGE, State of Callfornia, under date 11/19/1905, : 'in accordance with the pro•^ Case No. A21046. That the notice, of which the annexed is a printed copy, has vlsione of the California �a+^• been published in each regular and entire Issue of said newspaper and not in P 9rates her code, prevailing wage a ap I. any supplement thereof on the following dates, to-wlt: 03/2512016, 03/30/2016 Executed on: 0 313 012 01 6 At SANTA ANA ,CA I certify (or declare) under penalty of perjury that the foregoing is true and correct. 64L6�rb�'/ Sign re IIIIIII I III IIIIII II II VIII VIII IIIIIIIIIII I I� * A 0 0 0 0 0 4 0 4 9 2 0 5 Recorded in Official Records, Orange County Hugh Nguyen, Clerk -Recorder 11111111111111111111111111111111111111111111111 IhI 1111111111II NO FE *$ R 0 0 0 8 2 3 8 4 2 5 $ 201685000275 3:28 pm 03/22/16 266 OR02 201 0.00 60.00 0.00 0.00 0.00 0.00 0.00 0.00 MAYOR Miguel A. Pulido MAYOR PRO TEM Vincent F, Sarmlento COUNCIL MEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman A. Reyna Sal Tinajero 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) 973.1461 vmw.santa-ana.org NOTICE OF EXEMPTION CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Marla D. Huizar From the Requirements of the California Environmental Quality Act (CEQA) Fee Exemption per California Government Code Section 6103 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: Third StreetTraffic Calming Date of Approval: 05/03/2016 Project Number(s): PWA -2016 -294 -CITY Project Location, 1 CityWide (Partial) City: Santa Ana County: Orange ER Number: ER -2016-28 Project Description: Work includes replacement of sidewalk, wcr, ac traffic circle. Applicant Name: Mindy Ly, City of Santa Ana Applicant Address: 20 Civic Center Plaza, M36, Santa Ana, CA 92702 MAR 2 2 7016 Name of Public Agency Approving Project: City Council ORANce COUNTY CLERK -RECORDER DEPARTMENT Name of Person or Agency Carrying Out Project: Ly, Mindy BY, DEPu7Y 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: 15301(c) Reason(s) Why Project Is Exempt From CECIA: 15301(c) consists of replacing existing sw, wcr, ac traffic circle. fv d MAR 2 2 2016 HUGH NGUYEN, CLERK -RECORDER DEPUTY City Contact: Marilyn Boothe Telephone: (714) 647-5013 Signature: Title: Title: Senior Office Assistant Date: 3/22/16 SANTA ANA CITY COUNCIL Miguel A. Pulido Vincent F. Sarmiento Michele Martlnez Angelica Amezcua P. David Benavides Roman Rayne Sal Tinajero Mayor Mayor Pro Tem, Ward Ward Ward Ward Ward Ward MPulida(rDsanta-ana.ora VSarmienloflsama-ana.ora MMarlinez[eDsanta-anaoroAALnomua(dsontaanaom DBenevldgsnsanta-anaora RRevnahRaanta-ana ora STinaierofcasanta-ana.ora PAL 2 2 2016 Ca� CITY OF SANTA ANA CONSTRUCTION CONTRACT AGREEMENT PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAIR# U58DP005861) This CONSTRUCTION CONTRACT is made and entered into this 17th day of May, 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 Excel Paving Company, hereinafter referred to as "CONTRACTOR". WITNESSETH: 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 Erigineer of the CITY, the 3'a Street Traffic Calming Project, jrereinafter 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 Project Plans • Required Contract Provisions Federal -Aid Construction Contracts (Foran FHWA 1273) Davis -Bacon Act and Wages Appendices In case of conflict between the Contract Documents, the precedence of docrunents 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, $239,480.00, as set forth and identified in the BID PROPOSAL, which is attached hereto and incorporated herein as Exhibit "A". The BID PROPOSAL contains a schedule of unit price(s) or lump 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. I of 3 CITY OF SANTA ANA CONSTRUCTION CONTRACT AGREEMENT PROJECT NO. 15-6606: 3' STREET TRAFFIC CALMING (FAID# U58DP005861) 4, CONTRACTOR agrees to complete the Work of Improvement within the time specified in the Time for Completion of hnprovements 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°/x) of the Contract price, to guarantee the faithfal 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. . 7. 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 project above $500,000, the Warranty Bond amount shall be the greater of $100,000 or 10% of the final contract price. . s. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability Insurance and Worker's Compensation hisurance as outlined in the General Provisions, to be approved by the CITY, // 2 of 3 CITY OF SANTA ANA CONSTRUCTION CONTRACT AGREEMENT PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: MARIA D. HUIZAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALLHO City Attomey,��'— ��---- BY s Sandoval ief Assistant City Attorney 3 of CITY OF SANTA ANA: DAVID VA OS City Manager RECOMMENDED FOR APPROVAL: Director, Public Works Agency CONTRACTOR: Excel Paving Company By: —� `ti Title:President C.P Brown CALIFORNIA ALL-PURPOSE ACKNOWLEDONENT CML CODE $1188 A rotary public or other offices completing this certificate verifies only the Identity of the individual who signed the documerrtto which this certificate is attached, and not die tndhfulness, accuracy, or validity of to document. State of California County of Los Angeles ) On 3)2-� I t before me, C. Phillips, Notary Public Date Here Insert Name and Title of the Officer personally appeared C. P. Brown Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence- to be the person(* whose name(s) isAw subscribed to the within instrument and acknowledged to me that he/sba bey executed the same in hI authodked capacity(les), and that by hISAW (ttretr signature(s) on the Instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument, • '"� c. t�He�-41r�s yS'� CpMM. tr1`7968.77 h ami 1J�t'�Notnry Y"uUile-falifornia � t5 ua �,C75 ANGE4C5 C©IJNTY W ^^ My Comm. Gcplrrs Ost. 29,2016 Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State-of-Callfomia that -the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature. Signa f'NotaryPublic OPTIONAL Though this section is optional, complefing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: -.Signer(s) Document Date: Other Than Named Above: Capacity(fes) Claimed by Sigrrer(s) Signer's Name: ❑ Corporate Officer - Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator F1 Other: Signer Is Representing:— Signer's, Name: • Corporate Officer - Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: o r .. . • .. :rr s :Ir CITY OF SANTA ANA ADDENDUM NO. ONE PROJECT NO. 15-6606 PROPOSAL Exhibit A PROJECT NO. 15-6606: 3R° STREET TRAFFIC CALMING (FAID# U58DP0o5861) BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: P 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: Item Description Qty Unit Unit Price Amount I Unclassified Excavation Cy 80 $ $�fU�it DDr L q �r 2 AC Pavement* TN 55 $ ir7 3 ConstruetPCC Sidewalk (T-4")* SF 825 $ 4 Construct PCC Curb Rantp* SF 1140 $ d $ S Construct PCC Driveway (T=G")* —Sr 45 $ $ 6i®b 6 Conshuct PCC Curb only (B -I )* LF 260 $ $ 5jb' 7 Cotuhvct PCC Curb and Gutter (A-2.6)* LF 50 $ $ R Construct AC DIl(E Traffic Circle(Curb LF 65 $ $ Face = G') 9 Cousn•uci and Provide Bdek Paver Band* SF 70 $ ✓ 10 A j ust Manhole Frame utd Cover to Oracle EA $ $ I 1 Adjust Water Valve Frame and Cover to EA 1 $ Grade tP O b6 I Adjust Pull Box to Grade EA 1 $ $ Wo (goo - 13 Landscaping LS 1 $ $ 176600 0®60— 14 Landscape Maintenance (60 calendar LS 1 $ $ days): 451b – %06 — 15 Furnish and Install Soil* CY 20 $ $ .' P-1 of P-18 CITY QP SANTA ANA ADDENDUM NO. ONE PROJECT NO. 15-6606 PROJECT NO, 15-6606:3 RD PROPOSAL Exhibit A STREET TRAFFIC CALMING (FAID# U58DP005861) Tern Description Qty Unit Unit Price Amount 16 Signing and Stripurg L5 1 $ '�<dV0 b V $ 7J V �• 17 Temporary Consh•natlon Sign" EA 4 $ x(70- $ IS Furnish and Install Bike Raaks (Complete in Place)* EA 6$ $ q�b $ 19 Furnish & Install Bench by Victor Stanley EA 9 $ $ Model # CBF -10 (Complete in Place)* Z90— Z, ZSB6' 20 Install Tree Grates (Complete in Place)* EA 25 $ $ 21 Furnish and Install Ceramic Way -Finding EA 50 $ $ Markers.. (Complete in Place)* 1400D TOTAL BASE BID S Add Alternative Bid "A" 22 1 Furnish and Install Bronze (050 - 1) 322'60 TOTAL ADD ALTERNATIVE BID "A"�60— TOTAL 0—TOTAL BASE BID + ADD ALTERNATIVE BID "A" $ �1 i 0 9 r ne lowest responsible bidder shall be selected based on the Total Base Bid. The City reserves the right to award the Base Did, 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 hem will be dictated by the actual quantity used, and the Agency reserves the tight to increase or decrease the quantity of this item accordingly. TIME FOR COMPLETION OF I114PROVFMENTS AND L1_QUIDATED DAMAGES The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, within ntunher 30 w Titin cam after the commencement date stated in the Notice to Proceed. Preconstuction meeting shall take place one week after Council Award. Project 15-6606 shall be completed by August 15, 2016 and Bid Items (18, 19, 20, 21) shall he completed by July S, 2016. The liquidated damages amount, in lieu of the amount Standard Specifications, shall be $1,000 per calendar day. Name of Firm W. fie• Signature of BIJ specified in Subsection 6-9 of the Title C.I•#, mmm' PREVI)ENI. (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. It's corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) 11-2 of P-18 City project No.15-6606 REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS I. General II. Nondiscrimination III. Nonsegregated Facilities IV. Davis -Bacon and Related Act Provisions V. Contract Work Hours and Safety Standards Act Provisions VI. Subletting or Assigning the Contract VII. Safety: Accident Prevention VIII. False Statements Concerning Highway Projects IX. Implementation of Clean Air Act and Federal Water Pollution Control Act X. Compliance with Governmentwide Suspension and Debarment Requirements XI. Certification Regarding Use of Contract Funds for Lobbying ATTACHMENTS A. Employment and Materials Preference for Appalachian Development Highway System or Appalachian Local Access Road Contracts (included in Appalachian contracts only) L GENERAL 1. Form FHWA-1273 must be physically incorporated in each construction contract funded under Title 23 (excluding emergency contracts solely intended for debris removal). The contractor (or subcontractor) must insert this form in each subcontract and further require its inclusion in all lower tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services). The applicable requirements of Form FHWA-1273 are incorporated by reference for work done under any purchase order, rental agreement or agreement for other services. The prime contractor shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Form FHWA-1273 must be included in all Federal -aid design - build contracts, in all subcontracts and in lower tier subcontracts (excluding subcontracts for design services, purchase orders, rental agreements and other agreements for supplies or services). The design -builder shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Contracting agencies may reference Form FHWA-1273 in bid proposal or request for proposal documents, however, the Form FHWA-1273 must be physically incorporated (not referenced) in all contracts, subcontracts and lower -tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services related to a construction contract). 2. Subject to the applicability criteria noted in the following sections, these contract provisions shall apply to all work performed on the contract by the contractor's own organization and with the assistance of workers under the contractor's immediate superintendence and to all work performed on the contract by piecework, station work, or by subcontract. FAID#U58D005861 FHWA-1273 -- Revised May 1, 2012 3. A breach of any of the stipulations contained in these Required Contract Provisions may be sufficient grounds for withholding of progress payments, withholding of final payment, termination of the contract, suspension / debarment or any other action determined to be appropriate by the contracting agency and FHWA. 4. Selection of Labor: During the performance of this contract, the contractor shall not use convict labor for any purpose within the limits of a construction project on a Federal -aid highway unless it is labor performed by convicts who are on parole, supervised release, or probation. The term Federal -aid highway does not include roadways functionally classified as local roads or rural minor collectors. II. NONDISCRIMINATION The provisions of this section related to 23 CFR Part 230 are applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The provisions of 23 CFR Part 230 are not applicable to material supply, engineering, or architectural service contracts. In addition, the contractor and all subcontractors must comply with the following policies: Executive Order 11246, 41 CFR 60, 29 CFR 1625-1627, Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. The contractor and all subcontractors must comply with: the requirements of the Equal Opportunity Clause in 41 CFR 60- 1.4(b) and, for all construction contracts exceeding $10,000, the Standard Federal Equal Employment Opportunity Construction Contract Specifications in 41 CFR 60-4.3. Note: The U.S. Department of Labor has exclusive authority to determine compliance with Executive Order 11246 and the policies of the Secretary of Labor including 41 CFR 60, and 29 CFR 1625-1627. The contracting agency and the FHWA have the authority and the responsibility to ensure compliance with Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), and Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. The following provision is adopted from 23 CFR 230, Appendix A, with appropriate revisions to conform to the U.S. Department of Labor (US DOL) and FHWA requirements. 1. Equal Employment Opportunity: Equal employment opportunity (EEO) requirements not to discriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, rules, regulations (28 CFR 35, 29 CFR 1630, 29 CFR 1625-1627, 41 CFR 60 and 49 CFR 27) and orders of the Secretary of Labor as modified by the provisions prescribed herein, and imposed pursuant to 23 U.S.C. 140 shall constitute the EEO and specific affirmative action standards for the contractor's project activities under City project No. 15-6606 this contract. The provisions of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 at seq.) set forth under 28 CFR 35 and 29 CFR 1630 are incorporated by reference in this contract. In the execution of this contract, the contractor agrees to comply with the following minimum specific requirement activities of EEO: a. The contractor will work with the contracting agency and the Federal Government to ensure that it has made every good faith effort to provide equal opportunity with respect to all of its terms and conditions of employment and in their review of activities under the contract. b. The contractor will accept as its operating policy the following statement: "It is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age or disability. Such action shall include: 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, pre -apprenticeship, and/or on-the- job training." 2. EEO Officer: The contractor will designate and make known to the contracting officers an EEO Officer who will have the responsibility for and must be capable of effectively administering and promoting an active EEO program and who must be assigned adequate authority and responsibility to do so. 3. Dissemination of Policy: All members of the contractor's staff who are authorized to hire, supervise, promote, and discharge employees, or who recommend such action, or who are substantially involved in such action, will be made fully cognizant of, and will implement, the contractor's EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above agreement will be met, the following actions will be taken as a minimum: a. Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and then not less often than once every six months, at which time the contractor's EEO policy and its implementation will be reviewed and explained. The meetings will be conducted by the EEO Officer. b. All new supervisory or personnel office employees will be given a thorough indoctrination by the EEO Officer, covering all major aspects of the contractor's EEO obligations within thirty days following their reporting for duty with the contractor. c. Ali personnel who are engaged in direct recruitment for the project will be instructed by the EEO Officer in the contractor's procedures for locating and hiring minorities and women. J. Notices and posters setting forth the contractor's EEO policy will be placed in areas readily accessible to employees, applicants for employment and potential employees. e. The contractor's EEO policy and the procedures to implement such policy will be brought to the attention of employees by means of meetings, employee handbooks, or other appropriate means. FAID#U58D005861 4. Recruitment: When advertising for employees, the contractor will include in all advertisements for employees the notation: "An Equal Opportunity Employer." All such advertisements will be placed in publications having a large circulation among minorities and women in the area from which the project work force would normally be derived. a. The contractor will, unless precluded by a valid bargaining agreement, conduct systematic and direct recruitment through public and private employee referral sources likely to yield qualified minorities and women. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such identified sources procedures whereby minority and women applicants may be referred to the contractor for employment consideration. b. In the event the contractor has a valid bargaining agreement providing for exclusive hiring hall referrals, the contractor is expected to observe the provisions of that agreement to the extent that the system meets the contractor's compliance with EEO contract provisions. Where implementation of such an agreement has the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Federal nondiscrimination provisions. c. The contractor will encourage its present employees to refer minorities and women as applicants for employment. Information and procedures with regard to referring such applicants will be discussed with employees. 5. Personnel Actions: Wages, working conditions, and employee benefits shall be established and administered, and personnel actions of every type, including hiring, upgrading, promotion, transfer, demotion, layoff, and termination, shall be taken without regard to race, color, religion, sex, national origin, age or disability. The following procedures shall be followed: a. The contractor will conduct periodic inspections of project sites to insure that working conditions and employee facilities do not indicate discriminatory treatment of project site personnel. b. The contractor will periodically evaluate the spread of wages paid within each classification to determine any evidence of discriminatory wage practices. c. The contractor will periodically review selected personnel actions in depth to determine whether there is evidence of discrimination. Where evidence is found, the contractor will promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all affected persons. d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor in connection with its obligations under this contract, will attempt to resolve such complaints, and will take appropriate corrective action within a reasonable time. If the investigation indicates that the discrimination may affect persons other than the complainant, such corrective action shall include such other persons. Upon completion of each investigation, the contractor will inform every complainant of all of their avenues of appeal. 6. Training and Promotion: a. The contractor will assist in locating, qualifying, and increasing the skills of minorities and women who are City project No.15-6606 applicants for employment or current employees. Such efforts should be aimed at developing full journey level status employees in the type of trade or job classification involved. b. Consistent with the contractor's work force requirements and as permissible under Federal and State regulations, the contractor shall make full use of training programs, i.e., apprenticeship, and on-the-job training programs for the geographical area of contract performance. In the event a special provision for training is provided under this contract, this subparagraph will be superseded as indicated in the special provision. The contracting agency may reserve training positions for persons who receive welfare assistance in accordance with 23 U.S.C. 140(a). c. The contractor will advise employees and applicants for employment of available training programs and entrance requirements for each. d. The contractor will periodically review the training and promotion potential of employees who are minorities and women and will encourage eligible employees to apply for such training and promotion. 7. Unions: If the contractor relies in whole or in part upon unions as a source of employees, the contractor will use good faith efforts to obtain the cooperation of such unions to increase opportunities for minorities and women. Actions by the contractor, either directly or through a contractor's association acting as agent, will include the procedures set forth below: a. The contractor will use good faith efforts to develop, in cooperation with the unions, joint training programs aimed toward qualifying more minorities and women for membership in the unions and increasing the skills of minorities and women so that they may qualify for higher paying employment. b. The contractor will use good faith efforts to incorporate an EEO clause into each union agreement to the end that such union will be contractually bound to refer applicants without regard to their race, color, religion, sex, national origin, age or disability. C. The contractor is to obtain information as to the referral practices and policies of the labor union except that to the extent such information is within the exclusive possession of the labor union and such labor union refuses to furnish such information to the contractor, the contractor shall so certify to the contracting agency and shall set forth what efforts have been made to obtain such information. d. In the event the union is unable to provide the contractor with a reasonable flow of referrals within the time limit set forth in the collective bargaining agreement, the contractor will, through independent recruitment efforts, fill the employment vacancies without regard to race, color, religion, sex, national origin, age or disability; making full efforts to obtain qualified and/or qualifiable minorities and women. The failure of a union to provide sufficient referrals (even though it is obligated to provide exclusive referrals under the terms of a collective bargaining agreement) does not relieve the contractor from the requirements of this paragraph. In the event the union referral practice prevents the contractor from meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, such contractor shall immediately notify the contracting agency. 8. Reasonable Accommodation for Applicants / Employees with Disabilities: The contractor must be familiar FAID#U58D005861 with the requirements for and comply with the Americans with Disabilities Act and all rules and regulations established there under. Employers must provide reasonable accommodation in all employment activities unless to do so would cause an undue hardship. 9. Selection of Subcontractors, Procurement of Materials and Leasing of Equipment: The contractor shall not discriminate on the grounds of race, color, religion, sex, national origin, age or disability in the selection and retention of subcontractors, including procurement of materials and leases of equipment. The contractor shall take all necessary and reasonable steps to ensure nondiscrimination in the administration of this contract. a. The contractor shall notify all potential subcontractors and suppliers and lessors of their EEO obligations under this contract. b. The contractor will use good faith efforts to ensure subcontractor compliance with their EEO obligations. 10. Assurance Required by49 CFR 26.13(b): a. The requirements of 49 CFR Part 26 and the State DOT's U.S. DOT -approved DBE program are incorporated by reference. b. The contractor or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of 49 CFR Part 26 in the award and administration of DOT -assisted contracts. Failure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as the contracting agency deems appropriate. 11. Records and Reports: The contractor shall keep such records as necessary to document compliance with the EEO requirements. Such records shall be retained for a period of three years following the date of the final payment to the contractor for all contract work and shall be available at reasonable times and places for inspection by authorized representatives of the contracting agency and the FHWA. a. The records kept by the contractor shall document the following: (1) The number and work hours of minority and non - minority group members and women employed in each work classification on the project; (2) The progress and efforts being made in cooperation with unions, when applicable, to increase employment opportunities for minorities and women; and (3) The progress and efforts being made in locating, hiring, training, qualifying, and upgrading minorities and women; b. The contractors and subcontractors will submit an annual report to the contracting agency each July for the duration of the project, indicating the number of minority, women, and non -minority group employees currently engaged in each work classification required by the contract work. This information is to be reported on Form FHWA-1391. The staffing data should represent the project work force on board in all or any part of the last payroll period preceding the end of July. If on-the-job training is being required by special provision, the contractor City project No.15-6606 will be required to collect and report training data. The employment data should reflect the work force on board during all or any part of the last payroll period preceding the end of July. III. NONSEGREGATED FACILITIES This provision is applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The contractor must ensure that facilities provided for employees are provided in such a manner that segregation on the basis of race, color, religion, sex, or national origin cannot result. The contractor may neither require such segregated use by written or oral policies nor tolerate such use by employee custom. The contractor's obligation extends further to ensure that its employees are not assigned to perform their services at any location, under the contractor's control, where the facilities are segregated. The term "facilities" includes waiting rooms, work areas, restaurants and other eating areas, time clocks, restrooms, washrooms, locker rooms, and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing provided for employees. The contractor shall provide separate or single -user restrooms and necessary dressing or sleeping areas to assure privacy between sexes. IV. DAVIS-BACON AND RELATED ACT PROVISIONS This section is applicable to all Federal -aid construction projects exceeding $2,000 and to all related subcontracts and lower -tier subcontracts (regardless of subcontract size). The requirements apply to all projects located within the right-of- way of a roadway that is functionally classified as Federal -aid highway. This excludes roadways functionally classified as local roads or rural minor collectors, which are exempt. Contracting agencies may elect to apply these requirements to other projects. The following provisions are from the U.S. Department of Labor regulations in 29 CFR 5.5 "Contract provisions and related matters" with minor revisions to conform to the FHWA- 1273 format and FHWA program requirements. 1. Minimum wages a. All laborers and mechanics employed or working upon the site of the work, will be paid unconditionally and not less often than once a week, and without subsequent deduction or rebate on any account (except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act (29 CFR part 3)), the full amount of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment computed at rates not less than those contained in the wage determination of the Secretary of Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics. Contributions made or costs reasonably anticipated for bona fide fringe benefits under section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions FAID#U58D005861 of paragraph 1.d. of this section; also, regular contributions made or costs incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs which cover the particular weekly period, are deemed to be constructively made or incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to skill, except as provided in 29 CFR 5.5(a)(4). Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein: Provided, That the employer's payroll records accurately set forth the time spent in each classification in which work is performed. The wage determination (including any additional classification and wage rates conformed under paragraph 1.1b. of this section) and the Davis -Bacon poster (WH -1321) shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. b.(1) The contracting officer shall require that any class of laborers or mechanics, including helpers, which is not listed in the wage determination and which is to be employed under the contract shall be classified in conformance with the wage determination. The contracting officer shall approve an additional classification and wage rate and fringe benefits therefore only when the following criteria have been met: (i) The work to be performed by the classification requested is not performed by a classification in the wage. determination; and (ii) The classification is utilized in the area by the construction industry; and (iii) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (2) If the contractor and the laborers and mechanics to be employed in the classification (if known), or their representatives, and the contracting officer agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate), a report of the action taken shall be sent by the contracting officer to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor, Washington, DC 20210. The Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30 -day period that additional time is necessary. (3) In the event the contractor, the laborers or mechanics to be employed in the classification or their representatives, and the contracting officer do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions, including the views of all interested parties and the recommendation of the contracting officer, to the Wage and Hour Administrator for determination. The Wage and Hour Administrator, or an authorized representative, will issue a determination within 30 days of receipt and so advise the contracting officer or City project No. 15-6606 will notify the contracting officer within the 30 -day period that additional time is necessary. (4) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs 1.1b.(2) or 1.1b.(3) of this section, shall be paid to all workers performing work in the classification under this contract from the first day on which work is performed in the classification. c. Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate, the contractor shall either pay the benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. d. If the contractor does not make payments to a trustee or other third person, the contractor may consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona fide fringe benefits under a plan or program, Provided, That the Secretary of Labor has found, upon the written request of the contractor, that the applicable standards of the Davis -Bacon Act have been met. The Secretary of Labor may require the contractor to set aside in a separate account assets for the meeting of obligations under the plan or program. 2. Withholding The contracting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor, withhold or cause to be withheld from the contractor under this contract, or any other Federal contract with the same prime contractor, or any other federally - assisted contract subject to Davis -Bacon prevailing wage requirements, which is held by the same prime contractor, so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees, and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, including any apprentice, trainee, or helper, employed or working on the site of the work, all or part of the wages required by the contract, the contracting agency may, after written notice to the contractor, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. 3. Payrolls and basic records a. Payrolls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all laborers and mechanics working at the site of the work. Such records shall contain the name, address, and social security number of each such worker, his or her correct classification, hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in section 1(b)(2)(B) of the Davis -Bacon Act), daily and weekly number of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv) that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in section 1(b)(2)(B) of the Davis- FAID#U58D005861 Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred in providing such benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs, the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. b.(1) The contractor shall submit weekly for each week in which any contract work is performed a copy of all payrolls to the contracting agency. The payrolls submitted shall set out accurately and completely all of the information required to be maintained under 29 CFR 5.5(a)(3)(1), except that full social security numbers and home addresses shall not be included on weekly transmittals. Instead the payrolls shall only need to include an individually identifying number for each employee e.g. , the last four digits of the employee's social security number). The required weekly payroll Information may be submitted in any form desired. Optional Form WH -347 is available for this purpose from the Wage and Hour Division Web site at http://www.dol.govlesa/whd/forms/wh347instr.htm or its successor site. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the full social security number and current address of each covered worker, and shall provide them upon request to the contracting agency for transmission to the State DOT, the FHWA or the Wage and Hour Division of the Department of Labor for purposes of an investigation or audit of compliance with prevailing wage requirements. It is not a violation of this section for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for its own records, without weekly submission to the contracting agency.. (2) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (i) That the payroll for the payroll period contains the information required to be provided under §5.5 (a)(3)(ii) of Regulations, 29 CFR part 5, the appropriate information is being maintained under §5.5 (a)(3)(i) of Regulations, 29 CFR part 5, and that such information is correct and complete; (ii) That each laborer or mechanic (including each helper, apprentice, and trainee) employed on the contract during the payroll period has been paid the full weekly wages earned, without rebate, either directly or indirectly, and that no deductions have been made either directly or indirectly from the full wages earned, other than permissible deductions as set forth in Regulations, 29 CFR part 3; (iii) That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or cash equivalents for the classification of work performed, as specified in the applicable wage determination incorporated into the contract. City project No.15-6606 (3) The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH -347 shall satisfy the requirement for submission of the "Statement of Compliance" required by paragraph 3.b.(2) of this section. (4) The falsification of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under section 1001 of title 18 and section 231 of title 31 of the United States Code. c. The contractor or subcontractor shall make the records required under paragraph 3.a. of this section available for inspection, copying, or transcription by authorized representatives of the contracting agency, the State DOT, the FHWA, or the Department of Labor, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records or to make them available, the FHWA may, after written notice to the contractor, the contracting agency or the State DOT, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. 4. Apprentices and trainees a. Apprentices (programs of the USDOL). Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or if a person is employed in his or her first 90 days of probationary employment as an apprentice in such an apprenticeship program, who is not individually registered in the program, but who has been certified by the Office of Apprenticeship Training, Employer and Labor Services or a State Apprenticeship Agency (where appropriate) to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices to journeymen on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any worker listed on a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor is performing construction on a project in a locality other than that in which its program is registered, the ratios and wage rates (expressed in percentages of the journeyman's hourly rate) specified in the contractor's or subcontractor's registered program shalt be observed. Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's level of progress, expressed as a percentage of the journeymen hourly FAID#U58D005861 rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with the provisions of the apprenticeship program. If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved. b. Trainees (programs of the USDOL). Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified in the approved program for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who is not registered and participating in a training plan approved by the Employment and Training Administration shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any trainee performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration Withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. c. Equal employment opportunity. The utilization of apprentices, trainees and journeymen under this part shall be in conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR part 30. City project No. 15-6606 d. Apprentices and Trainees (programs of the U.S. DOT). Apprentices and trainees working under apprenticeship and skill training programs which have been certified by the Secretary of Transportation as promoting EEO in connection with Federal -aid highway construction programs are not subject to the requirements of paragraph 4 of this Section IV. The straight time hourly wage rates for apprentices and trainees under such programs will be established by the particular programs. The ratio of apprentices and trainees to journeymen shall not be greater than permitted by the terms of the particular program. 5. Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR part 3, which are incorporated by reference in this contract. 6. Subcontracts. The contractor or subcontractor shall insert Form FHWA-1273 in any subcontracts and also require the subcontractors to include Form FHWA-1273 in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR 5.5. 7. Contract termination: debarment. A breach of the contract clauses in 29 CFR 5.5 may be grounds for termination of the contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR 5.12. 8. Compliance with Davis -Bacon and Related Act requirements. All rulings and interpretations of the Davis - Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in this contract. 9. Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall not be subject to the general disputes clause of this contract. Such disputes shall be resolved in accordance with the procedures of the Department of Labor set forth in 29 CFR parts 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, the U.S. Department of Labor, or the employees or their representatives. 10. Certification of eligibility. a. By entering into this contract, the contractor certifies that neither it (nor he or she) nor any person or firm who has an interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). b. No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). c. The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. FAID#U58D005861 V. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT The following clauses apply to any Federal -aid construction contract in an amount in excess of $100,000 and subject to the overtime provisions of the Contract Work Hours and Safety Standards Act. These clauses shall be inserted in addition to the clauses required by 29 CFR 5.5(a) or 29 CFR 4.6. As used in this paragraph, the terms laborers and mechanics include watchmen and guards. 1. Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rale of pay for all hours worked in excess of forty hours in such workweek. 2. Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (1.) of this section, the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (1.) of this section, in the sum of $10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (1.) of this section. 3. Withholding for unpaid wages and liquidated damages. The FHWA or the contacting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph (2.) of this section. 4. Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (1.) through (4.) of this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (1.) through (4.) of this section. City project No. 15-6606 VI. SUBLETTING OR ASSIGNING THE CONTRACT This provision is applicable to all Federal -aid construction contracts on the National Highway System. 1. The contractor shall perform with its own organization contract work amounting to not less than 30 percent (or a greater percentage if specified elsewhere in the contract) of the total original contract price, excluding any specialty items designated by the contracting agency. Specialty items may be performed by subcontract and the amount of any such specialty items performed may be deducted from the total original contract price before computing the amount of work required to be performed by the contractor's own organization (23 CFR 635.116). a. The term "perform work with its own organization" refers to workers employed or leased by the prime contractor, and equipment owned or rented by the prime contractor, with or without operators. Such term does not include employees or equipment of a subcontractor or lower tier subcontractor, agents of the prime contractor, or any other assignees. The term may include payments for the costs of hiring leased employees from an employee leasing firm meeting all relevant Federal and State regulatory requirements. Leased employees may only be included in this term if the prime contractor meets all of the following conditions: (1) the prime contractor maintains control over the supervision of the day-to-day activities of the leased employees; (2) the prime contractor remains responsible for the quality of the work of the leased employees; (3) the prime contractor retains all power to accept or exclude individual employees from work on the project; and (4) the prime contractor remains ultimately responsible for the payment of predetermined minimum wages, the submission of payrolls, statements of compliance and all other Federal regulatory requirements. b. "Specialty Items" shall be construed to be limited to work that requires highly specialized knowledge, abilities, or equipment not ordinarily available in the type of contracting organizations qualified and expected to bid or propose on the contract as a whole and in general are to be limited to minor components of the overall contract. 2. The contract amount upon which the requirements set forth in paragraph (1) of Section VI is computed includes the cost of material and manufactured products which are to be purchased or produced by the contractor under the contract provisions. 3. The contractor shall furnish (a) a competent superintendent or supervisor who is employed by the firm, has full authority to direct performance of the work in accordance with the contract requirements, and is in charge of all construction operations (regardless of who performs the work) and (b) such other of its own organizational resources (supervision, management, and engineering services) as the contracting officer determines is necessary to assure the performance of the contract. 4. No portion of the contract shall be sublet, assigned or otherwise disposed of except with the written consent of the contracting officer, or authorized representative, and such consent when given shall not be construed to relieve the contractor of any responsibility for the fulfillment of the contract. Written consent will be given only after the contracting agency has assured that each subcontract is FAID#U58D005861 evidenced in writing and that it contains all pertinent provisions and requirements of the prime contract. 5. The 30% self -performance requirement of paragraph (1) is not applicable to design -build contracts; however, contracting agencies may establish their own self -performance requirements. VII. SAFETY: ACCIDENT PREVENTION T h 1 s p r o v 1 s 1 o n 1 s applicable to all Federal -aid construction contracts and to all related subcontracts. 1. In the performance of this contract the contractor shall comply with all applicable Federal, State, and local laws governing safety, health, and sanitation (23 CFR 635). The contractor shall provide all safeguards, safety devices and protective equipment and take any other needed actions as it determines, or as the contracting officer may determine, to be reasonably necessary to protect the life and health of employees on the job and the safety of the public and to protect property in connection with the performance of the work covered by the contract. 2. It is a condition of this contract, and shall be made a condition of each subcontract, which the contractor enters into pursuant to this contract, that the contractor and any subcontractor shall not permit any employee, in performance of the contract, to work in surroundings or under conditions which are unsanitary, hazardous or dangerous to his/her health or safety, as determined under construction safety and health standards (29 CFR 1926) promulgated by the Secretary of Labor, in accordance with Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 3704). 3. Pursuant to 29 CFR 1926.3, it is a condition of this contract that the Secretary of Labor or authorized representative thereof, shall have right of entry to any site of contract performance to inspect or investigate the matter of compliance with the construction safety and health standards and to carry out the duties of the Secretary under Section 107 of the Contract Work Hours and Safety Standards Act (40 ILS.C.3704). VIII. FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS T h i s p r o v 1 s i o n i s applicable to all Federal -aid construction contracts and to all related subcontracts. In order to assure high quality and durable construction in conformity with approved plans and specifications and a high degree of reliability on statements and representations made by engineers, contractors, suppliers, and workers on Federal - aid highway projects, it is essential that all persons concerned with the project perform their functions as carefully, thoroughly, and honestly as possible. Willful falsification, distortion, or misrepresentation with respect to any facts related to the project is a violation of Federal law. To prevent any misunderstanding regarding the seriousness of these and similar acts, Form FHWA-1022 shall be posted on each Federal -aid highway project (23 CFR 635) in one or more places where it is readily available to all persons concerned with the project: 18 U.S.C. 1020 reads as follows: City project No. 15-6606 "Whoever, being an officer, agent, or employee of the United States, or of any State or Territory, or whoever, whether a person, association, firm, or corporation, knowingly makes any false statement, false representation, or false report as to the character, quality, quantity, or cost of the material used or to be used, or the quantity or quality of the work performed or to be performed, or the cost thereof in connection with the submission of plans, maps, specifications, contracts, or costs of construction on any highway or related project submitted for approval to the Secretary of Transportation; or Whoever knowingly makes any false statement, false representation, false report or false claim with respect to the character, quality, quantity, or cost of any work performed or to be performed, or materials furnished or to be furnished, in connection with the construction of any highway or related project approved by the Secretary of Transportation; or Whoever knowingly makes any false statement or false representation as to material fact in any statement, certificate, or report submitted pursuant to provisions of the Federal -aid Roads Act approved July 1, 1916, (39 Stat. 355), as amended and supplemented; Shall be fined under this title or imprisoned not more than 5 years or both." IX. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. By submission of this bid/proposal or the execution of this contract, or subcontract, as appropriate, the bidder, proposer Federal -aid construction contractor, or subcontractor, as appropriate, will be deemed to have stipulated as follows: 1. That any person who is or will be utilized in the performance of this contract is not prohibited from receiving an award due to a violation of Section 508 of the Clean Water Act or Section 306 of the Clean Air Act. 2. That the contractor agrees to include or cause to be included the requirements of paragraph (1) of this Section X in every subcontract, and further agrees to take such action as the contracting agency may direct as a means of enforcing such requirements. X. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION This provision is applicable to all Federal -aid construction contracts, design -build contracts, subcontracts, lower -tier subcontracts, purchase orders, lease agreements, consultant contracts or any other covered transaction requiring FHWA approval or that is estimated to cost $25,000 or more — as defined in 2 CFR Parts 180 and 1200. 1. Instructions for Certification — First Tier Participants: a. By signing and submitting this proposal, the prospective first tier participant is providing the certification set out below. b. The inability of a person to provide the certification set out below will not necessarily result in denial of participation in this FAID#U58D005861 covered transaction. The prospective first tier participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter Into this transaction. However, failure of the prospective first tier participant to furnish a certification or an explanation shall disqualify such a person from participation in this transaction. c. The certification in this clause is a material representation of fact upon which reliance was placed when the contracting agency determined to enter into this transaction. If it is later determined that the prospective participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the contracting agency may terminate this transaction for cause of default. d. The prospective first tier participant shall provide immediate written notice to the contracting agency to whom this proposal is submitted if any time the prospective first tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. e. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200. "First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). I. The prospective first tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. g. The prospective first tier participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions," provided by the department or contracting agency, entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. h. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (https://www.epls.ao , which is compiled by the General Services Administration. City project No. 15-6606 I. Nothing contained in the foregoing shall be construed to require the establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of the prospective participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. j. Except for transactions authorized under paragraph (f) of these instructions, If a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 2. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — First Tier Participants: a. The prospective first tier participant certifies to the best of its knowledge and belief, that it and its principals: (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency; (2) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (a)(2) of this certification; and (4) Have not within a three-year period preceding this applicationiproposal had one or more public transactions (Federal, State or local) terminated for cause or default. b. Where the prospective participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. 2. Instructions for Certification - Lower Tier Participants: (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200) a. By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department, or agency with which 10 FAID#U58D005861 this transaction originated may pursue available remedies, including suspension and/or debarment. c. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. "First Tier Covered Transactions' refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). e. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. f. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause tilled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. g. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (httosa/www.eols.aov/), which is compiled by the General Services Administration. h. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. I. Except for transactions authorized under paragraph a of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person Who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the City project No. 15-6606 department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower Tier Participants: 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. XI. CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING This provision is applicable to all Federal -aid construction contracts and to all related subcontracts which exceed $100,000 (49 CFR 20). 1. The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: a. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 2. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 3. The prospective participant also agrees by submitting its bid or proposal that the participant shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such recipients shall certify and disclose accordingly. ffl FAID#U58D005861 Local Assistance Procedures Manual EXHIBIT 16-B Subcontracting Request STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION FRONT SUBCONTRACTING REQUEST DC -CEM -1201 (REV. 4/94) (OLD HC -45) CT# 7541-3514-7 See Instructions On Buck REQUEST NUMBER CONTRACTOR NAME COUNTY ROUTE BUSINESS ADDRESS CONTRACT NO. CITY/STATE ZIP CODE FEDERAL AID PROJECT NO. (Prom Special Provisions) SUBCONTRACTOR (Name, Business Address, Phone) BID ITEM NUMBERS) % BID ITEM SUBBED CHECKIF: (See Categories Below) 1 2 3) DESCRIBE WORK WHEN LESS THAN 100% OF WORI{ISSUBBED $AMOUNT BASED ON BID $AMOUNT Categories: 1) Specialty 2) Listed Under Fair Practices Act 3) Certified DBE/MBE/WBE/DVBE I Certify That: • The Standard Provisions for labor set forth in the contract apply to the subcontracted work. • If applicable, (Federal Aid Projects only) Section 14 (Federal Requirements) of the Special Provisions have been inserted in the subcontracts and shall be incorporated in any lower -tier subcontract. Written contracts have been executed for the above noted subcontracted wm9c CONTRACTOR'S SIGNATURE NOTE: This section is to be completed by the Resident Engineer 1. Total of bid items.................................................................................................... 2. Specialty items (previously requested)................................................................. $ 3. Specialty items (this request)............................................................................... $ 4. Total (lines 2+3)................................................................................................... S 5. Contractor must perform with own forces (lines 1 minus 4) x 0 6. Bid items previously subcontracted..................................................................... S 7. Bid items subcontracted ( this request)................................................................ $ 8. Total (lines 6+7)................................................................................................... S 9. Balance of work Contractor to perform (lines 1 minus 8) .................................... $ ............................. I..... $ 3. Copy -local agony Labor Compliance Officer 4. Contractor's lnfom>ation Copy Page 16-51 February 1, 1998 EXHIBIT 16-B Local Assistance Procedures Manual Subcontracting Request Back INSTRUCTIONS FOR COMPLETING SUBCONTRACTING REQUEST FORM All First-tier subcontractors must be included on a subcontracting request. Submit in accordance with Section 8-1.01 of the Caltrans Standard Specifications. Type or print requested information. Information copy is to be retained by the contractor. Submit other copies to project's Resident Engineer. After approval, the original will be returned to the contractor. When an entire item is subcontracted, the value to be shown is the contractor's bid price. When a portion of an item is subcontracted, describe the portion, and show the % of bid item and value. THIS FORM IS NOT TO BE USED FOR SUBSTITUTIONS. Prior to submittal of Form CEM -1201 involving a replacement Subcontractor, submit a separate written request for approval to substitute a listed subcontractor. Section 4107 of the Government Code covers the conditions for substitution. Submit a separate written request for approval of any DBE/MBE/WBE/DVBE substitution. Include appropriate backup information and state what efforts were made to accomplish the same dollar value of work by other certified DBE/MBE/WBE/DVBEs. NOTE: For contractors who will be performing work on railroad property, it is necessary for the contractor to complete and submit the Certificate of Insurance (State Forn DH-OS-AIOA) naming the subcontractor as insured. No work shall be allowed which involves encroachment on railroad property until the specified insurance has been approved. Page 16-52 October 5, 2012 LPP 12-02 MAYOR Miguel A, Pulido MAYOR PRO TEM Vicente Sarmiento COUNCILMEMBERS Angelica Amezcua P, David Benavides Michele Martinez Roman Rayne Sal TlnaJero April 6, 2016 ADDENDUM No. ONE CITY OF SANTA ANA 20 Civic Center Plaza a P,O, Box 1988 M-36 Santa Ana, California 92702 (714)647-5013 wwwsanta-ana oro CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Marla D. Huizar SUBJECT: PROJECT NO, 15-6606: 3rd Street Traffic Calming from Birch Street to Spurgeon Street The following change has been made to Specifications for the subject project: Specifications 1. Page xvii, Bid Opening, paragraph 1. Replace with the following: The Agency publicly opens and reads bids at the time and place noted on the Notice Inviting Bids. Prior to Bid Opening, Contractors will be required to comply with the City's new security policy and sign -in with the receptionist on the first floor (policy attached). Contractors will sign -in under Bid opening for Project 15-6606 to receive elevator access to the 3rd floor lobby. Contractors should allow themselves additional time to register in order to avoid missing the time - stamp deadline as stated on the Notice Inviting Bids. 2. Add new Appendix H, Proposed Downtown Street Furniture Map: See Attachment. 3, Pages P-1 of P-18 and P-2 of p-18; Replace with the attached pages P-1 of P-18 and P-2 of P-18. All other terms and conditions remain the same. CITY -OF ANT ANA William "Edwina G�a ez City Engineer SANTA ANA CITY COUNCIL Miguel A. Pulldo Vicente Sarmiento Michele lomtooz Angelica Amezcua P. David Benavides Roman Rayne Sal Toole. Mayor Mayor Pro Tem. Ward 1 Ward 2 Were 3 Wad 4 Ward 5 Ward B mou doedsanm-ana oro y8somientogisanto,armoLq mmoolnoz(Asanla-3na.grq a (d 1 - dbenay gsSaa S8m800a Ora RBynaealsanta-ane ertl mirm e(O4mme-ana Ora ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO, 15-6606 PROPOSAL PROJECT NO. 15-6606: 3" STREET TRAFFIC CALMING (FAID# U58DP005861) BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA 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 sums) set forth in the following schedule: Item Description Qty Unit Unit Price Amount I Unclassified Excavation CY 80 $ $ 2 AC Pavement* TN 55 $ $ 3 Construct PCC Sidewalk (T=4")* SF 825 $ s $ gi23 �V 4 Construct PCC Curb Ramp* SF 1140 $ $ — 5 Construct PCC Driveway (T=6")* SF 55 $ $ 110b 6 Construct PCC Curb only (B-1)* LF 260 $ $ 45b 13bb0' 7 Construct PCC Curb and Gutter (A-2-6)* LF 50 $ $ p-- c�1)• 8 Construct AC DIKE Traffic Circle(Curb LF 65 $ $ Face =6")* 157.- 9 Construct and Provide Brick Paver Band* SF 70 $ $ ✓T s V 10 Adjust Manhole Frame and Cover to Grade EA 1 $ $ I 1 Adjust Water Valve Frame and Cover to EA 1 $ $ Grade ep 0 — sbb s 12 Adjust Pull Box to Grade EA 1 $ $ 13 Landscaping LS 1 $ $ obbb' �ooaD- 14 Landscape Maintenance (60 calendar LS 1 $ $ days): 19b 200- v0-15 15 Furnish and Install Soil* CY 20 $ ";.� $ 1 i 6 D P -I ofP-18 CITY OF SANTA ANA ADDENDUM NO, ONE PROJECT NO, 15-6606 PROPOSAL PROJECT NO. 15-6606: 3RDSTREET TRAFFIC CALMING (FAID# U58DP005861) Item Add— Description Qty Unit Unit Price Amount 16 Signing and Striping LS 1 $ 17 Temporary Construction Sign* EA 4 $ 100' $ 2610 18 Furnish and Install Bike Racks (Complete inPlace)* EA 64 $ 4S b e $ 2$0 OD' 19 Furnish & Install Bench by Victor Stanley Model # CBF -10 (Complete in Place)*Z5-00- EA 9 $ $ Z SSV d 20 Install Tree Grates (Complete in Place)* EA 25 $ 0 $ 5-0 40 21 Furnish and Install Ceramic Way -Finding Markers (Complete in Place)* EA 50 $ Liq Q " $ Z 0Z)D TOTAL BASE BID $ 4 q 0— Add Alternative Bid "A" 22 1 Furnish and Install Bronze 50 I $ (05-b TOTAL ADD ALTERNATIVE BID "A" $ TOTAL BASE BID + ADD ALTERNATIVE BID "A" $ The lowest responsible bidder shall be selected based on the Total Base Bid. The City reserves the 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. TIME FOR COMPLETION OF IMPROVEMENTS AND LIQUIDATED DAMAGES The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, within number 30 working dM after the commencement date stated in the Notice to Proceed. Preconstruction meeting shall take place one week after Council Award. Project 15-6606 shall be completed by August 15, 2016 and Bid Items (18, 19, 20, 21) shall be completed by Judy 5, 2016, The liquidated damages amount, in lieu of the amount specified in Subsection 6-9 of the Standard Specifications, shall be $1,000 er calendar day. Name of Firth W. WMA Signature of BIDDER Title C.P. ROW11, PRESIDENT (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-18 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE j 111M.- 17, 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 Los Angeles ) On pft t 2016 beforeme, C. Phillips, Notary Public ®ate Here Insert Name and Ttt/e of the Otifcer personally appeared C. P. Brown Name(s) of Signers) who proved to me on the basis of satisfactory evidence- to be the persons) whose names) iaf subscribed to the within Instrument and acknowledged to me that helebmabey executed the same in hisAAjW twk authoriied capacity(les), and that by his/lgbOUTeir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. 'rte � C PHILLIPS caMM n199sa.�a M PdpYary Pu611c California �' ,y s,b L05 ANCkLES COUNTY LL _ My Comm. kxpires Oct. 7,�J, 201611 . Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph Is true and correct. WITNESS my hand and official seal. Signature Signat of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document, Description of Attached Document Title or Type of Document: Number of Pages: Signer(s) Document Date: Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer - Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator F1 Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: — Signer Is Representing: o .ice ,. ... . , :ii • ai , CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) 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 7028.15 of the California Business and Professions Code, the undersigned certifies under penalty of perjury that the foregoing is true and correct. RW. NUM Name of Firm 2=1 MIS COMM Signature of BIDDER c� r � Title C.P. BROWN, EFiFYMNIT (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-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT The undersigned contractor, or corporate officer, declares under 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: WNU OFACK rA WM Business E -Mail Address: Telephone: 599-5841 State Contractor's License No. and Class: STA4 Uc 690659 *AO License Expiration Date: State Dept. of Industrial Relations (DIR) Registration No.: tOD OW 3 3r3 State Dept. of Industrial Relations (DIR) Registration Expiration Date: Signed: Title: Cale B18 WN, PRE9-0C FNT P-4 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3an STREET TRAFFIC CALMING (FAID# U58DP005861) 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 Firm MME1 pAlqNC CMMW Signature of BIDDER Title (if an C.P. so state) P-5 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) OWNERSHIP AFFIDAVIT STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS: CITY OF SANTA ANA ) C" p' RR®LWN , being duly sworn, deposes and says: ❑ INDIVIDUAL That he/she is the party malting the foregoing proposal: ❑ 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 matte and execute instruments for the co -partnership by: who constitute the other members of the co -partnership. CORPORATION That he is of: ` PREWENT MEL PAVING CMVAW a corporation which is making the foregoing proposal: ❑ JOINT VENTURE That he is of: one of the parties malting 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 genuine and not collusive or sham, and has not in any manner sought by collusion to secure any advantage against the City of Santa Ana or any person interested in the proposed contract, for himself or any other person. `T. flx�� G --p- Oi , PRESIDENT Signature of Bidder Subscribed and sWo1A to before me this A`7R 1 12016. day of Signature o o ficer A inistering Oath (Notary Public) C. PHILLIPS W ;, COMM. #t1996177 m Notary m Y Pn blit, California q LOS ANGfw'LES COUNTY a My 00MIM. NOWOct. 29, 201® P-6 of P-18 20 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET. TRAFFIC CALMING (FAID# U58DP005861) KNOW ALL PRESENT that, PALP Inc. dba Excel Paving Company , asBIDDER, and Federal 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 of the bid Dollars ($ 10% ), which is ten percent (10'7o) 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. THE CONDITIONS OF TIES 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 seal this 30th day of March , 20 16 . :D1 C 2230 Lemon Avenue, Long Beach, CA 90806 562-599-5841 SURETY* 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 ofP-18 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 Orange 1011 March 30, 2016 before me, Debra Swanson, Notary Public (insert name and title of the officer) personally appeared Timothy D. Rapp who proved to me on the basis of satisfactory evidence to be the person(r) whose name(* is/a+=e subscribed to the within instrument and acknowledged to me that he/e4e44ey executed the same in his/4eW#te4f authorized capacity,+e ), and that by his r signature(*] on the instrument the person*, or the entity upon behalf of which the person(e) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature �.��e"•���y N FNAR DE6RA SWANSONcnCOMM. # 1997119 �OTYPUBLIC•CALIFORNIA�Ll ORANGE COUNTY(Seal) CORJ'M EXp.NOV1B,2018 Chubb POWER Federal Insurance Company Attn: Surety Department OF Vigilant Insurance Company 15 Mountain View Road wYe Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 Know All by These Presents, That FE COMPANY, a New York corporation, and P. appoint Douglas A. Rapp and Timothy Ina corporation, VIGILANT INSURANCE corporation, do each hereby constitute and each as their true and lawful Attorney- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other wrings obligatory In the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSU these presents and affixed their corporate seals on this 16th day of Kenneth C. Wentle, Assistant Secretary STATE OF NEW JERSEY ss. County of Somerset NY, and PACIFIC INDEMNITY COMPANY have each executed and attested , 2011, On this 16th day of December, 2011 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he Is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY. COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Norris, Jr., subscribed to said Power of Attorney is in the genuine handwriting of David B, Norris, Jr., and was thereto subscribed by authority of said I Laws and in deponent's presence. Notarial Seal KATHERINE J. ADELAAR 0�m)aas- NOTARY PUBUC 16 NEW JFRSF4Nn,2316665 COMMiseion Expires July IA, 2014 Notary Public CERTIFICATION Extractfrom the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: "All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations, The signature of such officers may be engraved, printed or lithographed, The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fact for purposes only of executing and attesting bonds and undertakings and other wrillngs obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking towhich It is attached." I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies") do hereby certify that (i) the foregoing extract of the By- Laws of the Companies is true and correct, (ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in Amencan Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (ill) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 30th day of March, 2016 vro �t o M'DIPNP . ! re"f � '�fW 1'DP'r'+ �/�L�'//✓c.G/✓/r6LTl� �r Kenneth C. We el, Assistant Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903- 3656 e-mail: surety@chubb.com Form 15-10- 02258- U (Ed. 5- 03) CONSENT 2 LE 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 Los Angeles On APR 11 2016 before me, C. Phillips, Notary Public - Date Here Insert Name and Tttle of the Officer personally appeared C. P. Brown Mame(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(e) whose name(s) is)Ww subscribed to the within Instrument and acknowledged to me that he/ahmftkaey executed the same in hisilmk1wk authorised capacity(les), and that by his/hfa§dh* signature(s) on the instrument the person(s), or the entity Upon behalf of which the person(s) acted, executed the instrument. *•, C, PHILLIPS COMM. (69996177 n ly Notary G'ublirCairforma K LCIS ANGELES COUNTY'�Comm. Expires Oct. 29,201 Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature. CA Sign re of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signer(s) Document Date: Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer - Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator F1 Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: `` w CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3pD STREET TRAFFIC CALMING (FAID# U58DP005861) 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: V2% of the bid or $10,000, whichever is greater o Buildings, parks, or other projects: %2% 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 C41 License #/Exp. GPD DIR Reg. #/Exp.Od (T Location 13m YJ Phone .W. 2 lid • (�� �(i Type Of Work tier Amount $ 2-1 A Name OrA License #/Exp. U DIR Reg. #/Exp. License # Location lob a Al $ Phone Type Of Work i Amount $ 1�T 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 Name License #/Exp. �— License #/Exp. DIR Reg. #/Exp. Ids JD 1 DIR Reg. #/Exp. License # p 2 License # Location 1(6 (6 _ Location Phone CP ® _ Phone Type Of Work `en den Type Of Work Amount $ �_®� Amount $ QI w Signature of Bidder C.p. RROW4, P-8 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606:3' STREET TRAFFIC CALMING (FAID# U58DP005861) REFERENCES The following are the names, addresses, and telephone numbers for THREE public agencies for which the BIDDER AA performed similar worr+k, within the past three years. 1. L�0 SAA 4A AA 10 3 � � VA Name and Address of Owner. i" 4*1 Na e and Telephone Number of p rso fa iliar with project. Contract Amount Type of Work Date Completed 2. 0\,a % lan, 303 U). (, trtmm wtakh, Name and dress of owner. sarnm) :159 !a®s3 mber of pe son familiar with project. Contract Amount Typ of W k D to Completed Name and Address of owner. Name and Telephone Nun 4a0 601 - Contract Amount of person familiar with project. X101" Type of Work Tr 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-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) ADDITIONAL REFERENCES 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 Teleph ne Number of ers n amiliar ith p oject. �C� cwt,,- u lui s Contract Amount Type of Work Date Completed 2. Clo LftUA a Name and Address of owner. 3. Name and Telephone Number of person amiliar withro'ect. Contract Amount Type of Work and Address of owner. A 'L Name and Telephone Number of person amiliar with project. Contract Amount Type of Work t Date Completed 141 Nua 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. 01 400 45L"10 (all0 P-10 ofP-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3' STREET TRAFFIC CALMING (FAID# U58DP005861) 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 portion thereof shall also constitute signature of this Non -collusion Affidavit. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed State of California County of LOS ANCIFLFS G, 8 OWIN, P1"14 T0@ ENT Subscribed and sworn to (or affirmed) before me on this day of g��20_, by C.P. BROWN , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me Notary Public Anature Notary Public Seal c NwLLIP ryyf GONfM #3.996177 n Public -California K LOS ANGELES COUNTY U+y Comm, Expires Oct. 29, 20161 P-11 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAIR# U58DP005861) 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 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with such rules, regulations, and orders. 6. In the event of the Contractor's non-compliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole or in part and the Contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Execution Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law. P-12 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3an STREET TRAFFIC CALMING (FAID# U58DP005861) 7. The Contractor shall include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontract or purchase order as the administering agency may direct as means of enforcing such provisions, including sanctions for noncompliance; provided, however, that in the event the Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, the Contractor may request that the United States enter into such litigation to protect the interests of the United States. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as amended, no discrimination shall be made in the employment of persons upon public works because of race, religious creed, color, national origin, ancestry, physical handicaps, mental condition, marital status, or sex of such persons, except as provided in Section 1420, and any contractor of public works violating this Section is subject to all the penalties imposed for a violation of the Chapter. Signed: C-1. � f Title: c,p, BROVIN, PPF-SIDENT Firm: L PANG C NY Date: I P-13 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3' STREET TRAFFIC CALMING (FAID# U58DP005861) 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: Apply to the joint apprenticeship committee administering the apprenticeship standards of the craft or trade in the area of the site of the public work for a certificate approving the contractor under the apprenticeship standards for the employment and training of apprentices in the area or industry affected. 2. Employ the number of apprentices or the ratio of apprentices to journeymen stipulated in the apprenticeship standards. 3. Contribute to the fund or funds in each craft or trade in which he/she employs journeymen or apprentices on the public work, in the same amount or upon the same basis and in the same manner as the other contractors, except contractors not signatory to the trust agreement shall pay a like amount to the California Apprenticeship Council. Signed: Title: G- P. RR WN, € flLSf NT' Firm: Date: APR i J_ 2016 P-14 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) STATEMENT REGARDING "ANTI -KICKBACK" REQUIREMENTS The undersigned is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the Copeland "Anti -Kickback" Act (18 USC 74) as supplemented in the Department of Labor regulations (29 CFR, Part 3). This act provides that each contractor or subcontractor shall be prohibited from inducing, by any means, any person employed in the construction or repair of public work, to give up any part of the compensation to which he/she is otherwise entitled. Signed:, Title: C.Po BROWN, PHES1aENT Date: APR 11 06 P-15 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under enalty of perjury under the laws of the State of California that the bidder has _ , has not been convicted within the preceding three years of any offenses referred to in that section,, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a checkmark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. P-16 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606: 3RD STREET TRAFFIC CALMING (FAID# U58DP005861) PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE 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 regulaf on? Yes No If the answer is yes, explain the circumstances in the following space. I P-17 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO. 15-6606:3' STREET TRAFFIC CALMING (FAID# U58DP005861) PUBLIC CONTRACT CODE SECTION 10232 STATEMENT In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two-year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor to comply with an order of the National Labor Relations Board. Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. P-18 of P-18 (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION WMA The BIDDER r mL PAVING COWAT proposed subcontractor hereby certifies that he has has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO -1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager: • is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any Federal agency; • has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federal agency within the past 3 years; • does not have a proposed debarment pending; and • has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. rK Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any fonds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, 'Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. V�p :K DISCLOSURE OF LOBBYING ACTIVITIES min�-@mm 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract ® a. bid/offer/application ® a. initial b. grant b, initial award b. material change c. cooperative agreement c. post -award d. loan For Material Change Only: e. loan guarantee year_ quarter _ f. loan insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Prime Subawardee Tier , if known ED M FAMO COW AW =Congressional District, if known 6. Federal Department/Agency: 8. Federal Action Number, if known: 10. a. Name and Address of Lobby Entity (If individual, last name, first name, MI) Congressional District, if known 7. Federal Program Name/Description: CFDA Number, if applicable 9. Award Amount, if known: b. Individuals Performing Services (including address if different from No. I Oa) (last name, first name, MI) (attach Continuation Sheet(s) if necessary) 11. Amount of Payment (check all that apply) $ E] actual [] planned 12. Form of Payment (check all that apply): 8 a. cash 6. in-kind; specify: nature 13. Type of Payment (check all that apply) a. retainer b. one-time fee C. commission d. contingent fee e deferred f. other, specify 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(,) if ne ssary) 15. Continuation Sheet(s) attached: Yes No 16. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only: Signature: Print Name: Telephone No.: (562) 599-5841 Date: ARE Authorized for Local Reproduction Standard Form - LLL INSTRUCTIONS FOR COMPLETION OF SF -LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of covered Federal action or a material change to previous filing pursuant to title 31 U.S.C, section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered Federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. I. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence, the outcome of covered Federal action. 2. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency malting the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP -DE -90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered Federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box. Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13. Check the appropriate box. Check all boxes that apply. if other, specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with Federal officials. Identify the Federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. 06-04-9NENDTh Insurance Company did Republic General Ins Corp This endorsement modifies such insurance as Is afforded by the provisions of Policy # AICG50211511 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702; its officers, employees, agents and volunteers are named as additional insureds ("additional Insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such Insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be canceled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702. .10 pays Notice of Cancellationfor Non -Payment of Premium (Completion of the following, including countersignature, is required to make this endorsement effective,) Effective 08101/15 this endorsement form as a part of Policy # A1CG50211511 Issued to i'alp, Inc. dba Excel Pavina Cmmnanv Insured Countersigned by Authorized Representative CITY OF SANTA ANA BONDS PROJECT NO.: 15-6606 Bond No, 8239-74-09 FAITHFUL PERFORMANCE BOND I{NOW ALL MEN BY THESE PRESENTS that PALP Inc. dba Excel Paving Company as CONTRACTOR, and Federal Insurance Company a,corporation, organized and existing under the laws of the State, and duly authorized to transact business under the laws of the State of Califor nia, as SURETY, are held and firm ly bound unto the City of Santa Ana, as AGENCY, in the penal sum of Two hundred thirty nine thousand four hundred eighty and 00/100 Dollars ($ 239,480.00 ), which is 100 percent of the total contract amount for t he above stated project, for the payment of which sum, CONTRACTOR and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION AR E SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated May 17, 2016 for Street Traffic Calming From Birch St. to Spurgeon St. (FAID U58DP005861) if CONTRACTOR faithfully performs and fulfills all obligations in the performance of the Work of Improvement to be done unde r said Contract Agreem But in the manner and time specified therein, then this obligation shall be null and void, other wise it shall rem ain in full f orce and effect in favor of AGENCY; pr ovided that any alterations in the obligations or tim e for completion made pursuant to the terms of the contract documents shall not in any way release either CONTRACTOR or SURETY, and notice of such alte rations is hereb y waived by SURETY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 20th day of May '2016 CONTRACTOR* PALP Inc. dba Excel Paving Company 2230 Lemon Avenue, Long Beach CA 90806 sworn to before me, 20 Signature: Notary Public in and for the County of Rate of premium on this bond is $ _ Total amount of premium charge is $ Varies NMI 562-599-5841 15 Mountain View Rd., Warren, NJ 07059 908-903-2000 this ___, day of State of perthousand. To be filled in, by Surety *Provide CONTRACTOR / ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. 1 of 3 CALIFORNIA ALL PURPOSE ACKNOWLEMMENT CIVIL CODE 61189 A notary public or other officer completing this certificate verifies only the identtty of the Individual who signed the document to which the certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Los Angeles ) On 5, W Ica beforeme, C. Phillips, Notary Public 0M Here Insert Name and Tfffe of the Ofilcer personally appeared C. P. Brown Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence- to be the persons) whose name(s) istAw subscribed to the within instrument and acknowledged to me that he/sty executed the same in hisAmoMwk authorised capacity(les), and that by hiehce Abolr signature(s) on the instrument the person(s), or the entityupon behalf of which the person(s) acted, executed the instrument. C. PwILUPs '`{ COMM.Ik9996177 � �a Y�-� Notary Pnhlu; C�; 1lornia g �a�x� LOS ANGELES COUNTY ��- My Comm. Expires Oct, 29:2016 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Signature otary Public Place Notary Seal Above OP77ONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title of Type of Document: Number of Pages: Signer(s) Document Date: Other Than Named Above: _ Capachy(fes) Claimed by Signers) Signer's Name: ❑ Corporate Officer - Titles): ' ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator F1 Other: Signer Is Representing Signer's Name: ❑ Corporate Officer Tale(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 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 Orange ) On May 20 2016 before me, Debra Swanson, Notary Public (insert name and title of the officer) personally appeared Douglas A. Rapp who proved to me on the basis of satisfactory evidence to be the person(7) whose name(&) is/are subscribed to the within instrument and acknowledged to me that he/ems executed the same in his/4er!#4& authorized capacity(♦-_&•), and that by hisP am4hai signature(* on the instrument the person(, or the entity upon behalf of which the person(&) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature NoDEBF2A SWAMSON ' CQMNi, # 1997119 s9� NOIARYPUBiIC•CAUFORNIA � � • `�"' ORANGE COUNTY � °flur MY COMM, EXP, NOV 10, 8016 (Seal) �'- KIChubb POWER Federal Insurance Company Attn: Surety Department OF Vigilant Insurance Company 15 Mountain View Road Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 ,C'aYl ld0 Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY a Wisconsin corporation, do each hereby constitute and appoint Douglas A. Rapp and Timothy D. Rapp of Aliso Viejo, Calillornia---------------- ---------------------- -------------------- each as their true and lawful Attorney- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to In said bonds or obligations. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 16th day of December, 2011. Kenneth C. Wande, Assistant Secretary Z -,pavi . Norris, Jr., Vice President STATE OF NEW JERSEY °•^-^" as. County of Somerset On this 16th day of December, 2011 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Kenneth Cr Wendel, being by me duly sworn, did depose and say that he Is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Norris, Jr., subscribed to said Power of Attorney is in the genuine handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By. Laws and in deponent's presence. Notarial Seal J Apr KATHERINE J. ADELAAR NOTARY PURUC OF NEW JFRSFI 0(Aft® s' Nr, 2316665 �PaV�G Gommil"ion Expires July IA, 2014 e'o�rr Notary Public M JEQ - � CERTIFICATION Extract from the By, Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: "All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- In. Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory In the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies') do hereby certify that (1) the foregoing extract of the By- Laws of the Companies Is true and correct, (it) the Companies are duly licensed and authorized to transact surely business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Departmem; further, Federal and Vigilant are licensed In Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (Iii) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 20th day of May, 2016 p ,�UrraWCF V� F� ♦ 5 Y % _ �i� Kenneth C. We el, Assistant Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903. 3656 e-mail: surety@chubb.com Form 15-10.02256-U (Ed. 5-03) CONSENT CITY OF SANTA ANA BONDS PROJECT NO.: 15-6606 Bond No. 8239-74-09 PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS that PALP Inc. dba Excel Paving Company as CONTRACTOR, and Federal Insurance Company a corporation, organized and existing under the laws of the S tate, and duly authorized to transact business under the laws of the State of Califor nia, as SURETY, are held and firm ly bound unto the City of Santa Ana, as AGENCY, In the penal SUM of Two hundred thirty nine thousand four hundred eighty and 00/100 Dollars ($ 239,480.00 ), which is 100 percent of the total contract amount for t he above stated project, for the payment of which sum, CONTRACTOR and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION AR E SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated May 17, 2016 for Street Traffic Calming From Birch St. to Spurgeon St. (FAID U58DP005861) if CONTRACTOR or any subcontractor fails to pay for any labor or m aterial of any kind used in the performance of the Work of Improvement to be done under said Contract Agreement, or fails to submit amounts due under the State Unem ployment Insurance Act with respect to said labor, SURETY will pay for the Sam e in an am ount not exceeding the sum set forth above, which amount shall insure to the benefi t of all persons entitled to file claims under the State Code of Civil Procedures; provided that any alterations in the work to be done, in aterials to be furnished, or time for completion made pursuant to the terms of the contract docum ents shall not in any way release either CONTRACTOR or SURETY, and notice of said alterations is hereby waived by SURETY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 20th day of May —'20 16 CONTRACTOR* PALP Inc.pdba Excel Paving Company 2230 Lemon Avenue, Long Beach CA 90806 President—C.P Brown sworn to before me, 20 Signature: Notary Public in and for the County of Varies 1,317.00 Rate of premium on this bond is $ _ Total amount of premium charge is $ 15 Mountain View Rd., Warren, NJ 07059 908-903-2000 this day of State of per thousand. To be filled in by Surety *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. 2of3 OALIPORNIA ALL-PURPOSC ACKNOWLEDGMENT CML CODE 61189 A notary public or other officer compieting this certificate verifies only the identity of the Individual who signed the documentto which this certificate Is attached, and not the truMiness, ao:wrac% or validity of that document. State of California County of Los Angeles ) On before ma, C. Phillips, Notary Public Date Hem Insert Name and Title of the Officer personally appeared C. P. Brown Narne(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(* whose names) IsAw subscribed to the within instrument and aolmowledged to me that he/atxy, executed the same in hisAwfVv* authorised capacity(les), and that by h1aftWilhat signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. CfMMfdi k199&177 n d� as'yr Nlotary PufJllc California g �,,,��,� 4f7S hhJGF:LFS COUfdTY °• 'ti ^„rye.%" MY 0e�mm. raglans Dr,G'Ls, 29ABj� Place Notary Seat Above I certify under PENALTY OF PERJURY under the laws of the State of Caiifomia that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature. Signatu Notary Public OPTIONAL Though this section Is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signers) Document Date: Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer - Trtle(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator n Other: Signer Is Representing:— Signer's, Name: ❑ Corporate Officer - Tdle($): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: ,n06 i :rr 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 Orange ) On May 20, 2016 before me, Debra Swanson, Notary Public (insert name and title of the officer) personally appeared Douglas A. Rapp who proved to me on the basis of satisfactory evidence to be the person(s) whose name(-) is/ere subscribed to the within instrument and acknowledged to me that he/eHa+iey executed the same in his/+ &W+,eir authorized capacity( ), and that by his,'H&, hei signature(* on the instrument the person(e), or the entity upon behalf of which the person(,e) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature b�'L%[%ynn =TAU ASWANSON M. # 1997119 :®YPUBLIGCALIFORNIA�NGE COUNTY N(Seal) M. EXP. NOV 10, 2016 Chubb POWER Federal Insurance Company Attn: Surety Department OF Vigilant Insurance Company 15 Mountain View Road Surety ATTORNEY Pacific IndemnityCompanyWarren, NJ 07059 Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Douglas A. Rapp and Timothy D. Rapp of Aliso Viejo, California ---------------- --------------------- -_.................. each as their true and lawful Attorney- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other writings obligatory In the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 16th day of December, 2011, Kenneth C. Wende, Assistant Secretary � DawrYO. Norns. .Ir VIf.B PfAAI(IPOr STATE OF NEW JERSEY County of Somerset ss. On this 16th day of December, 2011 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he Is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Nevis, Jr., subscribed to said Power of Attorney is in the genuine handwriting of David B, Norris, Jr„ and was thereto subscribed by authority of said By. Laws and in deponent's presence. Notarial Seal A0� . KATHERINE I ADELAAR NOTARY OAP ir. 2 NEW JFRSFI Nr. 231616 665 �j Comtttipion Expires July IA, 2014 c� Notary Public A'EYd JE1` .CERTIFICATION Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: "All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations, The signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President, any Secretary. any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory In the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and mrlified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.' I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies") do hereby certify that (i) the foregoing extract of the By- Laws of the Companies Is true and correct, (ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Departmorri further, Federal and Vigilant are licensed In Puerto Rica and the U.S. Virgin Islands, and Federal is licensed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (iii) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 20th day of May, 2016 Kenneth C. vverrmi Assistant Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903- 3656 e-mail: surety chubs cern Form 15-10- 022513- U (Ed. 5- 03) CONSENT N", � �} �f R Ell