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CAL-STRIPE INC.
i Recording Requested By, Recorded in Official Records, Orange County ' And When Recorded Mail To: Hugh Nguyen, Clerk-Recorder Clerk of the Council, City of Santa Ana 11�111f 11l111I111�1IIII1111II1��11I�111 Il��111I�1�111�11j�1111 llllllll 20 Civic Center Plaza,P.O.Box 1988 I Il f I II I r IfJ I+ If f Ifl J NO FEE $ Santa Ana,CA 92702 R 0 0 0 9 5 1 3 8 6 3 $ * 2017000360586 2:05 pm 08/24/17 217 416 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ITHIS SPAU ruts Uuuty i r Rir - t NOTICE OF COMPLETION . c 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 ca construction of CHESTNUT AVENUE AND BUSH/CYPRESS BIKE LANES under contract U M entered into on MAY 2, 2017, with CAL STRIPE, INC, on which contract LIBERTY MUTUAL INSURANCE COMPANY is surety. The property on which such work improvement was placed o is in the City of Santa Ana, County of Orange, State of California, and described as Project No. o 17-6611 located at: CHESTNUT AVENUE AND BUSH/CYPRESS STREETS. The work 7 improvement on said property was accepted as completed on JULY 28 2017. vCITY OF SANTA ANA, A MUNICIPAL COLORATION by / zDated: �� j 6, Principal Civil Engineer-Tyrone Chesanek O a TITLE W 0. VERIFICATION I, the undersigned, say: I am the City Engineer - Edwin "William" Galvez of the City of Santa Ana, California; I executed the foregoing Notice of Completion acting on behalf of the owner of the property therein described; I make this verification on behalf of said corporation by authorization of the City Council of the City of Santa Ana; I have read said notice and know the contents thereof; and I declare under penalty of perjury that the facts therein stated are true. r Executed on (i� '72, 7 at Santa Ana, Califo (Signature of individual swearing that the contents of Notice of Completion are true.) THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10) DAYS AFTER COMPLETION THE REGISTER This space for anng stamp only 625 N GRAND AVE, SANTA ANA, CA 92701 Telephone (714) 796-7000 /.Fax (714) 796-6059 PROOF OF PUBLICATION (201.5.5 C.C.P.) State of California ) County of ORANGE ) ss Notice Type: BID - NOTICE INVITING BIDS' Ad Description: Chestnut Ave and Bush/Cypress Bike Lanes I am a citizen of the United States and a resident of the State of California; I am over the age of eighteen years, and not a party to or Interested In the above entitled matter..I am the principal clerk of the printer publisher of the THE REGISTER, a newspaper published In the English language In the city of SANTA ANA, county of ORANGE, and adjudged a newspaper of general circulallon as defined by the laws of the State of California by the Superior Court of the County of ORANGE, State of California, under date 11/19/1905, Case No. A21046. That the notice, of which the annexed Is a printed copy, has been published in each regular and entire Issue of said newspaper and not in any supplement thereof on the following dates, to -wit: 12/16/2016, 12/22/2016 Executed on: 12/22/2016 Al SANTA ANA,CA I certify (or declare) under penally ofperjury that the foregoing Is true and correct, III I II 1111111 II 11 11111111 II 1111111111111111111 * A 0 0 0 0 0 4 3 0 4 1 8 4* Q MAYOR Miguel A. Pulido MAYOR PRO TEM Vicente Sarmiento COUNCIL MEMBERS Angelica Amezcua P, David Benavides Michele Martinez Roman A. Rayne Sal TlnaJero Recorded In Off clal Records, orange County HLlllch I�ILt 11 Illllllrl I � Icl rlllrll� I II III NO FE $ 8 0 0 0 8 9 2 7 2 0$ 201685001350 3,23 pm 12114/16 256 13 Z01 0.00 50,00 0.00 0,00 0.00 0.00 0.00 0.00 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 www,senta•ana.org NOTICE OF EXEMPTION CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Marla D. Huizar FILED DEC 14 2016 ORANGE COUNTY CLERK -RECORDER DEPARTMENT BY: DEPUTY 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: Chestnut and Bush/Cypress Bike Lanes Date of Approval: 02/07/2017 Project Number(s): PWA -2016 -1664 -CITY Project Location: 1 CityWide (Partial) City: Santa Ana County: Orange ER Number: ER -2016-163 Project Description: Stirping, signs and detection for bike lanes along Chestnut and Bush/Cypress. Applicant Name: Zdenek Kekula, City of Santa Ana Public Works Agency Applicant Address: 20 Civic Center Plaza M-43 SANTA ANA, CA 92702 Name of Public Agency Approving Project: City Council Name of Person or Agency Carrying Out Project: Kekula, Zdenek Exempt Status: ❑ Ministerial (Sec. 15268) ❑ Declared Emergency (Sec. 15269 (a)) ❑ Emergency Project (Sec. 15269 (b through e)) ❑ General Rule (Sec. 16061(b)(3)/(5)) ❑ Statutory Exemption: Q Categorical Exemption: 15301(b) Reasons) Why Project is Exempt From CEQA: City Contact: Zdenek Keekull�a p Signature: we w DEC 1 y 2016 HUGHNGUYEN,CLEAK•RECORDER Bri DEPUTY Telephone: (714) 647-5606 Title:1. men Date: SANTA ANA CITY COUNCIL Miguel A. Pulldo Vincente Sarmlento Michele Martinez Angelica Amezcua P. David Benavides Roman Reyna i Sal TlnaJero Mayor Mayor Pro Tem, ward 1 Ward 2 Ward 3Ward 4 Ward 6 i Ward e MPulldo Santa-ana ora', VSarmlenlo/oZWta ana oral MMertlnezfNsanta AAmezcua(cesanta-ana oraIPDenavitlasfo7saJr to ana o�gEReyna santa.am=Snnalerosanta-aneom 1-l0el"-4 ?WAC4 CITY OF SANTA ANA 6pl-kaw CONSTRUCTION CONTRACT PROJECT NO. 17-6611 CHESTNUT AVENUE AND BUSH/CYPRESS BIKE LANES This CONSTRUCTION CONTRACT is made and entered into this 2°d day of May, 2017 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 "CITY"), and Cal -Stripe Inc. (hereinafter "CONTRACTOR"). WITNESSETH; The CITY and the CONTRACTOR, for the consideration hereinafter named, mutually agree as follows: CONTRACTOR agrees to perform all the work and famish 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 Chestnut Avenue and Bush/Cypress Bike Lanes Project -(hereinafter- referred -to-as-the -- W-ORY OF IMP-ROVEMENr)--identified in -and -in accordance with the Contract Documents prepared by the City's Public Works Agency and approved by the City Council. The complete Construction Contract consists of the "Contract Documents" as defined by the Standard Specifications for Public Works Construction and which include the following: • Notice Inviting Bids • Information to Bidders • Bid Proposal • Bid Bond • Contract Form • Contract Bonds • General Provisions • Special Provisions • Technical Provisions and Project Plans • Appendices In case of conflict between the Contract Documents, the precedence of documents shall be as established in the Standard Specifications for Public Works Construction. 3. CITY agrees to pay and CONTRACTOR agrees to accept in full payment to complete the WORK OF IMPROVEMENT the sum total amount not to exceed Eighty-four Thousand Eight Hundred Seventy-five Dollars and Forty Cents ($84,875.40), 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 sam(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. rev. 12/20/2016 Page I of 3 4. CONTRACTOR agrees to complete the WORK OF IMPROVEMENT within the time specified in the Time for Completion of Improvements section of the BID PROPOSAL (Exhibit "A") including commencing construction within the timeframe therein specified after issuance of a Notice to Proceed. 5, The CONTRACTOR will pay, and will require all subcontractors to pay, all employees on the WORK OF IMPROVEMENT a salary or wage at least equal to the prevailing salary or wage established for such work as set forth in the wage determinations for this work in accordance with applicable State and Federal law. 6. CONTRACTOR shall, after award of this Contract, furnish two bonds to be approved by the CITY, one in the amount of One Hundred Percent (100%) of the Contract price, to guarantee the faithful performance of the work (Performance Bond), and one in the amount of One Hundred Percent (100%) of the Contract price to guarantee payment of all claims for labor and materials furnished (Payment Bond). This Contract shall not become effective until such bonds are supplied to and approved by the CITY. CONTRACTOR shall, prior to the release of the performance and payment bonds or the retention payment, furnish a warranty performance and payment bond (Warranty Bond). Said Warranty Bond shall also be required as a condition of project acceptance. For projects up to Five Hundred Thousand Dollars ($500,000), the Warranty Bond amount shall be the greater of Ten Thousand Dollars ($10,000) or Twenty Percent (20%) of the final contract price. For projects above Five Hundred Thousand Dollars ($500,000), the Warranty Bond amount shall be the greater of One Hundred. Thousand Dollars ($100,000) or Ten Percent (10%) of the final contract price. S. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability Insurance and Worker's Compensation Insurance as outlined in the General Provisions, to be approved by the CITY. Page 2 of 3 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. CARVALHO City Attorney By: 17 w J N M. FUNK Assistant City Attorney RECO MENDRD FOR APPROVAL: 641 V FRED MOU AVIPOUR Executive Director Public Works Agency CITY OF SANTA ANA Cynthia J. Kurt Interim City Manager CONTRACTOR: Cal -Stripe Inc. Arg.. tvw%4 NAME: Steve Fleener TITLE: General Manager Page 3 of 3 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: 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 1 Install White Turn Lane Line per City of 11211. 140 LP L J S.A Std. Plan No. 112513-1, Detail 2 Install 6" White Lines at 45 degrees at 20' O.0 78 LF $pp^ $ q t �1 10,`�J Jet]® 3 Install Double Yellow per City of S.A Std. "4". 419 LF $ S $ i Y7• 3- Plan No. 112513-1, Detail J ' U p 4 Install Two -Way Left Turn Lane per City 1125-B-1, "5". 240 LF $ _ $ / iiG of S.A Std, Plan No. Detail a FY 0®d 5 Install Yellow Center Line per City of S.A Std. Plan No. 1125B-1, Detail "6", 2838 LF $ _ I SQ $ 0a , 6 Install Bicycle Loop Legend per Detail "L„ 17 f EA $ �0'C 0o $ I;1 00, cc, 7 Install Lane Line Extension per City of S.A "8". 223 LF $ L ^ T > $ 7, R, Std. Plan No. 112513-2, Detail 8 Install or Refresh Street Legends, Arrows, Bike Lane Symbols. 61 EA $C I 'cryo $ and 9 Install Bike Lane Legend per Detail "A" 1440 SF $ $ (Green Epoxy -Modified Acrylic). "L e S v L70, o o 10 Install 6" Bike Lane Line per Caltrans Std. Plan A20D, Detail "39". 4071 LF $ $ pp 96 11 Install 6" Bike Lane Line per Caltrans Std. "39A". 3601 LF $ �/' $ '/, ma Plan A20D, Detail 12 Install Bike Lane Merging Area per Detail "R" Epoxy Acrylic). 3240 SF $ $ '3'0, a o (Green -Modified 13 Install 4" White Edge Line. 4104 LF $$ P-1 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611. CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 Item Description Qty. Unit Unit Price Amount 14 Install Bike Sharrow Panel per Detail "S" 1080 SF $ $ and Detail "A" (Green Epoxy -Modified "l1� fie, G, Acrylic). 15 Install New Sign. 40 EA $ o �0✓(yi (`J $ { f/ y i Vno+0a 16 Remove Conflicting Striping. 5472 LF $ (` $ 17 Remove Legend. 43 EA $ hy ! $ ' 18 Install New 2" Square Steel Post and Sign City S.A Std. Plan 1504. 25 EA $ q� C 4Y�i J ® $ 2 Sao Vo per of e 19 Install 12" White Thermoplastic Stop Bar, 180 SF $ $ 20 Install Type "Q" Bike Lane Loops per Detail `B" Modified Caltrans Std. Plan ES- 1 EA $ dP U© $ / p tI , 0,0 5B. G 21. Install Circular Type "D" Bike Loops per 21 EA $ // °t'� $ � 1i>a' Caltrans Std. Plan ES -513. C� � 1, QV 22 Install Fog Seal 13696 SF $ ( $ s TOTAL BASE BID $ W %4'' W 7 S' (�o P-2 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 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. f This bid item is considered a Specialty Item per Section 2-3.2 of the Standard Specifications. 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 thirty (30) working days after the commencement date stated in the Notice to Proceed. The liquidated damages amount, in lieu of the amount specified in Subsection 6-9 of the Standard Specifications, shall be $1,000 per calendar day. Name of Firm Signature of BIDDER Title (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-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES PAID#: 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. Name of Finn Signature of BP Title lgffoow (If an individual, so state. If a firm or c -partnership, state the firm name and give the names of all individual co-partners composing the firm. I£ a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) P-4 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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: Business E -Mail Address: Telephone: q(qr State Contractor's License No. and Class: 6W�256_4 License Expiration Date: 11-51 I`aork�) State Dept. of Industrial Relations (DIR) Registration No.: 1 00cco \N ©® State Dept. of Industrial Relations (DIR) Registration Expiration Date: �w Signed: 19, Title: P-5 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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 Finn Signature of BI] Title (if an individual, so P-6 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS Bili LANES FAID#: U58DP005861 OWNERSHIP AFFIDAVIT STATE OF CALIFORNIA ) COUNTY OF ORANGE )SS: CITY OF SANTA ANA?Nt ) lyc Q La er , being duly sworn, deposes and says: ❑ INDIVIDUAL That he/she is the party making the foregoing proposal: ❑ PARTNERSHIP That he/she is a member of the eo-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 other members of the co -partnership. N CORPORATION That he is of. a corporation which is making the foregoing proposal: ❑ JOINT VENTURE That he is of: one of the parties making the foregoing proposal as a joint venture, and the he/she has been and is duly vested with the authority to execute instruments for an on behalf of the parties making said bid who are: that such a bid is 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. �ACW _ Signature of Bidder Subscribed and sworn to before me this day of Oath (Notary Public) A nolary puel c or other oflrrnr comple0n, the; ceNM1cate vermes only the laterally of the individual who signed the document to whoh this ceddreale ra atl raided add not the truthfulness accuracyor validity of that document State of California. County of:i Girz AKAy+Jo Subscribed and sworn to (Q"It r sed) before me on this_ r day of M A Rd/4. A41-1 by 6-F 1I -U - Jd- proved to me on the basis of satisfactory evidence to be the persoarl who appeared before me. Signet ue - ' (seal) P-7 of P-39 Q= LORRAIN MANZANAgEi Comm: •21S16pp NOtaty PMblic � Cali(arni,T� 5Yi1 selhilydinq County ' COfINi1; Eiglires May 2!, 2020 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BBCE LANES FAID#:U58DP005861 KNOW ALL PRESENT that, Cal Stripe, Inc. , as BIDDER, and Liberty Mutual 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 Bid Amount 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 sum, BIDDER and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas BIDDER is about to submit a bid to AGENCY for the above -stated project, if said bid is rejected, or if said bid is accepted and a contract is awarded and entered into by BIDDER in the manner and time specified, then this obligation shall be null and void, otherwise it shall remain in full force mud effect in favor of AGENCY. 1N WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 6th day of March 2017. BIDDER* Cal Stripe, Inc., 2040 E. Steel Road, Colton, CA 92324, (909) 884-7170 .f- t&." SURETY* Liberty Mutual Insurance Company, 790 The City Drive South, Suite 200, Orange, CA, (714) 634-5712 Maria Guise, Attorney -in -Fact, 1301 Dove Street, Suite 200, Newport Beach, CA 92660, (619) 849-385 Subscribed and sworn to before me this day of 20_ Signature: See attached California All -Purpose Acknowledgment 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-8 ofP-39 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other afficer 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, at validity of that document. State of California County of Orange On MAR 9 6 2017 before me, Heather R. Saltarelli, Notary Public Here Insert Name and Title of the Officer personally appearedMaria Guise Names} of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(z) whose name(a) islam subscribed to the within Instrument and acknowledged to me that WshugtkU executed the same in hWher/tX0 authorized caparity(W* and that by Foie/her/tom signature(to on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. HEATHEa fjsI�RFIAJ 70 Slgnidurs�--O'LUJWLE Sguld�v o 0milp, County �1'1 'ta My Comm Explins,jifl 2i1 �p Signature of Notary Public Place Notary Seal Above — OPTIONAL Though this section is optional, completing this information can deter alteration of the document or- fraudulent rfraudolent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signeds) Other Than Named Above: -- CaPactly(les) Claimed by Signer(s) Signer's Name: Corporate Officer — Title(s): Partner — Limited I' .1 General Individual N, Attorney in Fact Trustee l,i Guardian or Conservator Other: Signer Is Representing: Signer's Name:,_._ Corporate Officer — Title(s): Partner — �" Limited General Individual j Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing: mmm ^cxt, came 02014 National Notary Association - www,NationaiNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5907 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner end to the extent herein stated. Certificate No. 7489142 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casually Insurance Company are corporations duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the lawsof the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Heather Saltarelll; James A. Schaller Jeri. Apodaca; Kim Luta.'. Maria Guise; Michael D. Parizino; Rachelle Rheault Rhonda C, Abel all of the city of Newport Beach state of CA each Individually if there be more than one named, its true and lawful attorney rr-factto make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as Its act and deed,:any and all undertakings bonds recognizances and other surety obligations in pursuance of these presents and shall be as binding upon the Companies as If they have been duly signed by the president and attested by the secretary of the Companies In their own proper persons, IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 20th dayof September .1 201 PNo cgfli �w Irosr, x,,usuP- a�o�wN `American Fire and Casualty Company The Ohio Casualty Insurance Company q tube Q o eia m 1912 999 Liberty Mutual Insurance Company x .n W m n t np r a s n Y Zeser'ican Insurance Company U7 by xnmN.M.?� 9,;, 6rvA ex's �d 7 v a, `� + r reulnxn t /J E STATE OF PENNSYLVANIA as David M. Care Assistant Secretary ++ COUNTY OF MONTGOMERY aOn this lath day of September 2016 , before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and 0 y Casualty Company, Liberty Mutual Insurance Company, The Ohio Casually Insurance Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing Instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer, . D IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written. +' m Oand COMMONWEALTH OF PENNSYLVANIA .a Notarial Seal C 'ej Teresa Pastella, Notary yCou gy; 0 N Plymouth Twp., Montgomery 28, myp L Teresa Pastella Notary Puhlic My Commission Expires March 28, 201"1.O Member, Pennsylvania Association of Notaries Nc `This Power ofAttorney is made and executed purrity of the following By-laws and Authorizations ofAmerican Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: 01N 36 d ARTICLE IV—OFFICERS—Section 12, Power of Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject tto such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -In -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, 0= acknowledge and deliver as surely any and all undertakings,bonds, recognizances and other surety obligations. Such attorneys -In -fact, subject to the limitations setforth in their respective E .6 powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so . ` executed, such Instruments shall be as binding as If signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under .O the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. �. ARTICLE XIII — Execution of Contracts — SECTION b. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose In writing by the chairman or the president, « L and subject to such Iimitatons as the chairman or the president may prescribe, shall appointsuch attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, o seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary Certificate of Designation —The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to act on behalf of the Company to make execute, seal, acknowledge and deliver as surety any: and all undertakings; bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary ofthe Company, wherever appearing upon a certified copy of any power of attorney Issued by the Company In connection with surety bonds shall be valid and binding upon the Company with the same force and effect as though manually affixed I, Gregory W. Davenport, the undersigned Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and; correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. 6A AMO c U ?��S IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this day of Ev9/ 20 PNDC�� yTV INSUH Py 1N5{,qR pN,Ns 'eA 4e �9� J1' owr2.,�Ny �0vwUW NC 4t �VPxt In e'n, �/ p n'' 1906 D o 7919 n � 1912 � � 9997 ° By: a e as o s, x yr, a y Gregory W. Davenport, Assistant Secretary t 153 of 500 LMS_12873_122013 N Y d "t' coo N sM Eop 00 O F r CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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: '/z% 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 'ft-aMC -u.rf i�CC l�iyrrq 7ko Name License #/Exp. M'74 , & 36V'141 7 License #/Exp. DIR Reg. #/Exp. ' a0W' 7 G' 39 wq DIR Reg. #/Exp. Location 14I Sg *Ai,,4. 01A+Location Phone c7ry) S?' — gV16 Phone Type Of Work ir�fH� �gyGg (..�00J Type Of Work Amount $ CYI S�, t G� Amount $ Name Name License #/Exp. License #/Exp. DIR Reg. #/Exp. DIR Reg. #/Exp. License # License # Location Location Phone Phone Type Of Work Type Of Work Amount $ Amount $ Name License #/Exp. DIR Reg. #/Exp. License # _ Location _ Phone Type Of Work Amount $ Sioarure of Bidder Name License #/Exp. DIR Reg. #/Exp. License # _ Location _ Phone Type Of Work Amount $ P-9 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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. 2. 3 Name hahl Address of Owner. Name and Telephone Number of pers n familiar with pro'ect. Contract Amount Type of`iT�� rk Date C lete of person familiar with project. Contract AmountT� Work Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. P-10 of P-39 "D CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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 similar work in the past five years. 1. 2. 3. Nurse and Telephone Number of person familiar wit project. Contract Amount Tof Work Date Completed and Telephone Number of Contract Amount Name and Telephone Number of person familiar with project. Contract Amount yl"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. .r A 1 s.'.... P-11 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any other BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Non -collusion Affidavit is part of the Proposal. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed State of California Nfluty of Subscribed and ss o (or affirmed) before me on this oved to me on the ais- person(s) who appeared before me Notary Public Signature Notary P A notary public or other officer completing this certihcale verifies only the Itlen11 of iM1e InEwitluai who sgne0 the Document to which this ceNhcate 19 aXacheJ. entl not the truthfulness accuracy or vaLtllty of that tlocumenl State of California. County of.SAnr 6,CAJA Ala? Subscribed and sworn to (ar af6lrretetl) before me on this day of M A k64 0l I7 by �' - CL. jy_ + - c proved to me on the basis of satisfactory evidence to be the person(ai who appeared before me Signature (seal) P-12 of P-39 20, by evidence to be the am N2ANARES2151f609 N • Csli/ornia �6np Ctwnty" war aq, aaao CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: 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 tennination; 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-13 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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. 8. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as amended, no discrimination shall be made in the employment of persons upon public works because of race, religious creed, color, national origin, ancestry, physical handicaps, mental condition, marital status, or sex of such persons, except as provided in Section 1420, and any contractor of public works violating this Section is subject to all the penalties imposed for a violation of the Chapter. Signed:lJ�1A Title: /0Jlvgmmx Firm: Date: -7 A o 117 P-14 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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: s Title: wryba y'^ Firm: 02 ITC - Date: 3/ o4l % P-15 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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 be/she is otherwise entitled. Signed: S , q4t� Title: Firm:/(l;�l'� Date: / / G, P-16 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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 regulation? Yes No ` If the answer is yes, explain the circumstances in the following space. P-17 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 BIDDER'S STATEMENT REGARDING REQUIRED FEDERAL CONTRACT PROVISIONS (FORM FHWA-1273) The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the required Federal Contract Provision (Form FHWA-1273) as shown in the appendix of the Special Provisions of this project. Signed Title Firm Date )/10 P-18 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder lF.i�-`div\ proposed subcontractor A-) /8 , 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. Signed lJ , Title Firm Date M h it P-19 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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 penalty of perjury under the laws of the State of California that the bidder has _ , has not i been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed Title Firm Date P-20 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES 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. Signed Title Firm Date ) //t7, P-21 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 TITLE 49, CODE OF FEDERAL REGULATION, PART 29 DEBARMENT AND SUSPENSION CERTIFICATION The bidder under penalty of perjury, certifies that except as noted below, he/she or any person associated therewith in the capacity of owner, partner, director, officer, manager: is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; has not suspended, debarred, voluntarily excluded, or determined ineligible by any federal agency within past three years; has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidders responsibility. For any exception noted above, indicate below to whom it applies, initialing agency, and dates of action. Note: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Signec Title / VV Firm 0 Date (,1/ 7 P-22 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 NON -LOBBYING CERTIFICATIONF FOR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influence or attempting to influence an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriate funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub -recipients shall certify and disclose accordingly. Signed Title Firm aiv Date 3 A 0 • Standard Form LLL may be obtained from Caltrans and FHWA offices. P-23 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 DISCLOSURE OF LOBBYING ACTIVITIES DISCLO LOBBYING ACMI'4'iES tWVMddyDire C"Ple a Otis fraena to 00641im pursuant to 31 UAS.C. 8362 l3ae fav noble n 1 4.. Type of Fa tewad Action_ 2. Stales of Federal 3. Repast Type: E � grant t �� - in 3 i iraw awarx8�i$a&wa ga 0h. mass"a rkise a, coopendive agmenwina a, pas%a vd For Material Chan" bnb : d. We year a. Wars guarantee data oP iast meP$ft f foam wourume A. dame and Address of Reporting Essfily: d. IfReporting Entfly in No, d is a Subawardee, Ender Naaue ❑lsim ❑ surd Addrresm of Prime. 'iWtr� irWmenear: Congressional Distant, iftmooa: C - sskmal District, d*m mvsI S, Federal DepartmenVAgerm'ay, 7,. Federal Program liaoralDascrtptian: CFDA Number. WAAWioatle: S. Fedarai Action (lumber, likxtarrrm: S_ Aviani Amount, etknawrt: W a. name and Address of Lolstrying Eaft b. Individuals Forfassathag Services (wrohmhng a d (it in di vKhm 0. las% narrrv; Tcst name. Aft aeflesesd isoma Ma. €0a) (fast name Tirstsusme, Mt): '•scut nneme it. Amount alikaynand(chwk a#6W 13. Type of payment (oheck &B lhad ): S ❑ achad ❑ Ptaana ❑ a. remraer ❑ d orrymaa air ❑c. 12. Form of payment(rbedk a#oustapp"; ❑ :assn ❑ it assa*st ew be ❑Q. srimMGG epadlY: aatura ❑e.eRwuns vokke _ ❑ t. ~. W -W.- 4d. Brief Dasrttiptien of Servic*aPedonnedw to ice PeKormaed and DaW%) of Service,. iemduding officer(s), employees or fAember(si rmdrmotesf, for Paysocad itdi�catod in ttz:rt III STL£izi F' 46. ConRir mannan She"51 S51SFiAlA aftaeaa f a #tF."'r""'"r'"'+.aoo.awums�au m..a auwes+m#rsm >x vac. aww+ c tmx rrxaww.emaayaxm mmamr u..axsssu.+ruwmaw.s lsmkwame:. xa a wrra ran rn. urs..: a.•:mmm..ann�max u:uc. .a x 1u. . ��: a�cimua�w tr.awxmta:ms<nv..ar+++.muw.r+ra x.eupr ren r�max ael4um� mrd�017AC YY mMM.M?al �FP1fY9.'.l farm R4 am4xu b m dlm arn+v me u.m awe r�aam as uu aaa aw. aua,� « -araawam. Tel<epitsvee N$.: Date: Fedscafffsaw0rdW „sandsm rvan ul. ow. i $! P-24 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 INSTRUCTIONS FOR COMPLETION OF SF -LL, DISCLOSURE OF LOBBYING ACTIVITIES Y, rlernrfy ilM9,yem «4mlBRW fetter,5?a�Gn A#1a41�&a aYlvt{y lcan46VtflecalecNt ca!n+sedixrkmumeMnixaxlema:vlM�eu few'�fzFaa x. aemGyGta eGntre «ane arM t=rntlaxal amtpa 3. fie fie Qsa tlatieltlCtYtT ntidsvPgN3. 6u'Wcae aPuilSvfa.p+ey«8c etlaaparAeean s»jPisu�ee fnnnmNwa pieulmcty�spne+rulsmo+e'�esk+'t xaemgttattertmvaasAsanecataetgeomtataeLfiub'G9ee5a�+$flfe&:ev�re eek+rtMdncrgpneWMJaKSJRFf+%a" acGora. a. PnMarGaexulltwee, aGtYeaw, CflY„miMNaFr4a2V n0Cecr�e .IPMyuwee«aatgEcssiIXtatf74tlMt. MFiruIMt. 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BG.ga}enis staxutetane;atxb�a,aeg; tae araaapwns«etebntGya'a49 r7•tne mGuarsilmenan Gama ViaGGuerceEa saxeerea fflnExd@ amldt {CSL°'H1e[ahexW fYaYMe «Gia > aerake5, uaGiYe%teAGGaNdtlRaaG`&mMm"IttrWAp affi{a3.gnLLrPaaf Matte. feeE lVaoaE, am aGu9etattty x 4. E#frasGteatsa�tiR gwm« a+u9v YP a)s+4ne pN+'9 nY#nsn a4ly. uRm tx ttas� 4lyaeto wzn 8neaae AChematacdappg amw«pamemmade a Wtvbe . at Gl%i aflmnilai e+381lgca 4t, eu�v Gee eea7e. ex 9tte a�neq,rewtecy.axkn:cmwesuaapY-e nnwetiatpagnnemct �aeenyurenataieanuvattaarit�mraur p;rtn�arn.. 13. 0.'aG Gee attpr[plta�fiDlKRb}. Gne4ti ae Ume6ib%9ppWf. M'.apPGGjt mallxm ta, mpAN4e Atwepwal gedadh",adaamte Gaep«6o»ramtae WO gatRNOaAY tr* V£lej«*ffket+lk>ei'i r4srtrsc4. anCnme aG pr>p *avftgs t affod adh", eAGt pore Gbae N1aM1G po aYkWt 4YnBanl atpz Peailra6 ctGciaib pw6a} aria faf:Mtra' naao-sm'sy an{same}aJ+'owtttciem«Ge+.r+s}eaogfuyecta;,m as Gunrr�marnen. 45. Chem aYt~ a no a W413A 9taR'M;-s}1F as. era uatirAai ansa al�famz7,YeGaeflxen. praxtarcaysstatan. nGe. a�xeYeTaa'/aentermex. sit —441MOW -clew P-25 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT 1. Local Agency: City of Santa Ana 2. Contract DBE Goal: 3. Project Description: Chestnut Ave & Bush/Cypress Bike Lanes 4. Project Location: 1", and Bush St from 1"to Civic Center 5. Bidder's Name: V Ix slnef L bC 6. Prime Certified DBE: ❑ 7. Bid Amount: 8. Total Dollar Amount for for AL� tors: I �y, t/-fc%. °J 9. Total Number of ALL Subcontractors: 10. Bid Item Number 11. Description of Work, Service, or Materials Supplied 12. DBE Certification Number 13. DBE Contact Information (Must be certified on the date bids are opened) 14. DBE Dollar Amount Local Agency to Complete this Section 21. Local Agency Contract Number: 15. TOTAL CLAIMED DBE PARTICIPATION 22. Federal -Aid Project Number: U58DP005861 23. Bid Opening Date: March 13, 2017 24. Contract Award Date: IMPORTANT: Identify all DBE firms being claimed for credit, regardless of tier. Names of the First Tier DBE Subcontractors and their respective item(s) of work listed above must be consistent, where applicable with the names and items of the work in the Local Agency certifies that all DBE certifications are valid and information on "Subcontractor List" submitted with your bid. Written confirmation of this form is complete and accurate. each listed DBE is required. `� J G/17 25, Local Agency Representative's Signature 26. Date 16 rep er's St -nature 11/7. Date 18. P eparer's Name 19. Phone 27. Local Agency Representative's Name 28. Phone 29. Local Agency Representative's Title 20. Preparer's Title DIN I x113 U 11UN: 1. Ungmal - Local Agency 2. Copy - Caltrans District Local Assistance Engineer (DLAE), Failure to submit to DLAE within 30 days of contract execution may Iesultin de - obligation of federal funds on contract, include additional copy with award package. ADA Notice: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Farms Management, 1120 N Street, MS -89, Sacramento, CA 95814. 1. Local Agency: 2. Contract DBE Goal: P-26 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 INSTRUCTIONS — CONSTRUCTION CONTRACT DBE COMMITMENT CONTRACTOR SECTION 1. Local Agency - Enter the name of the local or regional agency that is funding the contract. 2. Contract DBE Goal - Enter the contract DBE goal percentage as it appears on the project advertisement. 3. Project Location - Enter the project location as it appears on the project advertisement. 4. Project Description - Enter the project description as it appears on the project advertisement (Bridge Rehab, Seismic Rehab, Overlay, Widening, etc). 5. Bidder's Name - Enter the contractor's firm name. 6. Prime Certified DBE - Check box if prime contractor is a certified DBE. 7. Bid Amount - Enter the total contract bid dollar amount for the prime contractor. 8. Total Dollar Amount for ALL Subcontractors —Enter the total dollar amount for all subcontracted contractors. SUM = (DBEs + all Non -DBEs). Do not include the prime contractor information in this count. 9. Total number of ALL subcontractors — Enter the total number of all subcontracted contractors. SUM = (DBEs + all Non - DBEs). Do not include the prime contractor information in this count. 10. Bid Item Number - Enter bid item number for work, services, or materials supplied to be provided. 11. Description of Work, Services, or Materials Supplied - Enter description of work, services, or materials to be provided. Indicate all work to be performed by DBEs including work performed by the prime contractor's own foxes, if the prime is a DBE. If 100% of the item is not to be performed or furnished by the DBE, describe the exact portion to be performed or furnished by the DBE. See LAPM Chapter 9 to determine how to count the participation of DBE firms. 12. DBE Certification Number - Enter the DBE's Certification Identification Number. All DBEs must be certified on the date bids are opened. 13. DBE Contact Information - Enter the name, address, and phone number of all DBE subcontracted contractors. Also, enter the prime contractor's time and phone number, if the prime is a DBE. 14. DBE Dollar Amount - Enter the subcontracted dollar amount of the work to be performed or service to be provided. Include the prime contractor if the prime is a DBE. See LAPM Chapter 9 for how to count full/partial participation. 15. Total Claimed DBE Participation - $: Enter the total dollar amounts entered in the "DBE Dollar Amount" column. %: Enter the total DBE participation claimed ("Total Claimed DBE Participation Dollars" divided by item `Bid Amount"). If the total % claimed is less than item "Contract DBE Goal," an adequately documented Good Faith Effort (GTE) is required (see Exhibit 15- H DBE Information - Good Faith Efforts of the LAPM). 16. Preparer's Signature - The person completing the DBE commitment form on behalf of the contractor's' firm must sign their name. 17. Date - Enter the date the DBE commitment form is signed by the contractor's preparer. 18. Preparer's Name - Enter the name of the person preparing and signing the contractor's DBE commitment form. 19. Phone - Enter the area code and phone number of The person signing the contractor's DBE commitment form. 20. Preparer's Title - Enter the position/title of the person signing the contractor's DBE commitment form. LOCAL AGENCY SECTION 21. Local Agency Contract Number - Enter the Local Agency contract number or identifier. 22. Federal -Aid Project Number - Enter the Federal -Aid Project Number. 23. Bid Opening Date - Enter the date contract bids were opened. 24. Contract Award Date - Enter the date the contract was executed. 25. Local Agency Representative's Signature - The person completing this section of the form for the Local Agency must sign their name to certify that the information in this and the Contractor Section of this form is complete and accurate. 26. Date - Enter the date the DBE commitment form is signed by the Local Agency Representative. 27. Local Agency Representative's Name - Enter the name of the Local Agency Representative certifying the contractor's DBE commitment form. 28. Phone - Enter the area code and phone number of the person signing the contractor's DBE commitment form. 29. Local Agency Representative Title - Enter the position/title of the Local Agency Representative certifying the contractor's DBE commitment form. P-27 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 EXHIBIT 15-H DBE INFORMATION — GOOD FAITH EFFORTS DBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. U58DP005861 Bid Opening Date March 13, 2017 The (City/County of) Santa Ana established a Disadvantaged Business Enterprise (DBE) goal of ___0_% for this project. The information provided herein shows that a good faith effort was made. Lowest, second lowest and third lowest bidders shall submit the following information to document adequate good faith efforts. Bidders should submit the following information even if the "Local Agency Bidder DBE Commitment" form indicates that the bidder has met the DBE goal. This will protect the bidder's eligibility for award of the contract if the administering agency determines that the bidder failed to meet the goal for various reasons, e.g., a DBE firm was not certified at bid opening, or the bidder made a mathematical error. Submittal of only the "Local Agency Bidder DBE Commitment" form may not provide sufficient documentation to demonstrate that adequate good faith efforts were made. The following items are listed in the Section entitled "Submission of DBE Commitment" of the Special Provisions: A. The names and dates of each publication in which a request for DBE participation for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications Dates of Advertisement A414 B. The names and dates of written notices sent to certified DBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the DBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation Al;!f P-28 of P-39 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 i b C. The items of work which the bidder made available to DBE firms including, where appropriate, any Breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Performs Item Breakdown of Amount Items ($) Percentage Of Contract D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the b'idder's rejection of the DBEs, the firms selected for that work (please attach copies of quotes from the finis involved), and the price difference for each DBE if the selected firm is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: Names, addresses and phone numbers of firms selected for the work above: IVA E. Efforts made to assist interested DBEs in obtaining bonding, lines of credit or insurance, and any technical assistance or information related to the plans, specifications and requirements for the work which was provided to DBEs: P-29 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIICE LANES FAID#: U58DP005861 F. Efforts made to assist interested DBEs in obtaining necessary equipment, supplies, materials or related assistance or services, excluding supplies and equipment the DBE subcontractor purchases or leases from the prime contractor or its affiliate: G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using DBE frons (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.): Name of Agency/Organization Method/Date of Contact Results A11 H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. P-30 of P-39 CITE' OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 EXHIBIT 12-B BIDDER'S LIST OF SUBCONTRACTORS (DBE AND NON -DBE) — PART I PART The bidder shall list all subcontractors (both DBE and non -DBE) in accordance with Section 2-1.054 of the Standard Specifications and per Title 49, Section 26.11 of the Code of Federal Regulations. This listing is required in addition to listing DBE Subcontractors elsewhere in the proposal. Photocopy this form for additional firms. Local Assistance Procedures Manton Etihitin 12$ Bidder's List of 5ubeonhmctnts (DBE and 12-N DBE) Exhibit 12-B Bidder's List of subcontractor (DBE and non -DBE) As of March 1, 2015 Couhacto e (and sub-ccutbactors) wishing m i id on Public wmke contracts shall to registered with the State Division of Industrial Relatioru: avd cctofied to bid on Public Works contracts. Please regster at: bttos://efiling.dir.ca.gov/PW /Action5eivlet?action-disolavpWCRegistrationFot'm In accordance with Title 49, Section 26.11 of the Code offederal Regulations, and Section 4104 of the Public Contract Code of the State of Cahfaruvr, as arneeded, the following information is required foreach sub-cmi m um -who will periarmwork omonntutg to more ratan one half of one pet'ceat (9.5%)ref the Total Baie Bid or $10,000 (wlticlxever is greater). Photocopy this fotin for additional fit rax. Subcontractor Name and Location Line Pont &Description Subcontract Amount Percentage of aid item sub contracted Contractor License Number 09E JY/N) OBECett Number Annual Gross Receipts DER Reg Number Name:71" A � i -o'. �" (�fa- l aya,D, 0J Jy City, State. ,f.^ Xftci eti 1... ( /QGL?(,F�}iI'i Lj *Mm3lRion 1$15mvilmn mill Age ofs rmi5 rz Nance: ` _ ❑ <$imll�iaa $5 nulhan City, State: ® <510,ra lion Lj +415"Alion Ageof Finn: _ yrs. Name: �- <$r rmliian ❑ $S ndlWion City, State: e$iemdlmn Ageof Ran- yrs. Name: K$3 nNlaon Er <$5 -niot City, State: El *510nuftit ❑ *$15 meYlnsu Ageof Finn:_ws Name: - ❑ 'l Mitsui t$5 naillimsr City, State: ❑ ^$10 mvtl'mn +$15 me1Gan Age of R. _ yes. Name 7 7=7ximilhou city, State: a$W rapl[on Lj K$15niMisn Age of Rnn'_prs. Disnibution:ij Onglna4Local Agenq File 21Capy-DLAEw6Awmdbtr."a Page 1 of 1 Selrtember 2016 P-31 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 PROMPT PAYMENT OF FUNDS WITHHELD TO SUBCONTRACTORS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the following: The agency shall hold retainage from the prime contractor and shall make prompt and regular incremental acceptances of portions, as determined by the agency, of the contract work, and pay retainage to the prime contractor based on these acceptances. The prime contractor, or subcontractor, shall return all monies withheld in retention from a subcontractor within 30 days after receiving payment for work satisfactorily completed and accepted including incremental acceptances of portions of the contract work by the agency. Federal law (49CFR26.29) requires that any delay or postponement of payment over 30 days may take place only for good cause and with the agency's prior written approval. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code. These requirements shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcontractor in the event of a dispute involving late payment or nonpayment by the prime contractor, deficient subcontract performance, or noncompliance by a subcontractor. Signed S .I Title Firm Date 5 ✓ 1 ®' P-33 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-661.1 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 EXHIBIT 16-B — SUBCONTRACTING REQUEST Local Assistance Procedures Manual Exhibit 16-B Subcontracting Request CdI�zIRAS'RY4%k'N!E cro J+, W�. Cauhm e ,n, 1&haW<!^h.n ROL9'E BLl_3hrT.}SA'aD$�a`P5 LmW4 r:. J r+/ ref1/ CK]hIFAAC'I Ii'[h, IV -TAM. G ve L Eyr �! 11€T�- FmFAAC_AtDPmwTN%WEER SL`ECT'yh7B.K 1m .�rpa,rna eihexrvlmain�.swrE, riuma7 /1f f` '¢'��( ✓� 4 i Em Imm \`emER (,) ^^�t PERCSN AGE OF BMIMI SL^HCMnUCTOR c ccy, MXCn.ns1101BMS V) d 2 3 DESt-t!♦16€WcIi; YL EEM I.F., Trifid 100%s 1S'L1PS o DOLL46A}C 4713A5 ON MEBWA=MS t"ra -Fyc Categmies 1. spi dAty 2. Liat Under Fair Practice Art 3 t_.ertifiied BEE • The Standard Prmisemu for latw set for$la m the kart apply to the subcrndract�ed war& . If appht Ale, firm FHWA- of the Special Provm.oa lmve Lxe ut:ertevt in the .,Ar t ..is and diauEd be mmpofatedm any lawef-Etef. &embraet. Written contract, hove been exftvted few flee above noted aimbrcatifacted work. cmtradcw 5lgmht ]) ['.f% _ �`� 311,>111 % s t� t This wiimnis to becra gAeesdbv tlffi midentaigineee. I.. Toald bid itnes 2 FSF'a tscpseu ➢;; apyrrn7edl(efaE,plernbls. Xe NQ* In au imUuckon) S. spftmaftydama$htsw i)Slappluasb]e, ncrmtein flip imtu<ame) 4 doMS q�i„eti•�.•ij 5. Cinz �arrmtmFtpeeta$nr..xvtit9uaw:utatre(dtttes l m 1m4) X U. Bud.atempm WW4,, .b�Ia-d a- $id$PN0.`�.YYAe�kLRrY (tal8�ke�eP`$1 s S. To$ai 4iet^e%+«ry S .Y.. 9. Bai4�mexd,aaml.eontrakv Yaperimnt (lu>eslnveues B) B EhTE(SiGE'+ffii SL...^IATC'6E DS diz%iNntami: e]ai,,�mvi.CcearmcRuv Cnyry--&ce:.Sde�Fmyuaa Cq+y-OSP4-zvul3hiuuve�.edcrcnixE?dartsa�; aF �g4lldNs"W-.i9i/� P-34 of P-39 yIS,�(;, Page 1 of 2 July 2016 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BII,'E LANES FAID#: U58DP005861. Local Assistance Procedures Manual Exhibit 16-B 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 a DC -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-A10A) naming the subcontractor as insured. No work shall be allowed which involves encroachment on railroad property until the specified insurance has been approved. Page 2 of 2 July 2016 P-35 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 DIFFERING SITE CONDITIONS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the following: a. Contractor's Notification Promptly notify the Agency's Engineer if you find either of the following conditions: 1. Physical conditions differing materially from either of the following: • Contract documents • Job site examination 2. Physical conditions of anunusual nature, differing materially from those ordinarily encountered and generally recognized as inherent in the work provided for in the Contract Include details explaining the information you relied on and the material differences you discovered. If you fail to promptly notify the Engineer, you waive the differing site condition claim for the period between your discovery of the differing site condition and your notification to the Engineer. If you disturb the site after discovery and before the Engineer's investigation, you waive the differing site condition claim. b. Engineer's Investigation and Decision Upon your notification, the Engineer investigates job site conditions and: 1. Notifies you whether to resume affected work 2. Decides whether the condition differs materially and is cause for an adjustment of time, payment, or both Signed Title Firm Date 3Z P-36 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 BIDDER'S CERTIFICATE OF COMPLIANCE REGARDING `BUY AMERICA" REQUIREMENTS FOR STEEL OR MANUFACTURED PRODUCTS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the " Buy America" requirements of Section 165 of the Surface Transportation Assistance Act of 1982 and as shown in the special provisions of this proj ect. Signed Title Firm Date 3ZI aZI 7 P-37 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAID#: U58DP005861 NEPA COMPLIANCE FOR FEDERAL AID CONTRACTS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the Categorical Exemption/Categorical Exclusion Determination Form including and not limited to the National Environmental Policy Act (NEPA) requirements and environmental commitments found in the appendix of the Contract Documents of this project. Signed Title Firm Date P-38 of P-39 CITY OF SANTA ANA REBID PROPOSAL PROJECT NO.: 17-6611 CHESTNUT AVE & BUSH/CYPRESS BIKE LANES FAIR#: U58DP005861 TMP COMPLIANCE FOR FEDERAL AID CONTRACTS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the Traffic Management Plan (TMP) commitments found in the appendix of the Contract Documents of this project. Signed Title Firm Date I / 10 P-39 of P-39 1, �, iv-� Or(- L/ qj 4eqL-Irl. m L) I I // I fjvv�fcf C, Ler# &.w+ Ave &4 &A/cnloss S;kot Lo%er of As%^ 644cVewki la ct*vic Ce&tt& U%+S%Ass,%ICA 10#1 CITY OF SANTA ANA BONDS PROJECT NO.: 17-6611 f�\_'I1Tll_ ► ' C 1 '1 Bond No. 24070290 KNOW ALL MEN BY THESE PRESENTS that Cal Stripe. Inc. as CONTRACTOR, and Liberty Mutual 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 California, as SURETY, are held and firmly bound unto the City of Santa Ana, as AGENCY, in the penal sum of Eighty Four Thousand Eight Hundred Seventy Five and 40/100 Dollars ($ 84,875.00 ), which is 100 percent of the total contract amount for the 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 ARE SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated May 2, 2017 for Project No. 17-6611, Chestnut Avenue and Bush/Cypress Bike Lanes , if CONTRACTOR or any subcontractor fails to pay for any labor or material 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 Unemployment Insurance Act with respect to said labor, SURETY will pay for the same in an amount not exceeding the sum set forth above, which amount shall insure to the benefit of all persons entitled to file claims under the State Code of Civil Procedures; provided that any alterations in the work to be done, materials to be furnished, or time for completion made pursuant to the terms of the contract documents 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 Loth day of May 2017 . Steve * Cal Stripe, Inc., 2040 E. Steel Road, Colton, CA 92324, 909-884-7170 Liberty Mutual Insurance Company, 790 The City Drive South, Suite 200, Orange, CA 92568, 714-634-5712 uove xreec, �Ulte mu, ivewport eeacn, LA 92bbU, Subscribed and sworn to before me, 20 Signature: Please See Attached California All -Purpose Acknowledgment Notary Public in and for the County of State of this day of Rate of premium on this bond is $ 9.77 per thousand. Total amount of premium charge is $ Included in Performance Bond . To be,Jilled in by Surety *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. 2of3 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 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 San Bernardino ) On May 12 2017 before me, Lorraine Manzanares Notary Public Date Here Insert Name and Title of the Officer personally appeared Steve Fleener Nameg of Signerg who proved to me on the basis of satisfactory evidence to be the person(8) whose namele)(Zare subscribed to the within instrument and acknowledged to me that the/they executed the same in (bi'Yher/their authorized capacity", and that bya0her/their signature(* on the instrument the person", or the entity upon behalf of which the person(* acted, executed the instrument. �"� � ma ZANARE�S51609 ,'�r s ' •CallPornla �o County'y aa, aoa0 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. Signatur _ Signature of No ry Pu rc 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: Payment Bond Document Date: May 10, 2017 Signer(s) Other Than Named Above: no other signer Capacity(ies) Claimed by Signer(s) Signer's Name: Steve Fleener ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: cel Inc. Number of Pages: one Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — Ll Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: ©2016 National Notary Association • www.Nationa[Notary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 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 _Q_rap_gv ) Oil before me, Rhonda C. Abel, Notary Public,. Date Here Insert Name and Ditto of the Ofter personally appeared Maria Guise Name(s) of Signers) who proved to me on the basis of satisfactory evidence to be the person(z) whose name(s) ishm subscribed to the within instrument and acknowledged to me that kx/sheftey executed the same in kWherMitik authorized capacity(ias), and that by We/her/ftir signature(%) on the instrument the person), or the entity upon behalf of which the person(x) 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 RHONDA C. ABEL COMM, # 2051838 NOTARY PUBLIC -CALIFORNIA z� ORANGE COUNTY 0 Signature_`,,�__ �,),�a COMM, EXPIRE�OEC.14, 2017'' Signature of Notary Pui�izrw_ 'i, Place Notary Seat 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 Docurnent: Document Date: Number of Pages; —, Signer(s) Other Than Named Above: Capacity(ies) Claimed by $!gnarls) Signer's Name: Corporate Officer — Titlo(s): Partner — Fj Limited i� General Individual xi Attorney in Fact Trustee -1 Guardian or Conservator 1 Other: Signet, Is Representing: Signer's Name: Corporate Officer — Title(s): Partner — F-1 Limited General Individual i Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing: 02014 National Notary Association - www.NationalNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item 105007 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except In the manner and to the extent herein stated. Certificate No. 7486390 American Fire and Casually Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casually Insurance Company are corporations duly organized under the laws of the Slate of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the Stale of Massachusetts, and WestAmerican Insurance Company Is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Heather Saltarel6, James A. Schaller Jeri Apodaca: Kim Lw;: Maria Guise; Michael D Panzino Rachalle Rheault; Rhonda C. Abel all of the city of Newport Beach , state of CA each individually if there be more than one named, Its true and lawful attorney -In -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surely and as Its act and dead, any and all undertakings bonds recognizances and other surety obligations Inpursuance of these presents and shall be as binding upon the Companies as If they have been duly signed by the president and attested by the secretary of the Companies In their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 20th day of September .2016 PNo cAso `sv ws� slwq N,rviux 'American Fire and Casualty Company The Ohio Casualty Insurance Company 1ao6 o n 919 M h 1912 9Jt Liberty Mutual Insurance Company y 4 Ab a y a West merlcan Insurance Company a e � By, STATE OF PENNSYLVANIA as David M. Carey, Assistant Secretary COUNTY OF MONTGOMERY On this 20th day of September 1 2016 , before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Insurance Company, and West American Insurance Company, and that he, as such,being authorized so to dr, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed m name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and yearflrst above written, 01V�411NII� gP PAS}COMMONWEALTH OF PENNSYLVANIA wQNotmialSealT'' Teresa Pastella Notary Public By: Plymouth lwp., Montgomery County Teresa Pastella, Notary Public MyComm7 Member, Pernsylvenlu Asvome4on m N.buiea This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV— OFFICERS — Section 12. Power of Attorney Any officer archer official of the Corporation authorized for that purpose in writing by the Chairman orthe President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneysrin-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations, Such attorneys In -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation When so executed, such Instruments shall be as binding as If signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -In -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts— SECTION 5. Surety Bonds and Undertakings, Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -In -fact, as may be necessary to act in behalfof the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such Instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed bythe.prescient and attested by the secretary. Certificate of Designation —The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -In - fact as may be necessary to act on behalf of the Company to make, execute, seal., acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization— By unanimous consent of the Company's Board of Directors, the Company consents thatfacsimlle or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified dopy of any power attorney Issued by the Company in connection with surety bonds shall be valid and binding upon the Company with the same force and effect as though manually affixed I, Gregory W. Davenport, the undersigned Assistant Secretary, ofAmerican Fire and Casualty Company The Ohio Casualty Insurance Company, -Liberty Mutual Insurance Company, and WestAmerican Insurance Company do hereby certify that the original power ofattorney of which the foregoing is a full true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this day of 0(0(0(n 1NSpa,��1N5(Jq�Pp rNSUryAa.oaar�HyRr n'oMr'pp¢u no cMr �c919 �1972 e'� 1997x awa,aR�a1' �} �� FC O l� a e sM. LMS_12873_122013 2017 „r_,20 By 4 ~ ^G Gregory W. Davenport, Assistant Secretary 407 of 500 CITY OF SANTA ANA BONDS Bond No. 24070290 PROJECT NO.: 17-6611 KNOW ALL MEN BY THESE PRESENTS that Cal Stripe, Inc. as CONTRACTOR, and Liberty Mutual 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 California, as SURETY, are held and firmly bound unto the City of Santa Ana, as AGENCY, in the penal sum of Eighty Four Thousand Eight Hundred Seventy Five and 40/100 Dollars ($ 84,875.40 ), which is 100 percent of the total contract amount for the 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 ARE SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated May 2, 2017 for Project No. 17-6611, Chestnut Avenue and Bush/Cypress Bike Lanes e if CONTRACTOR faithfully performs and fulfills all obligations in the performance of the Work of Improvement to be done under said Contract Agreement in the manner and time specified therein, then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor of AGENCY; provided that any alterations in the obligations or time 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 alterations is hereby waived by SURETY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this -_Loth _ day of May _'2017 . * Cal Stripe, Inc., 2040 E. Steel Road, Colton CA 92324 909-884-7170 Steve Fleener, General Manager, 2040 E. Steel Road, Colton, CA 92324, 909-884-7170 SV.RG R'*- Liberty Mutual Insurance Company, 790 The City Drive South, Suite 200, Orange, CA 92868, 714-634-5712 Maria Guise, Attorney -in -Fact, 1301 Dove Street, Suite 200, Newport Beach, CA 92660, 619-238-1828 Subscribed and sworn to before me, 20 Signature: Please See Attached California All -Purpose Acknowledgment Notary Public in and for the County of State of this day of Rate of premium on this bond is $ 9.77 per thousand. Total amount of premium charge is $ 829.00 ** To be filled in by Surety ** Premium is for contract term and subject to adjustment based on final contract price. *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. I of 3 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 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 San Bernardino On May 12 2017 before me, Lorraine Manzanares, Notary Public Date Here Insert Name and Title of the Officer personally appeared Steve Fleener Names) of Signer('9) who proved to me on the basis of satisfactory evidence to be the person() whose name(b)®are subscribed to the within instrument and acknowledged to me thatd0she/they executed the same in cher/their authorized capacityo , and that byaher/theirsignatureM on the instrument the person, or the entity upon behalf of which the person(4),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. <ea` LORRAINE MANZANARES� WITNESS my hand and official seal. Comm. M2151609 ,� e;w►= � NogryPublic.CaNPornia� San9ern�rdinoCounty Signature �_ Comm•Expin:May26,;020 Signature ofNaryP blic 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: Faithful Performance Bond Document Date: May 10, 2017 Signer(s) Other Than Named Above: Capacity(les) Claimed bySigner(s) Signer's Name: Steve Reener ❑ Corporate Officer -- Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: cel supe, Inc. Number of Pages: one Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact _I Trustee ❑ Guardian or Conservator U Other: Signer Is Representing: 02016 National Notary Association - www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary poblio or other officer completing this certificate verifier 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 _QLw1ge On MAY 10 2017 __ before me, ___ Rhonda C. Abel_Npta_D( PLlbfic___,__ Date Here Insert Name and Title of the Officer personally appeared Maria Guise — Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Isham subscribed to the within Instrument and acknowledged to me that Im/sheAhity executed the same in *Wherl.6mir authorized capacity(tom), and that by tXbc/her/*wk signatura(z) on the Instrument the personoe), 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. �y_-�'—RRHH__D_A_C__A6WL C)N COMM. COMM #20�11338 NOTARY PUBLIC -CALIFORNIA 0 ORANGE Z T 0 Signature RANGE COUNTY 0 EX 0 C 1 111COMM, EXPIRES E4 2017•' SignatUrE of Notary PUbIIC Place Notary Seat 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: Document Date: Number of Pages: __ Signer(s) Other Than Named Above: Capacity(lies) Claimed by Signer(s) Signer's Name: I Corporate Officer — Title(s): I Partner — i7 Limited Fi General Individual fkj Attorney in Fact Trustee -1 Guardian or Conservator j Other: Signer Is Representing: Signer's Narne: Corporate Officer Title(s): Partner — f j Limited General Individual a Attorney in Fact Trustee Guardian or Conservator Other; Signer Is Representing: 07.014 National Notary Association - www.NationaiNotary.org - 1 -300 -US NOTARY (1.800-876-6827) Item #5907 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein staled. Certificate No. 7466397 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casually Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company Is a corporation duly organized under the laws of the State of Indiana (herein collectively caped the "Companies"), pursu ant to and by authority herein set forth, does hereby name, constitute and appoint, Heather Saltarellh James A. Schaller; Jeri Apodaca Kim Lum;.Maria Guise; Michael D Parizino- Rachelle Rheault; Rhonda C Abel all of the city of Newport Beach , stale of CA each Individually if there be more than one named, Its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on Its behalf as surety and as its act anddeed, any and all undertakings bands recognizances and other surety obligations to pursuance of these presents and shall be as binding upon the Companies as If they have been duly signed by the president and attested by the secretary of the Companies in their own: proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an: authorized officer of the Cor l thereto this 20th day of September 2016 A<JD C(�y� � Y InLSU� AKIN 6Ugq A'1NSU/rq �0 reMnnsr�9�t. QyvP oaswpr� ly 10 �xPogn '�. Q.� ,oa°cM F 4'P n t r` � 1906 0 0 1919 0 1972 ° � 1991 3 w �"U`'n V-'�� YS, ,rrvnnvc+`Q`N� `'eJ'P•'ra< bra � rn'mnH^ <.. # 1 # A tr # STATE OF PENNSYLVANIA as COUNTY OF MONTGOMERY seals of the Companies have been affixed American Fire and Casualty Company The Ohio Casually Insurance Company Liberty Mutual Insurance Company West American Insurance Company By: David M. Carey; Assistant secretary On this 20th day of September 2016 , before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Insurance Company, and West American Insurance Company, and that he., as such, being authorized so to do,. execute the foregoing instrument for the purposes therein contained by signing. on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written. yp PAgr COMMONWEALTH OP PENNSYLVANIA g Q4'�yenoNwFys�<`; Notarial Seal Teresa Pastella Notary Public By. ��/(.(.�ct-� of Plymouth Twp., Montgomery County Teresa Pastella, Notary Public 3 My Commission Expires March 28, 2017 9VA� \p Member, PennsyNanla Association of Notaries This Power of Attorney is made and executed pursuant to a'ni-by authority of the following By-laws and Authorizations of American Fire and Casually Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV- OFFICERS - Section 12, Power of Attorney. Any officer orother official of the Corporation authorized for that purpose In writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -In -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -In -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary Any power or authority granted to any representative or attorney -In -fact under the provisions of this article may be revoked at any time bythe Board the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII - Execution of Contracts - SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -In -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such Instruments and to attach thereto the seal of the Company. When so executed such Instruments shall be as binding as If signed by the president and attested by the secretary. Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M, Carey Assistant; Secretary to appoint such attorneys -In - fact as may be necessary to act on behalf of the Company to make, execute, seal acknowledge: and deliver as surety any. and all undertakings,,bonds, recognizances and other surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimi Company, wherever appearing upon a certified copy of any power of attorney Issued by the Company in connectl the same force and effect as though manually affixed I, Gregory W. Davenport, the undersigned Assistant Secretary, of American Fire and Casualty Company The Ohl West American Insurance Company do hereby certify that the original power of attorney of which the foregoing I Companies, is in full force and effect and has not been revoked, IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this day 4.'a13µ?o+�i.rr9 Jp�OPYe.9gr�gH lA�\PGR RNN <AN ar'LH9iy q� s : ��. e � AD � y Mrd` arm � .t � ,� �� a o 1906 0 0 7919 � 1912 ` �� 997 i e �� � .o a° o mr ha � w a '.. R� xs �d a'ylWxrA� �)�`V'a<.,n w„nen Y # # LMS_12873 122013 ;chardcally reproduced signature of any assistant secretary of the surety bonds shall be valid and binding upon the Company with airy Insurance Company;:: Liberty Mutual Insurance Company, and true and correct copy of the Power of Attorney executed by said MAY 1 0 2.011 20 1 Gregory W. Davenport, Assistant Secretary 408 of 500