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KLASSIC ENGINEERING & CONSTRUCTION, INC.,
Recording Requested By, Recorded in Official Records, Orange County And When Recorded Mail To: Hugh Nguyen, Clerk-Recorder Cleric of the Council,City of Santa Ana I II I Ilf I II I �IIl�I N 0 F E E 20 Civic Center Plaza,P.O.Box 1988 1I J I f I Santa Ana,CA 92702 * $ R 0 0 1 D h 9 3 7 7 7 $ * 201900007851510:43 aim 03/13/19 105 417 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.000.000.00 0.00 THIS SPACE FOR COUNTY RECORDERS USE ONLY F e NOTICE OF COMPLETION NOTICE IS HEREBY GIVEN that the undersigned City of Santa Ana, California, a municipal corporation, with the address of City Hall, 20 Civic Center Plaza, Santa Ana, California, 92701, is the owner of the property hereinafter described, that said owner has caused c construction of SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM a RENOVATION under contract entered into on JANUARY 16, 2018, with KLASSIC ENGINEERING & CONSTRUCTION, INC., on which contract ARGONAUT INSURANCE W 00 COMPANY is surety. The property on which such work improvement was placed is in the City M U o z of Santa Ana, County of Orange, State of California, and described as Project No. 15-7538 z w located at: SANTA ANA REGIONAL TRANSPORTATION CENTER. The work cimprovement on said property was accepted as completed on JANUARY 18, 2019. FAo w o CITY TA ANA,A MUNICIPAL CORPORATION w vz za o By w n. Dated: 3 i r p Princi Civil Engineer-Tyrone Chesanek x TITLE - --------------- - -- - - VERIFICATION I, the undersigned, say: I am the City Engineer - Edwin "William" Galvez of the City of Santa Ana, California; I executed the foregoing Notice of Completion acting on behalf of the owner of the property therein described; I make this verification on behalf of said corporation by authorization of the City Council of the City of Santa Ana; I have read said notice and know the contents thereof; and I declare under penalty of perjury that the facts therein stated are true. Executed on _ ` , at Santa Ana, California (Signature of individual swea ug that the contents of Notice of Completion are true.) THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10)DAYS AFTER COMPLETION THE REGISTER The space for ming siemp ony 625 N GRAND AVE, SANTA ANA, CA 92701 Telephone (714) 796.7000 / Fax (714) 7966059 PROOF OF PUBLICATION (20155 C.C.P.) State of California ) County of ORANGE ) ss Notice Type BID - NOTICE INVITING BIDS Ad Description: SANTA ANA REGIONAL TRANSPORTATION RESTROOM RENOVATION I am a citizen of the United States and a resident of the State of California; I am over the age of eighteen years, and not a party to or Interested In the above entitled matter. I am the principal clerk of the printer and publisher of the THE REGISTER, a newspaper published in the English language In the city of SANTA ANA, county of ORANGE, and adjudged a newspaper of general circulation as defined by the laws of the State of California by the Superior Court of the County of ORANGE, Slate 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: 10/16/2017, 10/25/2017 Executed on: 10/25/2017 At SANTA ANA,CA I certify (or declare) under penalty of perjury that the foregoing Is true and correct. Slr3nature III I II II II II II I II � II II III � I III emea * A 0 0 0 0 0 4 5 7 7 0 8 1 f< CNS#: 3062330 MAYOR Michele Martinez CITY MANAGER Miguel A. Pulido °" Raul Godinez II MAYOR PRO TEM - J CITYATTORNEY Michele Martinez Ward Sonia R. Carvalho COUNCIL MEMBERS s, CLERK OF THE COUNCIL P, David Benavides ora Marla D. Huizar Vicente Sarmlento lvillegas0santa-ana oraistinaiero(ftanta-ena.oro Jose Salado Sal Tinalero Juan Villages CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza (M-20) P.O. BOX 1988. Santa Ana, California 92702 (714).687.2700 • Fax (714) 9731461 www.santa-ana.org NOTICE OF EXEMPTION From the Requirements of the California Environmental Quality Act (CEQA) To: COUNTY CLERK From: City of Santa Ana County of Orange Planning & Building Agency P.O. Box 238 20 Civic Center Plaza M-20 Santa Ana, CA 92702 Santa Ana, CA 92702 Project Title: $A Regional Transporation Ctr Restroom R Date of Approval: 01/16/2018 Project Number(s): PWA -2017 -1876 -CITY Project Location: 1 CltyWide City: Santa Ana County: Orange ER Number: ER -2017-158 Project Description: Renovation of existing restroom facilities (first floor) Applicant Name: Suzi FurJanic, Public Works Applicant Address: 20 Civic Center Plaza SANTA ANA, CA 92702 Name of Public Agency Approving Project: City Council Name of Person or Agency Carrying Out Project: Furjanic, Suzi Exempt Status: ❑ Ministerial (Sec. 15268) ❑ Declared Emergency (Sec. 15269 (a)) ❑ Emergency Project (Sec. 15269 (b through e)) ❑ General Rule (Sec. 15061(b)(3)/(5)) ❑ Statutory Exemption: m Categorical Exemption: 15301 Reason(s) Why Project is Exempt From CEQA: Renovation does not expand existing use City Contact: Suzi Furjanlc Telephone: (714) 571-4241 Signature: 'ISL Title: /150G �G J�%i�hh Date: �2 ' (�j • /7 SANTA ANA CITY COUNCIL Miguel A. Pulido Michele Martinez Vincente Sarmlento Jose Solorio P. David Benavides Juan Vlllegas Sal Tinajero Mayor Mayor Pro Tem, Ward 2 Ward Ward Ward Ward Ward mpulido anta-ana om irlina Inez(aQsante-ana orn vsarmlento(ftanta-ana ora lsolorio(o).santa-ana om dbenavides0santaana oro lvillegas0santa-ana oraistinaiero(ftanta-ena.oro iNSURANCE NOT ON FILE WORK MAY NOT PROCEED ,PA RK OF COUNCIL CITY OF SANTA ANA O: Michael Ortiz TE; e `ONSTRUCTION CONTRACT PWA ( / ) PROJECT NO.: 1>5-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION This CONSTRUCTION CONTRACT is made and entered into this 16th day of January, 2018 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 Klasg'ie Engineering & Construction, Inc. (hereinafter "CONTRACTOR"). WITNESSETH: The CITY and the CONTRACTOR, for the consideration hereinafter named, mutually agree as follows: 1. CONTRACTOR agrees to perform all the work and 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 Santa Ana Regional Transportation Center Restrrom Renovation Project (hereinafter referred to as the "WORK OF IMPROVEMENT") identified in and in accordance with the Contract Documents prepared by the City's Public Works Agency and approved by the City Council. 2. The complete Construction Contract consists of the "Contract Documents" as defined by the Standard Specifications for Public Works Construction and which include the following: • Notice Inviting Bids • Information to Bidders • Bid Proposal • Bid Bond • Contract Form • Contract Bonds • General Provisions • Special Provisions • Technical Provisions and Project Plans • Community Workforce Agreement • 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 Two Hundred Ninety -Six Thousand Seven Hundred Thirty -Five Dollars ($296,73`5:00); as set forth and identified in the BID PROPOSAL, which is attached hereto and incorporated herein as Exhibit "A." The BID PROPOSAL contains a schedule of unit price(s) or lump sum(s) based on approximate quantities only, and the City does not expressly or by implication agree that the actual amount of work will correspond therewith, but reserves the right to increase or decrease the amount of any class or portion of the work or to omit portions of the work as may be deemed necessary or advisable. rev. 09/01/2017 Page 1 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. If applicable, the CONTRACTOR shall adhere to the CITY'S Community Workforce Agreement (CWA), a pre -hire collective bargaining agreement, which establishes the labor relations policies and procedures for CONTRACTOR to follow in the crafts persons employed to complete the WORK OF IMPROVEMENT as more fully described in the CWA. The CWA may be found on the City's website at: httl2://www,santa-ana.org/pwa/documents/CWA.12df 7. 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. 8. 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. 9. 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 1 Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney JOUN FUNK Assistant City Attorney RECOMMENDED FO ROVAL: EDWIN "WILLIAM" GALVEZ Acting Executive Director Public Works Agency CITY OF SANTA ANA c- 1 RAUL GODINEZv1I City Manager CONTRACTOR: Klassic Engineering & KEIVAN CEO Inc. Page 3 of 3 CITY OF SANTA ANA EXHIBIT A PROPOSAL, PROJECT NO,: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION 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 RENOVATION OF SARTC 1 LS $ $ NORTH RESTROOMS (MEN AND WOMEN) TOTAL BASE BID $ ADD ALTERNATE BID 1 2 RENOVATION OF SARTC 1 LS $---] $ ODMS (MEN AND WOMEN)SOUTH / TOTAL ADD ALTERNATE BID 1 $ 3 ELECTRICAL, PLUMBING 4* EA $10,000 $40,000 AND/OR STRUCTURAL REPAIR TOTAL ADD ALTERNATE BID 1 $40,000 I The lowest responsible bidder shall be selected based on the total base bid. The City reserves the right to award the Base Bid, and any, all, or none of the add -alternate bid items (if any). * The quantity for this bid item is shown for bid comparison only. The actual amount for this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. P-1 ofP-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: I5-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION TOTAL BASE "D1$ l ✓ % S —� TOTAL, ADD ALTERNATE BID 1 t / TOTAL, ADD ALTERNATE BID 2 $40,000 TIME FOR COMPLETION OF IMPROVEMENTS AND LIOUIDA T X13 DAMAGES The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, within SMTY (60) working days alter 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 $F500 per calendar day. Name of Firm Signature of BIDDER Title �� v (If an individual, so s e. If a firm or co -partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) P-2 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: LU -A-11 ) 1 Cl In 40.4 hi , REQUIREMENT: The undersigned bidder declares that they have carefully examined the location of the proposed work, that they have examined the Contract Documents in its entirety and hereby proposes to furnish all material and do all the work required to complete the said work in accordance with said plans (if any) and the specifications for the unit price(s) or lump sum(s) set forth in the following schedule: BASE BID: Item Description Qty Unit Unit Price Amount 1 RENOVATION OF SARTC 1 LS $ $ NORTH RESTROOMS (MEN TOTAL ADD ALTERNATE BID 1 AND WOMEN) TOTAL BASE BID $ ADD ALTERNATE BID 1 2 RENOVATION OF SARTC 1 LS —$-7$ $40,000 TOTAL ADD ALTERNATE BID 1 SOUT-1RESTROOMS(MEN AND WOMEN) TOTAL ADD ALTERNATE BID 1 $ ADD ALTERNATE BID 2 3 ELECTRICAL, PLUMBING AND/OR STRUCTURAL REPAIR 4* EA $10,000 $40,000 TOTAL ADD ALTERNATE BID 1 $40,000 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. 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. P-1 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION TOTAL BASE BID $ ! 7 TOTAL ADD ALTERNATE BID 1 $ pI 9 SD 0 v TOTAL ADD ALTERNATE BID 2 $40,000 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 SIXTY (60) working days after the commencement date stated in the Notice to Proceed. The liquidated damages amount, in lieu of the amount specified in Subsection 6-9 of the Standard Specifications, shall be $500 per calendar day. I P Name of Firm Signature of BIDDER v 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-2 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION BIDDER'S STA'TENIENT 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 fonds, check, draft, or BIDDERS bend 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 bins, 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 7088.15 of the California undersigned certifies under penalty of perjury that the fore Name of Firm Signature of BIDDER (s and Professions Code, the true and correct. Title C.E.O. (If an individual, so state. if a firm or co -partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, 'Treasurer and Manager, thereof.) P-3 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION CONTRACTOR'S ]ICI NSINCi AND REGIS'II2nlTN. S"In4EMENT 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: L�-lassie En >inee ein g & Constru Lion Irrc. Business Address:25rustir� ,.,,Stri Cern *w, Ca.92866 Business E; -Mail Address: klassia) Ian s,a amail.eorn Telephone: (714) 369-839 State Contractor's License No. and Class: A & B License Expiration Date; 2/28/201.9 State Dept. of Industrial Relations (DIR) Registration No.: 1000014420 State Dept. of Industrial Relations Registration Expjration P_aQ .- ' Y" Signed: Title: C.E.O. Pro of P-1 6 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 157538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION PRING S7:ATEMENT Contractor is aware of the requirements of California Labor Code Section 1.720, et sec}., as well as California Code of Regulations, Title 8, Section 16,000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. Since the services are being performed as part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and since the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at the commencement of this Agreement. Contractor shall make copies of the prevailing rates of per diem wages for each craft, classification or type of worker needed to execute the services available to interested parties upon request, and shall post copies at the Contractor's principal place of business and at the project site. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. The undersigned certifies that the foregoing is true and correct. Name of Firm Klassic Engirding €c Cgtutruction Signature of Title C.E.O. (if an individual, so state.) P-5 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION OWNERSHIP AFFIDAVIT STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS: CITY OF SANTA ANA _I��vt Yeim d� 'terxlg -,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 co -partnership firm designated as: and who has been and is duly vested with the authority to make and execute instruments for the co -partnership by: who constitute the other members of the co -partnership. CORPORATION That he is of: // �z �Yt�' .V:�r �'rsMu. y rSC.+�r crCJr 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 pen iynedol,collusive or sham, and has not in any manner sought by collusi to secure any iray gainst the City of Santa Ana or any person interested in the p ed -contract, for hiy other person. Signature of Subscribed and sworn to before me this Signature of officer P-6 of P-16 20 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) 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 Calif is County of HANIN ABDALLAH • Commission # 2059441 z " o Notary Public • California z Orange County My Comm. Expires Feb 28, 2018 b Subscribed and sworn to (or affirmed) before me L �J�� on this day of � ', 20Vq , by Date Month Year (1) 1Q(�` 1 0 (and (2)— Nam ,pM-of 2)Nam,pM-of Signer(s)' proved to me on the basis of satisfactory evidence to be the personk<who appeared before me. Signature L \. S gn ture of Notary Public Seal 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 rt-� Title or Type of Document: Ci y l QA-AawDocument Date: d 1 t 5 Number of Pages: __L__ Signer(s) Other Than Named Above: f -)/p, 02016 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5910 CITY OF SANTA ANA PROPOSAL PROJECTNO,: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION BID BOND Bond No.:CMGB0001912 KNOW ALL PRESENT that, Klassic Engineering & Construction Inc. as BIDDER, and Argonaut Insurance Company , as SURETY, are held and firmly bound unto the CITY OF SANTA ANA, as AGENCY, in the penal sul i of Ten Percent of the Greatest Amount Bid 10% of G.A.B Dollars ($ ), which is ten percent (101;o) 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 SUCI I that, whereas BIDDER is about to submit a bid to AGENCY for the above -stated project, if said bid is rejected, or if said bid is accepted and a contract is awarded and entered into by BIDDER in the manner and time specified, then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor of AGENCY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 13th day of.__,___November , 20 17 , BIDDER* Klassic Engineering & Construction Inc. 250 S Tustin Ave. Orange, CA 92866 SL1RE'Iy* Argonaut Insurance Company c/o CNtf6IA)20335 Ventura Blvd Suite 426 Woodland Hills CA 91364 to before me ,20 Signature: Notary Public in and for the County of , State of this day of Provide BIDDER/ SUI2'ETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. P-7 ofP-16 CMGsoo01912 Argonaut Insurance Company $0.00 Deliveries Only: 225 W. Washington, 24th Floor Chicago, IL 60606 United States Postal Service: P.O. Box 469011, San Antonio, TX 78246 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the Argonaut Insurance Company, a Corporation duly organized and existing under the laws of the State of Illinois and having its principal office in the County of Cook, Illinois does hereby nominate, constitute and appoint Gabriella Grady, Saito Lee Losino, Stephanie Hone She Their true and lawfid-agent(s) and attomey(s)-in-fief, each in their separate capacity if more than one is named above, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all bonds, contracts, agreements of indemnity and other, undertakings in suretyship provided, however, that the penal sum of any one such instrument executed hereunder shall not exceed the sump of: $10,000,000.00 This Power of Attorney is granted and is signed and sealed under and by the authority of the follovain Resolution adopted by the Board of Directors of Argonaut Insurance Company: "RESOLVED, That the President, Senior Vice President, Vice President, Assistant Vice President, Secretary, Treasurer and each of them hereby is authorized to execute powers of attorney, and such authority can be executed by use of facsimile �dgr ature, Which may be attested or acknowledged by any officer or attorney, of the Company, qualifying the attorney or attorneys named in the given power of attorney;-to=execute in behalf of, and acknowledge as the act and deed of the Argonaut Insurance Company, all bond undertakings and contracts of suretyship, and to affix the corporate seal thereto." IN WITNESS WHEREOF, Argonaut Insm'ance Company has caused itsoffiicial seal to be hereunto affixed and these presents to be signed by its duly authorized officer on the 8th day of May, 2017............Argonaut Insurance Company "�rp9uRAryp _ •., 1948 , e by: S 4LIHe19 Y� * Joshua C. Betz, Senior Vice President STATE OF TEXAS COUNTY OF HARRIS SS: On this 8th day of May, 2017 A.D„before me, a Notary Public of the State of Texas, in and for the County of Hands, duly commissioned and qualified, came THE ABOVE OFFICER OF THE OOMPANY, to me personally,mown to be the individual and officer described in, and who executed the preceding instrument, and he acknowledged the execdtnon of same, and being by me duly sworn, deposed and said that he is the officer of the said Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by tl1@ nnthoritty and direction of tine said corporation, and that Resolution adopted by the Board of Directors of said Company, referred to in the preceding instrument is now in force. 1N TESTIMONY WHEREOF, I have hereunto set my hand, and affixed my Official Seal at the County of Harris, the day and year first above written. KATHLEEN MEEKS "`•'-"4 �`�1• , � s Pp _ Nu¢ary "1111161Scute of Towes' espirea p7 -t5 -2n21 ' (Notary Public) 1, the undersigned Officer of the Argonaut Insurance Company, Illinois Corporation, do hereby certify that the original POWER OF ATTORNEY of which the foregoing is a full, true and correct copy is still in full force and effect and has not been revoked. IN WITNESS WHEREOF, I have hereunto set my hand, and affixed the Seal of said Company, on the 13th day of November 12017 •'��ry'���pgp�rjfuC S�''. g; 'i sf2?•` re48 Sarah Heineman , VP -Underwriting Surety THIS DOCUMENT IS NOT VALID UNLESS THE WORDS ARGO POWER OF ATTORNEYARE IN BLUE. IF YOU HAVE QUESTIONS ON AUTHENTICITY OF THIS DOCUMENT CALL (210) 321- 8400. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 rl�M,caKr,4i,rm�*'s�.f,�c•,�aYz xrc:[�r.,.2c�CsfwYu=4-,E,•r,LtiRk,fsM,tif'.,rcQ.caksc,Yasti^s,;r.kePa:2'c,cr:''r2irc:`a A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of LOS ANGELES On NOV 1 8 2017 before me, SHIRLEY GIGGLES, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared GABRIELLA GRADY Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. SHIRLEY GIGGLES Notary Publlc • Gallfornia Z � �'.-�+'• s" Los Angelos County z • s'r%l`+„ Goinmission 40 2163817 may. My Comm. Expires Sep 7, 2G2G Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signatur lure of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): EJ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 1'?'=zr:�a>sumer"u,:c.R=zs�u>xwuu:cw^'.v�:�.e*-cru 02014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION 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 Affid f art of the Proposal. BIDDERS are eatytined tha i)aking a false 1 ion may subject the certifier to criminal t��osecutn'. Signed State of California County of Subscribed and sworn to (or affirmed) before me on this d_�ay_. f 20 by proved to me on the basis of sans aiactory evidence to be the person(s) who appeared before me Notary 'Public Signature Notary Public Seal P-11 of P-16 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 wee Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) 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 HANIN ABDALLAH Commission # 2059441 z "-o Notary Public - California' z Orange County Fb2f,201Mom8a` Subscribed and sworn to (or affirmed) before me on this 6day of NOVeiVlti3c� , 20 by ppDate Q Month (y Year (1) �Vt?llk"x1r1 U�i1'(l.?QZ (and (2) ), Name%of Signer(s)--' proved to me on the basis of satisfactory evidence to be the person(,* who appeared before me. Signature Signature of Notary Public Seal 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 r` {�g Title or Type of Document: �pVl "CIOC \lAZ i&-) Oas1, ltocument Date: �I I Number of Pages: --\_- Signer(s) Other Than Named Above: 9 166C ©2016 National Notary Association - www,NationalNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5910 CITY OF SANTA ARTA PROPOSAL PROJECT NO.: 15-7538 SANTA .SNA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION LIS> �' OT' SUB-LONTR, CTORS Section 4100 or. seg. of the Public Contract Code squires listing of all subcontractors with the bid for all subcontract, work exceeding the following amount: o Streets, highways including bridge projects: 1/2% of the bid or $10,000, whichever is greater o Buildings, parks, or other projects: 'f % 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 Werk to the firms listed below: Name FMK Professional Inc License #/Exp. 959668 DIR Reg. #/Exp. _ Location 1'7925,&k Title ,iir Sia r Trvine C'�9„2„611 Phone (9191679 9800 Type Of Work Eleawica! Amount $ Name License #/Exp. DIR Reg. #/Exp. License # Location Phone�� Type Of Work Amount $ Name __ License #JExp. DIR Reg. 4/Exp. License # Location Phone Type Of Work [Amount. $ Signature of Bidder Name _ License #/Exp DIR Reg. 9/Exp, m Location Phone Type Of Work �~ Amount $ Name _ License #/Exp DIR Reg. #/Exp._ License # Location Phone Type Of Work Amount $ Name License #/Exp, DIR Reg. 4/Exp. License # Location Phone Type Of Work Amount $r P-8 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION REFERENCES The following are the names, addresses, and telephone numbers for LI LE public agencies for which the BIDDER has performed similar work within the past three years. 2. Name and Address of Owner. Mejhdi 714-744-5214 _ Name and Telephone Number of person familiar with project. Contract Amount Type of Work --Date Cornpleted —. Name and Address of owner. -- r Georee Kwiter 919-266-5332 Contract Amount person Type of Work 3. San Gabriel School District Name and Address ofowner. Bille Giles 626-664-0158 and Contract Amount Type of Work project. �4Date Completed Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. rti, M BondinP lU- uranc�rvicec 3101 W Coast 1dTdiehwIInsurance S@xy ,,j,LC 49515-4114 Argonaut Insurance Company 20335 Ventura Blvd. Ste. 426 Woodland Bills, Ca.91364 818348-4900 Farmers Insurance Office of Cathy Blol deet !9831 Yorba Linda Blvd. Ste. B Yorba Linda, Ca. 92886 714-528-3276 P-9 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO,: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION N Nn1-1SCI. N[ `l ON E Tll l T ,, The undersigned contractor or corporate officer, during the performance of this contract, certifies as follows: 1. The Contractor shall not discriminate against any enlployce 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. Snch action shall include, but not be limited to, the following: ernployment, upgrading, dernotion, or uansferp recruitment or recruitment advertising; layoff or termination rates of pay or other forms of compensation; and selection for training, including apprenticoghip. 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 can 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 repl'esentative of workers with which he/she has a collective bargaining agrecrment 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 }cost copies of the notice in conspickaous places available to employees and applicants for employment. 4. The Contractor shall comply with kill provisions ofFxeeutive Order 11246 of September 24, 1965, kind of the rules, regulations, and relovatat orders of the, Secretary (if Labor. 5. The Contractor shall furnish all information, and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and carders of'tire Secretary of labor, or pursuant thereto, and.will pernut access to his/her hoops, records, and accounts by the administering agency and the Secretary of Labor for purposes of inves@igation, to ascertain compliance with such rules, regulations, and orders. In the event of tlae C'ontractor'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 tit whole or in part and the Contractor may be declared ineligible for fiarther• 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 11245 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law. PF12 of P-16 CITY OF SANTA ANA PROPOSAL, PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION 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 perso sept as provided in Section '1420, and any contractor of publi orks violating this " s subject to all the penalties imposed for a violation of the " apter� ' - , I Signed: "title: C.E.O. Firm: Klassic Engineering & Construction Inc. Date: 11/14/2017 P-13 of P-16 CITY OF SANTA ANA PROPOSAL, PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION STATEMENT REGARDING APPRENTIC ESI-jLP RE.QuIREMENTS 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 standru'ds 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 fiords in each craft or trade in which he/she employs journeymen or apprentices on the public work, in the same ae tint or upon the same basis and in the same manner as the other cgntractors,,, exec t co pn . s trot signatory to the trust agreement shall pay a like amourCya4f 6rnia Aouncil. Signed: / Title: C.E.O. Firm: /Massie ESg neerin�L& Construction Inc. ry Date: 11/14/2017 P-14 o€'P-lo CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION STATEMENT REGARDING "ANTI-KICKBACIC_ 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 prohi it rom inducing, by any means, any person employed in the con ruction o):,repair of pub rk, to give up any part of the compensation to which he/she is o'thvrrwis"nfitled. Signed: Title: Firm: Klassic Engineering & Construction Inc. Date: P-15 ofP-I6 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15-7538 SANTA ANA REGIONAL TRANSPORTATION CENTER RESTROOM RENOVATION PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE In conformance with Public Contract Code Section 10162, the BIDDER shall complete, under penalty of peiJury, 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, aver been disqualified, retnoved, or otherwise prevented fron bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation? Yes No X If the answer is yes, explain the circumstances in the following space P-16 of P,16 Klassic Engineering and Construction, INC KEC250 S Tustin ST. Orange, CA 92866 FHWA 1273 TITTLE: C.E.O. DATE: 11/14/2017 (714) 369-8389 Klassicplans@gmail.com REQUIRED CONTRACT PROVISIONS FEDERAL --AID CONSTRUCTION CONTRACTS I. General II. Nondworirnination III, Nonsegregated Facilities IV. Davis -Baan and Related Act Provisions V. Contract Work Hours arid Safety Standards Act Provisions VI. Subletting or Assigning the Contract VII. Safety; Accident Prevention VIII. False Statements Concerning Highway Projects IX. Implementation of Cleary Air Act and Federal Water Pollution Control Act X. Compliance with Governmentwide Smponxlon and Debarment Requirements XI. Certification Regarding Use of Contract Funds for Lobbying ATTACHMENTS A. Employment and Materials, Preference for Appalachian Development l-tighway System or,Apaalachlan Local Accoss Road Contracts Qdciuded in Appalachian contracts only) 1. GENERAL 1. Foran FFIWA-1273 must be physically incorporated in each construction contract funded under'fitle 23 (excluding emergency eontiaots solely intended for debris removal). 'rho contractor (or subcontractor) roust insert this form In each subcontract and further require its inclusion in all lower tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services). The applicable requirements of Form FHWA-1?73 arra incoporoted by reference for work done under any purchase order, rental agreement or agreement for other services. 'Tho prime contractor shall be responsible for compliance by any subcontractor, lowerd'ier subcontractor or service provider. Forte FHWA-1273 must be included in all Federal -aid design - build contracts, in all subcontracts and In lower tier subcontracts (excluding subcontracts for design services, purchase orders, rental agreements and other agrecmments for supplies or services). The design -builder shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Contracting agencies may reference Form FHWA 1273 in bid proposal or request for proposal documents, however, the Foran FHWA-1273 must be physically incorporated (not referenced) In all contracts, subcontracts and lower -tier subcontract, (excluding purchase orders, rental agreements and other agreements for supplies or services related to a construction contract). 2. Subject to the applicability criteria rioted In the following sections, these contract provisions shell apply to all work performed on the contract by the contractor's own organization and with the assistance of workers under the contractor's immediate superintendence and to all work performed on the contract by piecework, station work, or by subcontract. FHWA-1273 -- Revised May 1, 2012 3. A breach of any or the stipulations contained in these Required Contract Provisions may be sufficient grounds for withholding of progress payments, withholding of final payment, termination of the contract, suspension / debarment or any other action determined to be appropriate by the contracting agency and FHWA. 4. Selection of Labor; During the performance of this contract, the contractor shall not use convict labor for any purpose within the limits of a construction project on a Federal -aid highway unless it Is labor performed by convicts who are on parole, supervised release, or probation. The term Federal -aid highway does not include roadways functionally classified as local roads or rural minor collectors. 11, NONDISCRIMINATION The provisions of this section related to 23 CFR Part 230 are applicable to all Fed vrahaid construction contracts and to all related construction subcontracts of $70,000 or more. The provisions of 23 CFR Part 230 are not applicable to material supply, engineering, or architectural service contracts. In addition, the contractor and all subcontractors must comply with the following policies: Executive Order 11246, 41 CFR 60, 29 CFR 1625-1627, Title 23 USC Section 140, the Rehab lliaten Act of 1973, as amended (29 USG 794), Title Vi of the Civil Rights Act of 1064, as amended, and related reguVations including 49 CFR Parts 21, 26 and ?7 and 26 CFR Parts 200, 23p, and 633. -rhe contractor and all subcontractors must comply with: the requirements of the Equal Opportunity Clause In 41 CFR e0 - I A(b) and, for all conehuction contracts exceeding $10,000, the Standard Federal Equal Employment Opportunity Construction Contract Specifications In 41 CFR 60.4.3. Note: The U.S. Department of Labor has exclusive authority to determine compliance with Executive Order 11246 and the policies of the Secretary of Labor Inducing 41 GFR 60, and 29 CFR 1626-1627, The contracting agency and the FHWA have the authority and the responsibility to ensure compliance with Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), and Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. The following provision Is adopted from 23 CFR 230, Appendix A, with appropriate revisions to conform to the U.S. Department of Labor (U5 DOL) and FHWA requirements. 1. Equal Employment Opportunity; Equal employment opportunity (EEO) requirements not to discriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, ruies,-regulations (28 CFR 36, 2.P CFR 1630, 29 CFR 1626-1627, 41 CFR 60 and 49 CFR 27) and orders of the Secretary of Labor as modified by the provisions proscribed harsh), and imposed pursuant to 23 U.S.C. 140 shall constitute the EEO and speoific of irmative action standards for the contracter's project activities under this contract. The provisions of the Americans with Disabilities Act of 1900 (42 U,$.C. 12101 of seq.) set forth under 28 CFR 15 and 29 CFR 1690 are incorporated by reference In this contract, in the execution of this contract, the contractor agrees to comply with the following minimum specific requirement activities of FFO: a. 'rho comb actor will work with the contracting agency and the Federal Government to ensure that It has made every good faith effort to provide equal opportunity with respect to all of its terms and conditions of employment and In their review of activities under the contract. b. The contractor will accept as Its operating policy the following statement: "It Is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sox, color, national miffin, age or disability. £duch action shall Include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pro, apprenticeship, and/or on-the- job training." 2. RE® Officer: The contractor will designate and make known to the contracting officers an EEO Officer who will have the reoponaibllity for and must be capable of effectively administering and promoting an active EEO program and who must be assigned adequate authority and responsibility to do $0. 3. Dissemination of policy: All members of the contractor's staff who are authorized to hire, superviso, promote, and discharge employees, or who recommend such notion, or who area substantially involved in such action, will be made fully Cognizant of, and will implement, the controcto€'s EEO policy and contractual rouponslbilities to provide EEO in each grade and classification of employment. To ensure that the above agreement will be mel, the following actions will be taken as a minimum: a. Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and them not less often than once every six months, at which time 'rho contractor's EEO policy and Its Implarnentmen EMIT be reviewed and explained. The meetings will be Co rdueted by the EEO Officer. b. All new supentlsory or personnel office employees will be given a thorough indoctrination by the EEO Officer, covering all major aspects of the contractor's EEC? obligations within thirty days following their reporting for duty with the contractor. o. All personnel who are engaged he direct reeruitment'ror the projet will be instructed by the EEO Officer in the contractor's procedures for locating and hiring mlnoritles and women. d. Notices and posters setting forth the contractor's EEC? policy MIR be placed In areas readily accessible to employees, applicants for employment and potential employees. e. The contractor's EEO policy and the procedures to implement such policy will be brought to the attention of employees by moans of meetings, employee handbooks, or other appropriate moans. C Recruitment: When advarttsing for employees, the contractor will include in all advertisements for employees the notation: "An Equal Opportunity Employer." All such advertisements will be placed in publications having a large circulation among minorities and women in the area from which the project work force would normally be derived. a. The contractor will, unless precluded by a valid bargaining agreement, conduct systematic arid. direct recruitment through public and private employee referral sources likely to yield qualified minorities and women. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such Identified sources procedures whereby minority and women applicants may be referred to the contractor for employment consideration. b, In the event the contractor has a valid bargaining agreement providing for exclusive hiring hall referrals, the coniroator is expected to observe the provisions of that agreement to the extent that the system meets the contractor's compliance with EEO contract provisions. Where Implementation of such an agreement has the effect of discriminating against minorities or women, or obligates the contractor to do the same, such Implementation violates Federal nondiscrimination provisions. o. The contractor will encourage its present employees to refer minorItlos and women as applicants for employment, Information and procedures with regard to referring such applicants will be discussed with employees. 6. Personnel Actions: Wages, working conditions, and employee benefits shall be established and administered, and personnel actions of every type, including hiring, upgrading, promotion, transfer, demotion, layoff, and tonnlnation, shall be taken without regard to race, color, religion, sex, national origin, age or disability. Tho following procedures shall be followed: a. The contractor will conduct periodic inspections of project sites to Insure that working conditions and employee facilities do not Indicate dlsimminatory treatment of project site personnel. 0. The contractor will periodically ovaIttate the spread of wage; paid within each olasslficatim+ to doierroino any evidence of discriminatory wage practices. c. The contractor will periodically review selected personnel actions in depth to determine whethrer there Is evidence of discrimination. Where evidence is found, the contractor will promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all effected parsons. d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor In connection with its obligations under this contract, will attempt to resolve such complaints, and will take appropriate corrective action within a reasonable time. If the Investigation Indicates that the discrimination may affect persons other than the complainant, such cerrective action shall include such other persons. Lippe completion of each investigation, the contractor will inform every coi'nplainant of all of their avenues of appoel. 6. Tialning and Promotion: a. The contractor will asaist in locating, qualifying, and Increasing the skills of minorities and women who are applicants for employment or current employees. Such efforts should be aimed at developing full journey level status employees in the type of trade or job classification involved. b. Consistent with the contractor's workforce requirements and as permissible under Federal and State regulations, the contractor shall make full use of training programs, I.e., apprenticeship, and on-the-job training programs for the geographical area of contract performance. In the event a special provision for training is provided under this contract, this subparagraph will be superseded as Indicated in the special provision. The contracting agency may reserve training positions for persons who receive welfare assistance in accordance with 23 U.S.C. 140(a). c. The contractor will advise employees and applicants for employment of available training programs and entrance requirements for each. d, The contractor will periodically review the training and promotion potential of employees who are minorities and women and will encourage eligible employees to apply for such training and promotion, 7. Unions: If the contractor relies in whole or in part upon unions as a source of employees, the contractor will use good faith efforts to obtain the cooperation of such unions to increase opportunities for minorities and women. Actions by the contractor, either directly or through a contractor's association acting as agent, will include the procedures set forth below: a. The contractor will use good falth efforts to develop, In cooperation with the unions, Joint training programs aimed toward qualifying more minorities and women for membership in the unions and Increasing the skills of minorities and women so that they may qualify for higher paying employment. b. The contractor will use good faith efforts to incorporate an EEO clause into each union agreement to the end that such union will be contractually bound to refer applicants without regard to their race, color, religion, sex, national origin, age or disability. c. The contractor is to obtain Information as to the referral practices and policies of the labor union except that to the extent such Information is within the exclusive possession of the labor union and such labor union refuses to furnish such Information to the contractor, the contractor shall so certify to the contracting agency and shall set forth what efforts have been made to obtain such information. d. In the event the union Is unable to provide the contractor with a reasonable Flow of referrals within the time limit set forth in the collective bargaining agreement, the contractor will, through independent recruitment efforts, fill the employment vacancies without regard to race, color, religion, sex, national origin, age or disability; making full efforts to obtain qualified and/or qualifiable minorities and women. The failure of a union to provide sufficient referrals (even though it Is obligated to provide exclusive referrals under the terms of a collective bargaining agreement) does not relieve the contractor from the requirements of this paragraph, in the event the union referral practice prevents the contractor from meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, such contractor shall immediately notify the contracting agency. 6, Reasonable Accommodation for Applicants/ Employees with Disabilities: The contractor must be familiar with the requirements for and comply with the Americans with Disabilities Act and ail rules and regulations established there under. Employers must provide reasonable accommodation in all employment activities unless to do so would cause an undue hardship, g. Selection of Subcontractors, Procurernpnt of Materials and Leasing of Equipment: The contractor shall not discriminate on the grounds of race, color, religion, sex, national origin, age or disability in the selection and retention of subcontractors, including procurement of materials and leases of equipment. The contractor shall take all necessary and reasonable steps to ensure nondiscrimination in the administration of this contract. a. The contractor shall notify all potential subcontractors and suppliers and lessors of their EEO obligations under this contract. b. The contractor will use good faith efforts to ensure subcontractor compliance with their EEO obligations, 10. Assurance Required by 49 GFR 26.13(b): a. The requirements of 49 CFR Part 26 and the State DOT's U.S. DOT -approved DBE program are incorporated by reference. b. The contractor or subcontractor shall not discriminate on the basis of race, color, national origin, or sex In the performance of this contract. 'The contractor shall carry out applicable requirements of 49 CFR Part 26 in the award arid administration of DOT -assisted contracts, f=ailure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as the contracting agency deems appropriate. 11, Rocordg and Reports: The contractor shall keep such records as necessary to document compliance with the EEO requirements. Such records shall be retained for a period of three years following the date of the final payment to the contractor for all contract work and shall be available at reasonable times and places for Inspection by authorized representatives of the contracting agency and the FHWA. a. The records kept by the contractor shalt document the following: (1) The number and work hours of minority and non - minority group members and women employed in each work classification on the project; (2) Tho progress and efforts being made in cooperation with unions, when applicable, to Increase employment opportunities for minorities and women; and (3) The progress and efforts being made in locating, hiring, training, qualifying, and upgrading minorities and women; b. The contractors and subcontractors will submit an annual report to the contracting agency each July for the duration of the project, Indicating the number of minority, women, and non-m1nority group employees currently engaged in each work classification required by the contract work. This information Is to be reported onI"--go nFiWe,-1, The staffing data should represent the project work force on board In all or any part of the last payroll period preceding the end of July. If on-the-job training is being required by special provision, the contractor will be required to collect and report training data. The employment data should reflect the work force on board during all or any part of the last payroll period preceding the and of July. IIL NONSEGREGATED FACILITIES This provision is applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The contractor must ensure that facilities provided for employees are provided in such a manner that segregation on the basis of race, color, religion, sex, or national origin cannot result. the contractor may neither require such segregated use by written or oral policies nor tolerate such use by employee custom, The contractor's obligation extends further to ensure that its employees are not assigned to perform their services at any location, under the contractor's control, whore the facilities are segregated. The term "facilities" includes waiting rooms, work areas, restaurants and other eating areas, time clocks, rostrooms, washrooms, locker rooms, and other storage or dressing areas, parking lots, ddnking fountains, recreation or entertainment areas, transportation, and housing provided for employees. The contractor shall provide separate or single user restrooms and necessary dressing or sleeping areas to assure privacy between sexes. IV, DAVIS-BACON AND RELATED ACT PROVISIONS This section is applicable to all Federal -aid construction projects exceeding $2,000 and to all related subcontracts and lower -tier subcontracts (regardless of subcontract size). The requirements apply to all projects located within the right -of, way of a roadway that is functionally classified as Federal -aid highway. This excludes roadways functionally classified as local roads or rural minor collectors, which are exempt. Contracting agencies may elect to apply these requirements to other projects. The following provisions are from the U.S. Department of Labor regulations in 29 CFR 6.5 "Contract provisluns and related matters" with minor revisions to conform to the FHWA- 1273 formai and €NWA program requirements. 1. Minimum wages a. All laborers and mechanics employed or working upon the site of the work, will be paid unconditionally and not lens often than once a week, and without subsequent deduction or rebate on any account (except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act (29 CFR part 3)), the full amount of wages and bona fide fringe benefits (or cash equivalents theraorr dye at time of payment computed at rates not less than those contained in the wage determination of the Secretary of Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between tho contractor and such laborers and mechanics. Contributions made ar costa reasonably anticipated for barna fide fringe tr notits under section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of paragraph 1.d. of this section; also, regular contributions made or costs Incurred for more than a weekly period (but riot less often than quarterly) under plans, funds, or programs which cover the particular weekly period, are deemed to be constructively made or Incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to skill, except as provided in 29 CFR 5,5(a)(4). Laborers or mechanics performing work in more than one classification may becompensatedat the rate specified for each classification for the time actually worked therein: Provided, That the employer's payroll records accurately set forth the time spent in each classification In which work is performed. The wage determination (including any additional classification and wage rates conformed under paragraph 1. 15, of this section) and the Davis -Bacon poster (WH -1321) shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. b.(1) The contracting officer shall require that any Gass of laborers or mechanics, Including helpers, which is not listed in the wages determination and which Is to be employed under the contract shall be classified in conformance with the wage determination. The contracting officer shall approve an additional classification and wage rate and fringe benefits therefore only when the following criteria have been met: (I) The work to be performed by the classification requested Is not performed by a classification in the wage determination; and (f) The classification Is utilized in the ore@ by the construction industry; and (til) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (2) If the contractor and the laborers and mechanics to be employed in the classification (if known), or their representatives, and the contrasting officer agree on the classification and wage rate (Including the amount designated for fringe benefits where appropriate), a report of the action taken shall be sent by the contracting officer to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor, Washington, DC 20210. The Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officor or will notify the contracting officer within the 30 -day period that additional time is necessary. - (3) In the event the contractor, the laborers or mechanics to be employed in the classification or their representatives, and the contracting officer do not agree on the proposed ciassifioation and wage, rate (including the amount designated for fringe bonetits, where appropriate), the oonaceting officer shall refer the questions, Including the views of all interacted parties and the recommendation of the conlraefing officer, to the Wago and Hour Administrator for determination. The Wage and Hour Administrator, or an authorized representative, will Issue a doterminatlon within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30 -day period that additional time is necessary. (4) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs 1.b.(2) or 1.b.(3) of this section, shall be paid to all workers performing work In the classification under this contract from the first day on which work is performed in the classification. c. Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics Includes a fringe benefit which is not expressed as an hourly rate, the contractor shall either pay the heneflt as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereaf. d. If the contracPor does not make payments to a trustee or other third person, the contractor may consider as part of tha wages of any laborer or meohanlr-the-amount of any casts reasonably anticipated In providing bona fide fringe benefits under a plan or program, provided, That the Secretary of Labor has found, upon the written request of the contractor, that the applicable standards of the Davis -Bacon Act have been met. The Secretary of Labor may require the contractor to set aside In a separate account assets for the testing of obligations under the plan or program.. 2. Withholding The contracting agency shall upon Its own action or upon written request of an authorized representatives of the Department of Labor, withhold or cause to be withheld from the contractor under this contract, or arty other Federal contract with the same prime contractor, or any other federally - assisted contract subject to Davis -Bacon prevalling wage requirements, which is hold by the same pnine contractor, so much of the accrued payments or advances as may he considered necessary to pay laborers and mechanics, Including appienficas, trainees, and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contract, In the event of failure to pay any laborer or mechanic, including any apprentice, trainee, of helper, employed or working on the site of the work, all or part of the wages required by the contract, the contracting agency may, after written notice to the contractor, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. 3. Payrolls and basic records a. Payrolls and basic records relating thorato shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all {sharers and mechanics working at the site of the work. Such records shall contain the name, address, and social security number of each such worker, his or her correct classification, hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in section 1(b)(2)(S) of the Davis -Bacon Act), daily and weekly number of hours worked, deductions made and actual wades paid. V01 slaver the Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv) that the wages of any laborer or mochanic Includes the amount of any costs reasonably anticipated In providing benefits under a pian or program described In section 1(b)(2)(B) of the Davis. Bacon Act, the contrntgr shall maintain records which show that the comini0nont to provide such benefits is enforceable, that the plan or program is financially responsible, and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred In providing such benefits. Contractors employing apprentices of trainees under approved programs shall malntaln written evidence of the registration of apprenticeship programs and certification of trainee programs, the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. b.(1) The contractor shall submit weekly far each week in which any contract work is performed a copy of all payrolls to the contracting agency. The payrolls submitted shall set out accurately and completely all of the information required to be maintained undor 29 CFR'3.3{a)(3)(i), except that full social security numbers and hor ne addresses shall not be included on weekly transmittals. Instead the payrolls shall only need to Include an individually identifying number for each employee e.g. , the last fourdigits of the employee's social security number), This required weekly payroll information may be submitted in any form desired. Optional Form WH -347 is available forthis purpose trom the Wage and Hour Division Wait site at http:;/wvAy,dol.gov/esetwhdtfprms/wh347instr,titm or its successor site. The prime contractor Is responsible for the submission of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the full social security number and currynt address of each covered worker, and shall provide them upon request to the contracting agency for transmission to the State COT, the FHWA or the Wage and Hour Division otthe Department of Labor for purposes of an investlgatlon or audit of compliance with prevailing wage requirements. It is not a violation of this section for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for its own records, without weekly submission to the contracting agency.. (2) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (1) That tine payroll for the payroll period contains the information required to be provided under §5,6 {a)(3)(ii) of Regulations, 29 GFR part 9, the appropriate information Is being maintained under §5.6 (a)(3)(i) of Regulations, 29 CFR part 5, and that such Information is correct and complete; (h) That each laborer or machanlc (including each helper, apprentice, and trainee) employed on the contract during the payroll period has been paid the full weekly wages carried, without rebate, either directly or indh•sally, and that no deductions have been made either directly or indirectly from the full wages earned, other than permisalble deductions as set forth in Regulations, 29 CFR part 3; (1ll) That each laborer or mechanic has boon paid not loss than the applicable wage rates and fringe benefits or cash equivalents for thp, classification of work performed, as specified In the applicable wage determination incorporated into the contract. (3) The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH --347 shall satisfy the requirement for eubrnission of the "Statement of Compliance" required by paragraph 3.b.(2) of this section. (4) The fahificatien of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under section 1009 of title 18 and section 231 of title 31 of the United States Code. c. The contractor or subcontractor shall make the records required under paragraph 3.a. of this section available for inspection, copying, or transcription by authorized representatives of the contracting agency, the State DOT, the FHWA, or the Department of Labor, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submmit the required records or to make them available, tho FHWA may, after written notice to the contractor, the contracting agency or the Stale DOT, take such nation as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upan request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. 4. Apprentices and trainees a. Apprentices (programs of the USDOL). Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship Troining, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or if a person is employed in his or tier first 91) days of probationary employment as an apprentice In such an apprenticeship program, who is riot Ind{vidually registered In the program, but who lies been certified by the Office of Apprenticeship Training, Employer and Labor Services or a £state Apprenticeship Agency (where appropriate) to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices to journeymen on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any worker listed on a payroll at an apprentice wage rate, who Is not registered or otherwise employed as stated above, shall be paid not less then the applicable wage nate on the wage determination far the classfilcation of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shall be paid riot loss than the applicable wage rate on the wage determination for the work actually performed. Where a contractor is performing gonotruction on a project. in a locality other than that in which Its program Is registered, the ratios and wage rates (expressed It, Percentages of the journeyman's hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. Every apprentice must be paid it not less than tine rate specified In the registered program for the apprentice's level of progress, expressed as a percentage of the journeymen hourly rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with the provisions of the apprenticeship program. If the apprenticeship program does not specify fringe benefits, apprentices must be paid the hill amount of fringe benefits listed on the wage determination far the applicable classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved. b. Trainees (programs of the USDOL). Except as provided In 29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered In a program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The ratio of trainees tojourneymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified In the approved program for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. lithe trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding journeyman wage rate on the wage determination which provides for less than hall fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who Is not registered and participating in a training plan approved by the Employment and Training Administration shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any trainee performing work on the job site in excess of are ratio permitted under the registered program shall he paid not less than the applicable wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. e. Equal employment opportunity. The utilization of ,apprentices, tralneeag arid journeymen under this part shall be in oonfoimity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR part 30. J. Apprentices and Trainees (programs of the U.S. DOT). Apprentices and trainees working under apprenticeship and skill training programs which have been certified by the Secretary of Transportation as promoting EEO in connection with Federal -aid highway construction programs are not subject to the requirements of paragraph 4 of this Section IV. The straight time hourly wage rates for apprentices and trainees under such programs will be established by the particular programs. The ratio of apprentices and trainees to journeymen shall not be greater than permitted by the terms of the particular program. 6. Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 GFR part 3, whinh are incorporated by reference in this contract. 6. Subcontracts. The contractor or subcontractor shall insert Form FHWA-1273 in any subcontracts and also require the subcontractors to Include Form FHWA-1273 in any lower tier subcontracts, The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR 5.5. 7. Contract termination: debarment. A breach of the contract clauses in 29 GFR 6,5 may be grounds for termination of the contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR 5.12. 8. Compliance with Davis•Bacon and Related Act requirements. All rulings and Interpretation,$ of the Davis - Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in this contract. 9. Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall not be subject to the general disputes clause of this contract. Such disputes shall be resolved in accordance with the procedures of the Department of Label set forth In 29 CFR parts 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, the U.S. Department of Labor, or the employees or their representatives. 10. Certification of eligibility, a. By entering into this conamof, the contractor certifies that neither It (nor he or she) nor any person or firm who has an interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(x)(1). L, No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract by virtue of section 3(a) of the Davls-Bacon Act or 29 CFR 0.12(7)(1). c. The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. V. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT The following clauses apply to any Federal -aid construction contract in an amount in excess of $100,000 and subject to the overtime provisions of the Contract Work Hours and Safety Standards Act. These clauses shall be insetted in addition to the clauses required by 29 CFR 5.5(a) or 29 CPR 4.6. As used in this paragraph, the terms laborers and mechanics Include watchmen and guards. 1. Overtime requirements. No contractor of subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek In which he of she Is employed on such work to work In excoss of forty hours In such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek. 2. Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth In paragraph (1.) of this section, the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States On the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each Individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (1.) of this section, in the sum of $10 for each calendar day on which such individual was required of permitted to wort( in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth In paragraph (1.) of this section. 3. Withholding for unpaid wages and liquidated damages. The FHWA or the contacting agency Shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to he withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph (2.) of this section. 4. Subcontrg0% The contractor or subcontractor shall Insert In any subcontrewts the clauses set forth in paragraph (1.) through (4.) of this pootian and also a clause requiring the; subcontractors to include these clau9e5 in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (1.) through (4.) of this section. VI, SUBLETTING OR ASSIGNING THE, CONTRACT This provision is applicable to all Federal -aid construction contracts on the National I fighway System, 1. The contractor shall perform with its own organization contract work amounting to not less than 30 percent (or a greater percentage if specified elsewhere In the contract) of the total original contract price, excluding any specialty items designated by the contracting agency. Specialty items may be performed by subcontract and the amount of any such specialty items performed they be deducted from the total original contract price before computing the amount of work required to be performed by the contractors own organization (23 CFR 63 5.116). a. The term "perform work with its own organization" refers 10 workers employed or leased by the prime contractor, and equipment owned or rented by the prime contractor, with or without operators. Such term does not include employees or equipment of a subcontractor or lower tier subcontractor, agents of the prime contractor, or any other assignees, The term may include payments for the costa of hiring leased employees from an employee leasing firm meeting all relevant Federal and State regulatory requirements. Leased employees may only be included in this tern If the prime contractor meets all of the following conditions: (1) the prime centimeter maintains control over the supervision of the day-to-day activities of the leased erripioyees; (2) the prime contractor remahts responsible for the quality of the work of the leased employees; (3) the prime contractor raisins all power to accept or exclude individual employees from work on the project; and (4) the prime contractor remains ultimately responsible for the payment of predetermined minimum wages, the submission of payrolls, statements of compliance and all other Federal regulatory requirements. It. "Specialty Items" shalt be construed to be limited to work that requires highly specialized knowkarrige, alelitles, or equipment net aminadiy available in the type of contracting organizations qualified and expected to bid or propose on the contract as a whole and In general are to be limited to minor components or the overall contract. 2. The contract amount upon which the requirements set forth in paragraph (1) of Section VI is computed Includes the cost of material and manufactured products which are to be purchased or produced by the contractor under She contract provisions. 3. The contractor shall furnish (a) a competent superintendent or supervisor who is employed by the firm, hes full authority tc direct performance of the work in accordance with the contract requirements, and Is in charge of all construction oporatiorm (regardless of who performs the work) and (b) such other of Its own organizational resources (supervision, management, and engineering services) as the contracting office, determines is necessary to assure the performance of the contract. 4, No portion of the contract shall be sublet, assigned or otherwise disposed of except with the written consent of Oho contracting officer, of authorized representative, and such consent when given shall riot be construed to relieve the contractor of any responsibility for the fulfillment of the contract. Written consent will be given only after the contracting agency has assured that each rubconiract is evidenced itr writing and that it contains all pertinent previsions and requirements of the prime contract. 5. The 30% self -performance requirement of paragraph (1) is not applicable to design -build contracts; however, contracting agencies may establish their own self,performance requirements. VPI. SAFETY: ACCIPENT PREVENTION T h 1 s IF r a v i s l a n I s applicable to all Federal-ald construction contracts and to all related subcontracts. 1. In the performance of this contract the contractor shall comply with ail applicable Federal, State, and local laws governing safety, health, and sanitation (23 CFR 636). The contractor shall provide all safeguards, safety devices and protective equipment and take any other needed actions as it determines, or as the contracting officer may determine, to be reasonably necessary to protect the life and health of employees on the job and the safety of the public and to protect property in connection with the performance of the work covered by the contract. 2. It is a condition of this contrac.,t, and shall he made a condition of each subcontract, which the contractor enters into pursuant to Oils contract, that the contractor and any subcontractor shall not permit any employee, In performance of the comraetrto-work in surroundings or under conditions which are gnsamtary, hazardous or dangerous to his(her health at safety, as determined under oonstructim safety and health standards (29 CFR 1926) promulgated by the Secretary of Labor, in accordance with Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.G, 3704). 3, pursuant to 29 CFR 4926.3, It is a condition of this contract that the Secretary of labor or authorized representative thereof, shall have right of antry to any site of contract performance to inspect or Investigate the matter of compliance with the construction safety and health standards and to carry out the duties of the Secretary under Section 107 of the Contract Work Flours and Safety Standards Act (40 U.F.C.3704). Vill, FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS T h 1 s p r o v i s i o n I s applicable to all Federal -aid construction contracts and to all related subcontracts. In order to assure high quality and durable construction in conformity wrth approved plans and specifications and a high degree of raliability art Statements and repre5ontationg made by engineers, contractors, suppliers, and workers on Fedorpl- aid highway projects, It is essential that, all persons concerned with the project perform their functions as carefully, thoroughly, and honestly as posselo. Willful falsification, distortion, or misrepresentation with respect to any facts related to the project is a violation of Federal law. To prevent any misunderstanding regarding the seriousness of these and slariar acts, Form pHWA-1022 shall be posted on each Featers°.rid hghway project (23 CFR 635) in one or more places whore It it, readily available to ail persons concerned with the project: 18 U.S.C. 1090 reads as follows: "Whoever, being an officer, agent, or employee or the United States, or of any State or Territory, or whoever, whether a person, association, firm, or corporation, knowingly makes any false statement, false representation, or false report as to the character, quality, quantity, or cost of the material used. or to be used, or the quantity or quality of the work performed or to be performed, or the cost thereof in connection with the submission of plans, craps, specifications, contracts, or costs of construction on any highway or related project submitted for approval to the Secretary of Transportation; or Whoever knowingly makes any false statement, false representation, false report or false claim with respect to the character, quality, quantity, or cost of any work performed or to be performed, or materials furnished or to be furnished, In connection with the construction of any highway or related project approved by the Secretary of Transportation; or Whoever knowingly makes any false statement or false representation as to material fact tri any statement, certificate, or report submitted pursuant to provisions of the Federal -aid Roads Act approved July 1, 1916, (39 Stat. 355), as amended and supplemented; Shall be fined under this title or imprisoned not more than 5 years or both." IX. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. By submission of this bid/proposel or the execution of this contract, or suboontrect, as appropriate, the bidder, proposer, Federal aid construction contractor, or subcontractor, as appropriate, will be declined to have stipulated as follows: 1. That any person who is or will be utilized In the performance of this contract Is not prohibited from receiving an award due to a violation of Section 308 of the Clean Water Act or Section 303 of the Clean Air Act. 2. That the contractor agrees to Include or cause to be included the requirements of paragraph (1) of this Section X In every aubccnbect, and further agrees to take such action as the contracting agency may direct as a means of enforcing such requirements. X. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION This provision Is applicable to all Federal -aid construction contracts, design build contracts, subcontracts, lower -tier subcontracts, purchase orders, lease agreements, consultant contracts or any other covered transaction requiring FHWA approval or that Is estimated to cost $?5,000 or more v as defined In 2 CFR Parts 190 and 1200. 1. Instructions for Certification — First Tier Participants: a, By signing and submitting this proposal, the prospective first tier participant is providing the certification set out below. b. The friability of a person to provide the certification sat out below will not necessarily result in dental of participation In this covered transaction. The prospective first tier participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective first tier participant to furnish a certification or an explanation shall disqualify such a person from participation In this transaction. c. The certification In this clause is a material representation of fact upon which reliance was placed when the contracting agency determined to enter into this transaction. If It is later determined that the prospective participant knowingly rendered an erroneous certification, in addition to other remedies avallahle to the Federal Government, the contracting agency may terminate this transaction for cause of default. d. The prospective first tier participant shall provide immediate written notice to the contracting agency to whom this proposal is submitted If any time the prospective first tier participant learns that its certification was erroneous when submitted or has become orroneuus by reason of changed circumstances. e. The torms "covered transaction," "debarred," "suspended," "ineligible," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 GFR Parts 180 and 1900. "First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as, subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower "tier Participants (such as subcontractors and suppliers). I. The prospective first tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered Into, it shall not knowingly center into any lower flier covered transaction with a person who Is debarred, suspended, declared Ineligible, or voluntarily excluded from participation In this covered transaction, unless authorized by the department or agency entering into this transaction. g. The prospective first tier participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions," provided by the department or contracting agency, entering Into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. h. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that Is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant Is responsible for ensuring that its principals are not suspended, debamad, or otherwise ineligible to participate In covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (hft s: lw AAy&PsgM/), winch is compiled by the General Services Administration. i. Nothing contained in the foregoing shall be construed to require the establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of the prospective participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. j, Except for transactions authorized under paragraph (f) of these instructions, If a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who Is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 2, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — First Tier Participants: a. The prospective first tier participant certifies to the beat of its knowledge and belief, that It and Its principals: (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency; (2) Have not within a three-year period preceding this proposal been convicted of or had a civil Judgment rendered against them for commission of fraud or a criminal offense in connection with obtalning, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State anfit ust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or loop]) with commission of any of the offenses enumerated in paragraph (a)(2) of this certlflop lon; and (h) Have not within a three-year period preceding this application/prepoaal had one or more public; transactions (F'oderal, State or local) 'terminated for taus@ or default. In. Where the prospective participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. 2. instructions for Certification - Lower Tier participants: (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $26,000 or inure - 2 CFP Parts 180 and 1200) a. By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b, The certification In this clause Is a matedal representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department, or agency with which 10 this transaction originated may pursue available remedies, including suspension and/or debarment. c. The prospective lower tier participant shall provide immediate written notice to the parson to which this proposal is submitted if at any time the prospective lower tier participant learns that Its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended; "'ineligible.," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFP Parts 180 and 1200. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. "First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (suoh as subcontracts). "First Tier Participant" refers to the participant who has entered Into a covered transaction with a grantee or subgranteo of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). a. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered Into, It shall not knowingly enter Into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this, covered iransantion, unless authorized by the department or agency with which this transaction originated, f, 'rho prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding (debarment, Suspension, Ineligibility and Voluntary exclusion -Lower Tler Covered Transaction," without modification, in all lower tier covered transactions and in all sollcltations for lower tier covered transactions exceeding the $25,000 threshold, g. A participant In a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, Ineligible, or voluntarily excluded from the covered transaction, unless.it knows that the certification is erroneous. A participant is responsible for ensuring that Its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website(htt�s.l(�Nv✓y✓.epls.govf), which is compiled by the General Services Administration. h. Nothing contained in the foregoing shall ba construed to require establishment of a system of records in order to render In good falth the certification required by this clause. The knowledge anal information of participant Is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings, I. Except for transactions authorized under paragraph a of these Instructions, if a participant In a covered transaction knowingly unions into a lower tier covered transaction with a person who Is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, In addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, Including suspension and/or debarment. Certification Regarding Debarment, SuspenSlon, Ineligibility and Voluntary Excluslon--Lowar Tier Participants: 1. The prospective louver tier participant Certifies, by submission of this proposal, that neither It nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating In covered transactions by any Federal department or agency. 2. Where the prospective lower tier participant to unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. - XL CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LONNYING This provision is applicable to all Federal -aid construction contracts and to all related subcontracts which exceed $100,000 (49 CFR 20). 1. The prospective participant cedifiec, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: a. No Federal appropriated funds have been pain or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the snaking of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for Influencing or attempting to Influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress In connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying;' in accordance with its instructions. 2. This certification Is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction Imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 3. The prospective participant also agrees by submitting Its bid or proposal that the participant shall require that the language of this -certification be Included in all lower tier subcontracts, which exceed $100,000 and that all such recipients shall certify and disclose accordingly. 11 Klassic Engineering and Construction, INC KEC250 5 Tustin ST. Orange, CA 92866 Proof of Registration with D& B Data Universal Numbering System (714) 369-8389 Klassieplans@gmail.com dun&bradstreet WOkome Keivan Shlrsli I Sign Out Government Update User Profile Transaction History FAQs Contact Us Home iupdme main Manu Wpdate Main Menu Me following comRamos are assoclited woh your prof11P Salort the company too would Illtc: to leviowv then selntt an option from the menu below. EmEm D-U-N-Sg Company Address, City, State u, Sovi Upwdafa O'mcevv + > Uetas Update POlicima mud MQM . > 0 Dun & Bradstreet, Inc., 2000-2015. All rights reserved:- FAQs I Contact Us Klassic Engineering and Construction, INC KEC250 S Tustin ST. Orange, CA 92866 Proof of Registration with System for Award a 0 1 (714) 369-8389 Klassicplans@gmail.com _. Crash......... d® ccolu it:atlon Ind1vid®a®8 1 BM vi.P.1.20111102-1229 WVVWS Viewa i f r u Cr - onPlrmatian Username Password j ......... Log Fn Forgot Username? Forgot Pas6wortl? Create an Account Create Individual Account Account Created- Confirmation �_- Confirmation Well Nov 1513:93:1] EST 2017 4onoratu!atlons — Your SAM amount has been created! But, you All not Acne. We Just sant yam An mmAll be tha email eddying We gnva us sp you can confirm yaar aFI ore@flan. In the email, thee@ Is a IInk that you must Ole, within neo Q hours to adivate your account. For now, click an DI to go hack to the SAM Home pope, Stn, ch RQIeOrds UaF1 Access Disclaimers Check Status Accessibility AbouC Privacy Policy Help This"'o l I S Gxr,l AtM L -tW R11mlf n[ tm,n raw uv:W.m rtut'e"FOR U`pnlAr IshONLY"TAB laselW eoreo. ,M1 TAI ford Ire4om l.. an.I... u,xV.a{'ar ll . are xul{l_ 11. dIv101!:rzry rHou'rduer, cp9M1le`p9cea:4mT FAPIIS.gov GSA.ynv/lAE GSA.gov USA.gov EXHIBIT 1 City of Santa Ana Section 3 Contract Clause These Clauses are to be inserted in all contracts A. The work to be performed under this contract number 15-7538 by and between the City of Santa Ana, hereinafter referred to as "City" and Klnssic F n¢ineerin¢ & Construction Ince hereinafter referred to as "Contractor", is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended 12 U.S.C. 1701u (section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated FIUD assistance or HUD -assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low -and very low-income persons. B, The parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other constraint that would prevent them from complying with the Part 135 regulations. _ C. The contractor agrees to send to each labor organization or representative of workers with which the Contractor has an agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the Contractor's commitments under this Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. D. The Contractor agrees to include a Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, upon a finding that the subcontractor is in violation of the regulations in 24 CFR part 135. The Contractor will not subcontract with any subcontractor where the Contractor has notice or knowledge that the subcontractor bas been found in violation of the regulations in 24 CFR Part 135. E. The Contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the Contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR part 135 require employment opportunities to be directed, were not to circumvent the Contractor's obligations under 24 CFR part 135. F. Noncompliance with regulations in 24 CFR Part 135 may result in sanctions, termination of this contract for default, and debarment or suspension frornfuture HUD assisted projects. The Contractor by this requirements an7d Copt Ana. of Contractor 759241 _A & B Contractor License Number & Designation reto declares under penalty of perjury: Contractor has read City contained therein for all of his/her operations within the City of Santa Keivan Shirati _ C.E.O. 11/t4/17 Print Name and Title Date _ 042098769 _ Federal DUNS Number City of Santa Ana Section 3 Now Hire Calculation Form Project Name: Santa Ana Regional TranaRggation Center Restroom Improvement Project Location: 1000 East Santa Ana Blvd, ._Sarna Street City State Zip Contractor Name: __Pe__k___W Kltassic Engineering & Construction Inc. Contractor Contact: Keivan Shirali ContraetorTelephoneNomber:714t4 9-�38__ __ Contractor Etnail Address: Ktass:ue tans mait.corn — Trade/Craft New 'dotal number of Section 3 residXif/ r(ew hires necessary to comply with contract: �8K4111:3YIE1• Contractor's Section 3 Affirmative Action. Plan Santa Ana Regional Transportation Center Restroom Improvements Projecti*fo. 15 7538_ ProjectNumber anti Title The undersignod contractor agrees to implement the following affirmative action steps directed at increasing the utilization of lower income residents and business concerns located within the County of Orauge. 1, `Pal.e affirmative action to ensure that employses or applicants for employment or training fare not discriminated against because of race, color, religion, sox or national origin, Send a notion of the contractor's Section 3 commitment to each labor organization or representative of workers and post a copy of the notice at a conspicuous place, available to employees and applicants for employment or training. To the greatest extent feasible, make a good faith effort to recruit for etoployinent or training lower income residents from the County, and to award contracts to business concerns which are bested in or owned in substantial part by persons residing in the County through use of. local advertising media, signs placed at the project site and notification to community organizations and public or private institutions operating within or serving the project area such as Service Employment and Redevelopment (SER), Opportunities Industrialization Center (OIC), Urban League, Contracted Employment Program, U.S. Employment Service, Chamber of Commerce, labor unions, trade associations and business concerns. 4. Maintain a file of all low-income area residents who applied for employment or training either on their own or on referral from any source, and the action taken with respect to each area resident. 5. Maintain a file of all business concerns located in the County who sabmittod a bid for work on the project, and the action taken with respect to each bid. 6. Maintain records, including copies of correspondence, memoranda, etc., which document that affirmative action steps have been taken. 7. Incorporate the Section 3 clause provisions in all Section 3 Affirmative Action Plan. Klassic Engineering & Construction I'nc. Company Name 250 S. Tustin St. Orange, Ca. 92866 Address! Street, City, State, Zip O42098769 DUNS Number U of Keivan Shirali Printed Name subcontractor(s) to submit a C.E.O. Title Y � EXHIBIT 9 City of Santa Ana Section 3 Contract Award Consideration Bidder's Name: d lassic Kagnneerig & Construction Inc. Please check the numbered statement that is applicable to your business: 1. Yd My business qualifies as a Section 3 business concern: If you have checked statement ZJILUI E➢11 please read the attached Section 3 Business Concern Preference - Bidding Requirements. (Please check the applicable grjalification for statement number 1) 51% owned by Section 3 residents; or Permanent, full-time employees include at least 30% Section 3 residents; or Will subcontract more than 25% of the dollar award of all subcontracts to be awarded to business concern(s) that meet either of the two preceding qualifications. Note: You are required to list all subcontractors and owner -operators in your bid statement. 2. My business does not qualify as a Section 3 business concern. Note: Section 3 business i Manual within tlsection of Business Keivan Shirali Print Name U= are located in this project's Contract Documents & Specifications 3 Economic Opportunities Plan. 11/14/17 _ Date EXHIBIT 12 CITY OF SANTA ANA WOMFN OWNED NoRi'rYBuS Es OIANED F;N'rF, RISES (W/MBE) GOOD FAITIT EFTFORTS Pursuant to 24 CFR Part 85 § 85,35 (e) of Code of Federal Regulations, contractor trust take all necessary affirmative steps to assure than minority business firms, women's business enterprises and labor surplus firers are. used whenever passible. Contractor shall submit the following information to dumoustratc that to goof faith tAw has been made to comply with the above section of the Code of Federal Regulations, Submittal of this 'form, in and of itself, may not provide sufficient documentation to demonstrate that goof faith effort was made, Documentation such ars copies of advertisement, letters of solicitation, telephone logs, rejected quotes, etc. should accompany this form. 1. The names and dates of advertisement of each newspaper, trade paper, and minority -focus paper in which a request for W/MBE participation for this project was, placed by the bidder: 2. The names and dates of written notices sent to W/MBF soliciting bids for this project and methods used for following up initial solicitation to determine with certainty whpthcr the W/MFIE were interested, The items of work whiol7 the bidder tnrade available to W/MBE Funis, including, where appropriate, any breaking down of the contracts into economically feasible units to facilitate W/MBE participation, and the information firrnished to W/MBE such as plans, specifications, ,aid requirea eats forthe work. Items of Work: '>,A'rNT'iAjrr Q Breakdown of Items: t) QJJ Information Furnished: C— MceA ,-+(D ' i I'- Q'V'-O% R\0003\PRQPSV(;Mi iUDFORMS° MHU5QQ4AMB- 5edion$Spoos. 00r EXHIBIT 12 (cont.) 4. Efforts made to assist W/MBE in obtaining bonding, lanes of credit or insurance, and any technical assistance related to the plans, specifications and requirements for the work which was provided to W/MBE: 5. Any additional data to support a demonstration of good faith effort, such as contr,3cts with W/MBE assistance agencies: I declare under penalty ofperjury that the foregoing information is true and correct to the best of my knowledge. I understand that the City ofSanta,4na aWlor the US. Department of Housing and Urban Development may verify the information provided hereini.n co cti n with WIMBE compliance evaluation/audit activities and that failure fo filly and truthfully comp i'his f resultin economic or other sanctions. Si uature: Klassie Engineering & Construction Inc. Name:--- Keivan Shit li�� Title: C.E.O. Date: Name of contractor/Satbcoantraetor: Klassie Engineering & Construction Inc. Contractor/Subcontractor Identification�� Number: 042098769 Address (Street, city, 250 S. Tustin St. Orange, Ca, 92866 Business Racial/Ethnic/Gender Code: Chicle the numeric code which indicates the racial/ethnic/gender character of the owner(s) and controller(s) of 51% of the business. When 51% or more is not owned and controlled by any single racial/ethnicity/gender category, circle the code which seems most appropriate. 1 = White Americans 2 — Black Americans 3 =Native Americans Woman Owned Business: Circle One: Yes 1 0 4 = Hispanic Americans 5 = Asian/Pacific Americans 6 = Hasidic Jews No F.\DOCS\PROPSVCS\HUDFORMS\MBU56U4AM0 - Sectlon35pecs. DOC NON COL LUSION AFFID AVIT {Title 23 United States Code Section 112 and Public Contract Code Section 7106} To the City of, Santg t DEPARTMF;NT QFPUBLIC WORKS In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106, the bidder declares that the bid is not made in the interest of, or on behalf" of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or coat 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. Klassic Er neeri & Construction Inc. Name of Contractor Address f 11/14/1 Date sectionespecs COC and Title b C.E.O. EXHIBIT 16 FEDERAL LOBBYIST REQUIREMENTS CERTIFICATION idaine of Firam: Iilassic En&nieeruDe &Construction Inc. —Date: -LUJ /17 Address: 250 �S II stint. State: Ca, 'IRS_:.. , Zip Code: 92866 'T'elephone: Z 9-83$2 Apting on behalf of the above-named firm as its Authorized Official, 1 make the following Certification to the Department of Housing and Urban Development (HUD) and the Community development Cou mission, County of Los Angeles, 1) No Federal appropriated funds have been paid, by or on behalf of the above-named firm to any person for influencing or attempting to influence; an affloer or elraployee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, loan, or cooperative agreement, arid] any extension, continuation, renewal, amendment, or modification thereof, and 2) ff any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employed or any 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 above-named turn shall coanpleto and submit Standard Form -LLL, "Disclosure Form to report Lobbying" in accordance with its instructions; and 3) The above, -named firm shall require that the language of this certiffwation be included in the award documents for all sub -awards at all tiers (including subcontracts, sub -grants, and contracts gander grants, loans, and cooperative agreements) and that all sub -recipients shall certify and disclose accordingly. 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 raking or entering into the transaction unposed by Section 1352 Title 31 U,S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not 1055 than $10,000 and not more than $100,060 for each such failure. Authorized Official: Name: Signatur F'.\DOGS,IPROPSVCS\HUnBORMS\M@U5804AM0- Seetlon35pecs.00C 1"itle. U.k,.C7. Date: EXHIB111 17 CERTIFICATION OF UNDERSTANDIN01 AND AUTIJORIZATiON Project Name: 5.21jtqAjK4 C ion �qj-tqr Res -t -room Renovat' Project Nomber: J5-7538 This is to certify that the, principals and the authorized payroll officer, below, have read and understand the labor standards clause,,, pertaining to the subject project. The following person(s) is designated as the payroll officer for the undersigned arid is authorized to sign the Statement of Corriplimice, Which Will accompany our weekly cerfliled payroll reports, for this, project; kh S �Mtdrl Pay 0 N, e palyro I , Klw,,sic Keivan Shirali CE.O. Title 11/14/17 Date 759241 Contractor/Subcontractor Licetise No. DUNS Number Tma cj� a Ism lt53ca ------- --- - - -- ---- p��� -1�o NST Wrt� 'P��(uc� MAIL " CITY OF SANTA ANA BONDS PROJECT NO.: 1.5-7538 Bond No.: CMGP0001036 Premium: Included in the Performance Bond Executed in Three (3) Originals ?VP F77 .at4 " 7: ")7 PAYMENT BO , "y 0c L t'� ��... ..... i KNOW ALL MEN BY THESE PRESENTS that Klassic Engineering & Construction, Inc. as CONTRACTOR, and Argonaut Insurance Company a corporation, organized and existing under the laws of the State, and duty authorized to transact business under the laws of the State of California, as SURETY, are held and firmly bound unto the City of Santa Ana, as AGENCY, in the penal sum of Two Hundred Ninety Six Thousand Seven Hundred Thirty Five and 00/100----------------------------------------------------------------, Dollars ($ 296,735.00 ), 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 January 16th, 2018 for Santa Ana Regional Transportation Center Restroom Renovation 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 Unemp,toyment 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 6th day of February , 2018 . Klassic Engineering & -Construction, Inc. CONTRACTOR* 250 S. Tustin St., Orange, CA92866, P. Number: 714-369-8389 Argonaut Iplurance Company, Subscribed and worn to before me, 20 Signature: ** SEE ATTACHED DOCUMENT ** Notary Public in and for the County of State of Rate of premium on this bond is $ 22.5 P. this day of thousand. Total amount of premium charge is $ 6,677.00 (Six Thousand Six . To be filled in by Surety Hundred Seventy Seven and 00/100 Dollars *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. CMGP0001036 Argonaut Insurance Company $6,677.00 Deliveries Only: 225 W. Washington, 24th Floor Chicago, IL 60606 United States Postal Service: P.O. Box 469011, San Antonio, TX 78246 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the Argonaut Insurance Company, a Corporation duly organized and existing under the laws of the State of Illinois and having its principal office in the County of Cook, Illinois does hereby nominate, constitute and appoint Gabriella Gradv- Shilo Lee Losino. Stephanie Hone Shear -` Their true and lawful agent(s) and attomey(s)-in-fact, each in their separate capacity if more than one is named above, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all bonds, contracts, agreements of indemnity and other undertakings in suretyship provided, however, that the penal sum of any one such instrument executed hereunder shall not exceed the sum of: - $10.000.000.00 This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolution adopted by the Board of Directors of Argonaut Insurance Company: "RESOLVED, That the President, Senior Vice President, Vice President, Assistant Vice President, Secretary, Treasurer and each of them hereby is authorized to execute powers of attorney, and such authority can be executed by use of facsimile signature, which may be attested or acknowledged by any officer or attorney, of the Company, qualifying the attorney or attorneys named in the given power of attorney, toexecute in behalf of, and acknowledge as the act and deed of the Argonaut Insurance Company, all bond undertakings and contracts of suretyship, smile affix the corporate seal thereto." IN WITNESS WHEREOF, Argonaut Insurance Company has caused its official seal to be hereumto affixed and these presents to be signed by its duly authorized officer on the 8th day of May, 2017. - ,,,a;,,,,, Argonaut Insurance Company Fri ^• SEALIN n tvaa , ,z b 110 il Joshua C. Betz, Senior Vice President STATE OF TEXAS ""•,"'. ""*""" COUNTY OF HARRIS SS: On this 8th day of May, 2017 A D , before me, a Notary Public of the State of Texas, in and for the ComTy of Harris, duly commissioned mid qualified, came THE ABOVE OFFICER OF THE COMPANY, to me personally lmown to be the individual and officer described in, and who executed the preceding instrument, and he acknowledged the execution of same, mid being by me duly sworn, deposed mid said that he is the officer of the said Company aforesaid, and that the seal affixed to the preceding instrumentis the Corporate Seal of said Company, and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said corporation, and that Resolution adopted by the Board of Directors of said Company, referred to in the preceding instrument is now in force. IN TESTIMONY W111PREOF, I have hereunto set my hand, and affixed my Official Seal at the County of Harris, the day and you fust above written. .4. rnTwaur:nn +s . nnetrr,8 '9� ^Navzry, u�l c, 3tuto atroxac g F': i�.: C.,..,. ExpirAp tn-nt^-802t (Notary Public) tdutury to ss-mU2•e 1, the undersigned Officer of the Argonaut Insurance Company, Illinois Corporation, do hereby certify that the original POWER OF ATTORNEY of which the foregoing is a full, true and correct copy is still in full force and effect mid has not been revoked. IN WITNESS WHEREOF, I have hereunto set my hand, and affixed the Seat of said Company, on the 6th day of February '2018 Sarah Heineman , VP -Underwriting Surety THIS DOCUMENT IS NOT VALID UNLESS THE WORDS ARGO POWER OF ATTORNEYARE IN BLUE. IF YOU HAVE QUESTIONS ON AUTHENTICITY OF THIS DOCUMENT CALL (210) 321- 8400. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 LA notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of LOS ANGELES On FEB 062018 before me, Date personally appeared RILEY GIGGLES, NOTARY PU Here Insert Name and Title of the Officer E HOPE SHEAR Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) 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 h.4ial seal. SHIRLEY GIGGLES M7'". ' Notary Public • California ^'. Los Angeles County Signature Cornmission # 2163817 of Notary Public My Comm. Expires Sep 7.2020! 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: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 02014 National Notary Association • www. National Notary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5907 CITY OF SANTA ANA BONDS PROJECT NO.: 15-7538 FAITHFUL PERFORMANCE BOND Bond No.: CMGP0001.036 Premium: $6,677.00 Executed in Three (3) Original, KNOW ALL MEN BY THESE PRESENTS that Klassic Engineering & Construction, Inc. as CONTRACTOR, and Argonaut Insurance Company , a corporation, organized and existing under the laws of the State, and duly authorized to transact business render the laws of the State of California, as SURETY, are held and firmly bound unto the City of Santa Ana, as AGENCY, in the penal sun of Two Hundred Ninety Six Thousand Seven Hundred Thirty Five and 00/100----------------------------------------------------------------. Dollars ($ 296,735.00 ), 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 eater into the annexed Contract Agreement with AGENCY dated January ;16th, 2018 for Santa Ana Regional Transportation Center Restroom Renovation, 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 nult 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 6th day of February 2018 . Klassic Engineering & Construction, Inc. CONTRACTOR* 250 S Tustin St Orange CA 92866 P Number: 714-369-8389 onaut Insurance Company, SURETY C!_ CMGIA - 20335 Venturn 11 Subscribed and sworn to before me, this day of 20 Signature: ** SEE ATTACHED DOCUMENT *r Notary Public in and for the County of State of Rate of premium on this bond is $ 22.5 per thousand. Total amount of premium charge is $ 6,677.00 (Six Thousand Six , To be filled in by Surety Hundred Seventy Seven and 00/'100 Dollars) "`Provide CONTRACTOR / ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. CMGP0001036 Argonaut Insurance Company $6,677.00 Deliveries Only: 225 W. Washington, 24th Floor Chicago, IL 60606 United States Postal Service: P.O. Box 469011, San Antonio, TX 78246 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the Argonaut Insurance Company, a Corporation duly organized and existing under the laws of the State of Illinois and having its principal office in the County of Cook, Illinois does hereby nominate, constitute and appoint Gabriella Gradv- Shilo Lee Losino. Stenhani Their true and lawful agent(s) and attomey(s)-in-fact, each in their separate capacity if more than one is named, above, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all bonds, contracts, agreements of indemnity and other undertakin s in suretyship provided, however, that the penal sum of any one such instrument executed hereunder shall not exceed the sum of $10.000.00000 - This Power of Attorney is granted mrd is signed and sealed under and by the authority of the following Resolution adopted by the Board of Directors of Argonaut Insurance Company: "RESOLVED, That the President, Senior Vice President, Vice President, Assistant Vice President, Secretary, Treasurer and each of them hereby is authorized to execute powers of attorney, and such authority can be executed by use of facsimile signature, which may be attested or acknowledged by any officer or attorney, of the Company, qualifying the attorney or attorneys named in the given power of attorney, to execute in behalf of, and acknowledge as the act and deed of the Argonaut Insurance Company, all bond undertakings and contracts of suretyship, and to affix the corporate seal thereto." IN WITNESS WHEREOF, Argonaut Insurance Company has caused its official seal to be hereunto affixed and these presents to be signed by its duly authorized officer on the 8th day of May, 2017. e - Argonaut Insurance Company P ,Pea .: by. '•.4t!Vrn?',: r "ran �. Joshua C. Betz, Senior Vice President STATE OF TEXAS COUNTY OF HARRIS SS: - On this 8th day of May, 2017 A.D, before me, allotary Public o'fthe State of Texas, in and for the County of Harris, duly commissioned and qualified, carne THE ABOVE OFFICER OF THE COMPANY, to me personally (mown to be the individual and officer described in, and who executed the preceding instrument, and he acknowledged the execution of same, and being by me duly sworn, deposed and said that he is the officer of the said Company aforesaid, and that the seal affixed to the preceding instrumefdis the Corporate Seal of said Company, and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said corporation, and that Resolution adopted by the Board of Directors of said Company, referred to in the preceding insrt meet is n6w in force, IN TESTIMONY WHEREOF, I have hereunto set my hand, and affixed my Official Seal at the County of Harris, the day and year first above written. a+>" Ka\ThIl4Ef5 A.�MEERS -"-�hwfl, ^ uAo ftin. §y'-SJniury Fl bl'v, ticpte al 7oxuy X4 F Ccmrn. Ergs. pl-,S 2P21 (Notary Public) ��'�.iinvr"` NOIa+p IQ G;iy9U$•9 I, the undersigned Officer of the Argonaut Insurance Company, Illinois Corporation, do hereby certify that the original POWER OF ATTORNEY of which the foregoing is a full, true and correct copy is still in full 'force and effect and has not been revoked. IN WITNESS WHEREOF, I have hereunto set my timid, and affixed the Seal of said Company, on the 6th day of February 2018 -. 4tSL"Alsi i f'�/f/ta.•(_— "a%C oda:, ansae lv,; `'•�f!N9!g"' Sarah Heineman , VP -Underwriting Surety THIS DOCUMENT IS NOT VALID UNLESS THE WORDS ARGO POWER OF ATTORNEYARE IN BLUE. IIP YOU HAVE QUESTIONS ON AUTHENTICITY OF THIS DOCUMENT CALL (210) 321 - 8400. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 ��di ��'�'".,,�T FSY'�T('�f�F'"Eli`C�'d3�rtl'ydilt"dntia`�P,Cx�"ra'k�d�£Y`.{:�n ihl2ka'Yh]lddSr 21'lti';k�d'1K:1.(+`C`h:.Ck."�i,� A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of LOS ANGELES On FEB n 6 2018 before me, SHIRLEY GIGGLES, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared STEPHANIE HOPE SHEAR Name(s) of Signers) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. .sr SHI GLES Notary Public - California CCS a .' ro.... Los Angeles County y Z , ,y,�.,sa COMMISelen # 2163817 My comm. Expires Sep 7, 2020 Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand nd official seal. Signature Si e of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): El Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: ©2014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907