Sully Miller Contracting Co......... - - - -- - -,
P
SECTION 1- BID SCHEDULE
BIDDER: Sully - Miller Contracting Co.
BID SCHEDULE
SCHEDULE OF PRICES FOR
WHITMORE AVENUE STREET RESURFACING PROJECT — PHASE 1
CDBG PROJECT No. P46029
BASE BID SCHEDULE
CBF -1
UNIT OF
EST.
UNIT
ITEM
NO.
REM DESCRIPTION
MEASURE
QTY.
PRICE
COST
1
Clearing & Grubbing per plans and
specifications per Section 02230
and Section 2 of the technical
provisions complete.
LS
1
7 D�
2
Disposal of Waste Materials.
LS
1
ydoo ,
aoo.
3
Place Compacted Selected Fill.
CY
100
4
Earthwork, Roadway, Excavation
and Fill.
LS
1
y70.
5
Cold Mill existing AC pavement
from 1" to 3" variable depth as
/$
indicated on the plans.
SF
65,650
8'1 7,
6
Construct 2 -Inch ARHM GG -C (PG
64 -16).
TONS
850
03.
70 SSo
7
Construct 1 -Inch Asphaltic Leveling
Course D1 PG 64 -10.
TONS
425
8
Remove 8- inches of existing
pavement and replace it with 6-
inches of AC B -PG 64 -10 Base
o
/
Course over compacted native.
SF
250
/a,S
dS•
9
Remove and Construct 4 -Inch
Thick PCC Sidewalk.
SF
3,250
10
Remove and Construct PCC Curb
and Gutter per APWA Std Plan
`�,
-7
120 -1.
LF
200
V,
11
Remove and Construct PCC
Driveway approach per APWA Std
PIan110 -1.
SF
1,850
�,aO
/33do.
12
Adjust Sewer Manhole to Grade.
EA
8
/0 3 .
S 30 ,
13
Adjust Water /Gas Valve to Grade
EA
9
3�S /
635,
CBF -1
BIDDER-Sully-Miller Contracting Co.
14
Install Survey Well Monument per
UNIT OF
EST.
UNIT
ITEM
NO.
City of Rosemead Std. Plan No.
MEASURE
QTY.
PRICE
COST
16
S08 -001 see appendix "A" per
detail. See Section 12 of the
technical provisions per details.
EA
2
-710.
yao.
15
Install Traffic Striping and
LS
1
SOn
/
Pavement Markers.
LS
1
/ 000 .
000.
TOTAL BASE BID PRICE (SCHEDULE BID PRICE): $ 0 OS� a 9�
7woN,4/,9Pro 6 Zye- Tha,5A,,.-O 'r,40I�NokF9. L✓ETYo.✓EtD«,,f✓tS.
Dollar amount in written form
ALTERNATE BID ITEM 1
TOTAL ALTERNATE BID # 1 PRICE (SCHEDULE BID PRICE): $
Dollar amount in written fc
ALTERNATE BID ITEM 2
NO.
ITEM DESCRIPTION
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
16
Install Irrigation System and
Landscape.per Plans 1-1.01, L2.01,
L3.01, L4.01 and 1-4.02 and
specifications complete.
LS
1
SOn
TOTAL ALTERNATE BID # 1 PRICE (SCHEDULE BID PRICE): $
Dollar amount in written fc
ALTERNATE BID ITEM 2
NO.
ITEM DESCRIPTION
UNIT OF
MEASURE
EST.
QTY.
UNIT
PRICE
ITEM
COST
17
Remove and dispose existing chain
link fence and construct 8 -feet high
block wall per plans S1 and S2
complete including 12 feet wide
and 8 feet high galvanize metal
gate (paint black). See appendix
"A" per details.
LF
125
aQ ci ,
'a S 000.
TOTAL ALTERNATE BID # 2 PRICE (SCHEDULE BID PRICE): $ of sf (b0. /
Dollar amount in written
CBF -2
BIDDER:Sully- Miller Contracting Co.
ALTERNATE BID ITEM 3
NO.
ITEM DESCRIPTION
UNIT OF
MEASURE
EST.
QTY.
UNIT
PRICE
ITEM
COST
18
Install 24 -Inch Box Parkway Tree
MEASURE
QTY.
PRICE
COST
19
Bradford Pear(Pyrus Calleryana)
per APWA Std. Plan 520 -3
EA
85
r5•
l
including 90 days maintenance
/
y%O
CO
period.
EA
32
/y 7-
TOTAL ALTERNATE BID # 3 PRICE (SCHEDULE BID PRICE): $ 1 % -7a-0•
POUVMT , THOUfA,✓D SarAl / W012i5-D 7G/6,✓Ty QDtiAl2f
Dollar amount in written form
ALTERNATE BID ITEM 4
TOTAL ALTERNATE BID # 4 PRICE (SCHEDULE BID PRICE)
wE2-1/E wwo/uw
Ilar amount in written form
/, a, %S• /
TOTAL BASE BID PRICE INCLUDING ALTERNATES (SCHEDULE BID PRICE):$ a5 71 /
Dollar amount in written form
The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which
cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and
after the bid opening, date, or until a Contract for the Work is fully executed by the Owner and a third
party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the
written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall
govern.
If the Bid Documents specify alternate bid items, the following Alternate Bid amounts shall be
added to or deducted from the Total Bid Price entered above. The owner can choose to
include one or more of the alternates in the Total Bid Price of the Project. If any of the.
Alternate Bids are utilized by the Owner, the resulting amount shall be considered the Total
Bid Price for the Project.
CBF -3
UNIT OF
EST.
UNIT
ITEM
NO.
IT EM DESCRIPTION
MEASURE
QTY.
PRICE
COST
19
Paint Home Addresses (Curb
Numbering)
EA
85
r5•
l
TOTAL ALTERNATE BID # 4 PRICE (SCHEDULE BID PRICE)
wE2-1/E wwo/uw
Ilar amount in written form
/, a, %S• /
TOTAL BASE BID PRICE INCLUDING ALTERNATES (SCHEDULE BID PRICE):$ a5 71 /
Dollar amount in written form
The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which
cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and
after the bid opening, date, or until a Contract for the Work is fully executed by the Owner and a third
party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the
written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall
govern.
If the Bid Documents specify alternate bid items, the following Alternate Bid amounts shall be
added to or deducted from the Total Bid Price entered above. The owner can choose to
include one or more of the alternates in the Total Bid Price of the Project. If any of the.
Alternate Bids are utilized by the Owner, the resulting amount shall be considered the Total
Bid Price for the Project.
CBF -3
BIDDER Sully-Miller Contracting Co.
Attached hereto is a certified check, a cashiers check or a bid bond in the amount of
10% of Did**
Dollars ($ ° * "* *) said amount being not less than ten percent (10 %) of the Total
Bid Price. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
we fail or refuse to execute the Contract and furnish the required bonds, certificates and
endorsements of insurance and other certifications within the time provided.
If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be
prepared by the Owner for execution, within five (5) Calendar Days following the Letter of Award for
the Contract, and will deliver to the Owner within that same period the necessary original Certificates
of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other
documentation and certification required by the Contract.
The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and
become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of Bidders California contractor's license(s) in good standing; (2) evidence
that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting
therefrom; and (3) any other information and documentation, financial or otherwise, needed by
Owner to award a Contract to the lowest responsible and responsive bidder.
Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
and subject to the terms and conditions described in the Contract Form and the Contract
Documents.
Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be
incorporated into a Contract arising out of this Submittal has been so identified by Bidder. Bidder
further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data
submitted herewith into a contract arising out of this Bid.
The undersigned acknowledges receipt, understanding and full consideration of the following
addenda to the Contract Documents.
Addenda Nos
The Bidder understands and agrees that the Total Bid Price is inclusive of all labor, materials, and
equipment or supplies necessary to complete the Work as described in the Bid Documents. If this
bid is accepted, the undersigned Bidder agrees to enter into and execute the Contract with the
necessary bonds and accept the Total Bid Price as compensation in full for all Work under the
contract.
CBF -4
By:
Signature
Michael'Edwards
Type or Print Name
Vice President
Title
BIDDER: c- M;1ler Contracting Co.
1100 E. Orangethorpe Ave., Ste. 200
Business Street Address
Anaheim, Ca 92801
City, State and Zip Code
714 -578 -9600
Telephone Number
Bidder's /Contractor's State of Incorporation: Delaware
Partners or Joint Venturers: *PLEASE SEE ATTACHED LIST OF CORPORATE OFFICERS*
Bidder's License Number(s): 747612 -A
NOTES:
1) By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the
representations made on the Contract Bid Forms.
2) If Bidder is a corporation, enter State of Incorporation in addition to Business Address
3) If Bidder is a partnership or joint venture, give full names of all partners or joint
venturers.
As further discussed in the Instructions to Bidders, Bidder will be required
to provide evidence that the person signing on behalf of the corporation,
partnership or joint venture has the authority to do so.
CBF -5
STATE OF CALIFORNIA l
COUNTY OF ORANGE Jj
On March 2, 2010 before me, J. Daniels, Notary Public, personally appeared Michael Edwards
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name 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
e °.,44e..e..e44s+e J DANIELS which the person(s) acted, executed the instrument.
COMM # 1813952 m
I certify under PENALTY OF PERJURY under the laws of
W NOTARYPUBLIC- CUNTYNIA ]7 the State of California that the foregoing paragraph is true
Q '. ORANGE COUNTY s
My commission Expires Sept 244, 2�N� and correct.
0000009400000000000000 0000NOOOON
WITNESS my hand and ooffi�/'fal seal .
Signaturey1r(��l
J. D els, Notary Public
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document: Bid Proposal - Signature Page
Document Date: March 2, 2010 Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s):
Signers Name
❑ Individual
Michael Edwards
FX corporate Officer — Title(s)
❑ Partner— Limited /General
Attorney In Fact
Trustee
❑ Guardian or Conservator
❑ Other
Vice President
Right Thumbprint
of Signer
Signers Name
❑ Individual
❑ Corporate Officer — Title(s)
❑ Partner — Limited /General
Attorney In Fact
Trustee
Guardian or Conservator
❑ Other
Signer is Representing: SULLY - MILLER CONTRACTING COMPANY
Right Thumbprint
of Signer
CERTIFICATE OF INCUMBENCY AND RESOLUTION
I, Gary Downey, do hereby certify that I am. the Assistant Secretary of Sully - Miller Contracting
Company, a Delaware corporation, and that as such I have access to and custody of the corporate
records and minute books of said corporation.
And I do hereby further certify that the following persons are duly elected officers of said
corporation.
TITLE
NAME
Chairman of the Board
Gordon R. Crawley
President
David Martinez
Chief Financial Officer /Treasurer /Vice President
Timothy P. Orchard
Vice President /Assistant Secretary
Michael Edwards
Secretary
Anthony L. Martino 11
Assistant Secretary
George Aldrich
Assistant Secretary
Scott Bottomley
Assistant Secretary
Gary Downey
I further certify that the following is a true and correct copy of a resolution duly adopted by the
Board of Directors of said Company at a meeting held on January 16`x', 2009, and that this
resolution has not been in any way rescinded, annulled, or revoked but the same is still in full
force and effect:
"AUTHORITY TO EXECUTIVE BIDS AND CONTRACTS"
Resolved, that any officer or assistant officer of this Company be and each of them is
hereby authorized to execute in the name and on behalf of this Company under its
corporate seal any and all proposals for the sale of products, merchandise and services of
this Company and any bids and performance bonds required in connection therewith, to
the United States, and of the State, territories and dependencies of the United States, the
District of Columbia, cities, towns, townships, counties, school districts, and to the
department, political subdivisions, agencies or wholly -owned corporations thereof, or to
any other person."
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal this 9 °i
day of February 2009. �- --�
(SEAL) Gary D wney /Assistant
Sully- iller Contracting
00 E. Orangethorpe A,
-.1 _Anaheim. CA 92801/
200
SECTION 2
BID DATA FORMS
CBF - 6
BIDDER: Sully - Miller Contracting Company
Bidder shall submit its Bid data in accordance with the format shown on each of the following Bid
Data Forms. Bidders shall prepare and use as many sheets as are necessary to adequately provide
the information required. Bidder shall ensure that every page of its Bid Data Forms is properly
identified with the Bidder's name and page number.
2.A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT Sully- Miller Contracting Company as
Principal, and Liberty Mutual Insurance Company
as Surety, are held firmly bound unto the CITY
OF ROSEMEAD (hereinafter called the OWNER) in the sum of
Ten percent of amount bid
DOLLARS
($ 10% 1, being not less than ten percent (10 %) of the Total Bid
Price; for the payment of which sum will and truly to be made, we bind ourselves, our
heirs, executors, administrators, successors, and assigns, jointlyand severally, firmly
by these presents.
WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work
i required for the Whitmore Avenue Street Resurfacing Project — Phase I as set
forth in the Notice Inviting Bids and accompanying Bid Documents, dated
3/3/2010
NOW, THEREFORE, if said Principal is awarded a Contract for the Work by the
OWNER and, within the time and in the manner required by the above- referenced
Bid Documents, enters into the written form of Contract bound with said Bid
Documents, furnishes the required bonds (one to guarantee faithful performance and
the other to guarantee payment for labor and materials) furnishes the required
insurance certificates and endorsements, and furnishes any other certifications as
may be required by the Contract, then this obligation shall be null and void; otherwise
it shall remain in full force and effect. In the event suit is brought upon this bond by
the OWNER and judgment is recovered, said Surety shall pay all costs incurred by
the OWNER in such suit, including reasonable attorneys' fees to be fixed by the
court.
SIGNED AND SEALED, this 22 day of February , 20 to .
Sull -Mille Contracting Company. (SEAL) Liberty Mutual Insurance Company (SEAL)
Principal Surety
By: By:
ignat a Si cyr attire victoria M. Campbell, Attorney -in -Fact
Michael Edwards, Vice President
CBF -7
STATE OF CALIFORNIA l
COUNTY OF ORANGE Jj
On March 2, 2010 before me, J. Daniels, Notary Public, personally appeared Michael Edwards
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document:
: o C°1•
Document Date: February 22, 2010 Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s):
Signer's Name Michael Edwards
Individual
Corporate Officer — Title(s)
❑ Partner — Limited /General
E] Attorney In Fact
Trustee
❑ Guardian or Conservator
Other
Vice President
Right Thumbprint
of Signer
Signers Name
Individual
Corporate Officer — Title(s)
❑ Partner — Limited /General
❑ Attorney In Fact
Trustee
Guardian or Conservator
❑ Other
Signer is Representing: SULLY - MILLER CONTRACTING COMPANY
1
Right Thumbprint
of Signer
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name 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
a°0O ° °` °°` ° ° J °.N«
instrument the person(s), or the entity upon behalf of
DANIELS
COMM # 1813952 m
which the person(s) acted, executed the instrument.
C NOTARYPUBLIC - CALIFORNIA y
W
I certify under PENALTY OF PERJURY under the laws of
ORANGE COUNTY +
Q my Commission Expires Sept 24,2012
the State of California that the foregoing paragraph is true
t° ° °ON>I °ONON °N °N ° °1N ° °N°
and correct.
WITNESS my hand and official seal
Signature 94A'0�
X Daniels, Notary Public
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document:
: o C°1•
Document Date: February 22, 2010 Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s):
Signer's Name Michael Edwards
Individual
Corporate Officer — Title(s)
❑ Partner — Limited /General
E] Attorney In Fact
Trustee
❑ Guardian or Conservator
Other
Vice President
Right Thumbprint
of Signer
Signers Name
Individual
Corporate Officer — Title(s)
❑ Partner — Limited /General
❑ Attorney In Fact
Trustee
Guardian or Conservator
❑ Other
Signer is Representing: SULLY - MILLER CONTRACTING COMPANY
1
Right Thumbprint
of Signer
CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT
State of California
County of Orange
On February 22, 2010 before me,Kim Heredia, Notary Public
DATE NAME, TITLE OF OFFICER - E.G., "JANE DOE, NOT PUBLIC"
personally appeared Victoria M. Campbell , who
proved to me on the basis of satisfactory evidence to be the person(s) whose names (s) is /aFe
subscribed to the within instrument and acknowledged to me that the /she /they executed the same in
this /her / theiF authorized capacity(ies), and that by this /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 hand and official seal.
KIM HEREDIA h
F .ry. COMM. If1757050 co
C i 0
NOTARY PUBLIC - CALIFORNIA (
m
ORANGE COUNTY
_I MY Comm, fi.piryy July 11,2011
SIGNATURE OF NOTARY
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER
❑INDIVIDUAL
❑CORPORATE OFFICER
TITLE(S)
❑ PARTNER(S) ❑ LIMITED
❑ GENERAL
® ATTORNEY -IN -FACT
❑ TRUSTEE(S)
❑ GUARDIAN /CONSERVATOR
❑ OTHER:
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
DESCRIPTION OF ATTACHED DOCUMENT
TITLE OR TYPE OF DOCUMENT
NUMBER OF PAGES
FEB 2 2 2010
DATE OF DOCUMENT
BIDDER: Snl l y -M; 1 1 Pr C'nntrarting Co.
2.13 LIST OF PROPOSED SUBCONTRACTORS
In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100
through 4114 of the California Public Contract Code, and any amendments thereto, each
Bidder shall provide the information requested below for each subcontractor who will perform
work, laboror render service to Bidder in or about the construction of the Work in an amount
in excess of one -half of one percent (greater than 0.5 %) of the Bidders Total Bid Price, or,
in the case of bids or offers for the construction of streets or highways, including bridges, in
excess of one -half of 1 percent of the Contractor's total bid or ten thousand dollars ($10,000),
whichever is greater, and shall further set forth the portion of the Work which will be done by
each subcontractor. Bidder shall list only one subcontractor for anyone portion of the Work.
Pursuant to Public Contract Code Section 4104, the Owner has determined that it will allow
Bidders twenty -four (24) additional hours after the deadline for submission of bids to submit
the information requested by the Owner about each subcontractor, other than the name and
location of each subcontractor.
If the Bidder fails to specify a subcontractor for any portion of the Work to be performed
under the Contract, it shall be deemed to have agreed to perform such portion itself, and
shall not be permitted to subcontract that portion of the Work except under the conditions
hereinafter set forth below.
Subletting or subcontracting of any portion of the Work in excess of one half of one percent
(greater than 0.5 %) of the Total Bid Price or, in the case of bids or offers for the construction
of streets or highways, including bridges, in excess of one -half of 1 percent of the
Contractors total bid or ten thousand dollars ($10,000), whichever is greater, for which no
subcontractor was designated in the original bid shall only be permitted in cases of public
emergency or necessity, and then only after Owner approval.
CBF -8
i
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
t "Duplicate Nen 2 Pages U needed for IlsUng additional subcontraotors.'1
of Subcontractor
Name and Location
Description of Work
of Subcontractor
to be Subcontracted
- ce j
Name:
Address: T ��.
i!
G✓iq
Name and Location
Description of Work
of Subcontractor
to be Subcontracted
Name: r cf`cc
STrI� /�1f /
Address: 27 Abr�(a S� t SV�iAc f
J
Name and Location Description of Work
of Subcontractor to be Subcontracted r
Name:
SsE
of Subcontractor
L/4,/,) SJ9 fie,/
Address:
00
a T
- ce j
Name and Location
Description of Work
of Subcontractor
to be Subcontracted(
Name: Ko ��}��SC4
LlInJSL Iii J
Address: �n ftia ll� v
i
�'t'ff9��oh
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
CBF -9
.....�',�. ���z-���r'�r~````,`''�`.'����,``—,.'`�---~`
� .
�
BIDDER: iug Co.
�
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— 2-C
The following are the names, addresses and telephone numbers for three public agencies for which BIDDER
has performed similar work within the past two (2)years:
� |
1
**PLEASE SEE &rr&CBRD LIST OF PROJECT REFERENCES**
Name and Address ofOwner
Name and telephone number of person familiar with project
�|
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2.
Contract amount Type of Work Date Completed
Name and Address of Owner
Name and telephone number vf person familiar with project
Coohuotannoun1 Type ofWork Date Completed
3.
Name and Address
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
4.
Name and Address of Owner
Name and telephone number nf person familiar with project
Contract amount Type of Work Date Completed
CBF-1O
BIDDER: Sull
SECTION 3
NON- COLLUSION AFFIDAVIT
CBF -11
ler Contracting Co.
BIDDER:Sully- Miller Contracting Co.
NON - COLLUSION AFFIDAVIT
In accordance with Public Contract Code Section 7106, the undersigned, being first duly
sworn, deposes and says that he or she holds the position listed below with the bidder, the
party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any
undisclosed person, partnership, company, association, organization, or corporation; thatthe
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. .
Signature"
Michael Edwards
Typed or Printed Name
Vice P
Title
Sully - Miller Contracting Company
Bidder
Subscribed and sworn before me
This _ day of 20_
(Seal)
* *PLEASE SEE ATTACHED CALIFORNIA NOTARY JURAT FOR PROPER WORDING **
Notary Public in and for
the State of California
My Commission Expires:
L
CBF -12
STATE OF CALIFORNIA
COUNTY OF ORANGE
Subscribed and sworn to (or affirmed) before me on this 02nd day of March, 2010, by Michael
Edwards, proved to me on the basis of satisfactory evidence to be the person who appeared
before me.
NoseNONOeeeeoONeeNNeNOeeeNCNeN4
J. DANIELS iD
COMM # 1813952 m
W NOTARY PUBLIC- CALIFOflNIA 3)
ORANGE COUNTY WITNESS my hand and official seal
Q My Commission Expires Sept.24
6oNONeeoeooeNONONONeNOOee �\ Q
Signature �
J. aniels, Notary Public
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document:
Non - Collusion Affidavit
Document Date: March 2, 2010 Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s):
Signer's Name Michael Edwards
Individual
�X Corporate Officer — Title(s)
Partner — Limited /General
E] Attorney In Fact
Trustee
Guardian or Conservator
Other
Signer is Representing
Vice President
Right Thumbprint
of Signer
Signers Name
❑ Individual
❑ CorporateOfficer — Title(s)
0 Partner — Limited /General
Attorney In Fact
Trustee
Guardian or Conservator
Other
SULLY - MILLER CONTRACTING COMPANY
1
Right Thumbprint
of Signer
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
"NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID"
§7106. Any public works contract of a public entity shall include an affidavit, in the following form:
State of California )
County of Orange
) ss.
Michael Edwards being first duly sworn, deposes and says that, he or she is
Vice President of Sully - Miller Contractinq Co. ,the party making the foregoing
bid, 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."
Project Name: Whitmore Ave. Street Resurfacing Project Number: CDBG Proj. No. P46029
Address:
Signature
•r iraFNINWaTelffene us.�
Title: Michael
Date: March 2, 2010
ce Presidents
* *Please See Attached California Notary Jurat for Proper Wording **
SWORN TO AND SUBSCRIBED TO BEFORE ME
This day of
/s/ Notary Public:
My Commission Expires:
,20
STATE OF CALIFORNIA
COUNTY OF ORANGE
Subscribed and sworn to (or affirmed) before me on this 02nd day of March, 2010, by Michael
Edwards, proved to me on the basis of satisfactory evidence to be the person who appeared
before me.
J. DANIELS D
Q @My COMM # 1813952 m
W NOTARYPUSLIC - CALIFORNIA 31 WITNESS my hand and official seal
Q ORANGE COUNTY
Commission Expires Sept 24,2(n I
%,< . .......................••••...• Signature Z6G�
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document: Non - Collusion Affidavit
Document Date: March 2, 2010
Signer(s) Other Than Named Above:
J. PJaniels, Notary Public
Number of Pages:
Capacity(ies) Claimed by Signer(s):
Signer's Name Michael Edwards Signers Name
❑ Individual
rX Corporate Officer — Title(s)
❑ Partner — Limited /General
❑ Attorney In Fact
Trustee
Guardian or Conservator
❑ Other
Vice President
Right Thumbprint
of Signer
❑ Individual
Corporate Officer — Title(s)
❑ Partner — Limited /General
❑ Attorney In Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other
Signer is Representing: SULLY - MILLER CONTRACTING COMPANY
1
Right Thumbprint
a
i
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
NON-SEGREGATED FACILITIES CERTIFICATION
FEDERALLY - /ASSISTED CONSTRUCTION PROJECTS
The federally- assisted construction contractor certifies that he /she DOES NOT and WILL NOT:
1. Maintain or provide, for his/her employees, any segregated facilities at any of his/her
establishments.
2. Permit his /her employees to perform their services at any location, under his /her
control, where segregated facilities are maintained.
The federally - assisted contractor agrees that a breach of this certification is a violation of the Equal
Opportunity Clause in this contract. As used in'this certification, the term segregated facilities means any
waiting room, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks,
locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or
entertainment areas, transportation, and housing facilities provided for employeeswhich are segregated
by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because
of habit, local custom, or otherwise.
The federally - assisted contractor agrees that (except where he /she has obtained identical certifications
from proposed subcontractors for specific time periods) he /she will obtain identical certifications from
proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt
from the provisions of the Equal Opportunity Clause, and that he /she will retain such certifications in
his /her files.
NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.
Date: March '2, 2010
., u .. .. u...
Project Number. colic; Project No. P46029
Address: 4100 V Orangethorpe Ave., Ste. 200, Anaheim, CA 92801
al
Title: Michael Edwards, Vice President
STATE OF CALIFORNIA l
COUNTY OF ORANGE Jj
On March 2, 2010 before me, J. Daniels Notary Public, personally appeared Michael Edwards
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document: Non - Segregated Facilities Certification
Document Date: March 2, 2010 Number of Pages: 1
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s):
Signers Name Michael Edwards Signer's Name
Individual
FX Corporate Officer - Title(s)
Partner - Limited /General
Attorney In Fact
Trustee
❑ Guardian or Conservator
❑ Other
Signer is Representing:
❑ Individual
Vice President ❑ Corporate Officer- Title(s)
Right Thumbprint
a
Partner - Limited /General
Attorney In Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other
SULLY - MILLER CONTRACTING COMPANY
Right Thumbprint
of Signer
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name 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
s.H.N.N....NNN D�L.N....Ne R
instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
- COMM # 1813952 m
W • _ NOTARY PUBLIC - CALIFORNIA
I certify under PENALTY OF PERJURY under the laws of
Q ORANGE COUNTY •,.
b My Commission ExpiresRept.24,201
the State of California that the foregoing paragraph is true
O.ssOeoeNOH9NONONOHN00N9NON
and correct.
WITNESS my hand and oo c al seal
/
Signature
J. aniels, Notary Public
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document: Non - Segregated Facilities Certification
Document Date: March 2, 2010 Number of Pages: 1
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s):
Signers Name Michael Edwards Signer's Name
Individual
FX Corporate Officer - Title(s)
Partner - Limited /General
Attorney In Fact
Trustee
❑ Guardian or Conservator
❑ Other
Signer is Representing:
❑ Individual
Vice President ❑ Corporate Officer- Title(s)
Right Thumbprint
a
Partner - Limited /General
Attorney In Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other
SULLY - MILLER CONTRACTING COMPANY
Right Thumbprint
of Signer
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
u
u
CERTIFICATION
WITH REGARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR
SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND
THE FILING OF REQUIRED REPORTS
The ®bidder, ❑proposed sub - contractor, hereby certifies that he /she ®has, ❑has not, participated
in a previous contract or subcontract subject to the Equal Opportunity Clause, as required by
Executive Orders 10925, 11114, or 11246, and that he /she ®has, ❑has not, filed with the Joint
Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal
Government contracting or administering agency, or the former President's Committee on Equal
Employment Opportunity, all reports due under the applicable filing requirements.
Date: March 2, 2010 Project Number. cosc; -P46� ContractAward:
Awarding Agency: city of Rosemead
Contractor Name: su11y- Miller contracting Company Total Number of Employees 375
Affiliate
By:
Title: Michael'Edwards, Vice President
I NOTE: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor
(41 CFR 60- 1.7(b)(1), and must be submitted by bidders and proposed subcontractors only in connection with contracts
and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from
the equal opportunity clause are set forth in 41 CFR 60 -1.5 (Generally only contracts or subcontracts of $10,000 or under
i•,
are exempt).
Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to
the Executive Orders and have notfiled the required reports should note that 41 CFR 60- 1.7(b)(1) prevents the award of
contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period
specified by the U.S. Department of the Interior or by the Director, Office of Federal Contract Compliance, U.S.
Department of Labor.
SF -100 (EEO -1) must be filed by
(A) All private employers who are:
(1) Subject to Title VII of the Civil Rights Act of 1964 (as amended) with 100 or more employees.
(2) Subject to Title VII who has fewer than 100 employees, if the company is owned or affiliated with
another company, or there is centralized ownership, control or management so that the group legally
constitutes a single enterprise, and the entire enterprise employs a total of 100 or more employees.
(B) All federal contractors (private employers), who:
(1) Are not exempt as provided for by 41. CFR 60 -1.5
(2) Have 50 or more employees, and
a. Are prime contractors or first -tier subcontractors, and have a contract, subcontract, or purchase
order amounting to $50,000 or more; or
b. Serve as a depository of Government funds in any amount, or
c. Is a financial institution, which is an issuing, and paying agent for U.S. Savings Bonds and Notes.
STATE OF CALIFORNIA
COUNTY OF ORANGE
On March 2, 2010 before me, J. Daniels Notary Public, personally appeared Michael Edwards
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name 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
teeaeeaeNaNeNN ....aNeNaee „aeN,e.� instrument the person(s), or the entity upon behalf of
J. DANIELS D which the persons) acted, executed the instrument.
§_ COMM # 1813952 m
W NOTARY PUBLIC- CALIFORNIA I certify under PENALTY OF PERJURY under the laws of
a ORANGE COUNTY 1 the State of California that the foregoing paragraph is true
My commission Expires Sept 24 and correct.
seeeaoeaeeoN9eaeNONONeNN10
WITNESS my hand and o Cal seal
Signature Qx zl,
J,Danells, Notary Public
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document: Certification with Regard to the Performance of Previous Contracts or Subcontracts
Subject to the Equal Opportunity Clause and the Filing of Required Reports
Document Date: March 2, 2010 Number of Pages:
Signers) Other Than Named Above:
Capacity(ies) Claimed by Signer(s):
Signer's Name Michael Edwards
Individual
❑ Corporate Officer — Title(s)
Partner — Limited /General
❑ Attorney in Fact
❑ Trustee
Guardian or Conservator
Other
Signer is Representing:
Vice President
Flight Thumbprint
of Signer
Signers Name
❑ Individual
❑ Corporate Officer — Title(s)
❑ Partner — Limited /General
❑ Attorney In Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other
SULLY - MILLER CONTRACTING COMPANY
1
Right Thumbprint
of Signer
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
_..- -
I'
I�
I'
6
Community Development Commission
County of Los Angeles
COUNTY LOBBYIST CODE CHAPTER 2.160
COUNTY ORDINANCE NO. 93 -0031
CERTIFICATION
NameofFirm: Sully- Miller Contracting Cnmg�nv
Address: 1100 E. Orangethorpe Ave., Ste. 200, Anaheim
State:. CA ZipCode:. g 801 Telephone Number: ( 714 ) 578 -c)6on
Acting on behalf of the above named firm, as its Authorized Official, I make the following Certification to the
County of Los Angeles and the Community Development Commission, County of Los Angeles.
1) It is understood that each person /entity /firm who applies for a Community Development
Commission contract, and as part of that process, shall certify that they are familiar with the
requirements of the Los Angeles County Code, Chapter 2.160 (Los Angeles County Ordinance
93 -0031) and;
2) That all persons /entities/firms acting on behalf of the above named firm have and will comply
with the County Code, and;
3) That any person /entity /firm who seeks a contract with the Community Development
Commission shall be disqualified therefrom and denied the contract and, shall be liable in civil
action, if any lobbyist, lobbying firm, lobbyist employer or any other person or entity acting on
behalf of the named firm fails to comply with the provisions of the County Code.
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
contract with the Los Angeles County and the Community Development Commission, County of Los Angeles.
Authorized Official:
Sully - Miller rnnY rarti nn ('n
(Cwo-ecmr5ubcenhngor)
March 2 2010
(Dale)
By:
igm
ro)
Michael Edwards, Vice President
wee)
STATE OF CALIFORNIA
COUNTY OF ORANGE
On March 2, 2010 before me, J. Daniels, Notary Public, personally appeared Michael Edwards
WITNESS my hand and ctlicial seal ,
Signature
aniels, Notary Public
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document: County Lobbyist Code Chapter 2.160 County Ordinance No. 93 -0031 Certification
Document Date: March 2, 2010
Signer(s) Other Than Named Above:
Number of Pages:
Capacity(ies) Claimed by Signer(s):
Signers Name Michael Edwards Signers Name
Individual
EX Corporate Officer — Title(s)
Partner — Limited /General
Attorney In Fact
Trustee
❑ Guardian or Conservator
Other
Signer is Representing
❑ Individual
Vice President ❑ Corporate Officer — Title(s)
Right Thumbprint
uw
❑ Partner — Limited /General
❑ Attorney In Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other
SULLY - MILLER CONTRACTING COMPANY
1
Right Thumbprint
of Signer
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name 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
�ONPOPPNPPPONPPPPPPPNPNNNNPNNOY
J. DANIELS y
which the person(s) acted, executed the instrument.
P ( )
NOTARYPUBLIC- CALIFORNIA M
@my COMM # 1813952 m
I certify under PENALTY OF PERJURY under the laws of
ORANGE COUNTY
Q
the State of California that the foregoing paragraph is true
z�
commission Expires Sept .24.2P♦OCiea
99000HPPNNONONONONONOPOOH
and correct.
WITNESS my hand and ctlicial seal ,
Signature
aniels, Notary Public
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document: County Lobbyist Code Chapter 2.160 County Ordinance No. 93 -0031 Certification
Document Date: March 2, 2010
Signer(s) Other Than Named Above:
Number of Pages:
Capacity(ies) Claimed by Signer(s):
Signers Name Michael Edwards Signers Name
Individual
EX Corporate Officer — Title(s)
Partner — Limited /General
Attorney In Fact
Trustee
❑ Guardian or Conservator
Other
Signer is Representing
❑ Individual
Vice President ❑ Corporate Officer — Title(s)
Right Thumbprint
uw
❑ Partner — Limited /General
❑ Attorney In Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other
SULLY - MILLER CONTRACTING COMPANY
1
Right Thumbprint
of Signer
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
WORKER'S COMPENSATION CERTIFICATION
1 certify, by signature below, that I am aware of the provisions of Section 3700 of the
California Labor Code which require every employer to be insured against liability for
worker's compensation or to undertake self - insurance in accordance with the provisions of
that code, and I will comply with such provisions before commencing the performance of
the work of this contract.
I
Date: March 2, 2010 Project Number: CDBG Project No. P46029
Project Name: Whitmore Avenue Street Resurfacing Project -Phase I
Company Name: Sully- Miller Contractinq Company
Address: 1100 E. Orangethorpe Ave. Ste. 200, Anaheim, Ca 92801
Print Name: Michael Edwards
Title:
Sign<
STATE OF CALIFORNIA l
COUNTY OF ORANGE Jj
On March 2. 2010 before me, J. Daniels, Notary Public, personally appeared Michael Edwards
Description of Attached Document
Title or Type of Document: Worker's Compensation Certification
Document Date: March 2, 2010
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s):
Number of Pages:
Signers Name Michael Edwards Signer's Name
Individual F-1 Individual
corporate Officer - Title(s)
Partner - Limited /General
Attorney In Fact
Trustee
Guardian or Conservator
E] Other
Vice President 1-7 Corporate Officer - Title(s)
Right Thumbprint
of Signer
Partner - Limited /General
7 Attorney In Fact
F7 Trustee
Guardian or Conservator
Other
Signer is Representing: SULLY-MILLER_ CONTRACTING COMPANY
Right Thumbprint
of Signer
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name 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
...b.<.•.••••••••••°••O.00•0000
instrument the person(s), or the entity upon behalf of
t,,.....
J. DANIELS
.....: COM # 1813952
M
which the person(s) acted, executed the instrument.
ly
NO PUBLIC - CALIFORNIA
OR ANGE COUNTY
OR s
Q .
I certify under PENALTY.OF PERJURY under the laws of
`JY Commission Expires Sept 24, 2072
mao.'°'°°°°°°•°°°°°°•°° °'..�
the State of California that the foregoing paragraph is true
8.• ° °°.°°°°
and correct.
WITNESS my hand and offi al seal
Signature C�LlG�
J. Crafiiels, Notary Public
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document: Worker's Compensation Certification
Document Date: March 2, 2010
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s):
Number of Pages:
Signers Name Michael Edwards Signer's Name
Individual F-1 Individual
corporate Officer - Title(s)
Partner - Limited /General
Attorney In Fact
Trustee
Guardian or Conservator
E] Other
Vice President 1-7 Corporate Officer - Title(s)
Right Thumbprint
of Signer
Partner - Limited /General
7 Attorney In Fact
F7 Trustee
Guardian or Conservator
Other
Signer is Representing: SULLY-MILLER_ CONTRACTING COMPANY
Right Thumbprint
of Signer
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
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WHITMORE AVENUE STREET RESURFACING
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CDBG PROJECT No. P46029
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- ---------
....... -
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
HUD FORM 4230A
REPORT OF ADDITIONAL CLASSIFICATION AND RATE
OMa ApprmW No bCF2501 -011
(Ev. 09nM2 )
1. FROM (name and address of requesting agency)
2. PROJECT NAME AND NUMBER
1. LOCATION OF PROJECT (City, County and State)
4. BRIEF DESCRIPTION OF PROJECT
5. CHARACTER OF CONSTRUCTION _
❑ Building ❑ Residential
❑ Heavy ❑ Other (specify)
❑ Highway
6. WAGE DECISION NO. (include modification number, if any)
7. WAGE DECISION EFFECTIVE DATE
❑ COPY ATTACHED
8. WORK CLASSIFICATION(S)
HOURLY WAGE RATES
BASIC WAGE FRINGE BENEFIT(S) (if any)
9. PRIME CONTRACTOR (name, address)
10. SUBCONTRACTORIEMPLOYER, IF APPLICABLE (name, address)
Gheck All That A i
❑ The work to be performed by the additional classification(s) is not performed by a classification in the applicable wage decision.
❑ The proposed classification is utilized in the area by the construction industry.
❑ The proposed wage rate(s), including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the
wage decision.
❑ The interested parties, including the employees or their authorized representatives, agree on the classification(s) and wage rate(s).
❑ Supporting documentation attached, including applicable wage decision.
heck One:
❑ Approved, meets all criteria. DOL confirmation requested.
❑ One or more classifications fall to meet all criteria as explained In agency referral. DOL decision requested.
FOR HUD USE ONLY
LR2000:
Agency Representative Oaf
(Typed name and signature)
Log In:
Log out:
Phone Number
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
TO;
(Name of labor UNOn. Workers Representatlw, otc.
(Address)
Name of Business (Contractor): sully- Miller Contracting Company
Project Name: Whitmore Ave. St. Resurf. Project Number CDBG Project No. P46029
The Undersigned currently holds a contract with City of Rosemead
involving Block Grant (CDBG) funds from the U.S. Department of Housing and Urban Development
or a subcontract with a prime contractor holding such contract.
You are advised that under the provisions of the above contract or subcontract and in accordance
with Section 3 of the Housing and Urban Development Act of 1968, the undersigned is obligated to
the greatest extent feasible, to give opportunities for employment and training to lower income
residence of the CDBG- assisted project area and to award contracts for work on the project to
business concerns which are located in or are owned in substantial part by project area residence.
Regarding employment opportunities for Section 3, the minimum number and job titles are:
Job Classification
Regarding job referrals, request that consideration be given, to the greatest extent feasible, to
assignment of persons residing in the service area or neighborhood in which the project is located.
The anticipated date the work will begin is For additional information, you may
contact- at ( 1 TW y n me
This notice is furnished to you pursuant to the provisions of the above contract or subcontract and
Section 3 of the Housing and Urban Development Act of 1968. Copies of this notice will be posted
by the undersigned inconspicuous places available t employ es or applicants for employment.
Michael Edwards By
(Print.., (S ppaWre)
March 2 2010 Vira Prpqjripn
N +�) (Tale)
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
1. Name and Address of Reporting Entity
(Recipient, Sub - recipient, Contractor, Subcontractor)
JOB
CLASSIFICATION
2. Federal Identification: (Contmct/Award No.)
3. Dollar Amount of Award:
4. Contact Person:
5. Phone: (include Area Code)
6. Reporting Period: -
7. Date Report Submitted
8. Program Code:
(Use a separate sheet for each Program Code)
%
Program codes
1. Flexible Subsidy 2. Section 2021811 3. Publicdndlan Housing Development, Operation and Modernization 4. Homeless Assistance S. HOME
6. HOME -State Administered 7. CDDG— Emhlemenl 9. CD9G- Slate Administered 9. Other CD Programs 10. Other Housing Programs
Part I: Employment and Training Commitment
i
i
ll
Part ll: Contract Award Commitment to Section 3 Businesses (Sabmntra lors,Suppliem,vendom, orSewimProdders)
NAMEOF
SECTION 3 BUSINESS CONCERN
JOB
CLASSIFICATION
TOTAL
NEW HIRES
SECTION 3
NEW HIRES
% of Aggregate Hires
Who are Section 3 Residents
Professionals
*Sully- Miller Contractii
g Company a
rees to com
ly with all
%
Technicians
requirements of the Co
tract bV miking
a Good
Faith Effort
%
Office/Clerical
to recruit and select
jualified wo
kers as sta
fing needs
%
Trade:
arise*
$
Percentage of the total dollar amount to be awarded to Section 3 Business Concerns:
%
Trade:
%
Trade:
%
Trade:
%
Total:
%
ll
Part ll: Contract Award Commitment to Section 3 Businesses (Sabmntra lors,Suppliem,vendom, orSewimProdders)
NAMEOF
SECTION 3 BUSINESS CONCERN
SPECIFY
CONSTRUCTION OR NONCONSTRUCTION CONTRACT
CONTRACT
AMOUNT
$
$
$
$
$
$
$
TOTAL
$
Percentage of the total dollar amount to be awarded to Section 3 Business Concerns:
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
0
A Section 3 responsive bidder who commits to hire Section 3 Residents by directing employment and training
opportunities toward low- and very low- income persons, particularly those who are recipients of government
assistance forhousing, may use any combination of outreach efforts to meet the Section 3 commitmentmade
when a Section 3 Economic Opportunity Plan has been submitted.
REMEMBER: All employees of a business /firm count toward meeting your Section 3 compliance goals—
Section 3 New Hires do not have to be construction workers, they just have to be a part of your permanent,
full -time staff.
j
SAMPLE OUTREACH EFFORTS FOR CONTRACTORS
SEEKING SECTION S RESIDENT EMPLOYEES
• Enter into 'first-source" hiring agreements with organizations representing Section 3 residents,
such as Work Source or a local Workforce Investment Board. For more information, visit
http://www.calwia.or,q/lv.ia/index.cfm
• Sponsor a HUD - certified "Step-Up" employment and training program for Section 3 residents.
• Advertise training and employment positions by distributing flyers (Notice of Section 3
I
Commitment or other flyer that identifies the positions to be filled, the qualifications required, and
where to obtain additional information about the application process) to every occupied dwelling
unit in the housing development(s) adjacent to the project site.
• Post training and employment position flyers in public housing developments, offices of the local
government, and other conspicuous places.
• Contact State - approved apprenticeship programs to gain access to potentially low - income
residents who are actively seeking job - placement and training. For more information on local
apprenticeship programs, you can visit the California Department of Industrial Relations' database
of local apprenticeship programs by visifing http• / /www dir ca gov /databases /dastaigstart asp
• Contact agencies administering HUD Youthbuild programs, and requesting their assistance to
recruit current HUD Youthbuild program participants who are in need of permanent placement.
• Advertise any positions to be filled through the local media, such as community television
networks, newspapers of general circulation, or commonly -used job placement websites such as
www.monster.com
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1 -
CDBG PROJECT No. P46029
SECTION( 3 RESIDENT CERTIFICATION(
(2008 Income Guidelines)
Employee's Name:
Employee's Address:
I hereby certify that I am a Section 3 resident; based on the following qualification(s):
1. 1 am a Public Housing Resident (specify Name of the Public Housing site):
2. 1 am a low- income resident of the metropolitan area.
Select your household size and gross annual income level (from all sources):
i
HOUSEHOLD SIZE & INCOME LEVEL
El
1
$26,550 or less
❑
2
$30,300 or less
❑
3
$34,100 or less
4
$37,900 or less
5
$40,950 or less
❑
6
$43,950 or less
❑
7
$47,000 or less
8
$50,050 or less
3. 1 am not a public housing or low- income resident of the metropolitan area.
Employee Signature
Must Be Completed by Employer
The above -named person is a permanent full -time employee who was hired on: -
The above -named person is a new -hire employee who was hired on:
This person's Job Classification is:
Name of Employer:
Date
.....................
Business Name:
Business Address:
SECTION 3 BUSINESS CERTIFICATION FORM
Sully- Miller Contracting Company
1100 E. Orangethorpe Ave., Ste. 200
Anaheim, CA 92801
Telephone Number: 714 -578 -9600
Contract/Bid Amount:
1. The above mentioned business firm is a Section 3 business concern based on the following qualifications:
❑ 51- percent owned by Section 3 Residents
(Submit Resident Certifications with this business certification form)
❑ At least 30- percent Permanent, full -time employees are Section 3 Residents
Total Number of all full -time employees , Number of Section 3 qualified Employees
(Submit the Resident Certification form(s) with this Business Certification form)
;I
2. The above mentioned business firm is not a Section 3 business concern, but commits to the Section 3 goal:
® Written Commitment (Section 3 Economic Opportunity Plan), outline intentions to:
Hire Section 3 qualified residents at least 30- percent aggregate new hire positions, and /or
Subcontract 25- percent or more of the contract amount to Section 3 qualified business concerns.
THE UNDERSIGNED DECLARES THAT THE ABOVE
' Sigh..afure of Ownef /Prindpal
Michael Edwards, Vice President
Sully- Miller Contracting Company
Business Name
IS COMPLETE AND CORRECT
March 2, 2010
Date
747612 -A
License Number
To Be Completed by Local Contracting Agency
Preference Category: oTargeted Service Area oYouthbuild 00ther - Census Tract Number:
STATE OF CALIFORNIA
COUNTY OF ORANGE
On March 2, 2010 before me, J. Daniels, Notary Public, personally appeared Michael Edwards
who proved to me on the basis of satisfactory evidence t(
be the person(s) whose name is /are subscribed to the
within instrument and acknowledged to me that
he /she /they executed the same in his /her /their authorize(
capacity(ies), and that by his /her /their signature(s) on the
instrument the person(s), or the entity upon behalf of
J. DANIELS •••••e Y which the person(s) acted, executed the instrument.
COMM # 1813952 m I certify under PENALTY OF PERJURY under the laws o
Q NOTARYPUBLIC - CALIFORNIA 3) the State of California that the foregoing paragraph is tru(
ORANGE COUNTY r
My Commission EXPireSSert. 24, 20, 1 and correct.
NHON4p0�y�000N�N0��ONO000H�
WITNESS my hand and official seal
Signature QAM411 �O
. Daniels, Notary Public
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document: Section 3 Business Certification Form
Document Date: March 2, 2010
Signer(s) Other Than Named Above:
Number of Pages: 1
Capacity(ies) Claimed by Signer(s):
Signers Name Michael Edwards Signers Name
Individual
0 Corporate Officer — Title(s)
❑ Partner — Limited /General
E Attorney In Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other
Signer is Representing:
Individual
Vice President F—] Corporateofficer — Titles)
Right Thumbprint
a
❑ Partner — Limited /General
❑ Attorney In Fact
Trustee
Guardian or Conservator
❑ Other
SULLY - MILLER CONTRACTING COMPANY
Right Thumbprint
of Signer
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
ii
i
SECTION 3 ECONOMIC OPPORTUNITY REPORT (CONTRACTOR)
1. Recipient Name and Address
(Recipient, sutrreciplent, Contractor, Subcontractor)
2. Project Number. ICe ""Award rm.l
3. Dollar Amount of Contract:
4. Contact Person:
5. Phone: (Include Area Code) ,
6. Reporting Period:
7. Date Report Submitted
8. Project Number:
9. Federal EIN:
D...4 1• C.....1,.......,..4 2 Traininn nnnn.fitnifina nrnvidod fn Inw- ironnrrlp_ individuals Minimum Goal: 30 %m New Hims)
JOB CLASSIFICATION
TOTAL
NEW HIRES
LOW - INCOME
NEW HIRES
%of Aggregate Hires
who are low- income
Name of Qualified Business Concern
Technicians
*Sully -Mille
Contracting Com
any agrees to corT31y
with all
Office /Clerical
requirement
of the Contract
by making a Gooc
Faith Effort
%
Professionals
to recruit
and select qualif'ed
workers as st
ffing needs
%
Construction Trade:
. arise.*
%
Construction Trade:
%
TOTAL
%
Dori II• Cd.rnn4ra rfc Awarded rnn.a...��...e.,e..,...,.�., r.,vu�vcw ,d Ma ndm�r „tm,a Amnuntl
Number of Subcontracts awarded:
Number of Section 3 Businesses Receiving Contracts:
Name of Qualified Business Concern
Construction or Non - construction Contract
Amount
$
Total Dollar Amount of Subcontracts awarded to Section 3 qualified Business Concerns:
Dollar Amount of All Subcontracts:
$
Percentage of the total dollar amount awarded to qualified Business Concerns:
the efforts that were made to
Trained and /or Employed— low-income individuals equal to _ ( %) of the aggregate new hires. (Attach Resident
Codifications)
Awarded a Subcontract to _ qualified Business Concerns equal to_ ( %) of the contract amount. (Attach Business
codifications)
Attempted to recruit low - income individuals through:
Advertised through local media, television, radio, newspaper (Attach copy of advertisement)
Signs prominently displayed at the project site
Contacts with community organizations
Contacted management to notify residents and posted or distributed flyers at public housing authority (Attach list)-
Participated in a HUD program or other program which promotes the training or employment of low- Income individuals
Participated in a HUD program or other program which promotes the award of contracts to Section 3 Qualified Business
Concerns
Contacted agencies administering HUD Youth -Build programs. (Attach list)
Maintained a file of eligible, qualified low- income Residents and qualified Business Concerns for future employment.
OTHER
(Attach supporting documentation)
CITY OF ROSEMEAD
WHITMORE AVENUE STREET RESURFACING
PROJECT PHASE -1
CDBG PROJECT No. P46029
Address: 1100 E. Orangethorpe Ave., Ste. 200, Anaheim
State: CA Zip Code: 92801 Telephone Number: ( 719 ) 578 -9600
Acting on behalf of the above named firm, as its Authorized Official, I make the following Certification to the U. S.
Department of Housing and Urban Development and the Community Development Commission, 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 officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of and Federal grant, loan or
cooperative agreement, and any extension, continuation, renewal, amendment, or modification
thereof, and;
2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee 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 firm shall complete and
submit Standard Form -LLL, `Disclosure Form to Report Lobbying ", in accordance with its
instructions, and;
3) The above name firm shall require that the language of this certification be included in the award
documents for all sub - awards at all tiers (including subcontracts, sub - grants, and contracts under
grants, loans, and cooperative agreement) 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 making or entering into the transaction
j imposed by Section 1352 Title 31, U. S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Authorized Official:
Sully- Miller Contracting Company
(Cvvtrxtm/Sabcvntream)
March 2, 2010
By:
n)
Michael Edwards, vice President
(Rib)
V
STATE OF CALIFORNIA l
COUNTY OF ORANGE Jj
On March 2 2010 before me, J. Daniels, Notary Public, personally appeared Michael Edwards
w0000900N0 •.000OOOONOOOO..ONONNOON4
J. DANIELS ZD
COMM # 1813952 M
ARY
NOTPUBLIC- CALIFORNIA
LU ORANGE COUNTY
Q My Commission Expires Sept. 24, 2012 Z
% eN .N.N.N....e <+<.•N.N°°°°°NSeoee4
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name 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 hand and official seal
Signature Q &4d
J. Oidiniels, Notary Public
Notary Seal
OPTIONAL
Description of Attached Document
Title or Type of Document: Federal Lobbyist Certification
Document Date: March 2, 2010
Signer(s) Other Than Named Above:
Number of Pages:
Capacity(ies) Claimed by Signer(s):
Signer's Name Michael Edwards Signer's Name
Individual
❑X Corporate Officer — Title(s)
Partner — Limited /General
Attorney In Fad
Trustee
Guardian or Conservator
Other
Signer is Representing:
Vice President
Right Thumbprint
of Signer
Individual
Corporate Officer — Title(s)
❑ Partner — Limited /General
❑ Attorney In Fact
❑ Trustee
❑ Guardian or Conservator
E] Other
SULLY - MILLER CONTRACTING COMPANY
Right Thumbprint
of Signer
Mar 02 10 02:28p
MAYOR:
MARGARET CLARK
MAYOR PRO TEM:
GARY TAYLOR
COUNCIL MEMBERS:
SANDRA ARMENIA
POLLY LOW
STEVEN LY
March 2, 2010.
6265692303
ttc� pscmcad
8838 E. VALLEY BOULEVARD • P,O. BOX 399
ROSEMEAD, CALIFORNIA 91770
TELEPHONE (626) 569 -2100
FAX (626) 307 -9218 ,
NOTICE OF CLARIFICATION
WHITMORE AVENUE STREET RESURFACING PROJECT
(Bid Opening Date: March 3, 2010)
To All Prospective Bidders:
p.1
Please note the following revisions on the plans on sheet S -2 for the above project:
The longitudinal Section indicates a 2 inches diameter pile. The proposed
diameter of the pile shall be 2 feet diameter instead of 2- inches.
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