ASR Constructors IncCITY OF ROSEMEAD
GARVEY PARK AQUATIC FACILITY
PROJECT No. P53129
CONTRACT BID FORMS
TABLE OF CONTENTS
SECTION 1 BID SCHEDULE .......................................................... ............................... 1
SECTION 2 BID DATA FORMS .... ............................... ......... ............................... 4
2.A BID BOND .................. :........ ... ..................................... ............................... 5
2.B LIST OF PROPOSED SUBCONTRACTORS .............. ............................... 7
SECTION 3 NON - COLLUSION AFFIDAVIT ................................. ............................... 10
SECTION 1 - BID
c mM1k �� �U g M,
BID FOR
GARVEY PARK AQUATIC FACILITY
PROJECT NO. P53129
BASE BID SCHEDULE
TOTAL BASE BID PRICE: $ , 9 Zi, CfJb
Dollar amount in written form �� p
Note: The City of Rosemead reserves the right to reduce or increase the quantities of any
items in the schedule of values above, within the limits define in Section 3 -2.2.1 of the
Standard Specifications, to stay within the budgeted amount of this project.
INCORPORATION BY REFERENCE
Notice Inviting Bids, Instructions to Bidders, General Conditions, Technical Specifications,
Geotechnical Study Report (September 3, 2010) and addenda, Asbestos and Lead Paint
Survey Report (August 5, 2010) and addenda, Bidder's Proposal, Plans, Standard
Specifications for Public Works Construction 2009 Edition ( "Greenbook "), Drawings, Project
Manual, Required Bonds and Forms, Permits, Addenda, and all applicable codes and
regulations are hereby incorporated in and made part of this Contract. The provisions of
the Greenbook shall apply to this Project except as may be modified by other provisions of
the Contract.
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which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting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.
Attached hereto is a certified check, a cashiers check o a bid bond in the amount of
Dollars ($ ) said amount bei no han 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.
CBF -1
e•• :.-M# i
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 forthe Contract, and will deliverto the Ownerwithin 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 Bidder's 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) anyother information and documentation,
financial orotherwise, 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. W Rtf MA On 1040110
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 -2
BIDDEF
5230 W tL5cm 5TtZE1;-T
Business Street Address
iZU1-7--W-15Ipe, I G14 61.2 o9
City, State and Zip Code
IS1.- 1"1e:I. U 5 6 0
Telephone Number
Bidder's /Contractors State of Incorporation: C R 6 :FOg1J 1 )a-
Partners or Joint Venturers:
Bidder's License Number(s): U15i �qS
IMUMN
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.
CBF -3
SECTION 2
BID DATA FORMS
CBF -4
Bond # 8215 10 59 J
BIDDER: ASR Constructors, Inc.
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 are properly identified with the Bidder's name and page number.
2.A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT ASR Constructors, Inc.
as Principal, and Federal Insurance Company
as Surety, are held firmly bound unto
the CITY OF ROSEMEAD (hereinafter called the OWNER) in_the sum of
Ten Percent and 00/100
DOLLARS
($ 10% -- - - - - -- ), being not less than ten percent (10 %) of the
Total Base Bid Price; forthe payment of which sum will and truly to be made,
we bind ourselves, our heirs, executors, administrators, successors, and
assigns, jointly and severally, firmly by these presents.
WHEREAS, said Principal has submitted a bid to the OWNER to perform all
Work required for the Garvey Park Aquatic Facility as set forth in the Notice
Inviting Bids and accompanying Bid Documents, dated NOV. 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 21st day of October 2010
ASR ConXtr/jictors, Inc
I
NO yIUA owy
5 uAry .
CBF -5
SEAL) Federal Insurance (SEAL)
Surety Company
By:
Zb
11-4L,
S" nature Yvette Aceves
Attorney -in -Fact
Chubb POWER Federal Insurance Company Attn: Surety Department
OF Vigilant Insurance Company 15 Mountain View Road
�® Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059
Know All by These Presents, That FEDERAL INSUR
COMPANY, a New York corporation, and PACIFIC INDEMN
appoint Yvette Aceves and Newton Kellam of Irvine,
Ina corporation, VIGILANT INSURANCE
corporation, do each hereby constitute and
each as their true and lawful Attorney- In- Fad to execute under such designation In their names and to affix their corporate seats to and deliver for and on their behalf as surety
thereon or otherwise, bonds and urrkrtaldrgs and other writings obligatory in the nature thereof (Weer Man hall bonds) given or executed in the course of business, and any
instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to In said bonds or obligations.
In Wimew Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested
these presents and affixed their corporate seals on this Sth day of October, 2010.
r Kenneth C: Wendel. AssLStam Secretary Davd . Norris, Jr., Vice Preside
STATE OF NEW JERSEY
ss.
County of Somerset
On this 6th day of October, 2010 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me
known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which
executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly swum, did depose and say that he Is Assistant Secretary of FEDERAL
INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof. that the seals affixed to the
foregoing Power of Attorney are such corporate seals and mm thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as
Assistant Secretary of said Companies by like authodty; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the
signature of David B. Norris, Jr., subscnbed to said Power of Attorney Is in the genuine hanMMting of David B. Norris, Jr., and was thereto subscribed by authority of said By-
Laws and in deponents presence. -
Notarial Seal Q F� KATF'IERINE J. ADELAAR
aO�ARY t Y PUBLIC OF NEW OWN
®�® Nom. 23166 July
� PLIB��,� Commission Ea�O kdy 16, 2016
`, rl'(ryY Notary Public
CERTIFICATION
Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY:
'All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the
President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The
signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any
Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any
certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fact for purposes only of executing and attesting bonds and undertakings and other
writings obligatory in the nature thereof. and any such power of attorney of cortificate bearing such facsimile signature or facsimile seal shall be valid and binding
upon the Company and any such power so exerted and cartified by such facsimile signature and facsimile seal shall be valid and binding upon the Company
with respect to any bond or undertaking to which It is attached.'
I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY
(the 'Companies') do hereby certify that
(I) the foregoing extract of the By- Laws of the Companies is true and correct,
(h) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are
authorized by the U.S. Tmasrxy Departmerr, further, Federal and Vigilant are licensed In Puerto Rico and the U.S. Virgin islands, and Federal Is licensed In
American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and
(Iii) the foregoing Power of Attorney Is true, correct and in full force and effect.
Given under my hand and seals of said Companies at Warren, NJ this
9
rNg11Nt' r , M • +� 0.F / G!/L1nAAA�P m W er,
nY YO �
Kd ne G. a Isrent Secretary
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER
MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903 - 3493 Fax (908) 903- 3656
e -mail: suretv@chubb.com
Form 15-10- 02256- U (Ed. 5- 03) CONSENT
I
State of California
County of Riverside
On Oct. 21, 2nTn beforeme, Minh Quang Tran, A Notary Public
(Here insert name and tide of the officer)
personally appeared Yvette Aceves ------------------
r
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 hand and o seal. MIN7QUANG TRAN C41451 NOTAALIFORNIA
(Norary Sea]) RIVERSIDE COUNTY
Signature ofNotary u tic My Comm. Expires April 24, 2011
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
Bid Bond
(Title or description of attached document)
(Title or description of attached document continued)
Number of Pages Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑
Individual (s)
❑
Corporate Officer
(Title)
❑
Partner(s)
fk
Attorney -in -Fact
❑
Trustee(s)
❑
Other
2008Version CAPAv12.10.07800- 873 -9865 www.NotmyClasseacom
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California most contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document The only exception is if a
document is to be recorded outside of California. In such instances, any alternative
acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that is illegal for a notary in
California (i.e. certifying fire authorized capacity of the signer). Please check the
document carefully for proper notarial wording and attach this fm-in frequired.
• State and County information must be the State and County where the document
signers) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the some date the acknowledgment is completed.
• The notary public must print his or her time as it appears within his or her
commission followed by a comma and then you title (notary public).
• Print the name(s) of document signer(s) who personally appear at the tune of
notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
he /she /9W— is /are) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression mot be clear and photographically reproducible.
Impression most not cover text or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document
Jill
01FISAI'll 011", W31 013
State of California
County of tZl rec5lck�
On Nov. 5, 2Ot0 before me,
(Here cal name
personally appeared
who proved to me on the basis of satisfactory evidence to be the person(s) whose names) 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 persons) 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 han and offici seal. � NH (UANG TRAN
w COMM. #1741451 a
NOTARY PUBLIC- CALIFORNIA y
(Notary Sea[) RIVERSIDE COUNTY
Signature of Notary Pdblif My Comm. Expires Avi 24, 2011
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
_L LAS
(Title or description of attached document)
(Title or description of attached document continued)
Number of Pages Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑ Individual (s)
❑ Corporate Officer
2008 Version CAPA v12.10.07 800- 873 -9865 www.NomryClasses.com
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document. The only exception is if a
document is to be recorded outside of California. In such instances, any alternative
acknowledgment verbiage as may be printed art such a document so long as the
verbiage does not require the notary to do something that is illegal for a notary in
California (i.e. certifying the authorized capacity of the signer). Please check the
document carefully for proper notarial wording and attach [his form if required.
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her time as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the name(s) of document signers) who personally appear at the time of
notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
he/she /fll is /ere) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If sea! impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and dale.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document
(Tide)
❑
Partner(s)
❑
Attorney -in -Fact
❑
Trustee(s)
❑
Other
2008 Version CAPA v12.10.07 800- 873 -9865 www.NomryClasses.com
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document. The only exception is if a
document is to be recorded outside of California. In such instances, any alternative
acknowledgment verbiage as may be printed art such a document so long as the
verbiage does not require the notary to do something that is illegal for a notary in
California (i.e. certifying the authorized capacity of the signer). Please check the
document carefully for proper notarial wording and attach [his form if required.
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her time as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the name(s) of document signers) who personally appear at the time of
notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
he/she /fll is /ere) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If sea! impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and dale.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document
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, labor or 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 Bidder's 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 any one
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 afterthe 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 and description of work to
be subcontracted.
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
one percent of the Contractor's total bid or ten thousand ($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 -6
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
. (* *Duplicate Next 2 Pages if needed for listing additional subcontractors. * *]
Name and Location
of Subcontractor
Description of Work
to be Subcontracted
f/
Name: �-
Address:_ SZ)S
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: % S S725F5
Address: i o Gc/> G J �/✓ r%
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Addre:
Name and Location
of Subcontractor
U
Description of Work
to be Subcontracted .
Name:
Address: 3/ 9 /wr-
Name and Location Description of Work '
of Subcontractor to be Subcontracted
�a
Name:
2.0 REFERENCES FOR BIDDER ( Duplicat page as needed)
CBF -7
M MA h
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
r *Duplicate Next 2 Pages if needed for listing additional subcontractors_ * *]
Name and Location
of Subcontractor
Address: O� .ra 6 �l�ryr i ti.
1/41<1 1-161 �0, s 0,4, 9 /yo 6
Description of Work
to be Subcontracted
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address: 97 2 G S y ✓,�� /�cooic lc -
Name and Location
of Subcontractor
cn, 9 2 s T7
Description of Work
to be Subcontracted
Name: U S IIIJ
-9,6 .G
Address: 3s-0 kAL�ovS
Qc,
Gtr-
72 62 6
Name and Location Description of Work
of Subcontractor to be Subcontracted .
L�rd'� v�Q�ycc�ll C
Name: 1"4 s ci �G� Jiti
Address: S, ACLeui S T,
Name and Location
of Subcontractor
Nan
Add
2.0
Description of Work
to be Subcontracted
�vv L
REFERENCES FOR BIDDER (Duplicate page as needed)
CBF -7
r/✓ 9�71a
U, till I I r
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
. [* *Duplicate Next 2 Pages if needed for listing additional subcontractors -']
Name and Location
of Subcontractor
Name: /,////// 7-z Ly�
Address: S/ 4 S, Fau/«/ S7�
Description of Work
to be Subcontracted
eD G !/Xry
Name and Location
of Subcontractor
Name: )6,c 4�1e' 6i�G
Address: !�'Z 3o
Description of Work
to be Subcontracted
ei, 92 sa 9
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:c
Gi ,PA" 5,2 3 2 <D
Name and Location Description of Work
of Subcontractor to be Subcontracted .
w- dcsJ l/d�4
Cs,sdy-- �E-ha�n ��l�- t•-r�-� --
c;vtJ -c�r�
`c.n c-L.h ) CA
Name and Location
of Subcontractor
Description of Work
to be Subcontracted
Name: (/'01"11,
Address: -151 &,
2.0 REFERENCES FOR BIDDER (Duplicate page as needed)
CBF -7
t-l-3 to
The following are the names, addresses and telephone numbers for at least three public
agencies for which BIDDER has performed similar work within the past four (4) years:
Name and Address of Owner
—01) Qoq . 9155. U4
Name and telephone number of public agency person familiar with project
X50, Ooo . °O � $t2,�0000.� � q►�iOUy �rhm1 S �v►- fiorno►
Contract amount Type of Work Date Co
2. „
and Addrbss of Owner
Name and telephone number of public agency person familiar with project
�501000 ADS # 5,000, 00100 ybl✓iox SCboo( ON- Gatnvy
Contract amount Type of Work Date mpleted
3.
Name and Address of Owner
Name and
ne number of public agency person familiar with project
Contract amount Type of Work Date
M -101=
BIDDER :ffim IIW �Q6 I NC-
2.D REFERENCES FOR SWIMMING POOL CONTRACTOR (C -53 LICENSE)
(Duplicate page as needed)
All of the work in sections 1 31 51 -1 31 58 (of the Project Manual for City of Rosemead
Project No, P53129 Garvey Aquatic Center) is to be the responsibility of one experienced
swimming pool contractor with a C -53 license, which can be either the bidder or a
subcontractor, primarily engaged in the construction of commercial public -use swimming
pools. A swimming pool contractor shall be considered primarily engaged as required
herein if the swimming pool contractor derived 50% of its annual revenue during the past
five years from public -use swimming pool construction. The swimming pool contractor
must have also, in the last five years, constructed at least three (3) commercially designed
municipal and public -use swimming pools, each of which shall have incorporated a
minimum size of 5,000 square feet of water surface area with a concrete and ceramic tile
perimeter overflow gutter and self - modulating balance tank. The following are the names,
addresses and telephone numbers for at least three completed projects as required:
2.
a
Name and Address of Owner
Name and telephone number of public agency person familiar with project
Contract amount Project Name Date Completed
Name and Address of Owner
Name and telephone number of public agency person familiar with project
Contract amount Project Name Date Completed
Name and Address of Owner
Name and telephone number of public agency person familiar with project
Contract amount Project Name Date Completed
CBF -9
SECTION 3
NON - COLLUSION AFFIDAVIT
CBF - 10
BIDDER: W l:UM KU6TM Wr .
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,
Of 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 orsolicited any other bidderto 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 datynplajive thereto, or paid, and will not
pay, any fee to any corporation, partnership, p y association, organization, bid
depository, orto any member or agent ther q� o ec uate a collusive or sham bid.
Typed or Printed Name
r , P L
P6� roNsT�eu�to�s, iNr�
Bidder
Subscribed and sworn before me
This �� y day of Wove 1kr 12010
(Seal)
Nota blic in and for
the State o ornia
My Commission Expires:
a�
Jurat
State of California
County of Riverside
Subscribed and sworn to (or affirmed) before me on this c� day of moo �loe j-
2010 by Alan Regotti and Patricia Berry --------- - - - - --
proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
Signature (Notary seal)
OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
Non— Collusion Affidavit
(Title or description of attached document)
(Title or description of attached document continued)
Number of Pages_ Doc I ument Date
(Additional information)
MINH QUANG TRAN
COMM. #1741451
NOTARY PUBLIC - CALIFORNIA to
RIVERSIDE COUNTY
My Comm. Expires Apnl 24, 2011
INSTRUCTIONS FOR COMPLETING THIS FORM
The wording of oAJurats completed in California after January 1, 2008 most
be in due faun as set forth within this Jurat. There are no exceptions. If o Jurat
to be completed does not follmv this form. the naoy must correct the
verbiage by using a jurat stamp containing the correct wording a' attaching a
separate poor form such as this one which does contain proper wording. In
addition. the notay anst require nn oath or affirmation from the doarnhent
signer regarding the truthfulness of the contents of the docinrent. The
donrnrenl must be signedAFTER the oath or agu niation. Ifthe docmnent was
previously signed, ii must be re- signed in front of the ,iota,), public dm'ing the
jurot process.
• State and County information must be the State and County where the
document signer(s) personally appeared before the notary public.
• Date of notarization must be the date that the signer(s) personally appeared
which must also be the same date thejurat process is completed.
• Print the name(s) of document signers) who personally appear at the time of
notarization.
• Signature of the notary public must match the signature on the with the office
of the county clerk.
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a differenijurat form.
+.• Additional information is not required but could help to ensure this
jurat is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date.
• Securely attach this document to the signed document
2008 Version CAPA v1.9.07 800 -873 -9865 www.NotaryClasses.conl