Gentry Borthers Inc.BIDDER: GENTRY BROTHERS, INC
BID SCHEDULE
' SCHEDULE OF PRICES FOR
WHITMORE STREET RESURFACING PROJECT - PHASE II
CDBG PROJECT No. P84429
BASE BID SCHEDULE
1
1
1
1
CBF -1
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
1
Clearing & Grubbing per plans and
specifications Complete. See TP -2,
_
TP -3 & TP-4 per details.
LS
1
_
2 oco
I o c o
2
Disposal of Waste Materials.
LS
1
jr 0
S� 0
3
Place Compacted Selected Fill.
CY
150
4
Earthwork, Roadway and
—
Excavation.
LS
1
5
Construct 2 -Inch ARHM GG -C (PG
cs
—
64-16).
TONS
155
l00
/ , j J U C .
6
Construct 2 -Inch AC Pavement (B —
PG 64
TONS
V
4 —
Q
—
S 5 O
-10).
155
1
7
Construct 6 -Inch Crushed
Miscellaneous Base 95% Relative
Compaction over 90% Compacted
Native.
TONS
450
8
Remove and Construct 4 -Inch Thick
—
PCC Sidewalk.
SF
3,665
9
Remove and Construct 6 -Inch PCC
—
Curb and 24 -Inch PCC Gutter per
y
Q
SPPWC Std Plan 120 -2.
LF
865
10
Remove and Construct Variable
High PCC Curb (6" to 9 ") and 24-
Inch PCC Gutter per SPPWC Std
7 Q 0 ;
Plan 120 -2.
LF
25
11
Remove and Construct PCC
Driveway approach per SPPWC Std
Plan 110 -2, Type B.
SF
1,482
J
12
Remove and Construct PCC Curb
Ramps per SPPWC Std. Plan 111-4.
EA
2
G
�J o '
3
CBF -1
BIDDER: GE NTRY BROTHERS, INC
I�
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F1
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TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 4 - 7 i . 7 yio
I
' Dollar amount in written form
CBF -2
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
13
Remove and Construct PCC Cross
and Longitudinal Gutters per
_ °
—
3y
SPPWC Std. Plan 122 -2.
SF
425
14
Construct Parkway Drain per
SPPWC Std. Plan 151 -2, Type 1,
".
15Co V
S =48
LS
1
15
Install Survey Well Monument per
City of Rosemead Std. Plan No.
S08 -001 see appendix "A" per detail.
The Survey Well Monument Cover,
Sleeve and Dome Concrete Marker
will be obtained from the Public
S
3 Op
Works Department at no cost.
EA
2
16
Construct Bio -swale per details as
shown on sheet 3 of 6 complete
including cleaning existing 8 -inch
pipe from inlet to outlet approximate
3 CG ,� '
3 a o
O
20 LF.
LS
1
17
Remove and Construct Metal Beam
Guard Railing (Wood Post with
Wood Block) per 2006 Caltrans Std.
U O
100
Plan A77A1 as shown on the plans.
LF
35
18
Adjust Sewer /Storm Manhole to
—
Grade.
EA
4
_
j 0 0
) 00
19
Adjust Water /Gas Valve to Grade.
EA
3
20
Install Traffic Striping, Street Signs,
Regulatory Signs, Pavement
Markers and others indicated on the
Sc0
1 F
construction plans.
LS
1
21
Paint Home Addresses (Curb
—
°
3 7 S
Numbering)
EA
23
-
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 4 - 7 i . 7 yio
I
' Dollar amount in written form
CBF -2
I
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BIDDER: GENTRY BROTHERS, INC
ALTERNATE BID ITEM 1
1 .
TOTAL ALTERNATE BID # 1 PRICE (SCHEDULE BID PRICE): $ I b , O (J o
Dollar amount in written form
' TOTAL AMOUNT INCLUDING BASE PRICE AND ALTERNATE: $ t 3 ya
-�,; N ip .vcl •� ✓ '� /A - ^'� /�t6V /r
Dollar amount in written form f
' 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.
Attached hereto is a certified check, a cashier's check or a Id bond i he amount of
Dollars ($ l 1) ) said amount being not less than to sen 10 %) of the Total
' Bid Price. The undersigne gees 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
CBF -3
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
CITY.
PRICE
COST
22
Install Irrigation System and
Landscape per sheet 5 and 6 and
—
c
specifications complete.
LS
1
/9.60-j
9 � 000
1 .
TOTAL ALTERNATE BID # 1 PRICE (SCHEDULE BID PRICE): $ I b , O (J o
Dollar amount in written form
' TOTAL AMOUNT INCLUDING BASE PRICE AND ALTERNATE: $ t 3 ya
-�,; N ip .vcl •� ✓ '� /A - ^'� /�t6V /r
Dollar amount in written form f
' 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.
Attached hereto is a certified check, a cashier's check or a Id bond i he amount of
Dollars ($ l 1) ) said amount being not less than to sen 10 %) of the Total
' Bid Price. The undersigne gees 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
CBF -3
' r BIDDER: GENTRY BROTHERS, INC
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 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) 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
of $500.00 dollars if project is not completed on 45 calendar days 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.
1 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
11
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By: i
Signature
QO N 5me
Type Print Name 1 �
Y2.�S�cia�.1 I
- Title
Bidder's /Contractor's State of Incorporation:
Partners or Joint Venturers:
Bidder's License Number(s):
0
6kZ
NOTES:
1
1
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
BIDDER: GEN TRY BROTHERS, INC
384 LIVE OAK AVE.I
IRWINnAI F CA 9170R
Business Street Address
City, State and Zip Code
ham" '3 s �(, 3�
Telephone Number
I
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1
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1
1
1
1
1
1
1
BIDDER: GENTRY BROTHERS, INC
SECTION 2
BID DATA FORMS
CBF -6
M
BIDDER: Gentry Brothers, 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 is properly
identified with the Bidder's name and page number.
2.A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT
and
Inc.
CITY OF ROSEMEAD (hereinafter
Ten percent of the total amount of the bid
as Surety, are held fin
called the OWNER)
as
bound unto the
in the sum of
($ 10% ) , 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, jointly and severally,
firmly by these presents.
WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work
required forthe Whitmore Street Resurfacing Project —Phase It as set forth in the
Notice Inviting Bids and accompanying Bid Documents, dated
March 16, 2011
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' fens to be fixed by the
court.
SIGNED AND SEALED, this 14th day of March I , 20 11
Ge Brothers, Inc. (SEAL)
Principal
Sig Nature i nFS � N
Federal Insurance Company (SEAL)
Surety
Signature atthew J. Coats, tiornevlid Fact
C.%F --(
CALIFORNIA
ALL - PURPOSE ACKNOWLEDGEMENT
State of California
County of Orange
On MAR 14 before me, Adelaide C. Hunter, Notary Public
(insert name and tide of the officer)
personally appeared Matthew J. Coats
who proved to me on the basis of satisfactory evidence to be the persons) whose name(s) is /are
subscribed to the within instrument and acknowledged to me that hefshefdtey executed the
same in his/her/their authorized capacity(ies), and that by hisAmr/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 hand and official seal.
Signature A
ADELAIDE C. HUNTER
Commission # 1808793
'o Notary Public •- California
Orange County
My Comm. Expires Aug B, 2012
Chubb POWER Federal Insurance Company Attn: Surety Department
OF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059
CIPAJ o
Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE
COMPANY, a New York co and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereb constitute and
appoint Linda D. Coats, Matthew J. Coats, Douglas A. Rapp and Timothy D. Rapp of Laguna Hills, Cal ifomla -- - - --
each as their true and lawful Anomey- In- Fact to execute under such designation in their names and to affix their corporate seals to antl deliver for and on their behalf as surety
thereon or whenxise, bonds and undertakings and other vsltirgs obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any
instruments amending or altenng the same, and consents to the modification or alteration of any instrument rafened to in said bonds or obligations.
In Witness Whereat, said FEDERAL 04SURANCE COMPANY, VICA ANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested
mesa presents and affixed their corporate seals on this 16th day d November, 2009.
Kenneth C. Wan , Assistant Secretary Ow' . Nanis, Jr., Vice Plael aril
STATE OF NEW JERSEY
SS.
County of Somerset
On this 16th day of November, 2009 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 commenies whch
executed the foregoing Power of Anonrey, and the said Kenneth C. Wendel, being by me duly swom, 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 vsre Mai affixed by authority of the By- Laws of said Companies; and that he signed said Power of Anomey as
Assistant Secretary of said Companies by like authority, and that he Is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the
signature of David B. Norris, Jr., subscribed to said Power of Attorney is in the genuine handwriting of David B. Norris, Jr., and was thefelo subscribed by authority of said By-
Laws and In deponent's presence. '
Notarial Seal KATHERINE J. ADEIAAR
. NOTA(?Y PUBLIC OF NEW JERSEY
pOTAR No 2316665
Commiuion Exp res July 16, 2014 IfG�K/'ot-��
PUBLI>; Notary Public
y �l'JEtig� CERTIFICATION
Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY:
'AII 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 respocbve designations. The
signature of such officers may be engraved, printed or lithographed. The signature of each of the fallowing officers: Chairman, President any Vice President. any
Assistant Vice President, arty Secretary, any Assistant Secretary and the seal of the Company may be affixed by faun mile to any power of abomey or to any
certificate relating thereto appointing Assistant Secratados or Attorneys- In- Fact fix purposes only of executing and attesting bords and undertakings and other
writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding
upon the Company and any such power so executed and codified by such facsimile signature and facsimile seal shall be valid and binding upon the Company
Mo 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 cerfiy that
(1) the foregoing extract of the By- Laws of the Companies Is true and correct,
(11) the Companies are duly licensed and aulhorimd to transact surety business, in all 50 of the United States of America and me District of Columbia and are
authomted by the U.S. Treasury Department; further, Federal and Vigilant are licensed In Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in
American Samoa, Guam, and each of the Provinces of Canada a rcept Prince Edward Island; and
(iii) the foregoing Power of Attorney is true, correct and In full force am effect.
Given under my hand and seals of said Companies at Warren. NJ this 14th day of March 2011.
n o
,'�psl AAC* y ri rs!w
/«�,J�O
Kenneth C. Wendel, Assistan�ry
IN THE EVENT.YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BONE) OR NOTIFY US OF ANY OTHER
MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903 - 3493 Fax (908) 903- 3858
e-mail: surety @chubbcom
Form 15-10- 01 U (Ed. 5- 03) CONSENT
CALIFORNIA ALL - PURPOSE CERTIFICATE OF AKNOWLEDGMENT
State of: California
Countyof: Los Ang
March 16, 2011 ,beforeme N. Smith, Notary---------------- - - - - --
(name and title of the officer)
personally appeared Rodney J. Gentry- - - - - -- - - - - --
who proved to me on the basis of satisfactory evidence to be the person 0) whose name() is/are
subscribed to the within instrument and acknowledged to me that he/aioy executed the same in
his4wMx it authorized capacity (Im)�and that by his /buc± k signature() on the instrument the person(W
or the entity upon behalf of which the personKacted, 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
N.
(Notary Seal)
=OPTIONAL INFORMATION —
Information below is NOT required by law however may deter fraudulent removal of this form.
Description of Attached Document
Number of Pages 1
Document Date: N / A
Bid Bond ---------
ZT4e or type of document
Additional information
Capacity Claimed by Signer(s)
❑ Individual(s)
❑ Corporate Officer
❑ Partner
❑ Attorney -in -Fact
❑ Trustee(s)
❑ Other
BIDDER: GENTRY BROTHERS. INC
' 2.B 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 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
Contractor's 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.
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BIDDER: GENTRY BROTHERS, INC
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
["Duplicate Next 2 Pages d needed for listlng additional subcontractors. " I
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address: ' C . ss '
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: /o. Lm�"C;77Ld i /.✓��fC 9�i 7
Address: 4 /,o i.� a a h.
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name:
Address.
Name and Location
of Subcontractor
Name:
Address:
CBF -9
Description of Work
to be Subcontracted
Description of Work
to be Subcontracted
1
1
1
1
1
BIDDER: GENTRY BROTHERS, INC
2.0 REFERENCES
The following are the names, addresses and telephone numbers forth ree public agencies for which BIDDER
has performed similar work within the past two (2) years:
1..
Name and
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
2.
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
3.
Name and Address of Owner
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
4.
Name and Address of Owner
of Owner
of Owner
Name and telephone number of person familiar with project
amount
Type of Work
Date Completed
CBF -10
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BIDDER: GENTRY BROTHERS, INC
1
SECTION 3
NON - COLLUSION AFFIDAVIT
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BIDDER: GENTRY BROTHERS, INC
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; 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.
Signature
Typed or Printed N ame
A t�S I Cr r
Title
GENTRY BROTHERS, INC
Subscribed and sworn before me
This _ day of
Notary Public in and for
the State of California
My Commission Expires:
Bidder
20
(Seal)
CBF -12
CALIFORNIA ALL - PURPOSE CERTIFICATE OF AKNOWLEDGMENT
State of: California
Countyof: Los Angeles
March 16, 2011 ,beforeme N. Smith, Notary----- - - - - -- - --
(name and title of the officer)
personally appeared Rodney J. Gentry - - - - -- - - --
who proved to me on the basis of satisfactory evidence to be the person (9) whose name(§) is/am
subscribed to the within instrument and acknowledged to me that he/atey executed the same in
his4wdtht� authorized capacity (*Z)�and that by his/buctb& signature(d) on the instrument the person(W
or the entity upon behalf of which the personKacted, 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
N. SMLTH
N OMM.# 1943001 '�pp
10RYFU9`IG CALIFORNIA VI
1 LC$ ANOVS Co "V
'S My C TA CoNU.; E>tP. Ava. 02, 2 017
(Notary Seal)
=OPTIONAL INFORMATION —
Information below is NOT required by law however may deter fraudulent removal of this form.
Description of Attached Document
Number of Pages 1
Document Date: N/A
Non - Collusion Affidavit
tle or type of document
Addiiional information
Capacity Claimed by Signer(s)
• Individual(s)
• Corporate Officer
❑ Partner
❑ Attorney -in -Fact
❑ Trustee(s)
❑ Other
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BIDDER: GENTRY BROTHERS. INC
CONTRACT BID FORMS
TABLE OF CONTENTS
SECTION 1 BID SCHEDULE ....................................................................... ............................... 1
SECTION 2 BID DATA FORMS ................................................................... ............................... 5
2.A BID BOND ................................................................................. ............................... 6
2.6 LIST OF PROPOSED SUBCONTRACTORS .......................... ............................... 7
SECTION 3 NON - COLLUSION AFFIDAVIT ................................... ...............................
CBF - 13
... 10
I
"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 )
Countyof-2405 ss.
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.¢. being first duly swom, deposes and says that, he or she is
�e C SI of GENTRY BROTHERS INC 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."
c
Project Name: �� r rn nak ll Project Number: e .
Company: GGNMY RROTUCOS INC
384 LIVE OAK AVE
Address: inwk,l� n Ic re 017n6
Signature:
Title:
Date: - 3
SWORN TO AND SUBSCRIBED TO BEFORE ME
This day of
/s/ Notary Public:
My Commission Expires:
20
CALIFORNIA ALL - PURPOSE CERTIFICATE OF AKNOWLEDGMENT
State of: California
Countyof: Los Angeles
March 16, 2011 ,beforeme, N. S m it h, N -
(name and title of the officer)
personally appeared Rodney J. Gentry-----------------------
who proved to me on the basis of satisfactory evidence to be the person (9) whose name(9) is4m
subscribed to the within instrument and acknowledged to me that he4bE&ey executed the same in
his/kerMx�r authorized capacity (*X)�and that by his/barlxk signature(x) on the instrument the person(*
or the entity upon behalf of which the personoacted, 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 m han nd official seal r ----'
y % MY . AtTH COMM i1 1843001 N ➢TAY PUBLI CALIFORNIA LOS COUNTY
Comm, EXP.. ES EXP. APR. O8, 8013 �
(Notary Seal)
� - OPTIONAL INFORMATION— —
Information below is N01'required by law however may deter fraudulent removal of this form.
Description of Attached Document
Number of Pages 1
Document Date: N/A
Non - Collusion Affidavit
T i" type of document
Additional information
Capacity Claimed by Signer(s)
• Individual(s)
• Corporate Officer
❑ Partner
❑ Attorney -in -Fact
❑ Trustee(s)
❑ Other
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1 NON - SEGREGATED FACILITIES CERTIFICATION
FEDERALLY - ASSISTED CONSTRUCTION PROJECTS
The federally- assisted construction contractor certifies that he /she DOES NOT and WILL NOT:
1 1 Maintain or provide, for his /her employees, any segregated facilities at any of his /her
establishments.
i 2. Permit his /her employees to perform their services at any location, under his /her
control, where segregated facilities are maintained.
1 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
1 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 employees which are segregated
1 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.
1 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.
1 NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.
1 Date: / 6 I / Project Number: `)
1 Company: GENTRY BROTHERS INC
Address: IRWINDALE CA 91706
1 By:
1 Title:
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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: - / Project Num f�(NV .2 ContractAward:
Awarding Agency: C r �� 4 16 sS, o d
1 Contractor Name: GeNmytwanims. we Total Number of Employees s c
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NOTE: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor
(41 CFR 60- 1.7(b)(1), and must be submitted by bidders and proposed subcontractors only in connection with contracts
and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from
the equal opportunity clause are set forth in 41 CFR 60 -1.5 (Generally only contracts or subcontracts of $10,000 or under
are exempt).
Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to
the Executive Orders and have not filed the required reports should note that 41 CFR 60- 1.7(b)(1) prevents the award of
contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period
specified by the 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.
1
Affiliate Company:
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Title:
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NOTE: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor
(41 CFR 60- 1.7(b)(1), and must be submitted by bidders and proposed subcontractors only in connection with contracts
and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from
the equal opportunity clause are set forth in 41 CFR 60 -1.5 (Generally only contracts or subcontracts of $10,000 or under
are exempt).
Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to
the Executive Orders and have not filed the required reports should note that 41 CFR 60- 1.7(b)(1) prevents the award of
contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period
specified by the 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.
1
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Community Development Commission
County of Los Angeles
COUNTY LOBBYIST CODE CHAPTER 2.160
COUNTY ORDINANCE NO. 93 -0031
CERTIFICATION
Name of Firm: GENTRY BROTHERS INC
384 HVE OAK AVE
Address: IRWINDALE CA 91706
State: Zip Code: Telephone Number: (✓,2 (— ) 3 -f 7 - % C 3 /
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:
' GENTRY BROTHERS, INC
(Cnnttvctor6ubcomrucior) (Signamre�
Mw) —�"'t
fl'itic)
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WORKER'S COMPENSATION CERTIFICATION
' I 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.
Date: S " / � - / 1 Project Number:
Project Name: (,cJk, fi a n el
' Company Name:
384 LIVE OAK AVE
Ad dress: IRWINDALE CA 91704
Print Name: ✓fti�
' Title: ,,f —
Signature:
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FEDERAL LOBBYIST CERTIFICATION
Name of Firm: GENTRY BROTHERS INC
384 LIVE UAK AVL
' Address: IRWINDALE CA 91706
State: Zip Code: Telephone Number:
' 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 ore mployee 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
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:
' GENTRY BROTHERS, INC
By:
(ContMODT nmctor) / (Signaturc)
(1)mc) (Ci0c1
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TO:
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NOTICE OF SECTION 3 COMMITMENT
(Name of Labor Union, Workers
Name of Business (Contractor):
GENTRY BROTHERS, INC
etc.
Project Name: l />\, tNnnr�,,. Project Number: I y,2r
The Undersigned currently holds a contract with C , 'J C' F W- SaG e4cl
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:
[1
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 ( )
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 in conspicuous places available to employees or applicants for employment.
o By
(Print Nonni) VSopamrc)
— /16- /1 le _-3
Durst (rltla)
11
Number
[1
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 ( )
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 in conspicuous places available to employees or applicants for employment.
o By
(Print Nonni) VSopamrc)
— /16- /1 le _-3
Durst (rltla)
11