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Sully-Miller Contracting Company
BIDDER: Sully - Miller Contracting Company SECTION 1- BID SCHEDULE CBF -1 • 1 'i I BIDDER: Sully - Miller Contracting Company BID SCHEDULE SCHEDULE OF PRICES FOR ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P8029 BASE BID SCHEDULE TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$a yD Sd0 CBF -2 UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE CITY. PRICE COST 1 Clearing & Grubbing per plans and i specifications. LS 1 2Gp voo. 2 Disposal of Waste Materials LS 1 3 Lpo. 3 00, / 3 Crack Sealing LS 1 X,3oo 4 Slurry Seal Type 11— See exhibit "A" & "B" per street locations & / areas. ELT 1,050 /SS, 73-a• 5 Traffic Striping and Pavement Markers — See exhibit "C" per details. LS 1 /S oo. /S o 6 Paint Home Addresses (Curb 1,98 7Numbering) TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$a yD Sd0 CBF -2 i --- - - - - -- - - - - -- - BIDDER: Sully - Miller Contracting Company ALTERNATE BID ITEM 1 NO. ITEM DESCRIPTION IT OST 7 Furnish and Install Street and IT!LITEM Regulatory Signs, See Exhibit D on Appendix A per Quantifies and Types. Contact Erick Gustafson at 213 -798 -7024 from Zumar or o. approved equal TOTAL ALTERNATE BID # 1 PRICE (SCHEDULE BID PRICE): $ y�oo . in written form / TOTAL AMOUNT INCLUDING BASE PRICE AND ALTERNATE: The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract forthe Work is fully executed by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 bid bond in the amount of 10% of Total Bid Dollars ($10% of Braid 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 Ownerfor 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. CBF -3 `i BIDDER: Sully- Miller Contracting Company 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 amount of $500.00 per calendar day and subject to the terms and conditions described in the Contract Form and the Contract Documents if project is not completed in 45 calendar days. 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. h 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 Assistant Secretary Title March 15, 2010 BIDDER: Sully - Miller Contracting Company 135 S. State College Blvd., Ste. 400 Business Street Address Brea, CA 92821 City, State and Zip Code 714 - 578 -9600 Telephone Number Date i Bidder's /Contractor's State of Incorporation:. Delaware Partners or Joint Venturers: N/A I "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, ..aTrnnrc6Gn nr inint venture has the authority to do so. CBF -5 STATE OF CALIFORNIA COUNTY OF ORANGE On March 15, 2011 before me, J. Daniels, Notary Public, personally appeared Gary Downey Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Bid Proposal- Signature Page Document Date: March 15, 2011 Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s): Signers Name Gary Downey Signer's Name ❑ Individual rX Corporate Officer — Title(s) ❑ Partner — Limited /General ❑ Attorney In Fad ❑ Trustee ❑ Guardian or Conservator ❑ Other Signer is Representing: Assistant Secretary Right Thumbprint of Signer ❑ Individual Corporate officer— Title(s) ❑ Partner — Limited /General_ ❑ Attorney In Fact nTrustee E] 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 instrument the person(s), or the entity upon behalf of J. DANIELS y COMM # 1813952 which the person(s) acted, executed the instrument. m Q NOTARY PUBLIC- CALIFONNIA ORANGE COUNTY I certify under PENALTY OF PERJURY under the laws of .� Issloe�eMEppN9Neoo, z�g 999Oe« the State of California that the foregoing paragraph is true �O9On�yy'M and correct. WITNESS my hand and Official seal Signature/ Q 4t 1P J. aniels, Notary Public Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Bid Proposal- Signature Page Document Date: March 15, 2011 Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s): Signers Name Gary Downey Signer's Name ❑ Individual rX Corporate Officer — Title(s) ❑ Partner — Limited /General ❑ Attorney In Fad ❑ Trustee ❑ Guardian or Conservator ❑ Other Signer is Representing: Assistant Secretary Right Thumbprint of Signer ❑ Individual Corporate officer— Title(s) ❑ Partner — Limited /General_ ❑ Attorney In Fact nTrustee E] Guardian or Conservator ❑ Other 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 Vice President Scott Bottomley Secretary Anthony L. Martino If Assistant Secretary George Aldrich Assistant Secretary Gary Downey Assistant Secretary Dennis Gansen 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 August 11, 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 21s` day of April 2010. (SEAL) Gark- DAney, Assistant State Colle vd., Ste. 400 CA 92 - - - - - -- .... ....... .. BIDDER: Sully - Miller Contracting Company SECTION 2 BID DATA FORMS OBF -6 ... Executed in Three Originals BIDDER: Sully-Miller Contracting Company i;. Bidder shall submit its Bid data in accordance with the format shown on each of the fol low ing 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 Sully- Principal, and as as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of Ten percent of amount bid 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 for the Annual 2010 -2011 Slurry Seal Project 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 bythe Contract, then this obligation shall be null andvoid; 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 11 day of _ Sully- Miller Contracting Company (SEAL) Principal ry CBF -7 0 March 20 11 Liberty Mutual Insurance CompMy--(SEAL) Surety Signature Kim Heredia, Aftorneyin•FacF .; i STATE OF CALIFORNIA l COUNTY OF ORANGE Jj On March 15. 2011 before me, J. Daniels Notary Public, personally appeared Gary Downey 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 J. DANIELS D which the person(s) acted, executed the instrument. COMM # 1813952 W NOTARY PUBLIC•CALIrONNIA 1m1 I certify under PENALTY OF PERJURY under the laws of Q oRm courrry the State of California that the foregoing paragraph is true b MY Commisslon Expires Sept. 24.201 eeoeew ooees�e+s�+kwsee ^+o+waee and correct. WITNESS my hand and official seal Signature J. Daniels, Notary Public Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Bid Bo Document Date: March 11, 2011 Signer(s) Other Than Named Above: Number of Pages: Capacity(ies) Claimed by Signer(s): Signers Name Gary Downey Signers Name E] Individual EX corporate officer — Title(s) F1Partner — Limited /General ❑ Attorney In Fact Trustee Guardian or Conservator ❑ Other ❑ Individual Assistant Secretary ❑ Corporate Officer — Title(s) Right Thumbprint OT ❑ Partner — Limited /General ❑ Attorney In Fact Trustee Guardian or Conservator Other Signer is Representing: SULLY - MILLER CONTRACTING COMPANY Right Thumbprint of Signer CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT State of California County of Orange MAR 1 1. 2011 On before me,V.M. Campbell, Notary Public DATE NAME, TITLE OF OFFICER - E.G., "JANE DOE, NOTARY PUBLIC" personally appeared Kim Heredia who proved to me on the basis of satisfactory evidence to be the person(s) whose names (s) Ware subscribed to the within instrument and acknowledged to me that tae /she /they executed the same in #is /her /ttae* authorized capacity(ies), and that by his /her /th& 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. =O.'Notarqy MPBELL WITNESS my hand and official seal. R 1910804 c - California County es Nor 25, 2014' SIGNATURE OF NOT 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 DESCRIPTION OF ATTACHED DOCUMENT ❑INDIVIDUAL ❑CORPORATE OFFICER TITLE OR TYPE OF DOCUMENT TITLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL NUMBER OF PAGES ® ATTORNEY -IN -FACT ❑ TRUSTEE(S) ❑ GUARDIANICONSERVATOR ❑ OTHER: MAR .1 1 .2011 DATE OF DOCUMENT SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) - -- -- BIDDER: Sully - Miller Contracting Company 23 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 aboutthe construction of the Workin 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 itwill 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. 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 forthe 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. i - - - - - -- BIDDER: Sully- Miller Contracting Company 2.6 LIST OF PROPOSED SUBCONTRACTORS (continued) F[ uplicate Next 2 Pages II needed for luting addilMnal Subcontractors.") Name and Location Description of Work of Subcontractor to be Subcontracted Name: L-� � /Grimm ✓i S� "'K' �/s %%ref Address' ILY ra N PTIL?4 2 �1f° c4- Name and Location of Subcontractor Name: Address: Description of Work to be Subcontracted Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: Name and Location of Subcontractor Name: Address: CBF -9 Description of Work to be Subcontracted BIDDER: Sully - Miller Contracting Company 2.0 REFERENCES The following are the names, addresses and telephone numbers for three public agencies forwhich BIDDER has performed similar work within the past two (2) years: * *PLEASE SEE ATTACHED LIST OF PROJECT — Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 2. Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 3. Name and Address of Owner 9 Name and telephone number of person familiar with project Contract amount Type of Work Date Completed Name and Address Name and telephone number of person familiar with project Contract amount Type of Work Date Completed CBF -10 St1LLY- MILLER C0NTRACT[NC, Co BIDDER'S EXPERIENCE AND QUALUIICATII®NS Project Name /Number: TORRANCE BOULEVARD / 28791C. Year of Project.. 10/2008 - 05/2010 Project Description: STREET RECONSTRUCTION. & ARHM OVERLAY Agency Name: CITY OF TORRANCE Contact Person: BETH OVERSTREET Telephone: 310 -618 -3074 Fax. 310 - 781 -6802 Original Contract Amount: $5,904,267 Final Contract Amount: $6,133,068 Change in original, contract amount is due to extra work and /or contract change.orders adding work. Project Name/Number LONG BEACH.ANNUAL 2009 / 28810C Year of Project. 01/2009 — 05 72010 Project Description: AC /ARHM — CONCRETE — BASE - SIGNALS — SURVEY — STRIPING - LANDSCAPE Agency Name: CITY OF LONG BEACH Contact Person: CHARLES RAMEY Telephone: 562 -570 -5170 Fax 562 -570 -5176 Original Contracf.Amount: $5,000,000 Final ContractAmounti $4,290,000 Annual Contract — work was done on an as needed basis. Project Name /Number: LACMA PHASE II PAVILION PROJECT 28006 / 29820C Year of Project:. 02/2009 — 04/2010 Project Description:. B PERMIT Agency Name: MATT CONSTRUCTION CORPORATION Contact Person: GREG WADE!: Telephone` 562- 903 -2277 Fax: 562- 903 -2290 Original Contract Amount: $92,507 Final Contract Amount:. $420,000 Change -in original contract amount is due to extra work and /or contract change orders - adding, work. Project Name /Number: LA SOUTHWEST COLLEGE — PARKING LOT.3 / 28795C Year of Project:, 09/2008 — 01/2010. Project Description: AC — BASE — CONCRETE — STRIPING Agency Name: CHEVRON ENERGY SOLUTIONS. Contact Person: STEVE PELASYED Telephone:. 714 - 577 -1374 Fax :, 714 -577 -1330 Original Contract Amount: $1,120,315 Final Contract Amount.. Change in original contract amount is due. to extra work and /or contract change orders�adding work. Project NamejNumber: 3RD STREET BETWEEN RECORD AVENUE.TO WOODS AVENUE/ 28787C Year of Project) 11/2008 — 12/2009 Project Description: AC = CONCRETE — UNDERGROUND = LANDSCAPE — STRIPING'.= SIGNALS Agency Name: LOS ANGELES COUNTY DEPARTMENT OF PUBLIC WORKS Contact Person: FAHIM RAHIMI Telephone :. j5261-458-3112 Fax: 626- 458 -2197 Original CoritractAmount: $3,411,736: Final Contract Amount: $3,628,000. Change in original'contract amount'is due to extra work and /or contract change orders adding work. ' Updated August 2010 SULLY - MILLER CONTRAc— l-ING' CO. BIIDDER'S.' EXPEREENCE AND QUALIFICATIONS Project Name /Number: 2007 -2008 PAVEMENT REHABILITATION- 28750C Start tand Finish Dates: 6/2008 TO 7/2008 Project Description: AC /ARHM — MANHOLES — SURVEY — STRIPING — COLD MILL Agency Name: CITY OF HAWAIIAN GARDENS Contact Person: STEVE.STEINBRECHER Telephone: 562 -908 -6200 Fax: 562- 695 -2120 Original Contract Amount: .$451,112 Final Contract Amount. $456,287 Change-in original contract amount is due to extra work and /or contract change orders adding work. Project Name /Number:, STREET PAVING PROGRAM- 28735C Start and Finish Dates; 3/2008 TO 5/2008 Project Description: ARHM — MANHOLES — MONUMENTS, — STRIPING — SWPPP- COLD MILL Agency Name: CITY OF WEST HOLLYWOOD Contact Person: MILA SOLOGUB Telephone: 323 - 848 -6338 Fax: 323 - 848 -6564_ Original Contract Amount: $340,986 Final ContractAmount: $315,916 Change in contract amount is due to items of work being deleted by the agency. Project Name /Number: STREET AND WATER IMPROVEMENTS IN PIONEER BOULEVARD- 27709C Start and Finish Dates: 11/2007 TO 4/2008 Project Description: WATER LINE AND STREET IMPROVEMENTS Agency Name: CITY. OF CERRITOS Contact Person: RASH SYED, Telephone: 562- 860 -0311 Fax: 562 -916 -1371 Original Contract Amount, $1,507,833 Final Contract Amount: $1,443,408 Change in, contract amount is due to items of work being deleted by the agency. Project Nameftmber. THE LACMA TRANSFORMATION PROJECT- 27662C Start and. Finish Dates: 6/2007 TO 4/2008 Project Description: B PERMIT Agency Name: MATT CONSTRUCTION CORPORATION Contact Person: GREG WADE Telephone: 562 -903 -2277 Fax: 562- 903 -2290 Original ContractAmount' $912,402 Final Contract Amount: $1,363,596. Change in',original contract:amount is`due to extra work and %or contract change orders adding work:, Project Name%Number: CATALINAMEDIA /THE POINTE- 27732C Start and Finish Dates: 1/200870 3/2008 Project Description: SEWER MAIN INSTALLATION Agency.Narne:, KRISMAR,CONSTRUCTION.CO,MPANY, INC. Contact Person:; GARY MORRISON Telephone: 310'458 -3170 Fax: 310.458 -9063 Original Contract Amount: $315,955 Final Contract Amount: $411;955 Change in. original contract_ amount is due to extra work and /or contract change orders adding work. Updated August 2010 Z STILLY- MILLER CONTRACTING CO. BIDDER'S' EXPERIENCE AND QUALIFICATIONS Project Name /Number: PACIFIC ELECTRIC INLAND TRAIL PHASES 2,& 3 / 27653C Start and Finish Dates: 3/07 TO 1/08 Project Description: R/R CONCRETE /AC'— LANDSCAPE /IRRIGATION — SIGNALS — STRIPE - UTILITIES Agency Name: cm OF RANCHO CUCAMONGA Contact Person: Contact Person: WALTERSTICKNEY, Contact Person: WALTER STICKNEY Original Contract Amount. $3,424,781 Original Contract Amount: $3,424,781 Change'in original contract amount is due to extra work and /or contract change orders adding work. Project NamejNumber: MARQUARDT AVENUE / 27689C Project Description: Start and Finish Dates: 7/2007 TO 9/2007 CITY OF LA MIRADA Project Description: R/R CONCRETE — AC ON FABRIC — ADJUST UTILITIES Agency Name; 'LOS ANGELES COUNTY DEPT: OF PUBLIC WORKS $2,164,089 Final Contract Amount: $2,575,166 Contact Person: EMILKURLYAND Telephone: 626 - 458 -3166 Start and Finish Dates: Fax: 626 - 458 -2197 Original Contract Amount: $183,915 Final Contract Amount. $183,915. Project Name /Number: Al-McA'STREEf IMPROVEMENT PROJECT /27699C Start and Finish Dates: 8/2007 TO 11/2067 Project Description: R/R CONCRETE & ASPHALT — STRIPING — ADJUST UTILITIES Agency Name:' CITY OF SOUTH EL MONTE, Contact Person: GEORGE CASTILLO Telephone: 562- 682 -3620 Fax: 562- 684 -0130 Original Contract Amount: $135,000 Final Contract Amount: $167,074 Change in original contract amount is due to extra workaild /or contract change orders adding work. Project Name /Number: REHABILITATION OF LA MIRADA BLVD. / 27664C Start and Finish Dates: 5/2067 TO 9/2007 Project Description: ARHM if AC PAVING, CONCRETE WORK,— LOOP. DETECTORS if SIGNALS; Agency Name: CITY OF LA MIRADA Con tact Person: GARYSANUI Telephone: 562- 943 -2385 Fax: 714 -522 -5800 Original Contract Amount: $2,164,089 Final Contract Amount: $2,575,166 Change in original contract` amount is due to extra work'and /or'contract change orders adding work. Project Name /Number: CSULB PARKING LOT 13 REPAIR — REPAVE / 27694C Start and Finish Dates: 7/2007 TO 8/2007 Project' Description: AC GRIND / OVERLAY — ASPHALT REPAIR - MINOR CONCRETE REPAIR Agency Name: CALIFORNIA STATE UNIVERSITY, LONG BEACH Contact Person: ENRIQUE ROBLES Telephone: 562- 985 -4175 Fax: 562 -985 -23_08 Original Contract Amount: $375,823 Final Contract Amount; $380,572 Change' in original contract amount is due to extra work and /or contract change orders adding work. Updi ted'August 2010. 3' SULLY- MILLER CONTRAc-riNG CO. BIDDER'S EXPERIENCE AND QUALIFICATIONS Project Name /Number: ORANGE LINE — CANOGA STATION PARK AND RIDE / 25568C Start and Finish Dates: 3 /2006 TO' 1/2007 Project Description: NEW TRANSPORTATION STATION INCLUDING AC PAVING &CONCRETE WORK Agency Name: METROPOLITAN TRANSPORATION AUTHORITY Contact Person: GHULAM SHAIKH Telephone: 818 - 262 -6300 Fax: 213 -922 -7384 Original Contract Amount: 13,732;500 Final Contract Amount: $12,415,392 Change in Contract amount is'due to items of work being deleted by the agency. Project Name /Number: SOUTH COAST PLAZA PARKING LOT /26608C Start and Finish Dates: 7/2006 TO 10/2006 'Project Description: COMPLETE REMOVE AND REPLACE OF PARKING LOT, CONCRETE CURB & Change in original contract amount is due to extra work and /or'contract change orders adding work. GUTTER; LOOP DETECTORS, AND STRIPING Agency Name: SOUTH COAST PLAZA Contact Person: ROBERTTHOMAS Telephone: .714 -546 -0110. Fax: 714 -546 -9835 Original Contract Amount: $3,100;009 Final Contract Amount: $3,932,226' Change in original contract amount is due to extra work and /or'contract change orders adding work. Project Name /Number: RESIDENTIAL STREET REHABILITATION WORK / 26573C Startand Finish Dates: 2/2006 to 8/2006 Project Description: ASPHALT CONCRETE, OVERLAY AT VARIOUS LOCATIONS CITYWIDE Agency Name: CITY OF WEST COVINA Contact Person: OSCAR CAPLIN Telephone: 626- 939 -8445 Fax: 626- 939 -8660 Original Contract Amount: $1,430,888 Final Contract Amount: $1,512;463 Change, in original contract amount is due to extra work and /or contract change orders adding work. Project. Name /Number: BERTH 401 7406 BACKLAND IMPROVEMENTS / 25567C Start and Finish Dates: 1/2006 to 4/2006 Project Description: ASPHALT AND CONCRETE PAVING /SITE IMPROVEMENT_ PROJECT Agency Name: PORT OF LOS ANGELES Contact person: KEN HARBOR Telephone: 310- 831 -5389 Fax: 310- 831 -5389 Original Contract Amount: $3,286,800 Final Contract Amount: $3,386,333 Change.in original contract amount is due to extra work and /or contract.change,orders adding work. Project.Name% Number: 195TH STREET IMPROVEMENT /_25506C Start-and Finish Dates: 5/2005 to 11/2005 Project Description: MEDIAN ISLAND and STREET REPAIRS Agency Name: CITY OF CERRITOS Contact Person: VIC MASAYA, Telephone: 562- 916 -1231 Fax: 562- 916 -1371 Original Contract Amount: $862,370' Final Contract Amount: $742,488 Change.in coritract.amount is due�to items of work being deleted by the. agency. Updat(A August_2010 SLJLIY- MILLER CON- FRACTING CO BIDDER'S EXPERIENCE AND QUALIFICATIONS Project Name /Number:, MALL PARKING LOT IMPROVEMENTS / 25492C Start and Finish Dates:, 3/2005 to 10/2005 Project Description: REPAIR and PLACE NEW AC PAVING and STRIPE PARKING STALLS Agency Name:: CITY OF TEMPLE CM- Contact Person: JANICE STROUD Telephone: 626 -285 -2171 Fax: 909 -594 -28.58 Original Contract, Amount: $8281837 Final Contract Amount. $894,012 Change in original contract amount is due to extra wdrk and /or contract change orders adding work. Project Name /Number: HELLMAN AVENUE STREET IMPROVEMENTS/ 24477C Start and Finish Dates: 6/2004 to 11/2005 Project Description: STREET RECONSTRUCTION PROJECT Agency Name: CITY OF ROSEMEAD Contact Person: KEN RUKABI_NE' Telephone: 562- 908 -6262 Fax: 562 -695 -2120 Original Contract:Amount,'; $1,051,667 Final. Contract Amount: $1;067,429 Change iri original contract amount is due; to extra work grid /or contract'change orders adding: work. Project Name /Number: HOLGATE AREA STREET REHABILITATION AND WATER MAIN if 24446C Start and Finish Dates: 3/2004 to 6/2005 Project Description: STREET REHABLITATION AND WATER MAIN REPLACEMENT Agency Name: CITY OF LA HABRA Contact Person: CHUCK STEPHAN Telephone: 562- 905 -9720 Fax: 562 -905 -9643 Original, Contract Amount:, $2,9961461 Final Contract Amount: $3,566,942 Change in original contract amount is due:to extra work and /or contract change orders adding work. Project Name /Number: PIER 400 BACKLANDS PHASE 2 / 23301C Start and Finish Dates: 4/2003 to 8/2004 Project. Description:, TRANSTAINER FACILITYi GRADING, PAVING, UNDERGROUND; CONCRETE. PROJECT FINISHED ON TIME — EXTRA DAYS FOR EXTRA WORK ONLY Agency Name: PORT OF LOS ANGELES Contact Person: MA_ HMOUD IRS_HEID• Telephone: 310 -732 =3525 Fax: 310-831 -5389 Original Contract;Amount:. $30;618,798 Final Contract, Amount:, $30,030;429 Change in contract amount is due to items of work being deleted by agency Project Name /Number: PHANTOM WEST STREET IMPROVEMENT / 82803C' Start and Finish Dates: 12/ 2002 to 8/ 2003 Project Description: UNDERGROUND, ASPHALT REHAB, CURB & GUTTER; COLD MILLING Agency Name' CITY,OF- VICTORVILLE Contact Person: MARK MILLER' Telephone 760. 955 - 9158. Fax: 760-455 -5159 Original ContractAmount: $4,771,477 Final Contract Amount: $4,994;840 Change in original contract amount is due to extra work and /or contract change orders adding work: Updated August 2010 SULLY- MILLER COIVTRACNCG CC). BIDDER'S EXPERIENU AND QUALXH IIC XONS Project, Name /Number: ARROW HIGHWAY- LIVE OAK AVENUE PHASE II / 22273C Start and Finish Dates: 11/ 2002 to 8/ 2003 Project Description: AC GRIND OVERLAY — NEW MEDIANS & DECORATIVE CONCRETE .Agency'Name CITY OF IRWINDALE Contact Person: KWOK TAM Telephone: 626 -430 -2212 Fax: 626- 962 -2018 Original Contract Amount;. $4;289,147 Final Contract Amount. $4,654,815 Change in original.cootract amount is due to extra work and /or contract change orders adding work. Project Name /Number: PIER 400: CONTAINER TERMINAL / 21130C. Start and Finish Dates: 1/ 2001 to 9/ 2002, Project Description: BACKLAND IMPROVEMENTS, -PHASE I Agency Name: PORT. OF LOS,ANGELES Contact Person: MAHMOUDISHEID, Telephone: 310- 732 -3525 Fax: 310- 831 -5389 Original Contract Amount:. $78,134;500 Final ContractAmount: $74;226,254 Change in contract amount is due to items of work; being deleted by agency. PROJECTS INVOLVING HEAVY STORY DRAIN, SEINER AND WATER IMTROVEMENTS Project Narrie/Numberi DOUGLAS, PARK STREET IMPROVEMENTS AND INFRASTRUCTURE / 26595C` Year of Project. 03/2006- 07/2007 I Project Description_ INFRASTRUCTURE - .SEWER, WATER, STORM DRAIN Agency'Name. BOEING REALTY CORPORATION Contact Person: STEVE!GARIS Telephone: 562- 593 -4730 Fax: 714- 850 -0086 Original Contract Amount: $11,256,511 1 Final ContractAmount: $19,932;964 Change in original contract.amount is due to extra w rk and /or contract change orders adding Work: Project Name/Number PORTOLA SPRINGS AND MODIESKA / 25534C Year of Project: 04/2005706/2006 Project Description; SEWER, WATER, STORM DRAIN IMPROVEMENTS Agency Name.' IRVINE COMMUNITY DEVELOPMENT COMPANY C0ntact-P6rSoi11: - BILL,MARTIN Telephone: 714- 734 -8100 Fax: 949- 464 -9715 original Contract - Amount:' .$8;62 5,84 8 Final ContractAmount: $9;602,943 Change in;original'co_ ntract a ount is du_e to extra work and /or contract change orders adding work., Updated- 4ugusCAiC ` G SULLY- MILLER CONTRAC'fINC-, Co. BIDDER'S EXPERIENCE AND QUALIFICATIONS ASPHALT RUBBERIZED HOT MIX (ARHM) PROJECTS Project Name/Numbei: Start and Finish Dates: Project Description: Agency Name: Contact Person: ANNUAL OVERLAY PROGRAM / 27697C 8/07 TO 7/08 ARHM OVERLAY — CONCRETE (C &G, SIDEWALK, DRIVEWAY) - LOOPS CITY OF CARSON RICK BOUTROS Telephone: 310 -952 -1700 ext. 1830; Project Value: $2,397;755 Project Name /Number. 2006 -2007 MAJOR ARTERIAL OVERLAY PROJECT / 27681C Start and Finish Dates: 7/07 TO 1/08 Project Description: ARHM OVERLAY — CONCRETE SIDEWALK/RAMPS — LOOPS — STRIPING Agency Name: CITY OF COMPTON Contact Person: CHARLES BERGSON Telephoner 3107605 -5696 Project Value: $1,846,709 Project Name /Number: NORMANDIE AVENUE - STPL- 5953(451) / 26647C Start and Finish Dates: 3/07 TO 9/07 Project Description: ARHM /AC PAVE — LANDSCAPE — CONCRETE — SIGNALS /LIGHTING /LOOPS Agency Name: LOS ANGELES COUNTY — DEPT. OF PUBLIC WORKS (LACDPW)' Contact Person: EMILKURLYAND Telephone:, 626- 4584166 Project Values $2,713;186 Updated October 2008 SULLY- NULLER C ONTRAC'T[NO CO. i!ran;C 7.1761 ?A 31vd!.,, E.:;DA ♦ C''� ?i, 1't�92;127. + !°i-1ON(L7!�'- 5 ?: ?- yr',RQ Pavement Preservation References: Job No. lob Valne Description Owner Contact 29881c 106,411 AC paving, sealcoat and re's Kinder Morgan. David Lannon stripe Carson Facility 310-2.51-15893 29375c, 257,093 Coldmill, AC overlay, sealcoat Pratt Whitney Leff Stern and restripe the North Lots Rockei'dyne 818 535 -63D:L at the DeSoto Facility, CA 29369c' 266,286 AC paving, sealcoat and restripe Swinertorr Raj Ramanalhan Salvation Anny parking lot Builders 213.440-4535 in Anahelm, CA. 29353c 7£1,:167 AC paving, sealcoat nd re- Hathaway- Rene Contreras stripe parking lot5.atThe Dinwlddle 5.62 -944 -9331 Buckley School. 23015e 230,412 AC paving, sealcoat and'restripe., Jorgensen 6III Vlzza Toyota Airtlite Terminal at 925- 244 -12D:} Long Beach Airport, CA:.. 23792c 369,575 AC repahs, sealcoat & resirilie.. Toyota Logisistics ion Keller Port of Los Angeles, CA. 718 -736 -2409 27636c 369,931 AC /P.CC-repairs; sealcoat anal Pratt Whlpuay Mike Daley rests icing at two facilities in Itocltetdyno 8:18-586-9052 Canoga Park, CA. 276750 623,996 AC /PCC repairs, se lcoat and The Boeing Wayne,Holt restriping at three facilities in Company .562 - 797-4234 Anahe4m „HUI1tlnBton Beach;, and Seal beach; CA. 23293e 327,9116, i Soulh-Coast.Diive Realignment. Cl Segerstrom Grant Wilson included Type 11Road Slurry, & Sons 714- 433 -3276 w /2% Latex 23292c 2.66,922 Flarbor Blvd Ynalignment F15egers0oifr GrantWilsoit included Type II'Road Slurry 3r Suns 7:1.I- 43373276 w/2% Latu 22277c. 1,450,Tt6: South .Coast Drive Realignment CJ Segerstrom Grdlit Wilson iit&0ed Type II Rriad Slushy 8i Sons 714- 433 -3276 w/2% Latex 8 BIDDER: Sully - Miller Contracting Company SECTION 3 NON - COLLUSION AFFIDAVIT CBF -11 BIDDER: Sully - Miller Contracting Company 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, orthat 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. Assistant secretani Title Sully - Miller Contracting Company Bidder Subscribed and sworn before me This —day of i .20 (Seal) "PLEASE SEE ATTACHED CALIFORNIA NOTARY JURAT FOR PROPER WORDING" Notary Public in and for the State of California My Commission Expires: CBF -12 STATE OF CALIFORNIA l COUNTY OF ORANGE Jj Subscribed and sworn to (or affirmed) before me on this 15th day of March, 2011, by Gary Downey, proved to me on the basis of satisfactory evidence to be the person who appeared before me. J. DANIELS Q COMM # 181 S m WITNESS my hand and official seal 't NOTARY PUBLIC- CALIFORNIA A / inRANGECOUNTY Signature nWV,W...yl�n Q Nty Comm1,10, E'Pi Sept. 24, 20.2 9 J. D niels, Notary Public Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Non - Collusion Affidavit Document Date: March 15, 2011 Signer(s) Other Than Named Above: Number of Pages: Capacity(ies) Claimed by Signer(s): Signer's Name Gary Downey Signer's Name E] Individual OX Corporate Officer — Title(s) ❑ Partner — Limited /General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other Signer is Representing: ❑ Individual Assistant Secretary ❑ Corporate Officer — Title(s) Right Thumbprint of Signer ❑ Partner — Limited /General Attorney In Fad ❑ Trustee ❑ Guardian or Conservator ❑ Other 1 Right Thumbprint of Signer CITY OF ROSEMEAD ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 i "NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID" entity shall include an affidavit, in the following form: §7106. Any public works contract of a public State of California County of Oran Oe.__ -- ) as. deposes and says that, he or she is Gary Downey being fist duly sworn, P Sully - Miller Contracting Company the party making the foregoing AssistantSecretary _of bid, that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or co poration; 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; thatthe 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 or to secure any advantage against r of that of any other overhead, profit, or cost element of the bid price, oos'ed contract; that all statements contain d the public body awarding the contract of anyone interested in the prop in the bid are true; and, further, that the bidder has not, directly or indiroctly, submitted his or her bid price it any breakdown thereof, or the contents thereof, or divulged association, ! gads zationlabid depository, onto any member pay, any fee to any corporation, partnership, company or agent thereof to effectuate a collusive or sham bid" project Number: CDBG Project No. P84129 Annual 2010 -2011 Slurry Seal Project. 1 Project Name: Sully - Miller Contracting Com an i Company: 135 S. State College Blvd., Ste. 400, Brea, CA 92821 Address: signature: / Gary-[ Title: Date: March 15, SWORN TO AND SUBSCRIBED TO BEFORE ME day of , 20 This Y Iy'. ` Is/ Notary Public: My Commission Expires: i "PLEASE SEE ATTACHED CALIFORNIA NOTARY JURAT FOR PROPER WORDING" STATE OF CALIFORNIA l COUNTY OF ORANGE Jj Subscribed and sworn to (or affirmed) before me on this 15th day of March, 2011, by GEC Downey, proved to me on the basis of satisfactory evidence to be the person who appeared before me. 6PMONP POPOOPPOO J. DANIELS t COMM # 1813952 m WITNESS my hand an official se�l W NOTARY PUB CALIFORNIA ORANGE COUNTY b MyCnmmisslonEzpiresSIPi.IIZ!!g Signature ft( oowooa .eseePeePPPPPPeeeesosaa J. Daniels, Notary Public Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Non - Collusion Affidavit Document Date: March 15, 2011 Signer(s) Other Than Named Above: Number of Pages: Capacity(ies) Claimed by Signer(s): Signer's Name Gary Downey Signer's Name F Individual FX Corporate Officer — Title(s) ❑ Partner — Limited /General ❑ Attorney In Fad ❑ Trustee ❑ Guardian or Conservator ❑ Other Signer is Representing: ❑ Individual Assistant Secretary 0 Corporate Officer — Title(s) Right Thumbprint of Signer ❑ Partner — Limited /General ❑ Attorney In Fact ❑ Trustee Guardian or Conservator ❑ Other SULLY - MILLER CONTRACTING COMPANY Right Thumbprint of Signer CITY OF ROSEMEAD ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 1 NON - SEGREGATED FACILITIES CERTIFICATION FEDERALLY - ASSISTED CONSTRUCTION PROJECTS I 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 a As used fn this certification, lthe term certification egregated faclilities means any Opportunity Clause in this contract. locker room room, and d other storage or dressing rarea s, restaurants parking lots, ndrink ngefolungtains,srecreation kor lockerainmentareas, transportation, and housing facilities provided for employees which are segregated by explicit directive , 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 subcontractors that timexpePods) he/she will has obtain obtained aln certifications from from proposed 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 15, 2011 Company: Sully - Miller Contractin Com 135 S. State College Blvd., Ste. Frlriro ' Project Number: CDBG Project No P84129 STATE OF CALIFORNIA l COUNTY OF ORANGE Jj On March 15, 2011 before me, J. Daniels, Notary Public, personally appeared Gary Downey Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Non Segregated Facilities Certification Document Date: March 15, 2011 Signer(s) Other Than Named Above: Number of Pages: 1 Capacity(ies) Claimed by Signer(s): Signers Name Gary Downey Signer's Name ❑ Individual FX Corporate Officer — Title(s) 11 Partner — Limited /General ❑ Attorney In Fact ❑ Trustee Guardian or Conservator ❑ Other ❑ Individual Assistant Secretary ❑ Corporate Officer — Title(s) Right Thumbprint M ❑ Partner — Limited /General ❑ Attorney In Fact ❑ Trustee ❑ Guardian or Conservator E] 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 instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. COMM # 1813952 m I certify under PENALTY OF PERJURY under the laws of RY PUBLIC •CALIFORNIA Q NOTA ORANGE COUNTY � the State of California that the foregoing paragraph is true jj NyCommisslonExpiresSept.24,2012 S.NON NNNNNINNMy00906NgC and correct. WITNESS my hand an official seal Signature 6 J. Daniels, Notary Public Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Non Segregated Facilities Certification Document Date: March 15, 2011 Signer(s) Other Than Named Above: Number of Pages: 1 Capacity(ies) Claimed by Signer(s): Signers Name Gary Downey Signer's Name ❑ Individual FX Corporate Officer — Title(s) 11 Partner — Limited /General ❑ Attorney In Fact ❑ Trustee Guardian or Conservator ❑ Other ❑ Individual Assistant Secretary ❑ Corporate Officer — Title(s) Right Thumbprint M ❑ Partner — Limited /General ❑ Attorney In Fact ❑ Trustee ❑ Guardian or Conservator E] Other Signer is Representing: SULLY - MILLER CONTRACTING COMPANY Right Thumbprint of Signer �i CITY OF ROSEMEAD ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 CERTIFICATION WITH REGARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR SUBCONTRACTS THE FILING OF REQUIRED OPPORTUNITY CLAUSE AND REQU RED REPORTS The ®bidder, ❑proposed sub - contractor, he certifies that he /she INhas, Ohas not, participated in a previous contract or subcontract subject to the Equal Opportunity Clause, as required by Executive Reporting 11114, or the that he/she Federal Cont❑ractscompliadn e, the Joint Federal P or the former President's Committee on Equal Government contracting or administering agency, applicable filing requirements. Employment Opportunity, all reports due under the app March 15, 2011 Project Number:CDBG Proms. No.. ContractAWard: $a8 Date: 12P$� 9 Awarding Agency: City of Rosemead Sully - Miller Contrac ' Total Number of Employees ass Contractor Name: Affiliate Company: N/A M NOTE: ce ' ion 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 ih re exempt contracts the equ contra its which are c ause are set forth in equal 41 CFR 60 -1.5 (Generally only contracts o subcontra tslof $10,DOD oufnder the equal opportunity are exempt). 1 prevents the award of Proposed prime contractors and subcontractors who have participated ud no in a previous contractor subcontract subject o eriod or such other period the Executive Orders and have notfiled the required reports should note that 4l CFR 60- 1.7(b)( p contracts and subcontracts unless such contractor submits a report covering the delinquent p specified by the U.S. Department of the Interior or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. SF-1 00 (EEO -1) must be filed bv; (A) All private employers who are: r owned or affiliated with 11) Subject to Title VII of the Civil Rights Act of 1964 (as amended) company more employees. 2 Subject to Title VII who has fewer than 100 employees, group another company, or there is centralized ownership, control or management s a total of 100 ohamore emp oyeesly constitutes a single enterprise, and the entire enterprise employ (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 contractors o or fir on more; contractors, and have a contract, subcontract, or purc ase order amounting b. Serve as a depository of Government funds in any amount, ent for U.S. Savings Bonds and Notes. c. Is a financial institution, which is an issuing, and paying g STATE OF CALIFORNIA COUNTY OF ORANGE Jj On March 15. 2011 before me, J. Daniels, Notary Public, personally appeared Gary Downey 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 R9690990999N999N9H9�MH9099999ee99694 instrument the person(s), or the entity upon behalf of J. DANIELS D which the person(s) acted, executed the instrument. COMM # 1813952 m W NITfORANBECODURIHNIA I certify under PENALTY OF PERJURY under the laws of ORANGE COUNTY D a 9.999....9+.e.c0e m uOe� lrressevc 2 Zoe t the State of California that the foregoing paragraph is true and correct. WITNESS my hand an offcial steal Signature 6 J. Qlaniels, 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 15, 2011 Signer(s) Other Than Named Above: Number of Pages: Capacity(ies) Claimed by Signer(s): Signer's Name Gary Downey Signer's Name ❑ Individual Fx Corporate Officer — Title(s) ❑ Partner — Limited /General Attorney In Fact Trustee Guardian or Conservator Other Signer is Representing Assistant Secretary Right Thumbprint or ❑ Individual ❑ Corporate Officer — Title(s) ❑ Partner — Limited /General D Attorney In Fact ❑ Trustee Guardian or Conservator D Other SULLY - MILLER CONTRACTING COMPANY Right Thumbprint of Signer CITY OF ROSEMEAD ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 i Community Development Commission County of Los Angeles COUNTY NO. CHAPTER 160 0031 COUNT CERTIFICATION Sully- Miller Contracting Com 3an Name of Firm: 135 S. State Collge Blvd. S Address: 578 -9600 State: CA zip Code: 9282.__ _ Telephone Number: (714 ) Acting on LosaAnfel s above nd the community Development Commission, County olf Los Angeles. on to the County of Lo Angeles for a Community Development 1) It is understood that each person /entityrm who t process Commission contract, and as part of thaCode, Chapt shall 2.160 (Los Angeles rCounty Ordinance requirements of the Los Angeles County 93- 0031) and; acting on behalf of the above named firm have and will comply 2) That all persons /entities /firms 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. certification is a material representation of fact upon which reliance was placed when this transaction This was made at entered into. Submission of this certification is a prerequisite for making or entering into i eles. contract with the Los Angeles County and th e Community Development Commission, County of Los ng Authorized Official: Sully - Miller Contracting Company (Cannaclor5ubwnMn=) March 15. 201 STATE OF CALIFORNIA l COUNTY OF ORANGE Jj On March 15, 2011 before me, J. Daniels Notary Public, personally appeared Gary Downey Description of Attached Document Title or Type of Document: County Lobbyist Code Chapter 2.160, County Ordinance No. 93 -0031 Certification Document Date: March 15, 2011 Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s): Signer's Name Gary Downey Signer's Name ❑ Individual r x Corporate Officer — Title(s) Partner — Limited /General Attorney In Fact Trustee ❑ Guardian or Conservator ❑ Other Signer is Representing: ❑ Individual Assistant Secretary [j Corporate Officer — Title(s) Right Thumbprint of Signer ❑ 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 J. DANIELS instrument the person(s), or the entity upon behalf of COMM q 1813952 m which the person(s) acted, executed the instrument. W NOTARY PUBLIC- CAUf-0RNIA Q ORANGE COUNTY .. I certify under PENALTY OF PERJURY under the laws of My Commimlon Expires Sept. 24, 2012 ¢ ...... .............................« the State of California that the foregoing paragraph is true and correct. WITNESS my hand an official segl Signature qhll" J. EMniels, 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 15, 2011 Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s): Signer's Name Gary Downey Signer's Name ❑ Individual r x Corporate Officer — Title(s) Partner — Limited /General Attorney In Fact Trustee ❑ Guardian or Conservator ❑ Other Signer is Representing: ❑ Individual Assistant Secretary [j Corporate Officer — Title(s) Right Thumbprint of Signer ❑ Partner — Limited /General ❑ Attorney In Fact Trustee Guardian or Conservator ❑ Other SULLY - MILLER CONTRACTING COMPANY Right Thumbprint of Signer :1 CITY OF ROSEMEAD ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 0 i .l' 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 orto ply with such provisions before commencing he performance of that code, and I will comply the work of this contract. Project Number: CDBG Project No. P84129 Date: March 15, 2011 Project Name: Annual 2010 -2011 Slur Seal P Sully - Miller Contracting Compan Company Name: Address: 135 S. State Colle e Print Name: vary' Title: Assistant __--- Signature: __ STATE OF CALIFORNIA l COUNTY OF ORANGE Jj On March 15. 2011 before me, J. Daniels, Notary Public, personally appeared Gary Downey Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Worker's Compensation Certification Document Date: March 1 Signer(s) Other Than Named Above: Number of Pages: Capacity(ies) Claimed by Signer(s): Signer's Name Gary Downey Signer's Name ❑ Individual Ox Corporate Officer— Title(s) ❑ Partner — Limited /General ❑ Attorney In Fact E] Trustee ❑ Guardian or Conservator ❑ Other Signer is Representing: ❑ Individual Assistant Secretary ❑ Corporate Officer— Title(s) Right Thumbprint of Signer 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 J. DANIEf S� instrument the person(s), or the entity upon behalf of COMM # 1813952 m which the person(s) acted, executed the instrument. cc NOTARY PUBLIC - CALIFORNIA. � Q ORANGE COUNTY >. I certify under PENALTY OF PERJURY under the laws of My commission Expires Sept. 24.2012 ; the State of California that the foregoing paragraph is true $ saoeH NeoeseeeeseswHNee'+ee ^e°°°°e°°° and correct. WITNESS my hanMt" official seal Signature Daniels, Notary Public Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Worker's Compensation Certification Document Date: March 1 Signer(s) Other Than Named Above: Number of Pages: Capacity(ies) Claimed by Signer(s): Signer's Name Gary Downey Signer's Name ❑ Individual Ox Corporate Officer— Title(s) ❑ Partner — Limited /General ❑ Attorney In Fact E] Trustee ❑ Guardian or Conservator ❑ Other Signer is Representing: ❑ Individual Assistant Secretary ❑ Corporate Officer— Title(s) Right Thumbprint of Signer Partner — Limited /General Attorney In Fact Trustee Guardian or Conservator Other SULLY - MILLER CONTRACTING COMPANY 1 Right Thumbprint of Signer a CITY OF ROSEMEAD ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 ce O O N Z� O� � o O 611 -O Oo a� 0 a i c a` ay O{ H O F U H Z O U N a O IL 0 z v m 0 L CL v t7 � m 0 E �U O o i k% q F O z a q I U a t5 d 'o L CL A m rn r L N r Cl Cl N O O N 7 C C El C � � C N V �N fL6 N Q C O y � V p c m A E � m E m z T R n E U is CITY OF ROSEMEAD ANNUAL 2010-2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 { U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (1. EPORT OF ADDITIONAL CLASSIFICATION AND RATE 2. PROJECT NAME A FROM (name and address of requesting agency) r N/A 4. BRIEF DESCRIPTIM 6. WAGE DECISION Nr -I ❑ COPY ATTACHED 6. .:I .1 WORK CLASSIFICATIONS) 9. PRIME CONTRACTOR (Mme- 3. ❑ Building ❑ Heavy ❑ Highway 10. HUD FORM 4230A OMa APprmd NM ai���o6) ❑ Residential ❑ Other (specify) HOURLY WAGE RATES FRINGE BENEFITS) (if any) BASIC WAGE I Check All That A 1 ifications) is not performed by a classification in the applicable wage decision. ❑ The work to be performed by the additional class ❑ 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 rates . able wage decision. ..__.- - -. -- --- - - -- -- - ❑ supporting documentation attached, includin g app lic`____.___ —__— ----- - --- -- Check One: ❑ Approved, meets all criteria. DOL confirmation requested. ❑ One or more classifications fail to meet all criteria as explained in age hcy referrFOR HUUDdUSE ONLY quested. LR2000: I Agency Representative (Typed name and signature) Phone Number Log In: Log Out: CITY OF ROSEMEAD ANNUAL 2010-2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 To: OPERATING ENUINMKa {Name of lab- Uui® or workers' Representativel CA [Address] Awarding Authority: City of. Rosemead Annual 2010 -2011 Slurry Seal Project, CDBG Project No. Project Name and Number: City of Rosemead The undersigned currently holds a contract with involving Community Development Block Grant (CDBG) funds from the U.S. Department of Housing and Urban Development (HUD) or a subcontract with a prime contractor holding such contract against any employee or You are advised that under the provisions of the above contract or subcontract and in accordance with Executive Order 11246, the undersigned is obligated not to discriminate ag n This obligation not applicant for employment because icludes, but shot limited to, the following: origi to discriminate in employm IIIRTr7C, PLACEMENT, UPGRADING, TRANSFER, OR DEMOTION; RECRUIT - TdN ADVERTISING, OR SOLICITATION FOR EMPLOYMENT; TREATMENT RATES OF MENT, A O OTHER O DURING Mp OTION FOR TRAINING, INCLUDINAPPRENTICESH ; AND SATION, LAYOFF OR TERMINATION. to the provisions of the above contract or subcontract and This notice is furnished to you pursuant Executive Order 11246_ e undersigned in conspicuous places available to employees Copies of this notice will be posted by th or applicants for employment. Sully - Miller Contracting Company {epnimctadSulwnniractor] March Secretary CITY OF ROSEMEAD ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 I I I, 1 I I TO: Sully- Miller Contracting Name of Business (contractor): Annual 2010 -2011 Slurry Seal Project Project Number: CDBG Project No. P84129 Project Name: City of Rosemead The Undersigned currently holds a contract with involving Block subcontract with acpBme funds from holding S. Department contractor Housing and Urban Development or a with Section '3eof the Housing and Urban Development Actnof )yme the undersigned ( s we obligated to tract or subcontract and 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 k o on the project o area residence. business concerns which are located in or are owned in substantial part by p ro 1 Regarding employment opportunities for Section 3, the minimum number and job titles are: Job Classification Regarding j ob 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. . For additional information, y ou May The anticipated date the work will begin is �— at contact ,„„� This notice of furnished g and Urban Development the provisions t Act of 1968, copies of this cnotice VAI be posted to you pursuant Section 3 applicants for employment. by the undersigned in conspicuous places available to employees or apP Gary Downey By: (Prim Ne 0 / March 15, 2011 CITY OF ROSEMEAD ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 YI I To: Awarding Authority: City project Name and Number: [Name of Labor U*oon or Workers ReQ [Address] 2010 -2011 Slurry Seal Project, CDBG Project The undersigned currently holds a contract with City of Rosemead involving Community Development Block Grant (CDBG) funds from the U.S. Departrnent of Housing (HUD) or a subcontract with a prime contractor holding such contract. and Urban Development and in accordance with the undersigned is obligated, to the You are advised that under the provisions of the above contract or subcontract, and employment to lower'- income residents of Section 3 of the Housi s for training ng and Urban Development Act of 19 > greatest extent feasible, to give oppofimLtie the project area and-to award contracts for work on the project to business concerns that are located in or are owned in substanti al part by Project -area residents. Regarding employment opportunities for this project, the minimum number and job titles are: job referrals, request that consideration be given, to the greatest extent feasible, to assignment Regarding j ect is located. of persons residing in the service area or neighborhood in which the proj The anticipated date the work will begin is For additional information, contact: contract This notice is furnished to you Pursuant to the provisions f tC nniesvof this notice will be posted by the subcontract 3 of the Housing and Urban Development Act of undersigned in conspicuous places available to empl Sully - Miller Contracting Company [Cantmctor5ubcunincm0 March 15, 2011 ---------- - CITY OF ROSEMEAD ANNUAL 2010-2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 A Section 3 resPonsn'e bidder who commits to hire Section 3 Residents br• directing employment and training opportunities toward In 3 and very low- income persons, particularin those who are recipients of government assistance jor housing, man use any combination Of Outreach efforts to meet the Section 3 commitment made when a Section 3 Economic Opportunity Plan has been submitted oats — Section 3 New your permanent full-time staff. REMEMBER: All employees of a business/firm count toward meeting your Section 3 compliance g Hires do not have to be construction workers; they j ust have to be a part of SAMPLE OUTREACH EFFORTS FOR CONTRACTORS SEEKING SECTION 3 RESIDENT EMPLOYEES Enter into "first- source" hiring agreements with organizations representing 1110 eresidnformati nos Work Source or a local Workforce Investment Board. http: / /www.calwia.orgllwWind ex.cfm . Sponsor aHUD- certified "Step -Up" employment and training program for Section 3 residents. j Advertise training and employment positions by distributing flyers (Notice of Section 3 Commitment d other flyer that identifies the positions to be filled, the qualifications required, and where [o obtain additional information about the application process) to every occupied dwelling unit in the housing developments) 1 adjacent to the project site. developments, offices of the local govern post training and employment position flyers in public housing ment and other conspicuous places. Contact State - approved apprenticeship programs to gain access to potentially low-income residents who all 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 visiting http: / /www.dir.ca.goN,/databases /das/aigstai't.aSp. I Contact agencies administering III7D youthbuild programs and request their assistance in recruiting current ! UD youthbuild program participants who are in need of permanent Placemen H t. . • 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 wuww.monster,com. i .E "Please See Attached Section 3 Resident Certification Forms" SECTION 3 RESIDENT CERTIFICATION (20091NooME GUIDELINES) Name: Address: I hereby certify that I am a Section 3 resident; based on the following qualification(s): I am a public Housing resident (specify Name of the Public Housing site): I am a low- income resident of the Los Angeles metropolitan area, select your Family Size and gross annual Income Limits (from all sources): FaMC3$31,401to$52,350 i ,,,��, to $27,750 - -p $27,75110 $44,400 0$44,401ormcre 50 or Less to $31,700 $31,701 >D $50,750 ❑ $50,751 ormore 50 or Less to $35,700 0 $57,101 or more 00 or Less 1 to $39,650 $39,651 �$ 0 $63,4510r more 800 or Less 1 to $42,600 600 m4ot� 0 $68,551 a more ,700 or Less 1 to $46,000 001 0 $73,601 or more ,600 or Less 1 to $49,15D 0$49,15110$78,700 0$78, 701 or more ,500 or Less ❑ $,1 to $52,350 0 2,3511D $83750 ❑ $83,751 or more re sident of the Los Angeles metropolitan area. I am not a public housing or low- Income 3. Date Employee Signature To Be Completed bV the Employer is a new -hire employee who was hired on: The above -named person This person's Work Classification is Business Name: Print Name of owner/ Agent: __� Signature of Owner I Agent: v11a� Section 3 Resident Certification ryees Residing In Los Angeles Cc aw wlmr t is chedred on lance rtun�— �a..a. •,� �......m- 21109Income tJrrdfa Employee's Name: �H✓ZV ..M Employee's Address: ' C) IN UPSUlk 1 hereby certify that I am a Section 3 resident, based on the full qualification(s): 1. ❑ 1 am a Public Housing Resident (spaWyN�eof eePab'OHoamaesu): 2. I am a low- income resident of the metropolitan area. My-household size and gross annual Income level from all sources is: r..Y. 3. ❑ 1 am not a public housing or low- income resident of the metropolitan area. % 3 -119 Employee Signature Date Must Be Completed by Employer The above -named person Is a permanent full -tine employee who was hired on: The abovemamed person is a permanent full -time new -hire employee who was hired am This person's Work Classification or Position Title is: Name Oct 1 RF® er. ,AkC1gO Employee's Name: Em loyee's Address: Section 3 Resident Certification siding in Riverside &San Bernardino Counties `be submlHed wUh BId d box 1'a checked on Sec/on 3 Bushes 2009 /name Umfis T�Zge) Ma < < ¢ RSr'rr�d p I hereby certify that I am a section 3 resident; based on the following civalification(s): t, I am a Public Housing Resident (spadNNwmOremPub1bWueme.rm): 2 ❑ I am slow- income resident of the metropolitan area. My- household size and gross annual Income level from all sources Is: 3. ❑ 1 am not a public housing or low- income resident of the metropolitan area. –PLC— 3D Zvi ployee Slg re Date Oc 13 AFO 7010 Must CorI7 pleted by Emolover The above -named person Is a permanent fulHime employee who was hired on: The above -named person Is a permanent full-time new-hke employes who was hued on: This person's Work Classlflcatlon or Position Title Is: ^ j q'-�`7 Employee's Name:, Employee's Address Section 3 Resident Certification siding in Riverside & San Bernardino Counties . _ _..,._,W.r...er. nil w o.... � k rharrnwf nn Section 3 BUSIlie881 2009 Income Limns I hereby certify that 1 am a Section 3 resident, based on the following qualification(s): 1. ❑ I am a Public Housing Resident (Specify Name or the POW FleesiW ells): 2. ❑ I am a low- Income resident of the metropolitan area. My household size and gross annual Income level from all sources Is: HOUSEHOLD SIZE &INCOME LEVEL ❑ 1 $37,300 or less ❑ 2 $42,650 or less ❑ 3 $47,950 or less ❑ 4 $53,300 or less .5 $57,550 or less ❑ 6 $61,850 or less El 7 $66,100 or less D 8 $70,350 or less 3. ❑ I am not a public housing or low - income resident of the metropolitan area. lZ,n,�_ r9.0 X6'31 iZ) Employee Sign re Date ?�0 Must Be Completed by Employer The above -named person is a permanent tulldime employee who was hired on: The above -named person Is a permanent full alms new -ti/re employee who was hired on: This person's Work classification or P1ositlon Tnle is :, Name of 6MOlerer: a-'-r ' 1 V�-`� lJt . ((1- I.�.I�ZU..0 V 1 ,i A MI, Section 3 Resident Cerl[flcatlon Employees Residing In Orange Cot, rnce Form- Must be submfMed w(fh Bkl M Box i !s checked c 20091ncome Limb Employee's Name: f-znQ 6 Employees Address: 't.90 I hereby certify that I am a Section 3 resident; based on the following qualification(s): 1, ❑ I am a Public Housing Resident (spacer Nwne orsw Puw Houahp 8.11GY 2. [+ I am a low- income resident of the metropolitan area. My household size and gross annual income level from all sources W. 1 $52,100 or less UO2 Wlew less r less r less r less r less r less ACT .r less 3. 1 am not a public housing or low- income resident of the metropolita���n area. Employee Signature Date Must Be completed bvEmplover The above -named person is a permanent UPUMe employee who was hired on: The above -named person Is a permanent full-time nenF Wri employee who was hired on: This person's Work Classiifi1catiofnn for Positio(njiitle1is. a t1>,U-i Name of F�nplorer. &Q^^^ 4 u gtgLA Section 3 Resident Certification nlovees Residing in Orange Cot rd with Bid if Box 1 is chocked on 2009 Income Limits Employee's Name: r 11L c. Employee's Address: 2232 E LGn� LAr1C /�p� $gnfg ina , C/� rJ210 I hereby certify that I am a Section 3 resident; based on the following qualification(s): 1, ❑ I am a Public Housing Resident (specify Name of the Public Housing she): 2. N( I am a low- income resident of the metropolitan area. My household size and gross annual income level from all sources is: HOUSEHOLD SIZE & INCOME LEVEL ❑ 1 $52,100 or less ❑ 2 $59,500 or less ❑ 3 $66,950 or less ❑ 4 $74,400 or less. ❑ 5 $80,350 or less CR 6 $86,300 or less ❑ 7 aY µ $92,250 or less ❑ 8 $98,200 or less 3. ❑ 1 am not a public housing or low- income resident of the metropolitan area. G,Q,t,_t �r _ I ! q Employee Signature Date Must Be Completed by Employer The above -named person is a permanent full -time employee who was hired on: I ` SCI The above -named person is a permanent full -time new -hip; employee who was hired on: This person's Work Classification or Position _ Tiitllee is; I n lip-tg � Name of Employer.. �� - �AR�1��n t,e'tt) C0 L Lt1qG--Cl Section 3 Resident COM"tion lyees Residing In Los Angeles Cc 2009 Income tJMb Employee's Name: 6 1111 1 yte QU• 1u ��•,,M� 90.2 Employee's Address:1U —?1 —� I hereby certify that I am a Section 3 resident; based on the following qualification(s): 1. ❑ i am a Public Housing Resident (spury Nymeofthe PUbua K*WM&6): 2. ❑ I am a low- Income resident of the metropolitan area. household size and gross annual income level from all sources is: M400 or less 750.or less 100 or less 460 or less OCj 1 .660 or less ,600 or less ,700 or less ,760 or less 3• ❑ 1 am not a public housing or low-income resident of the metropolitan area. oa Must Be Co is E o yet The above -named person Is a permanent full-ame employee who was hired on: The above -named person is a permanent fuMime new6hke employee who was hired on: This person's Work classification or ,Position Title is: Name of Employer: i I', 1RI-k5 Section 3 Resident Certification ,yeas Residing in Los Angeles Cc lance roan -I'll, �, 20091ncome Limb Employee's Name: 0aUr.- 14 1 FP +„ ve (-!a c Nt5 CA 917,,�r• Employee's Address: t 1 hereby certify that I am a Section 3 resident,, based on the following qualification(s): El I am a Public Housing Resident (specib Nam Of the PLOD Hey"i"ll av)' 2 ❑ I gun a`{ovwincome resident of the metropolitan area Mhousehold size and gross snnu'Finn ,omelevel �EL all sources is: q $44,400 or less 2 $60,760.or less 3 $67,1 "oo or less q $e3,46o or less 5 $69,660 or less 6 $73,600 or less 7 $79,700 or less a 563.760 or less ro AOCrr3 Rr� -9yy goo O�G .3 1 am not a public housing or low - income resident of the metropolitan area. 0 — -pte ErnploYOO Signature us a Com ete Ern to er �S The above named person la a permanent fulFt(me employee who was hired on: The above-named person Is a permanent tug time now-him employee who was bf 1 on This person's Work Classlficatlon or Position Title Is:. Name of Emptoyar: _ Section.3 Resident Certification sidina In Riverside & San Bernardino Counties 20091noome Uffub Employee's Name: A y�A4oV-. wiJ O� Employee's Address: l[ -goo I hereby certify that I am a section 3 resident; based on the following qualiflcation(s): I, ❑ . I am a Public Housing Restdent(speab Name of ft Public HaWng alle): 2. l am a low- income resident of the mptropolitan area. My, household size and gross annual income level from all sources is: 3, ❑ 1 am not a public housing or tow - income resident of the metropolitan area. Employee Signature Date OOj-�3 RFO Oft Must Be Completed by Emntover The above -named person Is a permanent full -time employee who was hired on: The above -named person is a permanent full -time new -hire employee who was hired on: 1— L��UL�C1 V1 Trila person's Work Gasslftcationl�oAr Position T1/itl�e is: CO ok n V.1 Name of Employer. �'•1L���� "'�Q�l 4CQ `�' - --- - - -- - - - M6_ orne U Employee's Name: .Employee's Address: it I hereby certify that I am a Section 3 resident; based. oil-, fhe quallification(s), am a Public Housing Resident (spedlY Name of the Public .HOuft 36)" 2 1 1 am a low4noorrie . resident of the metropolitan area. My_ el -from all.sources is: househo 4 tAA Ann nr,l;� � 3. oor x31.144© I am not a p. Libilo; housing or low4ncome resident of the Qtr000lb A t:� to M P OYSO Datb mptavas i�gnature t fultWirle, eMpi" who was hired on Cl C—) .Ttleabove-.namedperson l$3P8rmarwn... The I above -named . person is 8 permaneht flillbrne new-hkomployee who was hired This person's Work classificaflon or position Titte, + Nona of Employer i o 1(� qq Employee's Name: Employee's Address I hereby certify. that I am a Section 3 resident; based on the following qualifrcatlon(s): Section 3 Resident Certification iyeas Residing In Los Angeles Cc 2009 income IJmits 1, I am a Public Housing Resident(spe* Name of ft Pa WHemfng of): 2• am a low- income resident of the metropolitan area. My household size and gross annual income level from all sources is: �. OCjI d RFO 3• ❑ 1 am not a public housing or low- income resident of the metropolitan area. lw�d Z. B•� s-• f6 mployee Signature Date Must Be Completed by Employer The above -named person is a pennanentfuRkne employee who was hired orr. � — .3 — The above-named person Is a permanent full-time new.hire employee who was hired(oonn: :, � � � This person's Work classi0ca8on or Position Title Is: A t nLt I i P L �� Name $441400 or less 2 $60,750,or less 3 $57,100 or less 4 $63660 or less 5 $68,660 or less 8 $73,600 or less 7 $78,700 or less 8 $83,760 or less �. OCjI d RFO 3• ❑ 1 am not a public housing or low- income resident of the metropolitan area. lw�d Z. B•� s-• f6 mployee Signature Date Must Be Completed by Employer The above -named person is a pennanentfuRkne employee who was hired orr. � — .3 — The above-named person Is a permanent full-time new.hire employee who was hired(oonn: :, � � � This person's Work classi0ca8on or Position Title Is: A t nLt I i P L �� Name L'iIct 5 11 Section 3 Resident Certification :mployees Residing In Riverside &San B. * isnce Form — Must tie subm 11 B�� I i eked on Employee's Name: 4 r'l' 5 Employee's Address: C.`i0 I hereby certify that I am ,a Section. 3 resident; based on the following qualification(s): i, ❑ 1 am a Public Housing Resident (specify Name of the Public Housing alte): 2. I am a low- income resident of the metropolitan area. My household size and gross annual income level from all sources is: 3. ❑ 1 am not a public housing or low- income resident of the metropolitan area. � ,s Da /lam E r loyee signature Date oejj O t-o �g0 Must Be CorrlilMed by Emolover The above -named person is a permanent full -time employee who was hired on: The above -named person is a permanent full-time new -hire employee who was hired on: This person's Work Classification or Position Title is: Name of F.mPloYer: .- I,IYU..��t 1 l r>✓t�T4(1. \� %t`T —n glqco SECTION 3 RESIDENT CERTIFICATION (a7091NC MGU1MNE8) I Employee's Name: Employees Address: 15 I'1 I hereby certify that I am a Section 3 resident, based on the following qualiflcation(s): 1. ❑ I am a public housing resident (specify the 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): E LEVEL 0 orless 0 or less 00 or less Mrj 50 or less W,52,360orless 00 or less 00 or less 50 or less 50 orless 3_ ❑ I am not a public housing or low- income resi dent of the metropolitan area. - 12J7 15q 1 Date TO BE COMPLETED aYTHE EMPLOYER hh 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 persons job classification is: )` BusinessfCompanyname: — lLU i Name of employerfauthorized agent: 2tlbb 3• "i " �i a i :a CITY OF ROSEMEAD ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 SECTION 3 BUSINESS CERTIFICATION FORM i Business Name: Sully - Miller Contractin Com an 135 S. State College Blvd., Ste. 400 Business Address: Brea, CA 92821 i Telephone Number: 714- 578 -9600 Contract /Bid Amount: $a�♦ S� 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 Number of Section 3 qualified Employees — _i Total Number of all full -time employees his Business Certification form) (Submit the Resident Certification form(s) with t I 2. The above mentioned business firm is not a Section 3 business concern, but commits to the Section 3 goal: �t Written Commitment (Section 3 Economic opportunity Plan), outline intenti ons to: Hire Section 3 qualified residents at least 3o- percent aggregate new hire positions, and /or I Subcontract 25- percent or more of the contract amount to Section 3 qualified business concerns. ..i THE UNDERSIGNED DECLARES THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT March 15, 2011 Date Sig tur of Owner /Pr" eipal Gary Dowry y, Assistant Se etary 747612 -A Sully- Miller Contra g Company License Number usiness Name To Be Completed by Local Contracting Agency Preference Category: oTargeted Service Area oYouthbuild oother Census Tract Number: STATE OF CALIFORNIA l COUNTY OF ORANGE Jj On March 15, 2011 before me, J. Daniels, Notary Public, personally appeared Gary Downey Description of Attached Document Title or Type of Document: Section 3 Business Certification Form Document Date: March 15, 2011 Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s): Signers Name Gary Downey Signers Name ❑ Individual ❑Corporate officer— Title(s) ❑ Partner — Limited /General ❑ Attorney In Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other Signer is Representing ❑ Individual Assistant Secretary F—] Corporate Offcer — Title(s) Right Thumbprint of Signer ❑ 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 Y +••+•••••••< J « »« O ..•..• instrument the person(s), or the entity upon behalf of COMM # 1813952 D which the person(s) acted, executed the instrument. NOTARY PUBLIC• CALIFORNIA D Q ORANGE COUNTY I certify under PENALTY OF PERJURY under the laws of e••••M�• rMCommission EOpHsSept. 2�4, zoo} the State of California that the foregoing paragraph is true • and correct. official seal WITNESS my hanlaaid� Signature . Daniels, Notary Public Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Section 3 Business Certification Form Document Date: March 15, 2011 Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s): Signers Name Gary Downey Signers Name ❑ Individual ❑Corporate officer— Title(s) ❑ Partner — Limited /General ❑ Attorney In Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other Signer is Representing ❑ Individual Assistant Secretary F—] Corporate Offcer — Title(s) Right Thumbprint of Signer ❑ Partner — Limited /General Attorney In Fact Trustee Guardian or Conservator ❑ Other SULLY - MILLER CONTRACTING COMPANY Right Thumbprint of Signer --------------- --- ----- ----------- CITY OF ROSEMEAD ANNUAL 2010-2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 SECTION 3 ECONOMIC OPPORTUNITY REPORT (CONTRACTOR) 1. Recipient Name and Address 2. Project Number - icomracrnwa�a No.I 3. Dollar Amount of Contract (Recirrient. SuDreciplen4 Contractor, subc°ntradw) CDBG Proj. No. P84129 g ' 4. Contact Person: 5. Phone: (indude Area Coda) Sully - Miller Contracting Company Gary Downey, Asst. Sec. 714/578 -9600 135 S. State College Blvd., Ste. 400 7. Date Report Submitted Brea, CA 92821 6. Reporting Period: 03/16/11 Part l: Employment & Trainin JOB CLASSIFICATION Technicians Office /Clerical Professionals i Construction Trade: Construction Trade: TOTAL CDBG Proj. No. P84129 1 33- 0787630 Ries provided to low-income individuals (Minimum Goat 30 %°f New H' TOTAL LOW- INCOME °/ of Aggregate Hires NEW HIRES NEW HIRES Who are low- income 1 I 100 Part II; Subcontracts Awarded (m imum Subcontract Goal is 25% of the Prime Contract Amount) Number S Subcontracts awarded: Number of Section 3 Businesses Receiving Contracts: Name of Qualified Business Concern Construction or No 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: Part III: Summary of the efforts that were made to generate economic opportunities /o of the aggregate new hires. (Attach Resident Trained and /or Employed._ low-income individuals equal to _ (° ) Certifications) 1 Awarded a Subcontract to _ qualified Business Concems equal to _ (� °) of the contract amount. (Attach Business Certifications) 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 prograin 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 Attach supporting l documentation) OTHER - ........... ------------- - ---- - ----------- CITY OF ROSEMEAD ANNUAL 2010-2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 Name of Firm: Sully - Miller Contracting Company Address: 135 S. State College Blvd. Ste. 400 State: CA Zip Code: 92821 Telephone Number: ( 714 ) 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 officeror 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 i 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: Sully- Miller Contracting Company (Cemrecmr5ubcontmacr) March 15 2011 •` it STATE OF CALIFORNIA l COUNTY OF ORANGE Jj On March 15, 2011 before me, J. Daniels, Notary Public, personally appeared Gary Downey 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 DANIELS OOPOOQ instrument the person(s), or the entity upon behalf of J. DANIELS x s erson which the acted, executed the instrument. COMM # 1813952 m person(s) ) W NOTARY OR ORANGE I certify under PENALTY OF PERJURY under the laws of Q .. ORANGE COUNTY � 6pe09H�00�T lwe. wpws«paw4.2012 f the State of California that the foregoing paragraph is true and correct. WITNESS my hand anf official seal Signature J aniels, Notary Public Notary Seal OPTIONAL Description of Attached Document Title or Type of Document: Federal Lobbyist Certification Document Date: March 15, 2011 Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s): Signers Name Gary Downey Signet's Name F] Individual FX Corporate Officer — Title(s) Partner — Limited /General ❑ Attorney In Fact ❑ Trustee ❑ Guardian or Conservator Other Signer is Representing ❑ Individual Assistant Secretary F] Corporate Ofricer — Title(s) Right Thumbprint of Signer ❑ Partner — Limited /General ❑ Attorney In Fact Trustee Guardian or Conservator Other SULLY - MILLER CONTRACTING COMPANY 1 Right Thumbprint of Signer