Excel Paving Company• exelol i I I Ji I I I L , I I va ' ` •
Wailiuke
PALP. INCMBA
EXCEL PAVING COMPANY
BIDDER:
CONTRACT BID FORMS
TABLE OF CONTENTS
SECTION 1 BID SCHEDULE ....................................................................... ............................... 1
SECTION 2 BID DATA FORMS ................................................................... ............................... 5
2.A BID BOND ................................................................................. ............................... 6
2.B LIST OF PROPOSED SUBCONTRACTORS .......................... ............................... 7
SECTION 3 NON - COLLUSION AFFIDAVIT .............................................. ............................... 10
CBF -15
PALP INC,DGA
EXCEL PAVING COMPANY
CBF -1
RALP M1
B I DD ER:
BID SCHEDULE
SCHEDULE OF PRICES FOR
ROSEMEAD COMMUNITY RECREATION CENTER AND LIBRARY PARKING LOT PROJECT
PROJECT No. P83529
BASE BID SCHEDULE
Co33":
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
1
Clearing & Grubbing per plans and
LS
1
69400.
b99w ' 0 "
specifications. See technical
provisions TP -2, TP -3 & TP-4.
2
Removal, Haulaway & Disposal of
LS
1
Waste Materials.
3
Earthwork, Roadway, Excavation
CY
1,877
�$• ®�
g00
and Export.
4
Compacted Selected Fill
LS
1
Iq J00. 00
!
5
Demolition Per Plans and
LS
1
g1 30D .
00
Specifications Complete.
6
Construct 1 -inch Thick AC
Tons
325
Pavement "D1 -PG 64 -10" as
indicated on the plans.
7
Construct 3 -inch Thick Pavement
Tons
950
1'5. ' 01 '
7! 2 71).
"C2 -PG 64 -10" as indicated on the
plans.
8
Remove, Dispose Existing and
Tons
1,800
Construct 4 -inch Thick Crushed
Miscellaneous Base (CMB) 95%
Relative Compaction Over 95%
Compacted Native per Plans and
Specifications.
9
Construct 6 -Inch Thick PCC
SF
7.385
(p. 40
4721 y
Pavement "520 -A- 2500" per Plans
and Specifications
10
Construct 8 -Inch Thick PCC
SF
15,100
{ •��'
1 D 3 iL 35,
Pavement "520 -A- 2500" per Plans
and Specifications
11
Construct 4 -Inch Thick PCC
SF
6,750
Sidewalk "520 -C- 2500" per
SPPWC Std. Plan 113 -2.
Co33":
PALP INC,DBA
BIDDER: EXCEL PAVING COMPANY
CBF -3
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
12
Construct 4 -Feet Wide PCC Swale
LF
770
35•s°
Z 335.x"
per Plans and Specifications.
13
Construct PCC Alley Intersection
SF
800
o ®
(0q LID. ® °
per SPPWC Std. Plan 130 -2.
14
Construct PCC Curb Ramps per
EA
6
/ 7`/O. ®o
/O`/LtO- ob
SPPWC Std. Plan 111 -4.
15
Construct 6 -Inch PCC Curb and 6-
LF
260
25.
jp 55 Z. o
Inch PCC Gutter per SPPWC Std.
Plan 120 -2.
16
Construct 6 -Inch PCC Curb Only
LF
2,540
u • l5
Sf�2 fo J, o0
per SPPWC Std. Plan 120 -2.
17
Construct 8 -Inch PCC Curb and
LF
400
Z5. Z�6
1 O ®SO , as
24 -Inch Gutter per SPPWC Std.
Plan 120 -2.
18
Construct 6 -Inch Thick PCC
SF
450
g 3o
po
Driveway Approach per SPPWC
Std. Plan 110 -2; Type C.
19
Construct 6 -Inch PCC Curb and
LF
285
Z°
24 -Inch PCC Gutter per SPPWC
Std. Plan 120 -2.
20
Construct Cross and Longitudinal
SF
445
/y. 2a
&3t9•
Gutter per SPPWC Std. Plan 122 -2.
21
Adjust Sewer Manhole to Grade per
EA
2
L1 5g .
q1 d • a°
SPPWC Std. Plan 205 -2.
22
Construct 4 -Inch PVC (SDR 35)
LS
1
20 (0 Z,6,
Perforated Pipe over Crushed
Rock, 10 Feet Wide x 20 Feet Long
x 4 Feet Deep per Plans and
Specifications Complete.
23
Install Sewer Cleanout per SPPWC
LS
1
1g0t)
Std Plans 204 -1.
24
Construct Drain Inlet W/Traffic
EA
3
20�/ va
�BZ72
Grate, with Flo -Guard Plus Insert
(Fossil Filter) per Plans and
Specifications Complete.
25
Construct 4 -Inch Diameter PVC
LF
150
110 .
14 500
Schedule 40 per Plans and
Specifications Complete.
CBF -3
PALE INC.OBA
BIDDER: EXCEL PAVING COMPANY
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
26
Construct 6 -Inch Diameter VCP
LS
1
yL575.
Dj
Sewer Lateral including 12 -Inch x
y25Z�
12 -Inch unfiltered Area Drain,
Saddle Connection, Wye, LACDPW
Fee, Bedding and Pavement
Complete per Plans and
Specifications.
27
Construct New Masonry Trash
LS
1
p
/85bp °A
Enclosure including Gates per
Plans and Specifications Complete.
28
Install Book Return Container per
EA
2
769
Contempra 60 Series Book Return
Model # 00 -0860 Complete.
29
Install Pavement Markers and
LS
1
J J 85Z.W
1 J is z . am
Striping per Plans and
Specifications Complete.
30
Install Irrigation and Landscape per
LS
1
95/50-
9vmo .
Plans and Specifications Complete.
31
Install Parking Lighting and
LS
1
B(p5'70.ap
33(0576. °
Electrical System per Plans and
Specifications Complete.
32
Install Erosion Control per Plans
LS
1
Z°7455 p
27 56 ®o
and Specifications Complete.
33
Install Tree Well per SPPWC Std.
EA
4
22Z 00
090.
Plan 519 -3.
34
Install Survey Well Monument per
EA
9
50, 00
City of Rosemead Std. Plan S08-
001. See Section 2 -9 Surveying of
the General Provision -7 per
details (Cover, Sleeve & Dome will
be provided by the City at no cost).
MAYOR:
GARY TAYLOR
MAYOR PRO TEM:
STEVEN LY
COUNCIL MEMBERS:
SANDRA ARMENIA
MARGARET CLARK
FOLLY LOW
June 30, 2011
N �.
8838 E. VALLEY BOULEVARD - P.O. BOX 399
ROSEMEAD, CALIFORNIA 91770
TELEPHONE (626) 569 -2100
FAX (626) 307 -9218
ROSEMEAD COMMUNITY RECREATION CENTER AND LIBRARY PARKING LOT
PROJECT
PROJECT No. P83629
(Bid Opening Date: July 6"', 2011)
To All Prospective Bidders:
Please note the following revisions on the specifications for the above project:
1.
ALTERNATE BID ITEM No. 1
TOTAL ALTERNAT�BID PRICE $ ' + ►"
. W
X
1
Dollar amount in written form
Page 1 of 2
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
35
Construct 6 -Inch Thick PCC Pavement "520 -A-
SF
57,385
17&317,2D
3250" Plans and Specifications Complete,
36
Earthwork, Roadway, Excavation and Export.
CY
360
tdz,
fill
Z
37
Construct 6 -inch Thick Pavement "C2 -PG 64-
Tons
100
11q. 95
t lky5s
10" as indicated on the plans.
TOTAL ALTERNAT�BID PRICE $ ' + ►"
. W
X
1
Dollar amount in written form
Page 1 of 2
2.
Bid Item No. 9 est quantity shall read 7,385 (seven thousands three hundred eighty five)
square feet.
The addendum No. 2 forms a part of the Contract Documents for the above described project
and shall supplement or supersede referenced sections of original plans and specifications, This
Addendum No. 2 must be signed by the Bidder and submitted along with the Bidder's Proposal.
Failure to acknowledge receipt of addendum will disqualify the Bidder.
Very trujy4purs,
.'�,,°,^,.,j°,", �8k»/N��R�
'�^ /\Gsncmte(�k�|Enoinaar �'"^� �`~. ~'`
, EXCEL P COMPANY
Acknowledgement:
Bidder:
Date: JUL A
Title:
Page 2 of 2
BIDDER: PALP. INC.DBA
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.
Y �
Attached T hereto is a certified check, a cashier's check or a bid 1:1 nc in the amount of
) said amount being not less than ten percent (10 %) of the Total
Bid Price. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
we fail or refuse to execute the Contract and furnish the required bonds, certificates and
endorsements of insurance and other certifications within the time provided.
If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be
prepared by the Owner for execution, within five (5) Calendar Days following the Letter of Award for
the Contract, and will deliver to the Owner within that same period the necessary original Certificates
of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other
documentation and certification required by the Contract.
The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and
become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of 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 applyto 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 SIXTY (60) 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 No . _ I
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.
By:
Signature
230 LEMON AVENUE
Business Street Address
CBF -6
sa
State of California
County of Los
On JUL m 5 2011
before me, C. Phillips, Notary Public
f Here ussar name and due of the officer)
personally appeared C. P. Brown
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) isk(subscribed to
the within instrument and acknowledged to me that hchit&WW executed the same in his&=Wwir authorized
capacity(ies), and that by hisjV#Aqjksignature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
si of Notary Public
C, PHILLIPS
COW, #J.$09758 W
0 Notary Publlo-0811fornia g
' LOS ANGELC5 COUNTY �
My Comm, Explms Aug. 16, 2112
(Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
OF THE ATTACHED DOCUMENT
(Title or deaaipllon of attached document)
(Tab or description ofNWAA docrunent continued)
Ntuaber of Pages _ Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑
Individual, (s)
❑
Corporate Officer
(Tide)
❑
Partner(s)
❑
Attorney -in -Pact
•
Trustee(s)
•
Other
INSTRUCTIONS FOR COMPLETING THIS FORM
dry acbw /eggermeet corep1med in Cao(rornia muss corrector wrbhge exactly ar
aquae above N the Weary realm or a separate aebesarlaCjnwro Jbrrn newt be
propery canelefeerd and arrached to that duavment. The ady eareptlom is jr a
docuen Is to be recorded amide ofCat(rorna In such huhaon, arty a terreat1w
ackno eleA;men nrlNage ar may be proud on such a docweuM w long our the
verbiape don rot nqu4re the mkvy to do sorrrnMnif that it alegal for a notary In
Calo anew (h.e. eertWee the authorized capacity of the sisner). Pleare check the
deverro n ecrilad y* proper notarid wodinr and attach ddsfaree (fngetnd
• SWe and County information awn be the State and county whose the document
sigsler(a) pawndly appeared before the notary public fee rcknowledgmont
• Date of airs riallon must be the date dust the sigrer(s) personally appeared which
must Wits be the ammo date the acknowledgment Is completed.
• Tee notary public must print his or her name as it appears within his or her
commission followed by a comma and then your tide (notary public).
• Print the morels) of document signer(s) who personally appear at tlo time of
notedvation.
• Indicate the correct singular or plural forms by crossing off inconecl forms (i.e.
hdshdlluyr is 7m) or circling the correct forms, Failure to correctly indicate this
information may lead to rejection of document recording..
• the notary seal impression must be clear and pbotographically roproducible.
Impression most not cover text or lines. If sea( impression smudges, to-seal If a
sufficient era permits, otherwise complete a different acknowledgment form.
• Signature of toe notary public must match die signature on file with the office of
the county clerk.
6 Additional information is not required but could help to onsure this
acknowledgment is non misused or attached to a different docmneat
Indicate tide or type of attached document, number of page mid dote.
J indicate to capacity claimed by the signer. If the claimed capacity is a
coeporele offleer, indicate the title r c CFO, CFO, So Miry).
• Securely attach this document to the signed document
2008Vcmion CAPAv12.1007800.877 -9865 ,ware. Notary( lasses. con,
CO N ., ,;.
Type or Print Name
Title
ate
City, State and Zip Code
(562) 599.584
Telephone Number
Bidder's /Contractor's State of Incorporation: G A
Partners or Joint Venturers:
Bidder's License Number(s):
Ok
NOTES:
1)
2)
3)
By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the
representations made on the Contract Bid Forms.
If Bidder is a corporation, enter State of Incorporation in addition to Business Address
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
[oil.] 7
PALP IN
DD 1
SECTI �
/' DATA
PALP Inc. dba
BIDDER. Excel Paving Co mpany
Bidder shall submit its Bid data in accordance with the format shown on each of the following Bid
Data Forms. Bidders shall prepare and use as many sheets as are necessary to adequately provide
the information required_ Bidder shall ensure that every page of its Bid Data Forms are properly
identified with the Bidder's name and page number.
Z.A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT PALP Inc. dba Excel Paving Company as
Principal, and Federal Insurance Company
, as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
T p e r cent of the total amount of the bid
($ 10 % 1 , being not less than ten percent (10 %) of the Total
Bid Price; for the payment of which sum will and truly to be made, we bind ourselves,
our heirs, executors, administrators, successors, and assigns, jointly and severally;
firmly by these presents.
WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work
required for the Rosemead Community Center and Library Lot Project as set
forth in the Notice Inviting Bids and accompanying Bid Documents, dated
NOW, THEREFORE, if said Principal is awarded a Contract for the Work by the
OWNER and, within the time and in the manner required by the above- referenced
Bid Documents, enters into the written form of Contract bound with said Bid
Documents, furnishes the required bonds (one to guarantee faithful performance
and the other to guarantee payment for labor and materials) furnishes the required
insurance certificates and endorsements, and furnishes any other certifications as
may be required by the Contract, then this obligation shall be null and void; otherwise
it shall remain in full force and effect. In the event suit is brought upon this bond by
the OWNER and judgment is recovered, said Surety shall pay all costs incurred by
the OWNER in such suit, including reasonable attorneys' fees to be fixed by the
court.
SIGNED AND SEALED, this z9� Ih IN day of dune 20 >>
PALP Inc. dba Excel Paving Company (SEAL) Federal Insurance Company (SEAL)
Principal
l
By: A. By
Signature ignaturs Tlmotby D. Rapp
iislCd Jrt Attorney In Fact
I I•.;I l'
CBF -9
ACKNOWLEDGMENT
State of California
County of Orange
On 06/29/2011 before me, Debra Swanson, Notary Public
(insert name and title of the officer)
personally appeared Timothy D. Rapp
who proved to me on the basis of satisfactory evidence to be the persorjW whose nameA is /pd'
subscribed to the within instrument and acknowledged to me that he /306y executed the same in
his / pf1tWr authorized capacity ?' s), and that by his signaturef�j on the instrument the
personA, or the entity upon behalf of which the persorIKacted, 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 sea]. 4 NOT pOgRA SWANSON
COMM' # 1822117
Nt PURL GCAllFORNL COUNTY P's y Cantu Exorm NOV 10, 2012
Signature
Chubb ruvvt:m Federal Insurance Company Attn: Surety Department
OF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059
Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE
COMPANY, a New York cor 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, California---- - - - - --
each as their true and lawful Attorney- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed In the course of business, and any
instruments amending or altering the same, and consents to the modification or alteration of any Instrument rammed to in said bonds or obligations.
In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested
these presents and affixed their corporate seals on this 16th day of November, 2009.
k:�. „ A- Z LL211
Kenneth C, Wendel, Assistant Secretary . Nonis, Jn, Vice P ant
STATE OF NEW JERSEY
County of Somerset ss.
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 companies which
executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly swum, did depose and say that he Is Assistant Secretary of FEDERAL
INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the
foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as
Assistant Secretary of said Companies by like 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. Near is, Jr., subscribed to said Power of Attorney Is In the genuine handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By-
Laws and In deponent's presence.
Notarial Seal
KATHERINE I.ADELAAR
N NOTARY PIALIC OF NEW JERSEY
yOTAR 2316695
®r® y Oammisaion on Expires July 16, 2014
PUBL76 Notary Public
y F1VJEPg� CERTIFICATION
Extract from the By- Lews of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY:
"All pourers or attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the
President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The
signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any
Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any
certificate relating thereto appointing Assistant Secretaries or Attorneys. in- Fact for purposes only of executing and attesting bonds and undertakings and other
writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding
upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company
with respect to any bond or undertaking to which it is attached."
I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY
(the "Companies") do hereby certify that
(1) the foregoing extract of the By- Laws of the Companies is rue and correct,
(1I) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are
authorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed In
Amedcan Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and
(iii) the foregoing Power of Attorney is true, correct and in full force and effect.
Given under my hand and seals of said Companies at Warren, NJ this June 29, 2011
.cJPANr� uurtr `SePAxe
—s
a
�A'OIANP r I x �' e S NlW Y00.'f"r IV✓l2Yti[iN� WVV /Nile./
Kenneth C. Wendel,'A Istant Secretary
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER
MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903- 3656
e -mail: surety ®chubbcom
FOrm15- 10- 02258 -U (Ed.5 -03) CONSENT
State of Califomis
County of Los Angeles
On iiil beforeme, C. Phillips, Notary Public
(Here inse name and tide of the officer)
personally appeared C. P.
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/,Rsubscribed to
the within instrument and acknowledged to me that heJahadlbey executed the same in his&iedllmir authorized
capeolty(ies), and that by hislW ksignature(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.
-+� C. PHILLIPS
WITNESS my hand and official seal. ,' ' " Comm. #15097M h
Notary Pubho- Californla hr
LOS ANGELES COUNTY u
P My Comm. E¢pirea And, 16, 2012
Si of Notary Public (Notary )
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or desaipUon of attached document)
(Title or description of attached docomeot continued)
Number of Pages _ Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑
Individual, (s)
❑
Corporate Offer
'(Ttdc)
❑
Ptumer(s)
❑
Attorney -in -Pact
❑
Trustee(s)
❑
Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acanowlrkmenr convicted in Caftiornia must couarn verbiage esacrty caw
appears above N the Weary me ion or a Separate acblmwledgmeehf /01rrr shut be
property convicted and arsesclwd to that dononew rM oWy aseepdan is V a
docvmaN Lr to be recorded maside ojCafpqr nia Jr, inch s,rrsohes, carry dtermar1w
oessmowledgmeM verbiage car may be pritud on such a docvnrd as lag ou the
verbiage dos nil require she mNmy to do saneduf g dear is a legal for a notary In
ColVornu IV . cxet(fying the aced wired aynciry of the signer). please check the
doesuncnd oath k* proper nosaiaf wording and afmeh ddrf rm Vrogdrrd
• State and Couny Information mutt be the State and County where the document
signals) personally appeared before the notary public-For acknowledgment
• Date of nouriation must be the date that the signer(a) personally appeared which
must also be The tame date t acknowledgment Is completed.
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the tumult) of document signals) who personally appear at the time of
notarization.
• Indicate the correct singular or plural forma by crossing off incorrect lass (i.c.
hdshe/d"yr is /w) or circling the correct forms. Failure to correctly indicate this
information may Ind to rejection of document recording.
• The notary seal impression must be clear and pjhotographically reproducible.
Impression must not cover teat or lines. If seal impression smudges, re-sal if a
sufficient ern permits, otherwise complete a different aclowwledgman form.
• Signature of die notary public must match die signature on file with the once of
die county clerk.
4 Additional information is not requved but could help to enure this
ackmiviedgment is not misused or attached to a different doctmaal
Indicate tide or type of attached document, number of pages and date.
3 Indicate the opacity claimed by the signer, If the claimed apecity is a
corporals officer, indicate the Ude (i. c. CBO, CFO, Secretary).
• Securely attach this document to the signed docurnenl
2008 Version CAPA vt2.10.07 800.87] -9865 www.NotaryClessescom
PALP. INC.DBA
BIDDER: EXCEL PAVING COMPAN
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.
M11118iC;
PALP. INUBA
BIDDER: EXCEL PAVING QQMMW
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
[*'Duplicate Next 2 Pages if needed for listing additional subcontractors. - I
Name and Location Description of Work
of Subcontractor to be Subcontracted
r
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: fLAI kCll �tC�
Address: Cgr Ajo. CA ��ML7�ht 1
Name and Location
of Subcontractor
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name: C.G. c
Address: ,uSrt + CA
Name and Location
of Subcontractor
, „1 1..
A ddre ss: :....1 _ ri .
Description of Work
to be Subcontracted
MISC adwCa&
Description of Work
to be Subcontracted
S / isc
CBF - 11
PALP. INC.DBA
BIDDER: EXCEL PAVING CDMPAW
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
("Duplicate NW 2 Pages if needed for listing additional subcontractM.*j
Name and Location Description of Work
of Subcontractor to be Subcontracted
0 a :,.. r �:... &...,
d d - r vt r. _ 4t Tom, ; .A
Name and Location
of Subcontractor
Name
Address:
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
CBF -11
PALP. INC.DBA
BIDDER: EXCEL PAVING rnmPANY
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
("Duplicate Next 2 Pages if needed for listing addrUonal subwn6dors." t
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
Name and Location
of Subcontractor
Name:
Address:
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
CBF - 11
DD EX
2.0 REFERENCES
The following are the names, addresses and telephone numbers for three public agencies for which BIDDER
has performed similar work within the past two (2) years:
1. PAn ?o) 019,r r 11v
Name and Address of Owner
Name and telephone number of person familiar with project
�nl 10 � k y2x k 4 2,O t o
Contract amount Type of Work' Date Completed
2. TIA J1A �flJA A
Name and Addre
Name and teleph
5
Contract amount
Owner
3.
Contract a
4.
N Na am � /e � a � n nd d �
Name and
-' `ct
of person familiar
Type
of person familiar with project
W
Type of
ass of Owner
�Pt
lone number of person
If
'?qq 76
ar with project
ah,
Date Completed
CBF -12
PALP.INC:DBA
BIDDER: EXCEL PAVING COMpanro
SECTION 3
NON-COLLUSION AFFIDAVIT
CBF -13
PALP. INC
DD PAV I NG C OMPA NY
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 Name
Title PAW INC.DBA
EXCEL PAVING COMPANY
Subscribed and sworn before me
This _ day of 41-11 _ ?n�� 20_
eA P6 (Seal)
Notary Public i and for C. Phillips, Notary Public
the State of California
My Commission Expires: g°i(o °Z01 L
C. PHILLIPS
COMM. #1809758 N
Notary Public-California
CK
LOS ANGELES COUNTY
My Comm Expires AU6, b ®, 2012
CBF -14