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West Coast Storm, Inc.CITY OF ROSEMEAD PROPOSAL FOR INSTALLATION OF CONNECTOR PIPE SCREEN FULL CAPTURE TRASH SYSTEM IN THE CATCH BASINS WITHIN THE CITY OF ROSEMEAD TO THE CITY OF ROSEMEAD, as AGENCY In accordance with AGENCY's NOTICE INVITING SEALED BIDS, the undersigned BIDDER hereby proposes to furnish all materials, equipment, tools, labor, and incidentals required for the above - stated project as set forth in the Plans, Specifications, and Contract Documents therefore, and to perform all work in the manner and time prescribed therein. BIDDER declares that this proposal is based upon careful examination of the work site, Plans, Specifications, INSTRUCTIONS TO BIDDERS, and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and /or lump -sum prices set forth in the following BID SCHEDULE. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the proposal guarantee accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the BID SCHEDULE are solely for the purpose of comparing bids, and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO INCREASE OR DECREASE THE AMOUNT OF ANY QUANTITY SHOWN AND TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and /or lump -sum prices bid include all appurtenant expenses, taxes, royalties, and fees. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. If awarded the Contract, the undersigned further agrees that in the event of the BIDDER's default in executing the required contract and filing the necessary bonds and insurance certificates within ten (10) working days after the date of the AGENCY's notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Spc11 -15 C -1 BID SCHEDULE 900 INSTALLATION OF CONNECTOR PIPE SCREEN FULL CAPTURE TRASH SYSTEM IN THE CATCH BASINS WITHIN THE CITY OF ROSEMEAD ITEM DESCRIPTION UNIT ESTIMATED UNIT PRICES EXTENDED NO, QUANTITY AMOUNT Furnish and install connector pipe screen (CPS), including flow 1 deflector on top of the CPS unit, and EA 47 $423.00 $19,881.00 painting of staff gauges on the catch basin wall, and per LACDPW encroachment permit requirements. Furnish and install automatic 2. retractable screen (ARS) width (W) EA 5 $416.00 $2,080.00 equal or less than 5 feet. Furnish and install automatic 3 retractable screen (ARS) width (W) EA g $800.00 $4,800.00 greater than 5 feet but equal or less than 8 feet. Furnish and install automatic 4 retractable screen (ARS) width (W) EA 3 $1,200.00 $3,600.00 greater than 8 feet but equal or less than 15 feet. TOTAL BID SCHEDULE IN FIGURE $30,361.00 TOTAL BID SCHEDULE IN WORDS Thirty Thousand, Three Hundred Sixty One Dollars and No Cents. Spc11 -15 C -2 DESIGNATION OF SUBCONTRACTORS BIDDER proposes to subcontract certain portions of the work which are in excess of one - half of 1 percent of the total amount bid or $10,000, whichever is greater, as follows: NAME, ADDRESS, AND TELEPHONE NUMBER OF SUBCONTRACTORS PORTION OF WORK NO SUBCONTRACTORS WILL BE UTILIZED ON THIS PROJECT Prior to award of Contract, Contractor shall submit a list of suppliers and vendors in writing to the City Engineer. Spd 1 -15 C- 3 REFERENCES The following are the names, addresses and telephone numbers for three public agencies for which BIDDER has performed similar work within the past 2 years: County of Los Angeles, 900 South Fremont, 8th Floor, Alhambra, CA Name and Address of Owner Akbar "Aid" Gadim (818) 999 -9964 Name and telephone number of person familiar with project Multiple Contracts: Cleaning, Measuring, Manufacturing 11/2009 to Contract amount Type of work Date completed 2. City of Monterey Park, 320 West Newmark Avenue, Monterey Park, CA Name and Address of Owner Rev Alfonso (626) 307 -1325 Name and telephone number of person familiar with project Cleaning, Measuring, Manufacturing 2011 to $294,500.00 and Installation of CPS and ARS Present Contract amount Type of work Date completed City of Rancho Palos Verdes, 30940 Hawthorne Blvd., Rancho Palos Verdes, CA Name and Address of Owner Andv Winie (310) 544 -5249 Name and telephone number of person familiar with project Cleaning, Measuring, Manufacturing $19,400.00 and Installation of CPS 10/2010 - 3/2011 Contract amount Type of work Date completed The following are the names, addresses, and telephone numbers for all brokers and sureties from whom BIDDER intends to procure insurance and bonds: Alla Bezkrovny, Insurance, 30423 Canwood St., Ste. 228, Aguora Hills, CA (818) 706 -8680 Pinnacle Surety, 151 Kalmus Dr., Costa Mesa, CA (714) 546 -5100 Spc11 -15 C- 4 EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE BIDDER certifies that in all previous contracts or subcontracts, all reports which may have been due under the requirements of any AGENCY, State, or Federal equal employment opportunity orders have been satisfactorily filed, and that no such reports are currently outstanding. AFFIRMATIVE ACTION CERTIFICATION BIDDER certifies that affirmative action has been taken to seek out and consider minority business enterprises for those portions of the work to be subcontracted, and that such affirmative actions have been fully documented, that said documentation is open to inspection, and that said affirmative action will remain in effect for the life of any contract awarded hereunder. Furthermore, BIDDER certifies that affirmative action will be taken to meet all equal employment opportunity requirements of the contract documents. NONCOLLUSION AFFIDAVIT BIDDER declares that the only persons or parties interested in this proposal as principals are those named herein; that no officer, agent, or employee of the AGENCY is personally interested, directly or indirectly, in this proposal; that this proposal is made without connection to any other individual, firm, or corporation making a bid forthe same work. and that this proposal is in all respects fair and without collusion or fraud. Spc11 -15 C- 5 NONCOLLUSION AFFIDAVIT In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106, the bidder declares 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. Executed under penalty of perjury: Signature �. Ira ine Michelle Padilla Printed Name January 30,2012 Date President Title Spell -15 C-6 CALIFORNIA ALL - PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of ZS Q�e (lnrr� Int' On l) n D Zo t 2 before me, (Here insert name and personally appeared H % r' �\IP Pox) " 0 Gs who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) 1 m subscribed to the within instrument and ac owledged to me that e4hey- e xecuted the same i e /their authorized capacit and that by er/ signatur4g) - on the instrument the persona), 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. 1.. CHB COrM+1. N 1860714 otary Public -WbTA SAN BERNARDW ^' L w �� p FrAkea Mey 23'; 1013 (Notary Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT Nt)r �nlluS�ir.. (Title or or description of attached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such insta any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. • State and County information must be the State and County When the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the names) of document signors) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. Wshe/ is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document 2008 Version CAPA vl2.10.07 800 - 873 -9865 www.NotaryClasses.com BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Bidder's Name West Coast Storm, Inc. Business Address 1188 Leiske Drive, Rialto, CA 92376 Telephone No. (909) 890 -5700 State Contractor's License No, and Class 888152 Class A with HAZ Certific Original Date Issued 12/08/2006 Expiration Date 12/31/2012 The following are the names, titles, addresses, and telephone numbers of all individuals, firm members, partners, joint venturers, and /or corporate officers having a principal interest in this proposal: Michelle Padilla, President, 1188 Leiske Drive, Rialto, CA 92376, (909) 890 -5700 Rafael Padilla, Chief Executive Officer, 1188 Leiske Drive, Rialto, CA 92376,(909) 890 -5700 Renata Salo, Treasurer, 11.88 Leiske Drive, Rialto, CA 92376,(909) 890 -5700 The date of any voluntary or involuntary bankruptcy judgements against any principal having an interest in this proposal, or any firm, corporation, partnership or joint venturer of which any principal having an interest in this proposal was an owner, corporate officer, partner, or joint venturer are as follows: None. All current and prior DBA's alias, and /or fictitious business names for any principal having an interest in this proposal are as follows: Spc11 -15 C -7(a) IN WITNESS WHEREOF, this instrument has been duly executed by Bidder and Surety, on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s) pursuant to authority of its governing body. Dated: January 30, 2012 BIDDER: West Coast Storm, Inc. 1188 Leiske Drive CA 92376 The undersigned declares under penalty of perjury under the laws of the State of California that the representatives made hereto are true and correct. Contractor's Signature Michelle Padilla Printed Name Note: All signatures must be acknowledged before a Notary Public, and evidence of the authority of any person signing as attorney -in -fact must be attached. Spc11 -15 C -7(b) CALIFORNIA ALL - PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of IJC -( q�,eV ,- y - YA n(D On )n n �D 201 Z before me, /. II personally appeared M t C -eQmQ Pawl 1 ) 0, 9 who proved to me on the basis of satisfactory evidence to be the persono whose named 's }te subscribed to the within instrument and aclmowledged to me that e/ executed the same in their authorized capacity(ies), and that by Der signature(s} -on the instrument the person(s),or the entity upon behalf of which the person(4acted, executed the instrument. I certify imder PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WI n;� fc ial seal. Signatur o ublic L CHEMtS ; •k CWm. it 1850714 �' ' NOlaty Pubin:- CaldIXfii �. N SAN BERNARDNO (Notary Seal) tt ` My (,o mrnls®on EXpkea May 26 . 2013 ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT Nyr-\ 001 (U5; af-v C PO 6I C -1 U (Title or description of attached document) (Title or description of attached document continued) Number of Pages _ Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this fm m if required. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed, • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forts by crossing off incorrect forms (i.e. he /shelthey— is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document 2009 Version CAPA v12.10.07 800 - 873 -9865 www.NotaryClasses.com CITY OF ROSEMEAD PROPOSAL GUARANTEE -- e II, FOR INSTALLATION OF CONNECTOR PIPE SCREEN FULL CAPTURE TRASH SYSTEM IN THE CATCH BASINS WITHIN THE CITY OF ROSEMEAD KNOW ALL MEN BY THESE PRESENTS that West Coast Storm Inc. as BIDDER, and a corporation organized and existing under the laws of the State of Pennsylvania , and duly authorized to transact business underthe laws of the State of California. as SURETY, are held and firmly bound unto the Cityof Rosemead, as AGENCY, in the penal sum of (10 %) Ten percent of the total attached bid bond amount [IN WORDS] dollars ($ 10.0% of bid ),which is 10 percent of the total amount bid by BIDDER to AGENCY for the above - stated project, for the payment of which sum, BIDDER and SURETY agree io be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas BIDDER is about to submit a bid to AGENCY for the above - staled project, if said bid is rejected, or if said bid is accepted and a contract is awarded and entered into by BIDDER in the manner and time specified, then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor of AGENCY. IN WITNESS WHEREOF, the parties hereto have set their names, titles, hands, and seals this 27th day of January 2012 Dated: January 27, 2012 BIDDER: Name: West Coast Storm, Inc. Address: 1188 W. Leis Drive, Rialto, CA 92376 (Signature) Type Name andTite: MIC�"t;LLE TPR)kl -LF\� PI2trStl�ENT SURETY: Name: Westchester Fire In surance Company Address: 436 Walnut Street, Philadelphia, PA 19106 Note: This bond mustbe executed and dated, all signatures must be acknowledged before a Notary Public, and evidence of the authority of any person signing as attorney-in-fact must be attached. r o Type Name and Title: Shawn Blume, Attom -in -Fact ACKNOWLE State of California 1 County of Orange J On I ` I k before me, Barbara Copeland, Notary Public to Here Insert Noma ead Title oI the Oaicer personally appeared BARBARA COPELAND Commission # 1845510 i Notary Public - California z z z o Orange County My Comm. Expires Apr 1013 Place Notary Seal Above Shawn Blume who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he /sheRhey executed the same in his/her/their authorized capacity(ies), and that by his/her /their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and offici seal. Signature / Signal.. o Lary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Shawn Blume ❑ Individual ❑ Corporate Officer— Title(s): — ❑ Partner — ❑ Limited ❑ General q Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing:_ RIGHT THUMBPRINT OF SIGNER LN Number of Pages: Signer's Name: Cl Individual ❑ Corporate Officer — Title(s): ❑ Partner —❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: RIGHTTHUfd BPRINT OF SIGNER 02007 Naoalal Notary ASSOGI8110a• 93, 50 De Soto Aw.,Poleas,2402•ChaMrorth.CA 913132402 -w NatioaalNolaryorg Ilen45907 Reorder Call Toll- Free1-B008716 7 CALIFORNIA ALL - PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Dar On -SCI n ?x) 2(712- before me, personally appeared H t CV e \IQ Pocl "I10. who proved to me on the basis of satisfactory evidence to be the person(s) whose names is e subscribed to the within instrument and acknowledged to me that she /,:hey executed the same in er /their authorized capacity(ies), and that b er/ their- signaturo(s-) en the instrument the person*, or the entity upon behalf of which the persons} acted, executed the instrument. I certify trader PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNE and official seal. #I 714 4 ° Public- Cauttrrtle N BEFNARDlh (Notary Seal) 5 M, t�pranl.9elo Fr4>k� Y 26.2M3 St nature o ublic `Lg.,„ ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT Q F c p N'V-"q (Title or description of at ached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) - ❑ Other INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California most contain verbiage exactly as appears above in the sunny section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check fine document carefully for proper notarial wording and attach this form if required. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect fors (i.e. he/sheh is laze) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, reseal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document 2008Vemion CAPAvl2.10.07800- 873 -9865 www.NotaryC[asses.com THE BACK OF THIS DOCUMENT LISTS VARIOUS SECURITY FEATURES 0 THAT WILL PROTECT AGAINST COPY COUNTERFEIT AND ALTERATION.