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
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• State and County information must be the State and County When the document
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• 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
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• 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
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• 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.