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Kalban, Inci [1 1 r I I I I I i r r 1 r r r 1 r BIDDER: B,4 p 1 AC• SECTION 1- BID SCHEDUL CBF -1 1 1 BIDDER: A gL 8,4AJ 1 . 2 ✓ C CONTRACT BID FORMS TABLE OF CONTENTS SECTION 1 BID SCHEDULE ................................................... ............................... SECTION 2 BID DATA FORMS ..................... ............................... 2.A BID BOND ................................... ............................... 2.B LIST OF PROPOSED SUBCONTRACTORS........... SECTION 3 NON - COLLUSION AFFIDAVIT CBF - 13 ........1 5 6 7 10 I 1 i 1 1 1 1 I I I BIDDER: BID SCHEDULE SCHEDULE OF PRICES FOR SIDEWALK, CURB AND GUTTER REPLACEMENT PROJECT PROJECT No. 24002 BASE BID SCHEDULE q .�-v TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ ! 1 0 a g e�n &65 Dollar amount in written f6m f A lV ' CBF -2 UNIT OF EST. UNIT ITEM NO, ITEM DESCRIPTION MEASURE OTY. PRICE COST 1 Clearing & Grubbing per plans LS 1 and specifications. See technical provisions TP -2, TP -3 & TP -4. 2 Disposal of Waste Materials. LS 1 " 3 Remove, Dispose and Construct SF 21,000 flinches thick PCC Sidewalk per / by SPPWC Std. Plan 113 -1. / CO IIIQQQ I ale DD — 4 Remove, Dispose and Construct SF 500 PCC Driveway Approaches per SPPWC Std. Plan 110 -2. 5 Remove, Dispose and Construct LF 1,015 8- inches Curb and 24- inches Gutter per SPPWC Std. Plan 1 20-2. 6 Remove, Dispose and Construct LF 100 8- inches PCC Curb Only per SPPWC Std. Plan 120-2. I 7 Remove, Dispose and Construct FA 1 PCC Curb Ramp per SPPWC Std. Plan 111 -4. 3ocp W ��- 8 Install Survey property and EA 10 centerline tie Monument. 3eoo— q .�-v TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ ! 1 0 a g e�n &65 Dollar amount in written f6m f A lV ' CBF -2 BIDDER: / �, �i3�C• Note: The City of Rosemead reserves the right to reduce or increase the quantities of any items in the schedule of bid items above, within the limits define in Section 3 -2.2.1 of the Standard Specifications, to stay within the budgeted amount of this project. 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. The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract for the Work is fully executed by the Owner and a third party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall govern. Attached hereto is a certified check, a cashier's check or a bid bond in the amount of ) 25y SrVr/ Dollars ($ ____) 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. I I I I CBF -3 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. BIDDER: It e Lg�� c T �/ C ' The undersigned acknowledges receipt, understanding and full consideration of the following addenda to the Contract Documents. Addenda Nos. 0' ' 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. 1 1 1 I 1 I I I 1 CBF -4 1 1 1 1 By: �— Signature --- Qt j er- y0oa e c Type or Print Name U( C G Title BIDDER: ' Business Street Address 'Jj c/n t may, C/ t'135 City, State and Zip Code Telephone Number Bidder's /Contractor's State of Incorporation: CA[ 1" //'if Pa5 s or Joint pakiMrs: Bidder's License Number(s): 5 S :& 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, oartnershio or joint venture has the anfhnrity to do so_ CBF -5 1 1 1 1 1 1 1 1 1 1 1 1 1 BIDDER: !`Wle,,;;j , SECTION 2 BID DATA FORMS CBF -6 i i i i 1 i i i i i 01/31/2012 09:29 18185041067 KALHAN INC PAGE BIDDER: Kalban, Inc. Bidder shall submit its Bid data in accordance with the format shown on each of the following Bid Data Forms. Bidders shall prepare and use as many sheets as are necessary to adequately provide the information required. Bidder shall ensure that every page of its Bid Data Forms are properly Identified with the Bidder's name and page number. 2.A 1910 BDND KNOW ALL MEN BY THESE PRESENTS: THAT _ Principal Kalban, Inc. and 02/02 as Surety, are held fin CITY OF ROSEMEAD (hereinafter called the OWNER) as bound unto the in the sum of F$ o% ), being not less than ten percent (109;) 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 Sidewalk, Curb and Gutter Replacement 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 vold; 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 attomeys' fees to be fixed by the court. SIGNED AND SEALED, this 31st day of Kalban, Inc. (SEAL Principal By: �� B S to ne CBF -7 January 2CL 12 The Guarantee Company of North America USA (SEAL) Surety y: 5lgnature Patricia Ann Bauer, Attorney in Fact CALIFORNIA ALL-PURPOSE ACKNOWLE ;,�c..>, . ._cv,i.�s,:..,:.., ;,� ; a> --.i zHZS .�.i;:�5;w,ai,_..:,_...;.a> a q�`at,� -�.5 - >e.�<,�<,n. a> �S,:n<�.as_.- State of California l County of Los Angelne J On 1 - )Z before me, William Syrkin, Notary Publ Dale Here Insert Name and TWO of the OHicer personally appeared Patricia Ann Bauer WILLIAM SYRKIN E. Commission # 1839081 Notary Public - California n i' ��� Los Angeles County My Comm. Expires Mar 1, 2013 J who proved to me on the basis of satisfactory evidence to be the person(&) whose name( is/are subscribed to the within instrument and acknowledged to me that 'he /she/they executed the same in hWher/Haeir authorized capacity(!*, and that byfiis/hedt 4r signature(s),on the instrument the person(s), or the entity upon behalf of which the person(&) 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 - off' 'a1 al. ure Place Notary Seal Above Signat SI aWte of Nota ublic OPTIONAL Though the information below is not required by law, it may prove valuab ns 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: • Individual • Corporate Officer — Title(s): • Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee Top of thumb here ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signers Net ❑ Individual Number of Pages: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: RIGHT THUM E PRINT OF SIGNER L .: THE GUARANTEE COMPANY OF NORTH AMERICA USA Southfield, Michigan POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS: That THE GUARANTEE COMPANY OF NORTH AMERICA USA, a corporation organized and existing under the laws of the State of Michigan, having its principal office in Southfield, Michigan, does hereby constitute and appoint William Syrkin, Sergio D. Bechara, Rebecca Ann Haas- Bates, Patricia Ann Bauer, Richard Leroy Adair Millennium Corporate Solutions, Inc. its true and lawful attomey(s) -in -fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise. The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at the principal office. The Power of Attorney is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By -Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31" day of December, 2003. The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority: 1. To appoint Attorney(s) -in -fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof; and 2. To revoke, at any time, any such Attomey -in -fact and revoke the authority given, except as provided below 3. In connection with obligations in favor of the Kentucky Department of Highways only, It is agreed that the power and authority hereby given to the Attorney -in -Fad cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner — Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting duly called and held on the 31" day of December 2003, of which the following is a true excerpt: RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, contracts of indemnity and other writings obligatory in the nature thereof, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused aTEE G� this Instrument to be signed and its corporate seal to be affixed by its authorized officer, this 29th day of April, THE GUARANTEE NTEE COMPANY OF NORTH AMERICA USA �AMEP�' STATE OF MICHIGAN Stephen C. Ruschak, Vice President Randall Musselman, Secretary County of Oakland On this 29th day of April, 2010 before me came the individuals who executed the preceding instrument, to me personally known, and being by me duty sworn, said that each is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of said Company. Cynthia A. Takai IN WITNESS WHEREOF, 1 have hereunto set my hand at The Guarantee Notary Public, State of Michigan Company of North America USA offices the day and year above written. County of Oakland K °- "N = My Commission Expires February 27, 2012 " .......... � Acting in Oakland County I, Randall Musselman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect. IN WITNESS WHEREOF, I have thereunto set my hand and attached the seal of said Company this 31 St day of January 2012 ��pMTEEC °n Randall Musselman, Secretary a pp 'MAMEP� r11 MM 1 11001 11 1 319091.3011 State of California ss. County of Los Angeles On '2 " � - / 2 before me, Michael Edward Lifsey, Notary Public personally appeared Dave Poole MICHAEL EDWARD LIFSEY Commission N 1065224 'a -� Notary PuWIC • California z i Los Anpeles County M Comm. Expires Me j 5, 2014 who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entitiy upon behalf of which the person 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 OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fradulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: t D ' 6OAji> Document Date: � - �3 1 - 1 2-- Number of Pages: Signer Other Than Named Above: al;iere r,f 4,r/,// Mae Capacity Claimed by Signer Signer's Name: El 0 El El El El Vice President Signer is Representing: Inc. Dave Poole Individual Corporate Omcer - Title: Partner Attorney - in - fact Trustee Guardian Other: ' BIDDER: 2.B LIST OF PROPOS S UBCONTRACTORS 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 the information requested by the Owner about each subcontractor, other than the name and location of each subcontractor. 1 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. 1 1 1 CBF -8 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. 1 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. 1 1 1 CBF -8 1 BIDDER: 2.13 LIST OF PROPOSED SUBCONTRACTORS (continued) t "DupllcMe Next 2 Pages 'd waded for lisgng additimal submnVactors. ") Name and Location Description of Work of Subcontractor to be Subcontracted Name: C,LaA, a.CelitnfS Sl1�CV e� Address Co e Ca 41st P. 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: Name and Location of Subcontractor Name: Address: CBF -9 Description of Work to be Subcontracted Description of Work to be Subcontracted 1 1 1 1 1 BIDDER: x 1 '4z-0'4 - 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. leer -eknen/c e &-' Name and Address of Owner Name and telephone number of person familiar with project contract amount 2. Name and Address Type of Work Date Completed Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 3. Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 4. Name and Address of Owner Name and telephone number amount of person familiar with project Type of Work CBF -10 Date Completed KALBAN, INC. GENERAL ENGINEERING CONSTRUCTION 818 -504 -1065 Fax:818 -504 -1067 Recently Completed Projects and Reference List City of Burbank - Contact: Adam Salehi - 818 -238 -3946 2010 - 2011 Sidewalk Repair Program Removal and Replacement of Damaged PCC Various Locations $1,571,050.00 2009 - 2010 Sidewalk Repair Program Removal and Replacement of Damaged PCC Various Locations $334,000.00 2008 - 2009 Sidewalk Repair Program Removal and Replacement of Damaged PCC Various Locations $1,100,000.00 2007 CDBG Street Project Removal and Replacement of Damaged PCC Various Locations $120,000.00 2006 Sidewalk Repair Project Removal and Replacement of Damaged PCC Various Locations $535,230.00 2005 Oak St. & Bel Air Dr. Improvements Street Reconstruction Asphalt Resurfacing, PCC Replacment $720,000.00 2004 CDBG Street, Alley & Sidewalk Replacement of Asphalt Street with Portland Cement Concrete $598,010.00 2002 -2003 CDBG Street Project Street Reconstruction Asphalt Resurfacing, PCC Replacment $389,159.00 City of Anaheim - Contact: Dave Hernandez - 714 - 936 -4795 2010 Concrete R &R Services Annual Removal and Replacement of Damaged PCC Various Locations $1,060,000.00 2008 -2009 Resort Maintenance Removal and Replacement of Damaged PCC Various Locations $125,000.00 2007 -2008 Resort Maintenance Removal and Replacement of Damaged PCC Various Locations $260,000.00 2005 -2006 Resort Maintenance Removal and Replacement of Damaged PCC Various Locations $120,000.00 2002 Sidewalk Replacement Annual Contract Removal and Replacement of Damaged PCC Various Locations $333,000.00 City of Orange - Contact: Alan Throng - 714 - 744 -5544 2007 Annual Concrete Replacement Removal and Replacement of Damaged PCC Various Locations $500,000.00 2006 ADA Access Ramps Construct Wheelchair Access Ramps, Various Locations $1 32,276.00 2005 Annual Concrete Replacement Removal and Replacement of Damaged PCC Various Locations $400,000.00 2004 Annual Concrete Replacement Removal and Replacement of Damaged PCC Various Locations $204,000.00 City of Norwalk - Contact: Randy Hillman - 562- 929 -5719 2007 Local Street Project Street Reconstruction Asphalt Resurfacing, PCC Replacment $1,640,000.00 City of LaCanada Flintridge - Contact: Ying Kwan - 818-790-8882 2006 School Loading Bay Improvements Parkway Re- Construction at Loading Zone $131,978.00 Vista Del Valle /Haskell Intersection Recon. Reconstruction of Intersections $95,000.00 2002 - Verdugo Blvd Street Improvements Street Improvements $310,000.00 City of Pasadena - Contact: Reny Quijano - 626- 744 -4720 Street Reconstruction Avenue 64 Street Improvements $1,900,000.00 Site Improvements at Various Parks ADA Compliance PCC & Misc Structures $485,000.00 City of Huntington Park - Contact: Pat Fu - 323 -584 -6253 2010 Neighborhood St. Improvements Misc Street Repairs $436.167.51 2009 Alley Improvements Reconstruct PCC Alleys $231,129.00 2008 Alley Improvements Reconstruct PCC Alleys $356,230.00 2007 Alley Reconstruction Project Reconstruct PCC Alleys $308,993.20 City of Santa Clarita - Contact: Erven jasamilla - 661 - 225 -4344 2009 Traffic Circulation & Safety Median Island Construction & ADA Access Ramps $225,681.50 2006 Intersection Modification Street Reconstruction Asphalt Resurfacing, PCC Replacment $394,793.00 - 2003 -2004 Annual Concrete Rehabilitation Removal and Replacement of Damaged PCC Various Locations $231,600.00 2002 -2003 Annual Concrete Program Street Reconstruction Asphalt Resurfacing, PCC Replacment $396,000.00 Los Angeles County Department of Public Works - Contact: Issa Adawiya - 626- 458 -4942 2007 RDC 0012247 South Bay Bike Trail $425,000.00 2004 Project ID No. FCC0000856 Rubio Diversion Invert repair Project $423,200.00 2003 Project ID NO. FCC0000703 - Ward Channel Invert and Connector Pipe Repair $168,090.00 2002 Newburgh Street, ET AL Street Reconstruction Asphalt Resurfacing, PCC Replacment $298,000:00 City of Glendale - Contact: Sam Mody - 818 -548 -3945 2008/2009 ADA Curb Ramps Removal and Replacement of Damaged PCC Various Locations $1,234,404.00 2007/2008 ADA Curb Ramps Removal and Replacement of Damaged PCC Various Locations $1,038,000.00 2005/2006 ADA Curb Ramps Removal and Replacement of Damaged PCC Various Locations $1,071,000.00 San Fernando Corridor Street Improvements Street Reconstruction Asphalt Resurfacing, PCC Replacment $422,000.00 I 1 1 1 i 1 1 1 1 i 1 1 1 1 1 1 BIDDER: SECTION 3 NON - COLLUSION AFFIDAVIT CBF -11 0 BIDDER: 46 C 1;11 ' NON - COLLUSION AFFIDAVIT I 1 1 1 Subscribed and sworn before me / This - 1 day of FE re , 901ary Public in the State of Call 1 My 1 1 L_ Expires: �S = Z / Z Signature '-�4d6--- Odaae Typed or Printed Name f�IC� A O�c�S !7 Eirr Title I rrm 20 ) 2 — (Seal) MICHAEL EDWARD LIFSEY Commission * 1885224 g d Notary Public - California s �i Los Angeles County My Comni. E ires Ma 5, 2014 + CBF -12 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 behaB of, any undisclosed person, partnership, company, association, organization, orcorporation; thatthe 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 1 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. I 1 1 1 Subscribed and sworn before me / This - 1 day of FE re , 901ary Public in the State of Call 1 My 1 1 L_ Expires: �S = Z / Z Signature '-�4d6--- Odaae Typed or Printed Name f�IC� A O�c�S !7 Eirr Title I rrm 20 ) 2 — (Seal) MICHAEL EDWARD LIFSEY Commission * 1885224 g d Notary Public - California s �i Los Angeles County My Comni. E ires Ma 5, 2014 + CBF -12