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Black Forest ConstructionBIDDER: SECTION 1- BID SCHEDUL CBF -1 BIDDER: CONTRACT BID FORMS TABLE OF CONTENTS SECTION1 BID SCHEDULE ........................................................................ ..............................1 SECTION2 BID DATA FORMS ....................................---°.......................... ............................... 5 2.A BID BOND .................................................................................. ..............................6 2.B LIST OF PROPOSED SUBCONTRACTORS ........................... ..............................7 SECTION 3 NON - COLLUSION AFFIDAVIT ................................................ .............................10 CBF -13 BIDDER: 1 ?0 I l_' 7' BID SCHEDULE SCHEDULE OF PRICES FOR SIDEWALK, CURB AND GUTTER REPLACEMENT PROJECT PROJECT No. 24002 BASE BID SCHEDULE TOTAL BASE BID PRICE (SCH BID � PRICE):$ Dollar amount in written form :eIII� UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE OTY. PRICE COST 1 Clearing & Grubbing per plans LS 1 and specifications. See technical 0,90 g 000 provisions TP -2, TP -3 & TP -4. 2 Disposal of Waste Materials. LS 1 � 4S o �� YS D 3 Remove, Dispose and Construct SF 21,000 4- inches thick PCC Sidewalk per - SPPWC Std. Plan 113 -1_ 4 Remove, Dispose and Construct SF 500 o d 3 OF O p PCC Driveway Approaches per SPPWC Std. Plan 110.2. 5 Remove, Dispose and Construct LF 1,015 D, oO a� �TO 8- inches Curb and 24- inches � Gutter per SPPWC Std. Plan 120 -2. 6 Remove, Dispose and Construct LF 100 'x S- v o SO t7 8- inches PCC Curb Only per SPPWC Std. Plan 120-2. 7 Remove, Dispose and Construct EA 1 q ®D0. OO 2" ®OO © D PCC Curb Ramp per SPPWC /. Std. Plan 111 8 Install Survey property and EA 10 7 pa D, Do centerline tie Monument. TOTAL BASE BID PRICE (SCH BID � PRICE):$ Dollar amount in written form :eIII� BIDDER: gI� I� 1� =��G C'T`�� ' 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 I 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. r The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which 1 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 I party, whichever is earlier. The undersigned also agrees that if there is 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 id bo in the amount of Dollars ($ f s oo 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. 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: The undersigned acknowledges receipt, understanding and full consideration of the following addenda to the Contract Documents. Addenda Nos. \ /) 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 I necessary bonds and accept the Total Bid Price as compensation full for all Work under the contract. CBF -4 BIDDER: 6(Rj' ( - - K Cl- �- . M Title 2e'2 R- SA Cc - ,",Pe y-, Business Street Address City, State and Zip Code — t 1 q , 6 o Telephone Number Bidder's /Contractor's State of Incorporation: Partners or Joint Venturers: erg.,, Bidder's License Number(s): C( L ( 3 NOTES: t) 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, CBF -5 V�-"�V (=%�* r---'-\Q Type or Print Name BIDDER: ?,(QJC 1Z�,`„tee SECTION 2 BID DATA FORMS CBF -6 BIDDER: BLACK ROCK CONSTRUCT COMPANY Bidder shall submit its Bid data in accordance with the format shown on each of the following Bid Data Forms. Bidders shall prepare and juse as many sheets as are necessary to adequately provide the information required. Bidder shall ensure that every page of its Bid Data Forms are property identified with the Bidder's name and page number. 2.A BID BOND KNOW ALL MEN BY THESE PRESENTS: THAT BLACK ROCK CONSTRUCTION COMPANY as Principal, and PHILADELPHIA INDEMNITY INSURANCE COMPANY as Surety, are held finely bound unto the CITY OF ROSEMEAD hereinafter called the OWNER) in the sum of TEN PERCE OF THE TOTAL AMOUNT BID ($ ---- iui - - -- ) , being not less than•ten percent (10 0 /*) of the Total Bid Price; for the payment of which sum will and truly to be made, we bind ourselves, our heirs, executors, administratprs, 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, Curti and Guttor Replacement Project as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated FEBRUARY 8, 2012 NOW, THEREFORE, if said Principal is awarded a-Contract for the Work by the OWNER and, within the time and in the manner required by the above- referenced Bid Documents, enters. into the written form of Contract bound with said Bid Documents, furnishes the required bonds (one to guarantee faithful performance and the other to guarantee payment for labor and materials) furnishes the required insurance certificates and endorsements, and furnishes any other certifications as may be required bythe Contract,lthen 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 30TH dayof JANUARY , 20 12 . BLACK ROCK PHILADELPHIA INDEMNITY CONSTRUCTION COMPANY EAL) INSURANCE COMPANY (SEAL) Principal Surety By. By: Si lure BI GOSHEN, JR. Signature D.J. PICARD V PRESIDENT ATTORNEY -IN -FACT CBF -7 CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA County of ORANGE On JA NUARY 30, 2012 before me, D.J. PICARD, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared BILL GOSHEN, JR. D. J. PICARD Z Q COMM. ff 1907062 z y NOTARV _ic - CALIFORNIA ORANGE COUNTY Comm. Expires Oct. 1, 20U 0 00 0 NO who proved to me on the basis of satisfactory evidence to be the person(s) whose name (z) is/mg subscribed to the within instrument and acknowledged to me that hem executed the same in his /Shaixauthorized capacity(ies), and that by his /face signature(.) on the instrument the person", or the entity upon behalf of which the persorfM 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 ojfici seal. Signature Place Notary Seal Above Signature of Nola blic 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: BID BOND Document Date: JANUARY 30, 2012 Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: B_ JR _.__ ❑ Individual [i Corporate Officer Title(s): VICE PRESIDENT ❑ Partner -- ❑ Limited ❑ General El Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: BLACK ROCK CONSTRUCTI COMPANY_______ Number of Signer's Name: ❑ Individual ❑ Corporate Officer --- Title(s):--- Partner— ❑ Limited ❑ General ❑ Attorney in Fact C.7 Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 0 1007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313 -2402 -v,, .NationalNotaryorg Item #590] Reonter. Cab Toll -Free 1 -600 -616 -682] CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA County of ORANGE - On JANUARY 30, 2012 before me, CHERYL L. THOMAS NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared D.J. PICARD Name(s) of Signer(s) CHERYL L. THOMAS COMM. #1827274 z " •� Notary Public - California A z Orange County �• My Comm. Expires Dec. 18, 2012 who proved to me on the basis of satisfactory evidence to be the persona) whose names) isfaaacsubscribed to the within instrument and acknowledged to me that he/skizAbuy executed the same in his/lkk pt authorized capacity( and that by his&-tylkick signature(s) on the instrument the person(.-ii), or the entity upon behalf of which the person(24 acted, executed the instrument. 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. Signature Place Notan• Seal Above Signature of N otary 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: BID BOND Document Date: 30,_ 2012___ Number of Signer(s) Other Than Named Capacity(ies) Claimed by Signer(s) Signers Name: D.J. PICARD ❑ Individual Cl Corporate Officer — Title(s):____.__..____________ ❑ Partner — r0 Limited ❑ General V' Attorney in Fact ❑ Trustee Guardian or Conservator ❑ Other: Signer's Name: C] Individual ❑ Corporate Officer — Title(s)_ 1.7 Partner — I Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator 1 - 1 Other: Signer Is Representing: PHILADELPHIA _I_NDEMNITY INS_U_RANCE COMPANY Signer Is Representing: l Ka ti te 9 350 D S'L Ut-C a t�, ., C A 91312 - `24 02 (d 2001 National NOla,y ASSociauon•9e50 S A.re 2402 ChaiswrorlF CA 91313 -2402 �ry NanonalNolaryom Ilem k5ge7 Reorder: CaIITIIFreela0M76-e627 M PHILADELPHIA INSURANCE COMPANIES PHILADELPHIA INDEMNITY INSURANCE COMPANY 231 St. Asi ph's Rd., Suite 100 Bala Cynwyd, PA 19004 -0950 Power of Attorney KNOW ALL PERSONS BY THESE PRESENTS That PHILADELPHIA INDEMNITY INSURANCE COMPANY (the Company), a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint. TODD M. ROHM, CHERYL L. THOMAS, D.J. PICARD AND BEATA A. SENSI OF ROHM INSURANCE AGENCY Its true and lawful Attorney (s) in fact with full authority to execute on its behalf bonds, undertakings, recognizances and other contracts of indemnity and writings obligatory in the nature thereof, issued in the course of its business and to bind the Company thereby, in an amount not to exceed $5,000,000.00. This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of PHILADELPHIA INDEMNITY INSURANCE COMPANY at a meeting duly called the 1 I" day of July, 2011. RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the Company to. (1) Appoint Attorney(s) in Fact and authorize the Attorneys) in Fact to execute on behalf of the Company bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof and to attach the seal of the Company thereto; and (2) to remove, at any time, any such Attomey -in -Fact and revoke the authority given. And, be it FURTHER RESOLVED: That the signatures of such officers and the seal of the Company may be affixed to any such Power of Attorney or certificate relating thereto by facsimile, and any such Power of Attorney so executed and certified by facsimile signatures and facsimile seal shall be valid and biding upon the Company in the future with the respect to any bond or undertaking to which it is attached. IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND fIS CORPORATE SEALTO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 18 DAY OF JULY, 2011. `oEV,NITY j�., S L], GOppo 1927:m t Presid V h ••p S NHSvoo , ' p i� Christopher J. Maguire ; •' • ..... r: F President Philadelphia Indemnity Insurance Company, a Pennsylvania Corporation. On this 18" day of July 2011, before me came the individual who executed the preceding instrument, tome personally known, and being by me duly swom said that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY; that the seal affixed to said instrument is the Corporate seal of said Company; that the said Corporate Seal and his signature were duly affixed. COMMONWEALTH OF PENN YLVANLA NWA INI.N K r M Mdy A. l a W.Mw t NolnryPYR1 l n gWer ndan TxA. MwpomnrYOnunly t:txhxnlWen ra ono. lS. a01a F wayaning aUan a 0141107MI 1, Craig P. Keller, Executive Vice President, Chief Financial Officer and Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do herby certify that the foregoing resolution of the Board of Directors and this Power of Attorney issued pursuant thereto on this 18 day of July 201 fare two and correct and are still in full force and effect. I do further certify that Christopher J. Maguire, who executed the Power of Attorney as President, was on the dale of execution of the attached Power of Attorney the duly elected President of PHILADELPHIA INDEMNITY INSURANCE COMPANY, In Testimony Whereof) have subscribed my name and affixed the facsimile seal of each Company this 30th clever JANUARY 2(712 C' Executive Vice President, Chief Financial Officer & Secretary BIDDER: 2CY- . 2.5 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 f 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 afterthe deadline for submission of bids to submit the information requested by the Owner about each subcontractor, other than the name and location of each subcontractor. If the Bidder fails to specify a subcontractor for any portion of the Work to be performed under the Contract, it shall be deemed to have agreed to perform such portion itself, and shall not be permitted to subcontract that portion of the Work except under the conditions hereinafter set forth below. Subletting or subcontracting of any portion of the Work in excess of one half of one percent (greater than 0.5 %) of the Total Bid Price or, in the case of bids or offers 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. CBF -8 BiDDER: 2.0 LIST OF PROPOSED SUBCONTRACTORS (continued) 1 °fhm41cele Nest 2 Pages if needed for lls g addillonel subcontractors.-) Name and Location P Description of Work of Subcontractor .-j- 3 ( doc l t { , y..e to be Subcontracted Name: /L � G Ia_ d , C s_ n i � I y 4 Address: Name and Location of Subcontractor Name: Address: Name and Location of Subcontractor Name: 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 -9 BIDDE tC 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:` n U i. Name and Address of Owner 2. 3. 4. Contract amount v Type of Work Date Completed CBF -10 Name and telephone number of person fa iliar with project Contract amJType of Work Date Completed faan n f miliar with project Type of Work Date Completed Name and A Name and telephone number of person f miliar with project Contract amount Type of Work Date Completed Name and Address of Owner Name and telephone number of perso f liar with project Contract amount v Type of Work Date Completed CBF -10 BLACK ROCK CONSTRUCTION 282 N. ST. CRISPEN BREA, CA. 92821 City of Placentia Completed 6 -30 -2010 401 E. Chapman Ave Contract Amount $ 300,000.00 Placentia, Ca. 92870 Bob Makowski(714)920 -1921 Project: 2010 sidewalk & ramp improvements City of Anaheim Completed 10 -31 -2010 200 S. Anaheim Blvd. Contract Amount $ 42,000.00 Anaheim, Ca. 92805 Richard Aguire ( 714) 765 -5052 Rrb ept: 803 -809 Knott Ave. St. Improvements o f §ta Mesa Completed 3 -15 -2011 7733rd a Contract Amount $ 155,000.00 htMhaa'Ca.,92626 Gul vaj% (714) 754 -5045 T-t ecl ley 47 & multiple various Location Projects ItofBradbury Completed 4 -1 -2011 Imo RKA Consulting Group Contract Amount $200,000.00 on Creek Dr. Suite E ILO 91789 °T9ave /Cody(909)594 -9702 Project: Mm. Olive Dr. Phase 1 & 2 National City Completed 2 -15 -2011 1243 National City Blvd. Contract Amount $ 312,000.00 National City, Ca. 91950 Din Daneshafer (619) 336 -4387 Project: 2010 sidewalk & handicap ramps Replacement If you have any further questions, please give me a call at (714) 412 -3106. Sincerely, Bill Goshen Jr. Vice President 61DDER: ��� l� Se, SECTION 3 NON-COLLUSIONAFFIDAVIT CBF - 11 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, 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, orthat anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any gotporation, partnership, company association, organization, bid depository, or to arel6ber or agent thereof to effectuate a collusive or sham bid. Subscribed and sworn This — day of —G Typed or Printed Name \15 ` i< Title Bidder 20 (Seal) ary Public in and for State of California My Commission Expires: CBF -12 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 I C See Attached Document (Notary to cross out lines 1-6 below) See Statement Below (Lines 1 -6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 State of California q County of o n– 4 .. DEBORAH ANN GOSHEN _ Commission # 1876222 z`m� Notary Public - California i Orange County s My Comm. Expires Jan 8, 2014 Place Notary Seal Above Signature of Document Signer No.2 (if any) Subscribed and sworn to (or affirmed) before me on this t� of � 20 �— Dale Month I Year by Name of Signer proved to me on the basis of satisfactory evidence to be the person who appeared before me (.) (,) (and (2) ' -- Name of Signer proved to me on the basis of satisfactory evidence to be the rson who appeared before me.) Signature Suh Signature of Notary Public OPTIONAL tit "TI.-Y!411111 Though the information below is not required by law, it may prove valuable Top of thumb here Top of thumb here to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Further Description of Any Attached Document Title or Type of Document: y` `-"l(_�+ S'`E t Document Date: ��� _ ` Number of Pages: Signer(s) Other Than Name 0 2010 National Notary Association • NationalNotary.org • 1- 800 -US NOTARY (i -800- 876 -6827) Item #5910