Gentry Brothers Inc.CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
CONTRACT BID FORMS
BIDDER: GENTRY BROTHERS, INC
_
BID SCHEDULE
900
—
y c u .
L
I nstall andscape and n per Plans and
SCHEDULE OF PRICES FOR
ce .
30 cs cations
HELLMANISAN GABRIEL INTERSECTION IMPROVEMENTS
PROJECT
—
ESPL 5358 (012)
BASE
BID SCHEDULE
raffic Striping, Traffic
UNIT OF EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION MEASURE QTY.
PRICE
COST
—
Clearing & Grubbing per plans
s
LS
1
and specifications. See
,
technical provisions TP 2, TP
](''d 6ca.
3 &TP4. LS 1 j
2
Disposat of Waste Materials LS 1
Lf c
C v
_
Remove Existing and
Construct 9- Inches Thick PCC
3
Pavement (High Early
22,320
/01
y 3 La l I
Strength) 520 -A -5000. SF
Construct 6- Inches Thick
Crushed Miscellaneous Base
_ 4
95% Compaction over 90%
Compacted Soil. TONS 850
'3 1)
5
Cold Mill 2- Inches Existing
—
Pavement. SF 5,000
6
Construct 2- Inches AC TONS 70
Pavement (C2- PG 64 -10).
aGC
I `i pct
Construct 4 -inch thick PCC
a
v .
7
sidewalk per SPPWC Std Plan
—
113 -2. SF 230
8
Construct PCC Curb Ramps
co
per SPPWC Std Plan 111-4. EA
Remove Existing and
y Construct 6- Inches I nicK rte
y Approach per
Std Plan 110 -2.
SF
900
—
y c u .
L
I nstall andscape and n per Plans and
ce .
30 cs cations
Esca
Complete.
LS
1
raffic Striping, Traffic
Loops and Pavement
aut;
s
LS
1
CBF -1
BIDDER: GENTRY BROTHERS, INC
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$
51" 14- Ili. -J Awe -
Dollar amount in written
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cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and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.
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.
Attach rd hereto is a certified check, a cashier's check or bid bon' the amount of
Dollars ($ said amount being not less tha ercent (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
CBF -2
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
Construct Traffic Signal
12
Improvements per Plans and
Specifications Complete.
1
LS
( 06-6
J 6 ,-,) '
Remove, Dispose and Construct
Colored PCC Cross Walk
(Chromix) with Lithochrome
13
Colorhardener on top per Plans
and Specifications Complete per
LM Scofield Company or
Approved Equal. Contact person
e
Bruce Umeck 81 B- 324 -3534.
SF
3,050
2 -
76 s 2�U
Adjust Sewer Manhole to
14
Grade per SPPWC Std Plan
205 -2.
EA
6
306
A66
15
Adjust to Grade Water and
Gas Valves
Ea
10
0 y
j ba
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$
51" 14- Ili. -J Awe -
Dollar amount in written
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.
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.
Attach rd hereto is a certified check, a cashier's check or bid bon' the amount of
Dollars ($ said amount being not less tha ercent (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
CBF -2
BIDDER: GENTRY BROTHERS, INC
the Contract, and will deliver to the Owner within that same period the necessary original Certificates
of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other
documentation and certification required by the Contract.
The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and
become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of Bidder's California contractor's license(s) in good standing; (2) evidence
that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting
therefrom; and (3) any other information and documentation, financial or otherwise, needed by
Owner to award a Contract to the lowest responsible and responsive bidder.
Bidder understands and aarees that liauidated damaoes shall apply to this Contract in the amounts
of five hundred dollars ($500.00) if proiect is not completed in forty -five (45) working days. The
Contract Time will begin to run ten (10) Working Days from the date of the Notice of Proceed and
subject to the terms and conditions described in the Contract Form and the Contract Documents.
Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
and subject to the terms and conditions described in the Contract Form and the Contract
Documents.
Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be
incorporated into a Contract arising out of this Submittal has been so identified by Bidder. Bidder
further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data
submitted herewith into a contract arising out of this Bid.
The undersigned acknowledges receipt, understanding and full consideration of the following
addenda to the Contract Documents.
Addenda Nos.
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.
CBF -3
By:
Signature nn
Ell CV tis ti
Type or Print Name
�f� dS t ci trr�
Title
Bidder's /Contractor's State of Incorporation:
Partners or Joint Venturers:
NN
GENTRY BROTHERS, INC
384 LIVE OAK AVE.
IRWINDALE CA 91706
Business Street Address
City, State and Zip Code
Telephone Number
Bidder's License Number(s): 3 5 7 F
NOTES:
1) By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the
representations made on the Contract Bid Forms.
2) If Bidder is a corporation, enter State of Incorporation in addition to Business Address
3) 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 - 4
BIDDER: Gentry Brothers, 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 BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT Gentry Brothers, Inc. as
Principal, and Federal Insurance Company
as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
ten percent of the total amount of the bid
($ 10% ) , being not less than ten percent (10%) of the Total
Bid Price; for the payment of which sum will and truly to be made, we bind ourselves,
our heirs, executors, administrators, successors, and assigns, jointly and severally,
firmly by these presents.
WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work
required for the Hellman /San Gabriel Intersection Improvements Protect as set
forth In the Notice Inviting Bids and accompanying Bid Documents, dated
May 8, 2013
NOW, THEREFORE, if said Principal is awarded a Contract for the Work by the
OWNER and, within the time and in the manner required by the above- referenced
Bid Documents, enters into the written form of Contract bound with said Bid
Documents, furnishes the required bonds (one to guarantee faithful performance
and the other to guarantee payment for labor and materials) furnishes the required
insurance certificates and endorsements, and furnishes any other certifications as
may be required by the Contract, then this obligation shall be null and void; otherwise
it shall remain in full force and effect. In the event suit is brought upon this bond by
the OWNER and judgment is recovered, said Surety shall pay all costs incurred by
the OWNER in such suit, including reasonable attorneys' fees to be fixed by the
court.
SIGNED AND SEALED, this 6th day of
Gentry Brothers, Inc. (SEAL)
Principal
By: o w ��� By:
Sloiature n Y
5 ICS vt
20 13
Federal Insurance Company (SEAL)
Sure
Signature Linda D. Coats, Attorney -in -Fact
CBF -5
CALIFORNIA
ALL - PURPOSE ACKNOWLEDGEMENT
State of California
County of Orange
On MjAA L I N 12 before me, Summer L. Reyes, Notary Public
(insert name and title of the officer)
personally appeared Linda D. Coats
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 4re /she/t6y executed the
same in his/her /their authorized capacity(ies), and that by, Ohs /her /their signature(,) on the
instrument the person(s), or the entity upon behalf ofwhich the persons) acted, executed the
instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing paragraph is true and correct.
WITNESS my hand and official seal.
@My SUMMER L. REYES
Commission # 1986627
Notar Public.- California z z Orange County
Signature Comm. Ex Tres Jul 29, 2016
Chubb r OF Vigilant Insurance Company Mill"; 15 Mountain View Road
OF
Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059
Know All by These Presents; That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE
COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY a Wisconsin corporation do each hereby constitute and
appoint Linda D. Coats and Matthew J. Coats of Laguna Hills, California ----- __--------
each as their true and lawful Attorney- fn. Fact to execute under such designation in their names and to affgc their corporate seals to and deliver for and on their behalf as surety
thereon or Otherwise, bonds and undertakings and: other vinfings obligatory in the nature thereof (other than bail bonds) given or executed In the: course of business, antl any
instruments amending or altering the same, and consents to the modifioationor alteration of any Instrument referred to in said bonds or obligations.
In Witness Whereof said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested .
these presams and affixed their corporate seals on this 13t dayof December, 2011.
Kenneth C. Wendel, Assistant Secretary - David .: a � cesident
STATE OF NEW JERSEY
County of Somerset.
On this 1St day of December, 2011 before me, a Notary Public of New Jersey; personally came Kenneth Wendel. to me
known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which
executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, . being . by me duly sworn, did depose and :say that he Is Assistant Secretary of FEDERAL
INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows . the corporate seals thereof that the seals affixed to the
foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By. Laws of mid Companies; and that hesigned said Power of Attorney as
Assistant Secretary of mid Companies by like authority; and that he is acquainted with David S. Norris, Jr., and knows him to be Vice President of said Companies; and that the
signature of David B. Norris, Jr.: subscribed to said Power of Attorney is in the genuine handwriting of :David B. Norris, Jr. and was thereto subscribed by authority of sald Ity-
Laws and in deponent's presence.
Notarial Seal KATHERINE I ADELAAR
NOTARY PUBLIC OF NEW JFRSFI
r Nn 43f6685 C4mmiarlon6rpirrluly18,20i4 rrPS Notary itublic
CERTIFICATION
Extract from the By, Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE. COMPANY, and PACIFIC. INDEMNITY COMPANY:
"All powers of shammy for and on behalf of the Company may and shall be executed In the name and on behalf of the Company, either by the Chairman or the
Prealdent or a Vice President or an Asslatant slice President, jointly with the Secretary or an Ametant Secretary; under their respective designations. The
signature of such officers may be engraved, printed w lithographed, The signature of each of the following officers: Chairman. President. any Vice President; any
Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any
ceNficate relating thereto appointing Assistant - Secretaries or Attorneys In- Feet for purposes only of executing and 'attesting bonds and undertakings and other
writings obligatory In the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seat shall be valld and binding
upon the Company and any such prover so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company
with respect to any bond or undertaking to which is attached.`
I, Kenneth C, Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY
(the 'Companies) do hereby certify that
(i) the foregoing extract of the By- Laws of the Companies is tme and cored;
(ii) the Companies' are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are
authorized by the U.S. Treasury Department; furtttar, Federal and Vigilant are licensed in Puerto Rhea and the U.S. Virg In Islands, and Federal is licensed: in
American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and
( iii) the foregoing power of Attorney is true. comectand in full force and effect.
Given under my hand and seats of said Companies at Warren, NJ this 6th
T �
day of May, 2013
b' . ' / 4
Kenneth -G. WendellLA Seer""
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER
MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903 -.3493 Fax (906) 903 -.3656
e -mail: auras chubb.coIn
Form 1 &10.02256 -U (Ed. 5 -03) CONSENT
CALIFORNIA ALL - PURPOSE CERTIFICATE OF AKNOWLEDGMENT
State of California
Countyof: Los Angeles
b
On efore me,
May s, 2013 N. Smith, N - - - - --
,
(name and title of the officer)
personally appeared
Rodney J. Gentry -------------------------------- ----
who proved to me on the basis of satisfactory evidence to be the person (9) whose name(§) is/me
subscribed to the within instrument and acknowledged to me that he&baQy executed the same in
hisMOAMiiiKauthorized capacity CMX and that by his /tic signature(g) on the instrument the person(ac
or the entity upon behalf of which the person (aracted, 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 rn nd and official seal N. SMITH
N Comill 2012524 ��ee
NOTARY U - Yr
LOS AN0ELES COUNTY
My Comm UP. APR,
Signature of Notary Public
(Notary Seal)
- gym =— OPTIONAL INFORMATIONS �
Information below is NOT required by law however my deter fraudulent removal of this form.
Description of Attached Document
Number of Pages 1
Document Date: TT / A
Bid Bond
Ti" type of document
lJ�
Additional information
Capacity Claimed by Signer(s)
• Individual(s)
• Corporate Officer
❑ Partner
• Attorney -in -Fact
• Trustee(s)
• Other
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
BIDDER: GENTR B ROTHERS, INC
2.13 LIST OF PROPOSED SUBCONTRACTORS
In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100
through 4114 of the California Public Contract Code, and any amendments thereto, each
Bidder shall provide the information requested below for each subcontractor who will
perform work, labor or render service to Bidder in or about the construction of the Work in an
amount in excess of one -half of one percent (greater than 0.5 %) of the Bidder's Total Bid
Price, or, in the case of bids or offers for the construction of streets or highways, including
bridges, in excess of one -half of 1 percent of the Contractor's total bid or ten thousand
dollars ($10,000), whichever is greater, and shall further set forth the portion of the Work
which will be done by each subcontractor. Bidder shall list only one subcontractor for any
one portion of the Work.
Pursuantto 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 bythe 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 -6
�� G
GENTRY BROTHERS, INC
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
("Duplicate Next 2 Pages It needed for listing addlbonal subcontractors. I
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: r
Address A—& e, C,4. S � �y
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: o 4 jrc �iJ3
Address: _ A ( ,. c A. , /o. , Ivd —rC �L<
Name and Location
of Subcontractor
Name: f_C Z,
Address
Description of Work
to be Subcontracted
f ' a.p"^ -5
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 -7
BIDDER:
GENTRY BROTHERS, INC
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. A C( 11-r41 ke
Name and Address of Owner
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
2.
Name and Address of Owner
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 of person familiar with project
Contract amount Type of Work Date Completed
CBF -8
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GENTRY BROTHERS. INC
NON - COLLUSION AFFIDAVIT
CBF -9
BIDDER: GENTRY BROTHERS, INC
NON - COLLUSION AFFIDAVIT
In accordance with Public Contract Code Section 7106, the undersigned, being first duly
sworn, deposes and says that he or she holds the position listed below with the bidder, the
party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any
undisclosed person, partnership, company, association, organization, or corporation; that the
bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced
or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly
colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham
bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly
or indirectly, sought by agreement, communication, or conference with anyone to fix the bid
price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the
bid price, or of that of any other bidder, or to secure any advantage against the public body
awarding the contract of anyone interested in the proposed contract; that all statements
contained in the bid are true; and, further, that the bidder has not, directly or indirectly,
submitted his or her bid price or any breakdown thereof, orthe contents thereof, or divulged
information or data relative thereto, or paid, and will not pay, any fee to any corporation,
partnership, company association, organization, bid depository, or to any member or agent
thereof to effectuate a collusive or sham bid.
Signature n / I
�' �C Ag
Typed or Printed Name
de
Title
GENTRY BROTHER& INfi
Bidder
Subscribed and sworn before me
This_ day of 20_
(Seal)
Notary Public in and for
the State of California
My Commission Expires:
CBF -10
CALIFORNIA ALL- PURPOSE CERTIFICATE OF AKNOWLEDGMENT
State of: California
Countyof: Los Angeles
May 6, 2013 , before me, N. Smith Notary - - -- - - --
(name and fitle of the officer)
personally appeared
Rodney J. Gentry ---- - - - - --
who proved to me on the basis of satisfactory evidence to be the person N) whose name(g) is/kw
subscribed to the within instrument and acknowledged to me that he/w executed the same in
hisMi'f NKauthorized capacity (3M)�and that by his /bMiWi signature(g) on the instrument the person(*
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 mv,hand and official seal
of Notary Public
(Notary Seal)
INFORMATIONS :.-- :._w_
Information below is NOT required by law however may deter fraudulent removal of this form.
Description of Attached Document
Number of Pages 1
Document Date: N/A
Non - Collusion Affidavit-- - - - - --
or type of document
Capacity Claimed by Signer(s)
• Individual(s)
• Corporate Officer
❑ Partner
❑ Attorney -in -Fact
• Trustee(s)
• Other
Additional information
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
The Bidder shall list the name and address of each subcontractor to whom the Bidder proposes to
subcontract portions of the work, as required by the provisions in Section 2 -1.01, "General," of the special
provisions.
EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION
GENTRY BROTHERS, INC
The bidder proposed
subcontractor hereby certifies that he
has r has not , participated in a previous contract or subcontract subject to the equal
opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required,
he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract
Compliance, a Federal Government contracting or administering agency, or the former President's
Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements.
Note: The above certification is required by the Equal Employment Opportunity Regulations of the
Secretary of Labor (41 CFR 60- 1.7(b) (1)), and must be submitted by bidders and proposed
subcontractors only in connection with contracts and subcontracts which are subject to the equal
opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity
clause are set forth in 41 CFR 60 -1.5. (Generally only contracts or subcontracts of $10,000 or
under are exempt.)
Currently, Standard Form 100 (EEO -1) is the only report required by the Executive Orders or their
implementing regulations.
Proposed prime contractors and subcontractors who have participated in a previous contract or
subcontract subject to the Executive Orders and have not filed the required reports should note
that 41 CFR 60- 1.7(b) (1) prevents the award of contracts and subcontracts unless such
contractor submits a report covering the delinquent period or such other period specified by the
Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S.
Department of Labor.
EEOC -1
CITY OF ROSEMEAD
HELLMANISAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
Noncollusion Affidavit
(Title 23 United States Code Section 112 and
Public Contract Code Section 7106)
To the City of Rosemead, Los Angeles County
DEPARTMENT OF PUBLIC WORKS.
In conformance 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.
Note: The above Noncollusion Affidavit is part of the Bid. Signing this Bid on
the signature portion thereof shall also constitute signature of this
Noncollusion Affidavit.
Bidders are cautioned that making a false certification may subject the
certifier to criminal prosecution.
NA -1
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
DEBARMENT AND SUSPENSION CERTIFICATION
TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29
The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any
other person associated therewith in the capacity of owner, partner, director, officer,
manager:
• is not currently under suspension, debarment, voluntary exclusion, or
determination of ineligibility by any Federal agency;
• has not been suspended, debarred, voluntarily excluded or determined ineligible
by any Federal agency within the past 3 years;
• does not have a proposed debarment pending; and
• has not been indicted, convicted, or had a civil judgement rendered against it by
a court of competent jurisdiction in any matter involving fraud or official
misconduct within the past 3 years.
If there are any exceptions to this certification, insert the exceptions in the following
space.
Exceptions will not necessarily result in denial of award, but will be considered in
determining bidder responsibility. For any exception noted above, indicate below to
whom it applies, initiating agency, and dates of action.
Notes: Providing false information may result in criminal prosecution or administrative
sanctions.
The above certification is part of the Bid. Signing this Bid on the signature
portion thereof shall also constitute signature of this Certification.
DSC -1
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
NONLOBBYING CERTIFICATION
FOR FEDERAL -AID CONTRACTS
The prospective participant certifies, by signing and submitting this bid or bid, to the
best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of
the undersigned, to any person for influencing or attempting to influence an
officer or employee of any Federal agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection
with the awarding of any Federal contract, the making of any Federal grant, the
making of any Federal loan, the entering into of any cooperative agreement, and
the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid
to any person for influencing or attempting to influence an officer or employee of
any Federal agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with this Federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete
and submit Standard Form -LLL, "Disclosure of Lobbying Activities," in
conformance with its instructions.
This certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by Section 1352, Title
31, U.S. Code. Any person who fails to file the required certification shall be subject to
a civil penalty of not less than $10,000 and not more than $100,000 for each such
failure,
The prospective participant also agrees by submitting his or her bid or bid that he or she
shall require that the language of this certification be included in all lower tier
subcontracts, which exceed $100,000 and that all such subrecipients shall certify and
disclose accordingly.
NLC -1
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
DISCLOSURE OF LOBBYING ACTIVITIES
uurvirum IC i mo rVmrvl IU
1. Type of Federal Action:
a. contract
b. grant
c. cooperative agreement
d. loan
e. loan guarantee
f. loan insurance
�IJI.LV JC LVOO T IIV V Mu I I V I I ICJ rumoumiV I I V a, u.o, V. I:
2. Status of Federal Action: 3. Report Type:
FAI a. hid /nffer/annlicatinn ❑ a, initial
b. initial award b. material change
c. post -award
For Material Change Only:
year _ quarter
date of last report
5. If Reporting Entity in No. 4 is Subawardee,
Enter Name and Address of Prime:
4. Name and Address of Reporting Entity
P Prime n Subawardee
GENTRY BROTHERS INC Tier _ , if known
384 LIVE OAK AVE
IRWINDALE CA 91706
Congressional District, if known Congressional District, if known
6. Federal Department/Agency:
n/vn 9'
8. Federal Action Number, if known:
A/v ✓H'
10. a. Name and Address of Lobby Entity
(If individual, last name, first name, MI)
NcNti
7. Federal Program Name /Description:
CFDA Number, if applicable
9. Award Amount, if known:
b. Individuals Performing Services (including
address if different from No. 10a)
(last name, first name, MI)
(attach Continuation Sheet(s) if necessary)
11. Amount of Pa ent (check all that apply) 13. Type of Payment (check all that apply)
$❑ actual planned a. retainer
b. one -time fee
12. Form of Payment (check all that apply): c. commission
e a. cash d. contingent fee
b. in -kind; specify: nature a deferred
value f. other, specify
14. Brief Description of Services Performed or to be performed and Date(s) of Service, including
officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11:
(attach Continuation Sheet(s) if necessary)
15. Continuation Sheet(s) attached: Yes ❑ No
16. Information requested through this form Is authorized by
Title 31 U.S.C. Section 1352. This disclosure of Signature:
lobbying reliance was placed by the tier above when his
transaction was made or entered into. This disclosure is Print Name: C TS^ Tty
required pursuant to 31 U.S.C. 1352. This information
will be reported to Congress semiannually and will be
available for public inspection. Any person who fails to Title: nF 5
file the required disclosure shall be subject to a civil
penalty of not less than $10,000 and not more than Telephone No.:
$100,000 for each such failure.
Federal Use Only:
Authorized for Local Reproduction
Standard Form - LLL
INSTRUCTIONS FOR COMPLETION OF SF -LLL,
DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure torn shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or
receipt of covered Federal action or a material change to previous filing pursuant to title 31 U.S.C. section 1352. The fling of a
form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an
officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of
Congress in connection with a covered Federal action. Attach a continuation sheet for additional information if the space on the
form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing
guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and /or has been secured to influence, the
outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow -up report caused by a material change to the
information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last,
previously submitted report by this reporting entity for this covered Federal action.
4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if known.
Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward
recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include
but are not limited to subcontracts, subgranls and contract awards under grants.
5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state and zip
code of the prime Federal recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organization level
below agency name, if known. For example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (Rem 1). If known, enter the full Catalog of
Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identification in Rem 1 (e.g.,
Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or
loan award number, the application /proposal control number assigned by the Federal agency). Include prefixes, e.g.,
"RFP -DE -90 -001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the
Federal amount of the award /loan commitments for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in
item 4 to influenced the covered Federal action.
(b) Enter the full names of the individual(s) performing services and include full address 'if different from 10 (a). Enter Last
Name, First Name and Middle Initial (Mo-
ll. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying
entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that
apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made.
12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in -kind contribution, specify
the nature and value of the in -kind payment.
13- Check the appropriate box(es). Check all boxes that apply. If other, specify nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform
and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact
with Federal officials. Identify the Federal officer(s) oremployee(s) contacted or the officer(s) employee(s) or Member(s)
of Congress that were contacted.
15. Check whether or not a continuation sheet(s) Is attached.
-- 16. The certifying official shall sign and date the form, print his/her name title and telephone number.
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for
reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348 - 0046),
Washington, D.C. 20503. SF- LLL - Instructions Rev. 06-04- 90aENDIFo
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
EXHIBIT 15 -G1 Local Assistance Procedures Manual
Local Agency Bidder UDBE Commitment (Construction Contracts)
INSTRUCTIONS - LOCAL AGENCY BIDDER
UDBE COMMITMENT (CONSTRUCTION CONTRACTS)
ALL BIDDERS:
PLEASE NOTE: It is the bidder's responsibility to verify that the UDBE(s) falls into one of the following
groups in order to count towards the UDBE contract goal: 1) African Americans; 2) Asian - Pacific
Americans; 3) Native Americans; 4) Women. This information may be submitted with your bid. If it is not,
and you are the apparent low bidder or the second or third low bidder, it must submitted and received as
specified in the Special Provisions. Failure to submit the required UDBE commitment will be grounds for
finding the bid nonresponsive
A UDBE is a firm meeting the definition of a DBE as specified in 49 CFR and is one of the following groups:
African Americans, Asian - Pacific Americans, Native Americans, or Women.
The form requires specific information regarding the construction contract: Local Agency, Location, Project
Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract UDBE Goal.
The form has a column for the Contract Item Number and Item of Work and Description or Services to be
Subcontracted or Materials to be provided by UDBEs. Prime contractors shall indicate all work to be performed by
UDBEs including, if the prime is a UDBE, work performed by its own forces, if a UDBE. The UDBE shall
provide a certification number to the Contractor and expiration date. Enter the UDBE prime's and subcontractors'
certification numbers.The form has a column for the Names of UDBE contractors to perform the work (who must
be certified on the date bids are opened and include the UDBE address and phone number).
IMPORTANT: Identify all UDBE firms participating in the project regardless of tier. Names of the First -Tier
UDBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the
names and items of work in the "List of Subcontractors" submitted with your bid.
There is a column for the UDBE participation dollar amount. Enter the Total Claimed UDBE Participation dollars
and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of
item is not to be performed or furnished by the UDBE, describe exact portion of time to be performed or
furnished by the UDBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions
(construction contracts), to determine how to count the participation of UDBE firms.
Exhibit 15 -G1 must be signed and dated by the person bidding. Also list a phone number in the space provided
and print the name of the person to contact.
Local agencies should complete the Local Agency Contract Award, Federal -aid Project Number, Federal
Share, Contract Award Date fields and verify that all information is complete and accurate before signing and
-- filing.
Page 15 -32
July 31, 2009 LPP 09 -02
Local Assistance Procedures Manual EXHIBIT 15 -G1
Local Agency Bidder UDBE Commitment (Construction Contracts)
EXHIBIT 15 -G1 LOCAL AGENCY BIDDER UDBE COMMITMENT (CONSTRUCTION CONTRACTS)
NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM
LOCAL AGENCY: C 4 , a �` A i 1 , °"t`( r- LOCATION: /
PROJECT DESCRIPTION: !�F'6�M 9.� ni -�:.- + J q .�- (spb „ ��l ✓/ i.✓75r IC�f'
TOTAL CONTRACT AMOUNT:$
BID DATE: '5� - �'�” C 3
BIDDER'S NAME: GENTRY BROTHERS, INC
CONTRACT UDBE GOAL: 6
N "TRACT
ITEM NO.
ITEM OF WORK AND DESCRIPTION
OR SERVICES TO BE
S UBCONTRACTED OR MATERIALS
O BE PROVIDED (or contracted if the
idder is a UDBE)
UDBECERTNO.
ANDEXPIRATION
DATE are
address
NAME OF EACH UDBE IDOLLAR
(Must be certified on the date bids
opened - include UDBE
and phone number)
AMOUNT
BE
L
.S, J
5 31
oCJ '.
�tia� .rr
?t9 3 - 03
For Local Agency to Complete:
Local Agency Contract Number:
Federal -aid Project Number:
Federal Share:
Contract Award Date:
Local Agency certifies that all UDBE certifications have been verified and
information is complete and accurate.
Print Name Signature Dare
Local Agency Representative
(Area Code) Telephone Number:
Total Claimed UDBE
Participation
$
D %
�signature f Butd9v
/7 d.,.� �rT7
�J at Area o e 7`el. NO.
/(a 4I bi3.✓fb
Terson to Conrad (Flease Type or nnl
Local Agency Biddcr UDBE Commitment (Constmction Contracts)
(Rev 626109)
Distribution: (1)Original -Local agency Files
Page 15 -31
LPP 09 -02 July 31, 2009