Kalban Inc.CITY OF ROSEMEAD
SIDEWALK, CURB AND GUTTER REPLACEMENT PROJECT
PROJECT No. 24003
CONTRACT BID FORME`
BIDDER: KFAcf 1h1 . Z C+
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
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BIDDER: A 4( -'bANI _A C'
SECTION 1 -BID SCHEDULE
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BIDDER. eA(_ ,Aj -I—`u ,
BID SCHEDULE
SCHEDULE OF PRICES FOR
SIDEWALK, CURB AND GUTTER REPLACEMENT PROJECT
PROJECT No. 24003
BASE BID SCHEDULE
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ I X5 —
amount in
- Proposed sidewalk, curb and gutter and curb only are located City wide. Precise locations
will be layout by Public Works Inspector and will be provided atthe pre construction meeting
in a matrix format.
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.
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UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
CITY.
PRICE
COST
1
Clearing & Grubbing per plans
LS
1
and specifications. See technical
no
:Sox —
W
3o� —
provisions TP -2, TP -3 & TP-4.
2
Disposal of Waste Materials.
LS
1
3
Remove, Dispose and Construct
4- inches thick PCC Sidewalk per
SF
15,000
M
SPPWC Std. Plan 113 -1.
4
Remove, Dispose and Construct
SF
500
PCC Driveway Approaches per
SPPWC Std. Plan 110 -2.
5
Remove, Dispose and Construct
LF
200
8- inches Curb and 24- inches
a�
Gutter per SPPWC Std- Plan
120 -2.
6
Remove, Dispose and Construct
8- inches PCC Curb Only per
LF
100
SPPWC Std. Plan 120 -2.
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ I X5 —
amount in
- Proposed sidewalk, curb and gutter and curb only are located City wide. Precise locations
will be layout by Public Works Inspector and will be provided atthe pre construction meeting
in a matrix format.
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.
CBF -2
BIDDER: "AC319 I TkJC-
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
afterthe 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 cashiers check or a bid bond in the amount of
)p ro .✓ 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 Ownerfor execution, within five (5) Calendar Days following the Letter of Award for
the Contract, and will deliver to the Ownerwithin 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 It 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 contractors 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 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. _Z
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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.
By. \�
ie Business Street Address
-IAA, Jr� oazc � J H��s!, Cr1 4° �3Sz
Type or not Nam City, State and Zip Code
F) K . so/ ion )-
Title Telephone Number
Bidder's /Contractor's State of Incorporation: (� q
Partner int Venturers:
Bidder's License Number(s): Sd -75-,5 d %T I
NOTES:
1) By its signature on this Bid, the Bidder certifies under penakv 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,
partnership or joint venture has the authority to do su.
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BIDDER: e4L'254IV ) 4jC
SECTION 2
BID DATA FORMS
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08/18/2014 14:11 18185041867 KALBAN INC PAGE 02/62
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.
1A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT Kalban, Inc.
as
as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
Ten Percent of Amount Bid
($ tot 1, 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 Sidewalk, Curb and Gutter Replacement Project as set forth in
the Notice Inviting Bids and accompanying Bid Documents, dated,
5-27
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 affect. 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 19th day of August 2014
Kalban, Inc. (SEAL)
PrinciuII `
By: Z� By:
Signature �p
CBF -S
The Guarantee Company of lcan America ) SA
Surety
Sig ure 1ham Syrkm,
ttorney -In -Fact
CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT
STATE OF CALIFORNIA
County of Los Angeles
On August 19 2014 before me, Corinne L Hernandez Notary Public
Oale Here loser, rvame And True on he on,cer
personally appeared Wiliam Syrkin NamAlal of Snoaq :l
who proved to me on the basis of satisfactory evidence to
be the personH whose names) is/am subscribed to the
within instrument and acknowledged to me that heeiiii ey
executed the same In hisiherkhetF authorized capacity(7es),
and that by his"n.P FAR err signature(s) on the instrument the
_
person(a), 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 /y�nd official seal.
Signatur�d� dM -`J10 ' '
vlACe Nmary seal Aeove �nawa �rvo�ary cabl, O
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:. _
Document Date: Number of
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
Signer's Name:
❑ Individual
❑ Individual
❑ Corporate OfficerTitle(s):
❑ Corporate Off icerTitle(s):
❑ Panner— ❑ Limited ❑ General
❑ Partner — ❑ Limited O General
L Attorney in Fact
❑ Attorney in Fact
❑Trustee
•
❑ Trustee
❑ Guardian or Conservator
Top of thumb here
❑ Guardian or Conservator
Top of thumb here
❑ Other: _
Ll Other:-,
Signer Is Representing:
Signer Is Representing-
The Guarantee Company
of North America USA
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AIAAdo
CA
d1313 2402 orefIN4`isc>ford 15907 Border Call Tell F 00d
®YW9 National NOlery AS50Ciation• 935 0Ce$ olo PVe.,PO.BO[R402•LhalSworll,, CA 913132A62•ww•v.NarionelNOlarym9 INm tl590] flPO�eer'. Ca TdI Ree1B0081fi�669
1.1N•l`celare,!•,odo.'rl- a3li)4)CAll, ir_O 1-., 11,
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
Niliam Syrnin , .Sergirr D. Becharn, Rebecca Ann Haas- Bates, Patricia Ann Rubber, Richard Lera , Adair
Millennium CorOmate 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
Indemnify and other writings obligatory in the nature thereof which are or may be allowed, required or pernotted by law, statute role, rea latioM1 contract
or otherwise.
The execution of such instruments) 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 cooled so and may be revel 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 hold on the 31 "day of December, 2003.
The President or any Via President. acting with any Secretary or Assistant Secretary , shall have power and authonty:
1. To appoint Anomey(s) in- fad, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto Winds
and undertakings, contracts of indemnity and other writings obligatory in the nature thereof', and
2. To revoke at any time, any such Affomey -in -fact and revoke the authority given, except as provided below
3. In connection with obligations in favor of the Florida Department of Transportation only it is agreed that the power antl authority hereby given
to the Atlomey -m-Fact Includes any and all consents for the release of retained percentages anchor final estimates on engineering and
construction contracts required by the State of Florida Department of Transportation. It Is fully understood that consenting to the State of
Florida Department of Transportation making payment of the final estimate to the Contractor and/or Its assignee, shall not relieve this surety
cem parry of any of Its obligations under its bond.
4. 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 Fact cannot be modified or revoked unless prior writer 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 diversion.
Further, this Power of Atlomey is signed and sealed by retain Ile pursuant to resolution of the Board of Directors of the Company adopted at a meeting
duly called and held on the ad day of December 2011, 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 band 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
y.•e� IN VdTNESS WHEREOF. THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and
G Its corporate seal to be affixed by Its authorized officer this 23rd day of February 2012
y THE GUARANTEE COMPANY OF NORTH AMERICA USA
STATE OF MICHIGAN Stephen C. Ra cbak, Vice President Randall Mu dialman, Secretary
County of Oakland
On this 23rd day of February, 2012 before me came the individuals who executed the preceding instrument, to me personally known, and being by me
duly 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
Cynthia A. El IN WITNESS WHEREOF, I 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 popppp
TT My Commission Expires February, 27, 2018
%> Acting in Oakland County
voi+J
I, Randall MusselmagSecretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do herebyz ity that the above and foregoing Is a time
and coned copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which Is still In full force and effect .
I N VdTNESS WHEREOF, I have thereunto set my hand and attached the seal of said Company this 19th day of August 2014
, set Randall Mu
uelman, Secretary
State of California
ss.
County of Los Angeles
On Q - 2-7 -/7 before me, Michael Edward Lifsey, Notary Public
personally appeared Dave Poole
MICR EOIM0 2085890
MOtMY PY811C • Cgidwai t
W 11a9MO county
1 COrem, E IrM Ma 5.2018
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 official seal
Signature of Notary Paryre
OPTIONAL
,Y ✓ //•
Though the Information below is not required by law, it may prove valuable to persons relying ontX document and could
prevent fradulent removal and reattachment of this form to another locum t
Description of Attached Document
Title or Type of Document. 3 t O 130-Al '7
Document Date: -0 Number of Pages:
Signer Other Than Named Above: W r Ll. I kti
Capacity Claimed by Signer
Signer's Name.
mdrvidual
Corporate Officer - Title'.
Partner
Attorney - In - fact
Trustee
Guardian
atner'
Dave
Vice President
Signer is Representing'. Kalban, Inc.
BIDDER- i-v44 F11A) XA C -
2.B 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 aboutthe construction of the Work in an
amount in excess of one -half of one percent (greater than 0.5 %) of the Bidders 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 Contractors 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, otherthan 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.
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BIDDER: �`K� r 1 "f
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
P'DupGrate NeM 2 Pages R needed for listing additional subcontractors "I
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name A/D1c
Address:
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.
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Description of Work
to be Subcontracted
Description of Work
to be Subcontracted
BIDDER: 'JA.Nr -T G
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:
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
4,
of Owner
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
Name
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
CBF -9
KALBAN, INC.
GENERAL ENGINEERING CONSTRUCTION
818 -504 -1065 Faz:818 -504 -1067
Recently Completed Projects and Reference List
City of Burbank - Contact: Adam Salehi - 818- 238 -3946
2011 -2013 CD3G Street, Sidewalk Project
Removal and Replacement of Damaged PCC Various Locations
5626,944.00
2009 -2012 CDBG Street, Sidewalk Project
Removal and Replacement of Damaged PCC Various Locations
3568,945.00
2010 - 2011 Sidewalk Repair Program
Removal and Replacement of Damaged PCC Various Locations
31,571,050.00
2009 - 2010 Sidewalk Repair Program
Removal and Replacement of Damaged PCC Various Locations
5334,000.00
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
3535,230.00
ZOOS Oak St. & Bel Air Dr. Improvements
Street Reconstruction Asphalt Resurfacing, PCC Replacment
$720,000.00
City of Anaheim :-Contact: Mike Wood - 714- 765 -5110
2013 Concrete R &R Services Annual
2010 Concrete R &R Services Annual
Removal and Replacement of Damage PCC Various Locations
Removal and Replacement of Damaged PCC Various Locations
57,500,000.00
$1,560,000.00
2008 -2009 Resort Maintenance
Removal and Replacement of Damaged PCC Various Locations
$120,000.00
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
City of Norwalk - Contact: Randy Hillman - 562 - 929 -5719
2007 Local Street Project Street Reconstruction Asphalt Resurfacing, PCC Replacment 51,640,000.00
of Inglewood - Hunter Nguyen - 310- 412 -5333
C' Of
2013 Pedestrian Wheelchair Accessible Ramps Removal and Replacement of Damaged PCC Various Locations $407,000.00
2012 Sidewalk & Wheelchair Ramp Improvments I Removal and Replacement of Damaged PCC Various Locations 1 5531,443.00
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 5485,000.00
City of Lawndale - Miguel Alvarez - 310- 973 -3265
2013 156th at al, Street Reconstruction
Street Reconstruction Asphalt Resurfacing, PCC Replacment $495,840.00
2013 Citywide Concrete Repairs
I Removal antl Replacement of Damaged PCC Various Locations $383,294.00
City of Santa Clarita - Contact: Ewen 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
5394,793.00
2003 -2004 Annual Concrete Rehabilitation
Removal antl Replacement of Damaged PCC Various Locations
$231,600.00
2002 -2003 Annual Concrete Program
Street Recon struttion Asphalt Resurfacing, PCC Replacment
$396,000.00
City of Wine - Contact: Darrell Hartman - 949 - 724 -7556
2013 Curb Ramp Upgrades ADA Compliance PCC & Misc Structures $868,781.00
City of Whittier - Contact Alfredo Hernandez - 562 -567 -9850
2013 Alley Improvement Rehabilitation Alley Improvements $184,578.00
City of Glendale - Contact: Sarkis Oganesyan - 818- 937 -8242
2012 ADA Curb ramp Installation Program
I Removal and Replacement of Damaged PCC Various Locations
$799,335.00
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
BIDDER:
SECTION 3
NON - COLLUSION AFFIDAVIT
CBF - 10
BIDDER: 4 *ff'fj r TrJC-
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, thatthe 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.
lure
-OAJ�- ado L e
Typed or Printed Name ` �r
d GF- r( lA�si
Title /�
.FAl 1, .
Bidder
Subscrib d and sworn before me
ThiaZWday of 4ll ✓x,5r 20/—V
a(y "Public in and fi
State of California
My Commission F ices: MATS
CBF -11
(Seal)
y1C1MEL EDWARD LIFSEY
CBmmiaaW / 2087888
tidy ►VW . cal8ania
CpWtt��Wi 8 20185 2018