KASA Contruction, Inc CITY OF ROSEMEAD
DUFF PARK IMPROVEMENTS PROJECT
CONTRACT BID FORMS
BIDDER: KFSA CoAS4tV(A a1 ,TAC .
CONTRACT BID FORMS
TABLE OF CONTENTS
SECTION 1 BID SCHEDULE 1
SECTION 2 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: WASA CM Y\J 1tK•
SECTION 1 - BID SCHEDULE
CBF- 1
BIDDER: Y-16A Cm45 V ,1wc•
BID SCHEDULE
SCHEDULE OF PRICES FOR
DUFF PARK IMPROVEMENTS PROJECT
BASE BID SCHEDULE
UNIT OF EST. UNIT ITEM
NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST
1 Clearing &Grubbing per plans LS 1 L�
and specifications. See technical / JCXJO `'{S7 coo
provisions TP-2, TP-3 &TP-4.
2 Disposal of Waste Materials. LS 1 22 SOCK "17 coo
i
3 Remove, Dispose and Construct SF 1,225
4-inches thick PCC Sidewalk per 7 5 7c-
SPPWC Std. Plan 113-1.
4 Remove, Dispose and Construct 20 LF 130
feet high chain link fence 9 gage -7
and 2 inches mesh with top rail and 17c 22) 750
bottom tension wire including poles
and baseball backstop complete.
5 Remove, Dispose and Construct 8 LF 434
feet high chain link fence 9 gage 1 ��
and 2 inches mesh with top rail and ii S 1 9) 3
bottom tension wire including poles
complete.
6 Construct 4 feet high home run LF 380
fence 9 gage and 2 inches mesh n 7,0 6 00
with top rail and bottom tension wire L.
including poles complete.
7 Construct Dugout Complete(30 feet EA 2 F,000
x10 feet) �2 000 J
8 Furnish and Install 3 Row Aluminum EA 2
Bleachers-Seating Capacity 15. 37500 77 00 CJ
9 Furnish and Install Dugout benches EA 4
Elite Bench per Baseball Rack or )J '500 6) 00C.)
approved equal.
10 Install 4 feet wide Gate as indicated EA 3 -�
on the plans. 1 y COC) 3, 00 0
11 Install 20 feet wide Gate as EA 2 00C,
indicated on the plans. 2, coo J
CBF - 2
BIDDER: RASA Con 54TvA- w,tfrrc.
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ j 3 3 ✓ < C S - f°_
GYI P, hbtnJr2ci -Area +krucc nA, nine 11 m A C-ve. cOckiS .
Dollar amount in written form
Note: The City of Rosemead reserves the right to reduce or increase the quantities of any items in
the schedule of bid items above, within the limits define in Section 3-2.2.1 of the Standard
Specifications, to stay within the budgeted amount of this project.
If the Bid Documents specify alternate bid items, the following Alternate Bid amounts shall
be added to or deducted from the Total Bid Price entered above. The owner can choose to
include one or more of the alternates in the Total Bid Price of the Project. If any of the
Alternate Bids are utilized by the Owner,the resulting amount shall be considered the Total
Bid Price for the Project.
The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which
cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and
after the bid opening date, or until a Contract for the Work is fully executed by the Owner and a third
party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the
written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall
govern.
Attached hereto is a certified check, a cashier's check or bid bon\n the amount of
07- Dollars ($ ) said amount being not less than ten percent(10%) of the Total
Bid Price. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
we fail or refuse to execute the Contract and furnish the required bonds, certificates and
endorsements of insurance and other certifications within the time provided.
If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be
prepared by the Owner for execution,within five(5)Calendar Days following the Letter of Award for
the Contract, and will deliver to the Owner within that same period the necessary original Certificates
of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other
documentation and certification required by the Contract.
The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and
become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of Bidder's California contractor's license(s)in good standing; (2)evidence
that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting
therefrom; and (3) any other information and documentation, financial or otherwise, needed by
Owner to award a Contract to the lowest responsible and responsive bidder.
CBF - 3
BIDDER: OSA CoKs c -
Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
of five hundred dollars ($500.00) if project is not completed in THIRTY (30) calendar 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 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. N04.t
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 -4
BIDDER: kA5A Ca l.511 x-6/4 -
By: CdaG-.ei,;,.teR,6 (514Y SieWk Sun. rake
Signature Business Street Address
vtrn Icc01au✓ GA;Iw cA- °I I-710
Type or Print Name City, Statl and Zip Code
Get Tog_ti 57-02- GO
Title Telephone Number
Bidder's/Contractor's State of Incorporation: I '(A`;1-pf n i s`
Partners or Joint Venturers:
Bidder's License License Number(s): Cl 2-7 SNK - ,4-, 8/-/f), e • 17
Department of Industrial Relations
Registered No. _ ( 00000 X013
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,
partnership or joint venture has the authority to do so.
?ksf se.° aA(A d
CBF - 5
CERTIFICATE OF CORPORATE RESOLUTION
Of
KASA CONSTRUCTION INC.
1, DIANA KASBAR , President of KASA CONSTRUCTION INC.,organized and
existing under the laws of the State of California and having its principal place of business at
15148 Sierra Bonita Lane,Chino, CA 91710 , hereby certify that the following is a true copy of a
resolution adopted by the Board of Directors of the Corporation at a meeting convened and held on
NOVEMBER 09. 2014, at which a quorum was present and voting throughout and that such resolution
is now in full force and effect and is in accordance with the provisions of the charter and by-laws of the
Corporation.
RESOLVED : That the DIRECTORS are hereby authorized and directed to certify to any
interested party that this resolution has been duly adopted, is in full force and effect,and is in
accordance with the provisions of the charter and by-laws of the Corporation.
FURTHER RESOLVED, none at this time.
I further certify that this Corporation is duly organized and existing, and has the power to take the action
called for by the foregoing resolution.
DIRECTORS
DIANA KASBAR _ ,/,viu/ LA%_L 11-09-14
President - Date
SAM KASBAR it ',. 71 11-09-14
Vice President Date
SAM KASBAR a-0.7 u _ 11-09-14
Secretary . Date
DIANA KASBAR �AzLaiul/ss_d_ 11-09-14
Treasurer Date
Witness my hand seal of this Corporation on this 9th day of November , 2014 .
BIDDER: Y,rc A �pn51'�✓��lVyt .c .
SECTION 2
BID DATA FORMS
CBF -6
BIDDER: Kasa Construction.Inc
Bond No.:KASCO-4%5
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 Kasa Construction,Inc. ,as
Principal, end The Ohio Casualty 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
DOLLARS
(510%of the Bid ), 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 Duff Park Improvements Project as set forth in the Notice Inviting
Bids and accompanying Bid Documents, dated February 4,2015
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 certficates and endorsements,and furnishes any other certifications as
-- may be required bythe Contract,then Ills obligation shall be null and void;itemise
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 adorneye'fees to be fixed by the
court.
SIGNED AND SEALED,this 2 day of February , 2Q 15
The Ohio Casualty
Kasa Construction,Inc. (SEAL) Jnanance Comoanv (SEAL)
Principe Surety
By: ey:
Signature S 11 dy SpoTAttomep-in-Fact
CBF-7
THISPOWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
I • This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated.
Certificate No.rar■aoz
American Fire and Casualty Company Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West Arnencan Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS', That Anencan Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of
the Stale of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts.and West American Insurance Company
is a corporation duly organized under the laws of the Stale of Indiana(herein collectively called the"Companies").pursuant to and by authority herein set forth.does hereby name,constitute
and appoint, Matthew R.Dobyns,Randy Spohn
all of the city of Santa Ana ,stale of CA each individually if there be more than one named,its tie and lawful attorney-in-fact to make.execute,seal,acknowledge
and deliver,for and on its behalf as surety and as rts act and deed.any and all undedakings,bonds.recognizances and other surety obligations,in pursuance of these presents and shalt
be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons.
I �I
IN WITNESS WHEREOF this Power of Attorney has been subscribed by an authonzed officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 615t day of March 2014 .
American Fire and Casualty Company
The Ohio Casualty Insurance Company m
Liberty Mutual Insurance Company c
WpestA In t American Insurance Company•
.o
By:
ay:
c STATE OF PENNSYLVANIA 55 David M.Care)Assistant secretary
N
yre = 0
COUNTY OF MONTGOMERY c
tirn On this asst day of March , 2014 before me personally appeared David M Carey.who acknowledged himself to be the Assistant Secretary of American Fire and u F
✓ ly Casualty Company.Liberty Mutual Insurance Company,The Ohio Casually Insurance Company.and WestAmendan Insurance Company,and that he.as such,being authonzed so to do, >92
`p A execute the foregoing instmnem for the purposes therein contained by signing on behalf of the corporations by himself as a duly aulhonzed officer. E
.gyp. > IN WITNESS WHEREOF,I have hereunto subscribed my and affixed my notarial seal al Plymouth Meeting,Pennsylvania.on the day and year first above above written. Z a o
4i
• V I4n0. L.u�r�t9YC./. w00
CTeresa Pastella,Notary Public G
mo of
a
Cm This PowerofAdomey is male and executedpurrtaltbard by authority of the folbwing By-taws and Authonzations ofAmencan Fire and Casualty Company,The Ohio Casualty Insurance to ct
• Company,liberty Mutual Insurance Company,and West Arnencan Insurance Company which resolutions are now in full force and effect reading as blows'. t„
w
A: ARTICLE IV-OFFICERS-Section 12.Powerdenttomey.Any officer or other official of the Corporation allhorized for that purpose in wiling by the Chairman or the President.and subject 0 c
Cmo, to such er ge and as the Chairman or the President may prescribe.shall appoint such attorneys-in-fact as may be necessary to act in behaff of the Cotoretion to make,execute.seal, > gdr
O C acknowledge and deliver as surely any and all undertakings,bonds,by their recognizances aid other surety of any such Such attorneys-in-lad,subject to the limitations set forth in their respective -a $
E a powers of attorney shall have full power to bind the Corporation by their signature and execution of any such strn ent5 and to attach thereto the seal of the Coryamlbn. When so .>m
ip executed,such'Monuments shall be as binding as time by the President and attested to by the Secretary-Any power or aNntilti granted to any representative or attomey-m-fact under >a
T the provisions of this article may be revoked at any titre by the Board,the Chairman,the President or by the officer or officers granting such power or authority. «N
15 G ARTICLE X III-Execution of Contrasts-SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, Et?
> a and subiect to such imitations as the chairman or the president may prescribe,shall appoint such ammeys-infect.as may be necessary to act in behalf of the Company to make.execute n
p j seal,acknowledge and delver as surety any and all undertakings.bonds,recognizances and other surety obligations. Such attorneys-in-lad subject to the limitations set bib in their C oQ
Z 0 respective powers of attorney shall have full power to bird the Company by their signature and execution of any such instruments aid to attach thereto the seal of the Company. Wien so t3i�
executed such instruments shall be as binding as i signed by the president and attested by the secretary O b
Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company.aruthonzes David M.Carey,Assistant Secretary to appoint such attorneys-in- ~r-
fat as may be necessary to act on behalf of the Company to mace.execute,seal,acknowledge and deliver as surety any and all undertakings.bonds,recognizances and other surety
obligations.
Authorization-By unanimous consent of the Conpanys Board of Directors.the Company consents that facsimile or mechanically reproduced sgnature of any assistant secretary of the
Company wferever appearing upon a certified copy of any power of attorney issued by the Company in connection wtih surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I.Gregory W Davenport.the undersigned.Assistant Secretary.of American Fire and Casualty Company,The Ohio Casualty Insurance Company,Libery Mutual Insurance Company,and
AAst Arnencan Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full.ime and correct copy of the Power of Attorney executed by said
Companies.is in full force and effect and has not been revoked.
IN TESTIMONY MMEREOF,I have hereunto set my hand and affixed the seals of said Companies this 2nd day of February 20 15
By
Gregory W Davenport,Assistant Secretary
LMS_12573_122013 65 of 200
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the truthfulness,
accuracy, or validity of that document.
State of CALIFORNIA
County of ORANGE
On c�A 1C)l , 1 ,(79 before me, ERIKA GUIDO, NOTARY PUBLIC,
personally appeared RANDY SPOHN
Z who proved to me on the basis of satisfactory evidence to be the person(s)
whose names) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity (ics), and that by his/her/their signatures) on the
instrument the person(s), or the entity upon behalf of which the person(s)
acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of
California that the foregoing paragraph is true and correct.
ERIKA GUIDO WITNESS my h d and official seal.
COMM.;# COMM.3 e C tt20A
NOTARY CALIFORNIA N )1\ORANGE COUNTY
' y mmm expires May 5,1011 i 1�
ff L
St re o a •ry
Though the data below is not required by law, it may prove valuable to persons relying on the document and
could prevent fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
❑ INDIVIDUAL
❑ CORPORATE OFFICER
❑ PARTNER(S) ❑ LIMITED
❑ ATTORNEY-IN-FACT
❑ TRUSTEE(S)
❑ GUARDIAN/CONSERVATOR
❑ OTHER:
SIGNER IS REPRESENTING: _
NAME OF PERSON(S) OR ENTITY(IES)
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document,
State of California )
County of Jan ex()144-4,p )
On 2 ill 2-015- before me, VA eC}o`OZwva\G/ t5 `s UbtiC ,
Date ;� Here Insert Name and Title of the Officer
personally appeared Ji444 V-U.S\o ar
Name(s)of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies),and that by his/her/their signature(s)on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.j I
HECTOR L1YALA E WITNESS my h-• an official seal.
1t>`. Commission 1 2046822
���'" Nobly Public•California i / /
`-? .,) W San Bernardino County Signature /nl/////i —
•Comm.EseresOct262017E / •ignature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document,
Description of Attached Docume t pp t7vt �
Title or Type of Document: gi 1, q Document Date:
Number of Pages: Signer(s) Other Than Named Above:
Capacity(ies)Claimed by Signer(s)
Signer's Name: Signer's Name:
Corporate Officer — Title(s): I Corporate Officer — Title(s):
Partner — Limited J General -1 Partner — i Limited 1 General
_individual J Attorney in Fact 1 Individual H Attorney in Fact
_ Trustee _!
BIDDER: K nS4 Co 4SI Abr,Znc •
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 about the construction of the Work in an
amount in excess of one-half of one percent (greater than 0.5 %) of the Bidder's Total Bid
Price, or, in the case of bids or offers for the construction of streets or highways, including
bridges, in excess of one-half of 1 percent of the Contractor's total bid or ten thousand
dollars ($10,000), whichever is greater, and shall further set forth the portion of the Work
which will be done by each subcontractor. Bidder shall list only one subcontractor for any
one portion of the Work.
Pursuant to Public Contract Code Section 4104,the Owner has determined that it will allow
Bidders twenty-four(24)additional hours after the deadline for submission of bids to submit
the information requested by the Owner about each subcontractor, other than the name and
location of each subcontractor,
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: KA # Cm'1$1YU6{iP";TA(
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
["Duplicate Next 2 Pages 1r needed for listing additional subcontractors"j
Name and Location Description of Work
of Subcontractor to be Subcontracted % Fe hce t G-sfe-s
Name: Are- Fentt C' � -nPant
Address: 727 rlert.Lrra A✓c. .fee inie ric Cq 9/721j
License No.: ¶9ti 57
Department of Industrial RRelation Registration No. /00000'Vijs
Name and Location Description of Work
of Subcontractor to be Subcontracted/
unc.vefe
Name: M Ct
Address: 910 . Foo+1,11 614 . R7.0sn 762-
License No.: 3,y4,7/
Department of Industrial Relation Registration No. /00(7(`0 emit,
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
License No.:
Department of Industrial Relation Registration No.
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
License No.:
Department of Industrial Relation Registration No.
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
License No:
Department of Industrial Relation Registration No.
CBF - 9
BIDDER: kgk$A CowS}Nchrm
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. Lewis 1> Pera}, Lip N1 ac (Ackw;o - (IS6 kl. koun /-`e. VpLun f)64 9034
Name and Address of'Owner
greet e.V-0 - qoq-`4(r7SlS
Name and telephone number of person familiar with project
V6�3°15 ti ew Par IC �2oly
Contract amount Type of Work Date Completed
2. 1,;-41 oZ Ptwis - Ibl rt. r). Perr;S Ctt 41zf70
Namb and Address of Owner
SL6'1 C•c-a - gSl_ 1)q-0700
Name and telephone number of person familiar with project
2194) 0 nlww Qa-1 5/2015
Contract amount 1 Type of Work Date Completed
3. Sv[v�sor Ay- 5 Ai,45)a�.dt4 Ull�,w tL,w .w{. , SCW�__ ZSSN.(.ti.-ei�e, `'�q94
Name and Address of Owner H-p f L � a�✓y • L� �Y
(I trry 1 uc-z_ - 424- S33-633c
Name an telephone number of person familiar with project
1) Zfri i7 a— c41 kst y p E 3/2a,r
Contract amount TIYpe'of Work 1 1 Date Completed
4. C o. 3.t -lac 6(cp4-rn. - 7-3y20 val e.,tiA �1Y��3p Sa Clath(ca 9 135 s
Na and Address of Owner
't< L'Akt< _ 661,-x36—k(3j
Name and telephone number of person familiar with project
IagD) tf '.s aWOLE S/zor3
ntact amount Type of Work Date Completed
CBF - 10
BIDDER: kQ 4 CP" '11'1
SECTION 3
NON-COLLUSION AFFIDAVIT
CBF - 11
BIDDER: ` AcA emt5 Vut. itArtvc.I •
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, 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.
gnature
�iquta KasU -
Typed or Printed Name
kfavlir
Title
SSW CoK.St-- J-:.,..., t- c•
Bidder
Subscribed and sworn before me
This L day of�cbr1A5 , 20 t$'
(Seal)
- r/
I
.tary Public in and for
/re State of California IIECTA3AVALA
My Commission Expires: fit.-+- 2,VI 2On aY "• Wary Ptak•Canna
/ an Nenewne Caey
,.. Ms Cam ,112on(
•
CBF - 12