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PTM General Engineering Services Inc. • CITY OF ROSEMEAD GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) r •r _ 4 - • • PTM General Engineering Services Inc. BIDDER: BID SCHEDULE SCHEDULE OF PRICES FOR GARVEY AVENUE — HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) BASE BID SCHEDULE UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 1 Clearing & Grubbing per plans and specifications. LS 1 1,00ctioc ‘01 o oo,oe 2 Disposal of Waste Materials. LS 1 frC \t",c, Traffic Signal Upgrade at Garvey Avenue and Delta 3 Avenue per Plans and Specifications Complete. LS 1 PDOOLV.d bo,c �o Traffic Signal Upgrade at Garvey Avenue and 4 Rosemead Place/River Avenue per Plans and Specifications Complete. LS 1 :y:) eo \gopoo . oc- Traffic Signal Upgrade at 5 Garvey Avenue and Muscatel Avenue per Plans and Specifications Complete. LS 1 LoS LOP, ,fig, .00 TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ S92)P°i8•CO tk.,C v) a cQ �R V 1..t r�col Dollar amount in written form (\ V O Z� The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract for the Work is fully executed by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. CBF- 1 PTM General Engineering Services Inc. BIDDER: Attached hereto is a certified check, a cashier's check or a bid bond in the amount of ten percent Dollars ($ 10% J 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. 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 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. Q Addenda Nos. h D li AGc0Y1 4- pi/ z i 24 t b 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 - 2 • PTM General Engineering Services Inc. BIDDER: By. 5942 Acorn St. Signature Business Street Address Elizabeth H. Mendoza de McRae Riverside, CA 92504 Type or Print Name City, State and Zip Code President/CFO 951.710.1000 Title Telephone Number Bidder's/Contractor's State of Incorporation: California Partners or Joint Venturers: Elizabeth H. Mendoza de McRae President/CFO Brian Mendoza Secretary/V.P. Bidder's License Number(s): 891265 Department of Industrial Relations Registered No. 1000001433 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. CBF- 3 BIDDER: PTM General Engineering Services 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 PTM GENERAL ENGINEERING SERVICES, INC. ,as Principal, and INTERNATIONAL FIDELITY INSURANCE COMPANY , as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of TEN PERCENT OF AMOUNT BID DOLLARS (5 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 TRAFFIC SIGNAL MODIFICATION MISSION DRIVE AND WALNUT GROVE AVENUE as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated APRIL 22ND, 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 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 17TH day of APRIL , 2015 . INTERNATIONAL FIDELITY PTM GENERAL- , �4 EERING SERVICES, IN�SEAL) INSURANCE COMPANY (SEAL) Principal Ap Surety 1/ By: By: 4 Signature Si,/.1 , re PHILIP E. VEGA, ATTORNEY-in-FACT Elizabeth H.Mendoza de McRae III/ PRESIDENT/CFQ CBF - 6 Tel(973) 624-7206 POWER OF ATTORNEY INTERNATIONAL FIDELITY INSURANCE COMPANY ALLEGHENY CASUALTY COMPANY ONE NEWARK CENTER, 20TH FLOOR NEWARK, NEW JERSEY 07102-5207 KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY,a corporation organized and existing under the laws of the State of New Jersey, and ALLEGHENY CASUALTY COMPANY a corporation organized and existing under the laws of the State of Pennsylvania,having their principal office in the City of Newark,New Jersey,do hereby constitute and appoint KEVIN E. VEGA, BRITTON CHRISTIANSEN, PHILIP E. VEGA, MYRNA SMITH I I Covina, CA. their true and lawful attorney(s)-in-fact to execute,seal and deliver for and on its behalf as surety,any and all bonds and undertakings,contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed,required or permitted by law,statute,rule,regulation,contract or otherwise, and the execution of such instrument(s) in pursuance of these presents,shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes,as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed,and may be revoked, pursuant to and by authority of the By-Laws of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 20th day of July,2010 and by the Board of Directors of ALLEGHENY CASUALTY COMPANY at a meeting duly held on the 15th day of August,2000: "RESOLVED,that (1)the President,Vice President, Executive Vice President or Secretary of the Corporation shall have the power to appoint,and to revoke the appointments of,Attorneys-in-Fact or agents with power and authority as defined or limited in their respective powers of attorney,and to execute on behalf of the Corporation and affix the Corporation's seal thereto,bonds,undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2)any such Officers of the Corporation may appoint and revoke the appointments of joint-control custodians,agents for acceptance of process, and Attorneys-in-fact with authority to execute waivers and consents on behalf of the Corporation; and (3)the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any • bond, undertaking,recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto,such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation,to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and attested these presents on this 22nd day of July,2014. tIY STATE OF NEW JERSEY '' CASL Coun of Essex 1 �' ^ r ' '� """ ., .._ LL ....,-, 1 1935 SI AML ret el JE ROBERT W.MINSTER �� a ' ") 1 Executive Vice President/Chief Operating Officer LVpCL� (International Fidelity Insurance Company) and President(Allegheny Casualty Company) On this 22nd day of July 2014, before me came the individual who executed the preceding instrument,to me personally known,and, being by me duly sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies;that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, ,,,,,,,,,,,,, at the City of Newark,New Jersey the day and year first above written. OP'..s'si NR<i_;' ott„,&,. ,� j �J- �• ■ ▪ :0 NOTARY It• •4c PUBLIC �' TA.• 04-16 7a;9 ,•'� c A NOTARY PUBLIC OF NEW JERSEY %,�91 o .NEW,��```::' My Commission Expires April 16,2019 ''''10 mit OtO's CERTIFICATION I,the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit,and the copy of the Sections of the By-Laws of said Companies as set forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof,and of the whole of the said originals,and that the said Power of Attorney has not been revoked and is now in full force and effect. / -�^ IN TESTIMONY WHEREOF, I have hereunto set my hand this /"'l day of 1 o�I s MARIA BRANCO,Assistant Secretary i �,r'. ''S 3.�K�49 A per`-.! '4 •8,. Y, ; E $ : } r d y. A ,y, .e 4 2 # i :E e44 Y6.�$;N3 ?-S' :04 `°t ,s �hr��"�,,ah"^!� ;S«"''� z :.`5"" ,., f�`', s� 1 ; s k w � ; W, A �' d c a�� � 't. , 7�-° `.��'. -a [>f4� : "�� ��� ,, ` ' c.°F: ' s .< , , C k'` » try , ,. -„ . ¢ea �i � V a T } , e �i,:i. s&,—'s&, e.31}.]i*, �J'f.s ,,..a°P.dY°a]Xfat,' ;�>.Zl� f> [�5 & �ii.t'1'...;ir,&'-`c di . . -kaklIer d 1.A!', �f. 5{'.kC4:..4 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 ,a. 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 Ma''r 5 2oi'S - before me, PHILIP E. VEGA, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared ELIZABETH H. MENDOZA de McRAE 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 t e for-going paragraph is true and correct. PHILIP VELA WITNESS my hand and offici. , -al. c/^" 2 COMM.K 1977088 ti �. NOTARY PUBLIC•CALIFORNIA \z.g41 Los ANGELES COUNTY MyComm.Expires MAY 31.2018 Signature •k Signature oil .ry 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 Document Title or Type of Document: 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): ❑Corporate Officer — Title(s): ❑ Partner — ❑Limited ❑General ❑ Partner — ❑ Limited ❑General ❑ Individual ❑Attorney in Fact ❑Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: � SS �CLJvy y y y . y v >,.: r �.� . y s` •.` r . ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 •, •,:•.•�:• •, • .• •�...,,,./'.,:•." •�:•ter,•e:e?,:•.•, .,:.,,.,.�., .,,,, ., .,:•,-:.,.,.:.,.,.e.,,.,.-.,•., .�-.,:.,:., ., 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 Los Angeles APR 17 2015 On before me, Monica Blaisdell,Notary Public Date Here Insert Name and Title of the Officer personally appeared Philip E. Vega Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person* whose name* is/akei subscribed to the within instrument and acknowledged to me that he/ xagacexecuted the same in his/Ixedtt-fear authorized capacity(re )t and that by his/fxewitImk signature()on the instrument the person*, 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. MONICA BLAISDELL WITNESS my hand and official seal. Commission a 1970805 Notary Public-California '►% Orange County d..JC�C%IN�CK M Comm.E e1 Mu 26,2018 Signature i Signature of Notary Public BIDDER:T %.lon•Y4 6-kr� i� Ov (I 2.8 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-5 PTM General Engineering Services Inc. BIDDER: 2.B LIST OF PROPOSED SUBCONTRACTORS(continued) rDuplkate Next 2 Pages if needed for listing additional sutxxmtradors."I Name and Location Description of Work of Subcontr " - ti hp subcontracted Superior Pavement Markings,La it .CA 0638 Name: 14656 Industry Circle,La Mirada.CA 90638 ���1�0 Address: License No.776306 Exp:8/31/5,Class C32,C31 Tel:714)562-9100 Fax:714)995-9400 License No. Department of Industrial Relation Registration No. Name and Location nescription of Work of Subco Prime Performance Contractors subcontracted 2711 Ridgeline Dr#105,Corona,CA 92882 Name: License No.979710 Exp:12/31i lb Class:A c Li-'f" Address: Tel:951)362-1359 vtr: 00001 ..¢0!1 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. Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: License No.: Department of Industrial Relation Registration No. CBF-6 PTM General Engineering Services Inc. BIDDER: 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:166° VV 1. ( B{ 114 4G4el l° iA f� ',1,(14{D ca . ',1,(14{D Nam and Address of Owner MC, clri e 64 el^ 023) 88 . - /1#a Name and telephone number of person familiar with project cq ,q — 6 R i 5 W:l cr.,x,LA-Moitc 'tedi,t. g/2oi .3 Contract amount Type of Work Date Completed /727 3d r 2. ,- p (✓Y d wawkc�o a . ,5-04, Name and Address of Owner M✓. Me wQJ 1-4-i 2, c/b�') 377 - (1v2 Name and telephone number of person familiar with project / 3e'`//113 £ ø' T D&- b#414 opt( Vs . 6 (213 Contract amount Type of Work Date Completed 61/-/ r/,, /.3.2-3o ��H ti 3. © • / t'tig7iv 1 itrn ry 6. 4.. loco 2 Name and Address of Ow er ,�1r. ceilet (-5Z2-) 377- 9s/y e an hone number of person familiar with project Name telephone R p J e27-6 . 7M — T/s I-Aiee, Sr . ox/2of3 Contract amount Type of Work Date Completed rri ' ae1/. / /vi . 4. (I/ (094 Mccerypt ctit Ie.S.t-47 Ger-ri, (..27.Z 11 . /.777z) Name Nam d Address of Owner /WI/. ilq �i l€i% ( 2 ) 39 . ?/o Name and tele one number6f person familiar with project S 1-1.?k,8.py — 47/4,7,7(f., 6/44,/,/ /o/�ij amount of Work Date Completed Contract mo /type Cy 'J tt atfit 11AAAL CBF-7 CITY OF ROSEMEAD GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) 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 The bidder PTM General Engineering Services Inc. proposed subcontractor SN- c• , nom �,N �r ��., e , hereby certifies that he has X 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-I CITY OF ROSEMEAD GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSlPL 5358 (014) PTM General Engineering Services Inc. BIDDER: NON-COLLUSION AFFIDAVIT I CBF-8 PTM General Engineering Services Inc. BIDDER: 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. Signature Elizabeth H. Mendoza de McRae Typed or Printed Name President/CFO Title PTM General Engineering Services Inc. Bidder Subscribed and sworn before me This 28th day of April , 20 15 (Seal) Notary Public in and for del the State of California My Commission Expires: CBF-9 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 •. :.r,�.�v^rry^r. �•i^.�ry-rv;rrr..�, r�r-..�✓-•arr•�•�.�.mow:v�rr'. �;. ✓i. •�i... 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 al S, 2�/ before me, PHILIP E. VEGA, NOTARY PUBLIC / Date Here Insert Name and Title of the Officer personally appeared ELIZABETH H. MENDOZA de McRAE 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. ,. +i1,... PHILIP VEGA `; Comm.a 19»086 y WITNESS my hand and offic'. '-a ti l .141;i NOTARY eusi is-CALIFORNIA o A. LOS ANGEL E S MY Cmm.ExpreS MAY 312016 Signature /a Signature o ^ ry 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 Document Title or Type of Document: 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): ❑Corporate Officer — Title(s): O Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑General ❑ Individual ❑Attorney in Fact ❑Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 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 GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HS1PL 5358 (014) t .• 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 GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) 0; 1w i� 4 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: (I) 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 GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) 4: � L • • 4 3 :ju INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form 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 filing 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,subgrants 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(item 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 item 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(MI). 11. 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)or employee(s)contacted or the officer(s)employees)or Members) 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.06-04-90aENDIFs N/A= Not Applicable DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: N/A N/A a contract N/A ri ri a hid/offer/annlic-atinn a initial b. grant b. initial award b. material change c. cooperative agreement c. post-award d. loan For Material Change Only: e. loan guarantee year_ quarter f. loan insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: ElPrime El Subawardee N/A Tier , if known N/A Congressional District, if known Congressional District, if known 6. Federal Department/Agency: 7. Federal Program Name/Description: N/A N/A CFDA Number,if applicable 8. Federal Action Number, if known: 9. Award Amount, if known: N/A N/A 10. a. Name and Address of Lobby Entity b. Individuals Performing Services (including (If individual,last name,first name,MI) address if different from No. 10a) N/A (last name,first name, MI) N/A (attach Continuation Sheet(s)if necessary) 11. Amount of Payment(check all that apply) 13. Type of Payment(check all that apply) $ N/A 0 actual L planned a. retainer N/A b. one-time fee 12. Form of Payment(check all that apply): c. commission 8 a cash N/A d. contingent fee b. in-kind; specify: nature e 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: N/A (attach Continuation Sheet(s)if necessary 15. Continuation Sheet(s)attached: Yes 0 No Ri Era 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' Elizabeth H. Mendoza de McRae required pursuant to 31 U.S.C. 1352. This information President/CFO will be reported to Congress semiannually and will be available for public Inspection. Any person who fails to Title: file the required disclosure shall be subject to a civil 951.710.1000 penalty of not less than 310,000 and not more than Telephone No.: Date: 4.28.15 $100,000 for each such failure. Authorized for Local Reproduction Federal Use Only: Standard Form-LLL Standard Form LLL Rev.09.12-97 CITY OF ROSEMEAD GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) C. EXHIBIT 15-G1 Local Assistance Procedures Manual Local Agency Bidder UDBE Commitment(Construction Contracts) INSTRUCTIONS-LOCAL AGENCY BIDDER UDBE COMMITMENT(CONSTRUCTION CONTRACTS) I 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 15-61 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 15-61 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: City of Rosemead LOCATION: Rosemead PROJECT DESCRIPTION: Garvey Avenue Safety Improvement Project TOTAL CONTRACT AMOUNT:S BID DATE: 5.6.15 BIDDER'S NAME: PTM General Engineering Services Inc. CONTRACT UDBE GOAL: 6 7 CONTRACT ITEM OF WORK AND DESCRIPTION UDBE CERT NO. NAME OF EACH UDBE DOLLAR AMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids UDBE SUBCONTRACTED OR MATERIALS DATE are opened•include UDBE TO BE PROVIDED(or contracted if the address and phone number) bidder is a UDBE) y For Local Agency to Complete: Total Claimed UDBE $ Local Agency Contract Number Participation Federal-aid Project Number. % Federal Share: Contract Award Date: 411,— Local Agency certifies that all UDBE certifications have been verified and I'TZ ■ 0 information is complete and accurate. 4.28.15 951.710.1000 Elizabeth H. Mendoza de McRae Print Name Signature Date President/CFO Local Agency Representative Person to Contact (Please Type or Print) (Area Code)Telephone Number, Local Agency Bidder UDBE Commitment(Construction Contracts) (Rev 6/26/09) Distribution: (1)Original–Local agency files Page 15-31 LPP 09-02 July 31,2009 CITY OF ROSEMEAD GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) y , Local Assistance Procedures Manual Exhibit 15-H UDBE Information-Good Faith Effort EXHIBIT 15-H UDBE INFORMATION—GOOD FAITH EFFORTS UDBE INFORMATION-GOOD FAITH EFFORTS Federal-aid Project No. HSIPL 5218(014) Bid Opening Date 5.6.15 The City of Rosemead established an Underutilized Disadvantaged Business Enterprise (UDBE)goal of 6% for this project.The information provided herein shows that a good faith effort was made. Lowest,second lowest and third lowest bidders shall submit the following information to document adequate good faith efforts.Bidders should submit the following information even if the"Local Agency Bidder UDBE Commitment"form indicates that the bidder has met the UDBE goal.This will protect the bidder's eligibility for award of the contract if the administering agency determines that the bidder failed to meet the goal for various reasons,e.g.,a UDBE firm was not certified at bid opening,or the bidder made a mathematical error. Submittal of only the"Local Agency Bidder UDBE Commitment"form may not provide sufficient documentation to demonstrate that adequate good faith efforts were made. The following items are listed in the Section entitled"Submission of UDBE Commitment"of the Special Provisions: A. The names and dates of each publication in which a request for UDBE participation for this project was placed by the bidder(please attach copies of advertisements or proofs of publication): Publications Dates of Advertisement Goals Met B. The names and dates of written notices sent to certified UDBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the UDBEs were interested(please attach copies of solicitations,telephone records,fax confirmations, etc.): Names of UDBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation Goals Met Page 15-33 LPP 09-02 July 31,2009 'szhibit 15-H Local Assistance Procedures Manual IDBE Information-Good Faith Effort C. The items of work which the bidder made available to UDBE firms including, where appropriate,any breaking down of the contract work items(including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate UDBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate UDBE participation was made available to UDBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items ($) Of (y/N) Contract Goals Met D. The names,addresses and phone numbers of rejected UDBE firms,the reasons for the bidder's rejection of the UDBEs,the firms selected for that work(please attach copies of quotes from the firms involved),and the price difference for each UDBE if the selected firm is not a UDBE: Names,addresses and phone numbers of rejected UDBEs and the reasons for the bidder's rejection of the UDBEs: Goals Met Names,addresses and phone numbers of firms selected for the work above: Lyteforms 13841 Roswell Ave,Ste A,Chino CA 91710 DBE No.37133 Tel:(909)680-8123 Fax:(909)902-0128 E. Efforts made to assist interested UDBEs in obtaining bonding, lines of credit or insurance, and any technical assistance or information related to the plans, specifications and requirements for the work which was provided to UDBEs: Goals Met 'age 15-34 y 31,2009 LPP 09-02 • N CITY OF ROSEMEAD GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) ? S eaf kjL!1 e , titix • ' P 4 �'a�4 S i'.� x s' - 11Z it r 16 ..�` EXHIBIT 15-G2 Local Assistance Procedures Manual Local Agency Bidder DBE Information(Construction Contracts) INSTRUCTIONS-LOCAL AGENCY BIDDER DBE INFORMATION (CONSTRUCTION CONTRACTS) I SUCCESSFUL BIDDER: IThe 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 DBEs.Prime contractors shall indicate all work to be performed by DBEs including work performed by its own forces,if a DBE.The DBE shall provide a certification number to the Contractor and expiration date.Enter DBE prime and subcontractors certification number.The DBE contractors should notify the Contractor in writing with the date of the decertification if their status should change during the course of the contract.The form has a column for the Names of DBE certified contractors to perform the work (must be certified on the date bids are opened and include DBE address and phone number. IMPORTANT: Identify all DBE firms participating in the project—including all UDBEs listed on the UDBE Commitment form(Exhibit 15-G1),regardless of tier.Names of the First-Tier DBE 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 DBE participation dollar amount.Enter the Total Claimed DBE 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 DBE,describe exact portion of time to be performed or furnished by the DBE.)See Section "Disadvantaged Business Enterprise(DBE),"of the Special Provisions(construction contracts)to determine how to count the participation of DBE firms. Exhibit 15-62 must be signed and dated by the successful bidder.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 Number, Federal-aid Project Number, Federal Share,Contract Award Date fields and verify that all information is complete and accurate before signing and sending a copy of the form to the District Local Assistance Engineer within 15 days of contract execution. Failure to submit a completed and accurate form within the 15-day time period may result in the de-obligation of funds on this project. District DBE Coordinator should verify that all informations is complete and accurate.Once the information has been verified,the District Local Assistance Engineer signs and dates the form. Page 15-32b July 31,2009 LPP 09-02 Local Assistance Procedures Manual EXHIBIT 15-G2 Local Agency Bidder DBE Information(Construction Contracts) EXHIBIT 15-G2 LOCAL AGENCY BIDDER DBE INFORMATION(CONSTRUCTION CONTRACTS) I (Inclusive of all DBEs including the UDBEs listed at bid proposal) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCAL AGENCY: City of Rosemead LOCATION: Rosemead PROJECT DESCRIPTION: Garvey Aveniue Safety Improvements Project TOTAL CONTRACT AMOUNT: S BID DATE: 5.6.15 BIDDER'S NAME: PTM General Engineering Services Inc. CONTRACT UDBE GOAL: 6 ` CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE DOLLAR AMOUNT ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS DATE are opened-include DBE address TO BE PROVIDED(or contracted if the and phone number) bidder is a DBE) For Local Agency to Complete: Total Claimed DBE $ Local Agency Contract Number: Participation Federal-aid Project Number: Federal Share: 1 Contract Award Date: A Local Agency certifies that all DBE certification have been verified and Information is complete and accurate. Si of Bidder 4.28.15 951.710.1000 Print Name Signature Dale qet� Local Agency Representative Elizabeth H. Mende a cde McRae (Area Code)Telephone Number: President/CFO For Caltrans Review: Person to Contact (Please Type or Print) Print Name Signature Date Local Agency Bidder DBE information(Construction Contarcts) Caltrans District Local Assistance Engineer (Rev 6/26/09) Dlstribution: (1)Copy—Fax or scan a copy to the Caltrans District Local Assistance Engineer(DLAE)within 15 days of contract execution.Failure to send a copy to the DLAE within 15 days of contract execution may result in de-obligation of funds for this project. (2)Copy—Include in award package to Caltrans District Local Assistance (3)Original—Local agency files Page 15-32a LPP 12-01 January 27,2012 CERTIFICATE OF CORPORATE RESOLUTION I, Brian Mendoza , Secretary of PTM General Engineering Services Inc. , (Corporation) do hereby certify that at a duly constituted meeting of the Stockholders and Directors of the Corporation held at the office of the Corporation on December 30 , 2007(year), it was upon motion duly made and seconded, that it be VOTED: Elizabeth H. Mendoza de McRae, President/CFO OR. . . . Brian Mendoza, Vice President/Secretary Authorized to sign & execute contracts and submit bids with either one of the corporate officer' s signatures . It was upon further motion made and seconded that it be further VOTED: That Elizabeth H. Mendoza de McRae, President/CFO OR. Brian Mendoza, Vice President/Secretary in the capacity as of the Corporation is empowered, authorized and directed to execute, deliver and accept any and all documents and undertake all acts reasonably required or incidental to accomplish the foregoing vote, all on such terms and conditions as he in his discretion deems to be in the best interests of the Corporation. I further certify that the foregoing votes are in full force this date without rescission, modification or amendment. Signed this day ofitt4j , ?. f (year). A TRUE RECORD ATTEST 4:1-PBrian Mendoza Secretary/Clerk Vice President/Secretary (Corporate Seal) 53 • Brian Mendoza P.O. Box 7745 Riverside, CA 92513-7745 Email: brian @ptm-eng.com • Cell 951.722.5755 Chief Estimator and Supervisor of Outside Operations Supervisor of outside operations with over 18.years of experience, Electrician with over 20 years of experience. An effective communicator and team leader; experienced in coordinating and executing large and fast-paced projects. CAREER EXPERIENCE Freeway Electric/PTM General Engineering Services, Inc. Riverside, CA 06/2006 to Date Chief Estimator/Supervisor of Outside Operations In charge of managing the estimating department and finalizing bid packages; coordinating the beginning phase of an awarded project between the company and agency. Project submittals, = contract review. Coordinated and managed crews California region; handled various sized projects ranging in size from $1,000 to $4.5 million dealing with dry utilities, wet utilities, traffic signals, and road improvements. Maintained coordination Freeway Electric/PTM General Engineering and subcontractor, and project owners. In charge of handling project's administrative work; monthly gross estimates, project progress schedule, materials requisitions, contract change order negotiations and equipment purchase and rentals. High Light Electric Inc./Pete&Sons Construction Inc.Riverside, CA 10/96 to 06/2006 Chief Estimator In charge of managing the estimating department and finalizing bid packages. Coordinating the • beginning phase of an awarded project between the company and agency or prime contractor; project submittals, contract review. Successfully bid on projects totaling $12 million with an average spread 6%. Area Supervisor = Coordinated and managed 10 crews consisting of 6 members per team in the southern California region; handled various sized projects ranging in size from $1,000 to $4.5 million dealing with • dry utilities, wet utilities, traffic signals, and road improvements. Maintained coordination between High Light Electric Inc and subcontractor, general contractor and project owners. In charge of handling project's administrative work; monthly gross estimates, project progress schedule, materials requisitions, contract change order negotiations and equipment purchase and rentals. } 4 1 Continued... 1 BRIAN MENDOZA • Page 2 CAREER EXPERIENCE CONTINUED MBE Electric Inc. in Riverside, CA 10/1998-10/1996 Vice President and Head of Outside Operations Managed outside operations for all projects ranging in size from $1 to $2.5 million. Headed an around the clock electric crew and coordinated with CC Meyes to repair the I-10 Santa Monica Freeway after it collapsed during the 1994 Northridge Earthquake to complete the fast paced project in 66 days. Maintain coordination between MBE Electric and subcontractors, general contractor and project owners; implemented and enforced safety guidelines. Handled administrative work; monthly progress estimates, material requisitions, contract change order negotiations. Vasco Corporation in San Fernando, CA 10/1987-06/1998 Foreman(Part Time) Managed day to day operations of work crews and various projects ranging in size from $1,000 to $5,000 in Eastern Los Angeles County;traffic signals, street lighting, signal interconnect. Raymor Electric in Rosemead, CA 0611986-10/1987 Crew Leader(Part Time) In charge of work crew on projects ranging from$25,000 to$250,000 through out Los Angeles County. WORK SKILLS • Capable of operating heavy equipment such as skip loaders, cranes, and backhoes; • Hands-on experience with hand tools and power tools; • Capable of overseeing fast-paced and high profile projects; • An effective communicator and leader; EDUCATION • International Brotherhood of Electrical Workers Completed training course(1988-1989)in street lighting and traffic signal installations, code enforcement and blue print reading. • South Gate High School Received High School diploma in 1988 s • BRIAN MENDOZA • Page 3 CAREER EXPERIENCE CONTINUED PROFESSIONAL MEMBERSHIPS • International Brotherhood of Electrical Workers (IBEW) • National Electrical Contractors Association(NECA) ACCREDITATION • IBEW-Journeyman Wireman; CSLB-Electrical Contractors; Certified Trench Safety Coordinator. • LANGUAGES • English(Native) • Spanish(Fluent) AWARD RECEIVED = • Recipient of the U.S. Small Business "Young Entrepreneur of the Year"Award in 1996,nationally. • Recipient of the Certificate of Recognition by the City of Los Angeles for "Small Business"in 1997. • Recipient of the Certificate of Recognition by the City of Riverside for"Small Business"in 1997. • Recipient of the Certificate of Recognition by the State Assembly, Assemblyman Mr. Rod Pacheco, for the "top 500 Inland Empire Small Business"in 1997. • Ranked among the "Top 500 Inland Empire Hispanic Owned Companies" since 1997. • Certification of Appreciation for our participation and maximization in the "Century Freeway Affirmative Action" by CFAAC. PROFESSIONAL AND PERSONAL REFERENCES Caltrans project#07-1224U4 (Electrical contract amount$4.5 million) Project completed in 2005 Description of project: Installation of traffic signals, ramps metering, sign illumination, Highway lighting, fiber optic communication, and electrical irrigation along the I-10 . Freeway in Los Angeles County. • Doug Dwason-Project Manager for prime contractor, Balfour Beatty Cell(949)232-3276 and Office (909)397-8040 • Patty Galvan-Resident Engineer. Office (909)594-4270 • Veronica Ross-Electrical Inspector. Cell (714)606-6311 BRIAN MENDOZA • Page 4 CAREER EXPERIENCE CONTINUED City of Redlands Contract#208300-72304/41008 (Electrical contract amount is $218,800) Project completed in 2003 Description of project: Installation of traffic signals, modification of ramp metering, lighting and sign illumination. • Bill Hensley-Senior Civil Engineer- Office (909)798-7586 ext 2 • Juan Olvera-Project Manager for general contractor, H&H Construction- Cell (951)453-7712 and Office(909)473-7331. Caltrans project#08-4567174) Electrical contract amount is$938,238) Project completed in 2005 Description of project: Installation of lighting system along the I-5 Freeway in San Bernardino County. • Gary Vogel-Project Manager form prime contractor, Granite Construction Cell: (661)549-3953 and Office (661)726-4447 Sanbag Projects, Segment 1,2,3, early segment 9, segment 9, and alder Ave. (Total electrical contract amount was $3.2 million)Project completed in 2004. Description of projects: Installation of traffic signals, ramp metering, sign illumination, highway lighting, fiber optic communication, and electrical irrigation along the I-10 Freeway in San Bernardino County. • Harold Lantis-Sanbag Contract Manager- Cell (760)802-7730 and Office (909)875-8029 ext 213. • Tim Hanable-Caltrans Inspector- Cell (951)712-0021 • Al Ortega-Project Manager for prime contractor, Yeager Shanska- Cell (714)240- 5333. City of Indio Project#ST0137(Electrical contract amount was$1.4 million) Project completed in 2005 Description of project: Installation of street lighting system, traffic signals, electrical irrigation, and dry utilities. • Gary Baxter-Area Manager for prime contractor, Yeager Shanska Construction- Cell (909)721-9749 and Office (760)343-5472 • Tommy Young-Project,Manager for prime contractor- Cell (951)232-6618 and Office(760)343-5472 • Mehran Sepehri-City Engineer- Cell (760)250-2201 Additional Professional References: • Zale Harris-Caltrans Inspector-Cell (951)289-0047 _= • Ray Robles-Caltrans area supervisor- Cell (909)799-0646 State Of California �'0-■ i I �~ i, a«CONTRACTO RS STATE LICENSE BOARD=raffia= ACTIVE LICENSE a� C on ma Aff _ License Number 891265 Er., CORP • P T M GENERAL ENGINEERING SERVICES INC cent.bs, A C10 C31 C27 C32 B C61/D42 HAZ C-7 C13 C61/D09 Ili4ll Expiration Dale 02/28/2017 www.cslb.ca.gov T d BidSync: The State of California: PTM GENERAL ENGINEERING SERVICES INC Page 1 of 2 d ,. ,,,, , ,,! . , Services a ,4/1 Welcome I Logout ut Need assistance? Contact us .ca:E goo 590 9339 PTM GENERAL ENGINEERING SERVICES INC - #49664 Supplier Profile Legal Business Name PTM GENERAL ENGINEERING SERVICES INC Doing Business As PTM GENERAL ENGINEERING SERVICES INC Address 5942 ACORN ST Phone (951)710-1000 RIVERSIDE,CA 92504 FAX (951)710-1006 Email elizabeth@ptm-eng.com Business Types Construction Service Areas Alameda,Alpine,Amador,Butte,Calaveras,Colusa,Contra Costa,Del Norte,El Dorado, Fresno,Glenn,Humboldt,Imperial,Inyo,Kern,Kings,Lake,Lassen,Los Angeles,Madera, Marin,Mariposa,Mendocino,Merced,Modoc,Mono,Monterey,Napa,Nevada,Orange, Placer, Plumas,Riverside,Sacramento,San Benito,San Bernardino,San Diego,San Francisco,San Joaquin,San Luis Obispo,San Mateo,Santa Barbara,Santa Clara,Santa Cruz,Shasta,Sierra,Siskiyou,Solano,Sonoma,Stanislaus,Sutter,Tehama,Trinity,Tulare, Tuolumne,Ventura,Yolo,Yuba, Keywords ELECTRICAL INSTALLATION,MINOR CONCRETE,CURB&GUTTER,ASPHALT, UNDERGROUND UTILITIES,STRIPING,FENCING Construction License Types A-General Engineering B-General Building Contractor C-07-Low Voltage Communications and Wiring Systems C-10-Electrical(general) C-13-Fencing C-27-Landscaping C-31 -Construction Zone Traffic Control Contractor C-32-Parking and Highway Improvement D-09-Drilling,Blasting and Oil Field Work D-42-Sign Installation Classifications 301520-Fencing 721411 -Infrastructure building and surfacing and paving services 721515-Electrical system services 721527-Concrete installation and repair services - 721540-Specialty building and trades services Active Certifications TYPE STATUS FROM TO SB Approved Feb 13,2014 Mar 31,2016 - http://www.bidsync.com/DPXBisCASB?ac=supplierprofile&supplieroid=65... 4/17/2015 registration Payment Success Page 1 of 1 { 1 , ;9 nlifi1 ei` cue <0 + , 4 0 iro ��. Division of Labor Standards Enforcement Thank you for your payment. Payment Confirmation Number:XXLGKHSBBDPCI Registration Number:1000001433 Contractor Name:PTM GENERAL ENGINEERING SERVICES INC """NOTICE:If paying by ACH/EFT,please allow up to 7 days for processing.'^" ( Return to Public Works Hofnepage Copyright ft)2014 State of California 1 https://efiling.dir.ca.gov/PWCR/ActionServlet?action=paymentComplete 9/22/2014