Loading...
Ramona Inc.CITY OF ROSEMEAD GARVEY AVENUE SEWER RELIEF LINE PROJECT PROJECT No. 21845 C � 11 51 3 IT CONTRACT BID FORMS TABLE OF CONTENTS SECTION 1 BID SCHEDULE ........................................................ ............................... SECTION 2 BID DATA FORMS ................................................ ............................... 2.A BID BOND ............................................................. ............................... 2.B LIST OF PROPOSED SUBCONTRACTORS ....... ............................... SECTION 3 NON - COLLUSION AFFIDAVIT .................... ............................... ................1 ................5 ................6 ................7 ..............10 MR. ,, 011 SECTION 1- BID SCHEDULE CBF -1 BID SCHEDULE SCHEDULE OF PRICES FOR GARVEY AVENUE SEWER RELIEF LINE PROJECT PROJECT No. 21845 BASE BID SCHEDULE CBF -2 EST. UNIT ITEM NO. ITEM DESCRIPTION UNIT QTY. PRICE COST 1 Clearing & Grubbing per Plans and LS 1 Specifications. See Technical Provisions "o Pages TP -2 & TP -3 per Details. 1 600, °O 41 000 - 2 Disposal of Waste Materials. LS 1 a QQ oo / VOID o° 3 Prepare a Storm Water Pollution LS 1 Prevention Plan (SWPPP). Jrl D��ov � D�Q o0 4 Traffic Control Plans prepared by a LS 1 Registered Traffic Engineer. St ®Q®1 0 5 Unclassified Excavation. CY 100 /1-5" 00 1 S-00. 6 Remove and Dispose existing manhole EA 3 3 z a' including bedding, backfilling and Paving per Plans and Specifications Complete. 7 Construct Extra Strength 15 -Inch LF 2,600 diameter Vitrified Clay Pipe (VCP) t u8 ea ge c " including bedding, backfilling and Paving per Plans and Specifications Complete. 8 Construct 15 -Inch diameter Ductile Iron LF 81 (DI) Sewer Pipe including pipe structure 2� ` support per SPPWC Std. Plan 224 -2, zz,8 bedding, backfilling and paving per Plans and Specifications Complete 9 Remove and Dispose existing 8" Vitrified LF 330 Clay Pipe (VCP) sewer including pipe t 3 3 c plugs, bedding, backfilling and Paving per Plans and Specifications Complete, 10 Construct extra strength 8 -Inch diameter LF 176 Vitrified Clay Pipe (VCP) including 3A q?_ bedding, backfilling and Paving per 7 za" Plans and Specifications Complete. 11 Construct Reinforced Precast Concrete EA 11 Manhole per LACDPW Std. Plan 2003 -2, 9 0O" qu, rec CBF -2 TOTAL BASE BID PRICE c( 2-9 ( R72 " n;rte k,..rt dred f-v"c..ty yi5kt 1h.o -) a a ttit-�e h.✓m.dr+ -cl G�evZn}5- t cL� .o CWt C( (w c[K Dollar amount in written form CBF -3 EST. UNIT ITEM NO. ITEM DESCRIPTION UNIT QTY. PRICE COST 12 Construct Drop Manhole per CSD Std. EA 1 Plan S -a -205. i2,00z z, aoo 13 Install House Connection Remodeling EA 41 y including pavement per SPPWC Std. 2 ,z0o" Plan 223 -2 14 House Lateral Replacement per SPPWC EA 10 Std. Plan 222 -2. *(approx. 25% of 22 a2" existing laterals) 15 Construct Wye per LACDPW Std. Plan EA 50 2024 -1. sou uo,ouo° 16 Construct 72" Manhole Type "E" (case ll) LS 1 per CSD Std. Plan S -a -205. And detail a3, CDC' 2 3, D oc on sheet D1 17 Remodel and plug existing sewer LS 1 L, Do o O 6 - manhole per detail "A" on sheet D1 2 , 18 Remove existing and Construct 18" LS 1 diameter RCP (2000 -D), including R 506- q,500- concrete collars per SPPWC Std. Plan. 380-4, complete as shown on the plans 19 Sewer Flow Bypassing at all locations as LS 1 S cot _ shown on the plans. , S coo 20 Construct Terminal Cleanout Structure EA 1 3 0 0 q r" D0 per SPPWC Std. Plan 204 -2 21 Abandon Existing Sewer. Fill with low LF 830 density cellular concrete (LDCC) or 330 controlled low strength material (CLSM) with min. compressive strength of 3000PSI @ 28day and plug ends 22 Provide temporary and permanent EA 1 support for the 36" RCP Sewer per CSD , ° ° l c `' C, " Std. Plan S -a -222 and S -a -217. Complete in place. TOTAL BASE BID PRICE c( 2-9 ( R72 " n;rte k,..rt dred f-v"c..ty yi5kt 1h.o -) a a ttit-�e h.✓m.dr+ -cl G�evZn}5- t cL� .o CWt C( (w c[K Dollar amount in written form CBF -3 �� �� ALTERNATE BID ITEM 7 BARLETT AVENUE STREET RESURFACING TOTAL ALTERNATE BID PRICE 22( k, 04(. 1 b fwo Vn .d(td y.;xtee, 'I °u^d� pme L.,u.+cLre 01S, c, d Dollar amount in written form TOTAL BASE & ALTERNATE BID PRICE f 145, t &3.t(,� A ,,,j t( utA, c k- ...o4^e� e+v.r�� - 4"'t fvlu,5"d, c,,e k-,A'd 5 0l{.{� fl, (et d-1lkm tr a , d amount in written form t3 (1u caa Mum UNIT EST. UNIT ITEM NO. ITEM DESCRIPTION QTY. PRICE COST 1 Cold mill 2.0-inches thick existing SF 91,562 pavement. ° 2 Construct 2.0 inches thick pavement TONS 1,170 overlay ARHM -GG -C (PG 64 -16) as indicated on the plans. 3 Remove Existing, Dispose and SF. 1,200 '' Construct 4- inches thick PCC Sidewalk ( S, Co per SPPWC Std. Plan 113 -1. 4 Remove Existing, Dispose and EA 4 Construct PCC Curb Ramps per SPPWC Std. Plan 111 -4. 5 Remove Existing and Construct 6- SF 200 _ Inches Thick Driveway Approach per 1 3 SPPWC Std. Plan 110 -2 6 Adjust Sewer Manhole to Grade per EA 13 SPPWC Std. Plan 205 -1 and 206 -1. kSc t 2, 3 oc 7 Install Survey Well Monument per City EA 8 of Rosemead Std. Plan S08 -001. See Section 2 -9 Surveying of the General - 4 to Provision -7 per details (Cover, Sleeve & Dome will be provided by the City at no cost). 8 Install Traffic Striping, Traffic Signal LS 1 Loops and Pavement Markers per the t 0, c00" Striping Plans and Specifications Complete. 9 Install 36 -Inch Box Parkway Tree Crape EA 20 Myrtle "Muskogee" including 90 -days 2 Co z-tu,ccu - maintenance period and tree wells per SPPWC Std. Plan 520-4. TOTAL ALTERNATE BID PRICE 22( k, 04(. 1 b fwo Vn .d(td y.;xtee, 'I °u^d� pme L.,u.+cLre 01S, c, d Dollar amount in written form TOTAL BASE & ALTERNATE BID PRICE f 145, t &3.t(,� A ,,,j t( utA, c k- ...o4^e� e+v.r�� - 4"'t fvlu,5"d, c,,e k-,A'd 5 0l{.{� fl, (et d-1lkm tr a , d amount in written form t3 (1u caa Mum 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 eck, a cashier's check or bid bon in the amount of lo o Mr o I� rr`s ( said amount being not less than ten percent (10%) of the Total Bid rice. 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 contractors license(s) in good standing; (2) evidence that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting therefrom; and (3) any other information and documentation, financial or otherwise, needed by Owner to award a Contract to the lowest responsible and responsive bidder. CBF -5 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 BIDDER: ap71fie701t1A , - T44c- - further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data submitted herewith into a contract arising out of this Bid. The undersigned acknowledges receipt, understanding and full consideration of the following addenda to the Contract Documents. Addenda Nos. The Bidder understands and agrees that the Total Bid Price is inclusive of all labor, materials, and equipment or supplies necessary to complete the Work as described in the Bid Documents. If this bid is accepted, the undersigned Bidder agrees to enter into and execute the Contract with the necessary bonds and accept the Total Bid Price as compensation in full for all Work under the contract. CBF -6 � By: / Signature MiC AT,L GPl3A/AC Type or Print Name V, �OI2zs�D Mille BIDDER: P- AMOAM , "Zn1C 302 N. I "P57 AVz-AQ &, s(e. -#.L Business Street Address A tc- D , ✓ A C/ l 0 0 Ic City, State and Zip Code (6z6) ass- /35 Telephone Number Bidder's /Contractor's State of Incorporation: G41-1 To / Partners or Joint Venturers: Bidder's License Number(s): Department Industrial Relations Registered No. L©0000378'- 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, oartnershin or joint venture has the authoritv to do so. CBF -7 BIDDER: &inoNat -rw�. SECTION 2 BID DATA FORMS CBF -8 BIDDER: Ramona, - 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. KNOW ALL MEN BY THESE PRESENTS. THAT Principal, and as , as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of ($ of amount 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 GARVEY AVENUE SEWER RELIEF LINE PROJECT as setforth in the Notice Inviting Bids and accompanying Bid Documents, dated July 8 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- refefenced 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 7th day of July , 2015 . Ramona, Inc. (SEAL) U.S. Specialty insurance Com (SEAL) Principal Surety By: By: Signature Michael Grbavac Signature Frank Morones, Attorney -in" Fact Nl3zilu POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY _ UNITED VISTA ES SURE C U.S. SPECIALTY INSU RA£C E#d]M PANY W 1 IW I �b I V pl � 1 l Ans n a California MF BY THESE n Contract �r twn as of ng= Causpany, an assumed na rp tea ' �)'I nl actors Indemmt m I elates Surety Coml rylaol III 1 corporation and U.S. Specialty Insurance Company, a Texas corporation (collectively, the "Companies "), do by these presents make, constitute and appoint: Frank Morones of Brea, Il California s rue�nc ww l ttorneY(s) -in -ti Taal irze�a capacity if in f an�o' III I III II' ve with full powerand afo -_ I g1Bl on�e-&nt its name, place a0- to exseute cknowledge and lyl a I h �' n' l �nds, recogmzanees= - der or other instruments or contracts of suretyship to include riders, amendments, and consents of surety, providing the bond penalty does not exceed * * * * * * * * * * * * * * * * * ** * Ten Million * * * * * * * * * * * * * * * * * * ** Dollars ($ _ !110,000,000 00** ) This Power of Attorney shall expire without further action on December 8, 2016. This Power of Attorney is granted under and by am of hofo s wing resolutions a� �t dVlVby th 1 r s, of Directors of the Gs e i Rem 3lca th any Vic' r s , an t a V c President, any Seerefat inyVess e t s shall be and i re Y e 1 IIl� — ar �in t -k�s- appoint any one c i I� I � 1 t y(s )- chEaWdI in -Fact to repres aaU�� of the Company �eCf tie u o g rovisotts: — Attorney -in -Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and /or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder and nr i nstruments so executed by a su ch AM 'ne 'n F act shall be binding upon the any power of C a s f ; ed by Reyonko"l the President and sealed and effected — thehrszoraESSsse y P Y 9� V I en N I . ! III 1 naoure of any m¢e� €iceran aL om an heretof I41i1'llb tYYY wer of attorney or ectrfica [ l+� en' Uaosimd ,�,. attorne_ e�eanagf smile signature or fac ` i�l b Ii a binding upon the Com�2ny � spe - any bond or undertaking to which it is attached— IIII IN WITNESS WHEREOF, The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 10th day of De 2012. AMERIC�p��'. N C m T Al ANY COMPANY NEkA�O NN MPANY — UNITED III I II ANY U.S. SP ECIALT Y � SDRe1C)`1'ANY — _ oraSEals 1 � tpps nU IIII I III , 4 0 OA S' s[ai aw5�ev M ' " a s _ By. � !1 oit r e 1, Daniel P. Aguilar, Vice President ♦ e�irOF � � k ,o Ill 1 IIII IIII _ _ 4h aftfointat III V III VIII p ouDtyf M Airgeles SS. = IIII IIII l,.. IIII' IIIIII III III .IIIIII'' - - On 10th day of December, 2012, before me, Vanessa Wright, a notary public, personally appeared Daniel P. Aguilar, Vice President of American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S. Specialty Insurance Company who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and ackn owhe 3 o me that he exe l te I t e s e I � authorized capac� tl�l��- signature on the mst e je rsorilal r uponbehalN, 'f h e 1 11 lcll A, executed iDStrefine� � certify under PENALTY OF PE IIII r e laws of the State of CallitmudAhat the foregoing paragraph rstie RiRcrre�. WITNESS my hand and official seal. v.waxsar Signature (�. tciaLot AngliucNmv � I ���� pommak im DO III atrrrm Ieistant Secretaryriaaicanrtt caetors Indemnity ci1,II l 9'asO ,I �d�iW l g Company UlufgfP Company and U.S. Specialty Insurance Company, do hereby certify that the a ve an foregoing is a true and correcreopy of a Power of Attorney, executed by said Companies, which is still in full force and effect; furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect. :W ss here�I have hereunt sets 9'lhh d e the seals of said C np anres a�3a eles, Califerninthi dl t VI' Corporate Seals a I o n kee, sistant- Secw� i�enc�(� 1�3fl1 "•s �s4�a�� -. W�9reoFtE +ey IIII III IIII II'1 Ili �� l III III III �- ' � A notary public or other officer completing this Certificate verifics only the identity of t individual who signed file document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. "late ufCalifornia ) County of Orange (}/ before me, A^ 8i Note P Date Here Inoprt Name and Title of the Officer personally mppmmnnd Frank who proved to me on the basis of satisfactory evidence to be the person( whose. narne(c,) is/afe subscribed to the within Instrument and acknowledged to me that he/she,lthp executed the came n his/hen4heit authorized capacity(ies), ind that by hfsAtefA4:te* signature(is) on the Instrument the person(-t), or tire entity upon behalf of which the person(R) aated, executed the instrument. Notary Public - California orange County i a NO` Description of Attached Document Title u,TycpmfDocument: Number oY Pages: `___ | certify under PEmA[TYQF PERJURY under the laws of the State uf California that the foregoing paragraph io true and correct. WITNESS my hand and official seal. 8inortUon 4zeX2 a Sign ture of Notary Public signer(s) Other Than Named Above: Claimed by Signer's Name: []<}orpo��o(]��vCmr--/mo\�);---�'-_-'~._-- ['Partner -- []Limit*d []General []|ndividua} �I /t�orneyinFw�� [ Trustee [] Guardian vrConservator rl0ther Si Is : Place Notary Seal Above OPTIONAL - Tnough this section is optional, corripleti this information can deter alteration of the document or 0nod//untoaa800h/nwnt*fth/a thmnt»an unintended document, @mr'uNarne� 0 Corporate Officer []Portnar — UUm|ted !JGeneral 'L, individual []A�u,nayinFaot []Tn/otmw [] Guardian mrConservator Signer |oRepresenting: OU2014 National Notary Association - www.NationaINotary.org - 1-800-US NOTARY (1-800- Itern#5907 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 STATE OF CALIFORNIA COUNTY OF Los Angeles } On July 8, 2015 before me, Nu Hu Date appeared Zo proved to me on the basis of satisfactory evidence to be the person(4 whose name(a) is /a*E' bscribed to the within instrument and acknowledged to me that he /slat' /they executed the same his/bar /their authorized capacity(ias), and that by his/her /their signatures) on the instrument e person(srG or the entity upon behalf of which the person(k) acted, executed the instrument. certify tinder PENALTY OF PERJURY under the laws of the State of California that the paragraph is true and correct. my hand and official seal. Signature: (seal) OPTIONAL (here insert name and title of the officer) Michael Grbavac NU HUYNH r— 11 # 2108086 NO NotatY poDlic •California loo Angalas County M Comm. as may 19, 2019 Description of Attached Document Title or Type of Document: :o:e m 1 Number of Pages: _ Document Date: Other: BIDDER: kAmoA(A I - TNt_, 2.113 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 - 10 BIDDER: )e n1t7AJFt - rdcc . 2.B LIST OF PROPOSED SUBCONTRACTORS (continued) ["Duplicate Next 2 Pages if needed for listing additional subcontractors. Name and Location Description of Work of Subcontractor to be Subcontracted Name: L A-yrc....d M4 -k ky /, H-5 License No.: Department of Industrial Relation Registration No. 10 op; D TO Name and Location of Subcontractor Description of Work to be Subcontracted Name: } e <.: e.:.<w M ., zw55 -5+ f:"`5 � Address: 5 z- ew-5.7 s csF License No.: 774 Department of Industrial Relation Registration No. (c' 1 ?- G Name and Location of Subcontractor Description of Work to be Subcontracted 4r:, d Name: r}tf A nkwtt' c -t a PI ake Address: pc Acx zzza c e A License No.: 7(. Department of Industrial Relation Registration No. I cOcoo toll Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: License No.: Department of Industrial Relation Registration No. Name and Location of Subcontractor Description of Work to be Subcontracted Name: Address: License No.: Department of Industrial Relation Registration No. CBF -11 M K V ' 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: Cry T L11 fuzi✓fs X59" C nmp(AJ � , ��l �u��� � 9/744 1. S' pfASf M 4 59/fGz T � ilt2,�i/!Z it P+al T Name and Add r s of Owner I �! 13A U J t '-q oa Name a telephone number of person familiar with project l 3$3,536 C � 1 "fVc- 51i>R 2.6 5&W'6k - 240/2o1 Con ract amount Type of Work Date Complete 2. CZ ty 1 0 r( � puBt(c &,etas 3oa � �NavnA✓nv� oaaNe Name and 4ddress of Owner y� 3 - (µ Ssw y� �Lyc�nT r U s7T6g: Name and telephone number of person familiar with project 'u Q 2 us R G gu Uc u)I 6Gp➢iJJ(o f3 rL(, . 8�s /r Contract amount Type of Work Date Cc pleted 3. 0 0R - 05 4"V< GB{ ?C") /.t" Name tnd Address of Owner ,W ,ep g 6. ✓rrzNaa i� � y S/q�So ✓ . �iv�iLo�av atic lttS — r lJ 2 (-bW6 21 cS Lf 7 - 03 a 4. Name and telephone number of person familiar with project 4 1 1(00 b � > 93 I�Ai A- `� RZ Nh6 U Ti;G Contract amount Type of �` f 0S Nam and Address of Owner ys`/c lhi6 na�ms �caL 6t W6XT -rA ► Name and telephone number of person familiar with project Contract amount 0 'Oft /3rk.UsDS <P tdicsrf��c- 41/3 o /! Date Completed CBF -12 : lb ' I. ♦ _ SECTION 3 NON - COLLUSION AFFIDAVIT CBF -13 a. � i+. NON- COLLUSIQN 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 MI C,4A6l e� ^AVAC_ Typed or Printed Name Subscribed and sworn before me This _ day of — j - 62c/ the State of in and My Commission Expires: Title e efiaIO NH , ZNC - Bidder 20L' (Seal) NU HU W Commission 1 2106086 z Notary public - California C Los A "s County 19 2016 CBF -14 CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT notary public or other officer completing this certificate verifies only the identity of the individual who signed e document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that STATE OF CALIFORNIA COUNTY OF Los Angeles } On July 8, 2015 before me, Nu Huynh Notary Public, Date personally appeared (here insert name and title of the officer) Michael Grbavac who proved to me on the basis of satisfactory evidence to be the person(g) whose name(g) is /a-re subscribed to the within instrument and acknowledged to me that he /slae /db&y executed the same in his/her /their authorized capacity(i$s), and that by his/her /LLwir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(g) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature: ` ( Seal) OPTIONAL Description of Attached Document ni n 21 comnNesion * zlosoes Notary public • California -9MV Los Angeles County Comm. Ea lies May 19, 2019 NON - COLLUSION AFFIDAvz/ 1 or Type of Document: Number of Pages: _ Date: 7/8/15 Other: Division of Labor Standards Enforcement Thank you for your payment. Payment Confirmation Number: TJ51 PWAJJI PC5 Registration Number: 1000003782 Contractor Name: RAMONA INC. " NOTICE: Ifpaying by ACH /EFT, please allow up to 7 days forprocessing.' Return to Pubiie W Homepage Copyright Vi 2014 State off, aliirnme