Steiny and Company Inc.BIDDER: and Company, Inc.
BID SCHEDULE
SCHEDULE OF PRICES FOR
GARVEY AVENUE — HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
BASE BID SCHEDULE
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 501 1 35-17
Dollar amount in written form
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cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and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
UNIT OF
EST.
UNIT
ITEM
NO,
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
1
Clearing & Grubbing per plans
2 594
and specifications.
LS
2
Disposal of Waste Materials.
LS
1
3
3 225.
Traffic Signal Upgrade at
Garvey Avenue and Delta
3
Avenue per Plans and
I(o2,914 J
IGZ,'IIN.
Specifications Complete.
LS
1
Traffic Signal Upgrade at
Garvey Avenue and
4
Rosemead Place /River
1ln4�1(n9.
_
i�N,l�9.
Avenue per Plans and
Specifications Complete.
LS
1
Traffic Signal Upgrade at
5
Garvey Avenue and Muscatel
IG8,32o-
1b$�
Avenue per Plans and
Specifications Complete. Complete.
LS
1
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 501 1 35-17
Dollar amount in written form
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cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and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
BIDDER: and Company, Inc.
Attached hereto is a certified check, a cashier's check or a bid bond in the amount of
_ Dollars ($ ) said amount being not less than ten percent (10 %) of the Total
Bid Price. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
we fail or refuse to execute the Contract and furnish the required bonds, certificates and
endorsements of insurance and other certifications within the time provided.
If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be
prepared by the Owner for execution, within five (5) Calendar Days following the Letter of Award for
the Contract, and will deliver to the Owner within that same period the necessary original Certificates
of insurance. Endorsements of Insurance. Performance Bond, Payment Bond and all other
documentation and certification required by the Contract.
The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and
become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of Bidder's California contractor's license(s) in good standing; (2) evidence
that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting
therefrom; and (3) any other information and documentation, financial or otherwise, needed by
Owner to award a Contract to the lowest responsible and responsive bidder.
th
Contract Time will begin to run ten (10) Working Days from the date of the Notice of Proceed and
subject to the terms and conditions described in the Contract Form and the Contract Documents.
Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
and subject to the terms and conditions described in the Contract Form and the Contract
Documents.
Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be
incorporated into a Contract arising out of this Submittal has been so identified by Bidder. Bidder
further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data
submitted herewith into a contract arising out of this Bid.
The undersigned acknowledges receipt, understanding and full consideration of the following
addenda to the Contract Documents.
Addenda Nos.
The Bidder understands and agrees that the Total Bid Price is inclusive of all labor, materials, and
equipment or supplies necessary to complete the Work as described in the Bid Documents. If this
bid is accepted, the undersigned Bidder agrees to enter into and execute the Contract with the
® necessary bonds and accept the Total Bid Price as compensation in full for all Work under the
contract.
CBF -2
By:
Signature
Vincent P. Mauch
Type or Print Name
CFO
Title
BIDDER: and Company, Inc.
12907 E. Garv Avenue
Business Street Address
Bald win Park, CA 91706
City, State and Zip Code
626- 338 -9923
Telephone Number
Bidder's /Contractor's State of Incorporation: California
Partners or Joint Venturers: N/A
Bidder's License Number(s):
Department of Industrial Relations
Registered No. _ 1000004082
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 flrrther discussed in the Instructions to Bidders, Bidder n•ill be required
to provide evidence that the person signing on behalf of the corporation,
partners III or joint veo tore has the au thority to do so.
CBF -3
BIDDER:
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.
I :t -10
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
1111JJUilCM
($ ), 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 Highway Safety Improvement Project as set forth
in the Notice Inviting Bids and accompanying Bid Documents, dated
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 day of , 20_
SEAL)
Principal
in
Signature
to
Surety
Signature
CBF -4
RIDDER: and Company, Inc.
2.13 LIST OF PROPOSED SUBCONTRACTORS
In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100
through 4114 of the California Public Contract Code, and any amendments thereto, each
Bidder shall provide the information requested below for each subcontractor who will
perform work, labor or render service to Bidder in or about the construction of the Work in an
amount in excess of one -half of one percent (greater than 0.5 %) of the Bidder's Total Bid
Price, or, in the case of bids or offers for the construction of streets or highways, including
bridges, in excess of one -half of 1 percent of the Contractor's total bid or ten thousand
dollars ($10,000), whichever is greater, and shall further set forth the portion of the Work
which will be done by each subcontractor. Bidder shall list only one subcontractor for any
one portion of the Work.
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
i� 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
BIDDERSteiny and Company, Inc.
2,13 LIST OF PROPOSED SUBCONTRACTORS (continued)
["Duplicate Next 2 Pages if needed for luting additional subcontractors. °I
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: Y) 0 51,6 5
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.
Name and Location
of Subcontractor
Description of Work
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.
Name and Location
of Subcontractor
Description of Work
to be Subcontracted
Name:
Address:
License No.:
Department of Industrial Relation Registration No.
I M 93
BIDDER: Steiny and Company Inc.
2.0 REFERENCES
The following are the names, addresses and telephone numbers for three public agencies for which BIDDER
has performed similar work within the past two (2) years:
See Attached
Name and Address of Owner
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
2.
Name and Address of Owner
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
3.
Name and Address of Owner
Name and telephone number of person
Contract amount
4.
Name and Address of Owner
Name and telephone number of person
Contract amount
project
Type of Work Date Com
with project
Type of Work Date
CBF -7
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BIDDER: and Company, Inc.
NON — COLLUSION eA��l��ll/1�
CBF -8
BIDDER Steiny and Company, Inc.
NON - COLLUSION AFFIDAVIT
In accordance with Public Contract Code Section 7106, the undersigned, being first duly
sworn, deposes and says that he or she holds the position listed below with the bidder the
party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any
undisclosed person, partnership, company, association, organization, or corporation; that the
bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced
or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly
colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham
bid. or that anyone shall refrain from bidding; that the bidder has not in any manner, directly
or indirectly, sought by agreement, communication, or conference with anyone to fix the bid
price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the
bid price, or of that of any other bidder, or to secure any advantage against the public body
awarding the contract of anyone interested in the proposed contract; that all statements
contained in the bid are true; and, further, that the bidder has not, directly or indirectly,
submitted his or her bid price or any breakdown thereof, 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
Vincent P. Mauch
Typed or Printed Name
CFO
Title
Steiny an Company, Inc.
Bidder
*See Attached
Subscribed and sworn before me
This _ day of .20
(Seal)
Notary Public in and for
the State of California
My Commission Expires
CBF -9
CALIFORNIA UEKIMCA
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 l
County of Los Angeles j as.
On July 30, 2015 before me, Soraya A. Carrillo, Notary Public
Deb N.w and Title orOMee,(o.g.'9we Doe, N.ul Public")
personally appeared Vincent P. Mauch
Nn .v)of S1,e,us)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) isfare
subscribed to the within instrument and acknowledged to me that he/she4hey executed the same
in hisj%errAheir authorized capacity(ies), and that by his{her>ttkeir 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.
WITNESS my hand and official seal.
SORAYA A. CARRILLO
Commission # 2004435
Notary Public •California z
i Los Angeles County
My Comm. Expires Jan 18, 2017
(Saul)
OPTIONAL
Though the information below" not required by law, it may prove valuable to persons relying on the document and could prevent fi audulent
removal and reattachment of this form to another document.
Description of Attached Document: City of Rosemead Bid Proposal - HSIPL5358(014)
Title or Type of Document: Non - Collusion Affidavit
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer
Signer's Name: Vincent P. Mauch
Number of Pages:
❑ Individual
® Comorate Officer - Title(s): Chief Financial Officer
❑ Partner(s) - ❑ Limited ❑ General
❑ Attorney -in -Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer is Representing: Steiny and Company, Inc.
1J: \8 -27 -13 \Forms \Bid ProposaR2015 Notary Forms Blank 7/30/2015
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 __....._ _......._.
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.
5. 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 /p(oposal 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 orwill be expected to perform
i and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact
fA with Federal officials. Identify the Federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Members)
of Congress that were contacted.
® 15. Check whether or not a continuation sheet(s) is attached.
1 �■ 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 Nlanagerncnt and Budget. Paperwork Reduction Project (0343 - 0046),
Washington. D.C. 20503. SF-LLL - Instructions Rev. 06 -04 a0aENDIFa
i
a
1
I
I
DISCLOSURE OF LOBBYING ACTIVITIES
COMPLETE THIS FORM 10 UISCLOSt LOBB INb AU I IV I Its P'UKSUAN I I U 3 1 U.o.U. i33z
Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
contract ❑ a hid /nffn.damnlicatinn F - 12 initial
b. rant b. initial award b. material change
c. c operative agreement c. post -award
d. Ica For Material Change Only:
e. loan arantee year _ quarter
f. [loan insr nce date of last report
Name and A dress of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee,
Enter Name and Address of Prime:
El Prime F] Subawardee
Tier .if known
Congressional District, ' IF known
6. Federal Department/AgI
8. Federal Action Number, if known:
10. a. Name and Address of Lobby Entity
(if individual, last name, first name, MI)
Congressional District, if known
7. Federal Program Name /Description:
CFDA Number, if applicable
9. Award Amount, if known:
Individuals Performing Services (including
- ddEQss if different from No. 10a)
(last name, first name, MI)
(attach Continuation Sheet ) if necessary)
11. Amount of Payment (check all thatapply) 13. Type of Payment (check all that apply)
S actual Ul planned a. retainer
. one -time fee
12. Form of Payment (check all that apply): commission
e a. cash d. ontingent fee
b. in -kind specify: nature e d erred
value f. othe specify
14. Brief Description of Services Performed or to be performed and Dat (s) of Service, including
officer(s), employee(s), or member(s) contacted, for Payment Indicate in item 11:
(attach Continuation Sheet(s) if necessary)
15. Continuation Sheet(s) attached: Yes El
No El
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:
required pursuant to 31 U.S.C. 1352. This information
will be reported to Congress semiannually and will be
Title:
available for public inspection. Any person nho fails to
file the required disclosure shall be subject to a civil
penalty of not less than 310.000 and not more than
Telephone No.:
$100.000 for each such failure.
Fed eral Use Only:
F'nnn F1 Rav n9 -19-Ii
Authorized for Local
Standard Form -LLL
Loeai Assistance Procedures Jv mmM EXHIBIT 15-GI
Local Agency Bidder UDBE Commitment (CDnstruetion Contracts)
EXHIBIT I5 -GI LOCAL. AGENCY BIDDER UDBE COMMITMENT (CONSTRUc CONTRACTS)
NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OFTHIS FORM
Garvey Avenue
t.00A*I ION'
:_._..___..__--...___._.__._....._._........_._---_....------
Garvey Ave Highway Safety Improvement Project HSIPL
PROJI: c "f DESCRII I ION: . ___ ,....._..._.._.
5358 1
lot Al CO RAC. t un;N r �,.., .... _._ ...
Ell D DATL'.: _.___.--- - -- - -- - ......._.__ .....
BIDDEJZ'SYA,NIE _. Steiny and... Company,., Inc. „- _..,.,__
CON'I'RACI' t'DBF port.:
CONTRACT �FITM OF WOR K AND DF.Sc;Rll'lto\. itUHI ( In No 1NV41EOI CACII UDBE �1) () I_ LA R ArbtOtiNF
IIEMNO. OR,EF.RbiCliS IO,BE 1.ANDLAPIR.AI1Oti : {Must be c¢rlificd on the date biJ4
3UBCONTRACTE {D OR MATERIALS IDA 111 am opened - includeI �
lPO BF.: PROVIDED (nr contrtclttl it the �addrcs and phone number) ) i
'bidder is a U DBE)
r
For Local Agency to Complete: I
Ra11 Claimed tiDBE
Load Agency Contract Number:.__-___._.-_..____._ .......- ._— _.— ____....__.._._.. Participation (•:
r
Federal aid Prglcct Number: _ �.....
Fcdcral Sharc' _ ._...__.. ._. , __.. __._
Contract Award Date: -' !
I. ocal Agency cerlilies that all t.''DBI; certi ti catipns haee been veriI!Cd and
i rormation is complete and accurate.
Prior Nainc Si;;nxnrrc
l.uctd , \�cncy ReprcunfEU ivc
(Anti Code) I c lcplimic Nunbcr ...__.__. _..
626 -338 -9923 Uu`
Vincent P. Mauch CFO —.
Perron Co Contact i('liases7re or t'nnp
Local : \::cncr tiiddc' UDW: C"mmirnranl {(:n¢stnrninn Cnou;rU )
(rtes tr26'e9)
Distribution. (,I)Original I -peal a�enc� tiles
LPP 09 -02
PageI5 -31
July 31. 2009
FXtJlI3lT IS -Gl Local Assistance Procedures Manual
Local Agency Bidde UUBG C (Co rasfz - rrction Contracts)
INSTRUCTIONS - LOCAL AGENCY BIDDER
UDBE COMMITMENT (CONSTRUCTION CONTRACTS)
ALL BIDDERS:
PLEASE NOTE: It is the bidder's responsibility to verify that the UDBE(s) falls into one of the following
groups in order to count towards the UDBE contract goal: 1) African Americans; 2) Asian - Pacific
Americans; 3) Native Americans; 4) Women. This information may be submitted with your bid. If it is not,
and you are the apparent low bidder or the second or third low bidder, it must submitted and received as
specified in the Special Provisions. Failure to submit the required UDBE commitment will be. grounds for
finding the bid nonresponsive
A UDBE, is a firm meeting the definition of a DBE as specified in 49 CER and is one of the following groups:
African Americans, Asian - Pacific Americans, Native Americans, or Women.
'File form requires specific information regarding the construction contract: Local Agency, Location, Project
Description, Total Contract Arnount, Bid Date, Bidder's Name. and Contract UDBE.; Goal.
- The form has a column for the Connact Item Numberand 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 perforted 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.Theform has a columm for the Narnes of UDBE contractors to perform the work (whir must
be certified on the (late 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 it) the "List of Subcontractors" submitted Witt) your bid.
There is a column for the UDBE participation dollar arnount. 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'
itern is not to be perforated or furnished by the 'UDBE, describe exact potion 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-G I trust 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 shoul(I complete the f „oeal 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 1� -32
,July 31 2009 LPP 09 -02
Local AoiStno,cy"xedvpsMxvuu|
Local A
Bidder DBE lx(o,muhvu(Cou;\nnci C t
--� |
EXHIBIT 15-G2 LOCAL ^4CCMCYQlBoER DBE INFORMATION (CONSTRUCTION CONTRACTS) |
(hicli.tsivc of all DBEs illdl,iding the UDBEs listed at bid pmposah
El
NOT , E: , PLEA , SE -, R ::: "I E "I FERTO INSTRUCTIONS ON THE REVERSE, SIDE OF THIS FORM
Garvey Avenue
Lilt)(N.WS NAME:
I
M313CDN I RAC'. I Ell) OR
DA
ire opened - indudc [)[,it; adilles.,
For Local Agericy to COMPICte:
l"otil Claimed DBE
bil'orniatioll is
.�i,, P.
Distdb"hon/oco,' oi v JIM] n(IM S | :`*m�o a,/|"�w
u,�x^*vwo� o/ /\E `���'��p;o /a */°m*wo ( iwmx mmx�d,°w�* ."»m*ow /mm i's **m
mc|/dc ill ^`y1^d pw:^gr ill( x|'rm/vin
o)oli -|/*|x;oc'mm
LYPi2'V|
Janouryl7,lo|l
EXHIBt i Iti -152 Local Assistance Procedures Manual
Local Agency Bidder Df3[S Information (Construction Contracts)
INSTRUCTIONS - LOCAL AGENCY BIDDER DBE INFORMATION
(CONSTRUCTION CONT'RACT'S)
SUCCESSFUL BIDDER:
r
r
file form requires specific information regarding the construction contract [..Deal Agency. location, Project
Description, ) - otal Contract Amount, Bid Date, Bidder's Name, and Contract UDBF Goal.
The form has a column Tor the Contract Item Number and Item or 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 inchrding work performed by its own forces, ifa DBE -The DBE shall provide a certification number to the
Contractor and expiration date. Enter DBE prime and subcontractors certification nurnber. The DBE contractors
should notify the Contraclor in writing with the (late of tile decertification if their status should change during the
course of the contract. - file form has a column for the'Narnes 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 U,DBEs listed on the UDBE
Comminnent Form (Exhibit 15 -G 1), regardless ortier. 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 vour bid.
Therc 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 vour 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 I5-G2 most be signed and dated by the successfirl bidder. Also list a phone number in the space provided
and print the narne 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 Engineerwithin 15 days ofcontract execution.
Failure to submit a completed and accurate roan within the 15 -day time period may result in the de- obligation of
funds on this project.
District DBE Coordinator Sholdd 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 15-321 LIT 09 -02
,tiny 31.2009
t,ocal Assistance Procedures Manual Exhibit 15 -11
UDBE Inform Good Faith Effort
EXHIBIT 15 -14 UDBE INFORMATION —GOOD FAITH EFFORTS
UDBE INFORMATION - GOOn FAITH EFFORTS
Federal -aid Project No. FISIPL 521 g �4H) - Bid Opening Date
p� fhe —_ —__ Citv 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 uas
made.
LoFVest, second lowest and third lowest bidders shall submit the following information to document adequate
"ood 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 Cornmitment" form may not provide suflicient
documentation to demonstrate that adequate good faith efforts were made.
j I'he following items are fisted in the Section entitled "Submission of UDBE Commitment" ofthe Special
® provisions:
A. The navies and dates of each publication in which a request for UDBI participation For this
project was placed by the bidder (please attach copies of advertisements or proofs of
publication):
Publications Dates ol'A dl-ertise ment
B. The narnes and dates of written notices sent to certified U.DBF;s 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 solicitation, telephone records, lax
confirmations, etc.):
Exhibit Ij - }{
UDBE 111forrnation -Good faith Effort
Local Assistance Procedures Nlanual
I C. The iterns 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 facititate UDBE.
participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate
UI.>BE participation was made available to UDR F.' firms.
Items of Work Bidder Normally Breakdown of AmOUnt Percentage
Performs Item Items ($_) 0f
(YEN) Contact
D. The names addresses and phone numbers ofrejected UDBE firms, the reasons for the bidder's
rejection of the UDBEis 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:
Neunes, addresses and phone numbers of rejected UDBEis and the reasons for the bidder's
rejection of the UDBEis:
Names, addresses and phone numbers of firms selected for the work above:
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:
Pa ,, e 15-34
July 3 L 2009 Lt'P 09 -02
Local Assistance Procedures Manual
1..1111411 l - tl
UDBE:lnformation - Good Faith Effort
F_ Efforts made to assist interested UIDBEs in obtaining necessary equipment_ supplies, materials or
related assistance or services, excluding supplies and equip.mesit the UDBfs subcontractor
purchases or teases from the prime contractor or its affiliate:
G. The names of agencies. organizations or groups contacted to provide assistance in contacting,
recruiting and using UDB.E firms (please attach copies of requests to agencies and any responses
received, i.e., lists. Internet page download. etc.):
Name of Agencv�Ort aniz pion V[ethocVDate of Contact RescElts f
11. Any additional data to support a demonstration of good faith efforts (use additional sheets if
necessary):
NOTE: USE-. ADDI'rIONAL.SI-IEETS OF RAPER lF NECESSARY.
Page 15 -34a
LPP 09 -02 July 31, 2009
BIDDER: Stein and Corn any, 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 Stein Company, Inc
Principal, and _ _Endurance Rein
as
as Surety, are held firrnly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
Ten Per of the T otal Amount of the Bid
DOLLARS
_
($ 10% � , being not less than ten percent (10 ° !o) 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 Highway Safety Improvement Project as setforth
in the Notice Inviting Bids and accompanying Bid Documents, dated
August 015.__
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 24th day of __
Steiny and Company, Inc. _ SEAL)
Principal
By: _— _- By
S �gVl t flO�ent P. Mauch,CFO
J 2015
Endurance Reinsurance
C'or of Ameri ca_(SEALY
Suret q
8 ature Jerr Apod a, Attorney iii Pact
CBF - 4
CALIFORNIA A LL-PURPOSE k f E JS t
M n .Yi _M
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 — _ Orang _ )
On JUL 2 4 2015 before me, Rhonda C. Abel, Notary Public
Date Here Insert Name and Title of the Officer
Jeri A odaca
personally appeared � -� p -_ -_ _ _ __
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(O whose name( is/
subscribed to the within instrument and acknowledged to me that he/she /tw executed the same in
M /IherAM authorized capacity(), and that by bfher /fir signature(s) on the instrument the person(R),
or the entity upon behalf of which the persons) acted, executed the Instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct,
q a
O C WITNESS my hand and official seal.
f�NDAC.ABEL
RH COMM # 2051838
NOTARY PUBLIC - CALIFORNIA ORANGE COUNTY O ' r OMM. EXPIRES DEC. 14, 20171 Signature a_c. _v !`� ` �'- �C.S.,
Signature of Notary Public
Place Notary Seal Above
— -- - OPTIONAL —
Though this section Is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached 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:
Corporate Officer -- Title (s):
Partner — 10 Limited I_l General
Individual N Attorney in Fact
Trustee LI Guardian or Conservator
Other:
Signer Is Representing:
Signer's Name: _ o _
Corporate Officer — Title(s):
1 Partner — t_1 Limited ; :General
i 7 Individual Attorney in Fact
CI Trustee Guardian or Conservator
C;1 Other:
Signer Is Representing:
02014 National Notary Association - www,NationalNolary.org • 1- 800 -US NOTARY (1 -800- 876.6827) Item #5907
CALIFORNIA CERITH'1CNIE Of
�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 l
County of Los Angeles j ss.
On July 30, 2015 before me, Soraya A. Carrillo, Notary Public
DM. Nerve wd Tide d0flt -, (a e.'9we Doe, Not., Publii')
personally appeared Vincent P. Mauch
Nvnc(s)ofSiguer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is,4re
subscribed to the within instrument and acknowledged to me that hefshe/they executed the same
in his /he f4heir authorized capacity(ies), and that by his{henkheir 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.
WITNESS my hand and official seal.
J
$igneNre
SORAYA A. CARRILLO
Commission # 2004435
i ` -n - Notary Public - California i
Z "' Los Angeles County >
My Comm. Expires Jan 18, 2017
(Seel)
OPTIONAL
Though the information below is nohrequired by law, it may prove valuable to persons relying on the document and could prevent fraudulent
removal and reatlachment ofthis farm to another document.
Description of Attached Document:
Title or Type of Document: Bid Bond
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer
Signer's Name: Vincent P. Mauch
❑ Individual
® Corporate Officer - Title(s):
❑ Partner(s) - ❑ Limited
❑ Attorney -in -Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Number of Pages:
Chief Financial Officer
❑ General
Signer is Representing: Steiny and Company, Inc.
City of Rosemead Bid Proposal - HSIPL5358(014)
U: \8 -27 -13 \Forms \Bid Proposal\2015 Notary Forms Blank 1 7/30/2015
ENDURANCE REINSURANCE CORPORATION OF AMERICA
POWER OF ATTORNEY
BIDR371600153
Ynow eaTMen 6y these Present, that ENDURANCE REINSURANCE CORPORATION OF AMERICA, a Delaware corporation (the "Corporation'9, with offices at4
Manhattanville Road, 3rd Floor, Purchase, NY 10577, Purchase, New York 10604, has made, constituted and appointed and by these presents, does make, constitute and appoint
RHONDA C. ABEL, JERI APODACA, KIM LUU, MICHAEL D. PARIZINO, RACHELLE RHEAULT, HEATHER SALTARELLI, JAMES A.
SCHALLER its true and lawful Aflorney(s) -in -fact, at NEWPORT BEACH in the State of CA and each of them to have full power to act without the other or others, to make,
execute and deliver on its behalf, as surety or co- surety; bonds and undertakings given for any and all purposes, also to execute and deliver on Its behalf as aforesaid renewals,
extensions, agreements, waivers, consents or stipulations relating to such bonds or undertakings provided, however, that no single bond or undertaking so made, executed and
delivered shall brui ttttheCar grptlon for any portion of the penal sum thereof in excess of the sum of SEVEN MILLION FIVE HUNDRED THOUSAND Dollars
$7,500 OQ,p) y.L.� ����
Such bq da s p, goes, when duly executed by said attorneys) -in -fact, shall he binding upon the Corporation as fully and to the same extent as if signed by
the P,(ere t� operation g, p SFale seal attested by its Corporate Secretary.
Thig 'pImment is made under and by au)h yof certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on the 9th of January, 2014,
acS (which apps underthe hsaf �,entitled "Cedlficate ".
This weer of Attorn - and sealed at, !mile under and by authority of the following resolution adapted by the Board of Directors of the Corporation by unanimous written
C04 an January 90 said resoly has not since been revoked, amended or repealed:
RES�L,t ranting pow pd g pursuant to certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on January 9, 2014,
the sigfia f.gdifapgy,@0 $$aaLd the seal of the Corporation maybe affixed to any such power of attorney or any certificate relating thereto by facsimile, andanysuch
power of d cafe bezaRe s�Ch facsimile aground or seal shall be valid and binding upon the Corporation in the future with respect to any bond or undertaking to which it
is aHached. ` l ,. . 4P
This Power of Attorney shall expire and all authority hereunder shall terminate without notice at midnight (Standard Timer where said attorney(s) -in -fact is authorized to act.)
May 19, 2016
IN WITNESS WHEREOF, the Corporation has caused these presents to be duly signed and its corporate seal to be hereunto affixed and attested this 20th day of May, 2015 at
Purchase, New York.
(Corporate Seal) ENDURANCE REINSURANCE CORPORATION OF AMERICA
ATTEST By
MARIANNE L. WILBERT, SENIOR VICE PRESIDENT SHARON L SIMS, SENIOR VICE PRESIDENT
STATEOF NEWYORK ss: Purchase
COUNTY OF WESTCHESTER,:._..
On the 20th Qa� of ' �' y 2015 hejore me
residea irLS�od'C)1PI NEiv, F
In end Which executed the above ingtrom
of the Bory�rof Filrectors.otsaid Corporal
(No(P`i!at Seslj'.
came SHARON L. SIMS, SENIOR VICE PRESIDENTto me known, who being by me duly swom, did depose and say that (s)he
he Is a SENIOR VICE PRESIDENT of ENDURANCE REINSURANCE CORPORATION OF AMERICA, the Corporation described
he knows the seal of said Corporation; that the seal affixed to said instrument is such corporate seal; that It was so affixed by order
et (sjhe signed his (her) name thereto by like order.
CERTIFICATE
Arlie Used, Notary Public - My Commission Expires 10/29/2015
STATE OF•NF�W YORI1AA+ y t . 4 ,1 s�IPumhase
COUNTY OF WESTivYiISTBR
I, CHRISTOPHER DOtJElAN "the P ' RESIDENT of ENDURANCE REINSURANCE CORPORATION OF AMERICA, a Delaware Corporation (the 'Corporation), hereby certify:
1. That the original power of attorney of which the foregoing is a copy was duly executed on behalf of the Corporation and has not since been revoked amended or modified; that the
undersigned has compared the foregoing copy thereof with the original power of attorney, and that the same is a true and correct copy of the original power of attorney and of the
whole thereof;
2, The fallowing are resolutions which were adopted by the Board of Directors of the Corporation by unanimous written consent on January9, 2014 and said resolutions have not since
been revoked, amended or modied:
"RESOLVED, that each of the individuals named below is authorized to make, execute, seal and deliver for and on behalf of the Corporation any and all bonds, undertakings or
obligations in surety or cosurety with others:
�rxyurNwn CHRISTOPHER DONELAN, SHARON L. SIMS, MARIANNE L. WILBERT
And be it further ° ' s C&� r
,
RESOL,"V$ tale vltlu Pged above is authorized to appoint atlorneysin -fact for the purpose of making, executing, sealing and delivering hoods, undertakings or
ob�n$ llg�ho
r� roe sure gp�ehalFOF the Corporaton:'
3. � nders nedfurthercediges at the,Y�oye resolutions are free and correct copies of the resolutions as so recorded and of the whole thereof
IN I jESS WHE&,g hereunto sethg`hand and affixed the corporate seal this day.4UL 242015 ,20
(Crnrate Seal). A n
yl � CHRISTOPHER DONE AN,SIDENT
' Pnd,xp as rr �lrurP +r`vs a "r,�rae " "�na a,• "ua