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PTM Engineering Services Inc.1 1 '1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 i CITY OF ROSEMEAD GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) GQNTRACT . BID FORMS I 1 L I 1 1 1 I L I i I L I U BIDDER: PTM General Engineering Services Inc. BID SCHEDULE SCHEDULE OF PRICES FOR GARVEY AVENUE -- HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) necP min cr`urnin z TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 4 , 79 4 0 - 7 � N 0¢Z0 `4; ti r- RB- Y Ca amount in written form v�u �� k l �r v— V :S 7� ra� The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract for the Work is fully executed by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 CITY. PRICE COST Clearing & Grubbing per plans 1 and specifications. LS 1 lkzoco X2.000 � 2 Disposal of Waste Materials. LS 1 1, I OOO o Signal Upgrade at Garvey Avenue and Delta 3 Traffic Avenue per Plans and F Specifications Complete, LS 1 Isq 000 11 1sq, OOp Traffic Signal Upgrade at Garvey Avenue and 4 Rosemead Place /River Avenue per Plans and Specifications Complete. LS 1 16 q, ©dp *1 I6 k, 00® Traffic Signal Upgrade at 5 Garvey Avenue and Muscatel Avenue per Plans and Specifications Complete. LS 1 IP I SR, 079 # 15$, 07 / TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 4 , 79 4 0 - 7 � N 0¢Z0 `4; ti r- RB- Y Ca amount in written form v�u �� k l �r v— V :S 7� ra� The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract for the Work is fully executed by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 r PTM General Engineering Services Inc. BIDDER: Attached hereto is a certified o 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. H I 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. JJO ? E rc- -V a T- C-N A 5 or- 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. P CBF -2 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. B Signature Elizabeth H. Mendoza de McRae President /CFO Title 5942 Acorn St. Business Street Address Riverside, CA 92504 City, State and Zip Code 951.710.1000 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): 1 1 U J lJ 891265 BIDDER: PTM General Engineering Services Inc. Department of Industrial Relations Registered No. NOTES: 19-0901011 1 4313111-111 11 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 evidcnec that fhe person signing on behalf of the corporation, nartnershin or joint venture has the authority to do so. CBF -3 PTM GENERAL ENGINEERING 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 ($ 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 Garvey Avenue Highway Safety Improvement Project as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated AUGUST 5TH, 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 24TH day of JULY 2015 DEL11 Y PTM GENERAL ENGINEERING SERVICES, INC. (SEAL) INSURANCE COMPANY Principal By: By: Sig e Ehzabetb H. Mendoza de McRae PRESIDENT /CFO BIDDER: SERVICES, INC. Surety SEAL) LIP V�13G LTTORNEY -in -FACT CBF -4 thi au ar CI at TI C( of IN WI1 attesei Of the a e CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of ORANGE On OLWI 1; r ol before me, 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 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. i PHILIP VEGA WITNESS my hanq,,ed' official seal. COMM. # 1977088 y NOTARY PUBLIC CALIFORNIA o w '' - LOS ANGELES COUNTV Signature •" My COMM. Explre., MAY 1i ,A 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 — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: PHILIP VEGA, NOTARY PUBLIC Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General • Individual ❑ Attorney in Fact • Trustee ❑ Guardian or Conservator • Other: Signer Is Representing: ©2014 National Notary Association • www.NationalNotary.org • 1- 800 -US NOTARY (1- 800 - 876 -6827) Item #5907 CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189' A notary public or other officer completing this certificate verifies only the Identity of the Individual who signed the document to which this certificate Is attached, and not the truthfulness, accuracy, or validity of that document, State of California County Jf LosApgeles On before me, Date personally appeared Philip E. Vega Monica Blaisdell, Notary Public Here Insert Name and Title of the Officer Name(s) of Signers) who proved to me on the basis of satisfactory evidence to be the person( whose name(s) Is /a'k6 subscribed to the within instrument and acknowledged to me that he /abW/t cexecuted the same In his /%t"W& authorized capacity(ie X and that by his /barf4fgiKk slgnature(�,) on the instrument the person(o, or the entity upon behalf of which the person(s) acted, executed the Instrument. MON g e ® Co 'e" on , a 'g' 1970845 Notary ary Pu PuGllc - Colllornla z r Orange County > 4 Comm. Ee Irea Mar 2E, 2016 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 VtAN r ill Signature of Notary Public I ' 2.B I I LIST OF PROPOSED SUBCONTRACTORS PTM General Engineering Services Inc. 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 W ork 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. LJ P 11 I I I CBF - 5 I 1 2.B FIST OF PROPOSED SUBCONTRACTORS (continued) [ "Ouplicate Next 2 Pages if needed for listing additional subs ntmrkxs "I Name and Location Description of Work ' pff Subeontra _ - to ha ,ubconl aacled Prune Performance Contractors Name: 2711 Ridgeline Dr # 105, Corona, CA 92882 ^G3 `�� Address: License No. 979710 Exp:12/31LIr Class: A 1 ' — Tel 951) 362.1359 �e7fJ �„ tr License No.; b r: %OOOC) bUO Department of Industrial Relation Registration No. _____ Name and location of Subcontractor I I BIDDER: PTM General Engineering Services Inc. Description of Work to be Subcontr Name: Address. License No.: Department of Industrial Relation Registration No. Name and Location 0 , f Subcontra Name: Address License No.: Department of Industrial Relation Registration No. Name and Location of Subcontractor I 0 Description of Work to be Subcontracted Description of Work Lo be Subcontracted Name: Address: License No.: Department of Industrial Relation Registration No. Name and Locat of Subcontractor Description of Work to be Subcontracted Name: _ ' Address: _ License No.: Department of Industrial Relation Registration No. I L CBF-6 u I 2.0 REFERENCES BIDDER: PTM General Engineering Services Inc. I 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. Ci ty of Newport Beach 3300 Newport B lvd., Newport Beach, CA 91730 1 Name and Address of Owner Brad Sommers 949.644.3326 Name and telephone number of person familiar with project $547,050.00 Traffic Signal Rehabilitatio 2012 Contract amount Type of Work Date Completed 2, Caltrans 3727 30th St., Sacramento, CA 95816 Name and Address of Owner Danh Thai 949.279.8803 Name and telephone number of person familiar with project ' $354,453.00 Traffic Signal 2012 Contract amount Type of Work Date Completed City of Rosemead 8838 E. Valley B1vd.,Rosemead, CA 91770 Name and Address of Owner Rafael Fajardo 626.569.2100 Name and telephone number of person familiar with project ' $655,045.00 Safe Routes To school 2013 Contract amount Type of Work Date Completed 4. CityofMontebello 1600 W Beye lyBl�vd Montebello CA 90640 Name and Address of Owner Toe Boada 323.887.1460 Name and telephone number of person familiar with project $543,470.00 Safe Routes to School, Wilcox, La Merced Elementary 2013 Contract amount Type of Work Date Completed 1 CBF -7 Brian Mendoza P.O. Box 7745 Riverside, CA 92513 -7745 Email: brian @ptnt- 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 10196 to 06/2.006 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. Continued... BRIAN MEND02vA • Page 2 CAREEREXPERIGNCh CONTINUED MBE Electric Inc, in Riverside, CA 1.0/1998 - 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 eorrtpi- 0 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 baekhoes; • 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 BRIAN MENDOZA e Page 3 CAREER FxPERIENCE 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. • English (Native) • Spanish (Fluent) LANGUAGES 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 Affinnative 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 EXPRIZIENCE, CONTM TO 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 -7334. Caltrans project #08-4567V4) 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 CeII: (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 w $3.2 million) Project completed in 2004. Description of projects: Installation of traffic signals ramp meterirg, sign illumination, highway fighting, 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 8ST0137 (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: • Zala Harris - Caltrans Inspector- Cell (951)28940047 • Ray Robles- Caltrans area supervisor- Cell (909)799 -0646 i 1 [1 CITY OF ROSEMEAD 1 GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (074) I 1 I 1 11 I I I I 1 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. I EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder PTM General Enginee Services Inc. , proposed subcontractor , 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 an 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 i 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 -17(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. I I I ' FEUC- I H I I CITY OF ROSEMEAD C I GARVEY AVENUE I HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) I I I I I D I I I I 11 D I I I I 1 1 1 I J F 1 I 1 PTM General Engineering Services Inc. BIDDER: NON - COLLUSION AFFIDAVIT WNW. ' PTM General Engineering Services Inc. BIDDER: I D 1 I J I D I 1 I I I NON - COLLUSION AFFIDA 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 de pf3 itory, or to any member or agent thereof to effectuate a collusive or sham bid. Elizabeth H. Mendoza de McRae Typed or Printed Name President /CFO PTM General Engineering Services I nc. Bidder Subscribed and sworn before me This 30tbday of 14z -'20 15 Notary Public in and for the State of California My Commission Expires: CBF -9 (Seal) CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of ORANGE O i - - W(5 before me, Date personally appeared ELIZABETH 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, PHILIP VEGA COMM. d 1977088 0 NOTARYPU9LIC CALIFORNIA a Los ANGELES COUNTY Ln WE My Comm. Expires MAY 31.2016 j Place Notary Seal Above 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. Signatur Signature of Notary Public 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: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: D Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General • Individual D Attorney in Fact • Trustee D Guardian or Conservator ❑ Other: Signer Is Representing: Here Insert Name and Title of the Officer MENDOZA de McRAE PHILIP VEGA, NOTARY PUBLIC Signer's Name: ❑ Corporate Officer — Title(s): • Partner — ❑ Limited D General • Individual D Attorney in Fact D Trustee D Guardian or Conservator ❑ Other: Signer Is Representing: 02014 National Notary Association' www.Nationa]Notary.org' 1- 800 -US NOTARY (1- 800 -876 -6827) Item #5907 I 0 I I I I I C I I I I I 1 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. I I # CITY OF ROSEMEAD Ll I II GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 ( 014) I I I I I I I I I I I LJ E other person associated therewith in the capacity of owner, partner, director, officer, 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 1 manager: 1 i I I • 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. H 1 I I i 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-t I I I I CITY OF ROSEMEAD I I ' GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) I I I i I 1 i i i I I ' FOR FEDERAL -Alb CONTRACTS The prospective participant certifies, by signing and submitting this bid or bid, to the best of his or her knowledge and belief, that: (1) 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 nqt 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 $100,000 and that all such subrecipients shall certify and disclose accordingly. [1 I P L�J 1 .. Nt,C -1 u I I I I 1 CITY OF ROSEMEAD GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) L I 1 I I. QISCLO$URE -OF L' . 88YING ACTIVITIES' I 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.G. 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. I. Identify the type of covered Federal action for which lobbying activity is andfor has been secured to influence. the outcome of a covered Federal action. 1 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 fult name. address. city. slate 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 zubawardee, 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 "Sobawardoe" 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. ' 6, Enter the most appropriate Federal identifying number available for the Federal action identification in item I (e.g.. Request for Proposal (RFP) number, tnvitailon for Bid (fFB) number, grant announcement number, the contract grant, or loan award number, the applicaboNproposal 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. enterthe Federal amount of the awardfloan 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 dates) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with Federal officials. Identify the Federal officers) or employees) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheets) is attached 16. The certifying official shall sign and date the form, print hisfher 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 at 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. 20501 SF- LLLdnstructions Rev 05.04.90reENDIFn I I H C I I i C L C E I u I I j I F N /A= Not Applicable DISCLOSURE OF LOBBYING AcTIVITIFC 1. Type of Federal Action: 2, Status of Federal Action: 3, Report Type: V~ I n nnntrart a hirUnfferlannlfnntinn 1 1 initial N/A b. grant b. initial award b. material change c. cooperative agreement c. post award . loan e N/A For Material Change only: e. loan guarantee N/A year quarter I. roan 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: Prime [3 Subawardee Tier , if known N/A N/A Congressional District, if known 6. Federal DepartmentfAgency: N/A 8. Federal Action Number, if known: Congressional District, if known 7. Federal Program Name/Description: N/A CFDA Number, if applicable 9. Award Amount, if known: N/A N/A 10, a. Name and Address of Lobby Entity (If individual, last name, first name, MI) N/A b. Individuals Performing Services (including address if different from No. 10a) (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 $ actual planned a, retainer b. one -lime fee 12. Form of Payment (check all that apply): c. commission N 8 a, cash N/A d. contingent fee / b. in -kind; specify: nature_,_,_ _ e deferred value F. other, specify — A 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 necessa 15. Continuation Sheets) attached: Yes Q No 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 Elizabeth H. Mendoza de McRae required pursuant to 31 U.S.C. 1352 This information Print will be reported to Congress semiannually and will be available for public inspection. Any person who fails to Title: ____ ,_President/CFO file the required disclosure shall be subject to a civil 9517101000 Date: 7.30.15 penalty of not less than SIO.000 and not more than Telephone No.: 951. 710 $100.000 foreach such failure, - - -� Federal Use Only: Authorized for Local Reproduction Standard Form - LLL I I I CITY OF ROSEMEAD I i_. GARVEY AVENUE HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) I I I I I E I I I I j I I E I u I I 0 I I EXHIBIT 15 -GI Local Assistance Procedures Manual Local Agency Bidder UDBF Commitment (('unsu-action Contracts) INSTRUCTIONS - LOCAL, AGENCY BIDDER UDBE COMMITMENT (CONSTRUCTION CONTRACTS) ALL BIDDERS: PLEASE NOTE: It is the bidder's responsibility to verify that the (JoBE(s) falls into title of the following groups in order to count towards the 11i)IlE contract goal: I) African Americans; 2) Asian - Pacific Americans; 3) Native Americans; 4) Women,'I'Iiis information may be submitted with your bid. if it is not, and you are the apparent low hinder or the second or third low bidder, it must submitted and received as specified hl the Special Provisions. Failure to submit the required UDBF, comrnitntcnt will be grounds for finding the bid nonresponsive A UD13F, is a firm oeeting the definition of a DBC as specified h) 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', Name, and Contract t DBE: Goal. The Corm 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 c(mt•actois shall indicate all work to be performed by UDB1is including, if the prime is a UDBE, work performed by its own forces, if a UDBE.'Ihe UDBES shall provide a certification number to the Contractor and expiration date. Enter the UDBEI prime's and subcontractors' certification numbers. - fhe farm has a column lbi the Names of UDBE contractors to perform the work (who must be certified on the date bids are opened and include the UM31i address and phone titimber). IMPORTANT: Identify all UDBE1. Firms participating, in the project regardimss of tier. Names of the First -Tier LOBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List Or Subcontractors" submitted with vour bid. There is a colunul for the UDBF participation dollar ar iount. Enter the Total Claimed UDBU Participation dollars and percentage antotntt of items of work submitted with your bid pursuant to the Special Provisions. (it' I ()()% o r item is not to he performed or furnished by the UDf3Ei, (lescribe exact portion of time to be performed or furnished by the UDBE) Sec Section "Disadvantaged Business t ?nterprise (DIC)." of•the Special Provisions (construction contracts'), to determine how to coma the participation of UDBEi firms, Exhibit I5 -0 1 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 st t t*,encies shoid(i complete the Local Agency Contract Award, Fedcral-aid Project Number, Federal Sltare. Contract Award Date lields and vcrif% that all intbrmation is complete and accurate betixe signing! and film};. C Page 1> -3? ,IuhY 3L 200t) LPP 09 -oz 1] I I I 0 i I I I i. J I I I Local Assistance I'mcedores Mantial EXHIBIT 15-G1 Local Agency Bidder UDUE Commitment (Construction Contracts) EXHIBIT 15-61 LOCAL A(,'I IHIMER UDGE C:OMMI CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON TH R EVERS E SIDE OF TI; IS FORM I.00ALA(iFN(Y . ...... _ City of rosemead LOCA Rosemead, CA 1 IM PROSE C"I Garvey Avenue Highway Safety Improvement Project BIDDER'S NANIF- PTM General Engineering Services Inc. CONN RA('I'CDBJ: WAL CONI RACI f FFN t OF WORK A N L) D( R II'I t ID13 F CI It' 1 N07 0 DOLIAR ANIOUN I (011 \) M SERVICUS 1•0 BF AND EXPIRAI ION (Nlusi be 'e"i U date N'I's S( BCON] RAC I FO OR' NIA1 I;R IA 1.5 OA Ili ore opued - include (JDW. I'D Bk FIROVff)i .1) (or unntrected it the phone lillillher) W(ldcr is 11 UDIW) .... .... ..... ... . .... .. . . . . ........ --------- -- For Local Ageney to Complete: l ,W Claimed 111NBF $ locid Agent) Cultiract Number 1-111.11,11.1 - � - . � — --- -- ----- litipa;ioa federal -md f1towt NuniNr % Fcdclld shine. - ..... ........ . Cmunto Award Date — . ... .. ..... ......... . I "t;tI AlleilcN QvFti I its that al I t !I MF ccrfiritaitme; fill, t Iletti Yeri fied wal ill tilrillatt"'T 1% Complete mid iIQCII I WC 7.30.15 951.710,1000 .- — -- Elizabeth H. Mendoza de McRae Date PreaidcWGRO ...... ... Prison to ( keltao tTl��ml,pem I A"'m' Ble&! I"ID131: C", ..... 1Inlctl Celonel Wtc 62609i Distrilliltioll 1 tinal Lm';tl iwvnq lile. Inge 15 -31 111 1 1 1 09-112 July 31. 2009 1 1 ' Local Assistance Procedures Manual EXHIHIT IS -G2 Local Agency I idler D13m hltoratalioa (Coastruclim Coatracls) ' FxFtIRIT 15 -G2 L OCAL AC:ENc.X I31DUmZ DBE INFORMATION (CONSTRUCTION CONTRACTS) (Inciusivc ()['all DMlI including the IAMB listed at bill proposal) F I I 0 I d I I n lF1'Nf DI IFO({K ANl1 DGSCINP'I'IUN t313(i C:GR "I' N(7. \'AA41f OP F.ACII U81i ' ANX)UN, I tR si:RVIC6 TO VE, 'AND P: \PII{A]ION `p4fust he Cellilicd nn the dalle hiAS 'Ut31.'. il!KC'UN'1RrVC"rLD O1Z ptA'[IiRIA1.5 DAM ticopen(YI - indudc Difli nddicss P('713P. 1'ROVIDICD Ior canlm<ICd iY1hC �an;l phone rtunlhcp adder is a Dn FI N(Y1'E: PLEASE REFmR TO INSTRL/CTIONS ON THE ItF:VERSE Sll)F, OF TFItS F(.>Rh LOC:A[, AGENCY: _ City of Rosemead Rosemead, CA LOCA HON pRO.If Cr DIS( 'rtIVHON: Garvey Avenue Highway Safety Improvement Project nIDDATF „ 8 5.15 BIRD M NAMIi: PTM General Engmeering_Services Inc CONTRA('[ 11f)tili I.IOAI- I'I'CiNt NO. For Local Agency to Complete: t.(a:al Agancy Colllract Nunaw. . ............... Federnl -aid Prgiact Number. ............... ..... Contrite[,beard Ow: . „_ ............ I.ncal Mow) ceralies that Of 1)Rt cerNicJhon hav(I bCCnecl'i ncd and lulirrnlalion is ;olllpfcle and acunraa. Nrial Nai71C ZICni1t11 rC I7;rtC I oval Agerc) R(po.senulivc For C ltratts Review: Ir111I 'Vf11Yrl )ICItA(IIYe I1111V { allrans District Local As I;tumtcar "I'nud Claiamd UBP. I s P:rcticipaliau I 1 a \ I4rAd.� blff Inli +'r r'rb +m rCnualnrCUnn l'rnnfucis i ilia r1 .`f. fl ii Distribution: tl7 Copy Fus or scan It Copy to the Callr N Dw(nct I mat Assolimcc i twill rtIItALI, IdOnn 15days csccutioo. Failure to send it aryl to IIIC 171.:\1'. Iealnn 1 da,..,1' VNvolu ... I nnn, rreull in de. A I'ullds tin' Ibis Ia'( +)eel, Cl Cope IIIChidVM pa%:U%lV lo( Mill ns l hill ic( lm,:I,I\%i�tanec 0) 0, igiNd I aral;lt:cnc7 ilia ' 1'age 15.32a Id'P 12 -111 January27.21312 % i Si} aurrc of milder 7.30.15 951 710.1000 Elizabeth H. Mendoza de McRae President /. CEO..._ ....... ..... ._..__.__ -- ......._... person N(Omar (Please I)ivor Print) I 1 a \ I4rAd.� blff Inli +'r r'rb +m rCnualnrCUnn l'rnnfucis i ilia r1 .`f. fl ii Distribution: tl7 Copy Fus or scan It Copy to the Callr N Dw(nct I mat Assolimcc i twill rtIItALI, IdOnn 15days csccutioo. Failure to send it aryl to IIIC 171.:\1'. Iealnn 1 da,..,1' VNvolu ... I nnn, rreull in de. A I'ullds tin' Ibis Ia'( +)eel, Cl Cope IIIChidVM pa%:U%lV lo( Mill ns l hill ic( lm,:I,I\%i�tanec 0) 0, igiNd I aral;lt:cnc7 ilia ' 1'age 15.32a Id'P 12 -111 January27.21312 I 1 1 CITY OF ROSEMEAD 1 1 GARVEY AVENUE 1 HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) 1 u 1 1 1 1 i 1 I 1 1 1 Local Assistance Procedures Manual tirhibit i5 -if UD6f; hiformation - Good Failb F:I'fort EAHIBIT 15 -H UVRE INFORMATION —.GOOD FAl'PFl EPTORIS UEIBF, INFORMATION - GOOD FAITH EF FORTS ' Federal-aid Pro cc( No. 1_ISIP1,,,� <Sy Bid Opening Date 8.5.15 fhe __---- - Rt scmead_.....__..._ -- __.established an 1111(lei'utllized Disadvantaged Business l.:inicrprisc (UDBE) goal of 6 % for this project. The infimrtlakm provided herein shows that It good faith effort was made. Lowest, second lowest and third lowest bidders shall submit the following infian'Mion to document adequate good Will effbris. Bidders should submit the following information eo-^n if the "Local Agency Bidder UDBE Commitment" firm indicates that the bidder has met the Utml(i; goal. This will protect the bidder's eli tibility for award Of the contract if the administering agency deter rnines that the bidder failed to meet the goal fi r various reasons, c.g., a UDBE. tint was not certified at bid opening, or the bidder made a mathematical error. Submittal of only' the 'Local Agency Bidder 11DBF Commitment" form ntay not provide sttfticicnt documentation to demonstrate that adequate good froth efforts were made. [ 'he following items are fisted in the Section entitled "Submission orUDBE Committlicnt" of the Special Provision 's: A. The names and (fates of each publication in which a request for UDBEd participation for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications __..__.__ Date of Aril ertiscnunt C> oafs" IvTet-- '- - - - - _.....___ ____.___..- .__.---- ----..____. J I 1 B. The names atul dates of written notices sent to certified IID11F,s soIieitina bids fair this project and the dates and methods «sad for following up initial soticitations to detemvine with certainty whether the UDBEs were interested (please attach copies Of solicitations, telephone records, fax confirmations. etc.): Names of UD131',s Solicited DaW of Initial Follow Up Mcthods and Dates Solicitation __ ................... ..........................coals Nfzt---- ............ Pan' I5 -33 Exhibit I5 -11 U'nld,6 Information -Good Faith EXort Local Assis(ance Procedures Manual i C. The items of work which the bidder made available (o UDBF. Firms including, where appropriate. any breaking down of the contract work items (including those items normally performed by the bidder with its oven forces) into economically feasible units to facilitate UDBI participation. it is the bidder's responsibility to demonstrate that sufficient work to facilitate UDBIi participation was Horde available to UDI3E firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items O Qf (Y /N) Contract ' Goals Met I). ]lie names. addresses and phone numbers of (e)ected UDBE firms. the reasons €or the bidder's rejection of the UDBFs. the firms selected firr that work (please attach copies of quotes from the firms involved), and the price difference for each UDBF, if the selected firm is riot a UDBE: ' Namcs, addresses and phone numbers of rejected UDBEs and the reasons for the bidder's rejection of the UDBf*s: Goals Met _....... ._.__..-.. ._........ ......._..__...._.._.. ...._.. _._..__.. -.. - --- _ ... ............__._....__....__._. �. - -- - Namcs, addresses and phone numbers of firms selected for the work above: Goals Met - - --- .... . ... — .. . _ . .. E. Efforts trade to assist interested F- IDBIis in obtaining bonding, fines 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 .. . _. I i Page 15 -3a JulY 31, 2009 1.,1 (19 -02 Local Assistance Procedures Manual Exhibit IS -fl tlDBE luformatiou - Good Faith Effort I LITorts made to assist interested UDBE s in obtaining necessary eCluipment, supplies. materials or redated assistance or services. excluding supplies turd equipment the UDBE', subcontractor purchases or leases from the prime contractor or its affiliate: _.._ __......_..._._..--- -_- ._____.. Goals Met G, The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using UDBE FIMIS (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.): I I I I I I I C F Name ofAgcncv /Organizatlon Method /Date oft:ontact Results Goals Met 14. Any additional data to support a demonstration of good faith efforts (use additional sheers iF necessary): Goals Met NOTE: USE ADDH IONAI, S If-T IS OF PAPFR IF NUC LSSARY. Page I5-34a LPP 09 -02 July 31, 2009 | � f k / ! , &}k E }/E ■E ƒ(/ fE (ƒƒ ®` /7) § } §( {t§ ■ #(( m ■ !w, i a5} g # #, - ( ` � 2 /(\ ƒ§ (\ ! m- ) i2 }i} I\� 2 =} ■® (�2 ( � aJ« ■ IE/ { { ( }2 !■ (J\ �{ E 7 J E § 7 7 & ƒ � \ � k ) ) k W 8 0 m w r 00 o a x z z b 9 A r r i i 1 i CITY OF ROSEMEA© u i GARVEY AVENUE ' HIGHWAY SAFETY IMPROVEMENT PROJECT HSIPL 5358 (014) i 1 i n 1 i 1 i LOCAL BIDDER C)BE. INFORMATION; EXHIBIT 15 -G2 EXHIBIT IS -W Local .Assis(anee Procedures Manual Local Agency Bidder pill, Inrbrniation (Construction Contracts) r FNS "rRUCTIONS - LOCAL AGENCY BIODER DBE INFORMATION (CONSTRUCTION CONTRACTS) ' SUCCESSFUL BIDDER- The form requires specific infiorniation regarding the construction contract: Local Agency, Location, Project ' Description, "Dotal Contract Amount, Flid Date, Bidder's Name, and Contract UDBF. Goal, The tirrni 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 perRrrmed by DBEs including work performed by ils own forces. if a WE.The DIM shall provide a certification number to the Contractor and expiration date. Elmer INA,' prime and subconhactocscertilication nnrnbcr, 'file DBF, 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 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: Identity all DBL': firths participating in the project -- including; all UDBEs listed in the C!DBF. Commitment Form ('Exhibit 13 -01), regardless of tier. Names of the First-Tier DBF; subcontractors and their respective iteni(s) of work listed should be consistent, where applicable, with the nenies and items of work in the "List of'Subcontr actors" submitted with your bid. fhere is a column For the DBU participation dollar amount. finger tile'fotal Claimed DUE Participation dollars and percentage amount of items of work subnaitMI with your bid pursuant to the Special provisions. (lf 100% of item is not to be perriumed or furnished by the Dflf!, describe exact portion ortinic to be performed or rurnished by the DBE,.) See Section "Disadvantaged Business Enterprise (DP3['.), "of the Special Provisions (construction contracts) to determine how to count the participation of DBE firms. lixhibit 15 -G2 must be signed kill([ 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 Nunibcr, F'cforal -aid Project Number, Federal Share, Contract Award Date fields and verity that all ini rniation is complete and accurate before signing; and sanding a copy of the. dorm to the District local Assistance lcngineer within 15 cla of contract execution, Failure to submit a completed and accurate llxni within the 15 -clay time period may result in tie dc- obligation or funds on this project. 1 District DBE Coordinator should veril that all inforntations is complete and accurate. once the information has been verified, the District Local ASSistatace F.nineer signs and dates the (in m, I I 11 ige 15-32h .1 a fc 31. 2009 L. PP 09 -02 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 Elizaheth 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 o (year). A TRUE RECORD ATTEST Brian Mendoza Sectetary /Clerk Vice President /Secretary (Corporate Seal) i i 53 r egistration Payment Success M r; 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://payingby ACH/ EFT, please allowup to 7 days forprocessing ." RoYwn to Putdic Ylonot Hpmgpage Copyrlgltttl) 2014 State of California or Page 1 of 1 https:// efiling .dir.ca.gov /PWCR/ActionServlet ?action= paymentComplete 9/22/2014