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Bidder: Elecnor Belco Electric Inc. CITY OF ROSEMEAD ROSEMEAD PARK PEDESTRIAN LIGHTING PROJECT PROJECT No. 43006 CONTRACT BID FORMS BIDDER. Elecnor Belco Electric, Inc. CONTRACT BID FORMS TABLE OF CONTENTS SECTION 1 BID SCHEDULE I -4 SECTION 2 BID DATA FORMS 2.A BID BOND 6 2-B LIST OF PROPOSED SUBCONTRACTORS 7-8 2.0 BID BOND 9 SECTION 3 NON-COLLUSION AFFIDAVIT 10- 11 BIDDER:Elecnor Belco Electric, Inc. SECTION 1 - BID SCHEDULE CBF - 1 BIDDER'. Elecnor Belco Electric, Inc. BID SCHEDULE SCHEDULE OF PRICES FOR ROSEMEAD PARK PEDESTRIAN LIGHTING PROJECT PROJECT No.43006 BASE BID SCHEDULE UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST Clearing&Grubbing per plans LS 1 and specifications. See technical ' IUIUO *10. bOO provisions TP-2&TP-3. 2 Disposal of Waste Materials. LS 1 ot'uec St )00)CCC 3 Install Pedestrian Lighting LS 1 including electrical conduit, t� foundations, wiring and `W�� ' ,i(c pi tq c appurtenances per plans and specifications complete. `, CA) �TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 'CO( ��� v ceAgito(l1 -€t�rttit� nd Crte \ncrEC nnet�� e Dollar amount in written form CcA'u S LAN2faye) cavkc Note: The City of Rosemead reserves the right to reduce or increase the quantities of any items in the schedule of bid items above, within the limits define in Section 3-2.2.1 of the Standard Specifications, to stay within the budgeted amount of this project. If the Bid Documents specify alternate bid items,the following Alternate Bid amounts shall be added to or deducted from the Total Bid Price entered above.The owner can choose to include one or more of the alternates in the Total Bid Price of the Project. If any of the Alternate Bids are utilized by the Owner,the resulting amount shall be considered the Total Bid Price for the Project The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract for the Work is fully executed by the Owner and a third party,whichever is earlier. The undersigned also agrees that if there is a discrepancy between the written amount of the Bid Price and the numerical amount of the Bid Price,the written amount shall govern. Attached hereto is a certified check, a cashier's check or a bid bond in the amount of 10% Bid Bond Dollars ($ ) said amount being not less than ten percent(10%)of the Total CBF - 2 BIDDER. Elecnor Belot Electric, Inc. 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 end furnish the required bonds, certificates and endorsements of insurance and other certifications within the time provided. If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be prepared by the Owner for execution,within five(5)Calendar Days following the Letter of Award for the Contract,and will deliver to the Owner within that same period the necessary original Certificates of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other documentation and certification required by the Contract. The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body all rights, title,and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the Business and Professional Code), arising from purchases of goods, materials or services by the Bidder for sale to the purchasing body pursuant to the bid- Such assignment shall be made and become effective at the time the purchasing body tenders final payment to he Contractor. Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence satisfactory to the Owner of Bidder's California contractors license(s)in good standing;(2)evidence that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting therefrom; and (3) any other information and documentation, financial or otherwise, needed by Owner to award a Contract to the lowest responsible and responsive bidder. Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts of five hundred dollars($500.00)if project is not completed in FORTY-FIVE(45)calendar days.The Contract Time will begin to run ten(10)Working Days from the date of the Notice of Proceed and subject to the terms and conditions described in the Contract Form and the Contract Documents. Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be incorporated into a Contract arising out of this Submittal has been so identified by Bidder Bidder further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data submitted herewith into a contract arising out of this Bid. The undersigned acknowledges receipt, understanding and full consideration of the following addenda to the Contract Documents. Addenda Nos. 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- 3 BIDDER. Elecnor Belco Electric, Inc. I♦� 4331 Schaefer Avenue By. 5ture , Business Street Address Jo Wong Chino, CA 91710 Type or Print Name City, State and Zip Code Vice President 909-993-5470 Title Telephone Number 2/1/17 Date Bidders/Contractors State of Incorporation: California Partners or Joint Venturers: Bidder's License Number(s): 73e518 Department Industrial Relations Registered No.: 1000004804 NOTES: 1) By its signature on this Bid,the Bidder certifies under penalty of perjury the accuracy of the representations made on the Contract Bid Forms, 2) If Bidder is a corporation, enter State of Incorporation in addition to Business Address 3) If Bidder is a partnership or joint venture, give full names of all partners or joint venturers. As further discussed in the Instructions to Bidders,Bidder will be required to provide evidence that the person signing on behalf of the corporation, partnership or joint venture has the authority to do so. CBF-4 UNANIMOUS WRITTEN CONSENT IN LIEU OF 2016 ANNUAL MEETING OF THE BOARD OF DIRECTORS OF ELECNOR BELCO ELECTRIC, INC. March 1,2016 The undersigned, being all of the members of the Board of Directors (the "Board") of Elecnor Belco Electric, Inc., a California corporation (the"Company"), in lieu of holding a meeting of the Board, hereby take the following actions and adopt the following resolutions by unanimous written consent: WHEREAS, the Board has determined that it is in the Company's best interests to appoint a revised slate of Officers of the Company. NOW, THEREFORE, BE IT RESOLVED, that the following persons be, and hereby are, elected to the offices set forth opposite their respective names, to hold such offices until their respective successors are elected and qualified at or before the next annual meeting of the Board, or until their earlier respective deaths,resignations or removals: President and Chief Executive Officer Juan Bravo Chief Financial Officer Jeroni Gervilla Executive Vice President Alberto Garcia John Wong Vice President for Construction Secretary Pedro Enrile Roger DeVito Assistant Secretary FURTHER RESOLVED,that Juan Bravo, Jeroni Gervilla and Alberto Garcia in their respective capacities of President and CEO, Chief Financial Officer and Executive Vice President subject to such supervisory powers of the Board of Directors,hereby are authorized and directed to perform all the duties commonly incident to that office;shall have authority to execute in the name of the Corporation contracts, leases and other written instruments to be executed by the Corporation; and, shall perform such other duties as the Board of Directors may from time to time determine. AND IT IS FURTHER RESOLVED, that all actions heretofore taken by the officers of the Company on behalf of and in the name of the Company, relating to the conduct of the business of the Company, the expenditure of money, the making of contracts and all other acts taken or omitted in the performance of their duties to the Company be,and the same hereby are, in all respects,approved,ratified and affirmed,as of the date taken, done or omitted,respectively. The actions taken by the Board Consent shall have the same force and effect as if taken by the undersigned at a meeting of the Board of Directors,duly called and constituted pursuant to the Bylaws of the Corporation and the laws of the State of California. This Board Consent may be executed in counterparts, each of which shall be deemed an original,but all of which together shall constitute one and the same document. )SIGNATURE PAGE FOLLOWS IN WITNESS WHEREOF, the undersigned, being all of the members of the Board of Directors of Elecnor Belco Electric, Inc., have executed these actions by written consent as of the date first written above. • Argimiro Rarnoq, Director Ignacio Pr o, D ector Jose Miguel Franco,Director BIDDER: Elecnor Belco Electric, inc. SECTION 2 BID DATA FORMS CBF-5 BIDDER'. Fleenor Belcu Electric,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 Bidders name and page number. 2.A BID BOND KNOW ALL MEN BY THESE PRESENTS: THAT Elecnor Delco Electric,Inc. ,as Principal, and Fidelity and Deposit Company of Maryland , as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of • Ten Percent of Amount Bid DOLLARS (5 10% ), being not less than ten percent (10%) of the Total Bid Price;for the payment of which sum will and truly to be made,we bind ourselves, our heirs,executors, administrators, successors,and assigns,jointly and severally, firmly by these presents. WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work required for the ROSEMEAD PARK PEDESTRIAN LIGHTING PROJECT as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated February 1,2017 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 1st day of February , 2017 Fleenor Bele. I - . (SEAL) !_4 (SEAL) Principal / Suzy Seture Signature Adam Martin,Attorneyto-Fart (: lvls p��ld�a1[ CBF-6 ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identdy 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 LL-'1)\ • County of `Uel IYCT if O' } /� -{- On�Cfi( 1Ci1 IZoj7 before me, Lh11,IC C<ia) fl• tci- a d(c arl fr personally appeared J"X111 who proved to me on the basis of satisf tory evidence to be the person(s) whose name(s) Is re subscribed to the within instrument and acknowledged to me that Iii.he/they executed the same inEgieritheir authorized capacity(ies), and that by er/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ' v4. OLIVIA CHEA WITN my and and official seal. y-' .� , Commission No.21%7414 ^S/ • , �� � NOTARY NARDINO IFORNIACODNTY t /\ \ I ""IIVA/ MySComm EMaf APRIL�teee0 g 1` Notary Public Sig alure (Notary Public Seal) JJ ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS POR COMPI.l ZINC THIS FORM DOCUMENT Thissj rut complies with current California volutes regarding,lor�»ordng incl. DESCRIPTION OF THE ATTACHEDy ded,should be completed and ato the dxvment.9clawhvedgetsfrom completed }� i other stares may he completed for documents being sent to that nam so lung at the jl/✓s n ording does not require the California notary ro violate California notary nae (Title or description of attached bocumenl) • State and County information must be the State and County where the document signcrts)personally appeared before the notary public for acknowledgment --- • nate t omnruLon must be the date that the signer(st personally appeared which (brie ortlewi p of attached document continued) must also be the same date the acknowledgment is completed • the notarypublic must print his or her nameappears x+.thin his or her Number of Pages Document Date on a followed taw comma and mer your title(notary public • Print the name sl of document signer(s) who personally appear at rhe time of nol , CAPACITY CLAIMED BY THE SIGNER I • Indicate the correct singular or plural forms by crossing off incorrect forms(e Individual (s) he) h the" g thet r Failure toti a this information mayFormation rndy lead too rejection ofd [recording. r oral Facier[ • Thenotaryseal impressiont be drphotographicallytxl reproducible '�� � Impression must not cover text or lines. If tial pression smudges.re-seal if a It e sufficient area permits,otherwise complete a different acknowledgment form. Cl Partner(s) • Signature of the notary public most match the signature on file with the office of Me county clerk ❑ Attorney-in-Fact a Additional information is not required hut could help to ensure this I] Trustee(s) ucknowledgment If not misused or attached to a different document Other a Indicate title or type of attached document,number of pages and date f o Indicate the capacity claimed by the signer It the claimed capacity is a corporate officer,indicate the title Ii e CEO.CFO.Secretary) • Securely attach this document to the signed document with astaple ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. Connecticut State of 6titFfb%NY County of Hartford On February 1, 2017 before me, Ashley Sinclair (insert name and title of the officer) personally appeared Adam Martin who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. ASHLEY SINCLAIR NOTARY PUBLIC-173125 MY COMMISSION EXPIRES JAN.31,20V Signatur ./���r �4Seal) ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY.a corporation of the Slate of New York. the COLONIAL AMERICAN CASUALTY ANI) SURETY COMPANY,a corporation of the Stale of Maryland.and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"). by GERALD F.HALEY,Vice President.in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which are set forth on the reserse side hereof and are hereby certified to he in full lorce and effect on the date hereof, do hereby nominate, constitute,and appoint Nicole Ann CLARK,Jennifer M.GARTEN,Danielle D.JOHNSON,Aire LOPEZ,Adam MARTIN,Michelle Anne McMAIION,Aimee R.PERONDINE,Brian PETERS and Donna NI.PLANETA,all of Hartford,Connecticut, EACH its true and lawful agent and Attorney-in-Fact,to make,execute,seal and deliver,for,and on its behalf as surety,and as its act and deed:any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall he as binding upon said Companies, as fully and amply. to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZIiRICH AMERICAN INSURANCE COMPANY at its office in New York. New York..the regularly elected officers of the COLONIAL AMERICAN CASUALTY ANI) SURETY COMPANY at its office in Owings Mills. Maryland.. and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills. Maryland.. in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8.of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND.this 26th day of September.AD.2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND (Drum. ZA°*urs7s, *� ®•• l' tate ,Z , g ' V« F , r`t/ By Secretary Vice President Erie 1). Banes Gerald E Haley State of Maryland County of Baltimore On this 26th day of September.A.D.2016.before the subscriber.a Notary Public of the Slate of Maryland duly commissioned and qualified.GERALD F.HALEY.Vice President,and ERIC D.BARNES,Secretary, of the Companies.to Inc personally known to be the individuals and officers described in and who executed the preceding instrument.and acknowledged the execution of same and being by me duly sworn_deposdb and saith.that he/she is the said officer of he Company aforesaid,and that the seals affixed to the preceding imml merit are the Corporate Seals of said Companies.and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WI IEREOF.I hasc hereunto set my hand and affixed my Oficial Seal the day and year first above written. 'i,�itolr✓gtt'E 12 Maria D.Adamski.Notary Public My Commission ExpiresJuly 8.2019 POA-F 063-9180A BIDDER, Elecnor Delco Electric, Inc. 2.B LIST OF PROPOSED SUBCONTRACTORS In compliance with the "Subletting and Subcontracting Fair Practices Act,' Sections 4100 through 4114 of the California Public Contract Code, and any amendments thereto, each Bidder shall provide the information requested below for each subcontractor who will perform work, labor or render service to Bidder in or about the construction of the Work in an amount in excess of one-half of one percent(greater than 0.5%) of the Bidder's Total Bid Price, or, in the case of bids or offers for the construction of streets or highways, including bridges, in excess of one-half of 1 percent of the Contractor's total bid or ten thousand dollars ($10,000), whichever is greater, and shall further set forth the portion of the Work which will be done by each subcontractor. Bidder shall list only one subcontractor for any one portion of the Work. Pursuant to Public Contract Code Section 4104,the Owner has determined that it will allow Bidders twenty-four(24)additional hours after the deadline for submission of bids to submit the information requested by the Owner about each subcontractor,other than the name and location of each subcontractor. If the Bidder fails to specify a subcontractor for any portion of the Work to be performed under the Contract, it shall be deemed to have agreed to perform such portion itself, and shall not be permitted to subcontract that portion of the Work except under the conditions hereinafter set forth below. Subletting or subcontracting of any portion of the Work in excess of one half of one percent (greater than 0.5%)of the Total Bid Price or,in the case of bids or offers for the construction of streets or highways, including bridges, in excess of one-half of 1 percent of the Contractors 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-7 BIDDER. Elecnor Belco Electric, Inc. 2.B LIST OF PROPOSED SUBCONTRACTORS(continued) "Duplicate Next 2 Pages it needed for Ilsbng additioner subcontraclorsl'I Name and Location Description of Work of Subcontractor V�` /JIr.,li1V l//I/ to be Subcontracted Name. Address: License No.. Department of Industrial Relation Registration No. Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address. License No. Department of Industrial Relation Registration No. Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: License No. Department of Industrial Relation Registration No. Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: License No: Department of Industrial Relation Registration No. Name and Location Description of Work of Subcontractor to be Subcontracted Name. Address: License No.. Department of Industrial Relation Registration No. CBF -8 BIDDER. Elecnor Belco Electric, 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'. *Please see attached 1 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 familiar with project Contract amount Type of Work Date Completed 4. Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed CBF-9 belco References elecnor group Project Name Interconnect and Traffic Signal at La Mesa Project Description Interconnect,Traffic Signal, Fiber Optics Approximate Construction Date January 2014 - May 2014 Agency City of Victorville Address 14343 Civic Drive Contact Person Greg Heldreth Telephone 760-243-6360 Original Contract Value $1,169,918.00 Final Contract Value $1,278,432.85 Comments Extra work intiated by Agency Project Name Harvey/Wilson and Broadway Traffic Signal Project Description Traffic Signal Approximate Construction Date July 2015-September 2015 Agency City of Glendale Address 600 E. Broadway Room 2015, Glendale, CA 91206 Contact Person Sarkis Oganesyan Telephone 818-548-3945 Original Contract Value $308,000.00 Final Contract Value $316,285.83 Comments Extra work initiated by Agency Project Name Glasse!! St and Palm Ave Traffic Signal Project Description Traffic Signal Approximate Construction Date May 2015-September 2015 Agency City of Orange Address 300 E. Chapman Avenue, Orange, CA 92866 Contact Person Medel Llanes Telephone 714-744-5535 Original Contract Value $293,000.00 Final Contract Value $322,096.87 Comments Extra work initiated by Agency Project Name Traffic Signal Modernization Phase 6 Project Description Traffic Signal,Street Lighting, Fiber Optics Approximate Construction Date October 2014 - February 2015 Agency City of Newport Beach Address 100 Civic Center Drive, Newport Beach, CA 92660 Contact Person Brad Sommers Telephone 949-644-3311 Original Contract Value $734,072.00 Final Contract Value $837,264.73 Comments Extra work initiated by Agency Project Name Greenspot Road Improvements Project Description Traffic Signal, Street Lighting, Fiber Optics Approximate Construction Date June 2014- December 2014 Agency City of Highland Address 27215 Baseline, Highland, CA 92346 Contact Person Carlos Zamano Telephone 909-864-6861 Original Contract Value $1,606,300.00 Final Contract Value $1,724,048.57 Comments Extra work initiated by Agency Project Name Stewart Street Underpass Project Description Traffic Signal,Street Lighting Approximate Construction Date January 2014-August 2014 Agency City of Loma Linda Address 25541 Barton Rd., Loma Linda,CA 92354 Contact Person USS Cal Builders *Subcontract Work Telephone 714-828-4882 Original Contract Value $471,050.00 Final Contract Value $551,122.10 Comments Extra work initiated by Agency Project Name Grand Avenue Widening From 1st St to 4th St Project Description Traffic Signal,Street Lighting, Fiber Optic Approximate Construction Date November 2014 -September 2015 Agency City of Santa Ana Address 20 Civic Center Plaza, Santa Ana, CA 92701 Contact Person Excel Paving *Subcontract Work Telephone 562-599-5841 Original Contract Value $494,087.00 Final Contract Value $557,097.90 Comments Extra work initiated by Agency Project Name Gateway Cities ATMS Improvement Project Project Description Video Detection Systems Approximate Construction Date February 2015 -June 2015 Agency County of Los Angeles Department of Public Works Address 900 5. Fremont Ave.,Alhambra, CA 91803 Contact Person Omid Eman Telephone 626-607-7444 Original Contract Value $1,362,615.00 Final Contract Value $1,362,615.00 Comments Project Name Jeffrey Regional Bike Trail Project Description Bike Trail Lighting Approximate Construction Date January 2014- May 2014 Agency Irvine Community Development Company Address 550 Newport Center Dr., Newport Beach, CA 92660 Contact Person Hillcrest Contracting *Subcontract Work Telephone 951-273-9600 Original Contract Value $281,000.00 Final Contract Value $281,000.00 Comments Project Name Barham Blvd Street Improvements Project Description Traffic Signal and Street Lighting Approximate Construction Date December 2014- May 2015 Agency City of Los Angeles Address 555 S. Flower St, Los Angeles, CA 90071 Contact Person USS Cal Builders *Subcontract Work Telephone 714-828-4882 Original Contract Value $106,400.00 Final Contract Value $106,400.00 Comments BIDDER' Elecnor Delco ELectric, Inc. SECTION 3 NON-COLLUSION AFFIDAVIT CBF- 10 BIDDER: Elecnor Belco Electric, 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. ALP PA Sigr- So• ong Typed or Printed Name Vice President Title Elecnor Belco Electric, Inc. Bidder Subscribed and sworn before me This_day of , 20 (Seal) *Please see attached Notary Public in and for the State of California My Commission Expires: CBF- 11 JURAT 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 1A1�n TLirat.itto • Subscribed and sworn to (or affirmed) before me on this qday of vermeil/1 2011 by 361W\ \NCY1,6i proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. I .• • —1 OLIVIA CFiEA i 6 . NOTARY PIALICULIFORNIA ^ ' •tl Sign e (Seal) Comm lERNMpND COUNTY • Oh CaEars APPoLtalo ♦ a OPTIONAL INFORMATION INSTRUCTIONS The wading of all Jurats competed in Ca7ornia alley January 1. 2015 must be in the ! Mm as set forth within this Jurat There are no exceptions If a Jurat to be completed does not follow this formthe notary must correct the vertiage by using a lural stamp containing the correct wading or attaching a separate jure!form such as this one with does contain the proper wording. In addition. the notary must require an oath or DESCRIPTION OF THE ATTACHED DOCUMENT allmmahon from the document signer regaling the truthfulness of the contents of the document The document must be signed AFTER the oath or affirmation if the document Non Collusion Affidavit was previously signed, n must be resigned In front of the notary public during the Jural (Title or desomphon of atttlled document) process. • State and county information must be the stale and county where the (Title ortlaoipAon of attathed tlocuma'itwnfinuetl) document signer(s)personally appeared before the notary public. • Date of notarization must be the date the signer(s) personally • appeared which must also be the same date the jurat process is completed • Number of Pages Document Date • Pnnt the name(s)of the document signer(s)who personally appear at the time of notarization. • Signature of the notary public must match the signature on file with the Additional information office of the county clerk. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines.If seal impression • smudges. re-seal if a sufficient area permits, otherwise complete a different jurat form. • Additional information Is riot required but could help to ensure this jurat is not misused or attached to a different document. ♦ Indicate title or type of attached document,number of pages and date. '"' • Securely anon this document to the signed document with a staple.