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Bidder: DBX, Inc. CITY OF ROSEMEAD TRAFFIC SIGNAL MODIFICATIONS PROJECT SAN GABRIEL BOULEVARD AT RUSH AVENUE PROJECT No. 27004 CONTRACT BID FORMS BIDDER 1De;Xb Inc CONTRACT BID FORMS TABLE OF CONTENTS SECTION 1 BID SCHEDULE 1 SECTION 2 BID DATA FORMS 5 2.A BID BOND 6 2.B LIST OF PROPOSED SUBCONTRACTORS 7 SECTION 3 NON-COLLUSION AFFIDAVIT 10 BIDDER: 1 '( X,Tnc I SECTION 1 - BID SCHEDULE' CBF- 1 BIDDER: 0\51,-, Snc, BID SCHEDULE SCHEDULE OF PRICES FOR TRAFFIC SIGNAL MODIFICATIONS PROJECT SAN GABRIEL BOULEVARD AT RUSH AVENUE PROJECT No. 27004 BASE BID SCHEDULE UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 1 Clearing &Grubbing per plans LS 1 and specifications. 15°0'00 j c500.1/430 2 Disposal of Waste Materials. LS 1 1500.W IS0.).CO 3 Construct Traffic Signal LS 1 Modifications at San Gabriel Boulevard and Rush Avenue per (MAXI.00 q giD$j.W Plans and Specifications Complete. TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ j 01 onchu.ry.red otle.tkou So-14Si x )IAAm4.Jtr) •Pi d1 oar ri 000-15 a�' Zen ce,dg Dollar amount in written form 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 The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract for the Work is fully executed by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 eertified chock, a k„sl,i„roThhcck or a bid bond in the amount of Ten*vtenCo(=ioid Dollars (SKY%) ) 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. CBF -2 BIDDER: Cw' XLt1c. If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be prepared by the Owner for execution,within five(5)Calendar Days following the Letter of Award for the Contract,and will deliver to the Owner within that same period the necessary original Certificates of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other documentation and certification required by the Contract. The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the Business and Professional Code), arising from purchases of goods, materials or services by the Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and become effective at the time the purchasing body tenders final payment to he Contractor. Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence satisfactory to the Owner of Bidder's California contractor's license(s)in good standing;(2)evidence that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting therefrom; and (3) any other information and documentation, financial or otherwise, needed by Owner to award a Contract to the lowest responsible and responsive bidder. Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts of five hundred dollars ($500.00) if project is not completed in THIRTY (30) 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. I,aZe The Bidder understands and agrees that the Total E id Price is inclusive of all labor, materials, and equipment or supplies necessary to complete the W ark 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 at compensation in full for all Work under the contract. CBF -3 �, BIDDER: nX6Inc. By: Si nattuu.��e) C 42o24 AtYarakp AIVarodo Suij-e, Business Street Address James C. terry _rernensln CA 925QO Type or Print Name Cit,I, State and'Zip Code Presider& Seuriany ITreasuI'eb— G51-29ta-4'9o9 Title Te aphone Number Bidder's/Contractors State of Incorporation: al ) i 40; n 0- Laing 42o24 AVeni da N t varuM dia,Temec.J•, ca 4264o Partners or Joint Venturers: Bidder's License Number(s): 2`-10541 144C-10 'Q4(12.-1)311\7 Department Industrial Relations Registered No. 10uoo042Vz e4o. t�13oh'1 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 CERTIFICATION OF RESOLUTION I, James C. Perry, Secretary of DBX, Inc. a California corporation, do hereby certify that the attached RESOLUTION OF OFFICER'S AUTHORITY, to which I hereby attest, is a full, true and correct copy of a resolution of the Board of Directors of said corporation, duly adopted and approved by regular action of the said Board of Directors taken on February 27, 2017 in full conformance with the law and the By Laws of said corporation. I further certify that the resolution is still in full force and effect and has not been amended or revoked. IN WITNESS WHEREOF, I have hereunto set my hand as such Secretary, and affixed the corporate seal of said Corporation. I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed at Temecula, California on April 4, 2017.17`x( mes C. Perry, Secretary SEAL 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 ) PHYLLISSA MARi2 [ an. Notary PUMit.California f[[ SS. '-.'1si Riverside County v .1 Commissions 2169144 COUNTY OF RIVERSIDE ) 0 Comm.Exifu Au,114.2020 Subscribed and sworn to before me this 4th day of April, 2017, by James C. Perry, proved to me on the basis of satisfactory evidence to be the person who appeared before me. RESOLUTION OF OFFICER'S AUTHORITY "WHEREAS, from time to time this corporation, being DBX, Inc., a California corporation, Is called upon to execute documents by which this corporation enters into contracts, bonds, obligations of performance, surety and of other legal consequences, and "WHEREAS, third persons may require or request come written authority evidencing and identifying those persons who are officers and authorized to execute such documents for and on behalf of this corporation, now, therefore, it is "RESOLVED, that JAMES C. PERRY, who is President and Chief Executive Officer of this corporation, be, and he hereby is, and has been, empowered, authorized and directed to execute any and all kinds of documents, contracts, bonds, obligations of performance, surety and other documents by which this corporation assumes legal obligations, dealing with private and public entities, and "RESOLVED FURTHER, that any person who relies upon the authority granted and conferred in this resolution shall be indemnified and held harmless from any claim with respect to the existence or non-existence of such authority, and may continue to do so until personally receiving written notice that the authority herein conferred has been terminated." Dated: February 27, 2017 • .ames C. Perry, Secretary SEAL BIDDER: V'E')C Tri c_ I SECTION 2 I BID DATA FORMS CBF-5 BOND#8-B PREMIUM: NIL BIDDER: DBX, INCORPORATED 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 j3ID BOND KNOW ALL MEN BY THESE PRESENTS: THAT DBX, INCORPORATED as Principal, and THE GUARANTEE COMPANY OF NORTH AMERICA USA , 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% 3, being not less than ten percent (10%) of the Total Bid Price;for the payment of which sum will and truly to be made,we bind ourselves, our heirs, executors,administrators,successors, and assigns,jointly and severally, firmly by these presents. WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work required for the TRAFFIC SIGNAL MODIFICATIONS PROJECT AT SAN GABRIEL BOULEVARD AND RUSH AVENUE as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated APRIL 5, 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 Bld 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 shaff pay all costs Incurred by the OWNER in such suit, including reasonable attorneys fees to be fixed by the court. SIGNED AND SEALED, this 29TH dayof MARCH , 20 i7 . THE GUARANTEE COMPANY DBX, INCORPORATED (SEAL) OF NORTH AMERICA USA (SEAL) Principal //� nature Torre c. r1,3By: SignatUeCHAL. FLARE, Fhevid.en ICeciR nrS. ATTORNEY-IN-FACT CBF-6 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 rcr, .cnvrm caCCS'.:e.-Cc cCcr4r.r.r.c caect T,rT -7< . :r..rt:CCA'...r...ferne<ACCCC..CCCOcr.G<.CcKccn„rrc.,x. 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 Riverside ) On 14j4In before me, Phyllissa Martz, Notary Public Date Here Insert Name and Title of the Officer personally appeared James C. Perry Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies),and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. PHYLLl558 MARTZ WITNESS my hand and official seal. �!Ra. Notary Public . California Y 4. ,i, Nivxala camry �IU{�.U✓iY.J61`}'n.�l - % WMnba a 21 11.24 Signature ,, Comm.•CoVI Aft AW l 1,2024 Signature of Notary Pu is 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: James C. Perry __- Signer's Name: ik Corporate Officer — Title(s):President/Secretarv/Treas. H Corporate Officer — Title(s): I Partner — -I Limited ❑General -1 Partner — ' ' Limited ;General I Individual I I Attorney in Fact ! Individual i I Attorney in Fact i Trustee I I Guardian or Conservator I Trustee Guardian.or Conservator H Other: 1 Other: Signer Is Representing: Signer Is Representing: z--- .e. e d r. . .d.. .az•z-<z Teoz otc wr.E.zz. .zzx.me wz-cazoccca.cucaz c- en-z. �x ©2014 National Notary Association •www.NationalNotaiy org • 1-800-US NOTARY(1-800-876-6827) Item#5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. • STATE OF CALIFORNIA County of Orange 11 On 3-29-17 before me, Lexie Sherwood , Notary Public, Date Insert Nam I Notary exactly a it appears on the official seal personally appeared Charles L. Flake Name(s)of Signerls) ' who proved to me on the basis of satisfactory evidence to I be the person(s) whose name(s) is/are subscribed to the III I within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), LEXIE SHERWOOD and that by his/her/their signature(s) on the instrument the 11 04..,:f COMM.#2031752 a acted, (s), or the entity upon behalf of which the person(s)I acted, executed the instrument.2NOTARYPUBLICO CALIFORNIA n £ ORANGECOUNTY 27. Comm.Exp.JULY z�,zon 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 o tial seal. Signature ,N "/ Place Notary Seal Above Signature of Not Public exie herwood • Ilj OPTIONAL -- - Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of the form to another document. • Description of Attached Document Title or Type of Document: _ • IDocument Date: Number of Pages: - I'i Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: _ [11Individual ❑ Individual i ❑ Corporate Officer—.Title(s): 0 Corporate Officer —Title(s): ❑ Partner ❑Limited 0 General 0 Partner ❑Limited❑ General ❑ Attorney in Fact RIGHT THUMBPRINT ❑ Attorney in Fact RIGHTTHUMBPRINT ❑ Trustee OF SIGNER ❑ Trustee DESIGNER ❑ Guardian or Conservator Top of thumb here ❑ Guardian or Conservator Top of thumb here ❑ Other: ❑ Other: Signer is Representing: Signer is Representing: JI • ill THE The Guarantee Company of North America USA GUARANTEE Southfield,Michigan POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS:That THE GUARANTEE COMPANY OF NORTH AMERICA USA,a corporation organized and existing under the laws of the State of Michigan,having its principal office in Southfield Michigan,does hereby constitute and appoint David L.Culbertson,Charles L.Flake.Richard A.Coon,Spencer Flake Culbertson Insurance Services.Inc. its true and lawful attorney(s)-in-fad to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof,which are or may be allowed,required or pemlitted by law,statute,rule,regulation,contract or otherwise. The execution of such instrument(s)in pursuance of these presents,shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply, to all Intents and purposes, as if the same had been duly executed end acknowledged by its regularly elected officers at the principal office. • The Power of Attorney is executed and may be certified so,and may be revoked,pursuant to and by authority of Article IX,Section 9.03 of the By-Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31°day of December,2003. • The President,or any Vice President,acting with any Secretary or Assistant Secretary,shall have power and authority; • • 1. To appoint Attomey(s)-in-fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto. bonds and undertakings,contracts of indemnity and other wsilings obligatory in the nature thereof and 2. To revoke,at any time,any such Attorney-in-fact and revoke the authority given,except as provided below 3. In connection with obligations in favor of the Florida Department of Transportation only,it is agreed that the power and authority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee,shall not relieve this surety company of any of its obligations under its bond. 4 In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to Me Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner– Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. Further,this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting duly called and held on the fith day of December 2011,of which the following Is a true excerpt: RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond,undertaking,contracts of indemnity and other writings obligatory in the nature thereof,and such signature and seal when so used shall have the same force and effect as though manually affixed. „w.. IN WITNESS WHEREOF,THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and � y`t+5 is corporate seal to be affixed by its authorized officer,this 23rd day of February,2012. 9 15�/g' THE GUARANTEE COMPANY OF NORTH AMERICA USA R, p � h +,Pai_. i STATE OF MICHIGAN Stephen C.Rusehak,President dr COO Randall Musselman,Secretary County or Dekland On this 23rd day of February,2012 before me came the individuals who executed the preceding instrument,to me personally known,and being by me duly sworn,said that each is the herein described and authorized officer of The Guarantee Company of North America USA,that the seal affixed to said instrument is the Corporate Seal of said Company,that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of Cynthia A. Tekal IN WITNESS WHEREOF,I have hereunto set my hand at The Guarantee , 4mliLs ., NotaryPublic,Stale of Michigan Company of North America USA offices the day and year above written. T t4et County Expires Febrdu a. ---7-; ,4,l >w v�N.3:. My Commissionnty of sFebruaryD, 2018 l/.e/�. � ,.>^x Acting In Oakland County I,Randall Musselman,Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA,which is still in full farce and effect. i rrt\ IN WITNESS WHEREOF, I have thereunto sot my hand and attached the seal of said Company this 29 c hday of March .2017 • /0We1 -- • \N'I,-l Randall Musselman,Secretary BIDDER: C>6X, m-i.c. 2.6 LIST OF PROPOSED SUBCONTRACTORS In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100 through 4114 of the California Public Contract Code, and any amendments thereto, each Bidder shall provide the information requested below for each subcontractor who will perform work, labor or render service to Bidder in or about the construction of the Work in an amount in excess of one-half of one percent(greater than 0.5 %) of the Bidder's Total Bid Price, or, in the case of bids or offers for the construction of streets or highways, including bridges, in excess of one-half of 1 percent of the Contractor's total bid or ten thousand dollars ($10,000), whichever is greater, and shall further set forth the portion of the Work which will be done by each subcontractor. Bidder shall list only one subcontractor for any one portion of the Work. Pursuant to Public Contract Code Section 4104,the Owner has determined that it will allow Bidders twenty-four(24)additional hours after the deadline for submission of bids to submit the information requested by the Owner about each subcontractor,other than the name and location of each subcontractor. If the Bidder fails to specify a subcontractor for any portion of the Work to be performed under the Contract, it shall be deemed to have agreed to perform such portion itself, and shall not be permitted to subcontract that portion of the Work except under the conditions hereinafter set forth below. Subletting or subcontracting of any portion of the Work in excess of one half of one percent (greater than 0.5%)of the Total Bid Price or, in the case of bids or offers for the construction of streets or highways, including bridges, in excess of one-half of 1 percent of the Contractor's total bid or ten thousand dollars ($10,000), whichever is greater, for which no subcontractor was designated in the original bid shall only be permitted in cases of public emergency or necessity, and then only after Owner approval. CBF-7 BIDDER: nby. ihC. 2.B LIST OF PROPOSED SUBCONTRACTORS (continued) ("Duplicate Next 2 Pages if needed for listing additional subcontractors-'I Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: N ,lU NIL License No.: Department of Industrial Relation Registration Na 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: cbS.,I c. 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: 1. C4•1 oC COOme\\0- 1S\5 Syib14-) Si . Cockchel\a CR cw25.0 Name and Address of Owner OSCnr 9tainczc1 `1e0.3g8,S144 Name and telephone number of person familiar with project 7 350,184.2o 'S 9t14 SyntirD6Vs a, 17-12A)Ito Contract amount Type of Work Date Completed 2. C;ky oTwerrhinine Palms t PO dos- gQSj-1wen4Y„;ne Palm. Cr; g2,21-1 Name and Address of Owner R;r hoick larder'Srn 10-361-11199 Name and telephone number of person familiar with project 353,1 1o2 lir*. Clic S iriiipt tin f1?T.1Aaflit‘ rFri 11Co Contract amount Type of Work Date Completed 3. ('H 0c La Verres 366o t Streel L{,v erne co gns0 Name and Address of Owner Cody Ho.Ad.no, 61o9-SQL(-Q107- Name and telephone-number of person familiar with project 31A ,088.b5 TroePic-Sip rW SrSbo.fio>, 161vo111a Contract amount Type df Work Date Completed 4, rounAj of• it‘bers; 3S7.S 1 M±h 5+., !ti‘„rens ‘o en g7SUl Name and Address of Owner SJPn n-wnd.e2cc GSI- QSS to too Name and telephone number of person familiar with project 38O ,8bB . SZ Tru FFc S',grYJ s'nt+alld ., 313al1-‘0 Contract amount Type of Work Date Completed CBF- 9 BIDDER: cTheil ,�,ic• ISECTION 3 I NON-COLLUSION AFFIDAVIT CBF - 10 BIDDER: Den /=nc • 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. S' nature James C. Perry Typed or Printed Name Pres dent 1 Socreh n) 1 Tr eUSwe' Title \--36X. Inc Bidder Subscribed and sworn before me This day of 20 See aM-I-acked ffuvur (Seal) Notary Public in and for the State of California My Commission Expires: CBF- 11 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE§8202 � s�crcrrcrrm.cCate.far,.rxr:rcc -- --.czar..iC<ACC rvrvr rnrcncccs..,rm.E.tmrerrtr r „ l�!S`rcee Attached Document (Notary to cross out fines 1-6 below) ❑See Statement Below (Lines 1--6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2(f any) 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 Subscribed and swom to (or affirmed) before me County of vderS;de - on this 4 day of 0prt 1 , 201-7 , by Date Month Year (1) 30071e C . Perr (and (2) ), VHy .ISSA-MACi1RPTTOfpNames) of Signer(s) %R 1r' NotarYUPUWCh Riverside UntY .r% Commission Ti598aa proved to me on the basis of satisfactory evidence My Comm.Eret Al II,20201 to be the person(s) who appeared before me. Signature ". -"I\.L(irv. eni.Qil& Signature of Notary Public Seal 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: iY.,:c['4`u,`W`td,YdwcG:'V:s. z-C^=G`�rsiciv(.`cV`bcdrocigixtddx.witywc` (:`ti<dx.`_*.'uc'yiy .<4` (.'v(.w...'“(.`add,yy.`c(.e44r4Y ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5910