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F.M. Thomas Air Conditioning, Inc. - NIB No. 2020-03 - Garvey Park Gym Cooling Additions - Project No. 31019 CITY OF IROSEIVIE C ALIFORl�1IA-.. CONTRACT DOCUMENTS .�--, SPECIFICATIONS A.I"Tb•STAN00l)-I) wNGS . F.OI2 > • 'GARVEY'PARK.GYMCOOLING9ADDITION PROJECT No;3101 . FISCAL YEAR:2019 2020 IN THE CITY'•:OF ISOSE-1 . EA:D 5 6 M f a , c d- (.7 .,5.,,,,..„::::•.,......'--:",,,.''''.,•:'.••:-E,.:;•...-'.•:.:1'..;:l.:•!...,,-.,•:..,_.i.'.7.:_':_'''•_:::::,:::.1'.1::::::: ...1.1-,-.7:::::,.-:-,::T.',.:.‘,. ..-:,.:,,ri,, .,...--,,,•-:..,.•:::".:-.,...r:,,: .:::::,.......-: • .•.`�pPtlle4 PUI LICWO&KS`DEP RTI�IENT,ENGINEERINGDIVISION 8838E VALL•EY BOULEVARID; ROSEMEAD,CA 91770 'TELEPHON:E:•(626)569-2150 FAXi;(62.0)307.9218 1 ' BILDS DUEWEDNESDA ;-MARCHi18,2020,AT 10;30 AM Q p _' Es R,, ' fie�� _• •9745 . }a PL9Sr1NDSPECIFICATIOIVSAPPROVEDOlYDECfiMBER1019. x EXp:- ,'may CA City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 15 of 630 Bidder's representative. 28. BII➢IDIERt klEgF:ONSIVENUSS-"CI.IECKL-IST" The O'wner's`initial,responsieness evaluation wtll^consider Elle following: A. Completed and properly executed Bid Letter (Including a completed Total Bid Price, completed Bid Bond amount,acknowledged addenda,completed state of incorporation or partner/joint venturer information(if applicable),completed license number,and signature by authorized company officer); B. Completed Bid Data Forms(including valid and properly executed Bid Bond for 10%of the Total Bid Price and a completed List of Proposed Subcontractors); C. Properly executed Non-Collusion Affidavit;and D. Completed and properly executed Bidder Information Forms. If the Bidder is a joint venture,each joint venturer shall prepare and submit a separate form. Extra forms,if needed, can be obtained from the Owner, or photocopied by the Bidder, if necessary. 29. CONTRACT BID FORMS; LISTS OF SUBCONTRACTORS A. Contract Bid Forms. The Bid Letter and Forms must be completed as set forth below. (1) The Contract Bid Forms and Letter must be prepared using ink,indelible pencil or a typewriter. (2) The Bid Letter must be signed by the Bidder or on its behalf by the person or persons having the authority to do so. Proof of the authority to act on behalf of the firm must be submitted when requested. The proof shall be in the form of a certified copy of an appropriate corporate resolution, certificate of partnership or joint venture,or other appropriate document. If Bidder is an entity made up of multiple parties and no person or persons are designated to act on its behalf,all parties shall execute the Bid. (3) Addenda-Receipt of addenda must be acknowledged in the space provided in the Bid Letter. (4) The Bidder shall not delete,modify,supplement or make substitutions thereof,on the printed matter of the Contract Bid Forms or Bid Letter. (5) Corrections shall be initialed by the person who signs the Bid Letter. (6) Exceptions or qualifications to the Bid Documents are strictly forbidden. Any comment by the Bidder which the Owner determines can be construed as altering the requirements of the specifications or the terms and conditions of the Contract will render the Bid nonresponsive and disqualify the Bidder from consideration for award. B. List of Proposed Subcontractors(Forms). State law prohibits substitution of subcontractors listed in the original Bid except as otherwise provided in Sections 4107 and 4107.5 of the California Public Contract Code. Bidders are required ITB - 8 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 3 of 630 CITY OF ROSEMEAD GARVEY PARK GYM COOLING ADDITION PROJECT No. 31019 NOTICE INVITING BIDS �i„ City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 4 of 630 CITY OF ROSEMEAD NOTICE INVITING BIDS NIB No. 2020-03 NOTICE IS HEREBY GIVEN that the CITY OF ROSEMEAD, California, will receive sealed bids up to 10:30 o'clock a.m. on Wednesday, the 18th day of March , and they will be publicly opened at 11:00 a.m. for Type text here GARVEY PARK GYM COOLING ADDITION PROJECT No.31019 The project consists of the installation of cooling addition of the existing Garvey Park Gym building located at 7933 Emerson Place,Rosemead, CA 91770 and consists of new cooling system, electrical, fixtures, framing, and landscaping as indicated in the appendix and other related work as described in the Plans, Specifications,and Contract Documents,by this reference,made a part hereof. The engineer's estimate for this project is $240,000. The successful bidder shall have SIXTY (60)working days to complete the work. Liquidated damages shall be$500.00 per working day. Plans, Specifications, and Contract Documents may be obtained at the office of the City Clerk of the CITY OF ROSEMEAD, 8838 E. Valley Boulevard,Rosemead, California 91770, (626) 569- 2177, for a non-refundable charge of$25.00 and $40.00 if mailing is requested. All prospective bidders must register with the office of the City Clerk's in order for your bid to be considered responsive. SB 854 Requirements: This project is subject to the requirements of SB 854.No prime contractor or subcontractor may be listed on a bid proposal for a public works project unless registered and qualified with the Department of Industrial Relations pursuant to Labor Code section 1725.5. No prime contractor or subcontractor may be awarded a contract for public work on a public works project unless registered and qualified with the Department of Industrial Relations pursuant to Labor Code section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. The bid proposal must include a print out from the DIR registration website showing that the prime contractor and each subcontractor is currently registered and qualified. No bid proposals will be accepted nor any contract entered into with a prime contractor without proof of registration as required above. [Unless within the limited exceptions from this requirement for bid proposals only under Labor Code Section 1771.1(a)] Each bid must be accompanied by a bidder's security in an amount not less than 10% of the amount of the bid, as a guarantee that the bidder will, if awarded the Contract, enter into a satisfactory agreement and provide a Performance Bond and a Payment Bond, each not less than 100%of the total amount of the bid price. NIB- 1 i City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 7 of 630 CITY OF ROSEMEAD GARVEY PARK GYM COOLING ADDITION PROJECT No. 31019 • • INSTRUCTION TO BIDDERS City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 18 of 630 BIDDER: 00GE0❑GEOCLE000❑❑CC0GGG0 F.M. Thomas Air Conditioning, Inc. CITY OF ROSEMEAD r.. GARVEY PARK GYM COOLING ADDITION PROJECT No. 31019 SECTION 1-BID SCHEDULE CONTRACT BID FORMS { { CBF- 1 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 19 of 630 BIDDER: ❑t=r❑CM❑COLAJ❑C iDJ4U❑CODEO F.M. Thomas Air Conditioning, Inc. BASE BID SCHEDULE SCHEDULE OF PRICES FOR GARVEY PARK GYM COOLING ADDITION PROJECT No.31017 NO. ITEM DESCRIPTION UNIT EST. UNIT ITEM QTY. PRICE COST Install a Packaged DX Rooftop Unit to \15/11(..'`'S 1 Serve the Gymnasium, and the LS 1 $9) 11 fi 1 e`'$ F M 1,11400 Installation of a 480 Panel to Facilitate the Newly Added Equipment TOTAL BASE BID AMOUNT IN NUMBERS $1 7t-71E-1-,a; TOTAL BASE BID AMOUNT IN WORDS: 1-14 rtv'-t 2t,t - An,DV S CLVi S e, eAll Ire,)4-(r-el ver C\o\ 001 C. Note:The City ofRosemead 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. ALTERNATE 1 BID SCHEDULE SCHEDULE OF PRICES FOR GARVEY PARK GYM COOLING ADDITION . • PROJECT No.31017 NO. ITEM DESCRIPTION UNIT EST. UNIT ITEM QTY. PRICE COST Install a Split System to Serve the 1 Private Office LS 1 $1-1)76 $2'1116 Z .0 0 TOTAL ALTERNATE 1 BID AMOUNT IN NUMBERS $ � 71 7 6 2 • • CBF-2 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 20 of 630 BIDDER: ❑❑❑DO❑❑❑❑❑❑❑❑❑❑❑Co mom F.M. Thomas Air Conditioning, Inc. TOTAL ALTERNATE 1 BID AMOUNT IN WORDS: •'t—W4e.�R..n y et VAkf' S i �,c tw0 (k O Sk&'c , 1 ALTERNATE 2 BID SCHEDULE f SCHEDULE OF PRICES FOR GARVEY PARK GYM COOLING ADDITION PROJECT No.31017 EST. UNIT ITEM NO. ITEM DESCRIPTION UNIT QTY. PRICE COST 1 Install Exhaust Fan to Serve Both the LS 1 $1 e..S 7� �-�a��$ Gj?jLr.00 Men's and Women's Restrooms i TOTAL ALTERNATE 2 BID AMOUNT IN NUMBERS $ j 3 vo TOTAL ALTERNATE 2 BID AMOUNT IN ,WORDS: EC 1/`I i-k�kOVSG-vL A •�l VL' `'lAAA AveA Ort- -ccoc 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 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 CBF- 3 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 21 of 630 BIDDER: 0❑❑mCTf 7i D3000 ❑ F.M. Thomas Air Conditioning, Inc. 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 the 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 SIXTY(60)working days.The Contract Time will begin to run ten(10)Working Days from the date of the Notice to 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. none 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-4 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 22 of 630 BIDDER: ❑O❑❑❑❑00DDMDCC O=❑❑❑ F.M. Thomas Air Conditioning, Inc. By: �:. rW�� _ 231 Gemini Ave, Brea, Ca 92821 Signature -4111111111111111 Business Street Address Thomas Feyka Type or Print Name City, State and Zip Code President 714-738-1062 r._ Title Telephone Number .... Bidder's/Contractor's State of Incorporation: California Partners or Joint Venturers: Bidder's License Number(s): 313574 r • i . Department Industrial Relations ,�000003383 Registered No. 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- 5 UNANIMOUS CONSENT OF DIRECTORS IN LIEU OF A REGULARLY SCHEDULED ANNUAL MEETING F.M. THOMAS AIR CONDITIONING, INC. A California Corporation The action set forth below are taken by unanimous written consent of the Directors of F.M. Thomas Air Conditioning, Inc. ("Corporation"), a California corporation, without a meeting, in accordance with California Corporations Code section 307 and the Bylaws of the Corporation. In reaching their decision, the Directors have reviewed and considered the various actions taken by the Officers and Agents of the Corporation, have considered the activities of the Corporation during the past year and its plans for the future, and have discussed the Corporation's financial condition. Based on these considerations and on the Board's evaluation of the Corporation's financial condition, the Directors give their unanimous written consent to the adoption of the following resolution: 1. COMPANY ISSUES DELAYED HOLDING OF 2014 ANNUAL MEETING. Due to company issues, the Corporation did not have time to hold the Annual Meeting of Shareholders for the 2014 year. Thus, this written consent action in lieu of the Annual Meeting of Directors for the 2015 year shall serve to update the corporate books from the 2013 meeting. 2. RATIFICATION. The actions of this Corporation's officers that were taken in the conduct of the Corporation's business for, and on its behalf, since the last annual meeting of this Board are adopted, ratified, and approved in all respects as of the dates taken. 3. APPOINTMENT OF OFFICERS. The following persons are hereby appointed to the indicated offices, to serve at the pleasure of the board of directors: Title Name President Thomas M. Feyka Vice President Michael Feyka Secretary Carolyn K. Feyka Chief Financial Officer Carolyn K. Feyka 4. NECESSARY AUTHORITY. The Officers of this Corporation are authorized and directed to take such action and to execute such documents as they may deem necessary or proper to carry out the purpose and intent of the foregoing resolutions. [Signature Page to Follow] 1 Dated: • May i 9, 2015 ..--• _ / . .2„.......,74 Carolyn K. eyka, DRE6OR 1t4i . 2 _= -.;- - , : .R? Thomas M. Feyka, DI C 0 -. � - - • 2 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 23 of 630 BIDDER: OD=OMOOCIDOMODECOM F.M. Thomas Air Conditioning, Inc. SECTION 2 BID DATA FORMS CBF- 0 Bond No. CSBA-13130 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Cordial Page 24 of 630 BIDDER:F.M. Thomas Air Conditioning, Inc. Bidder shall submit its Bid data in accordance with the format shown on each of the following Bid Data Forms. Bidders shall prepare and use as many sheets as are necessary to adequately provide. the information required. Bidder shall ensure that every page of its Bid Data Forms are properly identified with the Bidder's name and page number. 2.A BID BOND KNOW ALL MEN BY THESE PRESENTS: THAT F.M. Thomas Air Conditioning, Inc. ,as Principal, and Merchants Bonding Company(Mutual) , 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 PARK GYM COLLING ADDITION PROJECT—as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated March 18, 2020 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 f„ 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, his 16th day of March , 2020 F.M. Thomas NASInditio Ing, Inc. (SEAL) Merchants Bonding Company(Mutual)(SEAL) Principal BF Surety By: istBy: Signature /i` "gnature Arturo Air Attorney-in-Fact CBF- 7 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 ) On 3/16/2020 before me, Melissa Ann Vaccaro, Notary Public (insert name and title of the officer) personally appeared Arturo Ayala 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. MELISSA ANN VACCARO t WITNESS my hand and official seal. COMM.#2241394 Notary Public-California F, ORANGE COUNTY a ` ; My Comm.Expires May 12,2022 Si9 naturM r� CC .ND(Seal) Melissa Ann Vaccaro • . IV1.ERCTBond No.CSBA-13130 BONDING COMPANY-„ POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC., both being corporations of the State of Iowa(herein collectively called the"Companies")do hereby make,constitute and appoint,individually, Arturo Ayala;Ben Stong;Daniel Huckabay;Dwight Reilly;Frank Morones;Michael D Stong;R Nappi;Shaunna Rozelle Ostrom • their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of MerchantsNational Bonding,Inc.,on October 16,2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." • In connection with obligations in favor of the Florida Department of Transportation only,it is agreed that the power and aut hority 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. In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to the 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. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 11th day of February , 2020 . Gj�'OR O,,..QO; �O• �a`(�POq '09•+ MERCHANTS BONDING COMPANY(MUTUAL) ,/.;•G .1-.1,1. e V �.�yc• MERCHANTS NATIONAL BONDING,INC. 78.= -0- O:� •f-. -o- mac: • • �`: 2003 ;0 :y 1933 :Z. By • :d;. •• i • J•. :��,•• 774_ �••4/ '......'-0 6••• •'•���"• ''`.,,.' President STATE OF IOWA ,''+'"•.... **•..••• COUNTY OF DALLAS ss. On this 11th day of February 2020 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. ,,PVOA<s POLLY MASON. Jr-, Commission Number 750576yA, Z a daeh My Commission Expires Po-tta • iiia • ,..,,,c, January 07, 2023 Notary Public (Expiration of notary's commission does not invalidate this instrument) I,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies,which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 16th day of •March ,2020 . ••,11,ON,q '••• ••1NG.C©A•`. ,„,6, ..csit 4 i:...,..,.:. : --,;.•, 4 •1-:., ,,,,,..„/..e. f...." 1/7" ......."4 's' 2003 ,••Lj •.1e. 1933 3• Secretary POA 0018 %2G) ............'. . 1 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 S. Com.•:. C C <. C_ .1 .•�C 44,, �.•�.••c3:c ca.;aC�Jc.C•.�s� C_ N_RCS•_a�,_..C:ca<:.-C,r.. vc:\*kt.e-i C_r., _�.(�C ,_ 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 )j ) On I0 fl-4 before me, .e�.`& d/ A) `Paial{,C . , Date Here Insert Name and Title of e Officer personally appeared `Fy gVt(.aA f" i,(�- Name(sAfif , who proved to me on the basis of satisfactory evidence to be the person(•) whose name(s) is//re' subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/ler/their authorized capacity(ies),and that by his/ber/tbeir 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. ;+.: RENEE RITCHIE �{��� 4,..0:,..;;".,.. `` NotaryPublic-California z Signature ra' * Orange County a �" f' Commission#2201353 Signature of Notary Public '�'";"t" My Comm.Expires Jun 16,2021 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: Signer's Name: ❑ Corporate Officer — Title(s): El Corporate Officer — Title(s): El Partner — ❑ Limited El General ❑ Partner — ❑ Limited El General ❑ Individual ❑Attorney in Fact El Individual ❑Attorney in Fact ❑Trustee ❑ Guardian or Conservator ❑Trustee ❑Guardian or Conservator E l Other: El Other: Signer Is Representing: Signer Is Representing: L,F.A0�4 v4�4,,,v4%h:✓4. ..y�4w4, 4�✓.4�4•:•yr^.'✓4w4w4w.4.l5.,L,K.14�4�4\✓4'rr4 .1�.4�✓.4.✓wy,4'✓4�✓.1"✓.4�4w.,,,,, ,,,,,�,,,4,,,4,4- ©2016 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 I City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 25 of 630 BIDDER: Cu EODOMMEM❑❑❑❑❑❑❑❑❑❑❑ 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 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- 8 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 26 of 630 BIDDER: COMEMMOODDEDLUSIEUM F.M. Thomas Air Conditioning, Inc. 2.B LIST OF PROPOSED SUBCONTRACTORS (continued) [**Duplicate Next 2 Pages if needed for listing additional subcontractors.**] Name and Location Description of Work of Subcontractor to be Subcontracted Name: Scott Manfredi Construction ceiling, roofing, footings, drywell Address: 8941 Atlantic Ave. #131 Huntington Bch, Ca 92646 License No.: 444234 Department of Industrial Relation Registration No. 1000028706 Name and Location Description of Work of Subcontractor to be Subcontracted Name: Michael Lawrence Electric Electrical L.\ • Adds: 0 5. C;1 Ct , Licn3cNo.:3409 SANDOVAL AVENUE PICO RIVERA, CA 90660 Department of Industrial Relation Registration No. 1000046014 Name and Location Description of Work of Subcontractor to be Subcontracted Name: PRECISION IRON WORKS Structual steel Address:14342 CERECITA DR. WHITTIER CA 90604 License No.: 1000647 Department of Industrial Relation Registration No.1000039907 Name and Location Description of Work of Subcontractor to be Subcontracted Name: The Crane Guys Crane Address: 14480 Alondra Blvd. La Mirada, Ca 90638 License No.: lic 967520 Department of Industrial Relation Registration No. 1000008224 Name and Location Description of Work of Subcontractor to be Subcontracted Name: inland air balance Address: 482 W. arrow hwy #C San Dimas, Ca 91773 License No.: 837772 Department of Industrial Relation Registration No. 1000013848 • CBF-9 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 27 of 630 BIDDER: onimpainorimmoompoomo F.M. Thomas Air Conditioning, 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: 1. City of Los Angeles Cesar Lopez Salazar 14832 Raymer St Van Nuys, Ca 91405 . Name and Address of Owner City of Los Angeles Cesar Lopez Salazar, HVAC Supervisor 213-978-7606 Name and telephone number of person familiar with project NTE $13M / year Task order contract to include HVAC retrofit, design, replacement 6/2005-Present Contract amount Type of Work Date Completed S55a0ntNa N. Fnloaw, Cera S9t2. 7032. Orange CountrySheriffs Dept. Name and Address of Owner Remon Tadrous 714-935-7472 Orange County Men's Jail phase 1 Name and telephone number of person familiar with project $1.7M HVAC Retrofit air handlers 12/2017 Contract amount Type of Work Date Completed 3. 550 N. Flower St. Orange Country Sheriffs Dept. Santa Ana, Ca 92703 Name and Address of Owner Remon Tadrous 714-935-7472 Orange County Men's Jail phase 2 Name and telephone number of person familiar with project $1.4M Orange County Men's Jail phase 2 Contract amount Type of Work Date Completed • CBF- 10 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 28 of 630 BIDDER: CDC❑CC❑❑JLI❑CCCCO J l❑ F.M. Thomas Air Conditioning, Inc. 4. Glendale UHSD 1440 E. Broadway, Glendale, Ca 91205 Name and Address of Owner Raymond Mikaily 818-507-0201 Name and telephone number of person familiar with project $791 ,000 Replace 60 Ductless Split systems 8/2018 Contract amount Type of Work Date Completed a.. L CBF- 11 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 29 of 630 BIDDER: 0000=00MaEMOLOCEED F.M. Thomas Air Conditioning, Inc. • • SECTION 3 NON-COLLUSION AFFIDAVIT • • CBF- 12 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 30 of 630 BIDDER: EMCOMEECf^FTI❑G ❑CW OD F.M. Thomas Air Conditioning, 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 fe- to any corporation, partnership,company association, organization,bid depositor , or to any member or agent thereof to effectuate a collusive or sham bid. • Signature Ir Thomas Feyka Typed or Printed Name President Title F.M. Thomas Air Conditioning, Inc. Bidder Subscribed and sworn before me This ('1`Vhday of (/lL/tk . , 20 01,6 (Seal) • .034•1*,, RENEE RITCHIE Notary Public in and for { Notary Public California z Orange County the State of California Commission X 220Comm.Expires tun 11365,32021 353 16,2021 My Commission Expires: &` i(,(2-4 CBF- 13 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 31 of 630 • BIDDER: D❑ r❑❑CD❑❑❑❑❑CID❑DE❑ F.M. Thomas Air Conditioning, Inc. • SECTION 4 REQUIRED FEDERAL FORMS CBF- 14 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 32 of 630 CONTRACTOR INFORMATION Company Name F.M. Thomas Air Conditioning, Inc. • Address 231 Gemini Ave, Brea, Ca 92821 Telephone 714-738-1062 Fax 714-738-0886 E-mail mfeyka@fmthomas.com Type of Firm: Individual 3 Partnership Corporation NI Corporation organized under the laws of the State of California } 313574 B, C-4, C-20, C-38 Contractor's License Number State ca Classification Expiration Date 2/28/21 DIR Registration Number 1000003383 Expiration Date 6/30/20 Names and titles of all officers of the firm Thomas Feyka, President Carolyn Feyka Secretary/Treasurer Michael Feyka, Vice President CBF- 15 • City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 33 of 630 CONTRACTOR'S NOTIFICATION OF SUBCONTRACTS AWARDED COVERED AREA: MONTH OF: Subcontractor's Contract Project Completion Date Name/Address Number Contract Amount Start Date(Estimate) (Estimate) Crafts to be Covered The undersigned hereby certifies that: Gs:The ECual Opportunity Clauses are indicated in each of the Listed Subcontracts❑ID Each subcontractor or lower tier subcontractor has been notified in writing prior to their beginning construction, of his respective obligations under the Affirmative Action ReCUirements, if applicable. By: EOCCiL FEECt7CCCCf TIECCO i I rE=0 f TCcLLECI 1m 0 r1MCMC ED t I I rfmcaii== lmcmr1Tn Signature Printed Name and Title CCL7CC❑ZCCCCCCOLLCCCCIC is ■ ECCEEC n=CCImmF'COMICC 1L1"3 LME -Cr f ;LLCM Contractor Name Contractor Address CBF- 16 Ealogiosminament Bid Package,cjrry Cr rlgAdiikigl etNo:31019 DepartRateeltCOVS9VMSals and Urban Development Opportunity Certification Office of Housing OMB Control No.2502-0029 Excerpt From 41 CFR §60-1.4(b) Federal Housing Commissioner (exp. 7/31/2009) The applicant hereby agrees that it will incorporate or cause to be (6) In the event of the contractor's noncompliance with the incorporated into any contract for construction work,or modifi- nondiscrimination clauses of this contract or with any of the cation thereof, as defined in the regulations of the Secretaryof said rules, regulations, or orders, this contract maybe can- Labor g Labor at 41 CFR Chapter 60,which is paid for in whole or in part celed, terminated, or suspended in whole or in part and the with funds obtained from the Federal Government or borrowed contractor may be declared ineligible for further Govern- on the credit of the Federal Government pursuant to a grant, ment contracts or federally assisted construction contracts in i contract,loan insurance,or guarantee,or undertaken pursuant to accordance with procedures authorized in Executive Order any Federal program involving such grant,contract,loan,insur- 11246 of September 24, 1965,and such other sanctions may ance,or guarantee,the following equal opportunity clause: be imposed and remedies invoked as provided in Executive During the performance of this contract,the contractor agrees as Order 11246 of September 24,1965,or by rule,regulation,or order of the Secretary of Labor,or as otherwise provided by law. follows: (7) The contractor will include the portion of the sentence imine- _"' (1) The contractor will not discriminate against any employee or diately preceding paragraph (1)and the provisions of para- applicant for employment because of race, color, religion, graphs(1)through(7)in every subcontract or purchase order sex,or national origin.The contractor will take affirmative unless exempted by rules,regulations,or orders of the Sec- action to ensure that applicants are employed, and that em- retary of Labor issued pursuant to section 204 of Executive ployees are treated during employment without regard to Order 11246 of September 24, 1965,so that such provisions their race,color,religion,sex,or national origin,such action will be binding upon each subcontractor or vendor. The shall include, but not be limited to the following: Employ- contractor will take such action with respect to any subcon- ment, upgrading, demotion, or transfer; recruitment or re- tract or purchase order as the administering agency may cruitment advertising; layoff or termination;rates of pay or direct as a means of enforcing such provisions, including other forms of compensation; and selection for training, sanctions for noncompliance: Provided,however, That in including apprenticeship. The contractor agrees to post in the event a contractor becomes involved in,or is threatened conspicuous places, available to employees and applicants with,litigation with a subcontractor or vendor as a result of 1 for employment, notices to be provided setting forth the such direction by the administering agency the contractor provisions of this nondiscrimination clause. may request the United States to enter into such litigation to (2) The contractor will,in all solicitations or advertisements for protect the interests of the United States. employees placed by or on behalf of the contractor,state that The applicant further agrees that it will be bound by the above equal all qualified applicants will receive considerations for em- opportunity clause with respect to its own employment practices ployment without regard to race, color, religion, sex, or when it participates in federally assisted construction work: s national origin. (3) The contractor will send to each labor union or representative Provided,That if the applicant so participating is a State or local government,the above equal opportunity clause is not applicable of workers with which it has a collective bargaining agree- to any agency,instrumentality or subdivision of such government ment or other contract or understanding, a notice to be which does not participate in work on or under the contract. F provided advising the said labor union or workers'represen- t tatives of the contractor's commitments under this section, The applicant agrees that it will assist and cooperate actively with and shall post copies of the notice in conspicuous places the administering agency and the Secretary of Labor in obtaining the compliance of contractors and subcontractors with the equal available to employees and applicants for employment. opportunity clause and the rules,regulations,and relevant orders (4) The contractor will comply with all provisions of Executive of the Secretary of Labor, that it will furnish the administering Order 11246 of September 24, 1965, and of the rules,regu- agency and the Secretary of Labor such information as they may lations and relevant orders of the Secretary of Labor. require for the supervision of such compliance,and that it will otherwise assist the administering agency in the discharge of the (5) The contractor will furnish all information and reports re- agency's primary responsibility for securing compliance. quired by Executive Order 11246 of September 24,1965,and The applicant further agrees that it will refrain from entering into by rules,regulations,and orders of the Secretary of Labor,or any contract or contract modification subject to Executive Order pursuant thereto,and will permit access to its books,records, 11246 of September 24,1965,with a contractor debarred from,or £ and accounts by the administering agency and the Secretary t of Labor for purposes of investigation to ascertain compli- who has not demonstrated eli•ibility for, Government contracts ance with such rules,regulations,and orders. and Federally-assisted const,uction contracts pursuant to the Executive order and wi 1 cary out such sanctions and penalties for violatio r of the eq al op`.ortunity clause as may be imposed Firm Name and Address By 4 F.M. Thomas Air Conditioning, Inc. 231 Gemini Ave, Brea, Ca 92821 Title Mr Thomas Feyka,tri resident CBF- 17 form HUD-92010(3/2006) VA form 26-421 -: : •: :.•,C i Prejeetfde:34849 Bocu.cnt Control Pogc 35 of G30 upon contractors and subcontractors by the administering agency (5) The contractor will furnish all information and reports or the Secretary of Labor pursuant to Part II, Subpart D of the required by Executive Order 10925 of March 6, 1961, as Executive order.In addition,the applicant agrees that if it fails or amended, and by the regulations, and orders of the said refuses to comply with these undertakings, the administering Committee,or pursuant thereto,and will permit access to his agency may take any or all of the following actions: Cancel, books,records,and accounts by HUD and the Committee for terminate,or suspend in whole or in part this grant(contract,loan, purposes of investigation to ascertain compliance with such insurance, guarantee);refrain from extending any further assis- regulations,and orders. tance to the applicant under the program with respect to which the (6) In the event of the contractor's non-compliance with failure or refund occurred until satisfactory assurance of future the nondiscrimination clause of this contract or with any of compliance has been received from such applicant;and refer the case the said regulations, or orders, this contract may be can- to the Department of Justice for appropriate legal proceedings. celled, terminated or suspended in whole or in part and the Excerpt from HUD Regulations contractor may be declared ineligible for further Govern- ment contracts or Federally-assisted construction contracts 200.410Definition of term"applicant". in accordance with procedures authorized in Executive Order (a) In multifamily housing transactions where controls over the 10925 of March 6,1961,as amende,and such other sanctions mortgagor are exercised by the Commissioner either through may be imposed and remedies invoke s provided in the said the ownership of corporate stock or under the provisions of Executive Order or by regulations,or order of the President's a regulatory agreement,the term"applicant"as used in this Committee on Equal Employment Opportunity,or as other- subpart shall mean the mortgagor. wise provided by law. (7) The contractor will include the provisions of Para- (b) In transactions other than those specified in paragraph(a)of graphs(1)through(7)in every subcontract or purchase order this section,the term"applicant"as used in this subpart shall unless exempted by regulations,or orders of the President's mean the builder, dealer or contractor performing the con- Committee on Equal Employment Opportunity issued pursu- struction,repair or rehabilitation work for the mortgagor or ant to Section 303 of Executive Order 10925 of March 6, other borrower. 1961, as amended, so that such provisions will be binding 200.420Equal Opportunity Clause to be included in contracts and upon each subcontractor or vender. The contractor will take subcontracts. such action with respect to any subcontract or purchase orders as HUD may direct as a means of enforcing such (a) The following equal opportunity clause shall be included in provisions,including sanctions for noncompliance:Provided, each contract and subcontract which is not exempt: however,that in the event the contractor becomes involved During the performance of this contract,the contractor agrees in, or is threatened with, litigation with a subcontractor or as follows: vender as a result of such direction by HUD,the contractor (1) The contractor will not discriminate against any em may request the United States to enter into such litigation to ployee or applicant for employment because of race, creed, protect the interests of the United States. color,or national origin.The contractor will take affirmative (b) Except in subcontracts for the performance of construction action to ensured that applicants are employed, and that work at the site of construction,the clause is not required to employees are treated during employment without regard to be inserted in subcontracts below the second tier. Subcontracts their race,creed,color,or national origin.Such action shall may incorporate by referenced to the equal opportunity clause. include, but not be limited to the following: employment, upgrading,demotion or transfer;recruitment or recruitment 200.425Modification in and exemptions from the regulations in advertising;layoff or termination;rates of pay or other forms this subpart. of compensation; and selection for training, including ap- • (a) The following transactions and contracts are exempt from the prenticeship. The contractor agrees to post in conspicuous regulations in this subpart: places, available to employees and applicants for employ- ment, notices to be provided setting forth the provisions of (1) Loans, mortgages, contracts and subcontracts not ex- the nondiscrimination clause. ceeding $10,000. (2)The contractor will in all solicitations or advertisements for (2) Contract and subcontracts not exceeding$100,000 for employees placed by or on behalf of the contractor,state that all standard commercial supplies or raw material; qualified applicants will receive consideration for employment (3)Contracts and subcontracts under which work is to be or has without regard race,creed,color,or national origin. been performed outside the United States and where no recruit- (3) The contractor will send to each labor union or repre- went of workers within the United States in involved. To the sentative of workers with which he has a collective bargain- extent that work pursuant to such contracts is done within the ing agreement or other contract or understanding,a notice,to Untied States,the equal opportunity clause shall be applicable; be provided,advising the said labor union or workers'repre- (4) Contracts for the sale of Government property where sentative of the contractor's commitments under this section, no appreciable amount of work is involved; and and shall post copies of the notices in conspicuous places (5) Contracts and subcontracts for an indefinite quantity available to employees and applicants for employment. which are not to extend for ore than one year if the purchaser (4) The contractor will comply with all provisions of Ex- determines that the amounts to be ordered under any such ecutive Order 10925 of March 6 1961,as amended,and of the contract or subcontract are not reasonably expected to exceed regulations,and relevant orders of the President's Commit- $100,000 in the case of contracts or subcontracts for standard tee on Equal Employment Opportunity created thereby. commercial supplies and raw materials, or $10,000 in the case of all other contracts and subcontracts. CBF- 18 form HUD-92010(3/06) VA form 26421 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 36 of 630 CERTIFICATION WITH REGARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND THE FILING OF REQUIRED REPORTS The®bidder, ❑proposed sub-contractor;herebycertfies that he/she❑has, has not,participated in a previous contract or subcontract subject to the Equal Opportunity Clause, as required by Executive Orders 10925, 11114, or 11246, and that he/she ❑has, Ihas not, 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 on Equal Employment Opportunity, all.reports.due under the applicable filing requirements. Date: Project Number ContractAward: $ Awarding Agency: l., Contractor Name: Total:Numberof Employees Affiliate Company: By: Title: 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 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). Proposed prime contractors and subcontractors who have participated in a previous contractor subcontract subject to the Executive Orders and have not filed the required,reports.shouldnotethat41 CFR 60-1.7(b)(1)prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such otherperiod specifiedby the U.S. Department of the Interior or by the Director, Office:of Federal Contract Compliance, U.S. Department of Labor. e..,. SF-100(EEO-1)must be filed by; (A)All private employers who are: (1) Subject to Title VII of the Civil Rights Act of 1964(as amended)with.100 or more employees. (2) Subject to Title VII who has fewer than 100 employees, if the company is owned or affiliated with another company, or there is centralized ownership, control or management so that the group legally constitutes a single enterprise, and the entire enterprise employs a total of 100 or more employees. (B)All federal contractors (private employers),who: ( (1) Are not exempt as provided for by 41 CFR 60-1.5 (2) Have 50 or more employees, and a. Are prime contractors or first-tier subcontractors, and have a contract, subcontract, or purchase order amounting to$50,000 or more; or b. Serve as a depository of Government funds in any amount,or c. Is a financial institution,which is an issuing, and paying agent for U.S.Savings Bonds and Notes. CBF- 19 • • City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 37 of 630 Exhibit: 13 • County Lobbyist Certification Los Angeles County Compliance Form-Tobe submitted with 13ld COUNTY LOBBYIST CODE CHAPTER 2.160 COUNTY ORDINANCE NO.93-0031 Name of Firm: F.M. Thomas Air Conditioning, Inc. • Address; 231 Gemini Ave, Brea, Ca 92821 State: Ca Zip Code; 92821 Telephone Number: ( ) 714-738-1062 Acting on behalf of the above named firm, as its Authorized Official, I make the following Certification to the County of Los Angeles and the Community Development Commission, County of Los Angeles: 1) It is understood that each person/entity/firm who applies for a Community Development Commission contract, and as part of that process, shall certify that they are familiar with the • requirements of the Los Angeles County Code, Chapter 2.160(Los Angeles County Ordinance • 93-0031)and; 2)That all persons/entities/firms acting on behalf of the above named firm have and wilt comply with the County Code,and; 3) That any person/entity/firm who seeks a contract with the Community Development Commission shall be disqualified therefrom and denied the contract and, shall be liable In civil action, if any lobbyist, lobbying firm, lobbyist employer or any other person or entity acting on behalf of the named firm fails to comply with the provisions of the County Code. This certification Is a material representation of fact upon which reliance was placed when this transaction was made or entered into, Submission of this certificati. is a prerequisite for making or entering into contract with the Los Angeles County and the !'ommurty Development Commission,County of Los Angeles, ja Authorized Official: • F.M. Thomas Air Conditioning, Inc.By: It (CAn(<actodsubcontracioo ( a 'tore) 03/17/20 Thomas Feyka, President (Date) (Title) CBF-20 • City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 38 of 630 NON-SEGREGATED FACILITES CERTIFICATION Federally-Assisted Construction Projects The federally-assisted construction contractor certifies that he/she DOES NOT and WILL NOT: 1. Maintain or provide, for his/her employees, any segregated facilities at any of his/her establishments. 2. Permit his/her employees to perform their services at any location, under his/her control,where segregated facilities are maintained. The federally-assisted contractor agrees that a breach of this certification is a violation of the Equal Opportunity Clause in this contract. As used in this certification, the term segregated facilities means any waiting room, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or • entertainment areas, transportation, and housing facilities provided for employees -which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color or national origin, because of habit, local custom,or otherwise. The federally-assisted contractor agrees that (except where he/she has obtained identical certifications from proposed subcontractors for specific time periods) he/she will obtain identical certifications from proposed subcontractors prior to the award of subcontractors exceeding$10,000 which are not exempt from the provisions of the Equal Opportunity Clause, and that he/she will retain such certifications in his/her files. NOTE:The penalty for making false statements in offers is prescribed in 18 U.S.C.1001 • Date: 03/17/20 Project Number: 31019 Compan • .M. ho --.'s Air Conditioning, Inc. By: a Title: Thom; Feyka, President F CBF-21 , City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 39 of 630 NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY/COUNTY of Rosemead / LA County DEPARTMENT OF PUBLIC WORKS. In accordance 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 Proposal. Signing this Proposal 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. CBF-22 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 40 of 630 • COMPLIANCE'WITH CLEAN AIR AND WATER ACTS (Applicable to federally assisted construction contracts andrelated subcontracts exceeding$100,000) During the performance of this contract, the contractor and all subcontractors'shall comply with the requirements of the Clean Air Act,as amended,42 USC 1857,et seq.,the Federal Water Pollution Control Act,as amended,33 USC 1251,et seq.,and the regulations of the Environmental Protection Agency with respect thereto,at 40 CFR Part 15,as amended. In addition to the foregoing requirements,all nonexempt contractors and subcontractors shall furnish to the ..• ownerthe following: 1.. A stipulation.by the contractor or subcontractors that any facility to be utilized in the performance of any nonexempt contract or subcontract is not listed on the List of Violating Facilities issued by the Environmental Protection Agency(EPA)pursuant to 40 CFR 15.20. 2. Agreement by the contractor to comply with all the requirements of Section 114 of the Clean Air Act, as amended.(42 USC 1857c-8) and Section 308 of the Federal Water Pollution Control Act, as amended(33 USC 1318)relating to inspection,monitoring, entry, reports,and information, as well.as all other requirements specified in said Section 114 and Section 308,and all regulations and guidelines issued thereunder: 3. A.stipulation that as a condition for the award of the contract,_prompt notice will be given of any notification received from the Director,Office of.Federal.Activities,EPA;indicating that a•facility,utilized or to be utilized for the contract is under consideration to be listed on the EPA List of Violating.Facilities. 4. Agreement by the contractor that he will include, or cause to be included, thecriteria and requirements in paragraph(1)through(4)of this section in every nonexemptsubcontract and requiring that - the contractor will take such action as the Government may direct as a means of enforcing such provisions: F.M. Thom Air Conditioning, Inc. Name of Contra for A 1 C m'' i Ave, Brea, Ca 92821 ddr-ss , President S'•n-iure:n. .iie 0 - '1 %20 Date I j• ... • • CBF-23 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 41 of 630 • WORKER'S COMPENSATION CERTIFICATION • I certify, by signature below, that I am aware of the provisions of Section 3700 of the •- California Labor Code which require every employer to be insured against liability for worker's compensation orfo undertake self-insurance in accordance with the provisions of that code,and 1 will comply with such provisions before commencing the performance of the work of this contract. Date: 03/17/20 Project Number: 31019 Project Name: Garvey Park Gym Cooling Addition Company Name: F.M. Thomas Air Conditioning, Inc. Address: 231 Gemini Ave, :rea, Ca 92821 Print Name: Thomas Fey ,; . Title: Pr- 'bent 4// Signature: firOW • CBF-24 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 42 of 630 NOTICE OF SECTION 3 COMMITMENT To: UA Local 250 [Name of Labor Union or Workers'Representative] 8355 S. Figueroa, Gardena, Ca 310-660-0035 (Address) Awarding Authority: City of Rosemead Project Name and Nurribert. Garvey Park Gym Cooling Addition 31019 The undersigned NA currently' holds a contract with involving Comniun)ty;Development Block Grant(CDBG)funds from the U.S. Department.of Housing and Urban Development(HUD)or a subcontract with a prime contractor holding such contract. You are advised that under the.provisions of the above contract or subcontract,and in accordance with Section 3 of the Housing and Urban Development Act of 1968,.the undersigned is obligated;to the greatest extentfeasible,to.give opportunities fortraining and employment to lower-income residents of the project area and to award contracts for work on.the project to business concerns that are located in or are owned. in substantialpart_by project-area residents. ] Regarding employment opportunities for this project,the minimum number and job titles are: :Minimurl'Number• Job Titles NA • is Regarding job referrals,request-that consideration be given,to the greatest extent feasible,to assignment of persons residing in the service area or neighborhood in which•the.project is located. The anticipated date-the work will begin is MAY 2020 For additional information,contact:. Ron Outhier 714-738-1062 / This notice is furnished to.you pursuant to the provisions of the above.cont :c'orsuby: fact and Section 3 of the Housing and Urban Development Act of 1968.. Copies of tjt s otice ,'ll,ve posted by the undersigned in conspicuous places available to employees-or applica fo empl•/ j t. F.M. Thomas Air Conditioning, Inc. r/ (ContractarlSubcontrador] r' [Signature] 03/17/20 Pr-si•ent , . .[Date] (Title) ] 3F F CBF-25 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 43 of 630 • Section 3 Economic Opportunity Plan 1. Name and Address of Reporting Entity 2. Federal Identification(Contract/Award No.): 3 Do lar Amount of Award: (Recipient,Sub,redpient•Contractor.Subcontractor): NA NA • F.M. Thomas Air Conditioning, Inc. 4. Contact Persian: 5. Phone(lnduda Area Code): Ron Outhier 714-738-1062 6. Reporting Paned: 7. Date Report Submitted: • NA NA B, Program Code: (Use a separate sheet for each Program Code) Program Codas 1. Flexible Subsidy 2: Section 202/811 3. Publicltndlan Housing Development,Operation and Modernization 4. Homeless Assistance 5 HOME '6. HOME—State Administered 7-. CDBG—Entitlement 8.CDBG—Slate Administered 9. Other CD Programs 10. Other Housing Programs Part I: Employment and Training Commitment TOTAL SECTION %OF AGGREGATE CODE(S) NEW 3 NEW HIRES WHO ARE JOB CLASSIFICATION HIRES HIRES ' SECTION 3 HIRES RACIAL ETHNIC Professionals • • Technicians • Office/Clerical . . . Trade: Trade: . • TOTAL: Part II: Contract Award Commitment to Section 3 Businesses(subcontraciers,.suppiters;Vendors,or Service Providers) SPECIFY CONSTRUCTION OR CODE(S) NONCONSTRUCTION CONTRACT NAME OF SECTION 3 BUSINESS CONCERN CONTRACT AMOUNT RACIAL ETHNIC • RACIAL BACKGROUND: SINGLE CATEGORIES DOUBLE CATEGORIES 1. American Indian/Alaska Native E. American Indian or Alaska Native AND White 2. Asian 7. Asian AND White 3. Black/African American B. Black or African American AND White 4. Native Hawaiian/Other Pacific Islander 9. American Indian or Alaska Native AND Black or African American 5. White 10. Other—for individuals not identified above. ETHNIC BACKGROUND: • A. Hispanic/Latino B. Not Hispanic/Latino CBF-26 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 44 of 630 • { Section 3 Business Certification Form Business Name: F.M. Thomas Air Conditioning, Inc. •Business Address: 231 Gemini Ave, Brea, Ca 92821 Telephone Number: 714-738-1062 Contract Amount:$ NA The•above-mentioned business firm is a Section 3•business concern based onthe following qualification: 1. ❑ 51 percent owned by Section:3 residents(attach•Section.3 Resident Certification farms) OR f•• 2. Permanent,full-time employees.include at least 30 percent Section 3•residents (attach Section 3 Resident Certification forms) OR 3'. 0. Written commitment to subcontract at least 25 percent of.contract amount to business concerns that meet Section.3 qualification stated in paragraph 1 or 2 above(attach Section 3 Economic Opportunity Plan,Section 3.Business Certification form for subcontractor,and.Section 3 Resident Certification forms)" OR 4. ® Written commitment that Section 3 qualified new hires will comprise at least 30 • percent of total new hires(attach Section 3 Economic.Opportunity Plan) Specify ethnicity.of business ownership: ® White American f Black American 0 Native American • .® Hispanic American 0 Asian Pacific 0 .Hasidic Jewish The undersigned by his/her signature affixed hereto declares under penalty of p-jury.ththe above information is complete and correct. • _ 03/17/20 Date Sii.a ire • Thomasir Print Name President Title CBF-27 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31019 Document Control Page 45 of 630 CERTIFICATION OF UNDERSTANDING AND AUTHORIZATION Garvey Park Gym Cooling Addition ProCect Name ❑❑❑❑❑❑❑Lu❑❑❑❑❑❑❑❑❑❑MOCCE❑❑❑❑m❑❑❑ ODOIDO❑UULrU❑❑OQ❑m❑mm❑ 31019 Pro[ect Number ❑❑❑❑❑mm❑O❑m❑❑❑ECI❑❑❑IM❑❑❑m0❑❑❑❑❑❑❑mm❑❑❑❑❑U m❑❑❑❑❑D^!❑ • This is to certify that the principles and the authoriCed payroll officer have read and understand the Minutes of the Preconstruction Conference and the labor standards clauses pertaining to the subCect protect. The following persontsEis designated as the payroll officer for the undersigned and is authoriiied to sign the Statement of Compliance, which will accompany our weedy certified payroll reports for this protect. Carolyn Feyka Secretary/Treasurer Designated Payroll Officer CName❑❑❑❑❑U❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑MO❑❑❑❑❑❑❑❑❑❑DU❑UL❑ Designated Payroll Officer CSignature■ iI❑❑m❑❑iri■ ■❑❑ ❑❑' "■lm❑❑u -m mm❑❑❑❑❑ F.M. Thomas Air Conditioning, Inc. AuthoriLed by CContractor/Subcontractor❑❑❑Orn❑O❑O❑❑❑LLIDEM❑❑❑❑❑m❑❑❑❑❑❑❑❑m❑❑❑❑❑❑❑❑ " —1 Secretary / Treasurer IhMML Signature ��� Title 7 03/17/20 CtRS❑Employer Identification Number Date CBF-28 • CONTRACTORS. `—� STATE LICENSE BOARD ACTIVE LICENSE t • • � .,..�. 313574 .CORP E.tuit . F M THOMAS AIR CONDITIONING INC C-4 C20 C38 0 =n. 02/28/2021 \,‘Nw.csIb.ca.gov ;ka 1/31/2020 Supplier Profile Printed on: 1/31/2020 7:32:41 AM To verify most current certification status go to: https://www.ca!eprocure.ca.gov -47 CAI IFORMIA DtIPARTMENT or. GENERAL. SE ....CS Office of Small Business & DVBE Services Certification ID:29235 Email Address: Legal Business Name: mfeyka@fmthomas.com F M THOMAS AIR CONDITIONING INC -, Business Web Page: Doing Business As(DBA) Name 1: http://www.fmthomas.com F M THOMAS AIR CONDITIONING INC Business Phone Number: Doing Business As(DBA) Name 2: 800/660-0891 Business Fax Number: Address: 714/738-0886 231 GEMINI AVE Business Types: BREA Construction , Service CA 92821 Certification Type Status From To SB Approved 10/04/2018 10/31/2020 Stay informed!KEEP YOUR CERTIFICATION PROFILE UPDATED! -LOG IN at CaleProcure.CA.GOV Questions? Email: OSDSHELP@DGS.CA.GOV Call OSDS Main Number.916-375-4940 707 3rd Street, 1-400,West Sacramento, CA 95605 htfnc/rra.anrrw.. na.....I rn..__.._�+__.._._... -. \1 Business Search -Business Entities-Business Programs Page 1 of• • Business Entity, Detail. • • Data is updated to • • y atsi the California Business Results reflect ' Search on Wednesday mornings.r PResul Results work processed through and Sao 6. P rpeoerssed. The data Times for the received dates Friday,filingsAuCur ent10ei Please providedof iled currently being is not a complete or certified record of an entity. Entity Name: EntityF. M. THOMAS AIR CONDITIONING Number: , INC, Date Ex' C0755790 led: Status: 09/30/1975 Jurisdiction: ACTIVE CALIFORNIA Entity Address: Entit 231 GEMINI AVE y City, State, Zip: Agent for BREA CA 92821 Service of Process: THOMAS FEY[CA Agent Address: Agent 231 GEMINI AVE City, State, Zip: BREA CA 92821 * Indicates the information is not contained .State's database. in the California Secretary o€ If the status of the process automatically corporation is "Surrender, " the agent Codeproc ss ison 2114 revoked. please refer to g for service of have surrendered. for information relatingCalifornia Co to service uponzradons t • For information on checking corporations that • For information on ordering o rres vin a name reportsorinor refer to Name Ad/orastat.t to request a more extensive search, refers of documents and/or status • For help with searching an entity • For descriptions of the various fields to Inform=4ue sts. name, refer to Search Ti s. Descri tions and Status Definitions. and status types, refer to Field • • • erivacy Statement Free Document Readers Copyright A 2016 California Secretary of State Registrations Page 1 of 2 • • State of California Department of Industrial Relations Back toDlR»(hlipslAvww.dir.ca.govq (https! 'i p i is ir,ca.gov/) RENEE RITCHIE— invoices@fmthomas.com Department of Industrial Relations(DIR)(https://www.dir.ca.gov/dlse/dlse.html)i My Registrations My Dashboard Select One... v l New Link Existing Registration Instructions: • To transfer an active registration from the old system,click Link Existing Registration. • To start a new application,select from the dropdown menu above and dick New. • To revise the existing registration,click Update. • To edit a saved application,click on the registration number.You cannot edit once the application status is "Submitted","Payment Pending","In Review","Expired"or"Renewed". • To renew an application,click Renew(link will be available 90-days before the license expiration date,until the expire date). • To pay registration fees,click the Pay Now link in the Registration#column. • Car Wash:To complete the registration process,you must print the submitted application or a copy of your email stating your application has been submitted and send It with the IRS Form 8821(htto://www.dlr.ca.gov/dlse/IRS8821-Form.odf).Upon receipt of the IRS response,please return to attach the IRS Clearance letter to your application.IRS form 8821 Instructions chtto://www.dir.ca.qov/dlse/IRS8821-Instructions.odf), Actions Business • Name Registration t7 Registration Submitted Status Effective Expiration Payment Type Date Data Date Salus FM THOMAS 1000003303 AIR Update CONDITIONING (/raOlstra0onslVlPFonn_VIP Fom,W,zard7 Public Werke Padilla INC idaa1R100000027yoxEAA) Active 07101/79 06!30/20 Mace Oue FM THOMAS 1000003303 AIR Update CONDmONING ffregistrationsNipForm_VIP FonnWcurd7 Public Works INC Id=a1 Rt0000001R2giEAC) AcUvo 06/25/10 06I30/19 About DIR Who we are(https://www.dir.ca.gov/aboutdir.html) DIR Divisions,Boards&Commissions(https://www.dir.ca.gov/divisions_and_programs.html) Contact DIR(httpsJ/www,dir.ca.gov/Contactus.html) Work with Us Jobs at DIR(https://www.dir.ca.gov/dfrjobs/dirjobs,htm) Licensing,registrations,certifications&permits(https://www.dir.ca.gov/permits-licenses-certifications.html) Required Notifications(https://www.dir,ca.gov/cosh/Required-Notifications.html) Public Records Requests(https://www,dir.ca.gov/pra_requesthtml) Learn More Acceso al idioms(httpJ/www.dir,q.gov//Bilingual-Services-Act/defaulthtml) Frequently Asked Questions(https:/Avww.dir.ca.gov/faqslisthtml) Site Map(https://www,dir.ca,gov/sitemap/sitemap,html) Back to Top Conditions of Use(https!/www,dir.ca.gov/odtsub/conditions.hfml) Disclaimer(https!/www,dir.p,gov/od_pub/disdaimer.html) Registrations Page 1 of 2 A State of California F+ Back to DIR>>(httpsftww.dir.ca.gov/) Department of industrial Relations (http rir:ca.govI) • Public Works Contractor Registration Search Enter at least one criteria to display registered public works contractor(s)matching your selections. Note:Search results will display all of the public works contractor registrations,both current and expired.Make sure a proper registration fiscal year is selected when performing a search. Input Label _.___.._._....._...__.... ....._.-.......-----._.._....._._.. From Date:(mm/dd/yyyy) To Date:(mm/dd/yyyy) ,fm themes air conditionin --.-__..._.....___...__.___.._ _.._. County _....._.._. - ____--._._.____.._.__.... ._.-._.__...__....__......._._._....__._..___._._..._.._..__-.____......_- -_--:............._.__....__..__....__.._-_.__..__._._...._1 i ___.__.._.................__._........__......_._._. City 'Search!!Reset Crafts(Select all Registrations that apply) Search Results:1 found Showing Page 1 of 1 Previous Next ❑Asbestos .._..._—._--- .---,.......___-_.._.__.._,_".—__....__..___.._.__.._.___...,..__ o Boilermaker- IPrintPDF gIIExport.+.i Blacksmith 'Add all to my Usti Mytist(1)— ❑Bricklayer/Brick FM THOMAS AIR CONDITIONING INC Tender IVlewDe[allsl It Remove from MyListl ❑Carpenter ! Detail; Registration Number. 1000003383 Registration History_ ❑Carpet,Linoleum, Status: Active Effective Date Expiration Date Resilient Tile Layer CSLB Number. " 313574 a/7/1/2019 6/30/2020 I]Cement Mason Legal Entity Type: Corporation - --•— i CI Consultant Mailing Address: 231 GEMINI AVE 6/25/2018 6/30/2019 ❑Driver(On/Off BREA 6/23/2017 6/30/2010 Hauling) CA 92821 6/30/2017 -•- . _ County: Orange 6/24/2016 6/3 ❑Drywall s Craft: _.._____.__._._...-61301--- El Plumber;Sheet Metal Worker 6/9/2015 6/30/2016 Installer/Lather/Finishe Email: invoices@fmthomas.com -----• C]Electrical Utility 12/26/2014 6/30/2015 ❑Electrician I DBA ❑Elevator i -..- _..- _w Name _-_....-_....__.--__-....,......._._._..__._...._--___--..-._._4......-....»-..__._..._.,.._.... Constructor FM THOMAS AIR COND _- -�.__. iIIONING INC -• 0 Field Surveyor • • ❑General Building o General Engineering ❑Glazier ❑Inspector/Field Soils,Material Tester ❑iron Worker ❑Laborer ❑Landscape 0 Marble Mason/Finisher ❑Operating Engineer 0 Painter ❑Parking/Highway/Improvement ❑Plasterer/Tender - ❑Plumber ❑Rooting 0 Sheet Metal Worker ❑Stator Rewinder ❑Teamster ❑Terrazzo Worker/Finisher httnS:I/Cadlr pera 4:-....-..,, /�___� .. - _- ® �i '�ECERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �.../ 12/30/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). • PRODUCER CONTACT Bowermaster&Associates NAME: Melissa Altergott P.O. Box 6026 PHONE - (a/c,NO,_Ext):714-733-6200 Irk Rol: _ 10805 Holder St Suite 350 E-MAIL malterg_ott@bowermaster.corn Cypress CA 90630 INSURER(S)AFFORDING COVERAGE NAIC# _ INSURERA:Valley Forge Insurance Company 20508 INSURED FMTHOMA-01 INSURER Continental Casualty Co. 20443 FM Thomas Air Conditioning, Inc. 231 Gemini Ave. INSURER c:Continental Insurance Company 35289 Brea CA 92821 INSURER D:Insurance Company of the West 27847 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:203295303 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE INSD INVD POLICY NUMBER POLICY EFFY) PDDF EXP {MMlDDYY'/) (MMI/DDIYYY Y1 LIMITS A X COMMERCIAL.GENERAL LIABILITY 6057223216 4/1/2019 4/1/2020 EACH OCCURRENCE 51,000,000 CLAIMS-MADE X OCCUR PREMISES(ETtla occaurence) $100,000 MED EXP(Any one person) $15,000 PERSONAL 8,ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 32,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG 32,000,000 OTHER $ B AUTOMOBILEUABILITY 6057258063 4/1/2019 4/1/2020 COMBINEOSINGLELIMIT 31,000,000 X ANY AUTO {Ea accident) BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per sodded) $ X HIRED NON-OWNED AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE $ (Per accident) S C X UMBRELLA LIAB X OCCUR 6057258077 4/1/2019 4/1/2020 EACH OCCURRENCE $4,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE 34,000,000 DED I X I RETENTIONS 1l1d300 $ D WORKERS COMPENSATION WSD505258300 1/1/2020 1/1/2021 X PER 0TH• AND EMPLOYERS'LIABILITY AN1'PROPRIETORlPARTNER/EXECUTIVE Y/N STATUTE ER OFFICFR/MEMBERFXCLUDED? n N/A E.L.EACH ACCIDENT 51,000,000 (Mandatory In NH) Il yes,describe under E.L DISEASE-EA EMPLOYEE_$1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 51,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) Evidence of Insurance CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FM Thomas Air Conditioning,Inc. 231 Gemini Ave Brea CA 92821 AUTH RIZED REPRESENTATIVE ____ ©1988-2015AcnPncnnonPATIAM All 1:,.t,k.......,.,.MCI