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Renewage Construction - NIB No. 2020-03 - Garvey Park Gym Cooling Additions - Project No. 31019 Doduthent Cdritrdl Page 18 of630- Bid Package,Garvey Park Coolit Addition,PfOject No!"3:r6-i - City.Of Rostrtidad,C6lifb-rtiid BI DDER 4n1O9$9. SrraCh0 CITY OF ROSEMEAD GARVEY PARK GYM COOLING ADDITION PROJECT No..31019 SECTION 1 -BID SCHEDULE 41•1”:511801,4010"1:;;;;11111111 illIVO:i0m0T2lowg.94M•111 CBF -i ) City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:39'"�s Document Control Page 19 of 630 BIDDER: feja P.: arucllos1 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 G 1 Serve the Gymnasium, and the LS 1 $_ 6 �Vq� $ 3�R 600 Installation of a 480 Panel to Facilitate 1 the Newly Added Equipment TOTAL BASE BID AMOUNT IN NUMBERS $ 39 1 s,c0 0 TOTAL BASE BID AMOUNT IN WORDS: hi'� Hoodred pIte47 10) Moii5ofd clue_ Handlred 44'3 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. 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 1 Install a Split System to Serve the LS 1 $ J Dv $ 6,©,-®®oi ' Private Office lfkrs to be ', 4.-0 faaSebidyf(valid 0.0 TOTAL ALTERNATE 1 BID AMOUNT IN NUMBERS $ k0/®�0- CBF - 2 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No.3 iv Document Control Page 2Q of 630 BIDDER: euoog:?_ em_strd&Oti TOTAL ALTERNATE 1 BID AMOUNT IN WORDS: ALTERNATE 2 BID SCHEDULE SCHEDULE OF PRICES FOR GARVEY PARK GYM COOLING ADDITION PROJECT No.31017 NO. ITEM DESCRIPTION UNIT EST. UNIT ITEM QTY. PRICE COST 1 Install Exhaust Fan to Serve Both the LS 1 $, p ��, �S� � S 060• Men's and Women's Restrooms C71) Iv;- add h b ie A ,n TOTAL ALTERNATE 2 BID AMOUNT IN NUMBERS $ 6:'9'9p." �1' TOTAL ALTERNATE 2 BID AMOUNT IN WORDS: ye 7:4akf�,r,� liars 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 bon i t 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 1 City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31u i a Document Control Page 21 of 630 BIDDER: - 40,,- Bidder -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. A/f4' 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:3 iu i u Document Control Page 22 of 630 BIDDER: 4°-.L.-_!:14: a - .; S .. v By: iikk l c-„ sk- - Signature Business Street Address b s\lc thOOLiNCLuenv .. e.LI\1.1) � CA A 2 2 Type or Print Name `1 City, State and Zip Code Title Telephone Number Bidder's/Contractor's State of Incorporation: CA Partners or Joint Venturers: V�9 Bidder's License Number(s): Sg gS3 C Sc Z —lb , • Department Industrial Relations Registered No. l 0:: Coe,Sc 7 3 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 i j City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No:31u i Document Control Page 23 of 30 BIDDER: 1"<t 747„, (P v 1©h SECTION 2 BID DATA FORMS CBF- 6 I 1 ( City of Rosemead,California did Package,Garvey Park Gym Cooling Addition,Project No:31u I a Document Control P ge 24 of 630 BIDDER: ke ne,w Co'N'. 1- ),0t- 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 ,as Principal, and , as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of DOLLARS ($ ),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 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 5C.1-' the other to guarantee payment for labor and materials) furnishes the required LA ,, insurance certificates and endorsements, and furnishes any other certifications as may be required by the Contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect. In the event suit is brought upon this bond by the OWNER and judgment is recovered, said Surety shall pay all costs incurred by the OWNER in such suit,including reasonable attorneys'fees to be fixed by the court. SIGNED AND SEALED, this day of , 20 . (SEAL) (SEAL) Principal Surety By: By: Signature Signature CBF - 7 AiLPH ' ; SURETY Th:suRc . ®�RO GF Surely Solufians: Fast. Simple. To: Renewage Energy Solutions, Inc. dba Renewage Construction From: Chris Eley Date: 3/6/2020 Re: Bid Bond for the City of Rosemead We are pleased to provide the bid bond you requested from our agency for the City of Rosemead.The bond is written with Lexon Insurance Company.This is an excellent company rated A or better by A. M. Best,the third party company that evaluates all surety and insurance companies. Please sign and complete the original bid bond form as indicated by the instruction flags. Once completed, please send it to the appropriate party at the City of Rosemead.We have also provided a copy for your records. If you have any questions about the servicing of the bond, please call our Little Rock office at(501)537-4568. Thank you for your business and the opportunity to serve you! Your Alpha Surety Service Team 650 South Shackleford Road, Suite 325 Little Rock,Arkansas 72211-3546 501-537-4568 501-537-7778 fax service@alphasurety.com Please visit our new website at www.alphasurety.com where you now have a complete bond management tool accessible 24/7 from anywhere in the world. You can view and update your existing bonds, order new bonds, view your payment history, receive reminders about your renewals and more...all at the click of a mouse. Our new tool helps streamline our services so that you don't experience the confusion you may have at other agencies with problems like lost paperwork and runaround on the phone looking for answers to simple questions about your bond.All you need is an email address to access your information online! Please email or call your Alpha Surety Service Team to get started today! National:Service.Center Phone 800-901-3099 One Financial tenter :Licensed in all.US.states, Fax501-537-7778 650 S.Shackleford Road;Suite`325Puerto Rico, &tTSVI" Einail service@alpliasurety.coin : LittleRgck,Arkansas 72211.3546. Website alpliasurety.cont City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No 31019 Document Control Page 24 of 630 BIDDER: Renewage Energy Solutions,Inc.dba Renewage Construction BOND NUMBER:BidB1006 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 Renewage Energy Solutions, Inc.dba Renewage Construction as Principal, and Lexon Insurance Company - , as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of Ten Percent of the contract bid DOLLARS ($10% ________),being notless 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 3/6/2020 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 Contact, then this obligation shall be null and void; otherwise it shall remain in full force and effect. In the event suit is brought upon this bond by the OWNER and judgment is recovered,said Surety shall pay all costs incurred by the OWNER in such suit,including reasonable attorneys'fees to be fixed by the court. SIGNED AND SEALED, this 6 day of March , 20 20 Renewage Energy Solutions,Inc.dba Renewage Construction(SEAL) Lexon Insurance Company (SEAL) `����rorrr` Cl",/ Principal Surety mss.��e�9Y So P G ., oiw0 L 7 By: II—•�[ By. `� ;Chris Eley,Attomey-In-Fact i1 3 SEAd�� i�' r Signature / ignature s0; p111212 � z� CBF-7 4JSOMPO _INTERNATIONAL AIIMEMEIMIIMMINEM POWER OF ATTORNEY 10974 KNOW ALL BY THESE PRESENTS, that Endurance Assurance Corporation, a Delaware corporation, Endurance American Insurance Company, a Delaware corporation, Lexon Insurance Company, a Texas corporation, and/or Bond Safeguard Insurance Company, a South Dakota corporation, each, a"Company" and collectively,"Sompo International,"do hereby constitute and appoint:Jason Jenkins,Chris Eley,Amelia McShane as true and lawful Attorney(s)-In-Fact to make,execute, seal,and deliver for,and on its behalf as surety or co-surety;bonds and undertakings given for any and all purposes,also to execute and deliver on its behalf as aforesaid renewals,extensions,agreements,waivers,consents or stipulations relating to such bonds or undertakings provided,however,that no single bond or undertaking so made, executed and delivered shall obligate the Company for any portion of the penal sum thereof in excess of the sum of TEN MILLION Dollars($10,000,000.00). Such bonds and undertakings for said purposes,when duly executed by said attorney(s)-in-fact,shall be binding upon the Company as fully and to the same extent as if signed by the President of the Company under its corporate seal attested by its Corporate Secretary. This appointment is made under and by authority of certain resolutions adopted by the sole shareholder of each Company by unanimous written consent effective the 15th day of June,2019,a copy of which appears below under the heading entitled"Certificate". This Power of Attorney is signed and sealed by facsimile under and by authority of the following resolution adopted by the sole shareholder of each Company by unanimous written consent effective the 15th day of June,2019 and said resolution has not since been revoked,amended or repealed: RESOLVED,that the signature of an individual named above and the seal of the Company may be affixed to any such power of attorney or any certificate relating thereto by facsimile,and any such power of attorney or certificate bearing such facsimile signature or seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached. IN WITNESS WHEREOF,each Company has caused this instrument to be signed by the following officers,and its corporate seal to be affixed this 15th day of June,2019. Endurance Assurance Corporatio Endurance American r, Lexon Insurance Company Bond Safeguard Inaura c�}C� pa A -.• insurance-company, By l"r"b . - By:�C 4 1 -( '4 By )., Tn,-; ,. , By LA:,J %'.'ie. Richard Appel;,,s%I ,&,;senior Counsel Richard Appela,S?Jiw,&,Senior Counsel Ric and Appel S._ • ; Seni ounsel Ric aM rd Appeli,�$1FR•& enio unset "5,..--- c0 .•ON aii.--1 1/4 4„ AAnc S.;� . P,$)INSU mP,p.P D�T O OCds-91 ', .oti' voRq y'._ 'OJ A-7,---nor,OF C �+--. Cc-..-01 U G c�` p?k 0 TO „-t h,,' 4d� SOUTH n rel. SEAL 'g a c�`i SEAL n; ;d �' L' . . .Li-,:;,; DAKOTA 0 b 2002 !Ea'-.E: „ A 1996 - s.-41.1 0 'INSURANCE DELAWARE,', -.;3 DELAWARE a3 ,tD -ti, ,°';N;; =`2Q COMPANY �,. Via`: :2 .)7 t, t'-� ,,, - ria„hww paJ ' ,.,,mna•S. ACKNOWLEDGEMENT ``, OR ''''':';'"''',..,,,,..,.,,,:e- .. - On this 15th day of June,2019,before me,personally came the above signatories known to me,who being duly sworn,did depose and say that he/t ey,4 ff bf icer of each of the Companies;and that he executed said instrument on behalf of each Company by authority of his offic under th by ws of each Company` N;....... R { STATE 4 O, TEWAR _ •.... 7. NOTARY. By: root Amy Taylor,Not Public. My Commission Expires 5/yf23 CERTIFICATE 1 '';Qoy os. ,i,,f,h NTA. I,the undersigned Officer of each Company,DO HEREBY CERTIFY that: 1.That the original power of attorney of which the foregoing is a copy was duly executed on behalf of each Company and has not since been revoked,amended or modified; that the undersigned has compared the foregoing copy thereof with the original power of attorney,and that the same is a true and correct copy of the original power of attorney and of the whole thereof; 2.The following are resolutions which were adopted by the sole shareholder of each Company by unanimous written consent effective June 15,2019 and said resolutions have not since been revoked,amended or modified: "RESOLVED,that each of the individuals named below is authorized to make,execute,seal and deliver for and on behalf of the Company any and all bonds, undertakings or obligations in surety or co-surety with others: RICHARD M.APPEL,BRIAN J.BEGGS,CHRISTOPHER DONELAN,SHARON L.SIMS, CHRISTOPHER L.SPARRO,MARIANNE L.WILBERT ;and be it further ' RESOLVED,that each of the individuals named above is authorized to appoint attorneys-in-fact for the purpose of making,executing,sealing and deliv-3'hg bonds, undertakings or obligations in surety or co-surety for and on behalf of the Company.” - 3.The undersigned further certifies that the above resolutions are true and correct copies of the resolutions as so recorded and of the whole thereof. . IN WITNESS WHEREOF,I have hereunto set my hand and affixed the corporate seal this 6 day®of March 1 20 20 - By: 'I, .. Dante S. .rie retary NOTICE: U.S.TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL(OFACI - - No coverage is provided by this Notice nor can it be construed to replace any provisions of any surety bond or other surety coverage provided. This Notice provides information concerning possible impact on your surety coverage due to directives issued by OFAC. Please read this Notice carefully. The Office of Foreign Assets Control(OFAC)administers and enforces sanctions policy,based on Presidential declarations of"national emergency". OFAC has identified and listed numerous foreign agents,front organizations,terrorists,terrorist organizations,and narcotics traffickers as"Specially Designated Nationals and Blocked Persons". This list can be located on the United States Treasury's website-https://www.treasurv.aov/resource-center/sanctions/SDN-List. In accordance with OFAC regulations,if it is determined that you or any other person or entity claiming the benefits of any coverage has violated U.S.sanctions law or is a Specially Designated National and Blocked Person,as identified by OFAC,any coverage will be considered a blocked or frozen contract and all provisions of any coverage provided are immediately subject to OFAC. When a surety bond or other form of surety coverage is considered to be such a blocked or frozen contract,no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments may also apply. Any reproductions are void. Surety Claims Submission:LexonClaimAdministration(8isompo-intl.com Telephone:615-553-9500 Mailing Address:Sompo International;12890 Lebanon Road;Mount Juliet,TN 37122-2870 c ® y P City of Rosemead,California Bid Package,Garvey Park Gym Cooling Addition,Project No 31019 Document Control Page 24 of 630 BIDDER: Renewage Energy Solutions,Inc.dba Renewage Construction BOND NUMBER:BidB1006 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 Renewage Energy Solutions, Inc.dba Renewage Construction as Principal, and Lexon Insurance Company • , as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of Ten Percent of the contract 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 3/6/2020 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 this bond by the OWNER and judgment is recovered,said Surety shall pay all costs incurred by the OWNER in such suit,including reasonable attorneys'fees to be fixed by the court. SIGNED AND SEALED, this 6 day of March 20 20 Renewage Energy Solutions,Inc.dba Renewage Construction(SEAL) Lexon Insurance Company (SEAL) Principal ©u® By: By: Chris Eley,Attorney-In-Fact Signature Signature CBF-7 ) City of Rosemead,California - Package,Garvey Park Gym Cooling Addition,Project No:31Gi's Document Control Page 25 of 630 BIDDER:. anstradlin 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 LA Package,Garvey Park Gym Cooling Addition,Project No.31G,6 Document Control Page 26 of 630 �5 BIDDER: i eiveva�tq%.. �Slgt-i ttcn 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: N/4 Address: License No.: Department of Industrial Relation Registration No. Name and Location Description of Work of Subcontractor to be Subcontracted Name: /U 14 Address: License No.: Department of Industrial Relation Registration No. Name and Location Description of Work of Subcontractor to be Subcontracted Name: tO I A- Addres s: License No.: Department of Industrial Relation Registration No. Name and Location Description of Work of Subcontractor to be Subcontracted Name: M 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- 9 City of Rosemead,California oid Package,Garvey Park Gym Cooling Addition,Project No:310 i _ Document Control Page 27 of 630 BIDDER: 4e c. CinStrulk '1 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. I. //e °°s. ��� Ct�r�wtti,,► Irr n a5Jri� �- L eptS �i C(Name aAddress of Owner p)s 5 A) Ver-/1100-- {. itS � y (19a T'Skr ' (I ) ;s 6.017 Name and telephone number of person familiar with project 251 o‘c, - oreil, c-10 dcair;� //iJiq Contract amount Type of Work Date Completed 2. Lvs (0,„,---4) /1 lJ�s� - ‘' ..T11(9r) Name and Address of Owned " L-4) 6)(3) Name and telephone number of person familiar with project $i 5311 c9g I • a/c hq' Contract amount Type of Work Date Completed 3. (1' 5 �T Q work /A '-..e.5. Name and Address of Owner L.���. ( 1149) -L?b Name.and telephone number of person familiar with project 01(LW- G‹..,y1C,44Contract amount Type of Work Date Completed CBF- 10 City of Rosemead,California oid Package,Garvey Park Gym Cooling Addition,Project No:31G Document Control Page 28 of 630 BIDDER: �: . :i . - . to 1.--(K /7411-jd, Lon.41,,j, 69 ti-f-ry 0691)-(-(7(' Ot—d6rd C°1-`7 Name and Address of Owner d NA. Ca,-; 14 l 67-0) 760 QS�� Name and telephone number of person familiar with project 11: ' 7a (-I0 VA014, Or- Contract amount Type of Work Date Completed CBF - 11 l City of Rosemead,California oid Package,Garvey Park Gym Cooling Addition,Project No:310 iDocument Control Page 29 of 630 BIDDER: -A. �► ri SECTION 3 NON-COLLUSION AFFIDAVIT CBF- 12 City of Rosemead,California LA Package,Garvey Park Gym Cooling Addition,Project No:310i Document Control Page 30 of 630 BIDDER: (QQ t.c 'Cs SSi s: NON-COLLUSION AFFIDAVIT In accordance with Public Contract Code Section 7106, the undersigned, being first duly sworn, deposes and says that he or she holds the position listed below with the bidder,the party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any undisclosed person,partnership,company,association,organization,or corporation;that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded,conspired,connived,or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly,sought by agreement,communication,or conference with anyone to fix the bid price of the bidder or any other bidder,or to fix any overhead,profit,or cost element of the bid price,or of that of any other bidder,or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract;that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof,or the contents thereof,or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership,company association,organization,bid depository,or to any member or agent thereof to effectuate a collusive or sham bid. Signature 3 Typed or Printed Name Title A notary public or other officer completing this R.Q.INe- a • sr'clac r-s. Certificate Verifies only the identity of the Bidder individual who signed the.document to which this certificate l attathed,grid not the truthfulness, accuracy,or validity of that document: • Subscribed and sworn before me TtiVki .T ,)1 S (VLCJcERS.,AforheY itteaL.rC This n- day of d•-l+�ractt , 20 (Seal) LiQ �� >Y,c 4 IAN JAMES VICKERS Notary Pu 'n and for ,- NOTARY PUBLIC-CALIFORNIA I the State of California p ,e yrs, COMMISSION#2198600 E �� LOS ANGELES COUNTY // My Comm.Exp.May 22,2021 My Commission Expires: 0 E/aa-/ --i,04 CBF - 13 i City of Rosemead,California —'oid Package,Garvey Park Gym Cooling Addition,Project No.3101J-" Document Control Page 31 of 630 BIDDER: Al- 0.1 SECTION 4 REQUIRED FEDERAL FORMS CBF - 14 City of Rosemead,California oid Package,Garvey Park Gym Cooling Addition,Project No:316 n' Document Control Page 32 of 630 CONTRACTOR INFORMATION Company Name te e, -Ccc\st c 1 Address (41 _& .S� EL $e uncle) - cf-k •g02Lts— Telephone c9 49)2.sk- fs'oft Fax lett)-430 4$cO E-mail ck'tSS'kCcs ienei z Type of Firm: Individual® Partnership® Corporation Corporation organized under the laws of the State of CA c-34 Contractor's License Number 99ra ; State CA ClassificationN c--L0 Expiration Date CA 13\67,(Za DIR Registration Number ity:240acc(A-5 Expiration Date (IC? I o ! 'Q)io Names and titles of all officers of the firm . Scab eas1CIACk t1,5\\ ,S7tAetl\-); 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: 6` MONTH OF: Subcontractor's Contract Project Completion Date Name/Address Number Contract Amount Start Date(Estimate) (Estimate) Crafts to be Covered -1V7/4 P/A 1V/4- 11///k}- /VA /V/1-7-: The undersigned hereby certifies that: (a) The Equal Opportunity Clauses are indicated in each of the Listed Subcontracts; (b) Each subcontractor or lower tier subcontractor has been notified in N riting prior to their beginning construction, of his respective obligations under the Affirmative Action Requirements, if applicable. ` Signa ure Printed Name and Title Contractor Warne Contractor Address CBF- 16 E�j(y_o�R�spr�Qa�l��li otnj ent did Package,trry 1 Oyb6raii'{at No:3lu1y DepartRieVirteEhWtg&WiVers l�lJ I Coil j! 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 Secretary of said rules, regulations, or orders, this contract may be can- 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 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 Order 11246 of September 24,1965,or by rule,regulation,or During the performance of this contract,the contractor agrees as order of the Secretary of Labor,or as otherwise provided by law. follows: (7) The contractor will include the portion of the sentence imme- (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 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: national origin. Provided,That if the applicant so participating is a State or local (3) The contractor will send to each labor union or representative 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. provided advising the said labor union or workers'represen- 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 Laborin 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 by rules,regulations,and orders of the Secretary of Labor,or The applicant further agrees that it will refrain from entering into pursuant thereto,and will permit access to its books,records, any contract or contract modification subject to Executive Order and accounts by the administering agency and the Secretary 11246 of September 24, 1965,with a contractor debarred from,or who has not demonstrated eligibility for, Government contracts of Labor for purposes of investigation to ascertain compli ance with such rules, regulations, and orders. and Federally-assisted construction contracts pursuant to the Executive order and will carry out such sanctions and penalties for violation of the equal oppor• nity clause as may be imposed Firm Name and Address By l�\ Title EL- Ltritte z `502.14S— CBF 5022 SCBF- 17 form HUD-92010(3/2006) VA form 26-421 City of fto3cmcad,California -- aid Package,Corvcy Pork Cym Cooling Addition,Project No:31019 Document Control Page 35 of 630 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- ment 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 26-421 City of Rosemead,California d Package,Garvey Park Gym Cooling Addition,Project No'316 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 0 bidder, 0 proposed sub-contractor, hereby certifies thatesheAthas colaip)participated in a previous contract or subcontract subject to the Equal Opport C -, as required by. Executive Orders 10925, 11114, or 11246, and thatOshe afThj flied with the Joint Re4aottiee, the Director of the Office of Federal Con ra— ompliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all_reperts-due-uncler the applicable filing requirements. Date: Project Number: ContractAward: $ Awarding Agency: Contractor Name: Total Number of Employees Affiliate Company: A Wag& 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( nrally contracts or subcontracts of$10 000 or under am, t). Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subjectto the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b)(1)prevents the award of contracts and subcontracts unless such contractor submits a reportcovering the delinquent period or such other period specified by the U.S. Department of the Interior or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. 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 - ofd Package,Garvey Park Gym Cooling Addition,Project No:310 i Document Control Page 37 of 630 Exhibit: 13 County Lobbyist Certification Los Angeles County Compliance Form—To be submitted with 13ld COUNTY LOBBYIST CODE CHAPTER 2.160 COUNTY ORDINANCE NO.93-001 Name of Firm: AQ.Alecx3cz _ StruckZcr) Address:. IL.t( AIR\cicN, r A gOV State:_ CA Zip Code: ? LL.t Telephone Number: ( j.Gi`) 2,5\ — ,y 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 will 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 aotion, 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 certification is a prerequisite for making or entering into contract with the Los Angeles County and the Community Development Commission,County of Los Angeles, Authorized Official: 1��.�Q::�1 � y: ` e�ntiebnUBy: (Signature) / (Y3 Are)(Dat /9020. 5 o CBF-20 • City of Rosemead,California rsid Package,Garvey Park Gym Cooling Addition,Project No:3101 y Document Control Page 38 of 630 NON-SEGREGATED FACILITES CERTIFICATION Federally-Assisted Construction Projects The federally-assisted construction contractor certifies thatjshe 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 AI /)02O Project Number: 310\� Company: ,fe\eA c e, Ccr1Stu ci501 1 Title: iS�ic�e t`� . CBF-21 City of Rosemead,California --bid Package,Garvey Park Gym Cooling Addition,Project No:310 i J- 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 Los Rc\e,S - DEPARTMENT OF PTJBLIC 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. ,7: 44-- Comes rk . CBF-22 City.of Rosemead,California -" Bid Package,Garvey Park Gyro Cooling Addition,Project No:310 i u Document Control Page 40 of 630 COMPLIANCE WITH CLEAN AIR AND WATER ACTS (Applicableto federally assisted construction contracts and related subcontracts exceeding$100,000) During the performance of this contract, the contractor and all subcontractors shall comply with the requirements of the Clean At Act,as amended,42 USC 1857,of 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 owner the 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 bythe 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 guidelinesissued 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 causeto be included, the criteria and requirements in paragraph(1)through(4)of this section in every nonexempt subcontract and requiring that the contractor will take such action as the Government may direct asa means of enforcing such provisions. Name of Contractor t4d NVAXAN. St- EL . -icjr.L.ncto , cel JO24 Address dandTifle (2(2-> /IA I `7,020 Date • CBF-23 City.of Rosemead,California Did Package,Garvey Park Gym Cooling Addition,Project No 3101u 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 beinsuredagainst liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code,and will comply with such provisions before commencing the performance of the work off this contract. Date:D11:11120.2.0Project Number: k.(:) c ` ProjectName. C ovey C p r\c 6.?1�1'.cezki 1,di we'! Company Name;::. /Q€,1 .AY:La'- y , `L. _ Address: . Q-i) ar _ . •. CA 021 S Print Nare:. . aS'Ltd 04gL 5. II Air Signature: /sem Air� • CBF-24 City of Rosemead,California nid Package,Garvey Park Gym Cooling Addition,Project No:310 Docurrient Control Page 42 of 630 NOTICE OF SECTION 3 COMMITMENT To: (Name f'Labor Union or Workers'Representative] (Address)A Awarding Authority: C's. cSF Rc�c ,� . PrbjectName.and Number. .. C�: �\ ,� .A _, .. �.84 . ,� eco \Gj The undersigned currently ' holds a contract with involving Community Development Block Grant(CDBG)funds from the U.S. Department of Housing and Urban Development(HUD)or a subcontract with a prime contractorholding 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 extent feasible,to give opportunities for training 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 substantial part by project-area residents. Regarding employment opportunities for this'project,the minimum number and job titles are: Minimum Number Job Titles ` l rcajF i c- / Qrc ct' C t \�1 Regarding job referrals,request that consideration be given,to the.greatest extent feasible,to assignment. of persons residing in the servicearea or neighborhood in which the project is located. The anticipated date the work wit begin is 0,,21, I6G0 l,ci 7,(4 Cln be,,. .GR A For'additional information,contact: w ti• s This notice is furnished to.you,pursuant to the-provisions of the above contract or subcontract and Section 3 of the Housing and Urban Development Act of 1968. Copies of this notice will be p ted by t Undersigned in conspicuous places available to employees or applicants fore pia ent. /frikk-f ulcL chuct1.cf1 [ ontractoriS beer lorj (Sign nal 6.—c I I ,xe 20, fa—e s% . [Date] Mlle) CBF-25 City of Rosemead,California ;id Package,Garvey Park Gym Cooling Addition,Project No:310 Document Control Page 43 of 630 Section 3 Economic Opportunity Plan f...1, Noma anti Address of Roger/mg.Entity 2. Face'si identification(Ce rract:Award No.) 3 Dolor Amount.of Mont fReoplent.SUt48L5GOni,Ce tractier,Sulxazstraciar).'. o ` CGS-2-0 ki [lek.A Ctry. COnS1u� s11 4. Corlett Perron 5. Phase(Include Area Code);; c cell 0 t cA Qn`2`t� •B. ReporiTgPer-od. 7, LStt ReponSubmitted: el B, Program Code': (Use a aepdrete street far tear Program Cet) Program Codes 1. p:sable S hsey 2 Sachin 2621811 3. Pu61 arlan Houe.ng Development,Operation,and Modem€osaon d! Homeless Assistance 5 HOME 6: HOME-States Adm:nisfered 7 CoeG-Entitlement nt 8. COS-Statepdmmistored g. Otter CD Programs 10 Omar Housing lrroqrarrs: Part I: Employment and Training Commitment TOTAL SECTION %OF AGGREGATE CODECS) NEW 3 NEW HIRES WHO ARE JOB CLASSIFICATION HIRES HIRES SECTION 3 HIRES RACIAL ETHNIC Professionals �j� Technicians 6 office/clerical Trade: Trade: Part II: Contract Award:Commitment to Section.3.RusinEwes ISeseonvesters,suppliers:veneers or Sely e Pumeere) SPECIFY CONSTRUCTION OR CODE(S) NONCONSTRUCTION CONTRACT NAME OF SECTION:3 BUSINESS CONCERN CONTRACT AMOUNT RACIAL ETHNIC • • RACIAL BACKGROUNI;: SINGLE CATEGORIES _ DOt EI,E CATEQORI S 1, American Indian/Alaska Native 6 American Indian or Alaska Native AND White 2, Asian 7', Asian AND White 3. BlaoacrAfrican American S. Black orAfrican American AND White 4. Native Hawaian(Other Pacific Islander 9. .American Indian or Alaska Native AND Black or African American S. ::Wleite 10. Other-for individuals not Identified above, ETHNIC BACKSRO.UND: A. Hispanic/Latino B. Not Hispanis/Letino CBF-26 City of Rosemead,California bid Package,Garvey Park Gym Cooling Addition,Project:No 31G i u Document Control Page 44 of 630 Section 3 Business Certification For Business Name: 4.11+2.-'Qctp kiuc,?pr Business Address: l Ls t c��.t'v�CC�. St - Telephone Number: `cI 5 3 o- bcc4 Contract Amount:$ The above mentioned business firm is a Section 3 business concern based onthe following qualification: 1. 0 51 percent owned by Section 3 residents(attach Section 3 Resident Certification forms) OR 2, -a 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 8usiness Certification form for subcontractor,and Section 3 Resident Certification forms) OR 4. 12i 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: 0 White American ❑ Slack American ❑ Native American o Hispanic American Q Asian Pacific 0 Hasidic Jewish The undersigned by hisfher signature affixed hereto declares under penalty of penury that the above information is complete and correct. O I l202ct - Date Si.nature, S�RCA _CCWOSNcl,u5\ Print Name R12Si s\r\-- • Title CBF-27 City of Rosemead,California tiid Package,Garvey Park Gym Cooling Addition,Project No:310, Document Control Page 45 of 630 CERTIFICATION OF UNDERSTANDING AND AUTHORIZATION Project Name Gc.Lcve acc C zAnn Ackcinicn Project Number "z.,\O k5 This is to certify that the principles and the authorized payroll officer have read and understand the Minutes of the Preconstruction Conference and the labor standards clauses pertaining to the subject project. The following person(s) is designated as the payroll officer for the undersigned and is authorized to sign the Statement of Compliance, which will accompany our weekly certified payroll reports for this project. Designated Payroll Officer(Name) Acaic ) Designated Payroll Officer(Signature)dr*i�';,�ai► f'rr Authorized by (Contractor/Sulseer actor) �es�eu�cn � CsAstrvc.breN i.nature Title /1.c - 0X5-451 • I ?a 20 (IRS) Employer Identification Number Date CBF-28