Unique Performance Construction, Inc.1
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BIDDER: t4,gsIE? ?C'ItOCMn )ft WI1~1NC~~~~►1C '
SECTION 1 - BID SCHEDULE
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BIDDER y> C Perro~mM> c ~4rYslru2 l 1. xi
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BID SCHEDULE
SCHEDULE OF PRICES FOR .
ANNUAL 2008-2009 CURB RAMPS CONSTRUCTION PROJECT
CDBG PROJECT No. P46402
BASE BID SCHEDULE
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
CITY.
PRICE
COST
1
Clearing & Grubbing per plans and
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specifications. See technical
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ew or ,
provisions.
LS
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Disposal of Waste Materials
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fir-
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Construct PCC Curb Ramps per
AP.WA Std. Plan 111-3 including
truncated domes ARMORCAST
Z2~7,
' S~' poor '
replaceable yellow cast in place or
approved equal. See Curb Ramp
Tabulation on Appendix A and TP-
7 per details and locations.
Ea
70
4
Furnish and install ONLY
Truncated Domes Detectable
3 00~
36mo~
Warning Surfaces - ARMORCAST
retrofit or approved equal. See
appendix A and TP-7 per details.
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TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ Y I ,//coo, -
;Xe. AiGa, 4, -.S 9 l
Dollar amount in written form
ALTERNATE BID ITEM 1
4 u
NO.
ITEM DESCRIPTION
UNIT OF
MEASURE
EST.
CITY.
UNIT
PRICE
ITEM
COST
5
Construct 4-inch PCC Sidewalk
3/s91-
per APWA Std Plan 113-1.
SF
450
6
Construct PCC Cross and
Oo _
Longitudinal Gutters per APWA
Std. Plan 122-1. Intersection of
SF
300
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BIDDER:\W4U2 \efmfmaXk nkti oIIt o
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' TOTAL ALTERNATE BID PRICE (SCHEDULE BID PRICE): $ er of
Dollar ount in written form
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ ` b 6 O 0®
i
we ~ r F l~
' Dollar amount in written form
The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which
cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and
' after the bid opening date, or until a Contract for the Work is fully executed by the Owner and a third
party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the
written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall
' govern.
If the Bid Documents specify alternate bid items, the following Alternate Bid amounts shall
be added to or deducted from the Total Bid Price entered above. The owner can choose to
include one or more of the alternates in the Total Bid Price of the Project. If any of the
Alternate Bids are utilized by the Owner, the resulting amount shall be considered the Total
' Bid Price for the Project.
Attached hereto is a certified check, a cashier's check or a bid bond in the amount of
Dollars ° ° )sad amount being not less than ten percent (10%) of the Total
Bid Price. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
we fail or refuse to execute the Contract and furnish the required bonds, certificates and
endorsements of insurance and other certifications within the time provided.
If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be
prepared by the Owner for execution, within five (5) Calendar Days following the Letter of Award for
' the Contract, and will deliver to the Owner within that same period the necessary original
Certificates of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all
other documentation and certification required by the Contract.
The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
' Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and
' become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of Bidder's California contractor's license(s) in good standing; (2)
evidence that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract
resulting therefrom; and (3) any other information and documentation, financial or otherwise,
needed by Owner-to award a Contract to the lowest responsible and responsive bidder.
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BIDDER: U~1_ 1T i A M"U O.1A11ocuA) ~uCJ'
Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
and subject to the terms and conditions described in the Contract Form and the Contract
Documents.
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.
I Addenda Nos.
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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.
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BIDDER: WQ4 PCiUtt+~0.yYL( C(it rvCN~I kU'
'
By:
1q3) y3expj ~ u-46. StuYc D"
Sig re
Business Street Address
'
\~CUIY~Q~ ~-0-~0.t1U
~oS-4a 1-~Pa~~ I} g2b21
Type or Print Name
City, State and Zip Code
R(PSIdP~11
(94q) 1045_ 5035
Title
Telephone Number
Bidder's/Contractor's State of Incorporation:
CDA)AiorQ;o.,
Partners or Joint Venturers:
'
Bidder's License Number(s): $01`610
NOTES:
'
f th
th
1) By its signature on this Bid, the Bidder cert if
e
e accuracy o
ies under penalty of perjury
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 point venture has the authority to do so.
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BIDDER: 1)4p.5dormalyo C°cn~t~~e ile~c~.
SECTION 2
BID DATA FORMS
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BIDDER: U1JIG\T ~O~N~(J Y1l°PS~rUll'%
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 'ke,
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 Annual 2008-2009 Curb Ramps Construction 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 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 day of 20_
(SEAL) (SEAL)
Principal Surety
By. By.
Signature Signature
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BIDDER: )WigIo, Fef6jwQ3ACr lcm4n~ o-br6-Z 6-t,
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.
Pursuantto Public Contract Code Section 4104, the Owner has determined that itwill allow
Bidders twenty-four (24) additional hours afterthe deadline forsubmission of bids to submit
the information requested by the Owner about each subcontractor, other than the name and
location of each subcontractor.
If the Bidder fails to specify a subcontractor for any portion of the Work to be performed
under the Contract, it shall be deemed to have agreed to perform such portion itself, and
shall not be permitted to subcontract that portion of the Work except under the conditions
hereinafter set forth below.
Subletting or subcontracting of any portion of the Work in excess of one half of one percent
(greater than 0.5%) of the Total Bid Price or, in the case of bids or offers for the construction
of streets or highways, including bridges, in excess of one-half of 1 percent of the
Contractor's total bid or ten thousand dollars ($10,000), whichever is greater, for which no
subcontractor was designated in the original bid shall only be permitted in cases of public
emergency or necessity, and then only after Owner approval.
CBF-7
BIDDER: '0011A
10 ~ormgnCt, ~o"~STN
23 LIST OF PROPOSED SUBCONTRACTORS (continued)
["Duplicate Next 2 Pages if needed for listing additional subcontractors."]
Name and Location Description of Work
of Subcontractor (1 11 to be Subcontracted
Name: UOOYA1i0. U OOTMQ Cbr\~tuC~inq . IBC'' Pc f lv "t~. R Q rS
Address: 1 tn21 ~rtAK SuJc G~` O
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
Name and Location
of Subcontractor
Name: _
Address:
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name:
Address:
CBF-8
Description of Work
to be Subcontracted
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BIDDER: )link 1 &nnaat_ Ar~S~rt~u ~ jrfC
2.C 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.
Name
of Owner
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
2.
Name and Address of Owner
Name and telephone number of person familiar with project
Contract amount
3.
Name and Address of
Name and telephone n
Contract amount
4.
Name and Address of
Type of Work Date compietea
of person familiar
of Work Date Completed
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
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BIDDERA)uigW fer or,-,ao COnS~rnC~~
SECTION 3
NON-COLLUSION AFFIDAVIT
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BIDDEtlA64IUa ~rForr mAXn l m~S YJe O' ~J ~acJ"
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.
Sign re
I (MAQ& yAbOJN
Typed or Printed Name
i'ms~ a_A
Title
I~ti/lim fp~ryy~ ~P l0>7b~T~i'~~f Jwln/'
Bidder
Subscribed and swo n before me
This Q6"-day of 200
Nota is in and for Cry
the State of California
Z/ OW2-
My Commission Expires:
(Seal)
ABDUL KALIM
Comm.# 1800454
N ' NOTARY PUBLIC-CALIFORNIA
ORANGE COUNTY
MY Comm. EXY. JUL. 2, 2012
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CITY OF ROSEMEAD
ANNUAL 2008-2009 CURB RAMPS CONSTRUCTION
PROJECT
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PART "A"
GENERAL PROVISIONS
' "NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID"
§7106. Any public works contract of a public entity shall include an affidavit, in the following form:
State of California )
t County of Or L ) ss.
' M~UtrnUL7 I being first td~u~lly~. sworn,, ,d`eposes and says that, he e;<--_ is
~'QSI(,KNf of 1)t 1_T n Cef1f711 OP 1 Dtl.l6kkO~i 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."
' CDR)& N0.
Project Name: a10DP Ia~t~ L(UtnuUU Curb RQIVIP6 Project Number: LJ Ab2
' Company: IV ofM(AyM 15~rtJbr(N~~~IUG'
Address: R31 NEWPga blvd. SA & J CDS12L 14ao , CA 9g(ca-7
Signature: I
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Title: Pre S
Date: 2 2j 24b~
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SWORN TO AND SUBSCRIBED TO BEFORE ME
' ABDUL KALIM This day of 20
OOMM. tl 1800 II4F54
NOTARYRGRNIF
N ORA HGE NGE COU COUNTY ~ /s/ Notary Public: -cam
My `GNU. Ezv. JuE.2, 2012
My Commission Expires: - Z Z~~
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NON-SEGREGATED FACILITIES CERTIFICATION
FEDERALLY-ASSISTED CONSTRUCTION PROJECTS
The federally-assisted construction contractor certifies that he/she DOES NOT and WILL NOT:
Maintain or provide, for his/her employees, any segregated facilities at any of his/her
establishments.
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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 subcontracts 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.
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Date: a l ;J 10,01) 9
Company:
Project Number: 01)56 Pqto°Z
Address: Iq3/ Aiet) orl blyd Sid OD 005-ML "e5o-, CA
By: Moth -ki, KabaAJ
Title: P1'ud64
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CERTIFICATION
WITH REGARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR
SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND
THE FILING OF REQUIRED REPORTS
The Hbidder, ❑proposed sub-contractor, hereby certifies that he/she 2 as, ❑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, ❑has 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.
CD86 00.
Date: A 91-M Project Number: P404L Contract Award: $
Awarding Agency:
Contractor Name: VNi4~e P~rFOr,~Qnee '(onstt hDAj~ ~N(r•TotalNumberofEmployee, 5
' Affiliate Company:
By: M Ount~ o
Maim
' Title: II?SI~PtI7
' 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 contract or subcontract subject to
' 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 report covering 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
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Community Development Commission
County of Los Angeles
COUNTY LOBBYIST CODE CHAPTER 2.160
COUNTY ORDINANCE NO. 93-0031
CERTIFICATION
Name of Firm: 1~ [AV IIvi L'V"D1rVu11 uvv'
Address: to N 11XJ± blvd. &a `1J CNio "P-so-~
State: CA Zip Code: g2W11 Telephone Number: (Q I i (n~5- 50~~
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
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 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:
' _ NlQtt P2~ FOVmA~t@Z &40 CO~, lAt/ By: f ~putll~tt~ kai ~^~1
(Contractor/Subcontractor) eture)
020V 900 f res~~P
(Dare) rr'ao)
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WORKER'S COMPENSATION CERTIFICATION
I
' 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 or to undertake self-insurance in accordance with the provisions of
' that code, and I will comply with such provisions before commencing the performance of
the work of this contract.
Date: o~I a5I a00~ Project Number.
Project Name: &irnud~ 010o81a0A Curb mmp1 hn&60o 60 PrVWJ,
Company Name: Wag Perrofrt'1ma Cbnsh-VOC00 , fo&
Address: 1931 bfvd 5L:& D. 06,41- Wes0. CA- 46,a7
' Print Name: WouWa,-,,-, kobaO
' Title:
Signe
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U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
HUD FORM 4230A
REPORT OF ADDITIONAL CLASSIFICATION AND RATE
oMa A (En.
2501-Mil
)
pvlo~I Number
(Exp.
1. FROM (name and address of requesting agency)
2. PROJECTNAME AND NUMBER
UNi-'UR Performer een5l'ru6h01J) IA-'
jq uAt ~063-' ler./6 rt[r-Os
ec'
193
1 Lnrewporf blvd. ScLUr .D
proj
CD&~ ' PH
Nkfda-
C
C0 t4e,56,- Ck q24(G?
1
3. LOCATION OF PROJECT (City, County and State)
P($ef(eal i 43 Ali jal5 C}
PROJECT
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4. BRIEF DESCRIPTION
5. CHARACTER OF CONSTRUCTION
1~
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'
/~g/p ~QCC /arw' r-uC~' 6U-/-'b rtt- ps
/
❑ Building ❑ Residential
/ /
❑ Heavy ~Gther (specify)
❑ Highway ,fJertU' e,
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6. WAGE DECISION NO. (include modification number, if any)
7. WAGE DECISION EFFECTIVE DATE
❑ COPYATTACHED
8. WORK CLASSIFICATION(S)
HOURLY WAGE RATES
BASIC WAGE FRINGE BENEFIT(S) (if any)
9. PRIME CONTRACTOR (name, address)
10. SUBCONTRACTORIEMPLOYER, IF APPLICABLE (name, address)
VNIgLU rGrt or nn C2 C o ~S f C(w~ /~d .
"
"
D
1`)SI Alec Ipor'4 101'd. 3f¢
Casf~b- f-~esA-CA 92(02
Check All That Apply_
❑ The work to be performed by the additional classification(s) is not performed by a classification in the applicable wage decision.
❑ The proposed classification is utilized in the area by the construction industry.
❑ The proposed wage rate(s), including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the
wage decision. ,
❑ The interested parties, including the employees or their authorized representatives, agree on the classification(s) and wage rate(s).
❑ Supporting documentation attached, including applicable wage decision.
Check ne0ne0
❑ Approved, meets all criteria. DOL confirmation requested.
❑ One or more classifications fail to meet all criteria as explained in agency referral. DOL decision requested.
FOR HUD USE ONLY
LL o2 ~
~Dluw7ikZ ~A.ACf I
LR2000:
Agency-Representative Date
Lo in:
g
(Typed name and signature)
(,"75-- 5?a55-
Log out:
Phone Number
unnwan<fB-011 PREVIOUS EDITION IS OBSOLETE
I
' EQUAL EMPLOYMENT OPPORTUNITY COMMITMENT
TO: &-/1-
(Name of Labor Unio , Workers Representative, etc.
All 14
(Address) r
' Name of Business (Contractor): UNigae I e~lcrMan c~ ~ansf~ue- /nr(i
Project Name: Onnu&~ 08-o9 e u,-lb ra,foPs Project Number. CD$9 00. P~f~No~
The Undersigned currently holds a contract with l l oA 'Ro"ea-,d involving
funds of the U. S. Government, or a subcontract wittia prime contractor holding such contract.
You are advised that under the provisions of the above contract or subcontract, and in accordance
with Executive Order 11246, the undersigned is obligated not to discriminate against any employee
or applicant for employment because of race, color, religion, sex or national origin. This obligation
not to discriminate in employment includes, but is not limited to the follow:
1. Hiring, placement, upgrading, transfer or demotion;
2. Recruitment, advertising or solicitation for employment;
3. Treatment during employment;
' 4. Rates of pay or other forms of compensation;
5. Selection for training, including apprenticeship; and
6. Layoff or termination.
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This notice is furnished to you pursuant to the provisions of the above contract or subcontract and
Executive Order 11246. Copies of this notice will be posted by the undersigned in conspicuous
places available to employees or applicants for employment.
/V )oum1a i ket"
(Print Neme) '
By:
,~/as/aPJ
(Date)
Pere
(Tate)
1
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NOTICE OF SECTION 3 COMMITMENT
' TO: h f A
(Name of Labor Union, Workers Representative, etc.
(Address)
Name of Business (Contractor): VA11Q1(2 1 CrCa~'t ae Ce (~'S>r~C~a~, ~n~Pi
' Project Name: &l\M.P D - Curb S Project Number: CDBG Ob, 12464
C8h5 ru 6,t0) Pred " nn
The Undersigned currently holds a contract with ~(hl DT POSP-An ec_Q
involving Block Grant (CDBG) funds from the U. S. Dep ment of Housing and Urban Development
' 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 extent feasible, to give opportunities for employment and training to lower income
residence of the CDBG-assisted project area and to award contracts for work on the project to
business concerns which are located in or are owned in substantial part by project area residence.
Regarding employment opportunities for Section 3, the minimum number and job titles are:
I Number
Job Classification
I
' 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 For additional information, you may
contact Y"JDUrv--A~?~ at (~`~g) Cn4/5 5b~~.
-Tub fm
' 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 posted
by the undersigned in conspicuous places available to employees or applicants for employment.
By: -
(Print Fame) (Siamre)
y
l~51 -9m-l /OrZa
(Date) (Title)
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SECTION 3 ECONOMIC OPPORTUNITY PLAN
1. Name and Address of Reporting Entity
2. Federal Identification: (Contract/Award No.)
3. Dollar Amount of Award:
(Recipient, Sub-recipient, Contractor, Subcontractor)
l
V/✓I Q LtF r lM~I ueJ /D cl7U~rw
"
"
d
r
I
4. Contact Person:
!ti(ctLti F lab
5. one (include Area Code)
9H9- S- 95
!1 CJilt!'.
Z:)
o
! nJ~ p
/%S
6. Reporting Period:
7. Date Report Submitted
0,06+A r4esc 904 -1-1
-
8. Program Code:
(Use a separate sheet for each Program Code)
Program Codes
FIFlemble Subsidy 2. Section 202/,811 3. Public/Indian Housing Development, Operation and Modernization 4. H
omeless Assistance 5. HOME
OME-State Administered 7. CDBG-Entitlement 8.
CDBG- State Administered 9. Other CO Programs
ig. Other Housing Programs
~....:4 .......6
rar[ I: r-m IV iiiy1, ally I •mu•••
TOTAL
SECTION 3
°h of Aggregate Hires
JOB
CLASSIFICATION
NEW HIRES
NEW HIRES
Who are Section 3 Residents
%
Professionals
Technicians
Office/Clerical
1
Trade: ir2t~
Trade:
Trade:
Trade:
TotaC.
_a a_ C....&;-- 4 0.,~; n n c cac . o~,.,.r>.a V-Hn % nr Service Providers)
Yar-E n: %,V I ILL aGL MWO I U vUluu -I
NAME OF
SECTION 3 BUSINESS CONCERN
.•a. _
SPECIFY
CONSTRUCTION OR NONCONSTRUCTION CONTRACT
CONTRACT
AMOUNT
$
$
$
$
$
TOTAL
$
Percentage of the total dollar amount to be awarded to Section 3 Business Concerns:
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SECTION 3 ECONOMIC OPPORTUNITY REPORT (CONTRACTOR)
1. Recipient Name and Address
(Recipient, Sub-recipient, Contractor, Subcontractor)
p
2. Project Number: Icomrocunwam No.)
OrDg6 O • f„+ 4APq 0~
'
3. Dollar Amount of Contract:
UNiQU6 t
Erforraaxe-c 5yLS~W..'Aio
l II u~ ll
D
1
1
1
Person, 1
4.~,(({`ontact
! buw%.k-&
s. Phone: (include Area Code)
lY 56,'S Y
JP4 P64
0
,45
.
C051k Mesa 0A 9.l(O P~
6. Reporting Period: -
-
7. Date Report Submitted
6. Project Number:
9. Federal EIN:
Part I' Fmnlnvment P. Tralnina Ormortunities orovlded to low-income individuals (Minimum Goal: 30% of New Hires)
TOTAL
LOW-INCOME
% of Aggregate Hires
JOB CLASSIFICATION
NEW HIRES
NEW HIRES
who are low-income
Technicians
%
Office/Clerical
%
Professionals
%
Construction Trade:
%
Construction Trade:
%
TOTAL
%
D -a14 II• Q.. Lr ..4. n4~ A.. arinrl , .,....~,.r r-., vs-, mtt.e P.Imc C-f-t Gninuntl
Number of Subcontracts awarded:
Number of Section 3 Businesses Receiving Contracts:
Name of Qualified Business Concern
Construction or Non-construction Contract
Amount
$
Total Dollar Amount of Subcontracts awarded to Section 3 qualified Business Concerns:
$
Dollar Amount of All Subcontracts:
$
-Percentage of the total dollar amount awarded to qualified Business Concerns:
%
Part III: Summarv of the efforts that were made to generate economic opportunities
Trained and/or Employed _ low-income individuals equal to of the aggregate new hires. (Attach Resident
Certifications) '
Awarded a Subcontract to _ qualified Business Concerns equal to of the contract amount. (Attach Business
Certifications)
Attempted to recruit low-income individuals through:
Advertised through local media, television, radio, newspaper (Attach copy of advertisement)
Signs prominently displayed at the project site
Contacts with community organizations
Contacted management to notify residents and posted or distributed flyers at public housing authority (Attach list)
Participated in a HUD program or other program which promotes the training or employment of low-income individuals
Participated in a HUD program or other program which promotes the award of contracts to Section 3 Qualified Business
Concerns
Contacted agencies administering HUD Youth-Build programs. (Attach list)
Maintained a file of eligible, qualified low-income Residents and qualified Business Concerns for future employment.
OTHER-- (Attach supporting documentation)
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SECTION 3 RESIDENT CERTIFICATION
(2008 Income Guidelines)
' Employee's Name:
Employee's Address:
I hereby certify that I am a Section 3 resident; based on the following qualification(s):
1. 1 am a Public Housing Resident (specify Name of the Public Housing site):
' 2. 1 am a low-income resident of the metropolitan area.
Select your household size and gross annual income level (from all sources):
HOUSEHOLD SIZE &INCOME LEVEL
❑
1 $26,550 or less
❑
2 $30,300 or less
❑
3 $34,100 or less
❑
4 $37,900 or less
❑
5 $40,950 or less
❑
6 $43,950 or less
❑
7 $47,000 or less
❑
8 $50,050 or less
' 3. 1 am not a public housing or low-income resident of the metropolitan area.
' .Employee Signature Date
Must Be Completed by Employer
The above-named person is a permanent full-time employee who was hired on:
' The above-named person is a new-hire employee who was hired on:
This person's lob Classification is:
Name of Employer:
' To Be Completed by Local Contracting Agency
Preference Category: ❑ Targeted Service Area ❑ Youthbuild ❑ McKinney Homeless ❑ Other Section 3
Census Tract Number:
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A Section 3 responsive bidder who commits to hire Section 3 Residents by directing employment and training
opportunities toward low- and very low-income persons, particularly those who are recipients of government
assistance forhousing, may use any combination of outreach efforts to meet the Section 3 commitment made
' when a Section 3 Economic Opportunity Plan has been submitted.
REMEMBER: All employees of a business/firm count toward meeting your Section 3 compliance goals-
Section 3 New Hires do not have to be construction workers, they just have to be a part of your permanent,
' full-time staff.
SAMPLE OUTREACH EFFORTS FOR CONTRACTORS
' SEEKING SECTION 3 RESIDENT EMPLOYEES
Enter into "first-source" hiring agreements with organizations representing Section 3 residents,
' such as Work Source or a local Workforce Investment Board. For more information, visit
htto'//www.calwia.orq/lwia/index.cfm
1 • Sponsor a HUD-certified "Step-Up" employment and training program for Section 3 residents.
' Advertise training and employment positions by distributing flyers (Notice of Section 3
Commitment or other flyer that identifies the positions to be filled, the qualifications required, and
where to obtain additional information about the application process) to every occupied dwelling
unit in the housing development(s) adjacent to the project site.
Post training and employment position flyers in public housing developments, offices of the local
government, and other conspicuous places.
'
Contact State-approved apprenticeship programs to gain access to potentially low-income
residents who are actively seeking job-placement and training. For more information on local
apprenticeship programs, you can visit the California Department of Industrial Relations' database
of local apprenticeship programs by visiting httl)*//www.dir.ca.gov/databases/das/aigstart.asp
their assistance to
uestin
d
ild
g
req
programs, an
• Contact agencies administering HUD Youthbu
recruit current HUD Youthbuild program participants who are in need of permanent placement.
• Advertise any positions to be filled through the local media, such as community television
'
networks, newspapers of general circulation, or commonly-used job placementwebsites such as
www.monster.com
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SECTION 3 BUSINESS CERTIFICATION FORM
' Business Name: ()0j'quj I~ffOrrvtQ/1P~ L"/~15,<7uG~b~, ln/Ci'
' Business Address: i93J NPjPo I b )v-d S y /G n D
CPA- Mesh-, CA- 6?;2(e9j
Telephone Number. 9~q- (phl5- 5 ba5~ Contract/Bid Amount: $ Sb
1. The above mentioned business firm is a Section 3 business concern based on the following qualifications:
❑ 51-percent owned by Section 3 Residents
(Submit Resident Certifications with this business certification form)
❑ At least 30-percent Permanent, full-time employees are Section 3 Residents
Total Number of all full-time employees , Number of Section 3 qualified Employees
(Submit the Resident Certification form(s) with this Business Certification form)
2. The above mentioned business firm is not a Section 3 business concern, but commits to the Section 3 goal:
' Written Commitment (Section 3 Economic Opportunity Plan), outline intentions to:
Hire Section 3 qualified residents at least 30-percent aggregate new hire positions, and/or
Subcontract 25-percent or more of the contract amount to Section 3 qualified business concerns.
THE UNDERSIGNED DECLARES THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT q
I I S' ature oo/f Owner/Princi/pDate
UNII{uL '0' yrr 0n& l d^S~~ue /to~ 1~c, . ~~~~(00
Business Name License Number
I
To Be Completed by Local Contracting Agency
Preference Category: oTargeted Service Area ciYouthbuild o0ther - Census Tract Number:
1
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SECTION 3 ECONOMIC OPPORTUNITY REPORT (CONTRACTOR)
1. Recipient Name and Address
SSub-recipient, Contractor, subcontractor)
(Recipient,
2. Project Number: cor"a Award No.)
/~DQ ,a PltP0Lr)6Pq_
"l
3. Dollar Amount of Contract:
p
UA/l va TerPoemonce l.enS~P✓P ~aJ
5wr "D('
d
~ bl
J
4. Contact IP~erson:
MOUtvtla!:Z~
5. Phone: (include Area Code)
Qq?-(p~(S 5-O2Sr
.
v
Pa~ycr
19 1 /
/
o~s~r, M~s0., ~ eafoa~
6. Reporting Period:
7. Date Report Submitted
8. Project Number.
9. Federal EIN:
n_" r. r~_r 4 T...i..t.... flnnnhunifinc nrnvirlori fn Inw-inrinni individuals (Minimum Goal: 30% of New Hires)
TOTAL
LOW-INCOME
% of Aggregate Hires
JOB CLASSIFICATION
NEW HIRES
NEW HIRES
Who are low-income
%
Technicians
Office/Clerical
%
Professionals
%
Construction Trade:
%
%
Construction Trade:
TOTAL
%
I ar"u. au
Number of Subcontracts awarded:
Number of Section 3 Businesses Receiving Contracts:
Name of Qualified Business Concern
Construction or Non-construction Contract
Amount
$
$
Total Dollar Amount of Subcontracts awarded to Section 3 qualified Business Concerns:
$
Dollar Amount of All Subcontracts:
$
Percentage of the total dollar amount awarded to qualified Business Concerns:
Part III: Summary of the efforts that were made to generate economic opportunities
Trained and/or Employed _ low-income individuals equal to (°/a) of the aggregate new hires. (Attach Resident
Certifications)
Awarded a Subcontract to _ qualified Business Concerns equal to of the contract amount. (Attach Business
Certifications)
Attempted to recruit low-income individuals through:
Advertised through local media, television, radio, newspaper (Attach copy of advertisement)
Signs prominently displayed at the project site
Contacts with community organizations
Contacted management to notify residents and posted or distributed flyers at public housing authority (Attach list)
Participated in a HUD program or other program which promotes the training or employment of low-income individuals
Participated in a HUD program or other program which promotes the award of contracts to Section 3 Qualified Business
Concerns
Contacted agencies administering HUD Youth-Build programs. (Attach list)
Maintained a file of eligible, qualified low-income Residents and qualified Business Concerns for future employment.
OTHER - (Attach supporting documentation)
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FEDERAL LOBBYIST CERTIFICATION
Name of Firm:
Address: 1 `J 3 /
X le
b)vd Sr. _
D • eD3-14 f`
/eaA
State: 0.A-
Zip Code:
Telephone Number:
(Q~~) cP L4S_ sa SS
Acting on behalf of the above named firm, as its Authorized Official, I make the following Certification to the U. S.
Department of Housing and Urban Development and the Community Development Commission, County of Los
Angeles.
1) No Federal appropriated funds have been paid by or on behalf of the above named firm to any
person for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of and Federal grant, loan or
cooperative agreement, and any extension, continuation, renewal, amendment, or modification
thereof, and;
2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee or any agency, a Member of Congress
an officer or employee of Congress or an employee of a Member of Congress in connection with
this
Federal contract, grant loan, or cooperative agreement, the above named firm shall complete and
submit -Standard Form-LLL, "Disclosure Form to Report Lobbying", in accordance with its
instructions, and;
3) The above name firm shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under
grants, loans, and cooperative agreement) and that all sub-recipients shall certify and disclose
accordingly.
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 the transaction
imposed by Section 1352 Title 31, U. S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Authorized Official:
4 ue /er~orMan~ C~rS By:
(Con=wr/Subconmector)
alDate ~daoq
(Signaturc)
Est
(Title)
CITY OF ROSEMEAD
ANNUAL 2008-2009 CURB RAMPS CONSTRUCTION
PROJECT
CONTRACT APPENDIX
1
1
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UniquePerfommw
Construction, Inc
FAX COVER
TO William (William Dunn Masonry)
FAX # : 562-432-3865
DATE 02124/2009
MESSAGE:
1931 D Newport Blvd.
Costa Mesa, CA92627
Phone: 949-645-5025
Fax: 949-631-7591
Lie. s 801860
FROM Matt Kabany
FAX # 1
# OFPAGES 1
Our Firm will be bidding a project for City of Rosemead on Feb., 2e, 2009 (Annual 2008-2009 Curb Ramps
Construction Project) CDBG Project No. P46402) we would like you participation in quoting in the bid item Please
forward ASAP. Thank you
Feel free to contact us for any further questions.
TRANSMISSION VERIFICATION REPORT
TIME : 02/24/2009 13:23
NAME .
FAX
TEL
SER.# L6J303848
DATEJIME
02/24 13:23
FAX N0./NAME
15624323865
DURATION
00:00:12
PAGE(S)
01
RESULT
OK
MODE
STANDARD
ECM
UniquePerfomw"
CO/ZS~iuL~lOit~ 1/1G
FAX COVER
TO : Vision Trucking, Georgia Shepherd FROM
FAX # : 562-292-1755 FAX #
DATE : 02/24/2009 # OFPAGES
MESSAGE:
1931 D Newport Blvd.
Costa Mesa, CA92627
Phone: 949-645-5025
Fax: 949-631-7591
Lic. # 801860
Matt Kabany
1
1
Our Firm will be bidding a project for City of Rosemead on Feb., 25h, 2009 (Annual 2008-2009 Curb Ramps
Construction Project) CDBG Project No. P46402) we would like you participation in quoting in the bid item Please
forward ASAP. Thank you
Feel free to contact us for any further questions.
TRANSMISSION VERIFICATION REPORT
TIME : 02/24/2009 13:25
NAME .
FAX
TEL
SER.# L6J303846
DATEJIME
02/24 13:24
FAX N0./NAME
15622921755
DURATION
00:00:53
PAGE(S)
01
RESULT
OK
MODE
STANDARD
ECM
1931 D Newport Blvd.
U*uePerfomw ce Costa Mesa, CA92627
Phone: 949-645-5025
Conowfion, Inc Fax: 949-631-7591
Lic. # 801860
FAX COVER
TO Rose Hammers (Pour Concrete Cutting & Removal FROM
FAX # 562-426-3813 FAX #
DATE :02/24/2009 # OFPAGES
MESSAGE:
Matt Kabany
1
1
Our Firm will be bidding a project for City of Rosemead on Feb., 25h, 2009 (Annual 2008-2009 Curb Ramps
Construction Project) CDBG Project No. P46402) we would like you participation in quoting in the bid item Please
forward ASAP. Thank you
Feel free to contact us for any further questions.
TRANSMISSION VERIFICATION REPORT
TIME 02/24/2009 13:26
NAME
FAX
TEL
SER.# L6J303848
DATE,TIME
02/24 13:26
FAX N0./NAME
15624263813
DURATION
00:00:11
PAGE(S)
01
RESULT
OK
MODE
STANDARD
ECM
1931 D Newport Blvd.
U*uePerfo mm w Costa Mesa, CA92627
Phone: 949-645-5025
COlL4&WfiO14 InC Fax: 949-631-7591
Lic. # 801860
FAX COVER
TO JMR General Engineering, Miguel Guajardo FROM Matt Kabany
FAX # : 562-726-1329 FAX # 1
DATE : 02124/2009 # OFPAGES 1
MESSAGE:
Our Finn will be bidding a project for City of Rosemead on Feb., 25 h, 2009 (Annual 2008-2009 Curb
Ramps Construction Project) CDBG Project No. P46402) we would like you participation in quoting in
the bid item Please forward ASAP. Thank you
Feel free to contact us for any further questions.
TRANSMISSION VERIFICATION REPORT
TIME 02/24/2009 13:31
NAME
FAX
TEL
SER.# L6J303848
DATEJIME
02/24 13:30
FAX N0./NAME
15627261329
DURATION
00:00:13
PAGE(S)
01
RESULT
OK
MODE
STANDARD
ECM
BIDDERUnique Performance
Construction, Inc.
Bond Number: B909603
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.
2A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT Unique Performance Construction, Inc.
3ific Insurance Com
as
as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
Ten Percent of Amount Bid
108 of bid 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 Annual 2008-2009 Curb Ramps Construction 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 the other to guarantee payment for labor and materials) furnishes the required
insurance certificates and endorsements, and furnishes any other certifications as
may be required by the Contract, then this obligation shall be null and void;
otherwise it shall remain in full force and effect. In the event suit is brought upon
this bond by the OWNER and judgment is recovered, said Surety shall pay all costs
incurred by the OWNER in such suit, including reasonable attorneys' fees to be fixed
by the court.
SIGNED AND SEALED, this 24th day of February 20 09 .
Financial,Pacific
Unique Performance Cons tructior(SEAL) Insurance Company -(SEAL)
Principal Inc Surety
%:r BY: By: lei( l
ignature I ature
anelle L. Miller, Attorney-in-
Fact
CBF-6
LIMITED POWER OF ATTORNEY
Financial Pacific Insurance Company
BOND NUMBER B909603 POWER NUMBER 9 0 9 6 0 3
PRINCIPAL Unique Performance Construction, Inc.
PENAL SUM 10% of amount bid
KNOW ALL MEN BY THESE PRESENTS, that Financial Pacific Insurance Company, a California corporation (the "Company"),
does hereby make, consti le ar¢I apyoiyt
,
anelle L LVltller, Jeff Aase, Will Mingram, Christopher M. Haenel
its true and lawful Attorneys-in-Fact, with limited power and authority for and on behalf of' (he Company as surety, to execute, deliver and affix
the seal of the Company thereto if a seal is required on bonds, undertakings, recognizances•or other wnttewobligations in the nature thereof as
follows: V 1 (
Bid, Performance, Payment, Subdivision and Miscellaneous Bonds upAo $1,500,000.00
and to bind the Company thereby. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following
resolutions adopted by the Board of Directors of Financial pacific Insaradce Company at the meeting/duly held July 6, 1995, which are now in
full force and effect:
RESOLVED, that the Presidentior any Vice P esident, in conjunction with(the Secretary or any Assistant Secretary, may appoint
attorneys-in-fact or agents-with authority as defined limitedrin the instrument evidencing~the~appointment in each case, for and on behalf of
the Company, to execute and deliver and affix the seal of ih'Co`mpany to bonds, undertakings, recognizances, and suretyship obligations of all
kinds; and said officers may remove any such attorney-in=factlor agent and revoke anypower of attorney previoasly granted such person.
A"I
RESOLVED~FURTHER, that any, bbond, sun lertaki ng,~recogmzance, or suretyship obligation shall be,valid _and;binding upon the
Company when signed and sealed (if a seaPbe required) by one or more attorneys-irifact pursuant, to_and'within the limits:of the authority
evidenced by the power of attorney issued•by'the.COmpany to such person or persons.
RESOLVED FURTHER,.that the_signature of any authorized officer and the-seal of the,Company may be affixed by facsimile to any
on, thereofauthorizing the execution arid~deliver`y~cf,any bond;-tinder iaking recognizance;,`or other suretyship
power of attorney or certifieati _
obligations of the Company; any such signature and seal when.so usedslal Pheve'the same; force a`ndeffecL3sthough manifally affixed.
IN WITNESS WHEREOF, Financial Pacific Insurance Company has caused these presents to be signed by its proper officers, and its
corporate seal to be hereunto affixed this 12th of September, 2007.
%.Ed r J. Paoletti,Nice President
1
STATE OF CALIFORNIA COUNTY OF PLACER
On this ...1614 anuary, 2008 before me„ Eisa Roper, Notary public,.fF sonally;appeared Edward7. Paoletn,andJdhn R.;,Hollingshead, who proved to
Inc on the basis of satisfactory evidence to be the persons whose names are subscribed to the within instrument and acknowledged to me that they
executed the same in their authorized capacities, and that by their signatures on the instrument the persons, or the entity upon behalf of which
the persons acted, executed the instrument.
t Roper P t
CERTIFICATE
I certify under the Penalty of Perjury under the laws of the State of California that the foregoing paragraph is true and correct.
ollingshead, SecretaryUSA ROPER
Signed and sealed at Placer, this 24th day of Februa , Z ryO 09 John
. ~ a ~Ll
DI a
COMM. # 1755752 i
2~ ~ NOTARY PUBLIC-CALIFORNIA
PLACER COUNTY
y Comm. Exrtres July 6, c 6,11
M 2071
R Hollingshead; Secr
1 n tary
Financial Pacific
Insurance Company
seal must
be affixed
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
STATE OF CALIFORNIA
County of San Bernardino
On February 24, 2009 before me, N Cruz notary public
Date Here Insert Name and Title of the Officer
personally appeared Janelle L. Miller
Name(s) of Signer(s)
N. CRUZ
COMM. #1674004 m
W Notary Public C iromia
CAUNIV
SAN BERNARD NO
Oil Corm. Exp. June 10, 2010
Place Notary Seal Above
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they
executed the same in his/her/their authorized capacity(ies),
and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s)
acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of
the State of California that the foregoing paragraph is true
and correct.
Witness mEignature d off iciaks
Signature
oly Pu li
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named
Capacity(ies) Claimed by Signer(s)
Signer's Name:
❑ Individual
❑ Corporate Officer
El Partner- ❑ Limited ❑ General
Cd Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
Number of Pages:
Signer's Name:
❑ Individual
❑ Corporate Officer -Title(s)_
❑ Partner- ❑ Limited ❑ General
❑ Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
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02007 National Notary A mialion • 9350 De Soto Ave, P.O. Box 2402 • Ohoo,vorth, CA 91313-2a02 • wvrx.NationalNotary.ag Item #5907 Reorder: Call Toll-Free 1-900.8]66827
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