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American Asphalt South, Inc.
u CITY OF ROSEMEAD ANNUAL 2008-2009 SLURRY SEAL PROJECT CONTRACT BID FORMS BIDDER: k 4 CONTRACT BID FORMS TABLE OF CONTENTS SECTION 1 BID SCHEDULE ......................................................................................................1 SECTION 2 BID DATA FORMS ..................................................................................................5 2.A BID BOND ................................................................................................................6 2.13 LIST OF PROPOSED SUBCONTRACTORS .........................................................7 SECTION 3 NON-COLLUSION AFFIDAVIT .............................................................................10 BIDDER: a It SECTION 1 - BID SCHE-D-U-L-E~ CBF-1 M4 7 7 i BIDDER: " &VS, rx BID SCHEDULE SCHEDULE OF PRICES FOR ANNUAL 2008-2009 SLURRY SEAL PROJECT CDBG PROJECT No. P46402 BASE BID SCHEDULE UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 1 Clearing & Grubbing per plans and specifications. See technical specifications TP2 & TP3. LS 1 rJ SDQ 7 ~~D ~G 2 Disposal of Waste Materials LS 1 p~, cU ADD va 3 Crack Sealing LS 1 Zfl3SD.pD 2D~5D.~'~ 4 Slurry Seal Type II - See exhibit "A" & "B" per street locations & areas j~ y!~ / p 8 2 SD . ELT 750 5 Traffic Striping and Pavement Markers - See exhibit "C" per details. LS 1 TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$_ / /P D/, 5. SD D !J! 1V'-7 //-,f to t Dollar amount in writtn form The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract for the Work is fully executed by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. CBF-2 BIDDER: lAel'%!461 •~ar/V Attached h9reto is a certified check, a cashier's check or a bid bond in the amount of ~1 1' li( 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 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. I 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 and subject to the terms and conditions described in the Contract Form and the Contract Documents. Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be incorporated into a Contract arising out of this Submittal has been so identified by Bidder. Bidder further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data submitted herewith into a contract arising out of this Bid. The undersigned acknowledges receipt, understanding and full consideration of the following addenda to the Contract Documents. Addenda Nos. The Bidder understands and agrees that the Total Bid Price is inclusive of all labor, materials, and equipment or supplies necessary to complete the Work as described in the Bid Documents. If this bid is accepted, the undersigned Bidder agrees to enter into and execute the Contract with the necessary bonds and accept the Total Bid Price as compensation in full for all Work under the contract. CBF-3 BIDDER: Aft' ?'0V r&/N///• ~ Onature z/ s T e or Print Name Title /M SA04 Af 01le Business Street Address City, State and Zip Code Telephone Number Bidder's/Contractor's State of Incorporation: GCi►~ry1~'4 Partners or Joint Venturers: I -tx I~ J. d. Bidder's License Number(s): ~'8yx/y el 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 ioint venture has the authoritv to do so_ CBF-4 MINUTES OF THE 2009 ANNUAL MEETING OF THE BOARD OF DIRECTORS OF AMERICAN ASPHALT SOUTH, INC. The 2009 annual meeting of the Board of Directors of American Asphalt South, Inc., a California corporation (hereinafter referred to as the "Corporation"), was held in Fontana, California, on January 20, 2009, commencing immediately after the 2008 annual meeting of the shareholders of the Corporation. Said 2008 annual meeting of the Board of Directors was held for the purpose of electing officers of the Corporation, considering reports of the affairs of the Corporation, and transacting other business within the powers of the Board of Directors. 1. CALL TO ORDER-CHAIRMAN AND SECRETARY The meeting was called to order by Allan A. Henderson, Chairman of the Board of Directors of the Corporation. Lyle Stone, the Corporate Secretary, acted as secretary of the meeting and recorded the minutes. Mr. Henderson then noted that at the 2008 annual meeting of the shareholders of the Corporation, which annual meeting had just concluded, that Allan A. Henderson, Kimberly L. Henderson and Jeffery R. Petty had been re-elected as members of the Corporation's Board of Directors, all to serve as such until the 2010 annual meeting of the shareholders of this Corporation. 2. VALIDITY OF MEETING Notice of the date of this meeting is stated in the By-laws of this Corporation, specifically Section 3.6. All Directors present agreed that this is a valid meeting of the Board of Directors. 3. DIRECTORS PRESENT The following Directors were present: Allan A. Henderson, Kimberly L. Henderson and Jeffrey R. Petty. The following Director(s) were absent: None. 4. ELECTION OF CHAIRMAN Allan A. Henderson was then unanimously re-elected to serve as the Chairman of the Board of Directors until the 2010 annual meeting. 5. APPROVAL OF PRIOR MINUTES The Chairman then presented to the meeting the minutes of the January 5, 2007 annual meeting of the Board of Directors of this Corporation, which are in the form of a written action. Said minutes were unanimously approved and all actions taken therein unanimously ratified. 6. NOMINATION AND ELECTION OF OFFICERS Page 1 The Chairman then called for nominations for the officers of the Corporation to serve for one year until the next annual Board of Directors meeting and until their successors are elected and qualified. The following persons were nominated for the offices designated beside his or her name: Allan A. Henderson Jeff Petty Lyle Stone Allan A. Henderson - President - Vice President - Secretary - Chief Executive Officer The Chairman called for further nominations but none was made. The above persons were unanimously elected to the offices to which he had been nominated. Furthermore, all elected officers are duly authorized to sign documents on behalf of the corporation. 6. ADJOURNMENT There being no further business, the meeting was adjourned. Stone Corporate Secretary Page 2 BIDDER: Ar%CQh f~liCiX~~~.~t/.r~✓JG SECTION 2 BID DATA FORMS CBF-5 BIDDER. % h A i~r~f' .Z•I~ Bidder shall submit its Sid 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 American Asphalt South, Inc. as Prinoipal, and The Guarantee Company of North America USA as Surety, are held firmly bound unto the CITY OF ROSEIVIM (hereinafter called the OWNER) in the sum of being not less than ten percent (10%) of the Total Bid Price; for the payment of which sum will and trulyto 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 Slurry Seal Project as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated March 18, 2009 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 affect. 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 attomeys' fees to be fixed by the court. SIGNED AND SEALED, this 5th day of March 2009 The Guarantee Company of American Asphalt South, Inc. (SEAL) North America USA (SEAL) Principal Surety By. By. $ _ afoSig ames gea-.'Attorney-in-Facr- re CBF,6 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Santa Clara On March S, 2009 before me, D. Guzman, Notary Public Date Mara Insert Name end Title at the Officer personally appeared James B. Shea, Attorney-in-Fact Nwne(s) of Signer(e) - - - - - - - - - - - - o. GUZMAN ComnftW * 1762780 Mtfatry Punic - Ctiifornlt "a Clem COwlhr 02011 C who proved to me on the basis of satisfactory evidence to be the person(o) whose name(;{) is/arer subscribed to the within instrument and acknowledged to me that he/sheftheq-executed the same in hi&%erAheifL-authorized capacityo*, and that by his/herkheirsignature($) on the instrument the person(a), or the entity upon behalf of which the person(j) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand a~( ic' I seal. n Signature r ~ l Place Notary Seal Above Signature otary Pudic 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 Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Individual ❑ Corporate Officer - Title(s): _ LJ Partner - ❑ Limited ❑ General ❑ Attorney In Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: HUM Top of thumb here 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: Top of In_~mb here 02007 National Notary Aseodatron - 9350 De Soto Ave., P.O. Bea 2402 • Chetavorth, CA 91313.2402 • www,Natl waft4aryorg Item /5907 Reorder: Call TalFFree 1 AO0-8766827 THE GUARANTEE COMPANY OF NORTH AMERICA USA Southfield, Michigan POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS: That THE GUARANTEE COMPANY OF NORTH AMERICA USA, a corporation organized and existing under the laws of the State of Michigan, having its principal office in Southfield, Michigan, does hereby constitute and appoint Jeffrey N. Aber, James B. Shea, Dora M. Hockett, Dianna Guzman Leavitt Pacific Insurance Brokers, Inc. its true and lawful attomey(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise. The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at the principal office. The Power of Attorney is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By-Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31" day of December, 2003. The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority: 1. To appoint Attomey(s)-in-fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof; and 2. To revoke, at any time, any such Attomey-in-fact and revoke the authority given, except as provided below 3_ In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting duly called and held on the 31"day of December 2003, of which the following is a true excerpt: RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, contracts of indemnity and other writings obligatory in the nature thereof, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and its corporate seal to be affixed by its authorized officer, this 5'" day of "c January, 2009. G THE GUARANTEE COMPANY OF NORTH AMERICA USA STATE OF MICHIGAN Stephen Dullard, Vice President Randall Musselman, Secretary County of Oakland On this 5"' day of January, 2009 before me came the individuals who executed the preceding Instrument, to me personalty known, and being by me duly sworn, said that each is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of said Company. ;Yfk Cynthia A. rakal IN WITNESS WHEREOF, I have hereunto set my hand at The Guarantee Notary Public, State of Michigan Company of North America USA offices the day and year above written. County of Oakland " My Commission Expires February 27, 2012 ` Acting in Oakland County 0. e, I, Randall Musselman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect. IN WITPESS WHEREOF, I have thereunto set my hand and attached the seal of said Company this 5th day of March, 2009. ~G St, '+,ws' d7 Randall Musselman, Secretary BIDDER: LIST OF PROPOSED SUBCONTRACTORS In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100 through 4114 of the California Public Contract Code, and any amendments thereto, each Bidder shall provide the information requested below for each subcontractor who will perform work, labor or render service to Bidder in or about the construction of the Work in an amount in excess of one-half of one percent (greater than 0.5 of the Bidder's Total Bid Price, or, in the case of bids or offers for the construction of streets or highways, including bridges, in excess of one-half of 1 percent of the Contractor's total bid or ten thousand dollars ($10,000), whichever is greater, and shall further set forth the portion of the Work which will be done by each subcontractor. Bidder shall list only one subcontractor for any one portion of the Work. Pursuant to Public Contract Code Section 4104, the Owner has determined that it will allow Bidders twenty-four (24) additional hours after the deadline for submission of bids to submit the information requested by the Owner about each subcontractor, other than the name and location of each subcontractor. If the Bidder fails to specify a subcontractor for any portion of the Work to be performed under the Contract, it shall be deemed to have agreed to perform such portion itself, and shall not be permitted to subcontract that portion of the Work except under the conditions hereinafter set forth below. Subletting or subcontracting of any portion of the Work in excess of one half of one percent (greater than 0.5%) of the Total Bid Price or, in the case of bids or offers for the construction of streets or highways, including bridges, in excess of one-half of 1 percent of the Contractor's total bid or ten thousand dollars ($10,000), whichever is greater, for which no subcontractor was designated in the original bid shall only be permitted in cases of public emergency or necessity, and then only after Owner approval. CBF-7 r- 'i r i f BIDDER: ,."n .~,r~~~,~~I•ss 2.6 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 ~ C' c /E G!A ~i7 f y Name: jl~ 5q Tf Address: 71,`7 sJ. 51A d n f^ -1« Llq- 9~ 7!r Z 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 Description of Work of Subcontractor to be Subcontracted Name: Address: Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address CBF-8 v BIDDER: i 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. (~/7~ Of/fq/~CNO LU~~b►!J~9i4 2. Name'and Address of Owner %..e 140"10 44 ;1 'al t /,?0/ ~W_ yfiy x ww Name and telephone number of person familiar with project 10, - Contract amount Ty of Work Date Completed 6" ~ a Iq Nam and Address of Owner 4dPI ILI Ile 10 Name and telephone number of person familiar with project Al.mO t x f/ 4G .T4Dg .11 Contract amount Type of ork Date ComrAnted 3. 1 Namd /f7, Nam/e` Contra 4. L' of Owner number of person familiar with project of oc/. „'eD8 Date Completed Nam6and Address of Owner x4w Na and telephone number of person familiar with project 9l',% ~~D, T cam/ l4D8 Contract amount Type of ork Da a Completed CBF-9 l ,.1 i I 1 -1 1 -1 I -1 I~ i l'i BIDDER: _~/!k1"/! '040/-V~// SECTION 3 NON-COLLUSION AFFIDAVIT I i CBF-10 1. u ~ BIDDER: f!/7J1,4'YA?n 7 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 i di l or n rect y, 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 7 awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. S' ature Ole XWhe Ty ed or Printed Name Title Bidder Subscribed and sworn before rr This 12!! day of , ,>r 4 , 20,V 9 (Seal) Notary Public in and for _ RcWX& IN COW the State of California ~ " NOTARY PUBLIC-GILIFORNIA D < SAN8VV*XW000NTY My Commission Expires: .4-J~-f ~J7Acyl "hGWO.E'J*13,2M I I I ~ j CBF - 11 ~a s .r NON-COLLUSION AFFIDAVIT I -Ili is "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 County of ) ss. `1// S4P.4 e bein first duly sworn, deposes and says that, he or she is 5eC►rlarrr of nCQh e4 - / -*W Z-41' , 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 Mil 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." 7 .l Project Name: Project Number lk'1411y0oe Company: /Y/!7L'/~'A►h /J,J//w~T ~avr~~/.-.~/ Address: Signature: Tide: ,xc re" 2f Date: ~4W RICHARD ENTRIN comm. 0150ti8B5 12 NOTARY PISL N. ~ sAN eERNARDNo My Comm. ISL. J* 13. 2= 1 SWORN TO AND SUBSCRIBED TO BEFORE ME This day of 20 © V /s/ Notary Public: A~ My Commission Expires: , yt /4 20L' I it NON-SEGREGATED FACILITIES CERTIFICATION 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. 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. Date; a llll 111 Company: Address: J By. Title: J 7 Project Number: 7i y00e l~ 1 I --j PAST PERFORMANCE CERTIFICATE 1 1 7 a _ i CERTIFICATION ° WITH REGARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND ~l THE FILING OF REQUIRED REPORTS I The'Xbidder, ❑proposed sub-contractor, hereby certifies that he/shelShas, ❑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*9has, ❑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. r~ Date: /7 O Project Number: Contract Award: $ / t(o,,6,4 s~ Awarding Agency: G a71- CII /nit 0[ 0-11 Contractor Name: ~inl►"~~Qrl yl~h4 /~f~ Total Number of Employees F~ Affiliate Company: y~ By: - Title: 7eMVWV C 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 exemptfrom the equal opportunity clause are setforth in 41 CFR 60-1.5 (Generally only contracts or subcontracts of $10,000 or under are exempt). 7 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 f~ 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 flied bv; (A) All private employers who are: (1) Subject to Tale 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. It COUNTY LOBBYING CERTIFICATION Name of F j Address: rl Community Development Commission County of Los Angeles COUNTY LOBBYIST CODE CHAPTER 2.160 COUNTY ORDINANCE NO. 93-0031 CERTIFICATION State: e~ Zip Code: Telephone Number. ( AV~P) J 7VVt; e 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 - T I 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; ss _1 ,4 i --i ~9 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 ~ prerequisite for making or entering into contract with the Los Angeles County and the Community Development Commission, County of Los Angeles, Authorized Official: _ /1007?4W (C0nV& Subamt=W) I I "I i'6h 1~ /.4/111W19 Madr) By: n• - 1 ~4 IF WORKER'S COMPENSATION CERTIFICATION u WORKER'S COMPENSATION CERTIFICATION 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: moy/ Project Name: Company Name: Address: Print Name: T zo Ole Title: Signature: Project Number. - '407O70i-6-4 is I.J CONTRACTOR LIST OF PROPOSED SUBCONTRACTORS V z Cl) z a g 1 i r c z 3 C n d `r' ro qo ro oe ~v O h z c 3 g v7 a z ~ h ~ C n N o ~ a ~ ~ n r~ 0 o i ~ r ~ Q I m ~I F v a N n O z O O "O O O m W 0 O iri I - REQUEST FOR ADDITIONAL CLASSIFICATION AND RATE -1 J 7 a U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT HUD FORM 4230A REPORT OF ADDITIONAL CLASSIFICATION AND RATE OMBApptordNmber25pS-00„ AM 1. FROM (name and address of requesting agency) 2. PROJECT NAME AND NUMBER 3. LOCATION OF PROJECT (City, County and State) 4. BRIEF DESCRIPTION OF PROJECT 5. CHARACTER OF CONSTRUCTION ❑ Building ❑ Residential ❑ Heavy ❑ Other (specify) ❑ Highway 6. WAGE DECISION NO. (include modification number, if any) 7. WAGE DECISION EFFECTIVE DATE ❑ COPY ATTACHED B. WORK CLASSIFICATION(S) HOURLY WAGE RATES BASIC WAGE FRINGE BENEFIT(S) (if any) 9. PRIME CONTRACTOR (name, address) 10. SUBCONTRACTOR/EMPLOYER, IF APPLICABLE (name, address) Check All That A I ❑ 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 fidd 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 One: ❑ 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 LR2000: Agency Representative Date Log I~' (typed name and signature) Phone Number Log out: HU04230A (503) PREVIOUS EDITION IS OBSOLETE 4 I ! . I I- 1 d It NOTICE OF EQUAL EMPLOYMENT OPPORTUNITY COMMITMENT I J 1,J I~ 1 4 I s 1 EQUAL EMPLOYMENT OPPORTUNITY COMMITMENT TO: (Name of Labor Union, Workers Representadve, etc. (Address) Name of Business (contractor): Project Name: Project Number: The Undersigned currently holds a contract with , involving funds of the U. S. Government, 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 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. This notice is fumished 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. (PrietName) By: (Sigf,aaaa) a If NOTICE OF SECTION 3 COMMITMENT a. i TO: 1 J f. NOTICE OF SECTION 3 COMMITMENT ' (Name of Labor Union, Workers Representative, etc Name of Business (contractor): Project Name: J l a 1 J 1 7 n Project Number: The Undersigned currently holds a contract with involving Block Grant (CDBG) funds from the U. S. Department 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: Minimum Job Classification Number 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 at j ) 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. (Print N==) (Date) By: csi~~) is It SECTION 3 - ECONOMIC OPPORTUNITY PLAN SECTION 3 ECONOMIC OPPORTUNITY PLAN 1. Name and Address of Reporting Entity (Recipient, Sub-recipient, Contractor, Subcontractor) 2. Federal Identification: (Contract/Award No.) 3. Dollar Amount of Award: 4. Contact Person: 5. Phone: (include Area Code) 6. Reporting Period: 7. Date Report Submitted 8. Program Code: (Use a separate sheet for each Program Code) Program Codes 1. Fiexlele Subsidy 2. Secdon 2112/811 3. Publiclindlen Housing Development, Operation and Modemizatlon 4. Homeless Assistance S. HOME 6. HOME -State Administered 7. CDBG - Entitlement 8 CDBG - State Ad i l . rn n stered 9. Other CD Programs 10. Other Housing Programs Part I- Fmnlnvmanf nnrl Tr~;.,t.,,, - . v........ JOB CLASSIFICATION V1 116 TOTAL NEW HIRES SECTION 3 NEW HIRES % of Aggregate Hires Who are Section 3 Residents Professionals Technicians Office/Clerical Trade: Trade: Trade: Trade: % Total: % Part ti' Cnntrac+ A,..Mr.4 - - - - - - - - NAME OF SECTION 3 BUSINESS CONCERN %W v G~. U Lr 1 [ J o u,I 11 e55e5 (Subcontractom, Suppiter SPECIFY CONSTRUCTION OR NONCONSTRUCTION CONTRACT s, Vendors, or Service Providers) CONTRACT AMOUNT t $ $ $ TOTAL $ Percentage of the total dollar amount to be awarded to Section 3 Buslness Concerns: OYCO SECTION 3 ECONOMIC OPPORTUNITY REPORT (CONTRACTOR) 1 a 1. Recipient Name and Address (Racipient. Sub-reciplent, Contractor, subcontractor) 2. Project Number. (cmkawAmd No.) 3. Dollar Amount of Contract: 4. Contad Person: 5. Phone: (induda Area Code) 6. Reporting Period: 7. Date Report Submitted 8. Project Number. 9. Federal EIN: Part I: Employment Br Training Opportunities provided to low-income individuals rMinlmumr3cLl*.M9r &Nmrwsra JOB CLASSIFICATION TOTAL NEW HIRES LOW-INCOME NEW HIRES % of Aggregate Hires who are low-income Technicians % Office/Clerical % Professionals % Construction Trade: % Construction Trade: % TOTAL % Part II: Subcontracts Awarded (Minimum Subcontract Goal is 25% of the Pri ne Contract Amount) 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 onnortunities 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 (96) 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) 14- J SECTION 3 - RESIDENT CERTIFICATION It 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. I am a Public Housing Resident (Specify Name of the Public Housing situ: 2. 1 am a low-income resident of the metropolitan area. Select your household size and gross annual income level (from all sources): HO USEHOLD SIZE & INCOME LEVEL 1 $26,550 or less 2 $30,300 or less 3 $34,100 or less 11 4- $37,900 or less 5 $40,950 or less 6 $43,950 or less E 7 $47,000 or less D 8 $50,050 or less 3 I 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-iYme employee who was hired on: The above-named person is a new-hire employee who was hired on: This person's Job Classification is: Name of Employer. 6 ®I To Be Completed by Local Contracting Agency Preference Category: ❑ Targeted Service Area ❑ Youthbuild ❑ McKinney Homeless ❑ other Section 3 Census Tract Number: a i ri e a a J 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 commitmentmade when a Section 3 Economic Opportunity Plan has been submitted. REMEMBER: All employees (if 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 http://Www.calwia.org/iwia/index cfm • 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 htti):/twww.dir.ca.gov/databases/das/aigstart.aso • Contact agencies administering HUD Youthbuild programs, and requesting their assistance to 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 placement websites such as www.monster.com r SECTION 3 - BUSINESS CERTIFICATION J SECTION 3 BUSINESS CERTIFICATION FORM American Asphalt South, Inc. Business Name: P.A. Sex a109"° j Business Address: Fontana, CA 92331 -.i 3, So Telephone Number:A y~9. 83? Contract/Bid Amount: $ J YD oz. 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: r. 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 Signature of Owner/ Principal Date B iness Name License Number To Be Completed by Local Contracting Agency Preference Category: oTargeted Service Area ❑Youthbuild ❑Other - Census Tract Number: Y e SECTION 3 - ECONOMIC OPPORTUNITY REPORT (CONTRACTOR) 40 r~ i r~ r{ I F~ 1 f SECTION 3 ECONOMIC OPPORTUNITY REPORT (CONTRACTOR) 1. Recipient Name and Address (Redpimt. sub-redplem Contractor. Subcontac tx) 2. Project Number, tCW&aWAward No_i 3. Dollar Amount of Contract 4. Contact Person: 5. Phone: (indude Area Code) 6. Reporting Period: 7. Date Report Submitted S. Project Number. 9. Federal EIN: Part I- Fmnlovment & Training Onnortunities urovided to low-income individuals mnlmum Goal! 3D%nrNewFFh i JOB CLASSIFICATION TOTAL NEW HIRES LOW-INCOME NEW HIRES % of Aggregate Hires who are low-income Technicians % Office/Cledcal % Professionals % Construction Trade: % Construction Trade: 0~ ; TOTAL Part II' Stthr_nnfirnr_tt Awarriotril R.11ntr .mlkiiMrnlrnr4r~"ta?59LnrlhnPrimaCnhwJAmnuntl 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 andlor Employed low-income individuals equal to (°k) 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) • FEDERAL LOBBYING CERTIFICATION FEDERAL LOBBYIST CERTIFICATION Name of Firm: ~/~G°~"%C4✓J fi'!/~/X~ /T ✓OC/~~ 1. Address: _,~;e4fiw r~"~~Gr' l 'hGr y1 ~9Q f1111 - 9~33~ State: Zip Code: 9633 Telephone Number. (.,W ) W,~W V 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: _,4wevo By: (sip) 51 i ,O f Nate) fc~r~r,~•y . R-