Wheeler Paving, Inc.BIDDER: wY, n~ .
CONTRACT BID FORMS
TABLE OF CONTENTS
SECTION 1 BID SCHEDULE 1
SECTION 2 BID DATA FORMS 5
2.A BID BOND ................................................................................................................6
2.6 LIST OF PROPOSED SUBCONTRACTORS .........................................................7
SECTION 3 NON-COLLUSION AFFIDAVIT .............................................................................10
BIDDER: Whr,M PASECTION 1 -BID SCHEDULEJ
CBF-1
tk)
BIDDER:
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
ifi
ti
TP2 & TP3
LS
1
spec
ca
ons
.
2
Disposal of Waste Materials
LS
1
5OD
3
Crack Sealing
LS
1
~QQ
4
Slurry Seal Type II - See exhibit
"A" & "B" per street locations &
00
areas.
ELT
750
5
Traffic Striping and Pavement
Markers - See exhibit "C" per
SdD
details.
LS
1
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ y Dollar amount in written
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cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and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
r1,~
BIDDER:
l
~ttac d ereto is a certified check, a cashier's check or a bid bond in the amount of
} + Dollars said amount being not less than ten percent (10%) of the Total
Bid Price. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
we fail or refuse to execute the Contract and furnish the required bonds, certificates and
endorsements of insurance and other certifications within the time provided.
If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be
prepared by the Owner for execution, within five (5) Calendar Days following the Letter of Award for
the Contract, and will deliver to the Owner within that same period the necessary original Certificates
of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other
documentation and certification required by the Contract.
The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and
become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of Bidder's California contractor's license(s) in good standing; (2) evidence
that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting
therefrom; and (3) any other information and documentation, financial or otherwise, needed by
Owner to award a Contract to the lowest responsible and responsive bidder.
Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
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: Mum ~ R,-
By:
Signature
Business Street Address
IQM~wo W gel V VeiaMeI(A' q ZS~~
Type or Print Name City, State and Zip Code
`1 fa,iA+e t 4 J l- l~ AS S. 7 2
Title % Telephone Number
Bidder's/Contractor's State of Incorporation: C iU , U y V~~A---,
Partners or Joint Venturers:
Bidder's License Number(s):
NOTES:
11k
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 authority to do so.
CBF-4
Corporate Resolution
RESOLVED that
Kimberly Wheeler President and Secretary
Richard Wheeler Vice President & Treasurer
Whose signatures appear below, or any of them, are hereby authorized, directed and empowered for and
on behalf of this corporation and in its name to execute documents on such terms as may be agreed to by
said persons.
Said is authorized to act upon this resolution until written notice of its revocation is delivered to said.
Authorized Signatures:
e
Kmberty Wheeler, President & Secretary Richard Wheeler, Vice President & Treasurer
Signature Signature
I, Kimberly Wheeler Secretary of Wheeler Paving , Inc. , a corporation,
do hereby certify that the resolution appearing above is full, true and correct copy of a resolution of the
Board of Directors of said corporation duly and regularly passed and adopted at a meeting of the Board of
said corporation which was duly and regularly called and held in all respects as required by law and by the
bylaws of said corporation on the 26th day of November , 2007 , and
that the signatures appearing on the above mentioned copy of said resolutions are the genuine signatures
of the persons mentioned in said resolution and authorized to act on behalf of said corporation as set forth
in said resolution.
I further certify that said resolution has not been amended or revoked and is still in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand as such Secretary this 26th day of November , 2007.
Corporate Seal
Secretary
BIDDER: \KWZ W
SECTION 2
BID DATA FORMS
CBF-5
BIDDER. Wheeler Paving, Inc.
Bidder shall submit its Bid data in accordance with the format shown on each of the following Bid
Data Forms. Bidders shall prepare and use as many sheets as are necessary to adequately provide
the information required. Bidder shall ensure that every page of its Bid Data Forms are properly
identified with the Bidder's name and page number.
2.A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT Wheeler Paving, Inc. as
Principal, and Travelers Casualty and Surety Company of America
, as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
Ten Percent (10%) of the Total Bid Amount
(S 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 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) fumishes the required
insurance certificates and endorsements, and fumishes 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 attomeys' fees to be fixed by the
court.
SIGNED AND SEALED, this 12th day of . March 2009
Wheeler Paving, Inc. Travelers Casualty and
(SEAL) Surety Company of America (SEAL)
Princip Sure
13 . By:
Signature Si natUre Kenneth A. Coate, Attorney- I n-Fact
CBF-8
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
County of Riverside
On MAR 12 2009
Date
personally appeared
before me, Michele M. Qualls, Notary Public ,
Here Insert Name and Title of the Officer
Kenneth A. Coate
MCHELE M. TOUMAL nLS
COMM. #1704204
v1}\
NO ARY PUBLIC - CALIFORNIA
ac RIVERSIDE COUNTY
t.4.,' Cumra Expires Nov. 11, 2010
who proved to me on the basis of satisfactory evidence to
be the person(4 whose name(s} is/are subscribed to the
within instrument and acknowledged to me that
he/she/they executed the same in his/hef/their authorized
capacity(ies}; and that by his/heNth& signatures} on the
instrument the person(s , or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
WITNESS my hand an1d~f official s`ealll..~
Signaturew,~~-'r C~ _ I (Ondjo
Place Notary Seal Above Signature of Notary Public
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): _
❑ Partner-0 Limited ❑ General
❑ Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
1ft1[rjij!1 milli
Signer's Nar
❑ Individual
Number of Pages:
❑ Corporate Officer - Title(s): _
❑ Partner - ❑ Limited ❑ General
❑ Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
Top of r.,•.,
02007 National Notary Associatioi- 9350 De Soto Ave., Po. Box 2402 -Chatsworth, CA 91 31 3-2402- www.NationalNotary.org Item #5907 Reorder: Call Toll-Free 1-800-876 827
TRAVELERS
PONVER OF ATTORNEY
Farmington Casualh Compam
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc.
Sealboard Surety Compan)
St. Paul Fire and Marine Insurance Company
Attorney-In Fact No. 219106
St. Paul Guardian Insurance Company
St. Paul Mercury Insurance Company
Travelers Casualty and Surely Company
Travelers Casualty and Surety. Company of America
United States Fidelitv and Guaranty Company
Certificate No. 002317995
KNOW ALL MEN BY THESE. PRESENTS: That seaboard Suretv Company is a corporation duly organized under the laws of the State of New York, that St. Paul
Fire and Marine Insurance Company. St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly organized under the laws
of the State of Minnesota, that Farmington Casualty Company. Travelers Casualty and Surety Company, and Travelers Casualty and Surety Company of America are
corporations duly organized under the laws of the State of Connecticut. that United States Fidelity and Guaranty Company is a corporation duly organized under the
laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa. and that Fidelity and
Guaranty Insurance Underwriters, Inc. is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"). and that
the Companies do hereby make. constitute and appoint
Kenneth A. Coate, and Julia B. Gladding
of the City of Riverside . State of California , their true and lawful Attornev(s)-in-Fact
each in their separate capacity if more than Line is named above, to sign, execute, seal and acknowledge any and all bonds. recognizances. conditional undertakings and
other writings obligatory in the nature thereof nn behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN R'ITNj:SS WHEREOF. the Conuy~0.iJ;s have caused this instrument to he signed and their corporate seals to he hereto affixed. this
LU_UG
day of - April
Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc
Seaboard Surety Company
St. Paul Fire and Marine Insurance Company
14th
St. Paul Guardian Insurance Company
St. Paul Mercury Insurance Company
Travelers Casualty and Surety Company
Travelers Casualty and Surety Company of America
United Slates Fidelity and Guaranty Company
Gr.su+ SaFFIr .t-,°;~'\, ~M.~~S ~~MSVq ~<v .wo ~y~ y
e ~ 1977 1927 -r.,.. t z: t ~ O . wtsrwm, ; O
Y ~c+" ; 1951 ,r, C SEAL 'o^! ~ ~ rwtw. (t N tt96
d a ~ + ~ ~ Cc rgN r, ~ r5 . rw't °+r ,♦'r AIN
State of Connecticut
City of Hanford ss.
By: _
Genre V I'honpi.on. eni"r 'ice President
14th April 2008
On this the Jay of ,before me personally appeared George W. Thompson. who acknowledged himself
to he the Senior Vice President of Farmington Casualty Company. Fidelity and Guaranty Insurance Company. Fidelity and Guaranty Insurance Underwriters, Inc.,
Seaboard Surety Company, St. Paul Fire and Marine Insurance Company. St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers
Casualty and Surety Company, Travelers Casualty and Suren Company of America. and United States Fidelity and Guaranty Company, and that he, as such, being
authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
Cot
In Witnes Whereof, I hereunto set my hand and utlicial seal. My Commission expires the ;11th day rd June. -101 1. Q~' C V
Nl,ine C Tetreault. Notary Public
58440-5-07 Printed in U.S.A.
OF
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company. Fidelity
and Guaranty Insurance Company. Fidelity and Guararuy Insurance Underwriters. Inc.. Seaboard Surety Company. St. Paul Fire and Marine Insurance Company.
St. Paul Guardian Insurance Company. St. Paul Mercury Insurance Company. Travelers Casualty and Surety Company. Travelers Casualty and Surety Company of
America, and United States Fidelity and Guaranty Company. which resolutions are now in full force and effect, reading as follows:
RESOLVED. that the Chairman. the President. any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice
President. the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf
of the Company, and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the
Company's seal bonds, recognizances. contracts of indemnity..md other writings obligatory in the nature of it bond. recognizance, or conditional undertaking, and any
of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her: and it is
FURTHER RESOLVED, that the Chairman. the President, any Vice Chairman, any Executive Vice President. any Senior Vice President or any Vice President may
delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy
thereof is filed in the office of the Secretary: and it is
FL'RTHF.R RESOLVED, that any bond, recognizance, contract of indemnity. or writing obligatory in the nature of a bond, recognizance, or conditional undertaking
shall he valid and binding upon the Company when (a) signed by the President. any Vice Chairman. any Executive Vice President, any Senior Vice President or any Vice
President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the
Company's seal by a Secretary or Assistant Secretary: or (b) duly executed (under seal, if required) by 'Inc or more Attorneys-in-Fact and Agents pursuant to the power
prescribed in his or tier certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority: and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President. any Vice President,
any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may he affixed by facsimile to any power of attorney or io any certificate
relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Aitomeys-in-Fact for purposes only of executing and attesting bonds and
undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be
valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the
Company in the future with respect to any txnd or understanding to which it is attached.
1. Kori M. Johanson, the undersigned. Assistant Secretary, of Farmington Casualty Company. Fidelity and Guaranty Insurance Company. Fidelity and Guaranty Insurance
Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company. St. Paul Mercury Insurance
Company. Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America. and United States Fidelity and Guaranty Company do hereby
certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is in full force and effect and has not been
revoked.
IN TESTIMONY WHEREOF. I have hereunto set my hand and affixed the seals of said Companies this
12th
day of
March
,p09
Kori M.
Johann
Assistant Secretary
G~SV,~~' S~EIp •;lK ati `~M ikSG ~ ~MSpq ~`w ~yar Y
U ~ C. ~ON~l ns i
Zb~~ o `1977 g «~oWtrtD ~ 1927 =,'~0~ e 3 iuurrrono. {~^~t~
Yr ~~i ~ 1r 951 s'~ •t nT'~f ;tl.SF:ItL.~.~o^J ~oS81CLas? CONN. B y~ 896 <
To verify the authenticity of this Power of Attorney. call I-8W-d?1-3880 or contact us at w'ww'.travelersbond.com. Please refer to the Attorney-In-Fact number. the
above-named individuals and the details of the bond to which the power is attached.
RED BORDER
CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
County of Z2 ,y~~1m~
On,r-jg,Qc" oa9 before me,
name
personally appeared A-*eW t0,F__.tzX-- raf
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 my hand and official seal.
k14"
Signature of Notary Public
K' 47 HANNA
Commission # 1702840
Notary Public - California
Los Angeles County
(Notary Seal) Comm Nov 19, 2010
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or description of attached document)
(Title or description of attached document continued)
Number of Pages Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑
Individual (s)
❑
Corporate Officer
(Title)
❑
Partner(s)
❑
Attorney-in-Fact
❑
Trustee(s)
❑
Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Arry acknowledgment completed in California must contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
property completed and attached to that document. The only exception is if a
document is to be recorded outside of California In such instances, any alternative
acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that is illegal for a notary in
California (i.e. certii ring the authorized capacity of the signer). Please check the
document carefulhv jar proper notarial wording and attach this form if required.
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
he/she/they- is /ere) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re-seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
i Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date.
4- Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document
f:p~%C i u
n~ottlt•':
BIDDER: W w" ywn i L'
2.13 LIST OF PROPOSED SUBCONTRACTORS
In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100
through 4114 of the California Public Contract Code, and any amendments thereto, each
Bidder shall provide the information requested below for each subcontractor who will
perform work, labor or render service to Bidder in or about the construction of the Work in an
amount in excess of one-half of one percent (greater than 0.5 of the Bidder's Total Bid
Price, or, in the case of bids or offers for the construction of streets or highways, including
bridges, in excess of one-half of 1 percent of the Contractor's total bid or ten thousand
dollars ($10,000), whichever is greater, and shall further set forth the portion of the Work
which will be done by each subcontractor. Bidder shall list only one subcontractor for any
one portion of the Work.
Pursuant to Public Contract Code Section 4104, the Owner has determined that it will allow
Bidders twenty-four (24) additional hours after the deadline for submission of bids to submit
the information requested by the Owner about each subcontractor, other than the name and
location of each subcontractor.
If the Bidder fails to specify a subcontractor for any portion of the Work to be performed
under the Contract, it shall be deemed to have agreed to perform such portion itself, and
shall not be permitted to subcontract that portion of the Work except under the conditions
hereinafter set forth below.
Subletting or subcontracting of any portion of the Work in excess of one half of one percent
(greater than 0.5%) of the Total Bid Price or, in the case of bids or offers for the construction
of streets or highways, including bridges, in excess of one-half of 1 percent of the
Contractor's total bid or ten thousand dollars ($10,000), whichever is greater, for which no
subcontractor was designated in the original bid shall only be permitted in cases of public
emergency or necessity, and then only after Owner approval.
CBF-7
BIDDER: wVY'~ ~1(~
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
("Duplicate Next 2 Pages if needed for listing additional subcontractors.")
Name and Location Description of Work
of Subcontractor ' to be Subcontracted
Name: ut'r, f`p1 fn ('CA ~YY1~1 t r C /VILt,~ P . - 4P
-lytC • r~(\~
Address: Q DC q~& 24,,r
Description of Work
to be Subcontracted
of Subcontractor
Name:
Address:
Name and Location
of Subcontractor
Name:
Address
Name and Location
of Subcontractor
Name:
Address:
CBF-8
Description of Work
to be Subcontracted
Description of Work
to be Subcontracted
of Work
BIDDER: Ww1u!r 1GulLI lVlli'
2.C
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:
Name an Address of Owner
a CYl / ASf ^ 1 b.]
of person fam'i'liarwith project
1"1 322°° kAW►}csU- t~. r OTtMz-6!.EJ -s-Mac ;UUE ZO03;
Contract amount Type of Work Date Completed
2. 9 i
Name an Address of Owner
number of person familiar with project
amount
Date
3.
Name and Address of Owne
-%I V%= -t-1 CCAA/L lrv/ 140 -0- to
Name and telephone number of person familiar with project
amount
Type of Work Date
7
4. Ctn4l OF P 0 110
Nam and Address of Owner
of person familiar with project
Date
CBF-9
BIDDER: wwa NN SECTION 3
NON-COLLUSION AFFIDAVIT
CBF-10
BIDDER: Wwtw ~W~ fl Irf,-► c
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.
O
Signature
Klmbtf\!A W Ae"
Typed or Print Name
gent A'60k fi e (
Title
W1~~P~~'Gt,U r G .
Bidder
Subscribed and sworn before. me
This ~ day of µarlA , 206n
~<T 46V, VX o►
Notary Public in and for
the State of California
My Commission Expires: a v. aoi0
(Seal)
K. T. HANNIA
Not 1 ry
Ommission Publle-Ca101 orrn o
Los Ang*lq>t County
COMM MW 19.2010
CBF - 11