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USS Cal Builders IncCITY OF ROSEMEAD ROSEMEAD PARK AQUATIC FACILITY PROJECT No. P53251 CONTRACT BID FORMS F/ 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 ................................. ............................... 11 SECTION 1 - BID 13IDDL12: USS Cal Builders, Inc. BID FOR ROSEMEAD PARK AQUATIC FACILITY PROJECT NO. P53129 BASE BID SCHEDULE TOTAL BASE BID PRICE: $ 'may 73c�y c�6 Dollar amount • ALTERNATE BID ITEM NO. 1, 2, 3, & 4 NO. ITEM DESCRIPTION UNIT OF EST. UNIT TOTAL ITEM MEASURE CITY. PRICE COST 1 Shade Structures SF 20 20'x 20' Module 33'x' CYO 2 Solar System LS 1 ao,cn� Gto,vX-10 3 Bleachers EA 8 6, 75o Sq, cav 14 1 Entry Marquee LS 1 Sign /Supports -Z!5� 06xv V-;, coo TOTAL ALTERNATE BID ITEMS PRICE: $ V,cc� Dollar amount in written form Note: The City of Rosemead reserves the right to reduce or increase the quantities of any items in the schedule of values above, within the limits define in Section 3 -2.2.1 of the Standard Specifications, to stay within the budgeted amount of this project. INCORPORATION BY REFERENCE Notice Inviting Bids, Instructions to Bidders, General Conditions, Technical Specifications, Geotechnical Study Report (September 3, 2010) and addenda, Asbestos and Lead Paint Survey Report (August 5, 2010) and addenda, Bidder's Proposal, Plans, Standard Specifications for Public Works Construction 2009 Edition ("Green book"), Drawings, Project Manual, Required Bonds and Forms, Permits, Addenda, and all applicable codes and regulations are hereby incorporated in and made part of this Contract. The provisions of CBF -1 BIDDER: USS Cal Builders, Inc. the Greenbook shall apply to this Project except as may be modified by other provisions of the Contract. The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract for the Work is fully executed by the Owner and a third party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall govern. Attached hereto is a certified check, a cashier's check or a bid bond in the amount of Ten Percent of the Amount Bid Dollars ($ lo% ) 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. CBF -2 BIDDER: USS Cal Builders, Inc. 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 BIDDEV USS Cal Builder$, Inc By: Signatu Je fifer Hotrum T e or Print N President Title Bidder's /Contractor's State of Incorporation: California Partners or Joint Venturers: Bidder's License Number(s): EilM"I 654454 8051 Main Street Business Street Address Stanton, CA 90680 City, State and Zip Code (714) 828 -4882 Telephone Number 1) By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the representations made on the Contract Bid Forms. 2) If Bidder is a corporation, enter State of Incorporation in addition to Business Address 3) If Bidder is a partnership or joint venture, give full names of all partners or joint venturers. CBF -4 131DDER: USS Cal Builders, Inc. SECTION 2 BID DATA FORMS CBF -5 '!— - 4 IDDIIt. USS CAL BUILDERS, INC. Bidder shall submit its Bid data in accordance with the format shown on each of the following Bid Data Forms. Bidders shall prepare and use as many sheets as are necessary to adequately provide the information required. Bidder shall ensure that every page of its Bid Data Forms are properly identified with the Bidder's name and page number. 2.A BID BOND KNOW ALL MEN BY THESE PRESENTS: THAT USS CAL BUILDERS. INC. as Principal, and SAFECO INSURANCE COMPANY OF AMERICA , as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of TEN PERCENT OF AMOUNT BID DOLLARS ($ 10% ), being not less than ten percent (10 %) of the Total Base 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 Rosemead Park Aquatic Facility as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated 11/03/2010 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 1ST day of NOVEMBER ,2010 SAFECOINSURANCE U S CAL BUILDS S, INC. (SEAL) COMPANY OF AMEg>CA (SEAL) P cipal Surety 1 By: L-az�-- Jennifer Hotrum, By. CBF -6 SignatG PHILIP v A, ATTORNEY -in -FACT 5 POWER East, OF ATTORNEY No. KNOW ALL BY THESE PRESENTS: 13003 Safeco Insurance Company of America General Insurance Company of America 1001 4th Avenue Suite 1700 Seattle, WA 98154 That SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA, each a Washington corporation, does each hereby appoint * * * * * * * * * * * *" * * * " * * * * ** *PHILIP E. VEGA; FRANK MORONES; Brea, its true and lawful attorney(s) -in -fact, with full authority to execute on its behalf fidelity and surety bonds or undertakings and other documents of a similar character issued in the course of its business, and to bind the respective company thereby. IN WITNESS WHEREOF, SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA have each executed and attested these presents this 19th day of January Dexter R. Legg Secretary Timothy A. Mikolajewski Vice President CERTIFICATE Extract from the By -Laws of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA: 2009 "Article V, Section 13. - FIDELITY AND SURETY BONDS ... the President, any Vice President, the Secretary, and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations, shall each have authority to appoint individuals as attorneys -in -fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business... On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or In any other manner reproduced; provided, however, that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA adopted July 28, 1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (I) The provisions of Article V, Section 13 of the By -Laws, and (ii) A copy of the power -of- attorney appointment, executed pursuant thereto, and (iii) Certifying that said power -of- attorney appointment is in full force and effect, the signature of the certifying officer may be by facsimile, and the seal of the Company may be a facsimile thereof. I, Dexter R. Legg , Secretary of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA, do hereby certify that the foregoing extracts of the By -Laws and of a Resolution of the Board of Directors of these corporations, and of a Power of Attorney issued pursuant thereto, are true and correct, and that both the By -Laws, the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the facsimile seal of said corporation this 1ST dayof NOVEMBER 2010 Qa�CE CQlgo9�` ECOMA Gegpoa,9T� p SJF NO SEAL ti CORPORATE SEAL� �4rF 1953 o!a �� l923 \S Dexter R. Legg, Secretary Of Mills Af WrteKib Safeco® and the Safeco logo are registered trademarks of Safeco Corporation. S- 0974 /DS 1/09 WEB PDF CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT State of California County of Los Angeles On 11 /01 /2010 before me, Monica Blaisdell, Notary Gala WM imud Name and RM 0 3x r personally appeared Philip Va9a Nameh) a sw0s MONICA BLAISDELL Commission # 1794078 .-a Notary Public - California £ Orange County Comm. Ma2tS,2012 PhDs N V Seal AGaa who proved to me on the basis of satisfactory evidence to be the person(zo whose name(A) is/ft subscribed to the within instrument and acknowledged to me that he /executed the same in his/r/ptauthorized capacity(WXX and that by his)pWAtAWignature(Xkon the instrument the person( ), or the entity upon behalf of which the person(;;) 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. Signature "t1 t m �I ) t�✓,17lkii SlgL,. d Nowq P c OPTIONAL Though the Information below Is not required by law, It may prove valuable to persons retying on the document and could prevent baudulant 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) Clalmed by Signer(s) Signer's Name: ❑ "Individual ❑ Corporate Officer—Title(s): _ ❑ Partner — ❑ Limited (J General ❑ Attorney in Fad G Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing; RIr:HT THUMBPRINT OF SIGNER LEI Number of Pages: Signer's Name: • Individual • Corporate Officer — Titfe(s): • Partner — ❑ Limited ❑ General • Attorney in Fad • Trustee • Guardian or Conservator • Other: Signer Is Representing: RIGHTTHUM MNT OF SIGNER VOW 02C07NMon�NatMAmodfi n -9 Da SOlo AW♦ P.O.B 24M-Ch M,CAe1313 402.1vHxvrNatl SNdaryarg IWM05907 Rmq :GUWIFrWIt D476.682r State of California County Of Orange On Z�� before me, Allen A. Othman, Public Notary Date Here Insert Name end Tit f th Offl -' I^ _ J - e a 6 aer personally appeared l%-P-14 Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /are subsrribed to the within instrument and acknowledged to me that ALLEN A. OiHMAN C he /she /they executed the same in his/her/their authorized - - commission EN A. # 1770208 MAN L capacity(ies), and that by his/her/their signature(s) on the Notary Public - California instrument the person(s), or the entity upon behalf of orange County which the person(s) acted, executed the instrument. Comm.Ex es Oct21.2mt 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 f i i seal. Signature _ Place Notary Seal Move //55,. yy p pg /� Signature of Note Public " Though the information below is not required bylaw, ii may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Dcscriptlen of attached Docuimrznt Title or Type of Document: Document Date: Signer(s) Other Than Narned Above: Capselty(tes) Claimed by Signer(s) Signer's Name: ❑ Individual • Corporate Officer— Title(s): _ • Partner —[I Limited ❑ General ❑ 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 -- Top of thumb here ❑ Trustee Top of thumb here ❑ Guardian or Conservator ❑ Other': Signer Is Representing: 02007 Na io nalNy Association- - azZ�{. 2*Chat Pth,CA 131G24¢iLv zG?;{'r,, 02001 National Notary 6350 De Solo AVa.,P.O.BOx 2402 •Chatsvvrih, CA 9131 &2402 -w .NebonatNotaryory Item;eso7 Reorder.Call Toll -Fre li800- G6 -Sa27 BIDDER:. USS Cal Builders, Inc 4141111111111111111 M IM37:To]901 4•1KIIII = ZK07►III1:71e1fl.fi 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 and description of work to be subcontracted. 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 one percent of the Contractor's total bid or ten thousand ($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: USS Cal Builders, Inc. 2.113 LIST OF PROPOSED SUBCONTRACTORS (continued) [ "Duplicate Next 2 Pages if needed for listing additional subcontractors. "] Name and Location of Subcontractor Description of Work to be Subcontracted Name: UVQ! 1 tyTA\V1e4-12 ctod fQ� 11 V 1 110. Address: Iln?3 Mot 12C\I CQ �N_ An OpzcA, CA Q4,2� Name and Location Description of Work of Subcontractor to be Subcontracted ���c�1rt Icll � C�I�C�cltl'ly Name: 1 ANQ-�G 4 SZnr, V Address: nIAC;3 Gk R GYIYYIP�C� 0� G604(� Name and Location of Subcontractor Description of Work to be Subcontracted Name and Location Description of Work of Subcontractor n to be Subcontracted_L, Name: SlV 11 V�0� fQ CCIV• `GI ti IC Address: 03;q� QA - I CPT q0 00 Name and Location Description of Work of Subcontractor to be Subcontracted Name: X49 QQ Address: c � e,.QAM n „ i,� �M ,n �a nit i 2.0 REFERENCE FOR BIDDER (Duplicate page as needed) BIDDER: USS Cal Builders, Inc. 2.B LIST OF PROPOSED SUBCONTRACTORS (continued) [" "Duplicate Next 2 Pages if needed for listing additional subcontractors."] Name and Location Description of Work of Subcontractor to be Subcontracted Name: I Address: Name and Location of Subcontractor Name and Location of Subcontractor Na Ad( Description of Work to be Subcontracted ZQ r-- t,��r: Description of Work to be Subcontracted as Name and Location of Subcontractor Name: Addre: Name and Location of Subcontractor Description of Work to be Subcontracted 9/K i i Description of • to be • . -• I ` BIDDER: USS Cal Builders, Inc. 2.13 LIST OF PROPOSED SUBCONTRACTORS (continued) [* *Duplicate Next 2 Pages if needed for listing additional subcontractors. * *] Name and Location of Subcontractor Nan Add Description of Work to be Subcontracted Name and Location of Subcontractor Name: Add re: Nwq1 slokjWW& ,CA Q&631 Description of Work to be Subcontracted Go P Name and Location of Subcontractor Description of Work to be Subcontracted csv %d�U111 \11G� , Name: 1111 (�11s Address: o S. S y11 �C%� Name and Location Description of Work of Subcontractor to be Subcontracted N A Name and Location of Subcontractor Description of Work to be Subcontracted Name: - Address: )LC) � �, . �r1Yl(A IG1Cp 1�1(a � (aC 2.0 REFERENCES FOR BIDDER (Dupl tecai page as needed) BIDDER: USS Cal Builders. Inc. 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: \rF60� \a e+ft' 1 %6C ; S`�� mtl�irlG� � Address: '22 W 2Wmllj I QkOW- ?qi Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: e7w Name and Location Description of Work of Subcontractor to be Subcontracted Name Address ,�, V� QS _ i "� a�� 74 Name and Location Description of Work of Subcontractor to be Subcontracted 9�t �21r��v Name: Address: Name and Location Description of Subcontractor o be Subcontracted Addre �L :�►'i���e!:�C�GL:elil�lin��:vu 2.0 REFERENCES FOR BIDDER (Duplicate page as needed) MI= BIDDER: USS Cal Builders, Inc. 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- �vc�2k Name: Address: 13-2 N. C-IL-AC A,fA9A ro rn.6 Name and Location Description of Work of Subcontractor to be Subcontracted Gawt 60 Name:QQn1 i)e1i 1� MQ�2bie �PCG Address: -2U(06 ft0S1 - j%j)QQ1 t2 CTa2Cli 1 F CA a L�-jj Name and Location Description of Work of Subcontractor to be Subcontracted Salap yNr s Name: ��}r�j }'�( SOECIQ�1S'�S Address: IbC70 VXdS(Aj \, , IVl�p �CC1 q2C;� Name and Location Description of Work of Subcontractor to be Subcontracted Name: �12G1 \11(0 MFCI1a11iCgl Address:2(()l hVlfl Md. L) C-i CA 413-�3 Name and Location of Subcontractor Description of Work to be Subcontracted Name: — Address: yY 2.0 REFERENCES FOR BIDDER (Duplicate page as needed) MF].'QM BIDDER: USS Cal Builders, Inc. 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: �rAPSr� 1Fvrcrsc� — ca; Address: 03 Pv7AtwS y Pry is F ccn cw avc6o Name and Location of Subcontractor Description of Work to be Subcontracted %,u. (, Name: CWwAPZc,,-) is �cF Address: ztoa ti. GLA4ficL o¢,v.r(,c CA, o17a Name and Location of Subcontractor Description of Work to be Subcontracted Name: MAgft Address: 4qy)2 - suavra Po rLn,arzssoz�u� �ZSo�t Name and Location of Subcontractor Description of Work to be Subcontracted 8u ewr. � sNrw- - Mlrsmc L► .u• n .dd Op cam- . Name and Location Description of Work of Subcontractor to be Subcontracted 0-9Fc wf �Z5 Name:_1hcj, Fvn eos — Address: OLm, 4,gw ?o,' CA, clvSlo 2,C REFERENCES FOR BIDDER (Duplicate page as needed) BIDDER: USS Cal Builders, Inc. The following are the names, addresses and telephone numbers for at least three public agencies for which BIDDER has performed similar work within the past four (4) years: 1. Santa Ana Unified School District: 1601 East Chestnut Ave., Santa Ana, CA 92701 Name and Address of Owner Mike Barber PCM3 Construction Manager; (714) 662 -2024 Name and telephone number of public agency person familiar with project $1,978,000.00 Site Work 8/31/2010 Contract amount Type of Work Date Completed 2. Los Angeles Community College District 915 Wilshire Blvd., Suite 1800, Los Angeles, CA 90017 Name and Address of Owner Serafin Fernandez (213) 798 -8466 Name and telephone number of public agency person familiar with project $38,582,000.00 Up- grade, new construction, LEED Project July 2010 Contract amount Type of Work Date Completed 3. City of Costa Mesa; 77 Fair Drive Costa Mesa CA Name and Address of Owner Susan Santoro (714) 754 -5096 Name and telephone number of public agency person familiar with project $18,194,000 Expansion and Renovation August 2009 Contract amount Type of Work Date Completed CBF -9 BIDDER: USS Cal Builders, Inc. 2.6 LIST OF PROPOSED SUBCONTRACTORS (continued) [* *Duplicate Next 2 Pages if needed for listing additional subcontractors. "] Name and Location of Subcontractor Description of Work to be Subcontracted t'uuHVe� rb x 59tf tYfwryr-,-S Name: _ 'F5s Address:I F Rsrestz> a�i �P7NGS ca 9067p Name and Location of Subcontractor Description of Work to be Subcontracted 6o,5 ?t 6aAza6 Name: j-;r6€ T-- Gcgss A� lyS1%t Address: l"-1 w. AGRoW VcurZj QM60rc Lk a%-7a6 Name and Location Description of Work of Subcontractor to be Subcontracted Name: GRAFrSMp.) Bann yra� Address:, o, ck y -x;;ri a3c05- Name and Location of Subcontractor Description of Work to be Subcontracted I GLZG (1 A& Name: 1#-P* Srvrc VcFCrgfl, Address: zlr3 t- Avakd� 3zl cem�rG �� gt2pg Name and Location of Subcontractor Description of Work to be Subcontracted Name: Address: 2.0 REFERENCES FOR BIDDER (Duplicate page as needed) BIDDER: USS Cal Builders, Inc. SECTION. 3... . NON - COLLUSION AFFIDAVIT CBF - 11 BIDDER: USS Cal Builders, Inc. NON - COLLUSION AFFIDAVIT In accordance with Public Contract Code Section 7106, the undersigned, being first duly sworn, deposes and says that he or she holds the position listed below with the bidder, the party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or h pace any breakdown thereof, or the contents thereof, or divulged informal n or data relat ve thereto, or paid, and will not pay, any fee to any corporation, partn rship, compa association, organization, bid depository, y g p ry, or to an member or agent ereof to ectuate a collusive or sham bid. Subscribed and sworn before me This day of Notary Public the State of Q ssion Expires: C.I._.r W& Jennifer Hotrum Typed or Printed President Title USS Cal Builders, Inc. Bidder 20 (Seal) s�. �, �.. sLt�. �. a,_ �'. iy': cra_' s2�' �' �• �' £�- s- r:S.S�w�s� +k�..�r�s�.isS�4 xef> c::�r- .v�.��.'�:ryr- ��rc?.ca:�X State of California County Of nrnnvp_ On Date _ personally appeared r before me, Allen A. Othman, Public Notary Here Insert Name and Title of the Officer ALLEN A. OTHMAN� ��� '� Commission # 1770208 <: -m s Notary Public • California °`� Orange County My Comm. Ex IresOct21,2011 who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subsrribed to the within instrument and acknowledged to me that he /she /they executed the same in his/herAheir 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 ban do " ' I seal. _ Place Notary Seel Above Signature Signature Signaturo 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 T han Named Above: Capac€ity(tes) Claimed by Signer(s) Signer's Name: ❑ Individual ❑ Corporate Officer — Title(s): ❑ Partner — ❑Limited El General ❑ Attorney In Fact • Trustee • Guardian or Conservator ❑ Other: Signer Is Representing: A`IG a �pj N 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: Y?lP. il! -pf4Tr3tt{ t23� NationT -be'� n, 93i'P. 0AVa-.K (.`C[?:�i'L2➢v r"- �.Y,%C:t.'�C4.n3!z7i '< 4�(��i xJ.-n -:, lit: gi^<. 4i .F'?�C['�i.T•ZncCq'.GiZ4i..:.. ©2007 National Notary Association, 9350 De Soto AVa.,RO.Bax24021Chatseorth,CA 91313- 2402 -w NatmalNetayorg Item CC5907 Reorder Cell T01ki'me 1- 800-876 -6627