PALP dba excel Paving Companye :91: ,;
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TABLE OF CONTENTS
RM IMMA
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
CBF -15
um
BIDDER:
BID SCHEDULE
SCHEDULE OF PRICES FOR
WALNUT GROVE AVENUE RESURFACING PROJECT
PROJECT No. P84329
BASE BID SCHEDULE
CBF -2
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
1
Clearing & Grubbing per plans
LS
1
and specifications. See technical
provisions TP -2, TP -3 & TP -4.
LAIA 100 ,
03-
2
Disposal of Waste Materials.
LS
1
e
3
Cold mill 2.5- inches thick existing
SF
462,580
pavement.
01A
6� tq
4
Construct 1.5 inches thick
TONS
4,350
pavement overlay ARHM -GG -C
(PG 64 -16) as indicated on the
plans.
®�i
oi 0o -j.
5
Construct 1.0 inches thick
TONS
2,900
Asphaltic Leveling course D1
(PG 64 -10) as indicated on the
plans.
6
Remove 6- inches of existing
SF
160
pavement and replace it with 3.5-
inches of AC B -PG 64 -10 Base
5,
Course over compacted native.
5
e
7
Remove, Dispose and Construct
SF
6,025
4- inches thick PCC Sidewalk per
SPPWC Std. Plan 113 -1.
5 , �0
32 S
8
Remove, Dispose and Construct
SF
434
PCC Driveway Approaches per
SPPWC Std. Plan 110 -2.
®%
�✓
9
Remove, Dispose and Construct
LF
93
8- inches Curb and 24- inches
Gutter per SPPWC Std. Plan
120 -2.
,66
10
Remove, Dispose and Construct
LF
20
8- inches PCC Curb Only per
SPPWC Std. Plan 120 -2.
CBF -2
BIDDER: E X C rc L PON I ° N' S C 0RAP M
t
T OTAL D i
i
Dollar amount in written form
CBF -3
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
11
Remove, Dispose and Construct
EA
10
PCC Curb Ramps per SPPWC
Std. Plan 111-4.
12
Remove, Dispose and Construct
LF
100
PCC 6- Inches PCC Curb and 6-
Inches PCC Gutter per SPPWC
Std. Plan 120 -2.
0S- ,
13
Remove, Dispose and Construct
SF
200
PCC Alley Intersection per
SPPWC Std. Plan 130 -2.
LA
OW
14
Adjust Sewer Manhole to Grade
EA
30
per APWA Std. Plan 205 -1 and
206 -1.
15
Adjust Water Valve /Gas Valve to
EA
82
Grade.
2�S" °
21`130
16
Install Survey Well Monument
EA
9
per City of Rosemead Std. Plan
S08 -001. See Section 2 -9
Surveying of the General
Provision -7 per details (Cover,
Sleeve & Dome will be provided
by the City at no cost).
2
17
Install Traffic Striping, Traffic
LS
1
Signal Loops including DLC
cable, Pullboxes, rigid cable, and
Pavement Markers per sheets 6,
7, 8, & 9 of the Striping Plans
and Specifications Complete.
k JS —
t J Y000, __
18
Prepare a Storm Water Pollution
LS
1
Prevention Plan (SWPPP)
J
Q
19
Paint Home Addresses (Curb
EA
200
Numbering)
((o ,
3100
t
T OTAL D i
i
Dollar amount in written form
CBF -3
tlFqj o PUV�.D
BIDDER: nA
ALTERNATE BID ITEM 1
TOTAL ALTERNATE BID # 1 PRICE
ALTERNATE BID ITEM 2
BID PRICE):
NO.
ITEM DESCRIPTION
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
20
Construct Landscape and
Irrigation on the median along
Rush Avenue as indicated on the
Plans and Specifications Complete
on sheets 11, 12 and 13.
LS
1
TOTAL ALTERNATE BID # 1 PRICE
ALTERNATE BID ITEM 2
BID PRICE):
NO.
ITEM DESCRIPTION
.UNIT OF
MEASUR
E
EST.
QTY.
UNIT
PRICE
ITEM
COST
21
Remove, Dispose and Construct
Colored PCC Cross Walk
(Chromix) with Lithochrome
Colorhardener on top per Plans
and Specifications on Exhibit "A"
Complete per LM Scofield
Company or Approved Equal.
Contact person Bruce Umeek 818-
324 -3534.
SF
14,652
i
TOTAL ALTERNATE
1
Dollar amount in written
2 PRICE (SCHEDULE BID PRICE): $ (Q�
TWO
\i*4v
� m /kIis. a /,�
0 10
TOTAL AMOUNT INCLUDING BASE PRICE AND ALTERNATES: $ mi l L
Dollar amount in written form
WAff
CBF -4
Dollar amount in written form
ALV h U B
,� ax`s
BIDDER: ftmfrw^ -� f tag , Yj
Note: The City of Rosemead reserves the right to reduce or increase the quantities of any items in
the schedule of bid items above, within the limits define in Section 3 -2.2.1 of the Standard
Specifications, to stay within the budgeted amount of this project.
If the Bid Documents specify alternate bid items, the following Alternate Bid amounts shall
be added to or deducted from the Total Bid Price entered above. The owner can choose to
include one or more of the alternates in the Total Bid Price of the Project. If any of the
Alternate Bids are utilized by the Owner, the resulting amount shall be considered the Total
Bid Price for the Project.
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 bic bond in the amount of
':TE PERCENT OF A RM �) 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
of five hundred dollars ($500.00) if project is not completed in forty -five (45) calendar days. The
Contract Time will begin to run ten (10) Working Days from the date of the Notice of Proceed and
subject to the terms and conditions described in the Contract Form and the Contract Documents.
Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be
incorporated into a Contract arising out of this Submittal has been so identified by Bidder. Bidder
further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data
submitted herewith into a contract arising out of this Bid.
l�
PAX INC1f
BIDDER: ELfc R, ?y €i @It`!si mmm-Aw
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.
NQ
0
BIDDER: r g�
Signature �
)SVrT
Type or Print Name
Title
:2230 LEMON AVENUE
LONG DEACii, CA 90806
Business Street Address
City, State and Zip Code
;362)699.5841
Telephone Number
Bidder's /Contractor's State of Incorporation: rAL FORMA
Partners or Joint Venturers:
Bidder's License Number(s): STATER,tr Sggegtd - ,9. ,
NOTES:
1) By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the
representations made on the Contract Bid Forms.
2) If Bidder is a corporation, enter State of Incorporation in addition to Business Address
3) If Bidder is a partnership or joint venture, give full names of all partners or joint
venturers.
As further discussed in the Instructions to Bidders, Bidder will be required
to provide evidence that the person signing on behalf of the corporation,
partnership or joint venture has the authority to do so.
CBF -7
PAM ICa
BIDDER: ",I j pffi Rr� COVE W
SECTI
BID DATA •
PALP Inc. On
BIDDER: Excel Paving Company
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 PALP Inc. doe Excel Paving Company as
Principal, and Federal Insurance Company
, as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
Ten percent of the total amount of the bid
($ 10% ) , being not less than ten percent (10 %) of the Total
Bid Price; for the payment of which sum will and truly to be made, we bind ourselves,
our heirs, executors, administrators, successors, and assigns, jointly and severally,
firmly by these presents.
WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work
required for the Walnut Grove Avenue Resurfacing Project as set forth in the
Notice Inviting Bids and accompanying Bid Documents, dated
May 18, 2011
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 11th day of May 20
PALP Inc. dba Excel Paving Company (SEAL) Federal Insurance Company (SEAL)
Principal Sur
p <'
�� -�
By: i X J By:
Signature t ttnCy ignature Timothy D. Rapp C `
Attorney in Fact
0 R`" I!)EPlT
CBF -9
ACKNOWLEDGMENT
State of California
County of Orange
On 05/11/2011 before me, Debra Swanson, Notary Public
(insert name and title of the officer)
personally appeared Timothy D. Rapp
who proved to me on the basis of satisfactory evidence to be the personw whose name4g) WPM
subscribed to the within instrument and acknowledged to me that he /ska/tbeq executed the same in
his /4er /their authorized capacity(*), and that by his /har /th& signature(e) on the instrument the
person(s), or the entity upon behalf of which the persona) 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 °° DEBFtA SWANSON
�'`a n� °^ COhiNI. #1822117 �
® NOThRY PUBLICCI�.IFORNIA �
" OF2ANGE COUNTY �
� ° My Caron. Fxpr¢s NOV 10, 2012
Signature (Seal)
KI Chubb POWER Feaeral Insurance company Attn: surety Department
OF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY pacific Indemnity Company Warren, NJ 07059
Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE
COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, .do each hereb constitute and
appoint Linda D. Coats, Matthew J. Coats, Douglas A. Rapp and Timothy D. Rapp of Laguna Hills, California —�—M—
each as their true and lawful Attorney- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed In the course of business, and any
Instruments amending or altering the same, and consents to the modification or alteration of any Instrument referred to in said bonds or obligations.
In WRneae Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested
these presents and affixed their corporate seals on this 16th day of November, 2009.
l� ,r g r_ L 26 zP /_
Kenneth Cpl Wendel, Assistant Secretary Nortis, Jr., Vice P,rpa6 ant
STATE OF NEW JERSEY
ss.
County of Somerset
On this 16th day of November, 2009 before me, a Notary Publicof New Jersey, personally came Kenneth C. Wendel, to me
known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companles which
executed the foregoing Pourer of Attorney, and the said Kenneth C. Wendel, being by me duly swum, did depose and say that he is Assistant Secretary of FEDERAL
INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNIT COMPANY and knows the corporate seals thereof, that the seals affixed to the
foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- taws of said Companies; and that he signed said Power of Attorney as
Assistant Secretary of said Companies by like authority, and that he Is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the
signature of David B. Norris, Jr -, subscribed to said Power of Attorney Is in the genuine handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By.
Laws and In deponents presence.
Notarial Seat KATHERINE J. ADEIAAR
NOTARY PUBLIC OF NEW JERSEY
D FEDERAL on f . Jul Cammiaaion p uly 16, 2014 Notary Public CERTIFICATION
Extract from the Sy- Laws of INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY:
"All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the
President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The
signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any
Asslamnt Vice President, any Secretary, any Assistant Secretary and me seal of the Company may be affixed by facsimile to any power of abomey or to any -
certificate relating thereto appointing Assistant Secretaries or Ahomeys- 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 pourer so executed and certified by such facsimile signature and facaimile seal shall be valid and binding upon the Company
with respect to any bond or undertaking to which it is attached:'
I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY
(the "Companies") do hereby canify that
(1) the foregoing extract of the By- Laws of the Companies Is true and correct,
(u) the Companies are duty licensed and authorized to transact surety business In all 50 of the United Slates W America and the Distinct of Columbia and are
authorized by the U.S. Treasury Department further, Federal and Vigilant are licensed in Puerto Rico and the U.S- Virgin Islands, and Federal is licensed In
American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and
(III) the foregoing Power of Attorney Is We, correct and in full force and effect.
Given under my hand and seals of said Companies at Warren, NJ this May 11 , 2011
7 i =
a'aMNP • r aM e 'rIW YJPf'+ It/ �i/r /Nr/ -Ln.VViJ/IgAJA
Kenneth C. Wendel; Assistant Secretary
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER
MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903 - 3493 Fax (908) 903- 3656
e -mail: suretynchubb com
Form 15.10- 02258- U (Ed. 5.03) CONSENT
110WX 1 1'
State of California
County of Los Angeles
On MAY 1 D 2011 before me, C Phillips Notary Public
(Here nowt none end nee of the officer)
personally appeared C.P.
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is6MRsubscribed to
the within instrument and acknowledged to me that hehkaffiUM executed the same in his&tezWmir authorized
capacity(ies), and that by his&*�frsignature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument. .
I certify tender PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
COUNTY .........
OU
C PHII LIPS
COMM 81809758 10
SS my hand and official seal . � L O S A " ;tsnfornla
WITNE "a.
YY, � L(!� /tNCEL ks NTY
�
i+F`', hl, L
Upuuw Aing 4 t6 2012
i
(Notary Sap
Signature otny Public
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or desc iptim of anwhed dotnmwot)
(Title or deserlpaoa of atmehed document continued)
Number of Pages _ Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑
Individual, (s)
❑
Corporate Officer
(Tide)
O
Partner(s)
❑
Attorney -in -Fact
❑
Trustee(s)
❑
Other
INSTRUCTIONS FOR COMPLETING THIS FORM
dray ocMowledgnwm completed in Calftornia roust cowain verbiage a MtdY be
appears abort it the nowy secwon or o tepamir, aeknowfedgrnnd form
property completed and atfacked to that doarnem. The oily e+eePndn Is V a
docvnen( is to U recorded outside ofCalrforWa fn each irmmoa, My alfer"Odw
ackwar w io n nee require the nalary too pri
o J melN g rho/ gat Jor notary
Calf ibe a ih.e. ornyying else aolhorteed aspaciy of the +Ignn). Please dock she
daaonant ear(fd(J6r pr9xr not O Wt wording and attach dial form ((required
• State and j;gaW information must be the State and county whose the document
sillei pe appeared before the notary public for wknowledgmtnl.
• Date of notarization mint be the date that the signers) Personally appeared which
moat also be the sumo date the acknowiedpneat to completed.
• The nobly public must print ids or her aunt u it appears within his or her
conuniasion followed by a comma said Hen your title (notuY public
• Rapt We narne(s) of document signWs) who personally appear at the time of
notarization.
• Indicate the sorted singulu or plural forms by crossing off incorrect forms (i.e.
Widielthapr is /are) or circling the corttcl forms. Fait"' to correctly indicate this
information may lead to mjwion of document recording:
• The notary sal impression must be clew and phoogriphfcally reproducible.
Impression most not cover " or lines. If stet impression smut rase If a
sufficient area permits, otherwise complete a different uckenew form
• Si of taw notary public must match the signature on file with the office of
the county clerk.
4- Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different docurri
Indicate title or type of attached docurrrenl, number of pages and date.
4 Indicate the capacity claimed by the signer. If the claimed opacity is a
wrporero officer, indicate the doe (i c. CEO, CFO, Secretary).
Securely attach this document to the signed document
2008 Version CAPA vl2.10.07 800 -871 -9865 wrvw.NomryClasses cmn
PM,? IMMA
BIDDER:
EXCEL. f MRIG COMPARI
2.113 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.
MansIs,
FIB INUBA
EXCEL. €AMID C uPAkM
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
[ Next 2 Pages if needed for listing additional subcontractors. - ]
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
nnayr l0®
P k
Address
t.
IN
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: 'Tj'c' LTY00 iwAS d FTU L
Address yN�,�� P r
k w& Gk �®Q
Name and Location Description of Work
of Subco to be Subcontracted
Name: �yl�eN ' PaV �.VlaA51 iN A V�
Address 5It2 rtss
Class Cv 0, 60D
Name and Location
of Subcontractor
J.
Addr •f L
r !
Description of Work
to be Subcontracted
U4 sv+c � - i6.
CBF -11
F" jj'�j�ABA
( "jTH, PIMUIERG MMAf NPI
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2.0 REFERENCES
The following are the names, addresses and telephone numbers for three public agencies for which BIDDER
has performed similar work within the past two (2) years:
Name and Address of Owner
\(kA- 4 F ow atgq ®101 Y
Name and telephone number of person familiar with project
\'SM I!M (� IA L W �1►1
Contract amount Tvoe of Work r)atp Cmmnlafari
2.
3. — %bffi1
Name and
Na a and
person
ID
a
Name and telephone number of person familiar with project
1 iAll �fl b 0A,(bAkA a6AO 0,U 1 �1
amount
CBF -12
Name and telephone number of person � familia r with / project
° Sk
Contract amount Type of ork Date Completed
BIDDER: —W L49MA
crl Pmvw pasi cod mimy
SECTI
N ON-COLLUSION AFFDA
CBF -13
M
BIDDER. EXCE.. PAYRIING CORMA '
NON - COLLUSION AFFIDAVIT
In accordance with Public Contract Code Section 7106, the undersigned, being first duly
sworn, deposes and says that he or she holds the position listed below with the bidder, the
party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any
undisclosed person, partnership, company, association, organization, or corporation; that the
bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced
or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly
colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham
bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly
or indirectly, sought by agreement, communication, or conference with anyone to fix the bid
price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the
bid price, or of that of any other bidder, or to secure any advantage against the public body
awarding the contract of anyone interested in the proposed contract; that all statements
contained in the bid are true; and, further, that the bidder has not, directly or indirectly,
submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged
information or data relative thereto, or paid, and will not pay, any fee to any corporation,
partnership, company association, organization, bid depository, or to any member or agent
thereof to effectuate a collusive or sham bid.
Signature
1 1 {�1, <pMl its i�r s.g v�f;,r i'1
Typed or Printed Name
Subscribed and sworn b�'�e1011
This _ day of
— 0*
Notary Public in n for
the State of Cali fo is
Title
u�afi, I WK ,
Bidder
20_
(Seal)
My Commission Expires: 2)4^ 12 — ` tr
W-JAC i ,
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