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Gentry Brothers, IncCITY OF ROSEMEAD RESIDENTIAL STREETS RESURFACING PROJECT PROJECT No. 21003 CONTRACT BID FORMS BIDDER: GENTRY[3ROTHERS. INC BID SCHEDULE SCHEDULE OF PRICES FOR RESIDENTIAL STREETS RESURFACING PROJECT PROJECT No. 21003 BASE BID SCHEDULE r� CBF -2 UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 1 Clearing & Grubbing per plans LS 1 andspecifications. See technical I �L GGO (.l �/ ocU provisions TP -2, TP -3 & TP-4. 2 Disposal of Waste Materials. LS 1 5C) O j a O" 3 Cold mill 2.0- inches thick existing SF 533,020 �• pavement. i 5 a9 4 Construct 1.5 inches thick TONS 5,000 pavement overlay ARHM -GG -C �� _ (PG 64 -16) as indicated on the y �( o c plans. 5 Construct 1;Q inches thick TONS 1,788 Asphaltic Leveling course D1 PG 64 -10 as indicated on the plans. 6 Remove 6- inches of existing SF 7,200 pavement and replace it with 3.5- �. g inches of AC B -PG 64 -10 Base 3,2 y00 Course over compacted native. 7 Remove, Dispose and Construct SF 12,942 4- inches thick PCC Sidewalk per y 7 16 SPPWC Std. Plan 113 -1. 8 Remove, Dispose and Construct SF 2,500 PCC Driveway Approaches per / - E ce r 0 SPPWC Std. Plan 110 -2. 9 Remove, Dispose and Construct LF 533 8- inches Curb and 24- inches Gutter per SPPWC Std. Plan 120 -2. 10 Remove, Dispose and Construct LF 100 PCC Cross Gutter per SPPWC 00(' Std. Plan 123 -2. , r� CBF -2 1 1 1 pp 6m TOTAL BASE BID PRICE (SCHEDULE BID PR // CE):$ J 1 0 7 3- - �+ /...4 I7� /i - �6yO �/c ✓S.'�+'e 7fldeL' �'f �...s � .. . �.., 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 22 PCC Curb Ramps per SPPWC f p0 3� U po Std. Plan 111-4. 12 Adjust Sewer Manhole to Grade EA 94 per APWA Std. Plan 205 -1 and 3 co a aC ; 206 -1. 13 Adjust Water Valve /Gas Valve to EA 84 _ Grade. c)o 14 Install Survey Well Monument EA 27 per City of Rosemead Std. Plan S08 -001. See Section 2 -9 _ < y° Surveying of the General Provision -7 per details (Cover, Sleeve & Dome will be provided by the City at no cost). 15 Install Traffic Striping, Traffic LS 1 Signal Loops and Pavement 3 J Markers per the Striping Plans and Specifications Complete. 16 Prepare a Storm Water Pollution LS 1 �o c / To 0 Prevention Plan (SWPPP) _ 17 Paint Home Addresses (Curb EA 600 - Numbering). / 6 9 6 18 Install Truncated Domes Only EA 8 yellow color by Amorcast or Approved Equal. pp 6m TOTAL BASE BID PRICE (SCHEDULE BID PR // CE):$ J 1 0 7 3- - �+ /...4 I7� /i - �6yO �/c ✓S.'�+'e 7fldeL' �'f �...s � .. . �.., i Dollar amount in written form CBF -3 ... I. ALTERNATE BID ITEM No. 1 MUSCATEL AVENUE FROM RAMONA AVENUE TO GARVEY AVENUE. CBF -4 UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE CITY. PRICE COST 19 Clearing & Grubbing per plans LS 1 and specifications. See technical ?6 o CO 3 provisions TP -2, TP -3 & TP-4. ' 20 Cold mill 2.0- inches thick existing SF 74,160 0 — Y ° ' pavement. 21 Construct 1.5 inches thick TONS 700 pavement overlay ARHM -GG -C `` y A �0 0 `- (PG 64 -16) as indicated on the plans. 22 Construct>: thick TONS 232 Asphaltic Leveling course D1 (PG 64 -10) as indicated on the 7�, / L Y 0 plans. 23 Remove, Dispose and Construct SF 3,318 4- inches thick PCC Sidewalk per SPPWC Std. Plan 113 -1. 24 Remove, Dispose and Construct SF 595 PCC Driveway Approaches per / S 7,f . SPPWC Std. Plan 110 -2. 25 Remove, Dispose and Construct EA 9 PCC Curb Ramps per SPPWC r;, 3 S Std. Plan 111-4. 26 Adjust Sewer Manhole to Grade EA 6 per APWA Std. Plan 205 -1 and 206 -1. 27 Adjust Water Valve /Gas Valve to EA 6 Grade. Z �G 28 Install Survey Well Monument EA 5 per City of Rosemead Std. Plan S08 -001. See Section 2 -9 G ; Surveying of the General Provision -7 per details (Cover, Sleeve & Dome will be provided by the City at no cost). 29 Install Traffic Striping, Traffic LS 1 Signal Loops and Pavement Markers per the Striping Plans and Specifications Complete. CBF -4 11 11 11 11 11 TOTAL ALTERNATE BID PRICE No. 1 (SCHEDULE BID PRICE):$ I SS IC o I o L OrA 9-..j, I 1- amount in written form ALTERNATE BID ITEM No. 2 TREE PLANTING UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 30 Install Truncated Domes Only EA Z - yellow color by Amorcast or Approved Equal. TOTAL ALTERNATE BID PRICE No. 1 (SCHEDULE BID PRICE):$ I SS IC o I o L OrA 9-..j, I 1- amount in written form ALTERNATE BID ITEM No. 2 TREE PLANTING TOTAL ALTERNATE BID PRICE No. 2 (SCHEDULE BID PRICE):$ /C/( C - Dollar amount in written form TOTAL BASE & ALTERNATE BID PRICE $ 3 G 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 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 e. -f A'/ CBF -5 UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE CITY. PRICE COST 31 Install 24 -Inch Box Parkway Tree EA 200 "Chinese Pistache" including 90- days maintenance period and tree wells. TOTAL ALTERNATE BID PRICE No. 2 (SCHEDULE BID PRICE):$ /C/( C - Dollar amount in written form TOTAL BASE & ALTERNATE BID PRICE $ 3 G 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 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 e. -f A'/ CBF -5 11 1 11 1 i 1 1 1 BIDDER: GENTRY BROTHERS. INC 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 Pereto is a certified check, a cashier's check or bid b in the amount of Dollars ($ said amount being not less than en percent (10 %) of the Total Bid riP ce. 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 subiect 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 -6 1 f 1 1 BIDDER: GENTRY BROTHERS, INC By: Signat're I Type or Print Name Title 384 LIVE OAK AVE. IRWINDALE CA 91706 Business Street Address City, State and Zip Code L.0 3 2 - a b 3 1 Telephone Number Bidder's /Contractor's State of Incorporation: C 9 . Partners or Joint Venturers: Bidder's License Number(s): -� 9 -? ( :, e Z 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 or joint venture has the authorl�to do so. so. CBF -7 CALIFORNIA ALL - PURPOSE CERTIFICATE OF AKNOWLEDGMENT �` -'1 .. �.:iiL.•XIFNNN R4pL #'Y.tY:'.H� Jwl:�i.'. >A:[. . �n.Y`:.ix. w. .. .. vdWYMeklr. 4w... ui4'T[flnuCYIK "wFMaN� State of: California Countyof: Los Angeles On March 21, 2012 before me , N. Smith, No t ar y -- ---------- ----- - - - - -- (name and Due of the officer) personally appeared R odney J. Gentry-- ---------------------------- - - - - -- who proved to me on the basis of satisfactory evidence to be the person N) whose name(§) is/,xe subscribed to the within instrument and acknowledged to me that he/ea executed the same in hisMKMKauthorized capacity (3e1Spf and that by his /herAftek signature(g) on the instrument the person(* or the entity upon behalf of which the personfq)tacted, 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 m hand and official seal NMITH Comm a+ q t34300i Nei.; k01114y o'_AiC'CAbfOWUA WEIfS COUNTY at. 2D13 : :1 ilFhlta ry Public .-...T (Notary Seal) —OPTIONAL INFORMATION. — .: , ...� ,.,.,:.:,;� Information below is NOT required by law however may decor fraudulent removal of this form Description of Attached Document Number of Pages 1 Document Date: N/n pe of document Additional information Capacity Claimed by Signer(s) ❑ Individual(s) a Corporate Officer ❑ Partner • Attorney -in -Fact • Trustee(s) • Other i' 1 l SECTION 2 BID DATA FORMS WON BIDDER: Gentry Brothers, 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 manysheets as are necessaryto 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 Gentry Brothers, Inc. 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 hid ($ _ 1 f 111„ ) , being not less than ten percent (10 %) of the Total Bid Price; fortne payment ofwhich 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 Residential Streets Resurfacing Project as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated - 0' - z. 0/ t_ 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 oertificates and endorsemerts, 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 1S111 day of March 20 1? Gentry Brothers, Inc. (SEAL) Principal / By: d 8y: S nature Federal Insurance Company ($EqL) Surdy Igr181111/e Whew J. Coats, Attorney in Fact CALIFORNIA ALL - PURPOSE ACKNOWLEDGEMENT State of California County of Orange On MAR 15 2012 before me, Adelaide C. Hunter, Notary Public (insert name and title of the officer) personally appeared Matthew J. Coats 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/shcfthey executed the same in his "rrtcr /their authorized capacity(ics), and that by his /h e n/their signatures) on the instrument the person(s), or the entity upon behalf of which the persons) 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. w�- ADELAIDE C. HUNTER - Tug± ;;,, Commission # 1808793 - .►IA l Notary Public -- California AA • Orange County A /� / My Comm. Expires Aug B. 2012 Signature � I � ✓� ufab OF Vigilant Insurance Company 15 Mountain View Road Surety ATTORNEY Pacific Indemnity Comparty Warren, NJ 07059 01-ILO Y 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 hereby constitute and appoint Linda D. Coats and Matthew J. Coats of Laguna Hills, California --------------- - - - - -- - -- each as their true and lawful Attorney. In- Fact to execute under such designation in then names and to affix tnehr corporate seals to and deliver for and on their benaff as surety thereon or otherwise, bonds and undertakings and other writings obligatory in the nature themof (other than ball bonds) given or executed In the course of business, am any instruments amending or altering the same, and consents to the modification or ahembon of any instrument referred too said bonds or obligations. In Witness 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 1St day of December 2011. Kenneth C. Wendel, 65ibtant ae tary David B s. Jr., Vde resident STATE OF NEW JERSEY SS County of Somerset On this let day o December, 2011 before me. a Notary Public of New Jersey, personally came Kenneth C Wendel, to me known to de Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which exalted the foegoing Power of Attorney, and the said Kenneth C. Wendel, being by me Bury sworn, did depose and ray that he Is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNrfY COMPANY and knows the corporate seals Hereof that the seal& affixed 10 the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of me By- Laws 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 w.th David B. Norris, Jr., and knows him to be Vice President of said Companies: and that the signature of David B. Noms, 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 deponent's presence. Notarial Seal KATHERINE J. ADEIAAR J ' �� NOTARY PUBUC OF NEW JIi NDARY y Nr.2316685 / �• + a Commission Expires July 15, 2014 pUBLI� Notary Public y A1sr rcp5� CERTIFICATION Extract from the By. Laws of FEDERAL INSURANCE COMPANY. VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY 'AII 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 Vm President or an Assistant Vice President, Kerry with the Secretary or an Assistant Secretary, under their respective designations. The signature of such offcere may be engraved, printed or IiMographed. The signature Of each Of the following offcars. Chairman, President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of abomey or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- In- Fact for purposes only of executing and attesting bonds and undertakings and other wnungs obligatory In the nature thereof and any such power of arlorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power as executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bores or undertaking to which n is attached.' I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (Me'Canpani do hereby certify the: (i) the foregoing extract of the li Laws of me Companies is true and correct, (6) the Companies are duly licensed and auti iiatl to transact surety business In all 50 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Department; further, Fedeal and Vigdent are licensed in Puerto Rico and file 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 Attoney is true, correct and in full force and effect Given under my hand and seals of said Companies at Warren, NJ this I ith day of March, 2012 Keene C WendeI ssistant 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) gD3- 3656 e -mail: suraty@chubb.com Form 15-10- 02258- U (Ed. 5- 03) CONSENT CALIFORNIA ALL - PURPOSE CERTIFICATE OF AKNOWLEDGMENT State of: California Countyof: Los Angeles On March 21, 2012 beforeme, N. S mi t h, N (name and He of the officer) personally appeared Rodney J. Gentry------------------------------ - - - - -- who proved to me on the basis of satisfactory evidence to be the person (9) whose name(6) istam subscribed to the within instrument and acknowledged to me that he/xbe&0y executed the same in hiA#RSWauthorized capacity ()W and that by his/ballxk signature(g) on the instrument the person(* or the entity upon behalf of which the person(ISracted, 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. hand and official seal d N. SMITH Com ft 1343001 /�pp S ' 074NY v,3L!CdAL!F0.9N!A VI Los ANGELES COUNTY MY Cer,a Eve Aca, N, 7013' (Notary Seal) =OPTIONAL INFORMATIONS - Information below is NOT required by law however may deter fraudulent removal of this form. Description of Attached Document Capacity Claimed by Signer(s) Number of Pages 1 Document Date: N/A Bid Bond---------- - - - - -- type of document Additional information • Individual(s) • Corporate Officer ❑ Partner ❑ Attomey -in -Fact ❑ Trustee(s) ❑ Other BIDDER: GENTRY BROTHERS, INC 2.8 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 Bidders 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 Contractors 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 -10 BIDDER 2.13 LIST OF PROPOSED SUBCONTRACTORS (continued) [ Next 2 Pages if needed for listing additional subcontractom I GENTRY BROTHERS, INC Name and Location Description of Work of Subcontractor to be Subcontracted / S7ti ^7 Name: S .,�i,eti /,i,.d"r v Address: I / ., aA F3 s In Name and Location of Subcontractor /I Name: Address: Name and Location of Subcontractor Name: Address: Description of Work to be Subcontracted 4 ` Description of Work to be Subcontracted Name and Location of Subcontractor Name: Address Description of Work to be Subcontracted Name and Location of Subcontractor Name: Address: Description of Work to be Subcontracted CBF - 11 BIDDER: GENTRY BROTHERS, INC 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: U Name and Address of Owner Name and telephone number of person familiar with project amount 2. Type of Work Date Completed Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed CBF -12 3. 1 1 ' 4. Type of Work Date Completed Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed CBF -12 N O N m M ^i. N m /D a Q c W N T N 0 W N O W N T N o N > N W W o N N N G W C N > d C a J C d > N J > O > d C a J C C N C a > W > d J t . 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A - auaf r .Caupog paleaddeAlleuosied Oww "m epp Pue emu) ----------------------- Aae ;oN 'z;3iwg •N'owex4eq' ZTOZ 'TZ uazeW SaTabuV soZ :lodlunoo eiwopleo :10 alels •LNAK9031AXONMV dO - AIV�)Id1.1AAJ IISO&IIIJ VINMOdII u011euu03ul leuo111ppV �ag1O ❑ (s)aalsruy ❑ l3ud -ul - �awo11V ❑ luawnooP3o a d Iaulred ❑ gtnepT;;V uotsnTTOJ -uoN iaoWo amodio0 ❑ :ale(] luawnoo(I (s)lenpinlpul in T sailed jo ragwnN (s)aau31S Sq pawle1O S)pudeO juawnaoQ pagaeuV ;o uoyduasaQ wioi sup to jr,ow.» walnpnj lalap hew 12Aa Oq meI dq pannbw ION si ,molaq uogeuuOJul MNOLLVWHOA II'IVNOI.LdOW — -- (IOSS AMON) paum pue erul si gdej6eied 6ulo6ajol ayl 1e41 epo1Qe010 alels eql ;o smel eql lapun A8ml3d d0 kilVN3d lapun 4piao •luawrulsul eql polnoaxa 'palwAuosiod eqi goigm Io jlegaq uodn flgue a41 Jo *)uosiad aql luawru)sw ag1 uo (11jair4eu6is »mWsiq (q )eql pue i#3tal) 4pedeo pazuoglneA*W"!q ui awes eLp palnoaxe ft{pagKjaq legl ow of pe6polmoujoe pue luawrulsw uigllm eql of paquosgns aWsi (pjaweu asogm (W uosied a p aq of souepina fuo)ae }sues ;o siseq ag) uo aw 01 panaid ogm ............................ A - auaf r .Caupog paleaddeAlleuosied Oww "m epp Pue emu) ----------------------- Aae ;oN 'z;3iwg •N'owex4eq' ZTOZ 'TZ uazeW SaTabuV soZ :lodlunoo eiwopleo :10 alels •LNAK9031AXONMV dO - AIV�)Id1.1AAJ IISO&IIIJ VINMOdII