The URL can be used to link to this page

PCIBIDDER: re1- CONTRACT BID FORMS TABLE OF CONTENTS SECTION BID SCHEDULE ........................................................................ ..............................1 SECTION2 BID DATA FORMS ................................................................... ............................... 6 2.A BID BOND ................................................................................. ............................... 7 2.6 LIST OF PROPOSED SUBCONTRACTORS .......................... ............................... 8 SECTION 3 NON - COLLUSION AFFIDAVIT .............................................. ............................... 11 BIDDER: pC�� SECTION 1- BID SCHEDULE CBF -1 BIDDER: / e-Z_ BID SCHEDULE SCHEDULE OF PRICES FOR CITY SIGNAGE REPLACEMENT PROJECT PROJECT No. 26001 BASE BID SCHEDULE NO. ITEM DESCRIPTION UNIT OF MEASURE EST. QTY. UNIT PRICE ITEM COST 1 Clearing & Grubbing per plans and LS 1 y300 00 specifications. See technical OD provisions TP -2. 2 Furnish and Install Street and Regulatory Signs, Per Exhibit A in 1p 9 0� 8D. d0 Appendix A per Matrix. Signs 9 a 80 00 manufactured by Zumar Industries, or Approved Equal. Contact: Erick Gustafson (562) 941 -4633 or 213 798 -7024 Cell LS 1 TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ s-ven-1 amount in written form * Contractor shall refer to Section 9 Measurement and Payment on Page 36 of the General Provisions regarding the required schedule of values. CBF -2 BIDDER: F C.;5 ALTERNATE BID SCHEDULE NO. ITEM DESCRIPTION UNIT OF MEASURE EST. QTY. UNIT PRICE ITEM COST 1 Clearing R Grubbing per plans and LS 1 S oD specifications. See technical 6'0 SO. PAD provisions TP -2. 2 Furnish and Install Street and Regulatory Signs, See Exhibit B on Appendix A, Alternate Bid Inventory per Matrix. Signs manufactured by Zumar Industries, or Approved Equal. Contact: Erick Gustafson S'f$ 7 �0 Old (562) 941 -4633 or i 213 798 -7024 Cell LS 1 TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 9 1 DOD• DD written form * Contractor shall refer to Section 9 Measurement and Payment on Pape 36 of the General Provisions regarding the required schedule of values. 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. CBF -3 BIDDER: PCs Attached hereto 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 Ownerfor 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. The undersigned acknowledges receipt, understanding and full consideration of the following addenda to the Cops raq Documents. c Addenda Nos. v Z 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 -4 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. vi 1A Ayof. V5 V'kFd. , l n.. t 4iAFiC V`.i %LI � �hl a. ti ❑ - V'rli J! i J FIfIll - UIVF (l 'f) 5P9 -21(10 FAX (G26) f,()7 -li" CITY OF ROSEMEAD ROSEMEAD, CALIFORNIA ADDENDUM NUMBER To all prospective bidders under Bid Documents for the CITY SIGNAGE REPLACEMENT PROJECT Project No. 26001 1. Bidder shall have a Class "A" or "C -32" license in good standing at the time bids are received. 2. All signs, excluding street name signs, shall be 0.080 millimeter aluminum and coated in 3M 1160A anti - graffiti coating. Regulatory signs shall utilize 3930 3M HIP reflectivity and all school signs shall utilize DG3 FYG reflectivity. 3. Bidder shall review updated sign inventory for clarification of sizing for street name and other regulatory signs which is posted on the City website at www.cityofrosemead.org. 4. The rest of Bid Documents as originally issued shall be used in submitting bids, and an acknowledgement of receipt of this Addendum Number 1 shall be entered on the page CBF — 4 of the Contract Bid Forms. Failure to provide such acknowledgement shall render the bid as non - responsive and subject to rejection. BY ORDER OF THE CITY OF ROSEMEAD Date: April 11, 2012 By - Rafael Fajardo Associate Civil Engineer 1 MAYOR: STEVEN LY MAYOR PRO TEM: SANDRA ARMENTA COUNCIL MEMBERS: BILL ALARCON MARGARET CLARK POLLY LOW April 5, 2012 i cy Rosemead 8838 E. VALLEY BOULEVARD • P.O. BOX 399 ROSEMEAD, CALIFORNIA 91770 TELEPHONE (626) 569 -2100 FAX (626) 307 -9218 Re: City Signage Replacement Project Dear Bidder: Per your request, enclosed please find a copy of specifications for the City Signage Replacement Project. All sealed bids are invited for the above - stated project; the City will receive such bids in the office of the City Clerk, 8838 East Valley Blvd., Rosemead, CA 91770, up to the hour of 10:30 am on Wednesday, April 18, 2012. All bids will be publicly opened at 11:00 am. Thank you for your interest. Sincerely, Erick¢.7femand= Ericka Hernandez Assistant to the City Clerk By: r Signature /n qq / Cam. J R LOfj Type or Print Name Title Bidder's /Contractor's State of Incorporation: Partners or Joint Venturers: BIDDER: F(7— Business Street Address / 90 �«lo , , "4 ,/ / i City, Std and Zip Code Slow - :2/ o s'o�/ Telephone Number Bidder's License Number(s): ��-.? FZ ' NOTES: 1) 2) 3) By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the representations made on the Contract Bid Forms. If Bidder is a corporation, enter State of Incorporation in addition to Business Address 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 authoritv to do so. CBF -5 oe BIDDER: z SECTION 2 BID DATA FORMS CBF -6 BIDDER: l 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 Principal, and as , as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of l� ) , 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 City Signage Replacement Project as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated 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 day of , 20 (SEAL) (SEAL) Principal Surety By: By: Signature Signature CBF -7 Bond No. Bid Bond The American Institute of Architects, AIA Document No. A310 (February, 1970 Edition) KNOW ALL MEN BY THESE PRESENTS, that we PCI as Principal hereinafter called the Principal, and Federal Insurance Compan a corporation duly organized underthe laws ofthe state of Indiana as Surety, bereinafter called the Surety, are held and firmly bound unto City of Rosemead as Obligee, hereinafter called the Obligee, in the stun of Ten percent of the total amount of the bid Dollars (S 1 0% ), for the payment of which win well and truly to be made, the said Priwipal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal bas submitted abid for City Signape Replacement Proiect NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material famished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or ponds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation shall be mill and void, otherwise to remain in full force and effiect. Signed and sealed this 9th day of April , 2012 Witness Witness D PCI GUi /� /Gl W C J a cz /b yes . Namdride ORSC 21328 (5/97) ACKNOWLEDGMENT State of California County of Orange ) On 04/09/2012 before me, Debra Swanson, Notary Public (insert name and title of the officer) personally appeared Douglas A. Rapp , who proved to me on the basis of satisfactory evidence to be the persona) whose name($) islare subscribed to the within instrument and acknowledged to me that he /ehem"y executed the same in his1 *e#their authorized capacity(ie*, and that by hisA4esit4eir signature(A on the instrument the person(), or the entity upon behalf of which the person($) 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. s� °`r� DEBRA SWANSON N p� COMM. # 1822117 ;U 2�® o NOTAR/PUBLIGCAUFORNIA pc " ORANGE COUNTY N Signature LMkQ (Seal) Chubb POWER Federal Insurance Company Attn: Surety Department OF Vigilant Insurance Company 15 Mountain View Road C Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 co-iues Know All by These Presents, That FEDERAL COMPANY, a New York corporation, and PACIFIC IN appoint Douglas A. Rapp and Timothy D. Rapp ma corporation, VIGILANT INSURANCE corporation, do each hereby constitute and 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 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 16th day of December, 2011. Kenneth C. Wentle, Assistant Secretary Nortis, Jr., Vice President STATE OF NEW JERSEY ` ss. County of Somerset On this 16th day of December, 2011 before me, a Notary Public of 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 companies which executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he Is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY 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- 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 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 genulne handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By- Laws and in deponent's presence. .Notarial Seal f` KATHERINE I ADELAAR NOTARY PUBLIC NEW J �OZaR,o �p Nn, 231616 FRSFI 685 Cominipion Expires July 16, 2074 PU c k V Notary Public bEyy JE CERTIFICATION Extract from the By- Laws of FEDERAL 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 Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fad for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power at 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`cerbfied by such facsimile signature and facsimile seal shall bervalid 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 certify that (i) the foregoing extract of the By- Laws of the Companies is true and correct, (ii) the Companies are duly licensed and authorized 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, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Fedeml 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 true, tarred and in full force and effect Given under my band and seals of said Companies at Warren, NJ this 9th day of April, 201 2. * °s � � Kenneth C. We el, 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 (9D8) 903 - 3656 e -mail: surety @chubb.cwm Form 15- 10. 0225B -U (Ed. 5 -03) CONSENT CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT State of California County of Los Angeles On y �� before me, Carey B. Freeman, Notary Date Here treed Name and Toe of file Officer personally appeared PCI By William G. Jacob, President Name(s) of Sigrrer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/am subscribed to the within instrument and acknowledged to me that he /sheAhey executed the same in his /her/theif authorized capacity(ies), and that by his/he0heif• signature(s) on the instrument the person(&) or the entity upon behalf of which the F !. person(&) acted, executed the instrument. COMI:I1e2Qjs3 �' N r i I certify under PENALTY OF PERJURY under the "' "' X J laws of the State of California that the foregoing paragraph is true and correct. — WITNESS my hand and official seal. Signature: Fc� Place Notary seal areffor StuM Above - SignaMr, of Notary Publk _ OPTIONAL Though the information below is not required by law, it may prove valuable to persons retying on the document _ and could prevent fraudulent removal and reattachme of this form. to another document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): _ ❑ Individual ❑ Individual • Partner —❑ Limited ❑ General Top of thumb here ❑ Partner — ❑ Limited ❑ General • Attorney in Fact ❑ Attorney in Fact ❑ Trustee ❑ Trustee ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other. ❑ Other: Signer Is Representing: Signer Is Representing: 0008 Nallmal Notary Assodatlun• 9350 Do Salo Ave.. P.O. Box 2902 •Chaamorth, CA 910132902 .Ne9NrelNelsry.org 1NmaS9W Reartler Ca11To11- Free1.8004n6.627 BIDDER: 2.B 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 -8 BIDDER: PCy 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 1 to be Subcontracted Name: /V / Address: Name and Location of Subcontractor Name: Address Description of Work to be Subcontracted Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address BIDDER: 2.0 The following are the names, addresses and telephone numbers for three public agencies forwhich BIDDER has performed similar work within the past two (2) years: °— 11 - 1 1 a Name and Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 2. Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 3. Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 4. and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed CBF -10 Striping • Sealcoat A Parking & Highway Improvement Contractor 1105 E. Hill St. P.O. Box 16118 Long Beach, CA 90806 -0618 Office: (562) 218 -0504 Fax: (562) 218 -0634 www.linetippci.com § g %4�AFM FCI /FLUOR/PARSONS JV Mid -City Expo -LRT 30,450.00 IN PROGRESS 5269C 707 Wilshire BI., 34th Floor Los Angeles, CA 90017 213 -243 -5638 Sully Miller Contr Co AGENCY REFERENCE LIST 135 S. State College Blvd., 2011 -2012 AGENCY PROJECT VALUE COMPLETED JOB# Accurate Striping Co Orange Co Svc PO BOX 7196 Expansion 56,860.00 IN PROGRESS 4690C Wildomar, CA Enhancements & 951 - 609 -3351 Grade Crossing FCI /FLUOR/PARSONS JV Mid -City Expo -LRT 30,450.00 IN PROGRESS 5269C 707 Wilshire BI., 34th Floor Los Angeles, CA 90017 213 -243 -5638 Sully Miller Contr Co Piedmont & 103,375.00 IN PROGRESS 5330C 135 S. State College Blvd., Lauderdale Ste 400 Brea, CA Imprvmnts 2009- 805.237 -3861 2010 Slurry Seal San Diego Unified Port District Pavement Marking 75,000.00 5542C PO Box120488 & Striping San Diego, CA 92112 -2776 619 - 686 -6321 - City of Calabasas Pavement Striping 60,100.00 5547C 100 Civic Center Way & Marking Calabasas, CA 91302 818- 224 -1600 Reyes Construction, Inc Camp Pendleton 42,220.00 5553C 1383 S. Signal Drive Pomona, CA - Aircraft Loading 91766 Apron 909.622 -2259 Western Paving Contractors Inc LAUSD So Region 66,612.00 5558C 15533 E. Arrow Hwy HS# 4 Irwindale, CA 91706 -2002 626 - 338 -7889 R.J. Noble Company Imperial Hwy Street 35,080.00 5587C 15505 E. Lincoln Ave/ PO Box 620 Smart Orange, CA 92856 -6620 714- 637 -1550 Toro Enterprises, Inc V A Hospital - Long 27,435.00 5593F PO Box 6285 Beach Oxnard, CA 93031 805 -483-4515 License #823802 Striping • Sealcoat A Parking & Highway Improvement Contractor 1105 E. Hill St. P.O. Box 16118 Long Beach, CA 90806 -0618 Office. (562) 218 -0504 Fax: (562) 218 -0634 www.lineuppci.com e 9y Toro Enterprises, Inc cio Simi Valley FY 27,840.00 PO Box 6285 Oxnard, CA 93031 2009 -2010 Annual 805483 -4515 Major Street Rehabilitation Western Paving Contractors Inc Methodist Hospital 15533 E. Arrow Hwy of So Cal- Arcadia Irwindale, CA 91706 -2002 626338 -7889 All American Asphalt Boise Ave & PO Box 2229 Edwards St Corona, CA 92878 Overlay- 961-736-7600 Westminster Western Paving Contractors Inc LAUSD Central LA 15533 E. Arrow Hwy Area HS# 13 Irwindale, CA 91706 -2002 626338 -7889 All American Asphalt Go Palos Verdes PO Box 2229 Estates Slurry Sea Corona, CA 92878 2011 -2012 951 - 736 -7600 Griffith Company 12200 Bloomfield Ave Santa Fe Springs, CA 90670 562 - 929 -1128 Caltrans Rte # 134 - cto Burbank Striping shared drive /agency reference 56,717.00 51,200.00 96,672.00 52,553.00 43,550.00 5621 C 5649C 5668C 5708C 5740C 5804C License #823802 BIDDER: P� SECTION 3 NON - COLLUSION AFFIDAVIT CBF - 11 BIDDER: 1 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 L6)1 %111fh -r 4 ' T cal Typed or Printed Name 70 c 'rest z L�'O f Title CZ Subscribed and sworn before me This AL day of Zo r/ / , 20LP Notary PUblic in and for the State of California My Commission Expires: /O - o? (Seal) aw CBF -12