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PTM General Engineeringi CITY OF ROSEMEAD HELLMAN/SAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT CONTRACT BID FORMS 1: I' II j -: t BIDDER: PTM General Engineering Se rvices Inc. BID SCHEDULE SCHEDULE OF PRICES FOR HELLMAN /SAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT ESPL 5358 (012) RARE RID RCNEni 11 F 3►, CBF -1 UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST Clearing & Grubbing per plans 1 and specifications. See x GO technical provisions TP 2, TP 3 &TP4. LS 1 '106 CY1 2 Disposal of Waste Materials LS 1 Remove Existing and 3 Construct 9- Inches Thick PCC §4 Pavement (High Early Strength) 520 -A -5000. SF 22,320 '9, f'y I $1 (019 '96 Construct 6- Inches Thick 4 Crushed Miscellaneous Base 95% Compaction over 90% Compacted Soil. TONS 850 4rj $2 3�5zza oa 5 Cold Mill 2- Inches Existing Pavement. SF 5,000 0" 56 55 - Z - 7F"0 '(30 6 Construct 2- Inches AC Pavement (C2- PG 64 -10). TONS 70 1 9 (. Yo 1339 • 6 Construct 4 -inch thick PCC 7 sidewalk per SPPWC Std Plan 113 -2. SF 230 5. I 8 Construct PCC Curb Ramps per SPPWC Std Plan 111-4. EA 2 23b5•6o V-730 Remove Existing and g Construct 6- Inches Thick PCC Driveway Approach per SPPWC Std Plan 110 -2, SF 900 1- 1 10 5 iyg5 60 Install Landscape and 10 Irrigation per Plans and Specifications Complete. LS 1 I7 qCr' 0b I I R9 1 OQ Install Traffic Striping, Traffic 11 Signal Loops and Pavement Markers LS 1 20655• c6'5- 6 3►, CBF -1 BIDDER: PT M General Engineering Services Inc. r ii r= t✓ (i f' i_ fw i, �p i r i TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ L/Zr � Z LI .3O Dollar amount in written � W,1, ee-A s The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and afterthe bid opening date, or until a Contract forthe Work is fully executed by the Owner and a third party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall govern. If the Bid Documents specify alternate bid items, the following Alternate Bid amounts shall be added to or deducted from the Total Bid Price entered above. The owner can choose to include one or more of the alternates in the Total Bid Price of the Project. If any of the Alternate Bids are utilized by the Owner, the resulting amount shall be considered the Total Bid Price for the Project. At X 9 hereto is a cg i id� d � c ec a cashier's check or a bid bond in the amount of br ers on Dollars ($ a 1 �` f saaidamount bein not lessthan ten g 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 bythe Ownerfor execution, within five (5) Calendar Days following the Letter of Award for CBF -2 UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST Construct Traffic Signal 12 Improvements per Plans and Specifications Complete. 1 LS n 360 , (Y) Remove, Dispose and Construct Colored PCC Cross Walk (Chromix) with Lithochrome 13 Colorhardener on top per Plans and Specifications Complete per LM Scofield Company or � Approved Equal. Contact person g .8 5 Bruce Umeck 818- 324 -3534. SF 3,050 Adjust Sewer Manhole to 14 Grade per SPPWC Std Plan 205 -2. EA 6 Z 5. Od 1 to 56 • d0 15 Adjust to Grade Water and Gas Valves Ea 10 $$. W TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ L/Zr � Z LI .3O Dollar amount in written � W,1, ee-A s 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 afterthe bid opening date, or until a Contract forthe Work is fully executed by the Owner and a third party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall govern. If the Bid Documents specify alternate bid items, the following Alternate Bid amounts shall be added to or deducted from the Total Bid Price entered above. The owner can choose to include one or more of the alternates in the Total Bid Price of the Project. If any of the Alternate Bids are utilized by the Owner, the resulting amount shall be considered the Total Bid Price for the Project. At X 9 hereto is a cg i id� d � c ec a cashier's check or a bid bond in the amount of br ers on Dollars ($ a 1 �` f saaidamount bein not lessthan ten g 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 bythe Ownerfor execution, within five (5) Calendar Days following the Letter of Award for CBF -2 I li r -. i r^ r� I i' t; is inn Q `t y i . BIDDER: P TM General Engineeruig Services Inc. 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 Bidders 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 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. None (p er Erica on 5M1 at 2:25pm) The Bidder understands and agrees that the Total Bid Price is inclusive of all labor, materials, and equipment or supplies necessary to complete the Work as described in the Bid Documents. If this bid is accepted, the undersigned Bidder agrees to enter into and execute the Contract with the necessary bonds and accept the Total Bid Price as compensation in full for all Work under the contract. CBF -3 Bidder 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. ;i P= i r L: Is �r i. I I , 1 By: Signatu Elizabeth H. Mendoza de McRae Type or Print Name President/CFO Title Bidder's /Contractor's State of Incorporation: Partners or Joint Venturers: BIDDER: PTM General Engineering Serv Inc. 5942 A Str Business Street Address Riverside, CA 92504 City, State and Zip Code 951- 710 -1000 Telephone Number California Not Applicable Bidder's License Number(s): 8 91265 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 sn_ CBF -4 BIDDER: PTM GENERAL ENGINEERIN SERVICES, 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 PTM GENERAL ENGINEERING SERVICES, INC. , as Principal, and INTERITA710NAL FIDELITY INSURANCE as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of TEN PERCENT OF AMOUNT BID ($ l u io ) , being not less than ten percent (10 %) of the Total Bid Price; forthe 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 Hellman /San Gabriel Intersection Improvements 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 3RD day of MAY , 2013 INTERNATIONAL FIDELITY PTM GENERAL ENGINEJRING SERVICES, INC. (SEAL) INSURANCE COMPANY (SEAL) Prin7igna Surety By 0 k n // ure #1G /GI,., Signature P E. VEGA, ATTORNEY -in -FACT CBF -5 Tel -7200 POWER OF ATTOR INTERNATIONAL FIDELITY INSURANCE COMPANY ALLEGHENY CASUALTY COMPANY ONE NEWARK CENTER, 20TH FLOOR NEWARK, NEW JERSEY 0710'-5207 KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY , a corporalion ornanized and eXistina Linde the laws of Iho. Stale of New, Jersey. and ALLEGHENY CASUALTY COMPANY a corporalion organi_ed and e�isling under the Pares of Iha Sl.lta of Pennnysylvania, havinq their principal office in the City of Newark New Jerse do hereby conslitule an d appoint KEVIN E. VEGA, BRITTON CHRISTIANSEN, MYRNA SMITH, PHILIP E VEGA Covina, CA their true and lawful attorney(s) -in -fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnify and other writings obligatory 1n the nature thereof, which are or may be allowed, required or pernutled by law, s13iio, rule, regulation, contract or otherwise, and the executmn of such insrumenl(s in psupresents, ance of these presen shall be as bindinq upon the said INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY ur Y COMPANY. as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorneyy is executed, and may be revoked, pursuant to and by authority of Ilia By -Laws of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGFIENY CASUALTY COMPANY and is granted under and by authority of the following resolution adopted by the Board of Dtre:clors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting clul% held on the 2011) day of July, 2010 and by the Board of Directors of ALLEGHENY CASUALTY COMPANY it a meeting duty held on the 151h day of August, 4000: 'RESOLVED, that ('I) the President, Vice President, or Secretary of the Car poralion shall have the power to appoint, and to revoke the appointments of. Allot neys -in -Fact or agents with power and outhorily as defined or limiled in their respective powers of attorney, and to execute on behalf of rho Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnityy and other wrillen obfinalions In the nalure thereof or related lherelo; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint - control Cll4ted311S, agents for acceptance of process, and Attorneyys- rn -facl with authority to execute waivers and consents on behalf of lie Corporation; and (3) the signature oI any such Officer Of the Corporation and the Corpoialioli s seal may be affixed by facsimile to an power of allorneyy or ccr'Ii0calic given fur the execulion of any bond, undertaking, recognizance, contract of inclemnily of other wrillen obligation in the na lure thereof or relalecl lherelo, such signature and seats when so usod whelbc:r hcrelreforr_ or hereafter, being hereby adopted by the Car�iomlion as the original signature of such officer and the original seal of [lip Corporation, In be valid ;und bindin u q upon [Ile, Corporation with Ihr. same force anc effocl as though manually affixed." IN WITNE=SS WHEREOF, INTE=RNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each exoritted nn sllesled These prescnls on this 12111 clay of March, 2012. STATE OF NEW JERSEY County of Essex ROBERT W. MINIS "FER Executive Vice PresidenllChief O(mralinq Officer (International 1= klelily Insurance Company) and President (Allegheny Casually Company) On this 12th day of March 2012, before me came the individual who executed the preceding instrument, to me personally known, and, being by mo duly sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUAI_TY COMPANY; that the seals affixed to said instrument are. the Corporate Seals of said Companies; lhal the said Corporate Seals and his signalure were; only arlfixecl by order of [lie Boards of Directors of said Companies. IN TESTIMONY WHEREOF, I have hereunto set my hand affixr•d Official :;eel, at the City of Newark, New .lersey the day and year firsl :above wul lee. �Y G' A NOTARY PUBLIC OF NEW JERSEY t; . My Commission Expires Mar. 27, 2014 9 f - NE`N S " "••,•, CERTIFICATION I, Iho undniiiigned officer of IN ERNA1JONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby ecrlify that I have: compared the lorrgoinq copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as col Iorlli in ,.aid Power of Attorney, with the Originals on file in the home office of said companies, and that the same are correct transcripts thereof, and of Ihr; veltole of the said orirdinals, and heal the said Power of Attorney has not been revoked and is now in full force and effecl. N TESTIMONY WHEREOF, I have hcrounlo set my hand this 3rd day of MAY, 2013 s MARIA BRANCO, Assistant Secrelary CA Ll;c ORTAIIA ALL - PURPOSE ACKNOWLEDGMENT Sla(e of California County or ORANGE On �� before me, Philip Vega, Notary public Data Here I06aN Name afta Tam 01 MQ QN1e6f personally appeared ELIZABETH H. MENDOZA de McRAE amo s o gnor( }) who proved to me on the basis of satisfactory evidence to be the person(% whose names) is/gre subscribed to the within Instrument and acknowled to me that hel�l� Ay executed the same it hid /�� •16ir authorized HP VEGA - s `'` capac iy(� s), and that by hl� /f'eI /heir signatu �( ) on the / COM. N P ILI 1977060 r.� I f N �' NOTARY M UB - CALIFORNIA PLIC Instrument the perSOn(ab), Or th e entity upon behalf Of YYU OSANGELESCOUNTY which the person(g) acted, executed the Instrument. VO My Comm. Expires MAY 31.2076 �...r.. _.,..,..,.-.�. ....... I certNy under PENALTY OF PERJURY under the laws of the State of California that the forego ng paragraph is true and correct. WITNESS my hand and oHide Plana Nalary 59al AE.. Signature u filAOmWaa I yPubllc ---- OPTIONAL. --� Though the information below is not required by law, It may prove vetudble to persons relying on rh ournent , and could prevent fraudulent removal and reattachment of this form to another documen4 Description of Attached Document Title or Type of Document; Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer($) Signer's Name: ❑ Individual ❑ Corporate Officer — Titie(s): _ ❑ Partner -0 Limited ❑General ❑ Attorney in Fact F1 Trus[oe ❑ Guardian or Conservator ❑ Other: Signer Is Representing: BIGNTTNUfit9PBINT - �:.OF9IGNEB Number of Pages; Slgrler's Name: • Individual • Corporate ONlocr — Tftle(s): _ • Partner —❑ Limped ❑ General ❑ Attorney in Fact gTrustee 0 Guardian or Conservator ❑ Other: Signer Is Representing; FIGHTTII 11HINT OFSGNGN 0720W NaAonel Nolery Aoeo�ieJen•9n5e Do Solo Aao..P,O,eax 29a2•CM1eleworlb, CA 913102ae2. www,NallonelNolaryolg Ilem h590] nooNec Call Yan -Flee t�ee697e -0821 CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT CML CODE g 7189 State of California County of Los Angeles MAY 0 3 2013 On before me, Monica Blaisdell, Notary Public Dale Here Insert Name antl Title of the Officer personally appeared _ Philip E. Vega _ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the personK whose name'(( is /ara subscribed to the within instrument and acknowledged to me that he /sllie /" executed the same in hisAber/tbeir authorized capacity(ies), and that by MONICA BLAISDELL t his /her /th& signature( on the instrument the Commission # 1970e z z person( or the entity upon behalf of which the - -m - a Notary Public - Califor nl Z ` orange county a personW acted, executed the instrument. My Comm. Expires Mar 26, 2016 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 4_k� official seal, �V ` _ Signature: + Place Notary Seal Above Signature of Notary Public CERTIFICATE OF CORPORATE RESOLUTION j Brian Mendoza Secretary of PTM General Engineering Services Inc (Corporation) do hereby certify that at a duly constituted meetirig of the Stockholders and Directors of the Corporation held at the office of the Corporation on December 30 , 2 0 0 7 (year), it was upon motion duly made and seconded; that it be VOTED: Elizabeth H. Mendoza de McRae, President /CFO ..... OR.... Brian Mendoza, Vice President /Secretary Authorized to sign & execute contracts and submit bids with either one of the corporate officer's signatures. It was upon further motion made and seconded that it be further VOTED: That Elizabeth H. Mendoza de McRae, President /CFO .....OR.... Brian Mendoza, Vice President /secretary in the capacity as of the Corporation is empowered, authorized and directed to execute, deliver and accept any and all documents and undertake all acts reasonably required or incidental to accomplish the foregoing vote, all on such terms and conditions as he in his discretion deems to be in the best interests of the Corporation. I further certify that the foregoing votes are in full force this date without rescission, modification or amendment. Signed this A day of �llftM vV (3 (Pear). A TRUE RECORD ATTEST (Corporate Seal) 0 Brian Mendoza Secretary/Clerk Vice President /Secretary 53 i' f' r . i I ' y s: i 1, t, BIDDER: PTM General Engineering Serv Inc. 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 (greaterthan 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 -6 i'. t. f' i l r . I:. BIDDER: PTM General Engineering Serv Inc. 23 LIST OF PROPOSED SUBCONTRACTORS (continued) Ruplimle Next 2 Pages If needed I" listing addl84mal subcontractors." J Name and Location Description of Work of Subcontractor to be Subcontracted Cr & T Construction Inc. •�� _ � Y , Name: 3249. Diamond Bar Blvd. PMB 275, Diamond Bar, 91765 Address License No. 868434 Exp 11- 30-13, Class C12 & C8 Tel: 9091396 -8453 Fax: 9091396 -0522 Name Description of Work to be Subcontracted Description of Work to be Subcontracted Address: Name and Location of Subcontractor Name: Address: Description of Work to be Subcontracted Description of Work to be Subcontracted CBF -7 Name and Location of Subcontractor Name: Address: t = to 4T Name and Location of Subcontractor {(` Name: Address: Name and Location of Subcontractor Name Description of Work to be Subcontracted Description of Work to be Subcontracted Address: Name and Location of Subcontractor Name: Address: Description of Work to be Subcontracted Description of Work to be Subcontracted CBF -7 F t � p 1i BIDDER: PTM General Engineering Services Inc. i _t CBF -8 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: r , 1. County of Riverside, 3525 14th Street Riverside CA 92501 Name and Address of Owner ; Mr. Ivan Mendoza, Tel: 951- 955 -6885 Name and telephone number of person familiarwith project $211, Traffic signal and lighting at Clay St. & De Anza Plaza Dr. 6/2011 Contract amount Type of Work Date Completed 1 * 2, Cal Trans, 1727 30th Street, Sacramento, CA 95816 ii Name and Address of Owner Mr. Danh Thai. Tel: 949- 279 -8803 Name and telephone number of person familiar with project t� $354,453 12- 01,5504 upgrade traffic signal 11/2012 Contract amount Type of Work Date Completed is 3. City of Newport Beach 3300 Newport Blvd. Newport Beach CA 92658 f Name and Address of Owner t Mr. Brad Sommers, TEL 949- 644 -3326 F Name and telephone number of person familiar with project $547,050 Traffic signal rehabilitation 11/2012 t6 Contract amount Type of Work Date Completed 3° 4. City of Rosemead, 8838 E. Valley Blvd. Rosemead CA 91770 Name and Address of Owner t Mr. Sean Sullivan, Tel: 626 -569 -2189 " Name and telephone number of person famdiarwith project $655,045 Safe Route to School 1/2013 Contract amount Type of Work Date Completed i _t CBF -8 Brian Mendoza P.O.B ox 7745 Riverside CA, 92513 -7745 Email:brian @ptm- eng.com Cell 951.722.5755 Chief Estimator and Supervisor of Outside Operations Supervisor of Outside operations with over 18 years of experience electrician with over 20 years of experience An effective communicator and team leader, experienced in coordinating and executing large and fast paced projects. CAREER EXPERIENCE Freeway Electric/ PTM Engineering Services, hie. Riverside CA 06/2006 to Date Chief Estimator /Supervisor of Outside Operations In charge of managing the estimating department and finalizing bid packages: coordinating the beginning phase of an awarded project between the company and agency. Project submittals, contract review Coordinated and manage crews California region: handled various sized projects ranging in size from $1,000 to $4.5 million dealing with dry utilities, wet utilities, traffic signals, and road improvements, maintained coordination Freeway Electric / PTM General Engineering and subcontractor, and project owners. In charge of handling project's administrative work: monthly gross estimates, project progress schedule, materials requisitions, contract change order negotiations and equipment purchase and rental. High Light Electric Inc. / Pete & Sons Construction hic. Riverside, CA 10/1995 to 06/2006 Chief Estimator In charge of managing the estimating department and finalizing bid packages Coordinating the beginning phase of an awarded project between the company and agency or prime contractor that include project submittals, contract review. Successfully bid on projects totaling $12 million with an average spread 6 %. Area Supervisor Coordinated and manage 10 crews consisting of 6 members per team in the southern California region: handled various sized projects ranging in size from $1,000 to $4.5 million dealing with dry utilities, wet utilities, traffic signal, and road improvements. Maintained coordination between High Light Electric Inc. and subcontractor, general contractor and project owners In charge of handling project's administrative work; monthly gross estimates, project progress schedule, materials requisitions, contract change order negotiations and equipment purchase and rentals. Page 1 of 4 Brian Mendoza CAREER EXPERIENCE CONTINUED MBE Electric, hrc. in Riverside, CA 10/1989 TO 10/1995 Vice President and Head of Outside Operations Manage outside operations for all projects ranging in size from & 1,000 to 2.5 million. Headed an around the clock electric crew and coordinated with CC Meyers to repair the I -10 Santa Monica Freeway after it collapsed during the 1994 Northridge Earthquake to complete the fast paced project in 66 days. Maintain coordination between MBB Electric and subcontractors, general contractor and project owners: implemented and enforced safety guidelines. Handled administrative work: monthly progress estimates, material requisitions, contract change order negotiations. Vasco Corporation in San Fernando, CA 10/1987 to 06/1989 Foreman (Part Time) Managed day to day operations of work crews and various project ranging in size from $1,000 to $5,000 in Eastern Los Angeles County: traffic signals, street lighting, signal interconnect. Raymore Electric in Rosemead, CA 06/1986 to 10/1987 Crew Lender (Part Time) In charge of working crews on projects that ranging from $25,000 to 250,000 throughout Los Angeles County. WORKING SKILLS • Capable of operating heavy equipment such as skip loaders, cranes, and backhoes • Hands -on experience with hand tools and power tools • Capable of overseeing fast -paced and high profile project • An effective communicator and leader EDUCATION • International Brotherhood of Electrical Workers • Completed training course (1988 -1989) in street lighting and traffic signal installations, code enforcement and blue print reading. • South Gate High School • Received High School Diploma in 1988 Page 2 of 4 BRIAN MENDOZA CONTINUED LANGUAGES • English (Native) • Spanish (Fluent) AWARD RECEIVED • Recipient of the U.S. Small Business "Young Entrepreneur of the year" Award in 1996, nationally. • Recipient of the Certificate of Recognition by the City to Los Angeles for "Small Business" in 1997. • Recipient of the Certificate of Recognition by the State Assembly, Assemblyman Mr. Rod Pacheco, for the "Top 500 Inland Empire Small Business" in 1997. • Ranked among the "Top 500 Inland Empire Hispanic Owned Companies" Since 1997. • Certification of Appreciation for our participation and maximization in the " Century Freeway Affirmative Action" by CFAAC PROFESSIONAL AND PERSONAL REFERNCES Caltrans project#071224U4 (Electrical contract amount $4.5 million) Description of project: Installation of traffic signals, ramp metering, sing illumination, Highway Lighting, Fiber option communication and electrical irrigation along the I -10 Freeway in Los Angeles County. Doug Dawson — Project Manager for prime contractor, Balfour Beatty Cell (949) 232 -3276 and Office (909) 397 -8040. Patty Galvan — Resident Engineer, Office (909) 594 -4270 Veronica Ross — Electrical Inspector, Cell (714) 606 -6311 Page 3 of 4 BRIAN MENDOZA REFERNCES CONTINUED City of Redlands Contract #208300 - 72304/41008 (Electrical contract amount is $218,800) project Completed in 2003 Description of project: Installation of traffic signals, modification of ramp metering, lighting and sign illumination. • Bill Hensley— Senior Civil Engineer— Office (909) 798 -7586 ext.2 • Juan Olvera — Project Manager for general contractor, H &H Construction —Cell (951) 453 -7712 and Office (909) 473 -7331. Caltrans project #08- 4567V4) Electrical contract amount is $ 938,238) project completed in 2005 Description of project: Installation of lighting system along the I -15 Freeway in San Bernardino County. • Gary Vogel —project Manager for prime contractor, Granite Construction Cell: (661) 549 -3953 and Office (661) 726 -4447. Sandbag Projects, Segment 1, 2, 3 early segment 9, and alder Ave. (Total electrical contract amount was $3.2 million) Project completed in 2004. Description of Projects: Installation of traffic signals, ramp metering, sign illumination, highway lighting, fiber optic communication, and electrical irrigation along the I -10 Freeway in San Bernardino County. Harold Lantis — Sandbag Contract Manager — Cell: (760) 802 -7730 and Office (909) 875 -8029 ext.213. Tim Hanable — Caltrans Inspector — Cell: (951) 712 -0021 Al Ortega — Project Manager for prime contractor, Yeager Skanska — Cell: (714) 240 -5333. City of Indio Project #ST0137 (Electrical contract amount was $1.4 million) project completed in 2005. Description of project: Installation of street lighting system, traffic signals, electrical irrigation, and dry Utilities. Gary Bexter — Area Manager for prime contractor, Yeager Skanska Construction Cell: (909) 721 -9749 and Office (760) 343 -5472. Tommy Young — Proj ect Manager for prime contractor — Cell: (951) 232 -6618 and Office (760) 343 -5472. Mehran Sepehri — City Engineer — Cell: (760) 250 -2201 Additional Professional References: Zale Harris — Caltrans Inspector — Cell: (951) 289 -0047 Ray Robles — Caltrans area supervisor — Cell: (909) 799 -0646 Page 4 of 4 BIDDER: PTM General Engineering Servi Inc. NON - COLLUSION AFFIDAVIT CBF -9 f �i i 1p 1 , BIDDER: PTM General Engineering Serv 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 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, organizatio bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Si nature Elizabeth H. M de McRae Typed or Printed Name President/CFO PTM General Engine ring Services Inc Bidder i_ Subscribed and sworn before me This _ day of Notary Public in and for the State of California My Commission Expires: 20 CBF -10 (Seal) i , t. , State of California County of ORANGE On s X63 before me, Philip Vega, Notary public one Male InGarl Name Ono TIM 01 no uqlcar personally appeared ELIZABETH H. MENDOZA de McRAE Name -) ni GlqnagF) who proved to me on the basis of satisfactory evidence to be the person(/) whose namcgs) Is/gre subscribed to the within Instrument and acknowled � to me that he(�I��h�i� executed the same in hi� /��P/6ir authorized PHILIP VEGA I a� COMM. n 1977088 y capac'dy(� S), and that by h� /t / el /tl�elr slgnatu �(s) on the C Y " NOTARYPUBLIC - CALIFORNIA o instrument the personO, or the entity upon behalf of LOS ANGELES COUNTY which the erson(g) acted, executed the Instrument. My Comm. Expires MAY 91,2016 p I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct_ i i WITNESS my hand and q(lpl seal. Pogo NolaN Seal Above Sig --- OPTIONAL Though the information below is not required by law, If may prove valuable to persons and could prevent Irzudulent removal and Peottabhment of this form to anot Description of Attached Document Title or Type of Document: Document bate: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Individual ❑ Corporate Officer -- Title(s): _ • Partner -0 Limited El General • Attorney in Fact f1 Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: E on the dooument Number of Pages; Signer's Name: ❑ Individual ❑ Corporate OHlcer — Title(s); '❑ Partner —❑ Limited ❑ General _ El Attorney in Fact MTrustee Top of (numb here 0 Guardian or Conservator ❑ Other; Signer Is Representing: 02667 Nellbnel NOlery fleoaiflJan• 935000 Salr,Avo.,P,O,Bax 2462•CnoleW0611,CA 61313.3962•www,Nalle9fllNOlaryel9 Ilem h5967 nooiduLCdll Tbu -I'IeB l- 969 -879 -9821 CITY OF ROSEMEAD HELLMAN /SAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT �i la- CITY OF ROSEMEAD r HELLMAN /SAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT �5 l I: i is f I. i Fs i e E I is r' The Bidder shall list the name and address of each subcontractor to whom the Bidder proposes to subcontract portions of the work, as required by the provisions in Section 2 -1.01, "General," of the special ( provisions. EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION TT The bidder PTM r7PnP,m r[ subcontractor O�'f I T 3 ? r° i' r e9 proposed hereby certifies that he has x , has not _, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60- 1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60 -1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO -1) is the only report required by the Executive Orders or their - implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60- 1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. r f l.i EEOC -1 is CITY OF ROSEMEAD HELLMAN/SAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT Ib F. i i s Noncollusion Affidavit } (Title 23 United States Code Section 112 and i Public Contract Code Section 7106) I l: To the City of Rosemead, Los Angeles County DEPARTMENT OF PUBLIC WORKS. Note: The above Noncollusion Affidavit is part of the Bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit. j Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. r� (.i j� NA -1 l In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest S i. of, or on behalf of, any undisclosed person, partnership, company, association, Li 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, (s 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 r -r fix any overhead, profit, or cost element of the bid price, or of that of any other 6 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 i 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. Note: The above Noncollusion Affidavit is part of the Bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit. j Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. r� (.i j� NA -1 CITY OF ROSEMEAD HELLMAN /SAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager: • is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any Federal agency; • has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federal agency within the past 3 years; • does not have a proposed debarment pending; and • has not been indicted, convicted, or had a civil judgement rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Bid. Signing this Bid on the signature portion thereof shall also constitute signature of this Certification. DSC -1 CITY OFRoSEMEAD HELLMAN/SAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT is I is 1. i i i NONLOBBYING CERTIFICATION [ FOR FEDERAL -AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or bid, to the best of his or her knowledge and belief, that: i` (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an 4 officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. If an funds other than Federal t ; ( ) Y appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of i any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal !' contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a 1 " prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or bid that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. is 1, r NLC -1 f; HELLMAN /SAN GABRIEL INTERSECTION �' IMPROVEMENTS PROJECT N/A = Not Applicable DISCLOSURE OF LOBBYING ACTIVITIES 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. cnntrart N/A Da. tud /nffer /annliration N/A 0 a. initial N/A b. grant b. initial award b. material change c cooperative agreement c. post -award d. loan For Material Change Only: e. ban guarantee year_ quarter f. loan insurance date of last report 4. Name and Address of Reporting Entity N/A S. If Reporting Entity in No. 4 Is Subawardee, Enter Name and Address of Prime: Prime Subawardee Tier _ , if known N/A Congressional District, if known 6. Federal Department/Agency: N/A 6. Federal Action Number, if known: 10. a. Name and Address of Lobby Entity (If individual, last name, first name, MD N/A Congressional District if known 7. Federal Program Name /Description: N/A CFDA Number, If applicable 9. Award Amount, if known: b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI) (attach Continuation Sheet(s) if necessary) 11. Amount of Payment (check all that apply) N/A 13. Type of Payment (check all that apply) N/A $ actual planned a. retainer b. one -time fee 12. Form of Payment (check all that apply): c. commission e a. cash N/A d, contingent fee b. in -kind; specify: nature a deferred value f. other, specify 14. Brief Description of Services Performed or to be performed and Dates) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11: N/A (attach Continuation Sheet(s) if neces ry) 15.. Continuation Sheet(s) attached: Yes E] No 16. Infornakon requested through this form Is authorized by Title 31 U.S.C. Section 1352. This disclosure of Signature: lobbying reliance was placed by the der above when his transaction was made orentered into. This disclosure is Elizabeth H. Mendoza de McRae required pursuant to 31 U.S.C. 1352. This information Print Name: wilt be reported to Congress semiannually and will be President/CFO for public inspection - Any person who fails to Title: rile the required disclosure shall be subject to a civl penalty of not less than $10,000 and not more Ihan Telephone No.: 951- 710 -1000 Date: 5/ 7113 $100,000 for each such fallure. Authorized for Local Reproduction Federal Use Only: Standard Form - LLL 1'. INSTRUCTIONS FOR COMPLETION OF SF -LLL, ` DISCLOSURE OF LOBBYING ACTIVITIES r ' This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the Initiation or receipt of covered Federal action Ora material change to previous filing pursuant to title 31 U.S.C. section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered Federal action. Attach a continuation sheet for additional information if the space on the fans is Inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the Implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity Is and/or has been secured to influence, the outcome of a covered Federal action. 2. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report If this is a follow -up report caused by a material change to the t information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District O known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include { but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, stale and zip i code of the prime Federal recipient. Include Congressional District, O known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. ! 8. Enter the most appropriate Federal identifying number available for the Federal action identification in Rem 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or ' loan award number, the application/proposal control number assigned by the Federal agency), Include prefixes, e.g., "RFP- DE -90- 001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the 1 ! Federal amount of the awardfloan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to Influenced the covered Federal action. (b) Enter the full names of the indivldual(s) performing services and include full address if different from 10 (a). Enter Last - Name, First Name and Middle Initial (Mh. 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (Rem 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in -kind contribution, specify the nature and value of the in -kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity notjust time spent in actual contact with Federal officials. Identify the Federal officer is) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. - 16. The certifying official shall sign and date the forth, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348- 0046), Washington, D.C. 20503. SF- LLL - Instructions Rev. 06-04.90uENDIFa 3 r , _I i t t i CITY OF ROSEMEAD HELLMAN /SAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT { j i t EXHIBIT f 5 -GI Local Assistance Procedures Manual Local Agency Bidder UDBE Commitment (Construction Contracts) is INSTRUCTIONS - LOCAL AGENCY BIDDER (> UDBE COMMITMENT (CONSTRUCTION CONTRACTS) ;i ALL BIDDERS: PLEASE NOTE: It is the bidder's responsibility to verify that the UDBE(s) falls into one of the following groups in order to count towards the UDBE contract goal: 1) African Americans; 2) Asian Pacific Americans; 3) Native Americans; 4) Women. This information may be submitted with your bid. If it is not, F and you are the apparent low bidder or the second or third low bidder, it must submitted and received as specified in the Special Provisions. Failure to submit the required UDBE commitment will be grounds for finding the bid nonresponsive { ' I A UDBE is a firm meeting the definition of a DBE as specified in 49 CFR and is one of the following groups: African Americans, Asian- Pacific Americans, Native Americans, or Women. The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract UDBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be Subcontracted or Materials to be provided by UDBEs. Prime contractors shall indicate all work to be performed by UDBEs including, if the prime is a UDBE, work performed by its own forces, if a UDBE. The UDBE shall t , provide a certification number to the Contractor and expiration date. Enter the UDBE prime's and subcontractors' 1 certification numbers.The form has a column for the Names of UDBE contractors to perform the work (who must be certified on the date bids are opened and include the UDBE address and phone number). f IMPORTANT: Identify all UDBE firms participating in the project regardless of tier. Names of the First -Tier UDBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the UDBE participation dollar amount. Enter the Total Claimed UDBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100 of item is not to be performed or furnished by the UDBE, describe exact portion of time to be performed or furnished by the UDBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions s (construction contracts), to determine how to count the participation of UDBE firms. Exhibit 15 -G1 must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. is LOCAL agencies should complete the Local Agency Contract Award, Federal-aid Project Number, Federal Share, Contract Award Date fields and verify that all information is complete and accurate before signing and filing, is f ( Page 15 -32 July 31, 2009 UP 09 -02 1` a i Local Assistance Procedures Manual EXHIBIT 15-G1 Local Agency Bidder UDBE Commitment (Construction Contracts) EXHIBIT 15 -G1 LOCAL AGENCY BIDDER UDBE COMMITMENT (CONSTRUCTION CONTRACTS) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCALAGENCY: City of Rosemead LOCATION: Hellman /San Gabreil Int PROJECTDESCRIPTION: Hel lman/San(Giabriel In�tersection Ira rovemems rojcct > • "Pq TOTAL CONTRACT AMOUNTS qz /f � l z"! BID DATE: 5/8/2013 BIDDER'S NAME: PTM General Engineering Services H1c. CONTRACT UDBE GOAL: 6% NTRACT EM OF WORKAND DESCRIPTION BE CERT NO. AME OF EACH UDBE DOLLAR AMOUNT ITEM NO. R SERVICES TO BE D EXPIRATION (Must be certified on the date bids BE UBCONTRACTEDOR MATERIALS ATE opened - include UDBE 0 BE PROVIDED (or contracted if the dress and phone number) idder is a UDBE) For Local Agency to Complete: Local Agency Contract Number: Federal -aid Project Number: Federal Share: Total Claimed UDBE Participation ado Contract Award @etc: Local A gency Rfi c p lRcertifications have been verified and rmatimon is is info comomplete cleand and accuratcurat e. Print Name Segnanne Dam Lo cal AgencyRepresentative (Area Code) Telephone Number: Elizabeth H. Mendoza de McRae, President /C _ DTad ranP.nl F glnefLltlg.Sei \tL- StDtalureo a er es_InG 5/7/2013 951- 710 -1000 azc Area e e . o. Elizabet h H. Mendoza de McRae erson to ntac[ pease ype or Pnnl Local Agency BidderllnBE Conuo6nrent (Covstrue6an Coolrecn) (Rev 6126109) Distribution: (1)Original —Local agency files LPP 09 -02 Page 15-31 July 31, 2009 i CITY OF ROSEMEAD HELLMANISAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT �I �- Local Assistance Procedures Manual Exhibit 15-H UDBE Information - Good Faith Effort EXHIBIT 15 -H UDBE INFORMATION —GOOD FAITH EFFORTS UDBE INFORMATION - GOOD FAITH EFFORTS Federal -aid Project No. SRTSL 5218 (012) Bid Opening Date 5/8/2013 The City of Rosemead established an Underutilized Disadvantaged Business Enterprise (UDBE) goal of 6 % for this project. The information provided herein shows that a good faith effort was made. Lowest, second lowest and third lowest bidders shall submit the following information to document adequate good faith efforts. Bidders should submit the following information even if the "Local Agency Bidder UDBE Commitment" form indicates that the bidder has met the UDBE goal. This will protect the bidder's eligibility for t y award of the contract if the administering agency determines that the bidder failed to meet the goal for various reasons, e.g., a UDBE firm was not certified at bid opening, or the bidder made a mathematical error. � � Submittal of only the "Local Agency Bidder UDBE Commitment" form may not provide sufficient documentation to demonstrate that adequate good faith efforts were made. The following items are listed in the Section entitled "Submission of UDBE Commitment" of the Special Z Provisions: i A. The names and dates of each publication in which a request for UDBE participation for this f. project was placed by the bidder (please attach copies of advertisements or proofs of publication): r> i, Publications Dates of Advertisement (3 oals met i' i. B. The names and dates of written notices sent to certified UDBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the UDBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of UDBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation �. tan,,k mat 1 zi j in LPP 09 -02 Page 15 -33 July 31, 2009 I i. tl { Exhibit 15 -H Local Assistance Procedures Manual UDBE Information -Good Faith Effort C. The items of work which the bidder made available to UDBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate UDBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate UDBE participation was made available to UDBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items ($) Of (yam Contract G oals Met D. The names, addresses and phone numbers of rejected UDBE firms, the reasons for the bidder's rejection of the UDBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each UDBE if the selected firm is not a UDBE: Names, addresses and phone numbers of rejected UDBEs and the reasons for the bidder's rejection of the UDBEs: Goals Met Names, addresses and phone numbers of firms selected for the work above: E. Efforts made to assist interested UDBEs in obtaining bonding, lines of credit or insurance, and any technical assistance or information related to the plans, specifications and requirements for the work which was provided to UDBEs: Goals Met Page 15 -34 July 31, 2009 UP 09 -02 i Local Assistance Procedures Manual Exhibit 15-H UDBE Information - Good Faith Effort F. Efforts made to assist interested UDBEs in obtaining necessary equipment, supplies, materials or related assistance or services, excluding supplies and equipment the UDBE subcontractor purchases or leases from the prime contractor or its affiliate: Goals met I: G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using UDBE firms (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.): Name of Agency /Organization Method/Date of Contact Results Goals met H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. Page 15-34a LPP 09 -02 July 31, 2009 i . rr i is CITY OF ROSEMEAD �r HELLMAN /SAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT t. F Li EXHIBIT 15 -G2 Local Assistance Procedures Manual Local Agency Bidder DBE Information (Construction Contracts) tr . INSTRUCTIONS - LOCAL AGENCY BIDDER DBE INFORMATION (CONSTRUCTION CONTRACTS) j I SUCCESSFUL BIDDER: The form requires specific information regarding the construction contract: Local Agency, Location, Project Description, Total Contract Amount, Bid Date, Bidder's Name, and Contract UDBE Goal. The form has a column for the Contract Item Number and Item of Work and Description or Services to be t ' Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by 6 DBEs including work performed by its own forces, if a DBE.The DBE shall provide a certification number to the Contractor and expiration date. Enter DBE prime and subcontractors certification number. The DBE contractors should notify the Contractor in writing with the date of the decertification if their status should change during the course of the contract. The form has a column for the Names of DBE certified contractors to perform the work (must be certified on the date bids are opened and include DBE address and phone number. IMPORTANT: Identify all DBE firms participating in the project -- including all UDBEs listed on the UDBE Commitment form (Exhibit 15 -GI ), regardless of tier. Names of the First -Tier DBE subcontractors and their respective iteru(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. I There is a column for the DBE participation dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of ( item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section 'Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts) to determine how to count the participation of DBE firms. Exhibit I S -G2 must be signed and dated by the successful bidder. Also list a phone number in the space provided and print the name of the person to contact. ' Local agencieS should complete the Local Agency Contract Number, Federal -aid Project Number, Federal Share, Contract Award Date fields and verify that all information is complete and accurate before signing and sending a copy of the form to the District Local Assistance Engineer within 15 days of contract execution. Failure to submit a completed and accurate form within the 15 -day time period may result in the de- obligation of i_. funds on this project District DBE Coordinator should verify that all informations is complete and accurate. Once the information has been verified, the District Local Assistance Engineer signs and dates the form. i , :l t ' Page 15 -32b July 31, 2009 LPP 09-02 t> I 1f T , t° I. I r 11 :a I- tv r. i_. la I -- i j r f. 7 r r i li Local Assistance Procedures Manual EXHIBIT I5-G2 Local Agency Bidder DBE Information (Construction Contracts) EXHIBIT 15 -G2 LOCAL AGENCY BIDDER DBE INFORMATION (CONSTRUCTION CONTRACTS) (Inclusive of all DBEs including the UDBEs listed at bid proposal) NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCALAGENCY: Cityof Rosemead LOCATION: Hellman/San Gabriel Intersection PROJECT DESCRIPTION: Hellinaan Intersection Improvements project TOTAL COMRACTAMOUNT: $ l 7 — A '92.q. 33 BID DATE. 5/8/ BIDDER'S NAME: PTM General Eng Services Inc CONTRACT UDBE GOAL: 6% CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE DOLLARAMOUNT ITEMNO. ORSERVICESTORS AND EXPIRATION (Must be certified on the date bids DRE S UBCONTRACTED OR MATERIALS DATE are opened- include DBE address TO BE PROVIDED (or contracted if the and phone number) b idder is a DB For Local Agency to Complete: Local Agency Contract Number, Federal -aid PmjectNumber. Federal Share: Contract Award Date: Local Agency certifies that all DBE certification have been verified and Information is complete and accurate. Print Name Signature Date Local Agency Representative Area Coda 'fel rte Number: Total Claimed DBE Participation $ -� PTM General Engineering Services Inc. Signature of Bidder 5/7/2013 951- 710 -1000 Date (Area Cede) Tel. No. Eliz abeth H. Mendoza de McRae For Caltrans Review: Prim Name SPgnatum Dale Callous District Local Assistance Engineer Person to Contact (PleweType or Print) LocalAgeacyBidder DBElnfonmtion (Constructioneomarets) (Rev 626109) Distribution: (1) Copy — Fax or scan a copy to the Calm ms DislictLocal Assistance Engineer(DLAE) within l5 days of contract execution. Failure to send a copy to the DLAE within 15 days of connect execution may result in de- obligation of funds fm this project (2) Copy — Include in award package to Caltrans District Local Assistance (3) Original —Local agency fries Eel 1" 12-01 Page 15-32a January27,2012