All American AsphaltCITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
CONTRACT BID FORMS
�r
BID SCHEDULE
SCHEDULE OF PRICES FOR
HELLMAN /SAN GABRIEL INTERSECTION IMPROVEMENTS PROJECT
ESPL 5358 (012)
BASE BID SCHEDULE
CBF -1
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
Clearing & Grubbing per plans
�
rr11 —
1
and specifications. See
technical provisions TP 2, TP
3 &TP4.
LS
1
2
Disposal of Waste Materials
LS
1
500.
00. 00
Remove Existing and
Construct 9- Inches Thick PCC
j1 nn
r �O _
313, �
3
.5V
Pavement (High Early
Strength) 520 -A -5000.
SF
22,320
Construct 6- Inches Thick
Crushed Miscellaneous Base
KOO
U , 500 —
4
95% Compaction over 90%
Compacted Soil.
TONS
850
5
Cold Mill 2- Inches Existing
1.60
7 1 UaQ _
Pavement.
SF
5,000
6
Construct 2- Inches AC
ajaoo
4 —
Pavement (C2- PG 64 -10).
TONS
70
Construct 4 -inch thick PCC
�0•�
z1vo —
7
sidewalk per SPPWC Std Plan
113 -2.
SF
230
8
Construct PCC Curb Ramps
ylyo _
a S00 _
per SPPWC Std Plan 111 -4.
EA
2
Remove Existing and
9
Construct 6- Inches Thick PCC
Driveway Approach per
SPPWC Std Plan 110 -2.
SF
900
10
Install Landscape and
Irrigation per Plans and
It
�� / 000—
t5tQo�
Specifications Complete.
LS
1
11
Install Traffic Striping, Traffic
Signal Loops and Pavement
Markers
LS
1
CBF -1
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ � 1 I f 000. as
Six handredb sauonly 4soron fhousa)nd/ doilub a,nd taro cc*
Dollar amount in written form
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cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and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 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.
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.
Attached hereto is a certified check, a cashier's check or a i bo in the amount of
/D 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
CBF -2
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
12
Construct Traffic Signal
60,000
WON
Improvements per Plans and
Specifications Complete.
1
LS
Remove, Dispose and Construct
Colored PCC Cross Walk
(Chromix) with Lithochrome
Colorhardener on top per Plans
goo
85 `f ''II
a0
13
and Specifications Complete per
LM Scofield Company or
Approved Equal. Contact person
Bruce Umeck 818- 324 -3534.
SF
3,050
14
Adjust Sewer Manhole to
gq.�,00
VU
51 �5Q —
Grade per SPPWC Std Plan
W
205 -2.
EA
6
15
Adjust to Grade Water and
/nt
� �U
5 1 710
Gas Valves
Ea
10
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ � 1 I f 000. as
Six handredb sauonly 4soron fhousa)nd/ doilub a,nd taro cc*
Dollar amount in written form
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 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.
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.
Attached hereto is a certified check, a cashier's check or a i bo in the amount of
/D 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
CBF -2
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 contractors license(s) in good standing; (2) evidence
that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting
therefrom; and (3) any other information and documentation, financial or otherwise, needed by
Owner to award a Contract to the lowest responsible and responsive bidder.
Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
of five hundred dollars ($500.00) if project is not completed in forty -five (45) working days. The
Contract Time will begin to run ten (10) Working Days from the date of the Notice of Proceed and
subject to the terms and conditions described in the Contract Form and the Contract Documents.
Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
and subject to the terms and conditions described in the Contract Form and the Contract
Documents.
Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be
incorporated into a Contract arising out of this Submittal has been so identified by Bidder. Bidder
further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data
submitted herewith into a contract arising out of this Bid.
The undersigned acknowledges receipt, understanding and full consideration of the following
addenda to the Contract Documents.
Addenda Nos. 0
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
By: V•U= tmtX L'7L1
ature Business Street Address
Q ut�rLA , C1� l L�
Type or Print Name City State and Zip Code
4 P�ce� 1 k So15)`�?�ln 11n00
Title Telephone Number
Bidder's /Contractor's State of Incorporation:
Partners or Joint Venturers:
Bidder's License Number(s): - 13
NOTES:
1) By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the
representations made on the Contract Bid Forms.
2) If Bidder is a corporation, enter State of Incorporation in addition to Business Address
3) If Bidder is a partnership or joint venture, give full names of all partners or joint
venturers.
As further discussed in the Instructions to Bidders, Bidder will be required
to provide evidence that the person signing on behalf of the corporation,
partnership or joint venture has the authority to do so.
CBF - 4
ALL AMERICAN ASPHALT
ALL A MERICAN AGG
P.O. BOX 2229, CORONA, CA 92878 -2229
STATE CONTRACTORS LICENSE #267073 -A
CORPORATE RESOLUTION
Resolved, that this Corporation, All American Asphalt, on May 3, 2013 authorizes Robert
Bradley to execute contracts and agreements on behalf of the Company in the capacity of
Vice President.
Michael Farkas
Secretary
TELEPHONE: 951- 736 -7600 • FAX: 951- 739 -4671
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
2.13 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, otherthan 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 -6
� � - � � ► \ ii ► � ,11.
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
[ "Duplicate Next 2 Pages It needed for listing additional subcontraclors.' I
Name and Location Description of Work
of Subcontractor to be Subcontracted
y J f R Iron soapin�
Name: Kato �,and� ea_
Address Ff4UYl 1((11 B1j
r
Name and Location Description of Work
of Subcontractor to be Subcontracted
GIOG 10(U f
Name: G a, A rm , Q ) Prormianal Eboinear�h�
Address
Name and Location
of Subcontractor
Name: C f U11 1 vtiirlV_
Address QI O !Uflj UA
Description of Work
to be Subcontracted
stripq
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
CBF -7
■ , �11i, 01 ► 1 U.
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:
1. ��e Q cR -11�_ �agks-�-
Name and Address of Owner
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.
Name and Address of Owner
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
"2012"
PAST WORK REFERENCES
City of Beverly Hills
345 Foothill Road
Beverly Hills, CA 90210
Contact: Juan Martinez, (310) 285 -2521
City of Costa Mesa
77 Fair Drive
Costa Mesa, CA 92628
Contact: Thomas Banks, (714) 754 -5222
City of Perris
170 Wilkerson Avenue, Ste. D
Perris, CA 92570
Contact: Chris Sunde, (951) 943 -5604
City of Dana Point
33282 Golden Lantern
Dana Point, CA 92629
Contact: Matt Sinacori, (949) 248 -3574
City of Long Beach
333 W. Ocean Blvd., 10` Floor
Long Beach, CA 90802
Contact: Chuck Ramey, (562) 570 -6634
City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92701
Contact: Edward Torres, (714) 647 -5018
City of Fountain Valley
10200 Slater Avenue
Fountain Valley, CA 92708
Contact: Alex Salazar, (714) 593 -4516
2010 -2011 Street Resurfacing Project
Contract Amount: $2,800,000.00
Start: 6/1/2011
Completed: 4/30/2012
2010 -2011 Citywide Street Rehabilitation
Contract Amount: $2,778,000.00
Start: 7/1/2011
Completed: 2/29/2012
Foss Field Parking Expansion
Contract Amount: $190,000.00
Start: 1/1/2012
Completed: 2/29/2012
Pacific Coast Highway & Niguel Shores
Contract Amount: $676,676.00
Start: 12/1/2011
Completed: 5/30/2012
Willow Street Improvements
Contract Amount: $661,661.00
Start: 12/1/2011
Completed: 6/30/2012
Bristol Street Widening
Contract Amount: $8,315,754.00
Start: 5/1/2009
Completed: 3/16/2012
Edinger Avenue Improvements
Contract Amount: $422,422.00
Start: 5/1/2012
Completed: 8/1/2012
"2011"
PAST WORK REFERENCES
City of Compton
205 South Willowbrook Avenue
Compton, CA 90220
Contact: Loujuana Mitchell, (310) 761 -1437
County of San Bernardino
825 E. Third Street
San Bernardino, CA 92415
Contact. Franklin Lund, (909) 387 -7920
County of Riverside
-- 2950 Washington Street
Riverside, CA 92504
Contact: David Hytkema, (951) 850 -6075
City of Stanton
7800 Katella Avenue
Stanton, CA 90680 -3162
Contact: Quang Le, (714) 890 -4234
City of Long Beach
333 West Ocean Blvd., 10 Floor
Long Beach, CA 90802
Contact: Chuck Ramey, (562) 570 -6634
City of Paramount
16400 Colorado Boulevard
Paramount, CA 90723 -5012
Contact: Len Gorecki, (562) 220 -2111
City of Huntington Beach
2000 Main Street
Huntington Beach, CA 92648
Contact: Dave Verone, (714) 375 -8471
Department of Transportation
464 W. Fourth Street
San Bernardino, CA 92410 -1400
Contact: Imad Abugharbieh, (951) 277 -8579
Northwood Avenue Reconstruction
Contract Amount: $1,180,000.00
Start: 10/18/2010
Completed: 5/4/2011
Cajon Blvd.
Contract Amount: $565,000.00
Start: 3/11/2011
Completed: 4/8/2011
De Luz Road Rehabilitation
Contract Amount: $740,000.00
Start: 4/25/2011
Completed: 5/23/2011
2010/2011 Citywide Reconstruction
Contract Amount: $322,322.00
Start: 3/1/2011
Completed: 4/30/2011
Annual Contract Street Reconstruction
Contract Amount: $3,433,415.00
Start: 5/1/2010
Completed: Still On -Going
Neighborhood Street Resurfacing
Contract Amount: $899,909.00
Start: 11/1/2010
Completed: 3/30/2011
Slater Avenue Improvements
Contract Amount: $1,926,341.00
Start: 8/2/2010
Completed: 2/30/2011
Route 91 Project
Contract Amount: $5,732,812.00
Start: 3/1/2010
Completed: 3/30/2011
NON - COLLUSION AFFIDAVIT
CBF -9
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; thatthe
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, orthe 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.
&
Typed or Printed Name
Ae )
Title
Subscribed and sworn before me
This SAA day of Wi lam 20
(Seal)
Notary Public in and for
the State of California
My Commission Expires:
CBF -10
5 I-
CALIFORNIA JURAT
State of California
County of Riverside Subscribed and sworn to (or affirmed) before
me on this 3rd day of May, 2013
Date Month
By (1) Robert Bradley
Name of Signer
Proved to me on the basis of satisfactory evidence
THORNE be the person who appeared before me
DONNA
Commission # 1892010
a -ra Notary Public - California s (and
z Riverside Coun y
' My Comm. Expires Jun 7, 2014
(2) None
Proved to me on the basis of satisfactory evidence
be the person who appeared before me.)
Signature 14_n� B�nk—
Prace Notary Seal Above Signature of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove
valuable to person relying on the document and could prevent
fraudulent removal and reattachment of this forth to another document.
Further Description of Any Attached Document
Title or Type of Document
Non - Collusion Affidavit .
Dated: 5/3/13 Number 1 of 1 Pages
Signer(e) Other Than Named Above:
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
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
The bidder P. \\ Anerco L�S�Hp�� proposed
sWXertHaetor — hereby certifies that he
has Z has-rrot, 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.
EEOC -1
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
Noncollusion Affidavit
(Title 23 United States Code Section 112 and
Public Contract Code Section 7106)
To the City of Rosemead, Los Angeles County
DEPARTMENT OF PUBLIC WORKS.
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
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.
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.
Bidders are cautioned that making a false certification may subject the
certifier to criminal prosecution.
NA -1
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
lu, ' • = ►Ale's' ' f)l1Am
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. I
P r
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 OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
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:
(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
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.
(2) If any funds other than Federal appropriated funds have been paid or will be paid
to any person for influencing or attempting to influence an 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 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
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.
NLC -1
CITY OF ROSEMEAD
HELLMANISAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
DISCLOSURE OF LOBBYING ACTIVITIES
UUMYLIz IC Ir11J rUKM I UIJU!LUJt LU116TINU HU I IV I I ItS YUKJUHN I I 01 U.J I 60
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
❑ a. nnntrart ❑ a. hid /offedannliratinn ❑ a_ initial
b. grant b. initial award b. material change
c. cooperative agreement c. post -award
d. loan For Material Ch g Only:
e. loan guarantee y/ofst uarter
f. loan insurance deport
4. Name and Address of Reporting Entity 5. If Reporting Entity in bawardee,
Enter Name and Addr e:
El Prime Fi Subawardee
Tier _ , if known
Congressional District, if known
6. Federal Department/Agency: 7
8. Federal Action Number, if known: A
,61onal District, if known
Program Name /Description:
CFDA Number, if applicable
Award Amount, if known:
10. a. Name and Address of Lobby Entity b. Individuals Performing Services (including
(If individual, last name, first name, address if different from No. 10a)
(last name, first name, MI)
(afKch Continuation Sheet(s) if necessary)
11. Amount of Payment iche all that apply) 13. Type of Payment (check all that apply)
$ /in-ki; al planned a. retainer
b. one -time fee
12. Form ok all that apply): c. commission
e a d. contingent fee
bify: nature a deferred
value f. other, specify
14. Br ief Drvices Performed or to be performed and Date(s) of Service, including
officer( , or member(s) contacted, for Payment Indicated in Item 11:
(attach Continuation Sheet(s) If necessary)
Continuation Sheet(s) attached: Yes n
No E]
Information requested through this form is authorized by
Title 31 U.S.C. Section 1352. This disclosure of
Signature:
lobbying reliance was placed by the tier above when his
transaction was made or entered into. This disclosure is
print Na
required pursuant to 31 U.S.C. 1352. This information
will be reported to Congress semiannually and will be
Title:
available for public inspection. Any person who fails to
file the required disclosure shall be subject to a civil
penalty of not less than $10,000 and not more than
1
Telephone No -:
$100,000 for each such failure.
Federal Use Only:
Authorized for Local Reproduction
Standard Form - LLL
INSTRUCTIONS FOR COMPLETION OF SF -LLL,
DISCLOSURE OF LOBBYING ACTIVITIES
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 or a 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
form 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
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 if 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, state and zip
code of the prime Federal recipient. Include Congressional District, if 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 (Rem 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
Federal amount of the awaidlloan 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 individual(s) performing services and include full address if different from 10 (a). Enter Last
Name, First Name and Middle Initial (MI).
1.1. 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 not just time spent in actual contact
with Federal officials. Identify the Federal officer(s) 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 dale the form, 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- 90eENDIFn
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
EXHIBIT 15 -G1 Local Assistance Procedures Manual
Local Agency Bidder UDBE Commitment (Construction Contracts)
INSTRUCTIONS - LOCAL AGENCY BIDDER
UDBE COMMITMENT (CONSTRUCTION CONTRACTS)
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,
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 commitmentwill be grounds for
finding the bid nonresponsive
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
provide a certification number to the Contractor and expiration date. Enter the UDBE prime's and subcontractors'
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).
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
(construction contracts), to determine how to count the participation of UDBE firms.
Exhibit 15 -GI 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.
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.
Page 15 -32
July 31, 2009 LPP 09-02
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
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 S 1q k -1 )
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 wil rotect the bidder's eligibility for
award of the contract if the administering agency determines that the bidder , f iled to meet the goal for various
reasons, e.g., a UDBE firm was not certified at bid opening, or the bidder grade a mathematical error.
Submittal of only the "Local Agency Bidder UDBE Commitment" to 'may not provide sufficient
documentation to demonstrate that adequate good faith efforts were made.
The following items are listed in the Section entitled "Submissiowo UDBE Commitment" of the Special
Provisions:
A. The names and dates of each publication in wh' h a request for UDBE participation for this
project was placed by the bidder t att ac copies of advertisements or proofs of
publication): \ ^
B. The names and dates of written otices sent to certified UDBEs soliciting bids for this project
and the dates and methods us for following up initial solicitations to determine with certainty
whether the UDBEs were in rested (please attach copies of solicitations, telephone records, fax
confirmations, etc.):
Names of UDBEs Sol' ited Date of Initial Follow Up Methods and Dates
Solicitation
Page 15 -33
LPP 09 -02 July 31, 2009
Exhibit 15 -H
UDBE Information -Good Faith Effort
Local Assistance Procedures Manual
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 ount Percentage
Performs Item Items (s) Of
Y/N Contract
D. The names, addresses and phone numbers of rejected UDBE rms, the reasons for the bidder's
rejection of the UDBEs, the firms selected for that work (pl e attach copies of quotes from the
firms involved), and the price difference for each UDBE if a selected firm is not a UDBE:
Names, addresses and phone numbers of rejected UDB and the reasons for the bidder's
rejection of the UDBEs:
Names, addresses and phone numbers of 1 lected for the work above:
f
r
E. Efforts made to assist interested UDB in obtaining bonding, lines of credit or insurance, and
any technical assistance or informatio related to the plans, specifications and requirements for
the work which was provided to UD Es:
Page 15 -34
July 31, 2009 LPP 09 -02
Local Assistance Procedures Manual
Exhibit 15 -H
- Good Faith Effort
F. Efforts made to assist interested UDBEs in obtaining necessary a tiipment, supplies, materials or
related assistance or services, excluding supplies and equipment he UDBE subcontractor
purchases or leases from the prime contractor or its affiliate:
G. The names of agencies, organizations or groups
recruiting and using UDBE firms (please attach
received, i.e., lists, Internet page Nwnload, etc'.
.ed to provide assistance in contacting,
of requests to agencies and any responses
of Contact
AA
\\ 1 I
H. Any additional data to
necessary):
a d4onstration of good faith efforts (use additional sheets if
NOTE: USE ADDITIONAL SHEETS(OF PAPER IF NECESSARY.
Page 15 -34a
LPP 09 -02 July 31, 2009
CITY OF ROSEMEAD
HELLMAN /SAN GABRIEL INTERSECTION
IMPROVEMENTS PROJECT
EXHIBIT 15 -G2 Local Assistance Procedures Manual
Local Agency Bidder DBE Information (Construction Contracts)
INSTRUCTIONS - LOCAL AGENCY BIDDER DBE INFORMATION
(CONSTRUCTION CONTRACTS)
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
Subcontracted or Materials to be provided by DBEs. Prime contractors shall indicate all work to be performed by
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 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 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 15 -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
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.
Page 15 -32b
July 31, 2009 LPP 09 -02
Bid.l3ond No. 08597423
BIDDER: All American Asphalt
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 All
as
Principal, and Fidelity and Deposit Company of Maryland
as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
($ 10% 1 , 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 HellmanlSan Gabriel Intersection Improveruents pro ect asset
forth in the Notice Inviting Bids and accompanying Bid Documents, dated
May 08, 2013
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 24th day of April , 2013
All American Asphalt (SEAL) Fidelity and Deposit Company of Maryland JSFAL)
Principal Surety
By: By;
ature e 2ber�gfad\4y; l' 'F Signatur William Syr ' - Attorney -In -Fact
CBF -5
CALIFORNIA ALL - PURPOSE ACKNOWLEDGEMENT
personally appeared Robert Bradley
Name(s) of Sgrmr(s)
f
who proved to me on the basis of satisfactory evidence to be the
person(s) whose name(s) is /are subscribed to the within instrument
and acknowledged to me that he /sheRhey executed the same in
his ,R;^•"e authorized capacity(ies), and that by his /herAh&
DONNA THORNE signature(s) on the instrument the person(s), or the entity upon behalf
: Commission # 1892010 z of which the person(s) acted, executed the instrument.
i Notary Public - California z
z " Riverside County I certify under PENALTY OF PERJURY under the laws of the State of
My Comm. Expires Jun 7, 2014 California that the forgoing paragraph is true and correct.
WITNESS my hand a`nd� official seal.
Signature R7 U r�Y�-0.., 11��
Place Notary Seal Above Signature of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to person relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document Bid Bond
Document Date 4/24/2013 Number of Pages: One (1)
Signer(s) Other Than Named Above: Fidelity and Deposit Company of Maryland
Capacity(ies) Claimed by Signer(s)
Signers Name: Robert Bradley
c Individual
X Corporate Officer— Title(s): Vice- President
• Partner — o Limited o General
• Attorney in Fact
o Trustee
o Other:
Signer is Representing:
Top or thumb here
Signer's Name:
o Individual
o Corporate Officer — Title(s):
❑ Partner— o Limited o General
o Attorney in Fact ".flhu-b
❑ Trustee
o Other:
Signer is Representing
CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT
State of California 1
County of Orange J
On 04/24/2013 before me, A Wilkison, Notary Public
Dale Here Insert Name and T 1. of the Cificer
personally appeared William Syrkin
Name(.) of Signega)
A. WILKISON
' Commission # 1866283
a " =ve ` - Notary Public - California z
z ' °y� r Orange County
My Comm. Expires Sep 26, 2013
Place Notary Seal Above
who proved to me on the basis of satisfactory evidence to
be the person(e) whose name(a) is /e+e subscribed to the
within instrument and acknowledged to me that
he /sheMiey executed the same in NL, h .. is 1. /4ter/their authorized
capacity(ies), and that by his /ker Ahalr signature(4 on the
instrument the persons} or the entity upon behalf of
which the persons) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
WITNESS my hand and official seal.
Signatur C,71� ,
Signature m Notary mix
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document: Bid Bond
Document Date: 04/24/2013
Signers) Other Than Named Above: All American
Capacity(ies) Claimed by Signer(s)
Signer's Name: William Syrkin
❑ Individual
Corporate Officer—Title(s): _
❑ Partner — ❑ Limited ❑ General
0 Attorney in Fact
J Trustee Top of thumb here
Guardian or Conservator
Other:
Signer Is Representing:
Fidelity and Depo5t Company a Maryland
Number of Pages: One
Signer's Name:
❑ Individual
❑ Corporate Officer— Title(s):
Partner —❑ Limited ❑ General
❑ Attorney in Fact
G Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
Top of [numb here
9 2007 National Notary Association -9350 De Seto Aw.. P.O Box 24W- Chat.umth, CA 91313- 24132•w NalonalNOlaryorg Item #590] Reorder. Call Toll-Free t- 801Y9]6-682]
EXTRACT FROM BY -LAWS OF THE COMPANIES
"Article V, Section 8, Attomeys -in -Fact The Chief Executive Officer, the President, or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attomeys -in -fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney-in-fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of
the By -Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney... Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the 10th day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice- President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
VIN STIMO REOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 2 day of 1 20
s`tl
~! a 50fyrP�rvq�
j d � a ��
Geoffrey Delisio, Vice President