Excel Paving CompanyMAYOR:
1'0i.7.r Low
MAYOR PRO TEM:
W ILLWA ALARCON
COUNCI L NIENIBERS:
SANDRA ARNIENTA
MARGARET CLARK
STEVEN LY
City o f p d
8838 E. VALLEY BOULEVARD P.O BOX 399
ROSEMEAD. CALIFORNIA 91770
TELEPHONE (626) 569 -2100
FAX (626) 307 -9218
CITY OF ROSEMEAD
ROSEMEAD, CALIFORNIA
ADDENDUM NUMBER 1
To all prospective bidders under Bid Documents for the
MISSION DRIVE STREET RESURFACING PROJECT
Project No. 21015
Bid Item No. 5 of Base Bid Schedule on CBF — 2 EST. QTY. (Estimated
Quantity) 1,1102 Tons shall be replaced by 1,102.00 Tons.
2. The rest of Bid Documents as originally issued shall be used in submitting bids, and
an acknowledgement of receipt of this Addendum Number 1 shall be entered on
the page CBF — 5 of the Contract Bid Forms. Failure to provide such
acknowledgement shall render the bid as non - responsive and subject to rejection.
BY ORDER OF THE CITY OF ROSEMEAD
Date: May 7, 2013
By Rafael Fajardo
Associate Civil Engineer
CITY OF ROSEMEAD
MISSION DRIVE STREET RESURFACING PROJECT
FROM ROSEMEAD BOULEVARD TO VALLEY BOULEVARD
PROJECT No. 21015
CONTRACT -BID FORMS
ohl
BIDDER: INC.DBA
EXCEL PAVING COMFRW
CONTRACT BID FORMS
TABLE OF CONTENTS
SECTION 1 BID
SCHEDULE.............................................. ...........................CBF1 - CBF6
SECTION 2 BID DATA FORMS ...................................... ...........................CBF7
2.A BID BOND ................................................. ...........................CBF8
2.6 LIST OF PROPOSED SUBCONTRACTORS ..................... CBF9 -CBF11
SECTION 3 NON - COLLUSION AFFIDAVIT ................ ....................CBF12 -CBF13
SECTION 1 - BID SCHEDULE
CBF -1
..
:,.fit- 1:, ,.-c_
y C
BID SCHEDULE
SCHEDULE OF PRICES FOR
MISSION DRIVE STREET RESURFACING PROJECT
FROM ROSEMEAD BOULEVARD TO VALLEY BOULEVARD
PROJECT No. 21015
BASE BID SCHEDULE
CBF -2
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
1
Clearing & Grubbing per plans
LS
1
`p I _
l �
and specifications. See technical
provisions TP -2, TP -3 & TP-4.
2
Disposal of Waste Materials.
LS
1
TWO
3
Cold mill 2.0- inches thick existing
SF
183,700
0
3 f0-7 q0
pavement.
4
Construct 1.5 inches thick
TONS
1,653
12
X52 GQ
pavement overlay ARHM -GG -C
(PG 64 -16) as indicated on the
plans. '
5
Construct 1.0 inches thick
TONS
1,1102
Asphaltic Leveling course D1
(PG 64 -10) as indicated on the
plans.
6
Remove 6- inches of existing
SF
500
5 1S
o�
2 V�s
pavement and replace it with 3.5-
inches of AC B -PG 64 -10 Base
Course over compacted native.
7
Remove, Dispose and Construct
SF
7778
tt(p(
4- inches thick PCC Sidewalk per
SPPWC Std. Plan 113 -1.
8
Remove, Dispose and Construct
SF
2270
22100
PCC Driveway Approaches per
SPPWC Std. Plan 110 -2.
9
Remove, Dispose and Construct
LF
592
�.�
2-q �ZU _
8- inches Curb and 24- inches
Gutter per SPPWC Std. Plan
120 -2.
CBF -2
,:;
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 5 m u t L
Dollar amount in written form
CBF -3
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
10
Remove, Dispose and Construct
EA
5
7140.-
PCC Curb Ramps per SPPWC
Std. Plan 111-4.
11
Adjust Sewer Manhole to Grade
EA
29
100
Wp x
per APWA Std. Plan 205 -1 and
206 -1.
12
Adjust Water Valve /Gas Valve to
EA
32
1� ��—
Grade.
13
Install Survey Well Monument
EA
5
per City of Rosemead Std. Plan
S08 -001. See Section 2 -9
Surveying of the General
Provision -7 per details (Cover,
Sleeve & Dome will be provided
by the City at no cost).
14
Install Traffic Striping, Traffic
LS
1
�SAl1 ,
Signal Loops, and Pavementq�1,
Markers ( Including 8" Raised
pavement markers per the .
Striping Plans and Specifications
Complete.
15
Prepare a Storm Water Pollution
LS
1
�37�
�,�
Prevention Plan (SWPPP)
16
Remove, Salvage and Install
EA
6
��
5
Street Name Signs on Existing
Poles; City will provide the Signs.
17
Remove, Salvage and Install
EA
2
Wi .-
402
Street Name Signs on new
Poles; City will provide the Signs.
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 5 m u t L
Dollar amount in written form
CBF -3
PALP INUBA
EXCEI. PAVING COMPAW
..
ALTERNATE BID ITEM No. 1
WROUGHT IRON FENCE
INTERSECTION OF WALNUT GROVE AVENUE AND MISSION DRIVE
NO.
ITEM DESCRIPTION
UNIT OF
MEASURE
EST.
QTY.
UNIT
PRICE
ITEM
COST
18
Install Wrought Iron Fence 6
LF
320
t q��
IT A 4,
feet, 1 1/2" rails and 3/4" pickets,
all tubing 100% galvanized inside
7KQ
and out and powder coated and
2" post per Kingmetals or
approved equal.
TOTAL ALTERNATE BID PRICE No. 1 (SCHEDULE BID PRICE):$ N 66D
.. (IM . . fin "I (Ud C. 6 HTq F&V-
Dollar amount in written form ' vOva Pf
TOTAL BASE & ALTERNATE BID PRICE $
1i, I I p 41 I
lc'�^LM
Dollar amount in written form I �
Note: The City of Rosemead reserves the right to reduce or increase the quantities of any items in
the schedule of bid items above, within the limits define in Section 3 -2.2.1 of the Standard
Specifications, to stay within the budgeted amount of this project.
If the Bid Documents specify alternate bid items, the following Alternate Bid amounts shall
be added to or deducted from the Total Bid Price entered above. The owner can choose to
include one or more of the alternates in the Total Bid Price of the Project. If any of the
Alternate Bids are utilized by the Owner, the resulting amount shall be considered the Total
Bid Price for the Project.
The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which
cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and
after the bid opening date, or until a Contract for the Work is fully executed by the Owner and a third
party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the
written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall
govern.
Attached hereto is a certified check, a cashier's check or a bid bond in the amount of
Dollars ($ ) said amount being not less than ten percent (10 %) of the Total
Bid Price. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
CBF -4
05/14/2013 12:40 FAX
MAYOR '
POLLY Low
MAYOR PRO 7'ERL
WWIAMAl.Nncow
COUNCIL MEMBERS:
SANDRA AR)aWA
MAIWAa Cw
STa%wKLY
May 13, 2013
lib 001/003
City of �Rqsgwad
8838 E. VALLEY BOULEVARD P.O BOX 399
ROSEMFAD, CALIFORNIA 91770
TELEPHONE (6261569 -2100
FAX(626)307-9218
CITY OF ROSEMEAD
ROSEMEAD, CALIFORNIA
ADDENDUM NUMBER
To all prospective bidders under Bid Documents for the
MISSION DRIVE STREET RESURFACING PROJECT
Project No. 21015
1. You hereby informed that Alternate No. 2 shall be added to the Contract Bid
Schedule of Items:
Alternate No. 2
Storm Drain Construction
NO
UNIT OF
EST
UNIT
ITEM
2
ITEM DESCRIPTION
MEASURE
QTY
PRICE
COST
19
Install Storm Drain System as
LS
1
Z3Q'Jt}�
indicated on the attached Plans
Complete.
TOTAL ALTERNATE BID PRICE No.2 (SCHEDULE BID PRICE):$ ISOM-
2. The rest of Bid Documents as originally issued shall be used in submitting bids, and
an acknowledgement of receipt of this Addendum Number 2 shall be entered on the
page CBF — 5 of the Contract Bid Forms. Failure to provide such acknowledgement
shall render the bid as non - responsive and subject to rejection.
BY ORDER OF THE CITY OSEMEAD
By
�/ Rafael Fajardo
Associate Civil Engineer
Page 1
F9 hT
., ll I.t.; WAUA
we fail or refuse to execute the Contract and furnish the required bonds, certificates and
endorsements of insurance and other certifications within the time provided.
If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be
prepared by the Owner for execution, within five (5) Calendar Days following the Letter of Award for
the Contract, and will deliver to the Owner within that same period the necessary original Certificates
of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other
documentation and certification required by the Contract.
The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and
become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of Bidder's California contractor's license(s) in good standing; (2) evidence
that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting
therefrom; and (3) any other information and documentation, financial or otherwise, needed by
Owner to award a Contract to the lowest responsible and responsive bidder.
Bidder 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 theCCon Documents.
Addenda No s�o ct (if
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 -5
the terms and conditions described in the Contract Form and the Contract Documents.
By:
Signs re
C, p. BROWN, PRESIDENT
Type or Print Name
Title
Bidder's /Contractor's State of Incorporation:
Partners or Joint Venturers:
Bidder's License Number(s):
NOTES:
PAIP. INC.DBA
BIDDER: EMEI PAVING COWANY
2230 LEMON AVENUE
LONG BEACH, CA 90806
Business Street Address
City, State and Zip Code
(562)599.5641
Telephone Number
PALP. INC.DBA
EXCEL PAVING COMPAW
STATE LI C. 688659 *A•
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
1
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 -6
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
Countyof LOS Angeles
On MAY 2 2 2013 before me, C.. Phillips, Notary Public
(Here uucrt name and tide of the officer)
personally appeared
who proved to me on the basis of satisfactory evidence to be the personW whose name(n) is/ttw subscribed to
the within instrument and acknowledged to me that he/skWAhO acexecuted the same in his/hae8heir authorized
capacityg §o, and that by hisAwz4WE signature( on the instrument the person(g), or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify trader PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNE S my h d and official seal.
Signatur Notary Public
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
or description of attached
(Tide or description of attached document continued)
Number of Pages _ Document Date
information)
CAPACITY CLAIMED BY THE SIGNER
•
Individual (s)
C. PHILLIPS
Corporate Officer
•;
COMM, #1996177 M
Partner(s)
'—
Attorney -in -Fact
Notary Public - California
Trustee(s)
❑
LOS ANGELES COUNTY u
(Notary Scal)
My Comm. Expires Oct. 29, 2016
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
or description of attached
(Tide or description of attached document continued)
Number of Pages _ Document Date
information)
CAPACITY CLAIMED BY THE SIGNER
•
Individual (s)
•
Corporate Officer
•
Partner(s)
•
Attorney -in -Fact
❑
Trustee(s)
❑
Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California most contain verbiage esactfy as
appears above in the notary section or a separate acknowledgment Jam must be
properly completed and attached to that document The only exception is if a
document is to be recorded outside ofCalifomia In such instances, any alternative
ackwwledgmet verbiage as may be printed on such a document so long as the
verbiage does rar require the notary to do something that u illegal far a notary in
Califon us (i.e. certifying the authorized eapadry of the signed. Please check the
document carefully for proper norav ial wording and attach rhisram tfrequired.
• Slate and County information must be the State and County where the document
signers) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
most also be the same date the acknowledgment Is completed.
• The noharf public most Fruit Ids or her time as it appears within his or her
commission followed by a comma and then your tide (notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarisation.
• Indicate die correct singular or plural forms by crossing off incorrect forms (i.e.
hetshe/they, is /ere) or circling the correct fomhs, Failure to correctly indicate this
information may lead to rejection of document recording.-
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment fomh.
• Signature of the notary public must match the signature on file with die office of
the county clerk.
Additional information is not required but could help to entire this
acknowledgment is not misused or attached to a different document.
indicate tide or type of attached document, number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
co lemre officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to die signed document
2008 Version CAPA v12.10.07 800 -873 -9865 whm•.NataryClasses.wm
SECTION 2
BID DATA FORMS
CBF -7
a
BIDDER: PALP Inc. dba Excel Paving Compan
Bidder shall submit its Bid data in accordance with the format shown on each of the following Bid
Data Forms. Bidders shall prepare and use as many sheets as are necessary to adequately provide
the information required. Bidder shall ensure that every page of its Bid Data Forms are properly
identified with the Bidder's name and page number.
2.A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT PALP Inc. dba Excel Pa ving Co as
Principal and Federal Insurance Company
, as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
Ten Dercent of the total amount of the bid
($ 10 ) , being not less than ten percent (10 %) of the Total
Bid Price; for the payment of which sum will and truly to be made, we bind ourselves,
our heirs, executors, administrators, successors, and assigns, jointly and severally,
firmly by these presents.
WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work
required forthe Mission Drive Street Resurfacing Project as setforth 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 8th day of May 20 13
PALP Inc. dba Excel Paving Company (SEAL) Federal Insurance Company (SEAL)
Principal! `` �� S e
By: �,f,.� By:
Signature Signatu y D. Rapp
Attorney in Fact
C.P. ®RoWN, PRESIDENT
CBF - 8
if
ACKNOWLEDGMENT
State of California
County of Ora
On 05/08/2013 before me, Debra Swanson, Notary Public
(insert name and title of the officer)
personally appeared Timothy D. Rapp ,
who proved to me on the basis of satisfactory evidence to be the personv) whose name($) isAw.&
subscribed to the within instrument and acknowledged to me that he /eheMiey executed the same in
his /4efA4&rauthorized. capacity(**, and that by hisAaerathair signature(y) on the instrument the
person($), or the entity upon behalf of which the person(y) 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.
tr` '�<, DEBRA SWANSON
WITNESS my hand and official seal.
NOTARYPUBUC•CAUFORHIA �
' tx '-�" •• ORANGE COUNTY N
��` v MY COMM, E %P. NGV 10, 2016
Signature O N N: a rELfl V� (Seal)
C Chubb PUwrbt Federal insurance company Ann: surety wepariment
OF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059
Know All by These Presents, That FEDERAL
COMPANY, a New York corporation, and PACIFIC IN
appoint Douglas A. Rapp and Timothy D. Rapp
ina corporation, VIGILANT INSURANCE
corporation, do each hereby constitute and
each as their We and lawful Attorney- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise, bonds and undertakings and other wddngs obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any
instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations.
In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested
these presents and affixed their corporate seals on this 16th day of December, 2011.
Kenneth�ssistant Secretary . Nonis, Jc, Vice President
STATE OF NEW JERSEY - -
County of Somerset ss.
On this 16th day of December, 2011 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me
known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which
executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he is Assistant Secretary of FEDERAL
INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the
foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as
Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of saitl Companies; and that the
signature of David B. Norris, Jr., subscribed to said Paver of Attorney is in the genuine handwriting of David B. Nonis, Jr., and was thereto subscribed by authority of said By.
Laws and in deponent's presence.
Notarial Seal KATHERINE J. ADELAAR
GIA30,��. NOTARY PUBUC NEW JFRSFy No, 2311516 665
Co fnmiIIIII Expiry July 16, 2014 Notary Public
CERTIFICATION
Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY:
"AIL powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the
President or a Vice President or an Assistant Vice President jointly with the Secretary or an Assistant Secretary, under their respective designations, The
signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Mce President, any
Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any
certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fact for purposes only of executing and attesting bonds and undertakings and other
wndngs obligatory in the nature thereof, and any such pourer of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding
upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company
with respect to any bond or undertaking to which it is attached.'
I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY
(the 'Companies) do hereby cerlify that
(i) the foregoing extract of the By- Laws of the Companies is "a and correct,
(ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are
authorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in
American Samoa, Guam, and each of the Provinces of Canada except Pnnce Edward Island; and
(iii) the foregoing Power of Attorney is we, comect and in full force and effect.
Given under my hand and seals of said Companies at Warren, NJ this 8th day of May, 2013
* s 2
�- Ken neth C. we el, Assistant Secretary
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER
MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903 - 3493 Fax (908) 903. 3656
e -mail: surety@chubb.com
Form 15 -10- 02258 -U (Ed. 5 -03) CONSENT
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
County of Los Angeles
On Mi222013 before me, C. Phillips, Notary Public
(Here insert name and tide of the officer)
personally appeared
who proved to me on the basis of satisfactory evidence to be the persortW whose name(n) is /pee subscribed to
the within instrument and acknowledged to me that he/skmklw�xexecuted the same in hi&%mffkc it authorized
capacityQ@O, and that by his/ttezaWz signature(s) on the instrument the person(§), or the entity upon behalf of
which the person(s) 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 d and official seal.
Sigmtur o Notary Public
(Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or description of attached document)
(Title or description ofanached document continued)
Number of Pages Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNFIt
� 5 `•••
C. PHILLIPS
COMM.996177
#12. n
N
. W'
Corporate Officer
Notary PubllcCellfornle LL
• Z r "
❑
LOS ANGELES COUNTY ,.
(Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or description of attached document)
(Title or description ofanached document continued)
Number of Pages Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNFIt
❑
Individual (s)
❑
Corporate Officer
(Title)
❑
Partner(S)
❑
Aftomey -in -Fact
❑
Trustee(S)
Ll
Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in Cal forma musr contain verbiage esoctly as
appears above m the nsoury section or a separate acknowfedgment form must be
properly completed and attached to that document The only exception is if a
document is to be recorded outside of Califorma In such inutam'es, any aftername
erbawledgmeru verbiage as may be primed on such a document so long as the
verbiage does not require the rotary to do something that is dfegal for a notary in
Calfarnfn (i.e. certifying the authorized capacity of the signer). Pleare check the
document carefully for proper notarial wording and ailach this form ifrequired.
• State end County information must be the Slate and Comfy where the docu ncm
signerr(s) personally appeared before the notary public for acknowledgment.
• Date of notarvation must be the date that the signers) personally appeared which
mutt also be the same date the acknowledgment Is completed.
• The notary public must print Its or her name as it appears within his or her
commission followed by a comma and then your tide (dowry public).
• Print the rmne(s) of document signer(s) who persomlly appear at the time of
notarvation. -
• Indicate the cored singular or plural fomis by crossing off incorrect forms (i.e.
he is /ere) or circling the correct forms. Failure W correctly indicate this
information may lead to rejection of document recording.
•
The notary seal impression must be clear and phomgmphically reproducible.
Impression must not cover teat or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with die office of
the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate tide of type of attached document, number of pages mid date.
Indicate the capacity claimed by the signer. If die claimed opocily is a
copwtate officer, indicate the who (ix CEO, CFO, Seaetary-).
• Securely attach this document to the signed document
2008 Version CAPA v12. 10.07 800 - 873 -9865 www.NotaryClasses.wm
. t,,:
.. -
2.113 LIST OF PROPOSED SUBCONTRACTORS
In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100
through 4114 of the California Public Contract Code, and any amendments thereto, each
Bidder shall provide the information requested below for each subcontractor who will
perform work, labor or render service to Bidder in or about the construction of the Work in an
amount in excess of one -half of one percent (greater than 0.5 %) of the Bidder's Total Bid
Price, or, in the case of bids or offers for the construction of streets or highways, including
bridges, in excess of one -half of 1 percent of the Contractor's total bid or ten thousand
dollars ($10,000), whichever is greater, and shall further set forth the portion of the Work
which will be done by each subcontractor. Bidder shall list only one subcontractor for any
one portion of the Work.
Pursuant to Public Contract Code Section 4104, the Owner has determined that it will allow
Bidders twenty -four (24) additional hours after the deadline for submission of bids to submit
the information requested by the Owner about each subcontractor, other than the name and
location of each subcontractor.
If the Bidder fails to specify a subcontractor for any portion of the Work to be performed
under the Contract, it shall be deemed to have agreed to perform such portion itself, and
shall not be permitted to subcontract that portion of the Work except under the conditions
hereinafter set forth below.
Subletting or subcontracting of any portion of the Work in excess of one half of one percent
(greater than 0.5 %) of the Total Bid Price or, in the case of bids or offers for the construction
of streets or highways, including bridges, in excess of one -half of 1 percent of the
Contractor's total bid or ten thousand dollars ($10,000), whichever is greater, for which no
subcontractor was designated in the original bid shall only be permitted in cases of public
emergency or necessity, and then only after Ownerapproval.
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BIDDER* PW. - 7c1i wRe lRw.w ii
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
[ Next 2 Pages if needed for listing additional subcontractors. "]
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: �YLCLXLflJ1 U1 U P llt ,kaN �Ald
Address 1��50_ (4UAMA, W AM
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Name and Location Description of Work
of Subcontractor to be Subcontracted
I I A
Name and Location
of Subcontractor
Name: SmAbv KMIPAyict &jm
Address: �i <_S� (� �u
Name and Location
of Subcontractor
Name:
Address
Description of Work
to be Subcontracted
S4-
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name:
Address _
Description of Work
to be Subcontracted
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.r. 1:
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: ``'',,''.. ,,
owpwt
,. I�OuI QO ✓k �► 3��3 �U. 226gw 61LO
Name and telephone numt*r of person familiar with project
41 UA 1M ►v-
Con ract amount Type of Work Date Completed
2.
d Address of Owner
Name ana reiepnone numoer or person ramuiar wan protect
Contract amount Type of Work
) A Date Completed
2,, / �� ,
Name and Address of Owner
LM -� An eA& l W� - 1 2 ,A 1,00-)
Contract
4.
Type of Work
IL')
Name and telephone numbbr of person familiar with project
y
amount
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BIDDER: 6 -if PAlAwa-�mjr
SECTION 3
NON - COLLUSION AFFIDAVIT
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PALP. MUM
BIDDER: EXCEL PAVING CQMPAW
NON - COLLUSION AFFIDAVIT
In accordance with Public Contract Code Section 7106, the undersigned, being first duly
sworn, deposes and says that he or she holds the position listed below with the bidder, the
party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any
undisclosed person, partnership, company, association, organization, or corporation; that the
bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced
or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly
colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham
bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly
or indirectly, sought by agreement, communication, or conference with anyone to fix the bid
price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the
bid price, or of that of any other bidder, or to secure any advantage against the public body
awarding the contract of anyone interested in the proposed contract; that all statements
contained in the bid are true; and, further, that the bidder has not, directly or indirectly,
submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged
information or data relative thereto, or paid, and will not pay, any fee to any corporation,
partnership, company association, organization, bid depository, or to any member or agent
thereof to effectuate a collusive or sham bid.
Signature
C. P. BKWN, PRESIDENT
Typed or Printed Name
Title
't .) Ltiu �.,
Subscribed and sworn before me
This _ day of MAY 2 2 2013 20_
(Seal)
Notary Public irka d for
the State of California
My Commission Expires: w LA op
_ C. PHILLIPS �r
COMM. #1996177 n
Notary Public- Califomia rc
LOS ANGELES COUNTY LL
" My Comm. Expires Oct. 29,2016
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