California Professional Engineering, Inc. CITY OF ROSEMEAD
GARVEY AVENUE
HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
CONTRACT BID FORMS
BIDDER:California Professional Engineering, Inc.
BID SCHEDULE
SCHEDULE OF PRICES FOR
GARVEY AVENUE - HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
BASE BID SCHEDULE
UNIT OF EST. UNIT ITEM
NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST
1 Clearing & Grubbing per plans 1c0
and specifications. LS 1 `" -� �
y0 v.N.
2 Disposal of Waste Materials. LS 1 I5oO I ,SOO
Traffic Signal Upgrade at
Garvey Avenue and Delta
3 Avenue per Plans and Iga(pc N.a(cct c
Specifications Complete. LS 1
Traffic Signal Upgrade at
Garvey Avenue and
4 Rosemead Place/River I$�,(QI 3 Jr 7 (p l a
Avenue per Plans and
Specifications Complete. LS 1
Traffic Signal Upgrade at
5 Garvey Avenue and Muscatel apa al
Avenue per Plans and aka,3)(4)
Specifications Complete. LS 1
4 .r3 .►
, ,cv iii _
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ �1-I Iako
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cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and
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.
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.
CBF - 1
BIDDER:
California Professional Engineering, Inc.
Attached hereto is a certified check, a cashier's check or a bid bond in the amount of
I 0°/10 F tears ($ ) 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 Owner for execution, within five(5) Calendar Days following the Letter of Award for
the Contract, and will deliver to the Owner within that same period the necessary original Certificates
of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other
documentation and certification required by the Contract.
The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and
become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of Bidder's California contractor's license(s)in good standing; (2)evidence
that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting
therefrom; and (3) any other information and documentation, financial or otherwise, needed by
Owner to award a Contract to the lowest responsible and responsive bidder.
Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
of five hundred dollars ($500.00) if project is not completed in forty-five (45) 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.
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 - 2
B y BIDDER Ptufessiuiial Engineering, Inc.
Ct*
By: ?fI xbeA n five
Signature ! Business Street Address
\/a11 men La pitmhz, CA . 1 146
Type or Prini Name
yp City, State and Zip Code
�YPS I G (P.2�� SID
Title lephone Number
Bidder's/Contractor's State of Incorporation: Cat cor C\
Partners or Joint Venturers:
Bidder's License Number(s): i q J -I a-1
Department of Industrial Relations
Registered No. I oot oc c1(bp
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- 3
•
WAIVER OF NOTICE AND CONSENT
TO HOLDING OF FIRST MEETING OF
INCORPORATORS AND DIRECTORS OF
CALIFORNIA PROFESSIONAL ENGINEERING INC.
A California Corporation
•
We, the undersigned, being all of the incorporators, first
directors and/or the directors named in the Articles of
Incoiporation of the above-named California corporation duly
formed by. the filing of said Articles of Incorporation in the
office of the California Secretary of State on August 18, 2000,
and desiring to hold..the first meeting of the Incorporators and
Directors of said corporation• for the purpose of completing the
organization of its affairs, DO HEREBY WAIVE NOTICE of said
meeting, and CONSENT to the holding thereof at 9316 Mabel
Avenue, South El Monte, California 91733, on October 1, 2000, at
•
10: 00 a.m. of said day, for the purpose of adopting Bylaws,
electing directors and officers, adopting a form of corporate
seal and share certificate, authorizing a notice of the
California Commissioner of Corporations that stock has been
issued in compliance with all the terms and conditions of
. Section 25102, of the California Corporations Code, or the filing
of an application fora permit, as the case may be, with said
office, and transacting such other business as may be brought
... before said meeting; and do hereby further agree that any
k business transacted at said meeting shall be as valid and legal
and of the same force and effect as though said meeting were
held after notice duly given.
WITNESS our signatures this day, October 1, 2000.
Van Nguyen, \T corporator
ij
L''
•
•
•
MINUTES
- 1 - •
•
•
MINUTES OF FIRST ORGANIZATIONAL MEETING
OF INCORPORATORS AND DIRECTORS OF
CALIFORNIA PROFESSIONAL ENGINEERING INC.
A California Corporation
The undersigned, being the Incorporator named in the
Articles of Incorporation of the above-named California
corporation, duly formed by the filing of said Articles of
Incorporation in the office of the California Secretary of State
on August 18, 2000, and desiring to hold the first
organizational meeting for the purpose of completing the
organization of its affairs, in accordance with the powers
conferred upon Incorporators by Section 210 of the General
Corporation Law, : held such meeting at 9316 Mabel Avenue, South
El Monte, California 91733, on October 1, 200.0, at 10: 00 a.m. of
said day.
Present at this session of the meeting: Van Nguyen, being
the Incorporator of said corporation named in its Articles of
Incorporation.
On motion and by unanimous vote, Van Nguyen was elected
temporary Chairperson and temporary Secretary of the meeting.
ARTICLES OF INCORPORATION FILED •
• The Temporary Chairperson stated that the originR1 rticles
of Incorporation of the corporation had been filed in the office
of the California Secretary of State, and had been assigned the
following filing date and State Corporation filing number:
Filing Date: August 18, 2000
Official Filing Number: 2196373
The Temporary Chairperson then presented to the meeting a
certified copy of said Articles of Incorporation, showing
filings as stated and the Temporary Secretary was directed to
insert said copy in the Book of Minutes of the corporation.
MINUTES
- 2 -
BYLAWS
•
The matter of the adoption of Bylaws for the regulation of
the affairs of the corporation was next considered. The
temporary secretary presented to the meeting a form of Bylaws
which were duly considered and discussed. On motion duly made
and unanimously carried, the following resolutions were adopted:
RESOLVED: That Ithe Bylaws presented to this meeting
and discussed' thereat be, and the same hereby are,
adopted as and for Bylaws of this corporation.
RESOLVED FURTHER: That the temporary secretary of this
corporation be and hereby is authorized and directed
to execute a certificate of the adoption of said .
Bylaws and to insert said Bylaws as • so certified in .
the Book of Minutes of this corporation, and to see
that a copy of said Bylaws, similarly certified, is •
kept at the principal office for the transaction of
business of this corporation, in accordance with
Section 213 of the California Corporations Code_
ELECTION OF DIRECTORS
The temporary Chairperson stated that the Bylaws adopted by
the Corporation provide that the number of Directors shall be.
one (1) .
The temporary emp ary Chairperson advised that the Incorporator, on
motion and by unanimous vote, had elected the following person
as the first Directors of the Corporation to serve until
successors are duly elected pursuant to the Bylaws, or until
resignation or removal, as the case may be, and effective upon
their acceptance of their position, to exercise the powers of
further organization and direction of the Corporation_ Each of
the newly elected Directors signified acceptance:
DIRECTOR 'S NAME AND ,ADDRESS SIGNATURE DATE
Van Nguyen
2574 S. Pepperda l e Drive • 1'12,6)
Rowland Heights, CA 91748
f
J .
•
•
MINUTES
- 3 -
RESIGNATION OF INCORPORATOR
' The meeting continued. Present at this session of said
meeting, in addition to the Incorporator were Van Nguyen, the
Director duly elected herein. In the interests of maintaining
continuity of action, the Director waived notice of said
organizational meeting, took his place and the meeting then
proceeded further.
The temporary. Chairperson advised that the Incorporator,
having completed the necessary steps in orgy i z;_a the
Corporation and having elected the appropriate number of
Directors to carry forward the management of the Corporation,
now wished to submit his resignation:
The undersigned Incorporator herewith resigns:
• U-:>\_A/\
A 1 Van Nguyen
The temporary Chairperson stated that theJIncorporator' s
tasks had now been accomplished and upon motion duly made and
recorded, said resignation. was accepted.
WAIVER
The temporary. Chairperson announced that the meeting was
held pursuant to written Waiver of Notice and Consent thereto
and was signed by all of ' the participants and upon m=otion made
and unanimously carried, was made a part of the records of the
meeting, and now precedes the minutes of this meeting in the
Book of Minutes of the corporation.
ELECTION OF OFFICERS
The meeting then proceeded to the election of officers.
The following were duly elected to the offices indicated after
the names of each:
Van Nguyen, President
•
Van Nguyen, Secretary
•
Van Nguyen, Chief Financial Officer
Each officer so elected being present accepted his office,
and thereafter, the president presided at the meeting as
Chairperson, and the secretary acted as secretary of the
meeting.
CORPORATE SEAL
The secretary presented for approval of the meeting a
MINUTES
- 4 -
•
•
proposed seal of the corporation, consisting of two concentric
circles with the name of the corporation in one circle and the
words and figures in the form as follows :
•
(SEAL)
•
•
• On motion duly made and unanimously carried, the following
resolution was adopted:
RESOLVED: That the corporate seal, in the foiiu,, words
and figures presented to this meeting be, and the same
hereby is, adopted as the seal. of this corporation.
SHARE CERTIFICATE
The secretary presented to the meeting a proposed form of
share certificate for use by the corporation. On motion duly
made and unanimously carried, said form of share certificate was
approved and adopted, and the secretary was instructed to insert
a copy thereof in the Book of Minutes immediately following the
minutes of the meeting.
ORGANIZATIONAL EXPENSES
In order to provide for the payment of expenses of
incorporation and organization of the corporation, on motion
duly made and unanimously carried, the following resolution was
adopted:
RESOLVED: That the President or Vice President and
the Chief Financial Officer of this corporation be,
and they hereby are authorized and directed to pay the
expenses of incorporation and organization of this
corporation.
•
ACCOUNTING YEAR
The Chairperson suggested that the meeting consider the
adoption of an accounting year, either fiscal or calendar, so
that the Franchise Tax Board could be notified thereof. On
motion duly made, seconded and unanimously carried, the
following resolution was adopted:
RESOLVED: That this corporation adopt an accounting
year as follows:
•
DATE ACCOUNTING YEAR BEGINS: November 1
DATE ACCOUNTING YEAR ENDS: October 31
MINUTES
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o .a mss:
PRINCIPAL OFFICE LOCATION
After some discussion, the location of the principal office
of the corporation for the transaction of the business of the
corporation was fixed pursuant to the following resolution,
adopted, on motion duly made, seconded and unanimously carried:
•
•
RESOLVED: That 9316 Mabel Avenue, South El Monte,
•
California 91733 be and. the same hereby is designated
and fixed as the principal office for the transaction
of the business of this corporation in the State of
California.
OFFICERS AUTHORIZED TO CONTRACT
To authorize the officers to contract and obligate the
corporation, in the ordinary course of business, the following
resolution was, upon motion duly made, seconded and carried,
adopted:
RESOLVED: That the following officers be, and the
same hereby are authorized to sign contracts and
obligations on behalf of the corporation:
Van Nguyen, President
MINUTES
- 6 -
•
California Professional Engineering, Inc.
C .ualitp O,epond axpectations
MEETING OF BOARD OF DIRECTORS
OF
CALIFORNIA PROFESSIONAL ENGINEERING, INC.
A meeting of the Board of Directors of California Professional Engineering, Inc. was
held on May 6, 2015 whereby a resolution was passed authorizing
Van Nguyen to sign on behalf of the Corporation,by his signature,to enter into any and
all contractual obligations t n behalf of this corporation.
President
See attached jurat.
9316 Mabel Avenue South El Monte,CA 91733 0 Ph: (626)452-8658 0 Fax: (626)448-0470 0 Email:van@cpengineeringinc.com
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Los Angeles
Subscribed and sworn to (or affirmed) before me on this 6th
day of May , 20 15 , by Van Nguyen
,
proved to me on the basis of satisfactory evidence to be the
person(s) who appeared before me.
3 yc""u � DIEM CHU
,;1--, CoMM.#2042313 rn
N , E.'' NOTARY PUBLiC•CALIFORNIA y'
.}�/ LOS ANGELES COUNTY
MY COMM,EXP.SEP.21,2011—
•
(Seal) Signatu e
California Professional Engineering, Inc. dba
BIDDER: California Professional Electrical Engineering
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:
California Professional
THAT Engineering, Inc. dba California Professional Electrical Engineering ,as
Principal, and The Hanover Insurance Company
, as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
Ten Percent of Bid Amount
DOLLARS
($ 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 for the Garvey Avenue Highway Safety Improvement Project as set forth
in the Notice Inviting Bids and accompanying Bid Documents, dated
May 6, 2015
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 4th day of May , 20 15 .
California Profess'0nal Engineerini, Inc. dba
Ca' • e•- - • - i•ineerin• (SEAL) The Hanover Insurance Company
Princip- Sure*
By: By: .4
Sig'ature Si!r'ture Yung T. ullick,Attorney-in-Fact
CBF-4
CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed
the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that
document.
STATE OF CALIFORNIA }
COUNTY OF Los Angeles }
On JIM 0 6 2015 before me, Diem Chu Notary
Public,
Date (here insert name and title of the officer)
personally appeared Van Nguyen
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/she/they executed the same
in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument
the person(s), 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 hand and official seal.
�, � �,�".'+�� DIEM CHU_ <
� � � COMM.# 20HU <
N 1.', t NOTARY PUBLiC•CALIFORNIA
:'E'er/ LOS ANGELES COUNTY
MY CQMN.EXP.SEP.21,2017'
Signature. _ eal)
OPTIONAL
Description of Attached Document
Title or Type of Document: -_ Number of Pages:
Document Date: Other:
2015 Apostille Service, 707-992-5551 www.CaliforniaApostille.us California Mobile Notary Network www.CAMNN.com
•
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
STATE OF CALIFORNIA
County of Orange
On May 4, 2015 before me, Christine T. Hoang , Notary Public,
Date Insert Name of Notary exactly as it appears on the official seal
personally appeared Yung T. Mullick
Name(s)of Signer(s)
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/she/they
��°.rTHF CHRISTINE T.HOANG • executed the same in his/her/their authorized capacity(ies),
N 5 ° ': COMM.#2008757 and that by his/her/their signature(s) on the instrument the
e 7 .,111- person(s), or the entity upon behalf of which the person(s)
-m+ NOTARYPUBLIC CALIFORIJIA acted, executed the instrument.
i '* ORANGE COUNTY N
Y �q MY COMM.EXP.FEB 25,2017
I certify under PENALTY OF PERJURY under the laws of
the State of California that the foregoing paragraph is true
and corr- . .
Witnes- my hand a ' *al -:1.
Signatur;
Place Notary Seal Above Signature of N•ary Public Christine T. Hoang
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 the form to another document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies)Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Individual ❑ Individual
❑ Corporate Officer—Title(s): ❑ Corporate Officer —Title(s):
❑ Partner ❑Limited ❑General ❑ Partner ❑Limited❑General
❑ Attorney in Fact RIGHT THUMBPRINT ❑ Attorney in Fact RIGHT THUMBPRINT
❑ Trustee OF SIGNER ❑ Trustee OF SIGNER
❑ Guardian or Conservator Top of thumb here ❑ Guardian or Conservator Top of thumb here
❑ Other: ❑ Other:
Signer is Representing: Signer is Representing:
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWERS OF ATTORNEY
CERTIFIED COPY
KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,both
being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a
corporation organized and existing under the laws of the State of Michigan,do hereby constitute and appoint
James W.Moilanen,Yung T.Mullick,and/or Jennifer C.Anaya
of Mission Viejo,CA and each is a true and lawful Attorney(s)-in-fact to sign,execute,seal,acknowledge and deliver for,and on its behalf,and as its act and
deed any place within the United States, or, if the following line be filled in, only within the area therein designated any and all bonds, recognizances,
undertakings,contracts of indemnity or other writings obligatory in the nature thereof,as follows:
Any such obligations in the United States,not to exceed Ten Million and No/100($10,000,000)in any single instance
and said companies hereby ratify and confirm all and whatsoever said Attorney(s)-in-fact may lawfully do in the premises by virtue of these presents.
These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions
are still in effect:
"RESOLVED,That the President or any Vice President,in conjunction with any Vice President,be and they are hereby authorized and empowered to appoint
Attorneys-in-fact of the Company,in its name and as its acts,to execute and acknowledge for and on its behalf as Surety any and all bonds,recognizances,
contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to attach thereto the seal of the Company. Any
such writings so executed by such Attorneys-in-fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the
regularly elected officers of the Company in their own proper persons."(Adopted October 7,1981-The Hanover Insurance Company;Adopted April 14,1982
-Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of America)
IN WITNESS WHEREOF,THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE
COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents,
this 3rd day of January 2012.
THE HANOVER INSURANCE COMPANY
N"N"" ,�� �� W+ cp�,� MASSACHUSETTS BAY INSURANCE COMPANY
fs �.; a vim CITIZENS SURANCE OMPANY OF AMERICA
urn SEAL
4
Robert Thomas.Vice President
THE COMMONWEALTH OF MASSACHUSETTS ) r°�— ( -'
COUNTY OF WORCESTER )ss. !oc r nstrom. iV ce President
On this 3rd day of January 2012 before me came the above named Vice Presidents of The Hanover Insurance Company,Massachusetts Bay Insurance
Company and Citizens Insurance Company of America,to me personally known to be the individuals and officers described herein,and acknowledged that
the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts Bay Insurance Company and
Citizens Insurance Company of America,respectively,and that the said corporate seals and their signatures as officers were duly affixed and subscribed to
said instrument by the authority and direction of said Corporations.
"`a BARBARA A.GARLICK
� �� Notary Public / {y 212 %/�sfL��
Cemmn+ealO+olMassachusetts .6)&4'9-!/ZC.•4.- (2, ,,�tJ� L ;e
° At,'Conmtlim ExAs Sea.21.2os
Barbara A.Garlick, Notary Public
My Commission Expires September 21,2018
I,the undersigned Vice President of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,
hereby certify that the above and foregoing is a full,true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further
certify that the said Powers of Attorney are still in force and effect.
This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company,
Massachusetts Bay Insurance Company and Citizens Insurance Company of America.
"RESOLVED,That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto,granted and executed
by the President or any Vice President in conjunction with any Vice President of the Company,shall be binding on the Company to the same extent as if all
signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile." (Adopted October 7,1981-The
Hanover Insurance Company;Adopted April 14,1982-Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company
of America)
GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 4TH day of MAY 20 IS
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
/"1St to
term Margosian,Vice President
BoDewlifornia Professional Engineering
2.B LIST OF PROPOSED SUBCONTRACTORS
In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100
through 4114 of the California Public Contract Code, and any amendments thereto, each
Bidder shall provide the information requested below for each subcontractor who will
perform work, labor or render service to Bidder in or about the construction of the Work in an
amount in excess of one-half of one percent (greater than 0.5 %) of the Bidder's Total Bid
Price, or, in the case of bids or offers for the construction of streets or highways, including
bridges, in excess of one-half of 1 percent of the Contractor's total bid or ten thousand
dollars ($10,000), whichever is greater, and shall further set forth the portion of the Work
which will be done by each subcontractor. Bidder shall list only one subcontractor for any
one portion of the Work.
Pursuant to Public Contract Code Section 4104, the Owner has determined that it will allow
Bidders twenty-four(24) additional hours after the deadline for submission of bids to submit
the information requested by the Owner about each subcontractor, other than the name and
location of each subcontractor.
If the Bidder fails to specify a subcontractor for any portion of the Work to be performed
under the Contract, it shall be deemed to have agreed to perform such portion itself, and
shall not be permitted to subcontract that portion of the Work except under the conditions
hereinafter set forth below.
Subletting or subcontracting of any portion of the Work in excess of one half of one percent
(greater than 0.5%)of the Total Bid Price or, in the case of bids or offers for the construction
of streets or highways, including bridges, in excess of one-half of 1 percent of the
Contractor's total bid or ten thousand dollars ($10,000), whichever is greater, for which no
subcontractor was designated in the original bid shall only be permitted in cases of public
emergency or necessity, and then only after Owner approval.
CBF - 5
BIDDE alifornia Professional Engineering, Inc
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
["Duplicate Next 2 Pages if needed for listing additional subcontractors."]
v.0 .
Name and Location - Description of
of Subcontractor to be ntracted St1c2\P+ +\1)9
Name: ()fOfl•E CcjAj N S \'R`► -z'CV1C Ili C
Address: •License No.: LI • a• •
Department of Industrial Relat. egistration No. I oo
Name and Ledation Description of Work 1254Q•11)9 CCNdv∎ti-
of Subcontractor to be Subcontracted
Name: V T EA.QCi ct\C 1 1(1C .
Address: I c)$,ZS 'lecnoo hv>v.1 OINtC\QZ\o C.Ps-c;\\-1(A�
License No.: 1 (p3 a3(4)
Department of Industrial Relation Registration No. i D5(014
Name and Location Description of Work m�r �\1G�
of Subcontractor to be Subcontracted S'Y1-P\n�
Na me: S∎. - V2(fQC\ . ckkvk c-\
Address: 5 OSS S�•, �{ cPSS .P�- SO.030
License No.: 1-1(0
Department of Industrial Relation Registration No. \ 1A-V1 (p
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
License No.:
Department of Industrial Relation Registration No.
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
License No.:
Department of Industrial Relation Registration No.
CBF - 6
BIDDlifornia Professional Engineering, Inc..
2.0 REFERENCES see Ct G(uwQA Corm S
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.
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
CBF - 7
929 Otterbein Ave., Unit E
• La Puente, CA 91748
• Ph: (626) 810-1338
• Fax: (626) 810-1322
www.cpengineeringinc.com
California Professional Engineering, Inc.
Traffic Signal -Job References
PROJECTS:
San Gabriel Blvd, et. al TSM0010049
Amount: $1,463,453.23
Owner: County of Los Angeles Department of Public Works
Project Manager:Abigail Flores
Contact Phone #: (626)458-3157
Status: Completed
Approximate Start/End Dates:Jan 2013—March 2014
Description of Supplies, Equipment, or Services Provided: Installation of Conduit,
Pullboxes, Traffic Signal, Interconnect Cable, Communication Equipment,
Loop Detectors and Bicycle Loops, Fiber Optic, Curb Ramps and Preemption
System.
Tustin Street & Palm Avenue Left Turn Signal Modification
Amount: $179,527.00
Owner: City of Orange
Project Manager: Medel Llanes
Contact Phone#: (714) 744-5535
Fax it (714) 744-5573
Status: Completed
Approximate Start/End Dates: Nov 2013-Jan 2014
Description of Supplies, Equipment, or Services Provided: Modify Traffic Signal at
One Intersection along with Traffic Control, Install New Cabinet, Safety
Lighting, Loops, Vehicle Pre-emption System, Sidewalk Access Ramps &
Traffic Signal Heads.
Woodruff/Washburn Traffic Signal
Amount: $156,697.58
Owner: City of Downey
Project Manager: Keith Hoey
Contact Phone#: (562) 622-5898
Fax#: (562) 904-7296
Page 1 of 3
Document Last Updated 7/2/2014
Status: Completed
Approximate Start/End Dates:Apr 2013-Aug 2013
Description of Supplies, Equipment, or Services Provided: Upgrading Traffic Signal
at Intersection, Trenching, Conduit Runs, and Installation of LED Safety
Lighting.
Traffic Signal Modification at Brookhurst
Amount: $237,213.67
Owner: City of Huntington Beach
Project Manager:John Griffin
Contact Phone#: (714)375-5011
Fax it (714) 374-1648
Status: Completed
Approximate Start/End Dates: March 2011-Sept 2011
Description of Supplies, Equipment, or Services Provided: Modify Traffic Signal at
Multiple Intersections along with Traffic Control, Installation of Curb Ramps &
Traffic Signal Heads, and Monument Preservations.
Traffic Signal System Upgrade Phase V-VIII
Amount: $292,175.99
Owner: City of Santa Ana
Project Manager: William Albright
Contact Phone #: (714) 647-5029
Fax it (714) 647-5622
Status: Completed
Approximate Start/End Dates:Jan 2011-Aug 2011
Description of Supplies, Equipment, or Services Provided: Installation of Conduit,
Pullboxes, Traffic Signal, Interconnect Cable, Communication Equipment,
Loop Detectors and Bicycle Loops, Fiber Optic, Cable, Signal Heads, CCTV
System, and Preemption System.
Traffic Signal at Various Locations HSIPL 5331 (017) & HSIPL 5331 (010)
Amount: $507,840.79
Owner: City of La Puente
Project Manager:Jason Brown, Willdan
Contact Phone#: (562) 908-6222
Status: Completed
Approximate Start/End Dates:June 2012—March 2013
Description of Supplies, Equipment, or Services Provided: Installation of Conduit,
Pullboxes, Traffic Signal,, Loop Detectors and Bicycle Loops, Curb Ramps and
Preemption System.
Page 2 of 3
Documen!Last Updated 7/2/2014
20th Street & Cherry Ave Traffic Signal
Amount:$247,540.60
Owner: City of Signal Hill
Project Manager: Natalie Avila, RKA Group
Contact Phone#: (909)594-9702
Fax#: (909) 594-2658
Status: Completed
Approximate Start/End Dates: Feb 2013—Sept 2013
Description of Supplies, Equipment, or Services Provided: Installation of Conduit,
Pullboxes, Traffic Signal, Interconnect Cable, Communication Equipment,
Loop Detectors and Bicycle Loops, Fiber Optic, Curb Ramps and Preemption
System.
Page 3 of 3
Document Last Updated 7/2/2014
CITY OF ROSEMEAD
GARVEY AVENUE
HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
EQUAL EMPLOYMENT
OPPORTUNITY
CERTIFICATION
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 California Professional Engineering, Inc. , proposed
subcontractor , hereby certifies that he
has:>- 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.
EEOC-1
CITY OF ROSEMEAD
GARVEY AVENUE
HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
NON-COLLUSION AFFIDAVIT
California Professional Engineering, Inc.
BIDDER:
NON-COLLUSION AFFIDAVIT
CBF - 8
BIDDEfCalifornin Professional Engineering, 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, organization, bid depository, or to any member or agent
thereof to effectuate a collusive or sham bid.
Signature
Van Nguyen
Typed or Printed Name
President
Title
L�alifornia Professional Engineering, Inc.
Bidder
Subscribed and sworn before me
This day of 20
(Seal)
Notary Public in and •
the State of Cali . nia P529,
My Com• ssion Expires:
CBF - 9
CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed
the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that
document.
STATE OF CALIFORNIA }
COUNTY OF 1,os Angeles I
On NAY 0 6 2015 before me, Diem Chu . Notary
Public,
Date (here insert name and title of the officer)
personally appeared Van Nguyen
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/she/they executed the same
in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument
the person(s), 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 hand and official seal.
cit.,,., DIEM CHU
���ppp,,•►r+_ COMM,#2042313 'n
N n NOTARY PU1t 2.042313 A
C ''{4, LOS ANGELES COUNTY
'Signature: �∎ L � ) " 'T" Mr COMM EXp SEa.21.2011 F
OPTIONAL
Description of Attached Document
Title or Type of Document: Number of Pages:
Document Date: Other:
`2015 Apostil le Seri ice. 707-992-5551 www.CaliforniaApostille.us California Mobile Notary Network www.CAMNN.com
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
GARVEY AVENUE
HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
DEBARMENT AND
SUSPENSION
CERTIFICATION
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 OF ROSEMEAD
GARVEY AVENUE
HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
NON-LOBBYING
CERTIFICATION
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) 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
GARVEY AVENUE
HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
DISCLOSURE OF LOBBYING
ACTIVITIES
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(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 item 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 award/loan 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).
11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity(item 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 date 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.06-04-90«ENDIF»
DISCLOSURE OF LOBBYING ACTIVITIES
COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
na contract n a hirl/offer/annlic tion n a initial
b. grant b. initial award b. material chang
c. cooperative agreement c. post-award
d. loan For Material Ch ge Only:
e. loan guarantee year quarter
f. loan insurance date of, st report
4. Name and Address of Reporting Entity 5. If Reporting Entity in No 4 is Subawardee,
Enter Name and Addr- s of Prime:
ElPrime ❑ Subawardee
Tier , if known
Congressional District, if known Congressional District, if known
6. Federal Department/Agency: 7. Fede I Program Name/Description:
FDA Number, if applicable
8. Federal Action Number, if known: . Award Amount, if known:
10. a. Name and Address of Lobby Entity b. Individuals Performing Services (including
(If individual, last name,first name, MI) 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) 13. Type of Payment(check all that apply)
$ Ei actual I I planned a. retainer
_ b. one-time fee
12. Form of Payment(check all that apply): c. commission
B a. cash d. contingent fee
—
b. in-kind; specify: nature e deferred
—
value f. other, specify
—
14. Brief Description Services Performed or to be performed and Date(s)of Service, including
officer(s),emplo (s),or member(s)contacted,for Payment Indicated in Item 11:
(attach Continuation Sheet(s)if necessary)
15. Continuation Sheet(s)attached: Yes 0 No 0
16. Information quested through this form is authorized by
Title 31 U. C.Section 1352. This disclosure of Signature:
lobbying r liance was placed by the tier above when his Van NgW
transactidn was made or entered into. This disclosure is Print Name:
required pursuant to 31 U.S.C. 1352. This information
will be reported to Congress semiannually and will be
available for public inspection. Any person who fails to Title: President
file the required disclosure shall be subject to a civil r� /� y� �I
penalty of not less than$10,000 and not more than Telephone No�_Q2-01(b o 13J� Date:
$100,000 for each such failure.
Authorized for Local Reproduction
F
der Use Only: Standard Form- LLL
Standard Form LLL Rev.09-12-97
CITY OF ROSEMEAD
GARVEY AVENUE
HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
UDBE COMMITMENT
EXHIBIT 15-G1
Local Assistance Procedures Manual EXHIBIT 15-G1
•
Local Agency Bidder UDBE Commitment(Construction Contracts)
EXHIBIT 15-G1 LOCAL AGENCY BIDDER UDBE COMMITMENT(CONSTRUCTION CONTRACTS)
NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM
LOCAL AGENCY: 60\10-1 LOCATION: U�y of R`�`�'"•►i'eei c1
PROJECT DESCRIPTION: Nenut-^ktGS��9i SGte'�I`6 I wiptoveni-en1' , )rt, ec -
TOTAL CONTRACT AMOUNT:$ 511 I I .(p— V
BID DATE: 051 RD 1 I
BIDDERS NAME: California Professional Enginccring, Inc.
CONTRACT UDBE GOAL: (-L' O
CONTRACT ITEM OF WORK AND DESCRIPTION UDBE CERT NO. NAME OF EACH UDBE (DOLLAR AMOUNT
ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids'UDBE
SUBCONTRACTED OR MATERIALS DATE are opened-include UDBE
TO BE PROVIDED(or contracted if the address and phone number)
bidder is a UDBE) 51-19. 3. (0
— \ ■ leriltErlearjEMWMII61.1 .1411101111011 •r .
ill opict
VLF 1C fin‘ La Puente,CA 91748
C13\ "‘
cyl uScc1 '
For Local Agency to Complete:
Total Claimed UDBE $ S )
Local Agency Contract Number: Participation
•
Federal-aid Project Number: 0
Federal Share: (II it
Contract Award Date:
Local Agency certifies that all UDBE certifications have been verified and Signature ter
information is complete and accurate.
ffiGUff (4) �S\
Da (Ar Code Tel.No.
Van Nguyen
Print Name Signature Date
Local Agency Representative Person to Contact (Please Type or Print)
(Area Code)Telephone Number. Local Agency Bidder UDBE Commitment(Construction Contracts)
(Rev 6/26/09)
Distribution: (1)Original–Local agency files
Page 15-31
LPP 09-02 July 31,2009
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 commitment will 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-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.
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
GARVEY AVENUE
HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
GOOD FAITH EFFORTS
EXHIBIT 15-H
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. HSIPL 5218 (014) Bid Opening Date 05-)OP
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
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
Provisions:
A. The names and dates of each publication in which a request for UDBE participation for this
project was placed by the bidder(please attach copies of advertisements or proofs of
publication):
Publications Dates of Advertisement
we av Jfl ,E
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
Page 15-33
LPP 09-02 July 31,2009
:xhibit 15-H Local Assistance Procedures Manual
JDBE 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
(Y/N) Contract
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:
We We kl P s
Names, addresses and phone numbers of firms selected for the work above:
k).0 COOL VD
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:
Wk
'age 15-34
'y 31,2009 LPP 09-02
CITY OF ROSEMEAD
GARVEY AVENUE
HIGHWAY SAFETY IMPROVEMENT PROJECT
HSIPL 5358 (014)
LOCAL BIDDER DBE
INFORMATION
EXHIBIT 15-G2
Local Assistance Procedures Manual EXHIBIT 15-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
LOCAL AGENCY: �� n }{ LOCATION: WI CT- 9osen'I2t
PROJECT DESCRIPTION: Ci n(XVeki pie h kkt Fe/11 1 YVI-OD* .LKr ProjeCr
TOTAL CONTRACT AMOUNT: $ 51 1 ) I a�
BID DATE: �I b II W I 1 S
BIDDER'S NAME: California Professional Engineering, Inc.
CONTRACT UDBE GOAL: ()°/D
CONTRACT ITEM OF WORK AND DESCRIPTION DBE CERT NO. NAME OF EACH DBE DOLLAR AMOUNT
ITEM NO. OR SERVICES TO BE AND EXPIRATION (Must be certified on the date bids DBE
SUBCONTRACTED OR MATERIALS DATE a opened-include DBE address
TO BE PROVIDED(or contracted if the nd phone number) _
bidder is a DBE) 'fit . 5 Zj�W.
— AS Ar
—G FA 'D 'jry t Cali ornia Professional Engineering,Inc.
�R1C,tS • I 929 Otterbein Ave.Unit E
'YY:t' "Aft_-. La Puente,CA 91748
.QC a �i� •"�
f\P- p
Ne' / te r.x 1
For Local Agency to Complete:
Total Claimed DBE $ S Ma,3g1,
Local Agency Contract Number: Participation
Federal-aid Project Number:
Federal Share:
9' %
Contract Award Date:
- I �O
Local Agency certifies that all DBE certification have been verified and /►
Information is complete and accurate.
Sign.t"dirridder
Print Name Signature Date 65 U , 0 0-1 3
Local Agency Representative Date Ar :Code)Tel.No
Van Nguyen
(Area Code)Telephone Number:
For Caltrans Review: Person to Contact (Please Type or Print)
Print Name Signature Date Local Agency Bidder DBE Information(Construction Contarcts)
Caltrans District Local Assistance Engineer (Rev 6/26/09)
Distribution: (1)Copy—Fax or scan a copy to the Caltrans District Local Assistance Engineer(DLAE)within 15 days of contract execution.Failure to
send a copy to the DLAE within 15 days of contract execution may result in de-obligation of funds for this project.
(2)Copy—Include in award package to Caltrans District Local Assistance
(3)Original—Local agency files
Page 15-32a
LPP 12-01 January 27,2012
a
•
,EXHIBIT 15-G2 Local Assistance Procedures Manual
Coca!Agency Bidder DBE Information(Construction Contracts)
INSTRUCTIONS - LOCAL AGENCY BIDDER DBE INFORMATION
(CONSTRUCTION CONTRACTS)
SUCCESSFUL BIDDER:
IThe 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-G1),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