Bidder: Siemens Industry, Inc. SIEMENS
April 5th, 2017 BID LETTER
City of Rosemead
Attn: City Engineer/ Rafael Fajardo
8838 E. Valley Blvd
Rosemead, CA 91770
RE: Bid for Traffic Signal Modifications Project art San Gabriel Blvd. & Rush Ave. Project No. 27004
Mr. Fajardo,
Siemens ITS would like to express our appreciation for the opportunity to participate in the Bid process
for the project listed above.
1. Our Total bid for the Project is $ 92,945.00 per the attached Bid Schedule.
2. Enclosed you will find our bid bond/ guarantee in the amount of 10% of the total equaling
$9,245.00.
3. At this time there are no addenda issued for this project therefore we acknowledge none.
4. We found no forms for the incorporation statement therefore we would like to state that we are
a corporation incorporated in the State of Delaware.
5. Our Contractor's License number is 758796 and is valid for A, B, C10 and C16 thru February
28`", 2019
We are the industry leader in maintenance services, energy efficiency retrofitting, advanced technology
implementations, and service upgrades for traffic signal and streetlight systems. We pride ourselves on
delivering personalized customer service and rapid response times through our highly experienced
team.
Siemens takes pride in providing complete solutions for all of our customers. Providing knowledgeable/
qualified personnel, rapid response times and innovation are the top priorities of our organization. We
are excited at the possibility and are looking forward to the opportunity to serve the needs of the City of
Rosemead and would like to thank you in advance for your consideration.
During the evaluation, if there are any questions regarding this proposal please, feel free to contact
either of us using the contact information listed below.
Respectfully,
Mic el J. Hutchens
Area Operations Manager
(714) 448-6943
michael.hutchens@Siemens.com
CITY OF ROSEMEAD
TRAFFIC SIGNAL MODIFICATIONS PROJECT
SAN GABRIEL BOULEVARD AT RUSH AVENUE
PROJECT No. 27004
CONTRACT BID FORMS
BIDDER:,IIgra S Intik qtly Th �.
CONTRACT BID FORMS
TABLE OF CONTENTS
SECTION 1 BID SCHEDULE 1
SECTION 2 BID DATA FORMS 5
2.A BID BOND 6
2.B LIST OF PROPOSED SUBCONTRACTORS 7
SECTION 3 NON-COLLUSION AFFIDAVIT 10
BIDDER: ,)IymnrAix tri:t tc.
SECTION 1 - BID SCHEDULE
CBF - 1
BIDDER: J1 WvvPmSSY�r>[�AS+Di c
BID SCHEDULE
SCHEDULE OF PRICES FOR
TRAFFIC SIGNAL MODIFICATIONS PROJECT
SAN GABRIEL BOULEVARD AT RUSH AVENUE
PROJECT No. 27004
BASE BID SCHEDULE
UNIT OF EST. UNIT ITEM
NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST
1 Clearing &Grubbing per plans LS 1
and specifications. so.oc, 850 c"-
2 Disposal of Waste Materials. LS 1A ISCO cz. ISOO
3 Construct Traffic Signal LS I '�
Modifications at San Gabriel qo,zJcl5- g0,5q, "
Boulevard and Rush Avenue per
Plans and Specifications
Complete.
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ 1Z r 9y 5.00
u-..�94,4y'Two T oc.sa..A t, roc N.r,..drea Fonr, �-.J� '9r1 la f5
Dollar arrfount in written form J
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
10%x4 Pia D..H,.,..j$ )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.
CBF- 2
BIDDER: `,t PX`tiF.AnS 1 irk ritksffy , =r`- .
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 ($500.00) if project is not completed in THIRTY (30) calendar days. The
Contract Time will begin to run ten (10)Working Days from the date of the Notice of Proceed and
subject to the terms and conditions described in the Contract Form and the Contract Documents.
Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be
incorporated into a Contract arising out of this Submittal has been so identified by Bidder. Bidder
further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data
submitted herewith into a contract arising out of this Bid.
The undersigned acknowledges receipt, understanding and full consideration of the following
addenda to the Contract Documents.
Addenda Nos. N J A
The Bidder understands and agrees that the Total E id Price is inclusive of all labor, materials, and
equipment or supplies necessary to complete the Work as described in the Bid Documents. If this
bid is accepted, the undersigned Bidder agrees to enter into and execute the Contract with the
necessary bonds and accept the Total Bid Price a;- compensation in full for all Work under the
contract.
CBF -3
•
BIDDER: SItW.zNS Tn rikt41 ,Znc.
By: % "-' Zion W wry , mod Art- C 4 .2.10
Sig"Ire Business Street Address
\\drat.A . Ruitcvrmc Ofavv e Ca.. '12$(28
Type or Print Name City, Stat and Zip Code
SW O1 .J QI .+12. s Han 0.2.-r- fly- 4
56-990 2
Title Te aphone Number
Bidder's/Contractor's State of Incorporation: -1)e\ wo ry
Partners or Joint Venturers: IIA
Bidder's License Number(s): . , - C o • •
Department Industrial Relations
Registered No. 1000002444
NOTES:
1) By its signature on this Bid,the Bidder certifies under penalty of perjury the accuracy of the
representations made on the Contract Bid Forms.
2) If Bidder is a corporation, enter State of Incorporation in addition to Business Address
3) If Bidder is a partnership or joint venture, give full names of all partners or joint
venturers.
As further discussed in the Instructions to Bidders, Bidder will be
required to provide evidence that the person signing on behalf of
the corporation, partnership or joint venture has the authority to do
so.
CBF -4
BIDDER: IQM'N?Ark Irr/Au sfiry Inc.
SECTION 2
BID DATA FORMS
CBF - 5
BIDDER: Siemens Industry Inc.
Bond Number.79434433-CHU-17-76
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 siemens Industry Inc.
,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 Percent of Bid Amount
DOLLARS
($ 10%of Amount Bid ), 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 TRAFFIC SIGNAL MODIFICATIONS PROJECT AT SAN GABRIEL
BOULEVARD AND RUSH AVENUE as set forth in the Notice Inviting Bids and
accompanying Bid Documents, dated April 5th,2017
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 iF
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 sth day of April 20 17
Siemens Industry Inc. ( AL) Federal Insurance Company (SEAL)
Principal ralr Surety
-
�rat
D ((,,
Z
BY By:
Signature ty,r�,_\ W+r=tiers Signature l//
Brittany D.Clavin,Attorney-In-Fact
•
•
4 -
CBF-6
j _.
ACKNOWLEDGMENT BY SURETY
STATE
OF Missouri
City of St. I.ovis ss.
On this 5th day of April 2017 before me personally
appeared Brittany D. Clavin , kumvu to me to be the Attorney-tit-Fact of
Federal Insurance Company
the corporation
that executed the within instrument, and acknowledged to me that such copxtratiou executed the same.
IN WETNESS WHEREOF, I have hereunto set my Iuvul and affixed my official seal, at my office in the aforesaid
County,the day and year in this certificate first above wrillcu.
Sandra I.. nun
My C'onuuissiuu Expires: 01/18/2021 Notary Public in the State or Missouri
(Seal) County of St. Louis
Commission #12150177
Notary Pubt c, No ary Seal
State of Missouri
Commissiion Co124501 77
My Commission Expires January 18, 2041
S-0230/GEEF 2/98
C ChubbPOWER Federal Insurance Company Attn: Surety Department
OF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059
OMJb
Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE
COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and
appoint Pamela A. Beelman, Cynthia L. Choren, Brittany D. Glavin, Joann R. Frank, Sandra L. Ham, Heidi A. Notheisen,
Karen L. Raider and Debra C.Schneider of St.Louis,Missouri- ------- ---------
each as their true and lawful Attorney-in-Factto execute under suds designation in their names and to affix their corporate seals to and deliver for and on their behalfas surety
thereon or otherwise,bonds and undertakings and other wobgs oMlgalay In the nature thereof(odder than bail bonds)given or executed In the course of business,and any
instruments amending or altering the same,and consents to the modulation or alRraton of any instrument referred to in said bonds or obligations.
In enema Whereof,Said FEDERAL INSURANCE COMEANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each executed and attested
Nese presents and affixed their corporate seals on this let day of March,2016.
lit s.Assistant v.
Secretary Do :. orris. r'Vice Pr L_L
e"' •`'"^ v�(*) F V
STATE OF NEW JERSEY
as.
County of Somerset
On this let day of March, 2016 before me,a Notary Putt of New Jersey.personalty Caine Dawn It Chwros,to me known to be Assistant Secretary of FEDERAL
INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY,the companies wltldl executed the foregoing Power Of Attorney,and the
SSM Dawn M. Chbms, being by me duly awom, did depose and say that she Is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE
COMPANY,and PACIFIC INDEMNITY COMPANY and knows the corporate seals Hereof,that the seals affixed to Me foregoing Power of Attorney are such corporate seals
and were thereto affixed by authoriy doe By-Laws Of Said Companies:and that she sgned said Power of Atomey as Aasistart Seaetery Of said COmpanire by like autaiy,
and that she is acquainted with David B.Norris.Jr.,and knows him to be Y President of said Companies;and that the signature Of David B.Norms,Jr.,subscribed to said
Power of Attorney is in the genuine handwriting of David B.Norris.Jr.,and was thereto subscribed by autmy M said By-Laws and In deponent's presence.
Notarial Seal .40.a`e \
Al KATHERINE J.ADELAAROTARY - NOTARY
PUBLIC OFNEW
JERSEY /
1
N0. 5
PUMA
� Commission Expires July ta,2o19
Notary Pudic
JER°+ CERTIFICATION
Extract from the By-Laws Of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY.
'Except as otherwise provided In these By-laws or by law or as otherwise directed by the Board of Directors,the President or any Vice President shall be autonad to
execute and deliver,in the name and on behalf of the Corporation.all agreements,bones,contracts,deeds,mortgages.and other instruments,either for the Corporations
own account or In a fiduciaryor other capacity.and the seal of the Corporation,it appropriate,shall be awed thereto by any of such officers Or the Secretary or an Assistant
Secretary. The Board of Directors,the President or any VO)President desgnaktl by the Board of Directors may authorize any other officer,employee or agent to execute
and deliver, in the name and on behalf of the Corporation, agreements,bans, contracts, deeds. morgages.and other Mstrume ts,either for the Corporation's wet
account or in a fiduciary or other capacity,and.H appropriate to affix the seal of the Corporation thereto. The grant or aunt authority by the Board or any such Omttr may
be general or confined to specific Instances.'
I,Dawn M.Chios.Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY(the'Companies')
do hereby cenlf that
(B the bregomg extract Of the By-Laws of the Companies is true and Correct.
(ii) the Companies are duly licensed and authorized to transact surety business in all SD of the United States OfAnirica and the Dsmct of Columbia and are
autonzed by Use V.S.Treasury Department;Neer.Federal end Vigilant are licensed In the U S.Virgin Islands,and Federal Is licensed in Guam,Puerto
Rico.and each tithe Provinces of Canada except Pence Edward Island,and
(iii) the foregoing Power of Attorney is true,cored and in full force and effect.
Given under my hand and seals of said Companies at Warren,NJ this 5th day of April, 2017.
(rya) 0 ..r,,,,,j7.4).
b � ! �' 1 I 1 , �i
Dawn M.Chores,Assistant Secretary
s THE EVENT YOU WISH TD NOTIFY US OF A CLAIM,VERIFY THE AUTHENTICrrY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER PLEASE CONTACT US AT ADDRESS
iS
LISTED ABOVE,OR BY Telephone 1008)WE Max Fax(908)903-TRW amait swetrelo ith cin
Form 15-1O-0225B-U GEN CONSENT('ev.07-15)
FEDERAL INSURANCE COMPANY
STATEMENT OF ASSETS, LIABILITIES AND SURPLUS TO POLICYHOLDERS
Statutory Basis
DECEMBER 31,2016
(in thousands of dollars)
LIABILITIES
AND
ASSETS SURPLUS TO POLICYHOLDERS
Cash and Short Term Investments $ (86,990) Outstanding Losses and Loss Expenses..... $ 11,482,308
United States Government,State and Unearned Premiums 2,723,875
Municipal Bonds 8,135,311 Ceded Reinsurance Premiums Payable 566,868
Other Bonds 5,471,330 Provision for Reinsurance 29,339
Stocks 130,689 Other Liabilities 1,144,976
Other Invested Assets 1289,903
TOTAL INVESTMENTS 14,940,243 TOTAL LIABILITIES 15,947,366
Investments in Affiliates:
Chubb Investment Holdings, Inc 3,727,406 Capital Stock 20.980
Pacific Indemnity Company 2,926,619 Paid-In Surplus 3,106,809
Executive Risk Indemnity Inc 1250,965 Unassigned Funds 8,296,020
Great Northern Insurance Company 504,162
Vigilant Insurance Company 319,505
Chubb European Investment Holdings,SLP. 277,361 SURPLUS TO POLICYHOLDERS 11,423,809
Chubb Custom Insurance Company 214.956
Chubb National Insurance Company 162.929
Chubb Indemnity Insurance Company 163,668
Other Affiliates 70,204
Premiums Receivable 1,510,107
Other Assets 1,303,050
TOTAL LIABILITIES AND SURPLUS
TOTAL ADMITTED ASSETS $ 27,371,175 TO POLICYHOLDERS $ 27,371,175
Investments are valued in accordance with requirements of the National Association of Insurance Commissioners.
At December 31,2016, investments with a carrying value of$565,702,495 were deposited with government authorities
as required by law.
State,County&City of New York. — ss.
Dawn M. Chloros,Assistant Secretary of the Federal Insurance Company
being duly sworn, deposes and says that the foregoing Statement of Assets, Liabilities and Surplus to Policyholders of said
Federal Insurance Company on December 31,2016 is true and correct and is a true abstract of the Annual Statement of said
Company as filed with the Secretary of the Treasury of the United States for the 12 months ending December 31,2016.
Subscribed and sworn to before me
this March 3,2017.
J No.02SE SHIPSEY Assistant Secretary
in Nassau
Notary Public,State of New York
Notary Public 74142
Qualified in NasCounty
Commission Expires March 10.2019
Form 15-10-0313A(Rev.3f171
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 Riverside
On April 5th, 2017 before me, Candace Gallaher - Notary Public
(insert name and title of the officer)
personally appeared Michael Hutchens
who proved to me on the basis of satisfactory evidence to be the persons) whose name(*islars
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/har their authorized capacity(es), and that by his/her/their signature(e) on the instrument the
person(A), or the entity upon behalf of which the person(e) 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.
55 CANDACE GALLAHER E
WITNESS my hand and official seal. � ` Commission♦2117338•C ' 7:
I :
r Notary Public California I
v. Orange County
/ My Comm.Expires Jul 24,2019E
Signature # # I I (Seal)
BIDDER: Si€M10.mc Tndi.sin, 1AC.
2.6 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 Contractors 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
Contractors 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- 7
BIDDER: SIF-m¢mc Infiacfrij Inc .
2.B LIST OF PROPOSED SUBCONTRACTORS(continued)
("Duplicate Next 2 Pages if needed for listing additional subcontactors."I
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: N i A
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 Na
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.
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
License No.:
Department of Industrial Relation Registration No.
CBF- 8
BIDDER: 1te,yho-.,.T v.Jl.Sfriif1YnC.
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:
t Cid oc Srd'twa L1413 00C Cavy3\A93 It-o; (=4 `12618
Name and Address of Owner ;J
DQVc. C\av\aQ(,n
Name and telephon number of person familiar with project
$ 1`�9J�0o " TY'S '�af'1ace..te,,,.ts Oagn', r�4
CCCcontract amount Type of Work Date&ComNleted
2- 'i .. '1•..r • , \y\ . . . - ' ' • . ' a . ' 120 .
War- and Address of Owner -
SarKit Drsoora. . 818 -S`1 o - 3rltoo
Name and telephone number of person familiar with project
i.53_2.2;5 G0 �.'�,yr 11.�t +install Lel) =sV:] 0n . pqo,nqq
Contract mount 1 Pype of Work Date ComtJletedl
3. CvA1 0 4 anona 1 31:10 Centro 1 4,,-.
Nameand Address of Owner
\) CA'or U - 909- 334- 34L4
Name and telephone number of person familiar with project
S29 1-54• cclace. Ltll'' O•rtgDt q
Contract amount Type of Work Datee--�tompleted
4. C.;.4-,4 _>< Or.lnr;o_ 3o3 E B .Si . 0K+0.6o Co . `1t3(y4
Name and Address of Owner
Ru\O tin Ca Marta As goe - 395- Ub,2
Name and telephone number of person familiar with project
Its ono " LC1 2s+to4f Om rq
ontract amount Type of Work Date-Completed
CBF- 9
BIDDER. RiQ.menS Zvic46LSftj.Inc
SECTION 3
NON-COLLUSION AFFIDAVIT
CBF - 10
BIDDER: urn ev.S IrnaZwSty.5,In c-.
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 f x 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 • -ny corporation,
partnership, company association, organization, bid deposito • ember or agent
thereof to effectuate a collusive or sham bid.
ralliWre
Signat �!
. j 14\rhael J- Nw+Ckvv.9
JTyped or Printed Name
SW Up wt o„5 hAAojw
{ Title
SLrrex.e I.vrrkueYrl . 2r.e -
- Bidder
Subscribed and n before me i "-0`� See,
This day of , 20
(Seal)
Notary Public in and for
the State of California
My Commission Expires:
CBF - 11
CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE§8202
rcn-ccre(•Z^.rmcxt-:c-,5stestr. :cteerrcc-,erra<-,cxcrr-c-,O(X e ecx:(0450 c, rsc-Xl,ne Cct.m
fi 3ee Attached Document (Notary to cross out lines 1-6 below)
fi See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary)
111 / 1
fi 3
3 3
Son for of Document Signer No.1 signature of Docum Signer Nu.201 any)
44
OOfi State of Californiali" Subscribed and sworn to (or atfirme efore me
County of 9�A\iQMV1-K1 on this en day of rl\ , 20 U] ,
Dale Month Teo
by •
p 3
LI (1) 1 „;me u1 Signer.l I i5
CANDACE GALLAHER
Commission•2117338 s proved to me on the basis of satisfactory evidence
< R Notary Public-California > to be the person who appeared before me (-HO-
7' 40 " Orange County a 20t° ( .
24 z My Comm.Doves Jul 2J
(2) Name of Signer
proved to me on the basis of satisfactory evidence
to be the erson ho ap .`e ?pfor. me.) ,'
Signature al t 111 I 1 I f
Place Notary Seal Above Signature•1 Nota y Public
ICCC OPTIONAL kb
-IGHT THUMBPRINT RIGHT THUMBPRINT
OF SIGNER At OF SIGNER p2
,? Though the Ir al on below is not metered by law R may prove. valuable Too of thumb here fat A mw nb here I
1% to personsrelying on the document and could prevent I' d le t removal SII
a 1d reattachment of this form to of er document 5
Further Description of Any Attached Document 3
Title or Type of Document. _ _
Document Date. Number of Pages-
Pignegsl Other Than Named Above
02w'-NatteoceAaochrui- t-r. :cteheouXOTARtet-800-87G-602 w—tfAAcet'u^u.�uu,t-tett-c.' ,ecItem J1
®2010 National Notary Association•NelionalNotary erg•1 RIO IIS NOTARY 11800 87668291 Item OA110
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DELEGATION OF APPROVAL AUTHORITY FROM
PRESIDENT KEVIN RIDDETT AND VICE PRESIDENT FINANCE&BUSINESS
ADMINISTRATION MATTHIAS SCHLELEIN
Mobility Management
Urban Transport l Mainline Transport
Intelligent Traffic Systeme
Rall Electrification
Customer Services
SIEMENS INDUSTRY,INC.—MOBILITY DIVISION
A The undersigned Judy Marks, Acting President and Matthias Schfelein,Vice President,
Finance and Business Administration of the Mobility DMNslen of Siemens Industry, Inc. (the
'Corporation'), a corporation duly organized and existing under The laws of the State of Delaware,by
virtue of the authority vested as President and Vice President Finance&Business Administration to
sign or countersign and otherwise execute In the name, or on behalf of the Corporation,any bids,
projects,contacts,agreements end any certificates,affidavits or ancillary documents In connection
Therewith to the extent the foregoing instruments and aro consistent with the limits of authority
granted under LoA guidelines and grants of release for and on behalf of the Corporation,do hereby tlI
delegate to and acknowledge that the following person(s)may exercise such authority for end on our
behalf up to$10 million.
AUTHORIZED SIGNATORIES
Business Ooeretions Finance/Central Surma rt Function
jName/Posihon) (Name/Positlnnl
John PaiJug Marsha Smith
VP—MM Senior Director,FBA—MM
Michael Cahill, Christopher Halleus,
VP—UT&MLT FBA—UT&MLT
Robin Stimson Michael Tyler
VP -UT&MLT MK&S Senior Director,FBA—CS
Chris Maynard Madeline Rodriguez
VP—CS Director LM
Steffen Goeller Miriam Scheer
VP—TPE FBA—TPE
Dave Ward James Thornton
VP—LM Head of Procurement—MC
Marcus Welz Rajarshi Ghosh
VP—ITS ITS BA
Steffen Hertel
Acting FBA—LM 4, [
B. It is further acknowledged that the following Individuals are hereby authorized to elfin or countersign
and otherwise execute in the name or on behalf of the Corporation the same documente ae j
referenced In paragraph A,up to end including a transactional limit of$5 million.Any ouch delegation
extends to but Is limited to the same scope,dominants and subject matter as referenced and granted
in paragraph A, limited to the monetary amount slated In this paragraph.
AUTHORIZED SIGNATORIES
Business Operations Finance/Central Support Function
(Name/Poston) maw/Roston)
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Douglas Dreisbach Catherine Wlson
Director of Projects, MM Manager,FDA—MM _
Jack Wilson Valerie Conway
Sales,MM Senior Director.SCM UT&MLT
Steve Glikin Jessica Shalegen
Sales Director-ITS Director,Procurement—MM
David Gutierrez Thomas VNechert
Director,UT Director LR
Luis Tench Resta Stefan Fischer
Director, Products, MM Finance Manager,MM
Matthew Rumbold
Manager, Procurement—CS j f
C. It is further acknowledged that the following individuals are hereby authorized to sign or countersign
and otherwise execute fn the name,or on behalf of the Corporation,the same documents as
referenced in paragraph A, up to and including a transactional limit of S3 million. Any such delegation
extends to but is limited to the same scope,documents and subject matter es referenced and granted y r
In paragraph A,limited to the monetary amount stated in this paragraph.
AUTHORIZED SIGNATORIES
Business Operations fence/Central Support Function
LNamttE201pn1 fNamelPasition} •
Tony Ritter Nikki Basal
Director, CS Director.UT
Reiner Martin Cathie Steele
Director CS Segment Controller CS UT
Omld Akbarzadeh-Paydar Wm Swain
Director,EG Segment Controller,MC I i
Mark Bennett Kelly Storin
VP,Operations UT&MLT Segment Controller,BG •
Raymond Sinned Carrie Hernandez
General Project Manager LM&MC Manager,SPR
Arnln Kick Michelle Picard
Director, HI Director, UT&MLT
David Hart Mlrko Giese
Manager,TPE Director,HI BA
Florian Walter Matihaeus Decker
Director CS SPR
Steve Teal Crelg Debevolse
Director, ITS Service Proecs Commercial,ITS
Dimitrios Anddkos David Anderson
Director, Bld&Project Management, ITS Project Procurement Manager,TPE
D. It is further acknowledged that the following individuate are hereby authorized to sign or countersign
and otherwise execute In the name,or on behalf of the Corporation,the same documents es
referenced in paragraph A,up to and Including a transactional limit of St million.Any such delegation
extends to but is limited to the same scope,documents and subject matter as referenced end granted
In paragraph A, limited to the monetary amount stated In this paragraph.
AUTHORIZED SIGNATORIES
Business Operations Finance/Central Support Function
(Name/Position) JName/Positiont
Stephan Klein, Tommy Charurat
Director, MM Director, Performance Controlling
IUT&MLT
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Paul Ellen, Sandra KIWheusen,
Director MM Commercial Manager, MM
David CoeMilo, Gisela Kaumienn
Director,MM Controller,MM i
Cave Jeanette Rudolf Wagner
Manager, MM Perfom,ancelControlling, MO
Jim Lyons Constance Kutschki
Sr. Manager,MM Manager,Order Management UT Sr MLT i
Jeff Balogh Ronald Stags
Sr. Director, MM Commercial Project Manager LIT
George Long Mary Matos l
Director, Engineering UT&MLT Commercial Project Manager,UT I
Robert Mariner Vasa Venhinen '
Senior Pro eat Mana•er, LM Commercial Pro ect Meneter,UT •
Jeffrey Curran Christine JaW,
Project Manager, UT Commercial Prolect Manager,CS
Duane Kapp Larry Chan i 3
Project Manager,CS Commercial Project Manager, CS
Ron VanHuukslcot Kavlla Petal I !
Project Mahegor,UT Commercial Project Manager,CS •
Thomas Stahllk Patrick Blackbume
Project Manager, UT Commercial Protect Manager,UT&MLT
Vlore!Anr,olu Christaph FIIlgers
Project Manager.UT Director, Operations Controlling UT&MLT 1
Carsten Nebe Manuel Schlmheifer • ',
Project Manager,UT Commercial Project Manager,LM
Mark Anderson Christopher Smith
Project Manager, CS Commercial project Manager, UT
Aeldrlk Matting Adam Huey '
Project Manager, UT Commercial Project Manager,LM
Jachen Woern Thomas Koprowekl
Project Manager CS Commercial Project Manager, Be Ih
Brad Bonn Gfrish Gupta
gJeat ManapBf CS Commercial Project Manager, LM
Chander Khanna, Amy Morrison' 1
Sr.Director,Manufacturing Processes Commercial Project Manager,TPE
UT&MLT
Paul Alchholzer David Spence
Project Manager, LM Commercial Protect Manager, ITS
Ibrahim Kalender Sabine Andnkos r¢
Project Manager, BG Commercial Service Manager, ITS
Berry Sider Natalle Mage
Program Manager,CS Commercial Project Manager,MM GI
Christopher Romeo Solomon Lee
Operations Manager,ITS Commercial Protect Manager.MMr
Luis Correia David Series •
Project Member,CS Procurement Commodity Manager, MM
Trine Baader Jensen Stuart Adler
Project Manager,CS __ Project Procurement Manager,MM _
Michael Hutchens Joel Nielsen
Operations Manager,ITS Commercial Project Manager,UT
William Tucker Carlijn Goldberg
Operations Manager,ITS Commercial Project Manager,BG
Christopher Mcelroy Matthew Chalmers •
Service Account Manager, ITS Finance Manager,MM
Gerhard Leitner James Rrynlewior
Field Engineering Management,CS Commercial Bid Manager,TPE •
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Ivan Bukln Darla Lesnyih
Project Manager,CS Commercial Project Manager,CS '
Brian Ouch Christopher Giesch
Project Manager,CS • Production Civil-oiler,TPE (I
Kevin McGrewDonna Lam t {
Director,Quality UT&MLT I Commercial Protect Manager,UT
Gouthem LIngannagari Noureenn Mitchell 1
I Senior Manager Projects, ITS ProcuremenlProleet Manager,ITS 1
David Scott Rose Saguaro
Branch Manager, ITS CommercialroJect Manager, ,
Field Service UT&MLT fI V
damil Naslr ISI
Engineering Director, MM
Ben Linden i
Senior Director Carborne Engineering,
_MM
Stephan Spred i
Project Manager,TPE
David Mortimer
Protect Manager,TPE
Chdslopher Hammett
Project Manager,TPE
TS Shoop
Project Manager TPE
Joshua Cardin
_IUD Manager,TPE
Abhlnev Mitre
Project Manager,TPE
' Shalleeh Malgeonker
Director of Operetlons TPE
Matthew Thomas ! F
Project Manager,CS
Mason Boswell _ I . y
Project Manager,UT 'I
Andreas Achhommer r
Project Manager.IPE J I ' j
Stefan Lauer I ` I
Project Manager,TPE
Drell Tharp
Prolect Manager,WE ! ,I
Mark Oodsey
Project Manager,WE
Shaven McCualg I
Director, Field Services UT&MLT i
E. It Is further acknowledged that the following Individuals am hereby authorized to sign or countersign
end otherwise execute In the name,or on behalf of the Corporation,the same documents as they are I�
referenced In paragraph A,up to and Including a trenaectianai Unit of 3250 thousand. Any such
delegation extends to but is limited to the same scope,documents and subject matter as referenced
and granted in paragraph A,limited to the monetary amount slated In this paragraph. i
AUTHORIZED SIGNATORIES
BuS=refs OperationsFinan /C tral9 pport Fq gjjgp
fNama/Posifionl :NamelPosll' 1
Diana Johnson Claudia Thiele
Bid Manager,ITS Commercial*cleat Maria er,ITS
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John Billings Cole Welker I
SW Manager,ITS ,Financial Analyst,WE
David Love
Sales Manager,ITS i
F. It Is further ackncNedged that each of the signatures of the pal one referred to In paragraphs A,B,
C,D,and E ere binding upon Ire Corpomtlon.
G. It Is furter acknowledged that any document shall require the slignatre of two(2)of the above
Authorized Signatories,one each from Business Operations anti from Finance/Central Support
Functions,whom shag have the requisite signature authority to 6 legally binding upon the
Corporation. I
H. It is further acknowledged that each of the persons referred to herein is authorized to delegate such
person's authoily heregnder to additional members of his or he management team up to the limit of 1
such person's delegation of authority,provided that such delegation is In written farm signed by the
delegator and filed with the Legal Department. I
I. It Is further acknowledged that the Secretary or en Assistant Seal re4ay of the Corporation le
authorized to Issue certifications attesting to the Incumbency,a thory and status of any of the
persons referred to In this resolution.
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IN WITNESS WHEREOF,we have hereunto subscribed ournanresiend affixed the corporate seal of the
said Corporation,as of the 1st day of January,2017.
jl f
, jui,liarko-6-1, R. 1 13 1'1
Aar President, i
Slemens Industry, Inc I
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_, si.4 ,.. Mobility Division p I
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,.r1r i4r .'IC•j.--- i 13i1 7 '
Matthias Schleleln
Vico President,Finance end Business Administration
Siemer,Industry, Inc. !
' Mobility Division I
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