Marina Landscape, Inc.li
CITY OF ROSEMEAD
,l
_l
RAMONA BOULEVARD
BEAUTIFICATION PROJECT
CONTRACT BID FORMS
BIDDER: wi,ri n6 Landscane I
SECTION 1 - BID SCHEDULE
J
J
i
J
J
CBF-0
BIDDER: On t 1 ~(AfId MLVJ II(A
BID SCHEDULE -
SCHEDULE OF PRICES FOR
RAMONA BOULEVARD BEAUTIFICATION PROJECT
i
J
J
I
I
BASE BID SCHEDULE
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
1
Clearing 8 Grubbing per plans and
1 Ip~
I
1 000-
specifications
LS
1
2
Disposal of Waste Materials
LS
1
Z I
21 100,
3
Furnish and Install 24-Inch Box
Pl
110
ans
Eucalyptus Torquata per
and Specifications.
Ea
29
4
Furnish and Install 5-gallons
lans
er
ose
R
k
Ci
t
10,
p
r
p
oc
s
us
Shrubs
and specifications.
Ea
34
5
Furnish and Install 5-gallons
Echium Candicans per
Sh
b
10•
qua
ru
s
plans and specifications.
Ea
46
6
Furnish and Install 5-gallons
~'72
~
Shrubs Muhlenbergia Rigens per
.
.
plans and specifications.
Ea
31
7
Furnish and Install 5-gallons
rmium Maori Queen
Ph
Sh
b
2 Z
232
1
o
ru
s
1
per plans and specifications.
Ea
56
8
Furnish and Install 5-gallons
riculata
er
A
Pl
b
1~
1•
p
ago
u
um
Shrubs
plans and specifications.
Ea
14
9
Furnish and Install 5-gallons
Shrubs Rosa Banskiae per plans
1~-
and specifications.
Ea
15
10
Furnish and Install 5-gallons
ia Fruticosa per
t
in
Sh
b
W
r
g
es
ru
s
plans and specifications.
Ea
68
11
Furnish and Install 1-gallon
er
Acacia Redolens
d
G
3U
2 tto
2
p
cover
roun
plans and specifications.
Ea
68
12
Furnish and Install 1-gallon
Groundcover Lantana
'~~SU
`
172'
Montevidensis per plans and
1
specifications.
Ea
453
CBF-1
BIDDER: 'u a m LAI ycow l iv
J
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
13
Furnish and Install Flats @ 18"
O.C. Myoporum Parvifolium per
plans and specifications
Flat
260
14
Furnish and Install 5-gallons Vines
Macfadyena Unguis Cati per plans
I lbw
and specifications.
Ea
73
15
Furnish and Install Irrigation
2I
C
~
SC
2
System Complete per plans and
,
J
-
t
specifications.
LS
1
16
Furnish and Install Miscellaneous
Concrete Work Complete per
plans and specifications.
LS
1
(g? 2
✓i
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$
StXT~I ~ Ck1 tZEE T~~SAND `JCi~(~~ ~yND~-fib ~1~'C~I -(~N~ Gltnr:~ N ~t~~f
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cannot be withdrawn for the number of Calendar Days indicated in the Notice Inviting Bids from and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. Project will be awarded on Base Bid Schedule.
Attached hereto is a certified check, a cashier's check or a bid bond in the amount of
Tv7>K, Dollars ) said amount being not less than ten percent (10%) of the Total
Bid Price. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
we fail or refuse to execute the Contract and furnish the required bonds, certificates and
endorsements of insurance and other certifications within the time provided.
I If awarded a Contract, the undersigned agrees to execute.the formal Contract, which will be
J 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
J other documentation and certification required by the Contract.
.J
CBF-2
BIDDER: I" ntjfi )I 1r1JS[AKJYV/-
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
and subject to the terms and conditions described in the Contract Form and the Contract
? Documents.
I
Bidder acknowledges that data submitted wi',h 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. <r' / ( l 27~ ~9 1
The Bidder understands and agrees that the Total Bid Price is inclusive of all labor, materials, and
i 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
J contract
CBF-3
In Testimony Whereof, the Company has caused this instrument to tie signed and its corporate seal to be affxed;by their.
authorized officers, this 12th day of January , 20Q2.
Attested and Certified
r
Martin J. Nil Secretary
STATE OF PENNSYLVANIA SS
COUNTY OF PHILADELPHIA SS
Arch Insurance Company
mtroui[ b
,.srnx
,m
Wood
r
J. Mi has 113 ete, ice i siden
I, Brian C. Kuhn, a Notary Public, do hereby certify that Martin J. Nilsen and J. Michael Pete personally known to me to be
the same persons whose names are respectively as Secretary and Vice President of the Arch Insurance.Company; a
Corporation organized and existing under the laws of the State of Missouri, subscribed to the foregoing instrument,
appeared before me this day in person and severally acknowledged that they being thereunto duty authorized signed,
sealed with the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as
their own free and voluntary ads for the uses and purposes therein set
00bAtONVVBAI.7HOP1`811INBYLV
NOTARIAL SEAL.
Brian C. Kuhn, Notary Poblic_ Brian C. Kuhn; Notary Public
CRY offtileddir ua, Philaxlephia County My commission expires 12-06-2011
CERTIFICATION M eommiuionex irefDmember06,2011
I, Martin J. Nilsen; Secretary of the Arch Insurance Company; do hereby certify that the attached Power of Attomeyda led
Jan arv 12 20~09 - on behalf of the person(s) as listed above is a true and coned copy and that the same has been in
full force and effect since the date thereof and is in full force and effect on the date of this certificate; and I do further.
certify that the said J. Michael Pete, who executed the Power of Attorney as Vice President,' was on the date of execution
of the attached Power, of Attorney the duly elected Vice President of the Arch' Insurance Company.
IN TESTIMONY WHEREOF, I have hereunto subscribed' my name and a ed the corpo I!of the Arch Insurance
Company on this 26th day of January 20 09
Martin J:.NII , Secretary
This Power of Attorney limits the acts of. those named therein to the bonds and undertakings specifically named therein
and they have no authority to bind the Company except in the manner and to the extent herein stated.
PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS:
Arch Contractors 8 Developers Group'
135 N. Robles Ave., Ste. 825
Pasadena, CA 91101
OOMLOO13 00 03 03
Page 2 of 2
~~8i!cer~
Lhcxad
Printed In U.S.A
By:
Signature -
lm ay\I(Ay)
Type or Print Name
yy,tS k
Title
BIDDER: 1" cwky G lvv/,
~ Q S Y Wl C sbi-tO
usinelss, Street Address
~C(11011,Y1°lYfl Cfl ~~5~
City, State and Zip Code
~I'~ICoCnbU
Telephone Number
Bidder's/Contractor's State of Incorporation: UM lfll~l^
Partners or Joint Venturers:
k\)ZA
Bidder's License Number(s): ~)YS LI(I113e NItYYt{°V; ~10&OO
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.
J
I
CBF-4
~j BIDDER: ~lNr 1 n~/1 lL\~~~UC~~ l~
i
SECTION 2
BID DATA FORMS
I
CBF-5
I
i.
BIDDER: Marina Landscape, Inc.
Bidder shall submit its Bid data in accordance with the format shown on each of the following BId
Data Forms, Bidders shall prepare and use as marry sheets as are necessary to adequately
provide the Information required. Bidder shall ensure that every page of $sBld Data Forms are
property identified with the Bidder's name and page number.
2A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT Marina Landscape, Inc
Principal, and
Arch Insurance Company as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) In the. sum of
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, johUy and
severally; firmly by these presents.
WHEREAS. said Principal has submitted a bid to the OWNER-to perform all Work
required for the Ramona Boulevard Beauttfication Project asset forth In the Notice
Inviting Bids and accompanying Bid Documents, dated
NOW, THEREFORE, if said Principal Is awarded a. Contract for the Work by the
OWNER and, within the time and in the manner required by the above- refarerroad
Bid Documents, enters Into the written form of Contract bound with said Bid
Documents, furnishes the required bonds (one to guarantee faithful peiformence
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, than this obligation shall be null and void;
otherwise It shall remain In full force and effect In the event suit is brought upon
thWbond by the OWNER and judgmant is. recovered, said Surety shall pay all costs
uuurrad bythe OWNER in such sutL including reasonable adomeys' fees Lobe fixed
by the court. .
SIGNED AND SEALED, this 26th . day of January 20 09
Maria andscape, Inc. _(SEAL) Arch Insurance C'ompany.(SEAL) _
Principal Suret
BY S BY i
9 a chew J. Coats - Attorney-In-Fact =
CBF-6
nr
CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
County of Orange
On JAN 2 6 2009
before me, Adelaide C. Hunterr Notary Public
(Here insert name and title of the officer)
personally appeared 11atthew J. Coats'
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/Elteir authorized
capacity(ies), and that by his/her/O teirsignature(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.
A,~
Signature of Notary Public
ADELAIDE C. HUNTER
Commission O 1808799
u Notary Public • California
Orange County
(Notary seal) Comm. Expires Au 8, 2012
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or description of enached document)
(Title or description of attached document continued)
Number of Pages _ Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑
Individual (s)
❑
Corporate Officer
(Tale)
❑
Partner(s)
❑
Attorney-in-Fact
❑
Trustee(s)
❑
Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Airy ackrtmrledgment completed in Calt1brma must contain verbiage a dy as
apxars above in the notary sircfom or a separate acknowledgment farm must be
property completed and attached to that docwnsnt. The only, ucepdon it if a
document ur to be recorded outside of Cal fornta In such instant", any altenuuive
acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the marry to do something that is illegal for a notary in
California (i.e. cenrying the authorized capacity of the signer). Please check the
document carefully for proper notarial wordtag and mach this form if required
• State and County infor ation most be the State and County where the document
stgnm(s) personally appeared before the notary public for acknowledgment.
• Date of notarization mart be the date that the signer(s) personally appeared which
most also be the same date the acknowledgment is completed.
• The notary public most print his or her name as it appears within his or her
eortuoission followed by a comma and then your tide (notary public).
• print the name(s) of document signer(s) who personally appear at the Nne of
nofarlmtion.
• Indicate the correct singular or plural format by crossing off incorrect forms (i.e.
IndsheAdwy,- is has) or circling the cortect forms. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproducible.
Impression most not cover tW or lines. If seal impression smudges, reseal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with the office of
the county cleric
R~ O Additional information a not required but could help to enure this
acknowledgment is not misused a attached to a different document.
O Indicate title or type of attached document, number of pages and date.
O Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document
2008 Version CAPA vl2.10.07 800-873-9865 www.NotmyClasses.com
CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
County of Orange
On before me, Kristen Ness. Notary Public
(Here ursert mane and title of the officer)
personally appeared
who proved to me on the basis of satisfactory evidence to be the personlo whose name( is/ subscribed to
the within instrument and acknowledged to me that he/ Ucy executed the same in hisdt)pj(t t& authorized
capacity AP, and that by his/kff/~pp* signature(, on the instrument the personk, or the entity upon behalf of
which the persontftacted, 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.
KFIS?EN NESS
ky~ d rialeal. NO oral PUBLIC LB9 FORON <
qp'
OFA
NCE WuNly A1r CoN+•+. Ezv. AC,. 111 110
n of otn Public (Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or description of attached document)
(Title or description ofattached document cominued)
Number of Pages Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑
Individual (s)
❑
Corporate Officer
critic)
❑
Partner(s)
❑
Attorney-in-Fact
❑
Trustee(s)
❑
Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in Californla must contain verbiage exactly ar
appears above in the notary section or a separate aalnawledgmentform must be
properly completed and attached to that document. The only armption is if a
document Is to be recorded outside ofCaltfornia In such instances, any alternative
acknowledgment verbiage ar may be printed on such a document so long as the
verbiage does not require the notary to do something that is illegal jar a notary in
Callforn to (4 e. certEfying the authorized capacity of the signer). Please checktha
document car;hdlytiorproper notarial wordu gand attach thisform cfrequired
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowlalgmeaaL
• Date of notarbation must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public mast prior his or her name as it appears within his or her
commission followed by a cornrna and than yon title (notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarimtioa -
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
hdsheidw, - is law) or circling the comect forms. Failure in correctly indicant this
information may lead to rejection of document mwrding.
• The notary seal impression must be clear and photographically reproducible.
Impression most not cover text or lines. If seal impression smudges, rascal if a
sufficient area permits, otherwise complete a different acknowledgment form
• Signature of the notary public must match the signature on file with the office of
the county clerk
4 Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different documem
O Indicate tide or type of attached document, number ofpages and data.
4 Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this documentto the signed document
2008Versioa CAPAv1210.07800.873.9865 wwwNotaryClasseacom
POWER OF ATTORNEY
Know All Men By These Presents:
That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its
principal office in Kansas City, Missouri (hereinafter referred to as the Tompany") does hereby appoint
Linda D. Coats, Matthew J. Coats, Timothy D. Rapp and Douglas A. Rapp of Laguna Hills, CA (EACH)
its true and lawful Attomey(s)-in-Fact, to make, execute, seal, and deliver from the date of issuance of this power for and
on its behalf as surety, and as its act and deed:
Any and all bonds and undertakings
EXCEPTION: NO AUTHORITY Is granted to make, execute, seal and deliver bonds or undertakings that guarantee the
payment or collection of any promissory note, check, draft or letter of credit.
This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond
within the dollar limit of authority as setforth.herein.
The Company may revoke this appointment at any time.
The execution of such bonds and undertakings in pursuance °f-these, presents shall be as binding upon the said
Company as fully and amply to all intents and purposes, as if the seime.had been duty executed and acknowledged by its
regularly elected officers at its principal office in Kansas City; Missouri.
This Power of Attorney Is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of
the Company on March 3, 2003, true and agate copies of which are. hereinafter set forth and are hereby certified to by
the undersigned Secretary as being in full force end effect . .
'VOTED, That the Chairman of the Board, the President, or any Vice President, or their appointees designated In writing
and filed with the Secretary, or the Secretary. shall have the power and authority to: appoint agents and attomeys-h4act,
and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and
undertakings, recognizanc es, contracts of indemnity and other writings; obligatory In the'riature thereof, and any such
officers of the Company may appoint agents for acceptance of process."
This Power of Attorney, is signed, sealed and certified: by facsimile under and by authority of the following resolution.
adopted by the unanimous consent of the Board of Directors of the Company on March 3, 2003:
VOTED, That the signature of the Chairman of the; Board. the 'President, 'or any Vice. President, or their' appointees
designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and
certifications by the Secretary, may be affixed by facsimile on. any power of attorney or bond executed pursuant to the
resolution adopted by the Board of Directors on March 3; 2003, and.any such power so executed, seated and certified
with respect to any bond or undertaking to which it Is attached, shall continue to be valid and binding upon the Company.
y
00ML0013 00 03 03
Page 1 of2 Printed, in U.S.A.
-I
BIDDER: ~Aoa ) n8 In I L"a , I r
2.13 LIST OF PROPOSED SUBCONTRACTORS
In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100
through 4114 of the California Public Contract Code, and any amendments thereto, each
Bidder shall provide the information requested below for each subcontractor who will
perform work, labor or render service to Bidder in or about the construction of the Work in
an amount in excess of one-half of one percent (greater than 0.5 of the Bidder's Total
Bid Price, or, in the case of bids or offers for the construction of streets or highways,
including bridges, in excess of one-half of 1 percent of the Contractor's total bid or ten
thousand dollars ($10,000), whichever is greater, and shall further set forth the portion of
the Work which will be done by each subcontractor. Bidder shall list only one subcontractor
for any one portion of the Work.
Pursuant to Public Contract Code Section 4104, the Owner has determined that it will allow
Bidders twenty-four (24) additional hours after the deadline for submission of bids to submit
the information requested by the Owner about each subcontractor, 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-7
I" BIDDER: M4rlnn ~Y~~~1I~'r I►~/.
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
I"Duplicate Next 2 Pages if needed for listing additional subcontractors.-]
Name and Location Description of Work
of Subcontractor to be Subcontracted /
Name: /VP SGG6G0lV7R~1 GTd3e~ IA71,-7-IC-1 ,~77CI~v
Address:
Name and Location Description of Work
of Subcontractor to be Subcontracted
i
Name:
Address:
i
i
I
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
CBF-8
H
l
I
l
I
_J
I
BIDDER: MJuf 1al r V=1.~ r I' `t'.
2.C 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:
Name and Adidress of Owner
CllriS LAEon (q';~ ( '~=141! exp. ,s ~ ~ursh~rr~~' Ei
Name and telephone number of person familiar with project
SglI 1q,? (adjm(t 1?ellw ~fiC/~ rh"d q 0311s108
Contract amount Type of Work Date Completed
2. L-N Q ~ I'm (Tuil/
Name d Address of Owner
(awd ',~Uxy- (-w) -771- X044? - Viect:~ e( rJlm ffi'F
Name and telephone number of person familiar with project CC
1 (01 !36 GCI lG~~(( °a~ff711CGL~]!/1I o(llbh
Contract arnount Type of Work Date Completed
3.
Name dd Address of Owner eLr (,e1ti11~ l dye
~l~crn ~ala,r (9s1) 0 -3D37 cards«o,571n
Name and telepho e number of person familiar with project
,-11 1,9 l~,iulJ~ar~~ ''aGrfi <ayioy~ 69/(~1107
4.
Completed
J(~Cf
Na and Address of Owner
~'no1111oV LY11;A11a ~~r~n~. r -n/il l1'ledicrn ~tl~~(~~~fprr~
N me and telephone Amber of person familiar with project
t40 D(20 (,V7dJ,4Pe,
Contract amount Type of Work Date Completed
CBF-9
ltcei; lPi It
t pYYiG~v
BIDDER: o n~. /i1 I L,
SECTION 3
NON-COLLUSION'AFFIDAVIT
CBF-10
BIDDER: moirln aYld,crT, k/.
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, ganization, bid depository, or to any
member or agent thereof to effectuate a collusi or sham bid.
DYp r I (nm n
Typed or Printed Name
_ffleMer A
Title
J Oairy ((AYJ«r PeIInc"
Bidder
Subscribed and sworn before me
J This day of rT/t flhr 20 (Seal)
KRISTEN. NESS
1 COMM.?? 1689170
J N 0-M NOTARY pALIFORNIA
ORANGE COUNTY
ary nA1r Cowl. Exc. 17G 26, 201
the State of California
My Commission Expires: Ab
I
CBF-11
BIDDER: " rim
CONTRACT BID FORMS
TABLE OF CONTENTS
SECTION 1 BID SCHEDULE ....................................................................................................1
SECTION 2 BID DATA FORMS 5
2.A BID BOND ..............................................................................................................6
2.6 LIST OF PROPOSED SUBCONTRACTORS 7
SECTION 3 NON-COLLUSION AFFIDAVIT ............................................................................10
I
I
CBF-12
J