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1293492.1
DECLARATION OF ELIGIBILITY TO CONTRACT
[Labor Code Section 1777.1; Public Contract Code Section 6109]
The undersigned, a duly authorized representative of the contractor,
certifies and declares that:
1.The contractor is aware of Sections 1777.1 and 1777.7 of the
California Labor Code, which prohibit a contractor or
subcontractor who has been found by the Labor Commissioner or the
Director of Industrial Relations to be in violation of certain
provisions of the Labor Code, from bidding on, being awarded, or
performing work as a subcontractor on a public works project for
specified periods of time.
2. The contractor is not ineligible to bid on, be awarded or perform
work as a subcontractor on a public works project by virtue of the
foregoing provisions of Sections 1777.1 or 1777.7 of the California
Labor Code or another provision of law.
3.The contractor is aware of California Public Contract Code Section
6109, which states:
(a) A public entity, as defined in Section 1100 [of the
Public Contract Code], may not permit a contractor or
subcontractor who is ineligible to bid or work on, or be
awarded, a public works project pursuant to Section 1777.1 or
1777.7 of the Labor Code to bid on, be awarded, or perform
work as a subcontractor on, a public works project. Every
public works project shall contain a provision prohibiting a
contractor from performing work on a public works project
with a subcontractor who is ineligible to perform work on the
public works project pursuant to Section 1777.1 or 1777.7 of
the Labor Code.
(b) Any contract on a public works project entered into
between a contractor and a debarred subcontractor is void as
a matter of law. A debarred subcontractor may not receive
any public money for performing work as a subcontractor on a
public works contract, and any public money that may have
been paid to a debarred subcontractor by a contractor on the
project shall be returned to the awarding body. The
contractor shall be responsible for the payment of wages to
workers of a debarred subcontractor who has been allowed to
work on the project.
4. The contractor has investigated the eligibility of each and every
subcontractor the contractor intends to use on this public works
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1293492.1
project, and determined that none of them is ineligible to perform
work as a subcontractor on a public works project by virtue of the
foregoing provisions of the Public Contract Code Sections 1777.1
or 1777.7 of the Labor Code, or any other provision of law.
I declare under penalty of perjury under the laws of the State of
California that the foregoing is true and correct. Executed this day
of ________________, 2023, at ___________________ (place of execution).
Signature
Name:
Title:
Name of Contractor:
_____________________________
April 26 Fullerton, CA
Andrew W. Bang
President/CEO
EIDIM Group, Inc. dba EIDIMA AV Technology
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1293492.1
BIDDER'S VIOLATION OF LAW/SAFETY QUESTIONNAIRE
In accordance with Government Code Section 14310.5 and in conformance
with Public Contract Code Section 10162, the Bidder shall complete,
under penalty of perjury, the following questionnaire:
QUESTIONNAIRE
Has the Bidder, any officer, principal or employee of the Bidder who
has a proprietary interest in the business of the Bidder, ever been
disqualified, removed, or otherwise prevented from bidding on or
completing a federal, state or local government project because of
violation of law or a safety regulation?
YES NO
If the answer is yes, explain the circumstances in the following space:
STATEMENT
In conformance with Public Contract Code Section 10232, the Contractor,
hereby states under penalty of perjury, that no more than on final
unappealable finding of contempt of court by a federal court has been
issued against the Contractor within the immediately preceding two-year
period because of the Contractor’s failure to comply with an order of
a federal court which orders the Contractor to comply with an order of
the National Labor Relations Board.
NOTE: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire.
Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution.
X
24
CONTRACTOR'S INDUSTRIAL SAFETY RECORD
Project Identification
Bid Date
This information must include all construction work undertaken in the
State of California by the bidder and any partnership, joint venture or
corporation that any principal of the bidder participated in as a
principal or owner for the last five calendar years and the current
calendar year prior to the date of bid submittal. Separate information
shall be submitted for each particular partnership, joint venture,
corporation or individual bidder. The bidder may attach any additional
information or explanation of data, which he would like, taken into
consideration in evaluating the safety record. An explanation must be
attached of the circumstances surrounding any and all fatalities.
ITEM 5 CALENDAR YEARS
PRIOR TO CURRENT YEAR
CURRENT
YEAR
2018 2019 2020 2021 2022 TOTA
L
2023
No. of Contracts
Total dollar amount of
contracts (in 1,000’s)
No. of lost workday
cases
No. of lost work day
cases
involving permanent
transfer to
another job or
termination of
employment
No. of lost workdays
*The information required for this item is the same as required for
columns 3 to 6, Code 10, Occupational Injuries, Summary - Occupational
Injuries and Illnesses, OSHA No. 102.
The above information was compiled from the records that are available
to me at this time and I declare under penalty of perjury that the
information is true and accurate within the limitations of these
records.
________________________________
Signature
________________________________
State Contractor’s Lic. No. & Class
________________________________
_____________________________
Name of Bidder (Print)
______________________________
Address
______________________________
City Zip Code
1293492.1
Telephone
Windmill Willow Room Audio Visual RFP
04/26/2023
2,869.634,668.74,082.34,680.12,678.3
43 30 33 23 7
18,979.03
0 0 0 0 0 0
136 3
800.00
0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Andrew W. Bang
1015 S. Placentia Ave.
Fullerton, CA 92831
824410; B, C7, C10, C33
(562) 777-1009
AFFIDAVIT FOR CORPORATION BIDDER
STATE OF CALIFORNIA )
)SS
COUNTY OF LOS ANGELES )
duly sworn, deposes and says:
That he is
of,
being first
a corporation which is the party making the foregoing proposal or bid;
that such bid is genuine and not collusive or sham; that said bidder
has not colluded, conspired, connived or agreed, directly or indirectly,
with any other bidder or person to put in a sham bid or that such other
person shall refrain from bidding; and has not in any manner sought by
collusion to secure any advantage against the City of Diamond Bar or
any person interested in the proposed contract, for himself or for any
other person.
Subscribed and sworn
to before me this
;etigna ture
,,,..,-
;;.z.. l day of __ ___._A_P,_r_�---'-/ _____ , 2 0 .;.'l. 3
1293492.1
I
Signature of Officer Administering Oath
(Notary Public)
26
Andrew W. Bang
President/CEO
EIDIM Group, Inc. dba EIDIM AV Technology
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
O n Of/. -z {-] UL-]before me, SUNG HUN AHN, NOTARY PUBLIC (insert name and title of the officer) personally appeared /2 "'� Y-<.? w W""' ' Is c:-. Y'\ > ,::::::::::;--, who proved to me on the basis of satisfactory idence to be e person�whose name¢;) �re �scribed to the within instrumelJY'c1hd acknowle.9fil:_d to me that �he'/they executed lhe same in0isjher/their authorized capacityj(es), and that bf.bigftier/their signature,(5jcn the instrument theperson� or the entity upon behalf of which the persr acted, executed the instrument.I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature---o::::,__k �/4....a::,______:��--· (Seal)
SUNG HUN AHN l
COMM.# 2318062 NOTARY PUBLIC-CALIFORNIA (/) ORANGE COUNTY -
MY COIIM. EXP. JAN. 22, 2024 _.
BID BOND
KNOW ALL PERSONS BY THESE PRESENTS that,
WHEREAS the City of Diamond Bar ("City"), has issued an invitation
for bids for the work described as follows:
Project No. FP 23504
WINDMILUWILLOW ROOM AUDIO VISUAL & PRODUCTION CONTROL ROOM SYSTEMS UPGRADE PROJECT
WHEREAS EIDIM Group, Inc. dba EIDIM AV Technology
1015 South Placentia Avenue, Fullerton, CA 92831 (Name and address of Bidder)
("Principal''), desires to submit a bid to Public Agency for the work.
WHEREAS, bidders are required under the provisions of the California
Public Contract Code to furnish a form of bidder's security with their
bid.
NOW, THEREFORE , we, the undersigned Principal, and.
The Gray Casualty & Surety Company
1225 West Causeway Approach, Mandeville, LA 70471 (Name and address of Surety)
("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto Public Agency
in the penal sum of TenPercent oftheTotalAmountBid
Dollars ( $ ----10% -----) , being not less than ten percent ( 10%) of the
total bid price, in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind oursel ves,
our heirs, executo rs, administrators, successors, and assigns, jointly
and severally, firmly by these presents.
THE CONDI TION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded
Principal is awarded a contract for the work by City and within the
time and in th e manner required by the bidding specifications, entered into the written form of contract included with bidding specifications,
furnishes the required bonds, one to guarantee faithful performance and
the other to guarantee payment for labor and materials, and furnishes
the required insurance coverages, then this obligation shall become
null and void; otherwise, it shall be and remain in full force and effect.
In case suit is brought upon this bond, Surety further agrees to pay
all court costs incurred by City in the suit and reasonable attorneys'
fees in an amount fixed by the court. Surety hereby waives the
provisions of California Civil Code § 2845.
IN WITNESS WHEREOF, each of which shall for all purposes be deemed an
original hereof, have been duly executed by Principal and Surety, on
the date set forth below, the name of each corporate party being hereto
affixed and these presents dul y signed by its unde rsigned
representative(s} pursuant to auth ority of its governing body.
Dated: April21st.2023
"Principal"
EIDIM Group, Inc. dba EIDIM AV Technology
1015 South Placentia Avenue Fullerton CA 92831
Its
"Surety"
The Gray Casualty & Surety Company
1225 West Causeway Approach, Mandeville LA 70471
By: Its Christin R ge Attorney-in-Fact
By: \�ss
Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as atto rney-in
fact must be attached.
(Seal) (Seal)
34
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 isattached, and not the truthfulness, accuracy, or validity of that document.
State of California County of ORANGE
On Off---2.( -2, 02-7 before me, SUNG HUN AHN, NOTARY PUBLIC (insert name and title of the officer)
personally appeared A� Yew Wu"' ' ',"' I )c,vi ".', ,,,c:· -' who proved to me on the basis of satisfacto evidence to b the Rerson(�whose name(.s1 (€)ire �scribed to the within instrument and acknowle�d to me tha�hefthey executed the same in(hi_yher/their authorized capacity� and that b�/fner/their signatur��on the instrument the perso� or the entity upon benalf of which the perso � acted, executed the instrument.
I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoingparagraph is true and correct.
(Seal)
SUNG HUN AHN �
COMM.# 2318062 (/) NOTARY PUBLIC· CALIFORNIA Oi!ANGE C0UIITY -
MY C0MY. EXP. JAIi. 22, 2024 _.
CALIFORNlA ALL-PURPOSE ACKNOWLED GEMENT
A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed
the document lo which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California County of Orange } On ____ A_P_R_2_1 _2 _02_3 ____ , before me, __ A_l_be_rt_M_e_le_n_de_z ___ ��N'-"o'"'"'ta=r..,__y--=-P--"'u=b=li=c,personally appeared _____________ C_h_ri_st_in_a_R_o-'g=--e_rs ____________ _ who proved to me on the basis of satisfactory evidence to be the person(X) whose name ().!;) is/ate subscribed to the within instrument and acknowledged to me that tle/she/th:t y executed the sa me in h>s/her/tlreir authorized capacity(iJ1:s), and that by lifs/her/their signature(� on the instrument the person(�, or the entity upon behalf of which the person(,X) acted, executed the instrument. I certify under PENALTY OF PERJURY u nder the laws of State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
SIGNATURE. __ __.A'--1 ....... /::::...._ ________ _
PLACE NOTARY SEAL AllOVE
Though the information below is not required by law, ii may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of attached document Title or type of document : __________________________ _
Document Dat e: _________________ Number of Pages: _______ _
Signer(s) Other than Named Abov e: ______________________ _
THE CRAY INSURANCE COMPANY
THE GRAY CASUAL TY & SURETY COMPANY
Perfom1ance Bonding
12/15/2022 09:30 5585400 70260
GENERAL POWER OF ATTORNEY
Bond Number: NIA-Bid Bond Principal: EIDIM Group, Inc. dba EIDIM AV Technology
Project: VVINDMILL/WILLOW ROOM AUDIO VISUAL & PRODUCTION CONTROL ROOM SYSTEMS UPGRADE PROJECT, CITY PROJECT NO. FP 23504
Date: April 21st, 2023
KNOW ALL BY THESE PRESENTS. THAT The Gray Insurance Company and The Gray Casualty & Surety Company, corporations duly
organized and existing under the laws of Louisiana, and having their principal offices in Metairie, Louisiana, do hereby make. constitute. and
appoint: Melissa Lopez, James W. Johnson, Jennifer Anaya, Chrisina Rogers, Christina Johnson, and Erik Johansson of Tustin,
California jointly and severally on behalf of each of the Companies named above its trne and lawful Attomey(s)-in-Fact, to make, execute. seal and deliver. for and on its behalf and as its deed, bonds, or other writings obligatory in the nature of a bond, as surety, contracts of suretyship as arc
or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract of suretyship executed
under this authority shall exceed the amount of $15,000,000.00.
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of both The Gray Insurance Company and The Gray Casualty & Surety Company at meetings duly called and held on the 261h day of June. 2003.
"RESOLVED. that the President, Executive Vice President. any Vice President. or the Secretary be and each or any of them hereby is authorized to
execute a power of Attorney qualifying the attorney named in the given Power of Attorney to execu1e on behalf of the Company bonds.
undertakings, and all contracts of sure1y. and that each or any of them is hereby authorized to attest to the execution of such Power of Attorney, and
lo attach the seal of 1he Company; and it is
FURTHER RESOLVED, 1ha1 1he signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any
certificate relating thereto by facsimile. and any such Power of Anomcy or certificate bearing such facsimile signature or facsimile seal shall be
binding upon the Company now and in the future when so affixed with regard to any bond, undertaking or contract of surely lo which it is attached.
IN WITNESS WHEREOF, The Gray Insurance Company and The Gray Casualty & Surety Company have caused their official seals to be hereinto
affixed, and these prcscn1s to be signed by 1hcir authorized officers this 281h day of October, 2021.
State of Louisiana
ss: Parish of Jefferson
Michael T. Gray
President
The Gray Insurance Company
Of Cullen S. Piske
President The Gray Casualty & Surety Company
On this 28th day of October, 202 I, before me. a Notary Public, personally appeared Michael T. Gray, President of The Gray Insurance Company.
and Cullen S. Piske, President of The Gray Casualty & Surety Company, personally known to me. being duly sworn, acknowledged that they
signed the above Power of Attorney and affixed the seals of the companies as officers of, and acknowledged said instrument lo be the voluntary act and deed. of their companies.
(".! l�i;h /1.:-.:-.e H!:r.i::z,,
Notcry PublicNotary ID No. 92653
Orleans Parish, Louisian;;
\,l{,W (/JV\-
Leigh Anne Hcnican Notary Public, Parish of Orleans State of Louisiana
My Commission is for Life
tHRAY SURETY
Telephone: 504-780-7 440
info@graysurety.com
The Gray In surance Company
The Gray Casualty & Surety Company
Surety Bond Seal Addendum
P.O. Box 6202
Metairie, LA 70009
In response to the logistical issues associated with the Covid-19 pandemic, The Gray Insurance
Company and The Gray Casualty & Surety Company, (individually, the "Com pany" and
collectively, the "Companies") have authorized the Attorneys-in-Fact named on the Power of
Attorney attached hereto and incorporated herein by reference to affix the Companies' seal to
any bond executed on behalf of the Companies by any such Attorney-in-Fact by attaching this
Addendum to said bond.
To the extent this Addendum is attached to a bond that is executed on behalf of any of the
Companies by such Attorney-in-Fact, each Company hereby agrees that the seal below shall
be deemed affixed to said bond to the same extent as if its raised corporate seal was physically
affixed to the face of the bond.
Dated this 1 Day of January 2021
By:
Cullen S. Piske
President, The Gray Casualty & Surety Company
Attorney-in-Fact, The Gray Insurance Company
35
1293492.1
CERTIFICATION OF NON-DISCRIMINATION AND AFFIRMATIVE ACTION
As suppliers of goods or services to the City of Diamond Bar, the firm
listed below certifies that it does not discriminate in its employment
with regards to race, religion, sex, or national origin; that it is in
compliance with all federal, state, and local directives and executive
orders regarding non-discrimination in employment; and that it will
pursue an affirmative course of action as required by the affirmative
action guidelines.
We agree specifically:
1.To establish or observe employment policies which affirmatively
promote opportunities for minority persons at all job levels.
2. To communicate this policy to all persons concerned including all
company employees, outside recruiting services, especially those
serving minority communities, and to the minority communities at
large.
3.To take affirmative steps to hire minority employees within the
company.
FIRM
TITLE OF OFFICER SIGNING
SIGNATURE DATE
Please include any additional information available regarding equal
opportunity employment programs now in effect within your company:
EIDIM Group, Inc. dba EIDIM AV Technology
President/CEO
04/26/2023
N/A
36
1293492.1
CERTIFICATION WITH REGARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND THE FILING OF REQUIRED REPORTS
The bidder , proposed subcontractor , hereby certifies that
he has , has not , participated in a previous contract or
subcontract subject to the Equal Opportunity Clause, as required by
Executive Orders 10925, 11114, or 11246, and that he has , has not
, 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 filing
requirements.
(COMPANY)
BY:
(TITLE)
DATE: , 20 .
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 of such other
period specified by the Federal Highway Administration or by the
Director, Office of Federal Contract Compliance, U.S. Department of
Labor.
EIDIM
X
EIDIM Group, Inc. dba EIDIM AV Technology
Andrew W. Bang
President/CEO
April 26 23