HomeMy WebLinkAboutOther Required Documents per Bid Package.PDFDECLARATION 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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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.
T declare under penalty of perjury under the laws of the State of
California that the foregoing is true and correct. Executed this day
of April 26 2.921Q, at Upland, CA (place of execution) .
2023
Signature
Name: Stan Kojder
Title: President
Name of Contractor:
Sunset Electrical Contractors, Inc.
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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.
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CONTRACTOR'S INDUSTRIAL SAFETY RECORD
Project Identification FP23504
Windmill Willow Room Audio Visual
Bid Date 04/26/2023
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 surrcundina anv and all Fai-alitiPc_
ITEM
5 CALENDAR YEARS
CURRENT
PRIOR TO CURRENT YEAR
YEAR
2018
2019
2020
2021
2022
TOTA
2023
L
No. of Contracts
37
47
56
51
69
260
775,000
Total dollar amount of
contracts in 1,000's
1.2 mil
1.4 mil
1.5 mil
1,7 mil
2.1 mil
7.9 mil
27
No. of lost workday
0
0
0
0
0
0
0
cases
No. of lost work day
cases
involving permanent
transfer to
0
0
0
0
0
0
Q
another job or
termination of
employment
No. of lost workdays
0 J
0 1
0
0 1
0
0
0
*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
to me at this time and I declare
information is true and accurate
records.
Stan Kojder
Name of Bidder (Print)
280 N Benson Ave Suite 9
Address
Upland 91786
City Zip Code
from the records that are available
under penalty of perjury that the
within th�-, limitL tions of these
Signature
886050 B,C10
State Contractor's Lic. No. & Class
909-948-8851
Telephone
24
1293492.1
AFFIDAVIT FOR CORPORATION BIDDER
STATE OF CALIFORNIA )
)SS
COUNTY OF LOS ANGELES )
Stan Kojder
duly sworn, deposes and says:
That he is President
of, Sunset Electrical Contractors, Inc.
, 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.
Signature
Subscribed and sworn
to before me this
26 day of April , 2023
Signature of Officer Administering Oath
(Notary Public)
26
1293492.1
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:
Windmill/Willow Room Audio Visual & Production Control Room Systems Upgrade project No .
WHEREAS Sunset Electrical Contractors, Inc. dba Sunset Audio Visual
280 N Benson Ave, Suite 9, Upland, CA 91786
(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
Old Republic Surety Company
P.O. Box 1635, Milwaukee, WI 53201
(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 Ten Percent of Amount Bid
Dollars ($TenPercentofAmountBid ) , being not less than ten percent (100) 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 ourselves,
our heirs, executors, administrators, successors, and assigns, jointly
and severally, firmly by these presents.
THE CONDITION 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 the 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.
33
1293492.1
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 duly signed by its undersigned
representative(s) pursuant to authority of its governing body.
2 16
Dated: April, 2023
_�
"Principal"
Sunset Electrical Contractors. Inc.
dba Sunset Audio Visual
"Surety"
Old Republic Surety Company
B y : By
y ;---
T tJennlfe astillo Attor J lot
M
Its
M
Its
Note: This bond must be dated, all signatures must be notarized, and
evidence of the authority of any person signing as attorney -in -
fact must be attached.
(Seal)
34
1293492.1
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF 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 k,,,,,,
County of } "at
On obefore me, �` h,r� -�i1►
Z}T—ere insert name an�title o the officer)
personally appeared s� � bd +c,.K•
who proved to me on the basis of atisfactory evidence to be the person whose
name is/yamsubscribed to the within instrument and acknowledged to me that
he/fey executed the same in his/be#thrt authorized capacity9asf, and that by
his/4&Ffth'eir signature(p on the instrument the person�W, or the entity upon behalf of
which the personXacted, 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.
RHEA MATHIS
WIT S5 my hand and official seal. OMM. #2335386 z
e Notary Public - California q
z Los Angeles Countyk-ft'— IVN'4�' — -*
M Comm, Expires Oct. 13, 2024
No Public Signature (Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM
This fa°m complies with current California statutes regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT if needed, should be completed and attached to the document. Acknowledgments
,from other states may be completed for documents being sent to that state so long
�j ��� as the wording does not require the California notary to violate California notary
i3 law.
(Title or description of attached document) • State and County information must be the State and County where the document
810 f70711) 'll C rri of D1 Adel ON P SlAf, signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
(Title or description of attached document continued) must also be the same date the acknowledgment is completed.
+ The notary public must print his or her nine as it appears within his or her
Number of Pages 6 Document Date �' 23 commission followed by a comma and then your title (notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
4elshcAhey- is late) or circling the correct forms. Failure to correctly indicate this
❑ Individual (s) information may lead to rejection of document recording.
❑ Corporate Officer The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re -seal if a
(Title) sufficient area permits, otherwise complete a different acknowledgment form.
❑ Partner{s) Signature of the notary public must match the signature on file with the office of
the county clerk.
❑ Attorney -in -Fact Additional information is not required but could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached to a different document.
Other Indicate title or type of attached document, number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
2015 Version www.NotaryCl2sses.corn 800-873-9865 • Securely attach this document to the signed document with a staple.
State of Arizona
County of Marico a
On this 24th day of April it 20 23 , before me
personally appeared Jennifer Castillo
personally known to me or proved to me on the basis of satisfactory evidence to be the person(s)
whose name(s) is/are subscribed to the foregoing instrument and acknowledged to me that
he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s)
on the instrument the person(s), or the entity on behalf of which the person(s) acted, executed the
instrument.
Notary Public
Melanie Ankeney
MELANGE Ai�KENEY My Commission Expires:
Nctary PuSiio, stays of Ariznna July 12, 2023
pAoricopa County
Corrtrnlssion # 564826
My CarnmiF- "n Expires
R J�. �fy 12 2023
* OLD REPUBLIC SURETY COMPANY
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock insurance corporation, does make, constitute and
appoint: David J. McKee, Joseph A. Clarken III, Jennifer Castillo, Melanie Ankeney,
Patrick R. Hedges, Chrystal Hedges of Phoenix, AZ
its true and lawful Attorney(s)-in-Fact, with full power and authority for and on behalf of the company as surety, to execute and
deliver and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof,
(other than bail bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note
guaranty bonds, self-insurance workers compensation bonds guaranteeing payment of benefits, asbestos abatement contract bonds, waste
management bonds, hazardous waste remediation bonds or black lung bonds), as follows:
ALL WRITTEN INSTRUMENTS
and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed.
This appointment is made under and by authority of the board of directors at a special meeting held on February 18, 1982.
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD
REPUBLIC SURETY COMPANY on February 18,1982.
RESOLVED that, the president, any vice-president or assistant vice president, in conjunction with the secretary or any assistant secretary, may appoint
attorneys -in -fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case, for and on behalf of the company to
execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and said officers may
remove any such attorney -in -fact or agent and revoke any Power of Attorney previously granted to such person.
RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company
(i) when signed by the president, any vice president or assistant vice president, and attested and sealed (if a seal be required) by any secretary or assistant
secretary; or
(ii) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and counlersigned and sealed (if a seal be
required) by a duly authorized attorney -in -fact or agent; or
(iii) when duly executed and sealed (if a seal be required) by one or more attorneys -in -fact or agents pursuant to and within the limits of the authority
evidenced by the Power of Attorney issued by the company to such person or persons.
RESOLVED FURTHER that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attorney or
certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the company; and such
signature and seal when so used shall have the same force and effect as though manually affixed.
IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be
affixed this 23rd day of March 2020
suyfr OLD REPUBLIC SURETY COMPANY
W �cowro�4TE �CO
� SEAL r i
1 Assi„ant Secreta.
''•"„a„i�'n„nna`
STATE OF WISCONSIN, COUNTY OF WAUKESHA - S5 President
On this 23rd day of March 2020 personally came before me, Alan PaVloc
and Karen J Haffner to me known to be the individuals and officers of the OLD REPUBLIC SURETY COMPANY
who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say: that
they are the said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal
and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation.
Al
�p'fAq
A08L�Gd:
Notary Public
My Commission Expires: 5eotember 28, 2022
CERTIFICATE (Expiration of notary's commission does not invalidate this instrument)
I, the undersigned; assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that the foregoing and attached
Power of Attorney remains in full force and has Piet been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of
Attorney, are now in force.
525542
ORSC 22262 (3.46)
�4 a eo.ran�e ErEe'�%
u3,, wtEAL »_
IRS Y:
Signed and sealed at the City of Brookfield, Wl this 24th day of April
Assis'!',t Secreta
2023
CONSTRUCTORS BONDING, INC.
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 Sunset Electrical Contractors, Inc.
TITLE OF OFFICER SIGNING President
SIGNATURE DATE 04/26/2023
Please include any additional information available regarding equal
opportunity employment programs now in effect within your company:
35
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 Sunset, proposed subcontractor DRC , hereby certifies that
he has , has not X , 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
X 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.
Sunset Electrical Contractors, Inc.
(COMPANY)
BY:
President
(TITLE)
DATE: April 26 2023
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.
36
1293492.1
NON -COLLUSION AFFIDAVIT
T0: THE CITY OF DIAMOND BAR:
STATE OF CALIFORNIA )
SS
COUNTY OF San Bernardino )
Stan Kojder , being first duly
sworn, deposes and says that he or she is president of
Sunset Electrical Contractors, Inc. , 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 another 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 contact or 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. �~ ---moo
gnature of Bidder
STATE OF CALIFORNIA )
)SS
COUNTY OF LOS ANGELES )
Subscribed and sworn to before me this 26 day of April ,2023
Notary Public in and for the County of
L05 AN 6 iv LE S , State of California
37
1293492.1