HomeMy WebLinkAboutBali Bid Docs FilledBIDDER'S PROPOSAL
FOR
GROUNDWATER DRAINAGE IMPROVEMENTS-PIIASE 4 & 5 (COPLEY & MOONLAKE)
FY 2022-2023 PROGRAM
PROJECT NO, PW23401
Date r% 920 4
To the City Council of the City of Diamond Bar:
The Undersigned hereby declares:
(a) That the only persons or parties interested in this proposal as principals are the following:
(If the bidder is a corporation, give the name of the corporation and the name of its president,
secretary, treasurer, and manager. If a co -partnership, give the name under which the co-
partnership does business, and the names and addresses of all co-partners. If an individual, state
the name under which the contract is to be drawn.)
(b) That this proposal is made without collusion with any person, firm or corporation.
(c) That he/she has carefully examined the location of the proposed work and has familiarized
himself/herself with all of the physical and climatic conditions and makes this bid solely upon
his/her own knowledge.
(d) That by submitting this Bidder's Proposal, he/she acknowledges receipt and knowledge of the
contents of those communications sent by the City of Diamond Bar to him/her at the address
furnished by him/her to the City of Diamond Bar when this Proposal Form was obtained.
(e) That he/she has carefully examined the specifications, both general and detail, and the drawings
attached hereto, and communications sent to him/her as aforesaid, and makes this proposal in
accordance therewith.
(f) That, if this bid is accepted, he/she will enter into a written contract for the performance of the
proposed work with the City of Diamond Bar.
7
(g) That he/she proposes to enter into such Contract and to accept in full payment for the work
actually done thereunder the prices shown in the attached schedule. It is understood and agreed
that the quantities set forth are estimates, and that the unit prices will apply to the actual quantities
whatever they may be.
�l L G JOti VQy
Address of Bidder lo
city
EI NlOki ill 13
Zip Code
Telephone of B
idder
BID SCHEDULE
CITY OF DIAMOND BAR
CONTRACT DOCUMENTS AND SPECIFICATIONS
GROUNDWATER DRAINAGE IMPROVEMENTS -PHASE 4 & 5 (COPLEY & MOONLAKE)
FY 2022-2023 PROGRAM
PROJECT PW23401
BASE BID
ITEM
APPROX.
DESCRIPTION
UNIT
NO.
QUANTITY
UNIT
WRITTEN IN WORDS
PRICE
AMOUNT
1
1
LS
MOBILIZATION
2
1
LS
TRAFFIC CONTROL
3
9
EA
INTERCEPT CURB DRAIN AND CONNECT TO 4"
STORM DRAIN PER DETAIL
4
140
LF
INSTALL 6" DIA. PVC (SDR-35) PIPE IN OPEN CUT
TRENCH. INCLUDES BACKFILL AND AC T-CAP
5
360
LF
INSTALL4" DIA. PVC (SDR-35) PIPE IN OPEN CUT
TRENCH. INCLUDES BACKFILL, LANDSCAPE
AND/OR AC T-CAP AS NECESSARY
6
5
EA
INSTALL STORM DRAIN CLEAN -OUT PER SPPWC
STD. NO. 204-1.
7
200
LF
INSTALL 4" DIA. PVC (SDR-35) PIPE, BY JACK
AND BORE, AT DRIVEWAY CROSSING..
8
1
EA
NSTALL SAND FILTER JUNCTION STRUCTURE
WITH HIGHFLOW BYPASS PER DETAIL A.
9
2
EA
INSTALL PIPE TO PIPE JUNCTION STRUCTURE
PER LOS ANGELES COUNTY DEPARTMENT OF
PUBLIC WORKS STANDARD DRAWING NO. 332-1.
10
140
SF
REMOVE AND REPLACE EXISTING CONCRETE
IN KIND, AS NECESSARY
1 1
1
EA
INSTALL MODULAR WETLAND SYSTEM, MWS L-
4-4-C OR APPROVED EQUAL. INCLUDES
IRRIGATION.
12
5
LF
REMOVE AND REPLACE EXISTING CURB AND
GUTTER AND REPLACE IN KIND. INCLUDE FULL
DEPTH AC SLOT PAVE.
TOTAL AMOUNT BASE BID SCHEDULE (IN FIGURES)
TOTAL AMOUNT BASE BID SCHEDULE (WRITTEN IN
WORDS):
The Contract will be awarded to the lowest responsible bidder based on the sum of base bid schedule.
10
Bid Schedule Note: Bid Price indicated refers to all items illustrated on the plans and details, and
delineated within the specifications installed and completely in place with all applicable portions of the
construction documents and includes all costs connected with such items including, but to necessarily
limited to, materials, transportation, taxes, insurance, labor, overhead, and profit, for General Contractor
and Subcontractors.
All work called for on the construction documents are to provide a completed project with all systems
operating properly and ready for use.
NAME OF BIDDER (PRINT)
oe var
CITY
STATE CONTRACTOR LI
ADDRESS
3�
ZIP CODE
-goo3
TELEPHONE
TION DATE
I declare under penalty of Perjury of the laws of the State of California that the representation
made herein are true and correct in accordance with the requirements of California Business and
Professional Code fiction 7028.15.
TOR SIGNA
ORIZED OFFICER
fig
LIST OF SUBCONTRACTORS *
BID OPENING DATE /tlri i ��l, 023
PROJECT NO. PW234 0/
LOCATION
CLIENT l (l-Lf 0-F !ij a y mLj bar
CONTRACTOR Cowl hu( h-yo , IVIC -
G
Name Under Which
Subcontractor is
Licensed
License
No,
Address
of
Office Mail
or
Shop
Percent
of
Total
Contract
Specific Description
of
Subcontract
* In compliance with the provisions of the Public Contract Code Section 4104, the undersigned bidder
herewith sets forth the name, location of the place of business, and California CONTRACTOR license
of each Subcontractor — who will perform work or labor or render service to the Prime CONTRACTOR,
specially fabricates and installs a portion of the work or improvement necessary to complete construction
contained in the plans and specifications, in an amount in excess of one-half (1/2) of one percent (1%)
of the General CONTRACTOR's total base bid amount or, in the case of bids or offers for the
12
construction of streets or highways, including bridges in excess of one-half (1/2) of 1 percent (1%)of the
Prime CONTRACTOR's total base bid or ten thousand ($10,000.00), whichever is greater, and the
portion of the work which will be done by each Subcontractor.
l3
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 provi ksions of Sections 1777.1 or 1777.7
of the California Labor Code or any other 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 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.
14
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 /}rI/� , 20a at qbIJe, j of vplace
of execution). V AfoH e, C/ RI733
rc II 1111111-Miii
Name of Company:
15
BIDDER'S VIOLATION OF LAW/SAFETY QUESTIONNAIRE
In accordance with Government Code Section 14310.5, 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:
NOTE: This questionnaire constitutes a part of the Proposal and signature on the
signature portion of this Proposal shall constitute signature of this
questionnaire.
Bidders are cautioned that malting a false certification may subiect the
certifier to criminal prosecution.
L
CONTRACTOR'S INDUSTRIAL SAFETY RECORD
Project Identification: GROUNDWATER DRAINAGE IMPROVEMENTS -PHASE 4 & 5
(COPLEY & MOONLAKE)
Bid Date: 4 f Uq I ti. 3
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
CURRENT
PRIOR TO CURRENT YEAR
YEAR
2018
2019
2020
2021
2022
TOTAL
No. of Contracts
l i e
(�p
s
0 Z
1 Z
141
(�
Total dollar amount of
b l bOb
bti �13
bl 010
4 b►RS3
b1,3191q
1120 0
contracts in 1,000 s
,
No. of lost workday
'
I
O
y
cases
No. of lost work day
cases
involving permanent
O
transfer to
another job or
termination of
employment
No. of lost workdays
a
53
62
1 S O
0
2 qS
*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, OSEA No. 102.
The above information was compiled from the records that are available to e at this time and I
declare under penalty of perjury that the information is true accurate in the limitations of
these records.
ga (% Cows ttL%ovr , Ivr r� .
Name of Bidder (Print) Si ure Mq
Address q�T ue VavjW waJ State Contractor Lic. No. & Class ;2Ur'V0
Sown FI mohfe, gr133 6262-top3 1436
City Zip Code Telephone
17
AFFIDAVIT FOR CORPORATION BIDDER
STATE OF CALIFORNIA
)SS
COUNTY OF LOS ANGELES
says:
of,
being first duly sworn, deposes and
a corporation which is the party making the foregoing bid 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
to before m
Sigryr�ure /�i{{�1�(,u
iy Public)
'ce Atld
#� ��6�.L
N,�,�
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Los Anqeles
Subscribed and sworn to or affirmed) before me on this f 9
day of 2023, by
e w )q7�&
C y
proved to me on the basis of satisfactory evidence to be the
person(s) who appeared before me.
MICHELLE R.DOYLE
COMM. #2293101 z zz Notary Public v California o
Los Angeles Counter
Comm. Expires June 19, 2023
(Seal) Signature of I�.
Michelle R. Doyle, Notary Wblic
BID BOIN LP
KNOW ALL MEN BY THESE PRESENTS, THAT WE Bali Construction, Inc.
as Principal, and
Travelers Casualty and Surety Company of America
as Surety, are held and firmly bound unto the City of Diamond Bar in the sum to ten percent
of the total amount of the bid of the Principal above named, to be paid to the said City or its certain
attorney, its successors and assigns; for which payment will and truly to be made, we bind
ourselves, our heirs, executors and administrators, successors or assigns, jointly and severally,
firmly by these presents.
In no case shall the liability of the surety hereunder• exceed the sum of Ten percent of the total amount bid *�**•
(10% of the total amount bid)
THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted
the above mentioned bid to the City of Diamond Bar for certain construction specifically described
as follows, for which bids are to be opened in PlanetBids on the date and time specified on
PlanetBids, for the GROUNDWATER DRAINAGE IMPROVEMENTS -PHASE 4 & 5
(COPLEY & MOONLAKE).
NOW, THEREFORE, if the aforesaid Principal is awarded the Contract, and within the time and
manner required under the specifications, after the prescribed forms are presented to him for
signature, enters into a written contract, in the prescribed form in accordance with the bid, and files
the two bonds with the City of Diamond Bar, one to guarantee faithful performance and other to
guarantee payments for labor and materials, as required by law, then this obligation shall be null
and void; otherwise it shall remain in full force and effect. In the event suit is brought upon this
bond by the obligee and judgment is recovered, the Surety shall pay all costs incurred by the City
in such suit, including a reasonable attorney's fees to be fixed by the Court.
1N WITNESS WHEREOF, we have hereunto set our hands and seals on this lath
day of .April , 2023.
Bali Construction, Inc.
(SEAL)
Travelers Casualty and Surety Company of America (SEAL)
SURETY
�—= Kim E. Heredia, Attorney -in -Fact
SIGNATURE AND TITLE
NOTE: Signatures of those executing for the Surety must be properly acknowledged.
24
CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT
v�mux,wxr r� xue.xrmr��.venrxr rw nK,ho.uo: nrw,rcin�rvViru..wme:-r<nru.:x.aurc n.Kw�mrouan,..-wm�nruvuvevnmrmwn.cnaxra.+nrkuun.ruree,nen.,muc,wn.ue.,.wcww�xurmrw.eun.umru�.weucw,mrmuww...,mr„�..n.uvr•:u.:xMrS
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.
�
x
a
State of California )
County of Orange ) �
�
3
�`SSANDRA DE LEON, NOTARY PUBLIC
�I
On W $�a-D�-3 before me, ,
(here insert name and title of the officer)
j
=
personally appeared KIM E. HEREDIA---------------------------- -----------------------------------------------------
?
i
l
who proved to me on the basis of satisfactory evidence to be the person) whose name() is�l�subscribed to
the within instrument and acknowledged to me that �/she/ executed the same ink/her/�g�
)
authorized capacity�gt�, and that by �t�/her/�I�� signaturelj�) on the instrument the person(, or the entity
�
upon behalf of which the person(,) acted, executed the instrument.
x
`-
I certify under PENALTY OF PERJURY under the laws of the
State of California that the foregoing paragraph is true and correct. �--��
KASSANDRA DE LEON
`
i
�_ COMM. #2408438 z
. � Notary Public
-
r
Z •California
WITNESS my hand and official seal. Orange County
M Comm, Expires Jul 15, 2026
Signature
Q
R
KASSAND E LEON, NOTARY PUBLIC (Seal)
'<
>r,x�r,u,�,.,,��,n,�wxn,.,,,�.,,:..,.,.�,��r.,.,.y.,,.x�.��,w,..,�r����:,n�rxM�,�x.,,�
I Optional Inforrx�ation
Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an
unauthorized document and may prove useful to persons relying on the attached document.
Description of Attached Document
The preceding Certificate of Acknowledgment is attached to a document
titled/for the purpose of
containing pages, and dated
The signers) capacity or autl-tority is/are as:
❑ Individuai(s)
Ix� Attorney -in -tact
❑ Corporate Officers)
I IIIP (5)
❑ Guardian/Conservator
❑ Partner -Limited/General
❑ Trus[ee(s)
❑ Other:
representing:
Names) of persons) or Fnnry(Ics) signer Is Representing
��:;;iia,.�.,.i���i�;.:n�;,:„ ,�
Method of Signer Identification
Proved to me on the basis of satisfactory evidence:
� form(s) of Identification � credible witnesses)
Notarial event is detailed in notary journal on:
Page N Entry M
Notary contact:
Other
❑ Additional Signers)
❑ Signer(s)Thumbprint(s)
®Copyright 2007-202[ Notary Rotary, PO Oox A t400, Des Moines, IA 5031 I-0507. All Rlghis Reserved. Item Number 101772. Please contact your Authorized Reseller to purchase copies of this form.
Travelers Casualty and Surety Company of America
A01► Travelers Casualty and Surety Company
TRAVELERS J St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and
St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein
collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Kim E. Heredia of
IRVINE California their true and lawful Attorney(s)min-Fact to sign, execute, seal and
acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of
the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or
guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seats to be hereto affixed, this 21st day of April,
2021.
State of Connecticut
By:
City of Hartford ss.
L.
Vice President
On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior
Vice President of each of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the
purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer.
IN WITNESS WHEREOF, I hereunto set my hand and official seal. �',"//,�!�.,�L My Commission expires the 30th day of June, 2026 t
p06110 , Anna P. Nowik, Notary
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of
the Companies, which resolutions are now in full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice
President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint
Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority
may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings
obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may
remove any such appointee and revoke the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or
any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided
that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance,
contract of indemnity, or
writing obligatory in the nature of a bond,
recognizance,
or conditional undertaking shall be valid and binding upon the Company when (a)
signed by the President, any Vice Chairman,
any Executive
Vice President, any Senior Vice President or any Vice
President, any Second Vice President, the Treasurer, any Assistant
Treasurer, the
Corporate Secretary or any Assistant Secretary and duly
attested and sealed with
the Company's seal by a Secretary or Assistant Secretary;
or (b) duly executed (under seal, if required) by one or more Attorneys4n-Fact
and Agents pursuant to the power prescribed
in his or her
certificate
or their
certificates of authority
or
by one or more
Company officers pursuant
to a written
delegation
of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President,
any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to
any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -
Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of
Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed
and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or
understanding to which it is attached.
I, Kevin E. Hughes,
the
undersigned, Assistant Secretary
of each of the
Companies, do hereby
certify that the above and foregoing is a
true and correct copy of
the
Power of Attorney executed by said
Companies, which
remains in full force and
effect.
Dated this 18th day of April 2023
T/
��Y� •J�,SY AMO �G
4r
W v
Y 1!
• `fit � 1.�` `
�G✓ � AAA l _
Kevin E. Hughes, Assi font Secretary
To verify the authenticity of this Power afAttorney, please cal/ us at 1-8004214880.
P/ease refer to the above -named Attorneys) -in -Fact and the details of the bond to which this Power of Attorney Is attached.
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Los Angeles )
On �tl(l 1 `I , 2d23 before me,
Michelle R. Doyle, Notary Public
(insert name and title of the officer)
personally appeared %V�uf'�"f1GLtJ f v/�yC.l
who proved to me on the basis of satisfactory evidence to be the person( whose name(`) is/
subscribed to the within instrument and acknowledged to me that he/sWe/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/thpir signature(% on the instrument the
person(,), or the entity upon behalf of which the personks) 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.
Signatu
(Seal)
COMM. #2293101 z
Notary Public •California c
Los Angeles Countune er
Comm. Expires JIla 20231
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 PSQI� (�i�CFn��fi�ti ,Ih!',•
TITLE OF OFFICER SI
SIGNATURE
DATE L/I /7I
Please include any additional information available regarding equal opportunity employment programs
now in effect within your company:
25
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 134 (i CoylJlru Cfi0y1 , iytG. 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.
Ga,li covlq%uzf�vhl' Iv�C
(COMPANY)
BY:
�I'S SI Ski!/1 � J �GrG �Jl t-s/J
(TITLE)
DATE: A ph I /b , 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.
26
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 134 (i CoylJlru Cfi0y1 , iytG. 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.
Ga,li covlq%uzf�vhl' Iv�C
(COMPANY)
BY:
�I'S SI Ski!/1 � J �GrG �Jl t-s/J
(TITLE)
DATE: A ph I /b , 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.
26
NON -COLLUSION AFFIDAVIT
TO: THE CITY OF DIAMOND BAR:
STATE OF CALIFORNIA )
SS
COUNTY OF 10 I" )
deposes and says that he tSt• she is
being fitst duly sworn,
o--foVl; / hbq.rnirALm , h4t .
the party malting 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 and other bidder to put in a false or sham bid, and has not directly
or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid,
or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly,
sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any
other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder,
or to secure any advantage against the public body awarding the contract of anyone interested in the
proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not,
directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or
divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation,
partnership, company association, organization, bid depository, or to any member or agent thereof to
effectuate a collusive or sham bid.
STATE OF
COUNTY OF LOS AN
Subscribed and sworn to before
is
Notary Public in and for the County of
day of
2023.
State of California
2� cvf�r IIl7Cirvfr
'`toolA& IPv�lic.
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Los Angeles
Subscribed and sworn to (or affirmed) before me on this
day of ; , 20 23 , by
M-e e-r
proved to me on the basis of satisfactory evidence to be the
persons) who appeared before me.
(Seal)
MICHELLE R. DOYLE
COMM. #2293101
Notary Public • California
Los Angeles County
Comm. Expires June 15, 2G
Signatur6i
Michelle R. Doyle, Notary Pu c
z
0