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EXPERIENCE STATEMENT To be responsive, the bidder must list below a minimum of three public agencies for which bidder has performed similar work within the past three years. Only projects in excess of $200,000 each qualify as similar for this project. 2 Project Title 2020 - 21 Annual Concrete Rehab Program Contract Amount $301 894.70 Type of Work Concrete Improvements Client City of Santa Clarita Agency Project Manager Scott Hamilton Phone (661) 294-2563 Date Completed 9/16/21 o Subcontracted 2% Project Title 2022 Sidewalk Repair & Replacement Contract Amount 582,631.60 Type of Work Concrete Improvements Client City of Calabasas Agency Project Manager Anna Hartounian Phone (818) 224-1688 Date Completed 03/31/2023 % Subcontracted 1 3. Project Title _ Contract Amount Type of Work Client 2021 Sidewalk Rehabilitation 262,851 Concrete Improvements City of Moorpark Agency Project Manager Daniel Kim Date Completed 05/26/2022 Phone (805) 517-6255 % Subcontracted 1 NOTE: If requested by the City, the bidder shall furnish a certified financial statement, references, and other information sufficiently comprehensive to permit an appraisal o/f� his current financial condition. Bidder's Signature I-, 10 Each bidder shall possess a valid Contractor's License issued by the Contractor's State License Board at the time his/her bid is submitted. The class of license shall be applicable to the work specified in the contract. Each bidder shall also have no less than three (3) years of experience in the magnitude and character of the work bid. Bidder Qualifications called for to be submitted at time of bid include, but are not necessarily limited to: 1. The Contractor shall have been in business under the same name and California Contractors License for a minimum of three (3) continuous years prior to the bid opening date for this Project. The license used to satisfy this requirement shall be of same type required by the contract. 2. License classification shall be as required by the contract specifications. 3. The Contractor shall have three (3) years of experience in the construction of ADA compliant curb ramps and CDBG work. 4. The Contractor shall perform at least 50% of contract with its own forces. 16. LISTING SUBCONTRACTORS: Each bidder shall submit a list of the proposed subcontractors on this project as required by the Subletting and Subcontracting Fair Practices Act (Government Code Section 4100 and following). Forms for this purpose are furnished with the contract documents. The name and location of business of any subcontractor who will perform work exceeding 1/2 of 1% of the prime contractor's total bid or ten thousand dollars ($10,000.00), whichever is greater, must be submitted with the bid. Any other information regarding the foregoing subcontractors that is required by City to be submitted may be submitted with the bid, or may be submitted to City up to 24 hours after the deadline established herein for receipt of bids. The additional information must be submitted by the bidder to the same address and in the same form applicable to the initial submission of bid. 17. WORKER'S COMPENSATION: In accordance with the provisions of Section 3700 of the Labor Code, the Contractor shall secure the payment of compensation to his employees. The Contractor shall sign and file with the City the following certificate prior to performing the work under this contract: "I am aware of the provisions of Section 3700 of the Labor Code which require 11 compensation or to undertake self insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract." The form of such certificate is included as part of the contract documents. 18. BID DEPOSIT RETURN: Deposits of three or more low bidders, the number being at the discretion of the City, will be held for ninety (90) days or until posting by the successful bidder of the Bonds required and return of executed copies of the Agreement, whichever first occurs, at which time the deposits will be returned after consideration of the bids. 19. EXECUTION OF CONTRACT: The bidder to whom award is made shall execute a written contract with the City on the agreement form provided, and shall secure all insurance and bonds as herein provided within ten (10) days from the date of written notice of the award. Failure or refusal to enter into a contract as herein provided, or to conform to any of the stipulated requirements in connection therewith shall be just cause for the annulment of the award and the forfeiture of the proposal guarantee. If the successful bidder refuses or fails to execute the Contract, the City may award the Contract to the next lowest responsible bidder or re -advertise. On the failure or refusal of the lowest responsible bidder or next lowest responsible bidder to execute the Contract, such bidder's guarantees shall be likewise forfeited to the City. 20. "OR EQUAL": Pursuant to Division 5, Chapter 4, Article 4 (commencing at #4380) Government Code, all specifications shall be deemed to include the words "or equal", provided however that permissible exceptions hereto shall be specifically noted in the specifications. 21. EMPLOYMENT OF APPRENTICES: Attention is directed to Sections 1777.5, 1777.6 and 1777.7 of the California Labor Code and Title 8, California Administrative Code, Section 200 seq. to ensure compliance and complete understanding of the law regarding apprentices. The Contractor and any subcontractor under him shall comply with the requirements of said sections in the employment of apprentices; however, the Contractor shall have full responsibility for compliance with said Labor Code section, for all apprenticeable occupations, regardless of any other contractual or employment relationships alleged to exist. In addition to the above State Labor Code Requirements regarding the employment of apprentices and trainees, the Contractor and 12 all subcontractors shall comply with Section 5 a. 3, Title 29 of the Code of Federal Regulations (29CFR). 22. EVIDENCE OF RESPONSIBILITY: Upon the request of the City, a bidder whose bid is under consideration for the award of the Contract shall submit promptly to the City satisfactory evidence showing the bidder's financial resources, his construction experience, and his organization and plant facilities available for the performance of the contract. 23. WAGE RATES: The Contractor and/or subcontractor shall pay wages as indicated in the "Notice Inviting Sealed Bids" section of these specifications. The Contractor shall forfeit as penalty to the City of Diamond Bar, two hundred dollars ($200.00) for laborers, workmen, or mechanics employed for each calendar day, or portion thereof, if such laborer, workman or mechanic employed is paid less than the general prevailing rate of wages herein referred to and stipulated for any work done under the proposed contract, by him, or by any subcontractor under him, in violation of the provisions of Labor Code, and in particular, Sections 1770 to 1781 inclusive. Copies of all collective bargaining agreements relating to the work as set forth in the aforementioned Labor Code are on file with the Department of Industrial Relations, Division of Labor Statistics and Research. 24. PERMITS, FEES AND LICENSES: The Contractor shall possess a valid business license prior to the issuance of the first payment made under this Contract. Any work required within Caltrans right-of-way will require a separate permit to be obtained by the Contractor. 25. TIME OF COMPLETION AND LIQUIDATED DAMAGES: Bidder must agree to commence work on or before the date of written "Notice to Proceed" of the City and to fully complete the project within thirty (30) working days thereafter. Bidder must agree also to pay as liquidated damages, the sum of seven hundred and fifty dollars ($750.00) for each calendar day thereafter. 26. CLAIMS FILING AND PROCESSING: The City and Bidder agree to attempt to orally resolve any disputes which may give rise to a claim (hereafter, "Claim") that falls within the definition of Public Contract Code section 9204 (hereafter, "Section 9204"). If these efforts are unsuccessful, the City and Bidder shall process the Claim in accordance with Section 9204. In summary, if the Bidder decides to submit a Claim to the City, it shall be sent by registered or certified mail, return receipt requested, together with reasonable documentation to support the Claim. A Claim may include a Claim by a subcontractor or 13 a lower tier subcontractor meeting the requirements of Section 9204 (d) (5) . Within 45 days of receipt of the Claim, or any extension thereof agreed upon by the City and the Bidder, the City will conduct a reasonable review of the Claim and provide the Bidder with a written statement identifying what portion of the Claim is disputed and what portion is undisputed. Payment of any undisputed portion of the Claim shall be made within 60 days after the City issues its written statement. If the City does not provide a written statement within the time specified, the Claim shall be deemed rejected. If the Bidder disputes the City's written statement or if the Claim is deemed rejected, the Bidder may demand in writing by registered or certified mail to the City, return receipt requested, an informal conference to meet and confer in an effort to settle the disputed portion of any Claim. Within 30 days of receipt of such written demand, the City shall schedule a meet and confer conference. If any portion of the Claim remains in dispute after the conference, the City shall, within 10 City business days of the conclusion of the conference, provide the Bidder with a written statement identifying any portion that remains in dispute and any portion that is undisputed. Payment of any undisputed portion shall be made within 60 days after the City issues its written statement. Any remaining disputed portion shall be submitted to nonbinding mediation in accordance with Section 9204 (c) (2) (B) , unless the Bidder and City waive the mediation upon mutual written agreement. 27. CONFLICT OF INTEREST: In the procurement of supplies, equipment, construction and services by sub -recipients, the conflict of interest provision including, but not limited to, 2 CFR part 200, Subpart B, 200.112, 24 CFR Part 570.611 and 24 CFR part 85, Section 85.36 (b), respectively, shall apply. No employee, officer or agent of the sub -recipient shall participate in selection or in award of administration of a contract supported by Federal funds if a conflict of interest, real or apparent, would be involved. 14 a lower tier subcontractor meeting the requirements of Section 9204(d)(5). Within 45 days of receipt of the Claim, or any extension thereof agreed upon by the City and the Bidder, the City will conduct a reasonable review of the Claim and provide the Bidder with a written statement identifying what portion of the Claim is disputed and what portion is undisputed. Payment of any undisputed portion of the Claim shall be made within 60 days after the City issues its written statement. If the City does not provide a written statement within the time specified, the Claim shall be deemed rejected. If the Bidder disputes the City's written statement or if the Claim is deemed rejected, the Bidder may demand in writing by registered or certified mail to the City, return receipt requested, an informal conference to meet and confer in an effort to settle the disputed portion of any Claim. Within 30 days of receipt of such written demand, the City shall schedule a meet and confer conference. If any portion of the Claim remains in dispute after the conference, the City shall, within 10 City business days of the conclusion of the conference, provide the Bidder with a written statement identifying any portion that remains in dispute and any portion that is undisputed. Payment of any undisputed portion shall be made within 60 days after the City issues its written statement. Any remaining disputed portion shall be submitted to nonbinding mediation in accordance with Section 9204 (c) (2) (B) , unless the Bidder and City waive the mediation upon mutual written agreement. 27. CONFLICT OF INTEREST: In the procurement of supplies, equipment, construction and services by sub -recipients, the conflict of interest provision including, but not limited to, 2 CFR part 200, Subpart B, 200.112, 24 CFR Part 570.611 and 24 CFR part 85, Section 85.36 (b), respectively, shall apply. No employee, officer or agent of the sub -recipient shall participate in selection or in award of administration of a contract supported by Federal funds if a conflict of interest, real or apparent, would be involved. 14 BIDDER'S PROPOSAL CITY OF DIAMOND BAR AREA 3 RESIDENTIAL NEIGHBORHOOD ADA CURB RAMP IMPROVEMENT PROJECT CDBG PROJECT NO. 602474-22 CIP PROJECT NO. SI23104 Date June 9 , 20 23 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: Jose Angel Fierros, President Salomon Fierros, Vice President Jose Ernesto Fierros, Corporate (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 has carefully examined the location of the proposed work and has familiarized himself with all of the physical and climatic conditions, and makes this bid solely upon his own knowledge. (d) That by submitting this Bidder's Proposal, he acknowledges receipt and knowledge of the contents of those communications sent by the City of Diamond Bar to him at the address furnished by him to the City of Diamond Bar when this proposal form was obtained. (e) That he has carefully examined the specifications, both general and detail, and the drawings attached hereto, and communications sent to him as aforesaid, and makes this proposal in accordance therewith. 15 (f) That, if this bid is accepted he will enter into a written contract for the performance of the proposed work with the City of Diamond Bar. (g) That he 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. Accompanying this proposal is a certified or cashier's check or bidder's bond, payable to the order of the City of Diamond Bar in the sum of II 10 %e n J 6 d DOLLARS ($ ) Said bidder's bond has been duly executed by the undersigned bidder and by a financially sound surety company authorized to transact business in this state. It is understood and agreed that should the bidder fail within ten (10) days after award of contract to enter into the contract and furnish acceptable surety bonds, then the proceeds of said check, or bidder's bond, shall become the property of the City of Diamond Bar; but if this Contract is entered into and said bonds are furnished, or if the bid is not accepted then said check shall be returned to the undersigned, or the bidder will be released from the bidder's bond. 14838 Bledsoe St. Address of Bidder Sylmar, CA 91342 City zip Code 16 (818) 838-6040 Telephone of Bidder Fe-h Stfinaturoof Bidder BID SCHEDULE CITY OF DIAMOND BAR CONTRACT DOCUMENTS AND SPECIFICATIONS AREA 3 RESIDENTIAL NEIGHBORHOOD ADA CURB RAMP IMPROVEMENT PROJECT CDBG PROJECT NO. 602474-22 CIP PROJECT NO. SI23104 ITEM EST. DESCRIPTION UNIT NO. QUANT. UNIT WRITTEN IN WORDS PRICE AMOUNT CONSTRUCTION STAKING AND 1 1 LS MONUMENT PRESERVATION. ODO `LO�DOO REMOVE EXISTING IMPROVEMENTS AND CONSTRUCT CURB RAMP PER SPPWC STD. 2 16 EA PLAN NO. 111-5, INCLUDING L` 000 N000 « MOBILIZATION, TRAFFIC i CONTROL, AND PUBLIC SAFETY. REMOVE EXISTING CURB AND 90 �/ `f. 7-30 3 47 LF GUTTER AND RECONSTRUCT PER SPPWC STD. PLAN 120-3. REMOVE EXISTING CROSS 4 75 SF GUTTER AND RECONSTRUCT PER 30 2�2 S0 SPPWC STD. PLAN 122-3. THERMOPLASTIC TRAFFIC 5 1 LS STRIPING, PAVEMENT bs-000 (05000 MARKINGS, AND CURB MARKINGS. MANDATORY BID SCHEDULE ITEMS: TOTAL AMOUNT BID (IN FIGURES)-*22!S-/L9t) " TOTAL AMOUNT BID, SCHEDULE? (WRITTEN IN WORDS) : `rwp hd� -111;4* Avt 4hoUSad. -AL)r Au)tJa/elg4-�t * °Oleo 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 include all costs connected with such items including, but to necessarily limited to, materials, transportation, 17 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. Award will be based on the items of Bid Schedule. Therefore, Contractor shall completely fill out Bid Schedule. Accompanying this proposal is (Insert "$ 10o cash", "cashier's check", "certified check", or "bidder's bond" as the case may be) in the amount equal to at least ten percent (10%) of the total bid. The undersigned further agrees that in case of default in executing the required contract, with necessary bond, within ten (10) days, not including Sundays and legal holidays, after having received notice that the Contract has been awarded and ready for signature, the proceeds of the security accompanying his bid shall become the property of the City of Diamond Bar, and this proposal and the acceptance thereof may be considered null and void. FS Contractors, Inc. C t 1 e/r j 6/9/23 NAME OF BIDDER (PRINT) U SIGWATURE DATE 14838 Bledsoe St. ADDRESS Sylmar 91342 (818) 838-6040 CITY ZIP CODE TELEPHONE 1005940 A-CB-C27 STATE CONTRACTOR LICENSE NO. AND CLASSIFICATION I declare under penalty of Perjury of the laws of the State of California that the representations made herein are true and correct in accordance with the requirements of California Business and Professional Code Section 7028.15. m F OR AUTHORIZED OFFICER 19 LIST OF SUBCONTRACTORS * BID OPENING DATE 6/9/23 PROJECT AREA 3 RESIDENTIAL NEIGHBORHOODPROJECT NO. 602474-22 ADA CURB RAMP IMPROVEMENT PROJECT LOCATION Various Location Diamond Bar CLIENT City of Diamond Bar CONTRACTOR FS Contractors, Inc. Name Under Which Subcontractor is Licensed License No. Address of Office, Mail, or Shop Percent of Total Contract Specific Description of Subcontract �Se [mod SJrVE ��� LSyll 61q Al. Eck4o �. S�rVe ©r e. CA IZ969 supwtar WVAM+ *4 776306 531-2 cypre.5s Sf. qq S�r C ass 9063° * 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 20 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 construction of streets or highways, including bridges in excess of one-half of 1 percent (0.5%)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. 21 DECLARATION OF ELIGIBILITY TO CONTRACT [Labor Code Section 1777.1; Public Contract Code Section 61091 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 22 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 June 9 , 2023, at Sylmar, CA (place of execution). J. q,.J Sign ure Name: Jose Angel Fierros Title: President Name of Contractor: FS Contractors, Inc. 23 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 x 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. 24 CONTRACTOR'S INDUSTRIAL SAFETY RECORD Project Identification 602474-22 Bid Date 6/9/23 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 three 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 ( i rC 11m..gi-An ac ciirrn in ii n A -i i c-, i : ITEM 3 CALENDAR YEARS — -- yCURRENT PRIOR TO CURRENT YEAR YEAR 2020 2021 2022 TOTAL No. of Contracts 76 24 184 Total dollar amount of contracts in 1,000's 6,351 12,409 9,836 28,596 2,847 No. of lost workday cases 3 1 1 5 3 No. of lost work day cases involving permanent transfer to 0 0 another job or 0 0 0 termination of ern to ent No. of lost workda s 15 240 90 215 *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. FS Contractors, Inc. Name of Bidder (Print 14838 Bledsoe St. Address Sylmar, CA 91342 City Zip Code Signat4ure 1005940 A-C8-C27 State Contractor's Lic. No. & Class (818) 838-6040 Telephone 25 AFFIDAVIT FOR CO -PARTNERSHIP FIRM STATE OF CALIFORNIA ) N / A )SS COUNTY OF LOS ANGELES ) being first sworn, deposes and says: That he is a member of the co -partnership firm designated as duly 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. That he has been and is duly vested with authority to make and sign instruments for the co -partnership by who constitute the other members of the co -partnership. Signature Subscribed and sworn to before me this day of 20 Signature of Officer Administering Oath (Notary Public) M. AFFIDAVIT FOR CORPORATION BIDDER STATE OF CALIFORNIA ) )SS COUNTY OF LOS ANGELES ) Jose Angel Fierros being first duly sworn, deposes and says: That he is President of, FS Contractors, Inc. 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 day oS E E I Signat e ATTACHMENT Signature of Officer Administering Oath (Notary Public) 27 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL .. 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 June 9, 2023 before me, Martha Isabel Lopez Riuhi Notary Public Date Here Insert Name and Title of the Officer personally appeared Fierros who proved to me on the basis of satisfactory evidence to be the persorAerWhose nameWls/ate sub�scribe�dd to the within instrument and acknowledged to me that he/sbeffhey executed the same in his/heAthairauthorized capacityapo�and that by s/hef%f e signature�n the instrument the person(sr or the entity _upon behalf of which the person(a)�cted, executed the instrument. 0MARINA ISABEL LOPEZ RIUBI Notary Public• California Los Angeles County Commission if2356361 •'� "'� My Comm. Expires May 21, 2025 Place Notary Seal Above 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. Signature Signature of Notary Pu is OPTIONAL Though this section is optional, completing this information can deter alteration of the fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signer(s) Other Than Named Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ Gene ElIndividual ❑ AM Fact ❑ Trustee rdian or Conservator ❑ Other: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 011 • 0tt •t AFFIDAVIT FOR INDIVIDUAL BIDDER STATE OF CALIFORNIA ) N / A )SS COUNTY OF LOS ANGELES ) being first duly sworn, deposes and says: That he 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 day of Signature M Signature of Officer Administering Oath (Notary Public) m AFFIDAVIT FOR JOINT VENTURE STATE OF CALIFORNIA ) N/A )SS COUNTY OF LOS ANGELES ) being first duly sworn, deposes and says: That he of, one of the parties submitting the foregoing bid as a joint venture and that he has been and is duly vested with the authority to make and sign instruments for and on behalf of the parties making said bid who are: 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. Sianature Subscribed and sworn to before me this day of , 20 Signature of Officer Administering Oath (Notary Public) BOND No. 29 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: AREA 3 RESIDENTIAL NEIGHBORHOOD ADA CURB RAMP IMPROVEMENT PROJECT CDBG PROJECT NO. 602474-22 CIP PROJECT NO. S123104 WHEREAS FS Contractors Inc. 14838 Bledsoe Street, Sylmar, CA 91342 (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 RLI Insurance Company 16165 N. 83rd Avenue Suite 201, Peoria, AZ 85382 (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 the Total Amount of the Bid 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 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. 34 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. Dated: June 9, 2023 "Principal" FS Contractors, Inc. By: P1`Gsid Its Its "Surety" RLI Insurance Company M Its Pietro Micciche A rney-in Fact 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) (Seal) 35 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL .. A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this cerfificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Los Angeles S Ui1�A q ) On e— "1 �U before me, Angel Nunez, Notary Public Date Here Insert Name and Trtie of the Officer personally appeared Pietro Micciche Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the personoo whose name(gj isW6 subscribed to the within instrument and acknowledged to me that he/Ahp6ft executed the same in his/)pflti(t{UG1K authorized capacity(W, and that by his/lIS10l 10(signature(s) on the instrument the perso oo, or the entity upon behalf of which the person(6) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing pagraph Is true and correct,----) / WITNESS my an official seal. ANGEL NUNEZ Notary PublicAngeles • California Signatur Los Angeles County Signature of Notary Public Commissian r 132s675 " My Comm. Expires Mar 14, 2024 Place Notary Seal Above OPT10NAt Though this section Is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signer(s) Document Date: Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limijjla�dd ❑ General ❑ Individual Q1Attomey in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other. Signer Is Representing: 02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 POWER OF ATTORNEY RLI Insurance Company Contractors Bonding and Insurance Company 9025 N. Lindbergh Dr. Peoria, IL 61615 Phone: 800-645-2402 Know All Men by These Present's: That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That RLI Insurance Company and/or Contractors Bonding and Insurance Company, each an Illinois corporation, (separately and together, the "Company") do hereby make, constitute and appoint: Patricia Zenizo. Pietro Micciche. Eli abete Salazar. jointly or severally in the City of Glendale , State of California its true and lawful Agent(s) and Attomy(s) in Fact, with full power and authority hereby conferred, to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds and undertakings in an amount not to exceed Twenty Five Million Dollars ( $25,000,000.00 1 for any single obligation. The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon the Company as if such bond had been executed and acknowledged by the regularly elected officers of the Company. RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have each further certified that the following is a true and exact copy of a Resolution adopted by the Board of Directors of each such corporation, and is now in force, to -wit: "All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." IN WITNESS WHEREOF, the RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have caused these presents to be executed by its respective Vice President with its corporate seal affixed this 25th day of April 2022 . RLI Insurance Company ,.•`NOWGI,NG.N •••,,; JppNCEC'p' , Contractors Bonding and Insurance Company 00 .q n : pPOR •'4y : a��r •. A%. F p0 4r . n ° a'., PPG '.�: .�{ /�•� SEAL 'g* SEAL y Barton W. Davis Vice President State of Illinois l «irvo%s •,,;<�I N O�s,•` )} SS „ " County of Peoria CERTIFICATE On this 25th day of April , 20" , before me, a Notary Public, personally appeared Barton W. Davis . who being by me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of the RLI Insurance Company and/or Contractors Bonding and Insurance Company and acknowledged said instrument to be the voluntary act and deed of said corporation. By: L.l.U7t�QhW�•V4W Catherine D. Glover Notary Public CATHEPoNE D. nlr)Vm OFFICIALSEM Nowy P NIC -am 01i Ir. i°1i nvw's Myconrnbloninvil r AftFCh 21 2024 I, the undersigned officer of RLI Insurance Company and/or Contractors Bonding and Insurance Company, do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable; and furthermore, that the Resolution of the Company as set forth in the Power of Attorney, is now in force. In testimony whereof, I have hereunto set my hand and the seal of the RLI Insurance Coand/or Cogtractora Bonding antJ, Insurance Company typapy his day of I , I1 O_ • _. . RLI Insurance Company _ Contractors Bonding and Insurance Company - By: Qq,-4 D : rife,-- - . Jeffrey Milicls V Corporate Secretary 0449553020212 A0058DI9 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CUIL CODE 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 June 9, 2023 before me, Martha Isabel Lnne7, Riuhi, Notary Public Date Here Insert Name and Title of the Officer personally appeared M. who proved to me on the basis of satisfactory evidence to be the person("hose nameje) is/ar6� subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/heAthaKauthorized capacity(e , and that by his/of/tpeGsignature(a) o the instrument the persoDW, or the entity -upon behalf of which the person(lcted, executed the instrument. r MARTHA LIBEL LOPEZ RIUBI Notary Public - California ° c Los Angeles County Commission a 2356361 Y My Comm. Expires May 21, 2025 Place Notary Seal Above 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. Signature Signature of Notary Public OPTIONAL Though this section Is optional, completing this information can deter alteration of the fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signer(s) Other Than Named Capacity(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Titla s): ❑ Partner — ❑ Limited ❑ Gene ❑ Individual ❑ Attor Fact ❑ Trustee rdian or Conservator ❑ Other: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator F-1 rnhwr Signer Is Representing: �, 00-00,00101,00 ��... .. t CERTIFICATION OF NON-DISCRIMINATION AND AFFIRMATIVE ACTION As suppliers of goods or services to the listed below certifies that it does not with regards to race, religion, sex, or compliance with all federal, state, and orders regarding non-discrimination in pursue an affirmative course of action action guidelines. We agree specifically: City of Diamond Bar, the firm discriminate in its employment national origin; that it is in local directives and executive employment; and that it will is required by the affirmative 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 FIRM To take affirmative steps to hire minority employees within the company. FS Contractors, Inc. TITLE OF OFFICER SIGNING /Prresident SIGNATURE �. 4.'- ��f/10 rle,,� DATE 6/9/23 Please include any additional information available regarding equal opportunity employment programs now in effect within your company: N/A 36 CERTIFICATION WITH REGARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND THE FILING OF REQUIRED REPORTS FS Contractors, Inc. hereby certifies that The bidder , proposed subcontractor he has x 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 x , 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. DATE: June 9 FS Contractors, Inc. (COMPANY) (/n BY • JC�l �lein�j President (TITLE) 20 23 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. 37 NON -COLLUSION DECLARATION (TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID) The undersigned declares: I am the President the foregoing bid. FS Contractors, Inc. of , the party making The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. 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. All statements contained in the bid are true. 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, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose. Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on 6/9/23 [date], at Sylmar [city], CA [state]. FS Contractors, Inc. Business Name Signa re ofVBidder (must be notarized) 14838 Bledsoe St. Sylmar, CA 91342 Business Address Attach Notary Acknowledgement Form to this form when submitting 38 • -NIA ALL-PURPOSE ACKNOWLEDGMENTe 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 June 9, 2023 before me, Adarthn Tcahel Lopez Riuhi Notary Public Date Here Insert Name and Title of the Officer personally appeared GTl who proved to me on the basis of satisfactory evidence to be the pars nhose name(e)'(s/ar� subscribed jp the within instrumentand acknowledged to me that he/s tf xecuted the same in his/h�ev/ihe'If authorized capacity(i , and that bpis/t�hir signature on the instrument the persor)(s,� or the entity -upon behalf of which the person(a'j 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. MARTNA ISABEL LopEZ RIUBI WITNESS my hand and official seal. Notary pubBC - California Los Angeles County >E Commission # 2356361 Signature •'� My Comm. Expires May 21, 2025 Signature of Notary Publi Place Notary Seal Above OPTIONAL Though this section Is optional, completing this information can deter alteration of the fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signers) Other Than Named Capacity(les) Claimed by Slgner(s) Signer's Name: ❑ Corporate Officer — Title(s ❑ Partner — ElLimited ❑ Gene ❑ Individual ❑ Attor Fact ❑ Trustee rdian or Conservator ❑ Other: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: The corporate officer named in a corporate resolution as authorized to enter into this Agreement. A copy of the corporate resolution, certified by the Secretary close in time to the execution of the Agreement, must be provided to the City. 46 A 14838 BLEDSOE STREET • SYLMAR, CA 91342 PHONE: (818) 838-6040 , FAX: (818) 838-6.171 CONTRACTOR'S LICENSE 81005940 CLASS A-C8-C27 • DIR #1000033438 BOARD RESOLUTION OF ES CONTRACTORS INC. ADOPTED ON January 4, 2016 RESOLVED THAT: 1. The following are the appointed Directors of FS Contractors, Inc. Jose Angel Fierros, President Salomon Fierros, Vice President Jose Ernesto Fierros, Secretary 2. The board of directors approves all the directors to execute contracts and agreements on behalf of FS Contractors, Inc. Secretary's Certification: I certify that this resolution was duly adopted by the board of directors of FS Contractors, Inc. at a properly noticed open meeting held on January 4, 2016. Jose Ernes o Fierros, Secretary 1/4/16 APPENDIX A FEDERAL/STATE CONTRACT COMPLIANCE DOCUMENTS AND FORMS COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FEDERAL CONTRACT CLAUSE, PROVISIONS, DOCUMENTS, AND FORMS NOTICE TO BIDDERS COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) COMPLIANCE DOCUMENTS FOR CONSTRUCTION CONTRACTS of LESS Than $200,000 A Bidder is required to familiarize itself with the information provided on the following pages. Failure to comply with and/or meet the requirements may result in a bid being determined incomplete or non- responsive. A bidder is required to submit the following Compliance forms with its Bid Proposal: w 1: County Lobbying Certification �J 2: Request for Additional Classification and Rate 3: Contractor's List of Proposed Subcontractors v) 4: Worker's Compensation Certification V 5: Non -Segregated Facilities Certification N? 6: Past Performance Certification �G 7: Notice of Equal Employment Opportunity Commitment •: 8: Non Collusion Declaration V9: Federal Lobbying Certification COUNTY LOBBYIST CODE CHAPTER 2.160 COUNTY ORDINANCE NO. 93-0031 CERTIFICATION Name of Firm: FS Contractors Inc Address: 14838 Bledsoe St. State: CA Zip Code: 91342 Telephone Number: ( 818 ) 838-6040 Acting on behalf of the above named firm, as its Authorized Official, I make the following Certification to the Los Angeles County Development Authority (LACDA). 1) It is understood that each person/entity/firm who applies for a Los Angeles County Development Authority contract, and as part of that process, shall certify that they are familiar with the requirements of the Los Angeles County Code, Chapter 2.160 (Los Angeles County Ordinance 93-0031) and; 2) That all persons/entities/firms acting on behalf of the above named firm have and will comply with the County Code, and; 3) That any person/entity/firm who seeks a contract with the Los Angeles County Development Authority shall be disqualified therefrom and denied the contract and, shall be liable in civil action, if any lobbyist, lobbying firm, lobbyist employer or any other person or entity acting on behalf of the named firm fails to comply with the provisions of the County Code. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into contract with Los Angeles County and the Los Angeles County Development Authority. Authorized Official: FS Contractors, Inc. (Contractor/Subcontractor) 6/9/23 (Date) 41 By: �. (Signaturc) President U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT HUD FjORM 4230A REPORT OF ADDITIONAL CLASSIFICATION AND RATE OMBApprovel Number 2501-001I (E)q. af01/2022) 1. FROM (name and address of requesting agency) 2. PROJECT NAME AND NUMBER FS Contractors, Inc. 3. LOCATION OF PROJECT (City, County and State) 14838 Bledso St. Sylmar, CA 9134 4. BRIEF DESCRIPTION OF PROJECT 5. CHARACTER OF CONSTRUCTION ❑ Building ❑ Residential ❑ Heavy ❑ Other (specify) ❑ Highway 6. WAGE DECISION NO. (include modification number, if any) DATE of WAGE DECISION: 7. WAGE DECISION EFFECTIVE DATE (LOCK -IN): ❑ COPY ATTACHED 8. WORK CLASSIFICATION(S) HOURLY WAGE RATES BASIC WAGE FRINGE BENEFIT(S) (if any) Laborer $51.90 $30.70 Cement Mason $38.50 $25.91 Operator $52.97 $30.70 9. PRIME CONTRACTOR (name, address) 9a. 10. SUBCONTRACTORIEMPLOYER, IF APPLICABLE (name, address) FS Contractors, Inc. ❑ Agree ❑ Disagree 9b. SIGNATURE DATE 6/9I23 Check All That Apply: ❑ The work to be performed by the additional classification(s) is not performed by a classification in the applicable wage decision. ❑ The proposed classification is utilized in the area by the construction industry. ❑ The proposed wage rate(s), including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage decision. ® The interested parties, including the employees or their authorized representatives, agree on the classification(s) and wage rate(s). ❑ Supporting documentation attached, including applicable wage decision. Check One: ❑ Approved, meets all criteria. DOL confirmation requested. ❑ One or more classifications fail to meet all criteria. DOL decision requested. FOR HUD USE ONLY LR2000: Agency Representative Date Logit : (Typed name and signature) Log out: Phone Number HI M930A 19-191 PREVIOUS EDITION IS OBSOLETE U Z U m V/ W a ce a O a Z O U 0 0 0 0 m C7 w Z J a H Z ul 0 F5 w w (M W a v E E Z 2 a1 m w m OO w aO K � F i J VN A N 1 rt� N 1 y E o N N y r C w v Z r Tpp O a1 � _s O n Q F jz � $ Ij v w 2 (y � .� N J! IN a) a, rn �_ Q P aj o v E Z E z c s WORKER'S COMPENSATION CERTIFICATION I certify, by my signature below, that I am aware of the provisions of Section 3700 of the California Labor Code. §3700 requires every employer be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code. I further certify that I will comply with such provisions before commencing the performance of the work of this contract. Date: 6/9/23 Project Name: Company Name: Address: Project Number: 602474-22 AREA 3 RESIDENTIAL NEIGHBORHOOD ADA CURB RAMP IMPROVEMENT FS Contractors, Inc. 14838 Bledsoe St. Sylmar, CA 91342 Print Name: Jose Title: President Signature: Fierros Certification of Understanding and Authorization This certification is required when a Payroll Officer is not listed on the business license rdaomnl Contractor Name: FS Contractors, Inc. Project Name: AREA 3 RESIDENTIAL NEIGHBORHOOD CDe6PrgfWtNumber. 602474-22 ADA CURB RAMP IMPROVEMENT Project Location: Diamond Bar Local Contracting Agency (LCA): Labor Standards Officer (LSO): Telephone. The contractor certifies, by signature below, that the designated payroll officer has received a copy of the federal wage decision assigned to this project as identified below; CA CA20230022 Modification Number Dated The payroll officer acknowledges, by signature below, that she/he have also received, read, and understands the following provision and publication; No, Federal Labor Standards Provisions (HUD-4010 form), and ► Contractor's Guide to Prevailing Wage Requirements for Federally -Assisted Construction Projects. Further, the person designated as the Payroll Officer understands the laborstandards reporting requirements applicable to the above listed project, and she/he is hereby authorized to sign the Statement of Compliance form that will accompany each weekly payroll report for this project on behalf of the contractor. FS Contractors, Inc. 1005940 Contractor's Business Name License Number Jose Angel Fierros r/e,� Print Name of Owner or Principal listed on the business license Signature W Owner okRincloal listed on the business license President 6/9/23 Date Jose Angel Fierros L �- Fes" Print Name of Payroll Officer V Signatu or Payroll Officer NON -SEGREGATED FACILITIES CERTIFICATION Federally Assisted Construction Projects The federally assisted construction contractor certifies that he/she DOES NOT and WILL NOT: Maintain or provide, for his/her employees, any segregated facilities at any of his/her establishments. 2. Permit his/her employees to perform their services at any location, under his/her control, where segregated facilities are maintained. The federally assisted contractor agrees that a breach of this certification is a violation of the Equal Opportunity Clause in this contract. As used in this certification, the term segregated facilities means any waiting room, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because of habit, local custom, or otherwise. The federally -assisted contractor agrees that (except where he/she has obtained identical certifications from proposed subcontractors for specific time periods) he/she will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity Clause, and that he/she will retain such certifications in his/her files. NOTE: The penalty for making false statements in offers are prescribed in 18 U.S.C. 1001. Date: 6/9/23 Company: FS Contractors, Inc. Address: 0 14838 Bledsoe St. Sylmar, CA 91342 Title: President Project Number: 602474-22 PAST PERFORMANCE CERTIFICATION With regard to performance of previous contracts or subcontracts subject to the Equal Opportunity Clause and filing of required reports The 11bidder, ❑proposed sub -contractor, hereby certifies that he/she Mhas, ❑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/she ❑has, Qfhas not, filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance (OFCCP), 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. Date: 6/9/23 Awarding Agency: Contractor Name: Affiliate Company: By: Title: President Project Number: 602474-22 ContractAward: of Diamond FS Contractors, inc. Total Number of Employees 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). 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 or such other period specified by the U.S. Department of the Interior or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. SF-100 (EEO-1) must be filed bv; (A) All private employers who are: (1) Subject to Title VII of the Civil Rights Act of 1964 (as amended) with 100 or more employees. (2) Subject to Title VII who has fewer than 100 employees, if the company is owned or affiliated with another company, or there is centralized ownership, control or management so that the group legally constitutes a single enterprise, and the entire enterprise employs a total of 100 or more employees. (B) All federal contractors (private employers), who: (1) Are not exempt as provided for by 41 CFR 60-1.5 (2) Have 50 or more employees, and a. Are prime contractors or first -tier subcontractors, and have a contract, subcontract, or purchase order amounting to $50,000 or more; or b. Serve as a depository of Government funds in any amount, or c. Is a financial institution, which is an issuing, and paying agent for U.S. Savings Bonds and Notes. EQUAL EMPLOYMENT OPPORTUNITY COMMITMENT TO: Southern California Cement Masons (Name of Labor Union, Workers Representative, etc. 5417 Peck Rd. Arcadia, CA 91006 (Address) Name of Business (Contractor): FS Contractors, Inc Project NameA.REn -A RFc)nFhiTtnt Project Number: 602474-22 NEIGHBORHOOD ADA CURB RAMP IMPROVEMENT The Undersigned currently holds a contract with , involving funds of the U. S. Government, or a subcontract with a prime contractor holding such contract. You are advised that under the provisions of the above contract or subcontract, and in accordance with Executive Order 11246, the undersigned is obligated not to discriminate against any employee or applicant for employment because of race, color, religion, sex or national origin. This obligation not to discriminate in employment includes, but is not limited to the follow: 1. Hiring, placement, upgrading, transfer or demotion; 2. Recruitment, advertising or solicitation for employment; 3. Treatment during employment; 4. Rates of pay or other forms of compensation; 5. Selection for training, including apprenticeship; and 6. Layoff or termination. This notice is furnished to you pursuant to the provisions of the above contract or subcontract and Executive Order 11246. Copies of this notice will be posted by the undersigned in conspicuous places available to employees or applicants for employment. Jose Angel Fienros (ram Nan,e) 6/9/23 (Dart) By. — (sig..mr,) Prsident jida) EQUAL EMPLOYMENT OPPORTUNITY COMMITMENT TO: Southern CA Laborers Apprenticeship (Name of Labor Union, Workers Representative, etc. 1385 W. Sierra Madre Azusa, CA 91702 (Address) Name of Business (Contractor): FS Contractors Inc Project Number: 602474-22 Area 3 Residential Neighborhood Pro Project Name: g 1 ADA The Undersigned currently holds a contract with , involving funds of the U. S. Government, or a subcontract with a prime contractor holding such contract. You are advised that under the provisions of the above contract or subcontract, and in accordance with Executive Order 11246, the undersigned is obligated not to discriminate against any employee or applicant for employment because of race, color, religion, sex or national origin. This obligation not to discriminate in employment includes, but is not limited to the follow: 1. Hiring, placement, upgrading, transfer or demotion; 2. Recruitment, advertising or solicitation for employment; 3. Treatment during employment; 4. Rates of pay or other forms of compensation; 5. Selection for training, including apprenticeship; and 6. Layoff or termination. This notice is furnished to you pursuant to the provisions of the above contract or subcontract and Executive Order 11246. Copies of this notice will be posted by the undersigned in conspicuous places available to employees or applicants for employment. Jose Angel Fierros (Print Name) 6/9/23 By: �(Signena'e) President (Tide) California Public Contract Code requires every bid on every public works contract of a public to include a declaration under penalty of perjury under the laws of the State of California, in the following form: NONCOLLUSION DECLARATION TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID The undersigned declares: President I am the ____ of ____, the party making the foregoing bid. FS Contractors, Inc. The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. 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. All statements contained in the bid are true. 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, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose. Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on ___[date], at ___[city], ___[state]." 6/9/23 Sylmar CA FEDERAL LOBBYIST CERTIFICATION Name of Firm: FS Contractors, Inc. Address: 14838 Bledsoe St Sylmar State: CA Zip Code: 91342 Telephone Number: ( 818 ) 838-6040 Acting on behalf of the above named firm as its Authorized Official, I make the following Certification to the U. S. Department of Housing and Urban Development and the Los Angeles County Development Authority (LACDA). 1) No Federal appropriated funds have been paid by or on behalf of the above named firm to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of and Federal grant, loan or cooperative agreement, and any extension, continuation, renewal, amendment, or modification thereof, and; 2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee or any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with this Federal contract, grant loan, or cooperative agreement, the above named firm shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying", in accordance with its instructions, and; 3) The above name firm shall require that the language of this certification be included in the award documents for all sub -awards at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreement) and that all sub -recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into the transaction imposed by Section 1352 Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Authorized Official: FS Contractors, Inc. (Contwctw/Suboontrector) 6/9/23 President we)