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HomeMy WebLinkAboutBid Submittal - City of Diamond BarBIDDER'S PROPOSAL CITY OF DIAMOND BAR AREA 4 RESIDENTIAL NEIGHBORHOOD ADA CURB RAMP IMPROVEMENT PROJECT CDBG PROJECT NO. 602604-23 CIP PROJECT NO. SI24104 Date 10 A� I , 20_ 1 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: 5 �a ! �S Gu 1 Pre r m + uov[5f1mo, Culot-ell, S.Crefaru (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. Ac phis proposal is a certified or cashier's check or C"Sidder's bon payable to the order of the City of Diamond Bar in the sum Q.f }} �jojkfq 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. Address of Bidder .0vAmij0 t 1-7(,e l City Zip Code 16 q 6[ Q H rph ne f id Ir rigrAture of Bidder BID SCHEDULE CITY OF DIAMOND BAR CONTRACT DOCUMENTS AND SPECIFICATIONS AREA 4 RESIDENTIAL NEIGHBORHOOD ADA CURB RAMP IMPROVEMENT PROJECT CDBG PROJECT NO. 602604-23 CIP PROJECT NO. S124104 r BASE BID SCHEDULE ITEM EST. DESCRIPTION UNIT NO. QUANT. UNIT WRITTEN IN WORDS PRICE AMOUNT 1 1 LS CONSTRUCTION STAKING AND MONUMENT PRESERVATION. �` yy } 4X3 IU3 REMOVE EXISTING IMPROVEMENTS AND CONSTRUCT CURB RAMP PER SPPWC STD. 2 6 EA PLAN NO. I11-5, INCLUDING lof 000 �of 000 MOBILIZATION, TRAFFIC CONTROL, AND PUBLIC SAFETY. REMOVE EXISTING CURB RAMP OR SIDEWALK AND CONSTRUCT 3 95 SF CONCRETE SIDEWALK PER SPPWC STD PLAN 113-2 and 130-2. THERMOPLASTIC TRAFFIC 4 1 LS STRIPING, PAVEMENT MARKINGS, AND CURB MARKINGS. BASE BID SCHEDULE ITEMS: TOTAL AMOUNT (IN FIGURES) BASE BID SCHEDULE TOTAL AMOUNT Dusa d 14, k(todired ADD ALTERNATE SCHEDULE q2, tj �g . (WRITTEN IN WORDS): Q.Io r ITEM EST. DESCRIPTION UNIT NO. QUANT. UNIT WRITTEN IN WORDS PRICE AMOUNT REMOVE EXISTING AA-1 4 EA IMPROVEMENTS AND CONSTRUCT jp1Vo() f oloob CURB RAMP PER SPPWC STD. ! 17 ITEM EST. DESCRIPTION UNIT NO. QUANT. UNIT WRITTEN IN WORDS PRICE AMOUNT PLAN NO. 111-5, INCLUDING MOBILIZATION, TRAFFIC CONTROL, AND PUBLIC SAFETY. REMOVE EXISTING CURB RAMP OR SIDEWALK AND CONSTRUCT AA-2 20 SF CONCRETE SIDEWALK PER fV 0 ��(�0 b SPPWC STD PLAN 113-2 and 130-2. REMOVE EXISTING CROSS AA-3 2,142 SF GUTTER AND RECONSTRUCT PER �(�p I� SPPWC STD. PLAN 122-3 .� j ADD ALTERNATE SCHEDULE ITEMS: TOTAL AMOUNT (IN FIGURES) -+ ADD ALTERNATE SCHEDULE TOTAL AMOUNT (WRITTEN IN WORDS):Ohe- kuk[j, vui ni'vi efuh Jnusar.d b0z kundLtd &mlve,dollrA BASE BID + ADD ALTERNATE SCHEDULE ITEMS: TOTAL AMOUNT (IN FIGURES)-* l D D BASE BID + ADD ALTERNATE SCHEDULE TOTAL AMOUNT (WRITTEN IN WORDS): 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, taxes, insurance, labor, overhead, and profit, for General Contractor and Subcontractors. 18 All work called for on the construction documents are to provide a completed project with all systems operating properly and ready for use. The Contractor shall completely fill out the Bid Schedule including Base Bid and Add Alternate. Award of the project shall be determined based on the lowest responsible bidder. The lowest responsible bidder shall be calculated on the sum of "Base Bid" only. Accompanying this proposal is b idd"wro kortd (Insert "$ "cashier's check", "certified the case may be) in the amount (100) of the total bid. cash", check", or "bidder's bond" as equal to at least ten percent 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. t,iroceU NvtJyac� oyl, Inc, ( PY VAW/- Si teI )- o7.L, NAME OF BIDDER (PRINT) SIGNfTURE DATE Mildred / ADDRESS CITY ZIP CODE TELEPHONE �Z� �Lcrg N I B' 0 0i H-V� 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 Jrqu remenn of California Business and Professional Code Section 7J CONTRACTOR SAGNATURE OR AUTHORIZED OFFICER 19 BID BOND NO. 11-757-104 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 4 RESIDENTIAL NEIGHBORHOOD ADA CURB RAMP IMPROVEMENT PROJECT CDBG PROJECT NO. 602604-23 CIP PROJECT NO. SI24104 WHEREAS Metrocell Construction, Inc. 1166 Mildred Street, Ontario, CA 91761 (Marne 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 American tractors indemnity Comoan 801 South Figueroa Street#700 Los Angeles CA 90017 (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 Amount Bid in 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 NO. 11-757-104 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: Mav 6, 2024 "Principal" Metrocell Construction, Inc. 13y= M Its "Surety" American Contractors Indemnity Company By : & (L, Its Attorney -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 ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies onlythe identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Orange On May 1, 2024 before me, L. Nahina Pfister, Notary Public Date Here Insert Name and Title of the Officer personally appeared Blake A. Pfister Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the L. NAHINA PFISTER laws of the State of California that the foregoing Notary Public -California 9 paragraph is true and correct. 5 Orange County WITNESS my hand and official seal. Commission # 2479518 My Comm Expires Jan. 13, 2028 Signature { MLUA Place Notary Seal and/or Stamp Above Signature of kotkPublic 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: Bid Bond 1 1--757-1 04 Document Date: May 5, 2024 Signer(s) Other Than Named Above: N/Ar. None Capacity(ies) Claimed by Signer(s) Signer's Name; Blake A. Pfister ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual M Attorney in Fact ❑ Trustee. ❑ Guardian or Conservator ❑ Other: Signer is Representing: American Contractors Indemnity Com an Number of Pages: 2 Signer's Name: ----- ❑ Corporate Officer -- Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: -.:Y : ', �K ,:r.. $'�^: ::��sm:r :^�-, ' 7r`.='#s- :�: "'d• ':C� .R�p'.�a. :��i�: •,x £F:rsS:;' � "�C?:��Yw - :?t:•vyir_. � �:2,F� @2019 National• • • Statepf Calif4rn4' •N,006unty of Los Ahgelds-':0' oqmplefingl-thoq c0difipa(to, ypnfps onlytheftntity of the individualwhO,-,Signed the document to 1, thko-ad6 '00' t I,Ldfid not the ii6th61qdsg,`r,a Oabddcy, or men !8 fore me, Sohia 0. Carrejo, a notary publicPersb75silly I appeared Danibl' Agui 6r, Vlc6 President of Company, Texas Bonding Company, United States Surety Company and U.S. Specialty Insurance ie.basis of4atisfactory evidento be the peonrib 4,.whose name is subsced to the -Within instrument h1G, executed 64ar4, in fills�ce rs :'-:authonzi�a capacty-and lik by his;si6hOjur­e. ori:!W6instrument (half of whicb:3.ffiePe�ri6n46t4a- x ecutedA11"e Instrument under the laws of the State of California that the foregoing paragraph is true and correct. 9 0 I.- - 12398711 I'll L 0��ANPOAOYqQ2S I V t t6ihw-'b6th suttsfy for morekinfoOrnat ory CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of San Bermardino On May 6, 2024 before me, Lisa Y. Serrano, Notary Public (Here insert name and title of the officer) personally appeared James Culwell who proved to me on the basis of satisfactory evidence to be t11e person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State or California that the foregoing; paragraph is true and correct. LISA YOLANDA SERRANO Notary Public - Cail(ornia WITNESS d and official seal. " - San BenowcilnoGounty F Comiflission # 2332885 o•"� My Comm, Expires Sep t, 2Q24 (Notary Seal) Signature tl`InLa Ill: ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENI• e In till_ ('title or description of attached dOCEnncnl ) City of Diamond Bar (Title or description of attached document continued) NumberofPages 2___ Document Date 05/06/24 (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ® Corporate Officer President (Title) ❑ Partner(s) © Attorney -in -Fact ❑ Trustee(s) ❑ Other INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed ar Califurnra ttarst Contain ver•brage exacrl}' as appears abore in the notary section ar a separate acknuuledgnreat ftnot nutst be properlr completed and attached to that thwument. The orrty exception is if' a document is to be recorded ourside of C'atifor Ain. !n such instauc•es. and - alternative acknowledgment reiburge as nigt• be printed on such a docnmem so long cis tine verbiage does not require the notaryy to do something that is illegalfin. a rrotaly in Califoiwirt (i.e. certifying the authorized capacity of the signer}. Please cheek the document caref+rNj• fin proper notarial wording and attach this for-w ii equirerl. • State and County information must be the State mid County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date or notarization must be the date that the signer(s) personally appearcd which must also be the same date the acknowledgment is completed. • the notary public must print his or her matte as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/shc1#w)- is /are ) or circling the correct forms. Failure to correctly indicate this infomtation may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. lmpression must not cover test or lines, If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowiedgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional informuuon is not required but could help to ensure this acknowledgment is not misused or attached to a different document. v Indicate title or type of attached document, number of pages and date- . Indicate the capacity claimed by the signer_ If the claimed capacity is a corporate officer, indicate the title (Le. CEO, CFO, Secretary) • Securely attach this document to the signed document 2008 Version CAPA v 12,10.07 800-873-9865 wi�-.v.NotaryClasscs.com LIST OF SUBCONTRACTORS * BID OPENING DATE PROJECT "[ R6[ tK&Ll �Qq PROJECT NO. IpO2 O --3 Zgioq LOCATION CLIENT fit V 1 �iyoo � CONTRACTOR M,?,�"Ujl COMB Mu Name Under Which Subcontractor is Licensed License No. Address of office, Mail, or Shop Percent of Total Contract Specific Description of Subcontract i i�1 ,Stir } -4ftAq, r �� * 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 Kai (0 , 202W at C}Vt jrtt f �� (place of execution) . Name: -J G{yYtlr-a U,, [Ivvv-" Title: Pre&Ide',4 Name of Contractor: hic- . 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: and Questionnaire are part of 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 &"a 4 RRs14 / 6 MekakboAood 4A Curd kamp I rn rovem-evf Bid Date LQ j .o1� 14 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 circumstances surrounding anv and all fatalities. ITEM 3 CALENDAR YEARS CURRENT PRIOR TO CURRENT YEAR YEAR 2021 2022 2023 TOTAL 2024 No. of Contracts Total dollar amount of ; � 1 C1 M Y �� M 2-0 contracts in 1,000's .� No. of lost workday , 49- cases No. of lost work day cases involving permanent transfer to (g �7 another job or termination of employment No. of lost workdays *The information required for this item is the same as required for columns 3 to 6, Code 10, Occupational Injuries, Summary - Occupational Injuries and Illnesses, OSHA No. 102. The above information was compiled from the records that are available to me at this time and I declare under penalty of perjury that the information is true and accurate wit hi he limitations of these records. � J , / ROmoel Cony mru off,-J igc Name of B' der (Print f I UP t Address . C& City Zip Code 1Zat e' C10 4 E State Contractor �s /Lic. No. & Class Telephone 25 AFFIDAVIT FOR CORPORATION BIDDER STATE OF CALIFORNIA ) )SS COUNTY OF LOS ANGELES ) a mes GV Iyu-ilt , being first duly sworn, deposes and says: That he is of, Mi %E.P1I��tilii�� l(� 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. axl� A Subscribed and sworn to before me this day of 20 Signrure of Officer Administering Oath to (Notary Public) 'Se, aC'� e',J` 27 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of San Bermardino On May 6, 2024 before me, Lisa Y. Serrano, Notary Public (Here insert name and title ofthe oiFcer) personally appeared James Culwell who proved to me on the basis of satisfactory evidence to be the person(s) whose nalne(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/lier/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument, certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. *my LISA YOLANDA SERRANO Notary public - California WITNESS t„y hand a fticial seal. San Bernardino County Comfiiission # 2332885 Comm, Expires Sep 1, 2024 (Notary Scalp Signature orNotarv' ubl' ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMEN-1 Affidavit for Corporation Bidder (Title or description orattached document) City of Diamond Bar (Title nr description of altaclied document continued) Nuntberof Pages I — Document Date 05/06/24 (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ® Corporate Officer President (Title) ❑ Partner(s) 0 Attorney -in -Fact 0 Trustee(s) IJ Other INSTRUCTIONS FOR COMPLETING THIS FORM An acknowledgment completed in earfrrrrra must comain rerbrage exactly as appears alwre in the notary section or a separate acktioir•ledgmentt fora[ near be properly completed and anaelred to that document, The orily exerprion is if a dncumeur is to be recorvded outside ofCalifornria- In such insrarrces, an alienrati» e acknairledgment rerbtage as nray be printed on such a document so long as Cite rerbiage clues not require fire norai:r to do something that is illegal far a notary in Calffomia (i.e. cerfifving, rite attdinri_ed capacity of the signer). Please check fire rdac•nnrean uotijirdJy for' prtrptr moray tad o'nnding arrd uaach this Joran r'f required. • State and County information must he the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date or notarWition must be the date that the Signer(S) personally appeared which must also be the same date die acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the namc(s) of document signer(s) who personally appear at the time of notarization, • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. Wshe/they is lere ) or circling The correct forms. Failure to correctly indicate this information may ]cad to reiectioti ordocument recording. • The notary seal impression must he clear and photographically reproducible. Impression must not cover test or lines If seal impression smudges, rc-seal if a sufficient area permits, othcrnvise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. r� Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document 2008 Version CAPA v 12. I0.07 800-873-9865 iuww.NotaryClasses.com CERTIFICATION OF NONDISCRIMINATION 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 AAeJ_rD6e1J C_VJS I r 0,fi JYI l TITLE OF OFFICFA SIGNI SIGNATURE --/�jC DATE. 'I l, Please include any additional information available regarding equal opportunity employment programs now in effect within your company: 36 CERTIFICATION WITH REGARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND THE FILING OF REQUIRED REPORTS The bidder!"{ , proposed subcontractor l� , hereby certifies that 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 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. uhm .Inc . (COMPANY BY: Pr 2S (TITLE) DATE: " L11 20A 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 ! I am the Raid-eM of M�TTU I �1'iS�Qgthe party making the foregoing bid. 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 a d correct and that this declar tipn is executed 7 on (� [date], at Q{IUrtdi [city] , CA [state]! WD dell coils��00 l h C. Business Name Signature of B' der (must be notarized) M MJ&VQ 0 S �_ Uytpi'io ( G 0 1-7q l Business Address Attach Notary Acknowledgement Form to this form when submitting CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of San Bermardino On May 6, 2024 before me, Lisa Y. Serrano, Notary Public (here insert riame and title of the officer) personally appeared James Culwell who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signaturc(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. 1 certify under PENALTY OF PERJURY tinder the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my (rand and official seal. Signature or r r� LISA YOLANDA SERRANO Notary Public • California San Bernardino County w Comriiission N 2332885 `'«.r•+� My Comm. Explres Sep 1, 2024 (Notary Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT Non -Collusion Declaration (Title or description orattached document) City of Diamond Bar (Title or description of attached document continued) Number of Pages 1 Document Date 05/06/24 (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ® Corporate Officer President (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) 12 Other INSTRUCTIONS FOR COMPLETING THIS FORM Any ackounrledgmrent completed at California must Contain rerbtage exactly as appears abo•e in the notaty section or If separate wkranrledgment form naim be properly compleeecl and attached ro thar document. 1he only exception is if a docttnrent is to he recorded outside of California. In such instances, any ahernative acktrorledgrrtenl verbrage as may be printed or such a document so long as rile rerbiage does not r egtrire the notatl, to Flo something drat is illegal for a notary in California #.e- certif ing the awhoriced capacit v of the signer). Please check the dncanrent carefully for pr oper norarial n•ording mid attach this faun ifregtrirrd. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date or nutarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. • lore notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public)_ • Print the name(N) or document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect Forms (i.e. he/she/Miry- is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to re,lection ordocument recording. • The notary seal impression must be clear and photographically reproducible. impression must not cover text or lines If seal impression smudges, re -seal if a sufficient area permits, otli mvise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk, Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. S Indicate the capacity claimed by the signer_ If the claimed capacity is a corporate officer, indicate the title (i.e. CEO. CFO, Secretary), • Securely attach this document to the signed document 2008 Version CAPA v 12.10.07 800-873-4865 %v%vw.NotaryClasses.com 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 $250,000 each qualify as similar for this project. 1. Project Title Mz0 try WC4 d1 Contract Amount kb 0�-o Dd Type of Work MOSOYINU140(i,[C- 011 Client 1. h epQ rfmfo Agency Project Manager A)T[koy Floret Phone 6W --�M -9653 Date Completed Z1-1,0b7i % Subcontracted 2. Project Title C11: Contract Amount i , 111 1 141 Type of Work Client Agency Project Manager _�.,d&N rd Phone C)LA'3 1•- &5-7-7 Date Completed 111 ,26 % Subcontracted 3. Project Title Contract Amount 2 Type of Work Client L ' { KeAVIy V rfC h J(A K � Agency Project Manager Phone Z �' � � ''VtJt Date Completed ��,r�'%/2 o Subcontracted NOTE: if requested by the City, 7dIth dder s all furnish a certified financial statement, references, information sufficiently comprehensive to permit an appraisas urrent uncial condition. Bidder's Signature 10