HomeMy WebLinkAboutCDBG Diamond BarEXPERIENCE 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.
I. Project 'Title AAA --rAZ -��,Q+.,b.�i�`v►,-
Contract Amount ? 2 401 V o o
Type of Work ?,4,. 4 Ga., G►ckr
Client $wild LA GGD ELA G
Agency Project Manager �{rtY�s �S4 Phone
Date Completed 09 j 3v j 2022 % Subcontracted
2. Project Title ";IleAr L;Ke: R rAiry `aVF,1,,t �cstvr' v•.
Contract Amount 315 ova f
Type of Work ?<mv L;-, RrS4nrC
Client Las Am&tes Szx&�Vjes� Co11
Agency Project Manager VOsko" %non Phone (323) 22q- 0}-4°1
Date Completed 061$0 202 3 Subcontracted
3. Project Title ca"pr+S Wt.1-e U h-litIA --let'ove'e l
T
Contract Amount '319 vno
Type of work iate iyr lkh! U!�L, ` e�7i�► CA"'�rP' u1 +1�
Client Zimld LAcep -- L.A s(-
Agency Project Manager EL!j RCA-rx—J Phone OAS) 535 - g544
Date Completed 0'51 31 r 2 o 24 s Subcontracted C)
NOTE: If requested by the City, the bidder shall furnish a certified
financial statement, references, and other information sufficiently
comprehensive to permit an appraisal of his current financial condition.
Bidder's Signature
10
BIDDER'S PROPOSAL
CITY OF DIAMOND BAR
AREA 4 RESIDENTIAL NEIGHBORHOOD
ADA CURB RAMP IMPROVEMENT PROJECT
CDBG PROJECT NO. 602604-23
CIP PROJECT NO. S124104
Date °L41 2b . 20 2 L4
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:
V,w, w'y Af y-V-0,V-
(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
DOLLARS ($ g,
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.
% G 6 0 g �a� n l�d.t�. [Z j,
Address of Bidder
C,iko
City
(323) 31`4--�12-z
Telephone of Bidder
9ti�v �
Zip Code Signa of Bidder
16
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
BASE BID SCHEDULE
ITEM
EST.
DESCRIPTION
UNIT
NO.
QUANT.
UNIT
WRITTEN IN WORDS
PRICE
AMOUNT
f
1
1
LS
CONSTRUCTION STAKING AND
5,pov
5vva
MONUMENT PRESERVATION.
REMOVE EXISTING
IMPROVEMENTS AND CONSTRUCT
CURB RAMP PER SPPWC STD.
2
6
EA
PLAN NO. 111--5, INCLUDING
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
I
LS
STRIPING, PAVEMENT
��
MARKINGS, AND CURB
btoo�D
MARKINGS.
BASE BID SCHEDULE ITEMS:
TOTAL AMOUNT (IN FIGURES)—>
BASE BID SCHEDULE TOTAL AMOUNT (WRITTEN
4) S P_.tJ e., 1-] �"j *
ADD ALTERNATE SCHEDULE
5 --S, � 5 0
INp WORDS)
ITEM
EST.
DESCRIPTION
UNIT
NO.
QUANT.
UNIT
WRITTEN IN WORDS
PRICE
AMOUNT
s
REMOVE EXISTING
AA-1
4
EA
IMPROVEMENTS AND CONSTRUCT
ji Ile000
ji 44,Ooa
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
,6 ;n
1,000
SPPWC STD PLAN 113-2 and
130-2.
REMOVE EXISTING CROSS
AA-3
2,142
SF
GUTTER AND RECONSTRUCT PER
SPPWC STD. PLAN 122-3.
ADD ALTERNATE SCHEDULE ITEMS:
TOTAL AMOUNT (IN FIGURES)-*
ADD ALTERNATE
'i; III ,9-+v
SCHEDULE TOTAL AMOUNT (WRITTEN IN WORDS): O'ne
BASE BID + ADD ALTERNATE SCHEDULE ITEMS: .3
TOTAL AMOUNT (IN FIGURES) --> { q $ -} 2 0
BASE BID -4- ADD ALTERNATE SCHEDULE TOTAL AMOUNT (WRITTEN IN WORDS):
vif -----
Ori e ,�# 11�k�w-,�� � Set,c�. j-�h,,�i•.
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
(Insert "$ Sr 50G, . na cash",
"cashier's check" " „ " certified Check or "bidder's s band 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.
m o T
; r►er.,r;
_
0 510 512 0 211
NAME OF BIDDER {PRINT}
I ATURE
DATE
% (46 o g F""
p„ t-. Rd
- -
ADDRESS
cl%ixv
G
�` Dq
{323� 3!�-ail2Z
CITY
ZIP CODE
TELEPHONE
Lice%sc =W
log °l23 S
_ Glass "A"
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.
CONTR !(yl, SIGNATURE OR AUTHORIZED OFFICER
19
LIST OF SUBCONTRACTORS *
d BID OPENING DATE 0$10612OZ61
Ate+ y R� i "L'Date, - 602604- 2-S
PROJECT A b A (my-6 RA-,!p 'J•,PROJECT NO. C I P I241ok
LOCATION K JWW(t i vfAhb^ l At V iur• c- d ?Josr Co -A
CLIENT Cif 6� Diu
CONTRACTOR A i v r-e.r;
Name Under
Which
Subcontractor
I
L ensed
License
No.
Address
of
office, Mail,
or
Shop
Percent
of
Total
Contract
Specific
Description
of
Subcontract
* In compliance with the provisions of the Public Contract Cade
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 (112) 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:
I. The contractor is aware of Sections 1777.1 and 1777.7 of the
California Labor Code, which prohibit a contractor ❑r
subcontractor who has been found by the Labor Commissioner or the
Director of Industrial Relations to be in violation ❑f 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 t❑ 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 ❑n 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 May , c b, 2024, at S", &ty (place of execution) _
Signature
Name: AM-f'rwir
Title: Ovj,.•ev'
Name of Contractor:
�,A A-�- F111% ncc r;n
23
BIDDER'S VIOLATION OF LAW/SAFETY QUESTIONNAIRE
In accordance with Government Code Section 14310.3 and in conformance
with Public Contract Code Section 10162, the Bidder shall complete,
under penalty of perjury, the following questionnaire:
Has the Bidder, any ❑fficer,
has a proprietary interest
disqualified, removed, or
completing a federal, star
violation of law or a safety
YES
QUESTIONNAIRE
principal or employee of the Bidder who
in the business of the Bidder, ever been
otherwise prevented from bidding on or
e or local government project because of
regulation?
NO
If the answer is yes, explain the circumstances in the following space:
STATEMENT
In conformance with Public Contract Code Section 10232, the Contractor,
hereby states under penalty of perjury, that no more than on final
unappealable finding of contempt of court by a federal court has been
issued against the Contractor within the immediately preceding two-year
period because of the Contractor's failure to comply with an order of
a federal court which orders the Contractor to comply with an order of
the National. Labor Relations Board.
NOTE: The above Statement and Questionnaire are part of the
Prmos_al_ S±2ning 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 Lfl$& pm]Ca-# (fl26a4-Z3
G P �i4 'ems �PF S I 2 410 4
Bid Date o5"106 1:2o24
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 surroundina anv and all fatnlit-;Ps_
ITEM
3 CALENDAR YEARS
CURRENT
PRIOR TO CURRENT YEAR
YEAR
2021
2022
2023
TOTAL
2024
No. oFContracts
0
2
3
5
2
Total dollar amount of
contracts (in 1.000's)
�
� 3 �.�,
� � g i
� � 9 S
No. of lost work -day
cases
a
0
4
O
No. of lost work day
cases
involving permanent
transfer to
Q
0
0
another job or
0
O
termination of
1 em loN,ment
No. of last workdays
0
0
0
0
p
*The information required for this item is the same as required for
columns 3 to 5, Code 10, Occupational Injuries, Summary ---- Occupational
Injuries and Illnesses, OSHA No. 102.
The above information was compiled
to me at this time and I declare
information is true and accurate
records.
M A T
Name of Bidder (Print
+ u b o 8 F.,a", w vt
Address
"'W 1-�til� 0A ClIg01�
City Zip Code
from the records that are available
under penalty of perjury that the
within the limitations of these
Signature
log 012 3$ — cAt,ts
State Contractor's Lic. No. & Class
[323) `31-1 --3-1 22
Telephone
25
AFFIDAVIT FOR INDIVIDUAL BIDDER
STATE OF CALIFORNIA )
)SS
COUNTY OF LOS ANGELES }
duly sworn,de-poses and says:
rrr IN-
, being first
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.
r
Sig re
Subscribed and sworn
to before me this
0� day of 20 214
Signature of Officer Administering Oath
(Notary Public)
A notary public or other officer complept
this {ertlt3tate verifies only the idea 4 of
the m4widuaf who signed the document to
wNch this certffkata is attached. and not
the truthfvineus amoacyr ofvalldtty of that
document.
R E PfNEDA
*tary Pubifc • calfPomia
tm Angeles county
Lammfs icn 4 264cC44
fxavn Fro 21.2g2i
rr r rf� 1
28
Bond No. ORBB310167
M3 48M 14)061
KNOW ALL PERSONS BY THESE PRESENTS that,
WHEREAS the City of Diamond Bar ("City"), has issued an invitation
for bads for the worn described as follows:
AREA 4 RESIDENTIAL NEIGHBORHOOD
ADA CURB RAMP IMPROVEMENT PROJECT
CDBG PROJECT NO. 602604-23
CIP PROJECT NO. S124104
WHEREAS AHMAD JARRAR DBA MAJ ENGINEERING
14608 FAWN PATH RD, CHINO HILLS, CA 91706
(Name and address of Bidder)
("Principal"), desires to submit a bid to Public Agency for the work.
WHEREAS, bidders are required under the provisions of the California
Public Contract Code to furnish a form of bidder's security with their
bid.
NOW, THEREFORE, we, the undersigned Principal, and
OLD REPUBLIC SURETY COMPANY
445 S. Moorland Road, Suite 200, Brookfield, WI 53005
(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 EIGHT THOUSAND FIVE HUNDRED AND 00/100 DOLLARS
Dollars($ 8,500.00 ), being not less than ten percent (10) of the
total bid price, in lawful money of the ❑nited States ❑f America, for
the payment of which sum well and truly t❑ 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.
7..,
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
❑riginal 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 t❑ authority of its governing body.
Dated: APRIL 30, 2024
"Principal"
AHMAD JARRAR DBA
MAJ ENGINEERING
By -
s Ahmad Jarrar, Owner
NIA
Its
"Surety"
OLD REPUBLIC SURETY COMPANY
BY:
s Jacob Ealen,-A}torney-in-Fact
By: N A
Its
Note: This bond must be dated, all signatures must be notarized, and
evidence of the authority ❑f any person signing as attorney -in --
fact must be attached.
(Seal) (Seal)
35
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Sacramento
On April 30, 2024
before me, David M. Neeley, Notary Public
(insert name and title of the officer)
personally appeared Jacob Ellen
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 helshelthey executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
persons), 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 of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal. o. r4 DAVID M, KEELEY
votary P"lic Caitfor,
=t 5a� amento Cosviry r
Cormissior. 2389312
Y ' My C."". Expires 3a" 3, zi32rr
Signature P� (Seal)
* OLD REPUBLIC SURETY COMPANY Bond No. ❑RBB310167
POWER CE ATTORNEY
KNOW ALL MEN BY THESE PRESENTS- That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock insurance corporation, does make, constitute and
appoint
Jacob Ellen, James Drake, David Neeley of Sacramento, CA
its true and lawful Attorneys) -in -Fact, with full power and authority for and on behalf of the company as surety, to execute and
deliver and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof,
(other than bail bonds, hank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note
guaranty bonds, self-insurance workers compensation bonds guaranteeing payment of benefits, or black lung bonds), as follows?
ALL WRITTEN INSTRUMENTS
and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed.
This appointment is made under and by authority of the board of directors at a special meeting held on February 18, 1982.
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD
REPUBLIC SURETY COMPANY on February 18,1982,
RESOLVED that, the president, any vice-president or assistant vice president, in conjunction with the secretary or any assistant secretary, may appoint
attorneys -in -fact or agents with authority as defined or limited in the instrument evidencing the appointment In each case, for and on behalf of the company to
execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and said officers may
remove any such attorney -in -fact or agent and revoke any Power of Attorney previously granted to such person.
RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company
(i) when signed by the president, any vice president or assistant vice president, and attested and sealed (if a seal be required) by any secretary or assistant
secretary, or
(ii) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (if a seal be
required) by a duly authorized attomey-in-fact or agent; or
(iil) when duly executed and sealed (if a seal be required) by one or more attorneys -in -fact or agents pursuant to and within the limits of the authority
evidenced by the Power of Attorney issued by the company to such person or persons.
RESOLVED FURTHER that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attorney or
certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the company; and such
signature and seal when so used shall have the same force and effect as though manually affixed.
IN WITNESS WHEREOF OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be
affixed this 29th day of September 2022
CsuRL,!` ,
C,gpoftufgr
SEAL
=a' roar �ti:
F�'a a,rrr� r mxna•:
j4W44A
Asa.,,a nt Secreta T
STATE OF WISCONSIN, COUNTY OF WAUKESHA - SS
OLD REPUBLIC SURETY COMPANY
A/,04-
President
On thls 29th day of September 2022 , personally came before me, Alan Pavlic
and Karen J Haffner to me known to be the individuals and officers of the OLD REPUBLIC SURETY COMPANY
who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say: that
they are the said officers of the corporation aforesaid, and that the seat affixed to the above instrument is the seal of the corporation, and that said corporate seal
and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation.
'rS•.AVeL�G,-. - NotaryPubLe
My Commission Expires: September 28, 2026
CERTIFICATE (Expiration of notary's Commission does not invalid ote this instrument)
I, the undersigned, assistant secretary of the OLD REPUBLIC SURETY -COMPANY. a Wisconsin corporation, CERTIFY that the foregoing and attached
Power of Attorney remains in full force and has not been revoked: aR•x furti er norc. that the Resolutions of the board of directors set forth in the Power of
Attorney, are now in force.
30th April 2024
39 1033 v ' SEAL �o Signed and sealed at City ofll rookfieid. W! this day of
o
❑RSC22262 3-06Y"""ro,r
{ Assis....�t Secrets
California Contractors Ins
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 X , proposed subcontractor , 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 N , has not
, filed with the Joint Reporting Committee, the Director of the office
of Federal Contract Compliance, a Federal Government contracting or
administering agency, or the former President's Committee on Equal
Employment Opportunity, all reports due under the applicable filing
requirements.
(COMPANY)
BY : A1r,..r, j
0 ,r01Ae,1r
(TITLE)
DATE: 05 1,05; , 202W .
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)
t1y 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.
Nr7
NON -COLLUSION DECLARATION
(TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID)
The undersigned declares:
I am the owne,
the foregoing bid.
of MAC � %SweeX; . 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
California that the foregoing is
declaration is executed on
under the laws
true and correct
o510112v2w
of the State of
and that this
[date], at
[city] . GA [state] .
N4 AT:� Gr
Business Name Signature of Vdder (must be notarized)
lko? ?"A CtJ CIL"V 401, CA 1Itgoy
Business Address
Attach Notary Acknowledgement Form to this form when submitting
38
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