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BIDDER'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 May 6 , 20 24 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: Gentry General Engineering, Inc. Brenton Gentry - President, Secretary, Treasurer, and Manager (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 bidder's bond DOLLARS ($ 10% ) . 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. 320 W. Tropica Rancho Rd. Address of Bidder Colton, CA 92324 City Zip Code 909.330.1128 Telephone of Bidder Signature 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. SI24104 BASE BID SCHEDULE ITEM EST. DESCRIPTION UNIT NO. QUANT. UNIT WRITTEN IN WORDS PRICE AMOUNT CONSTRUCTION STAKING AND 1 1 LS MONUMENT PRESERVATION. $10,500.00 $10,500.00 REMOVE EXISTING IMPROVEMENTS AND CONSTRUCT CURB RAMP PER SPPWC STD. 2 6 EA PLAN NO. 111-5, INCLUDING MOBILIZATION, TRAFFIC $28,000.00 $168,000.00 CONTROL, AND PUBLIC SAFETY. REMOVE EXISTING CURB RAMP OR SIDEWALK AND CONSTRUCT 3 95 SF CONCRETE SIDEWALK PER $20.00 $1,900.00 SPPWC STD PLAN 113-2 and 130-2. THERMOPLASTIC TRAFFIC STRIPING, PAVEMENT 4 1 LS $4,000.00 $4,000.00 MARKINGS, AND CURB MARKINGS. BASE BID SCHEDULE ITEMS: TOTAL AMOUNT (IN FIGURES) $184,400.00 BASE BID SCHEDULE TOTAL AMOUNT (WRITTEN IN WORDS) one hundred eighty-four thousand four hundred dollars and zero cents ADD ALTERNATE SCHEDULE ITEM EST. DESCRIPTION UNIT NO. QUANT. UNIT WRITTEN IN WORDS PRICE AMOUNT REMOVE EXISTING $22,000.00 $88,000.00 AA-1 4 EA IMPROVEMENTS AND CONSTRUCT 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 $20.00 $400.00 SPPWC STD PLAN 113-2 and 130-2. REMOVE EXISTING CROSS AA-3 2,142 SF GUTTER AND RECONSTRUCT PER $44.00 $94,248.00 SPPWC STD. PLAN 122-3. ADD ALTERNATE SCHEDULE ITEMS: TOTAL AMOUNT (IN FIGURES) --> $182,648.00 ADD ALTERNATE SCHEDULE TOTAL AMOUNT (WRITTEN IN WORDS): one hundred eighty-two thousand six hundred forty-eight dollars and zero cents BASE BID + ADD ALTERNATE SCHEDULE ITEMS: $367,048.00 TOTAL AMOUNT (IN FIGURES)-> BASE BID + ADD ALTERNATE SCHEDULE TOTAL AMOUNT (WRITTEN IN WORDS): three hundred sixty-seven thousand forty-eight dollars and zero cents Bid Schedule Note: Bid Price indicated refers to all items illustrated on the plans and details, and delineated within the specifications installed and completely in place with all applicable portions of the construction documents and include all costs connected with such items including, but to necessarily limited to, materials, transportation, taxes, insurance, labor, overhead, and profit, for General Contractor and Subcontractors. m All work called for on the construction documents are to provide a completed project with all systems operating properly and ready for use. The Contractor shall completely fill out the Bid Schedule including Base Bid and Add Alternate. Award of the project shall be determined based on the lowest responsible bidder. The lowest responsible bidder shall be calculated on the sum of "Base Bid" only. Accompanying this proposal is bidder's bond (Insert "$ 10% "cashier's check", "certified check", the case may be) in the amount equal t (100) of the total bid. cash", or "bidder's bond" as o 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. Gentry General Engineering, Inc. May 6, 2024 NAME OF BIDDER (PRINT) SIGNATURE DATE 320 W. Tropica Rancho Rd. ADDRESS Colton, CA 92324 909.330.1128 CITY ZIP CODE TELEPHONE Class A License # 974279 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. CONTRACTOR SIGNATURE OR AUTHORIZED OFFICER 19 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 San Bernardino On MM awl U . 2 o Zy before me, Andrea Scarbrough, Notary Public (insert name and title of the officer) personally appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the person(eA whose name(,) is/ore subscribed to the within instrument and acknowledged to me that he/stjd/tf 6y executed the same in his/hqf/tt it authorized capacity(i�s), and that by his/hgr/th'qfr signature( on the instrument the person(, , or the entity upon behalf of which the person( 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. OMYANDRa NICOLE SCARBROUGN Notary Public - California WITNESS my hand and official seal. San Bernardino County Commission # 2397494 Comm. Expires Mar 17, 2026 r Signature (Seal) LIST OF SUBCONTRACTORS * BID OPENING DATE May 6, 2024 PROJECT Area 4 Residential Neighborhood ADA Curb Ramp Improvement PROJECT NO . CIP No: S124104 CDBG No:602604-23 LOCAT ION City of Diamond Bar CLIENT City of Diamond Bar CONTRACTOR Gentry General Engineering, Inc. Name Under Which Subcontractor is Licensed License No. Address of Office, Mail, or Shop Percent of Total Contract Specific Description of Subcontract Case Land Surveying, Inc. L5411 614 N Eckhoff St `5% survey Orange, CA 92868 Chrisp Company 374600 43650 Osgood Rd <2% striping and markings Fremont, CA 94539 * 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 6109] The undersigned, a duly authorized representative of the contractor, certifies and declares that: 1. The contractor is aware of Sections 1777.1 and 1777.7 of the California Labor Code, which prohibit a contractor or subcontractor who has been found by the Labor Commissioner or the Director of Industrial Relations to be in violation of certain provisions of the Labor Code, from bidding on, being awarded, or performing work as a subcontractor on a public works project for specified periods of time. 2. The contractor is not ineligible to bid on, be awarded or perform work as a subcontractor on a public works project by virtue of the foregoing provisions of Sections 1777.1 or 1777.7 of the California Labor Code or another provision of law. 3. The contractor is aware of California Public Contract Code Section 6109, which states: (a) A public entity, as defined in Section 1100 [of the Public Contract Code], may not permit a contractor or subcontractor who is ineligible to bid or work on, or be awarded, a public works project pursuant to Section 1777.1 or 1777.7 of the Labor Code to bid on, be awarded, or perform work as a subcontractor on, a public works project. Every public works project shall contain a provision prohibiting a contractor from performing work on a public works project with a subcontractor who is ineligible to perform work on the public works project pursuant to Section 1777.1 or 1777.7 of the Labor Code. (b) Any contract on a public works project entered into between a contractor and a debarred subcontractor is void as a matter of law. A debarred subcontractor may not receive any public money for performing work as a subcontractor on a public works contract, and any public money that may have been paid to a debarred subcontractor by a contractor on the project shall be returned to the awarding body. The contractor shall be responsible for the payment of wages to workers of a debarred subcontractor who has been allowed to work on the project. 4. The contractor has investigated the eligibility of each and every subcontractor the contractor intends to use on this public works 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 California that of May penalty of perjury under the foregoing is true and , 2024, at Colton, California the laws of the State of correct. Executed this day (place of execution). Signature Name : Brenton Gentry Title: President/ CEO Name of Contractor: Gentry General Engineering, Inc. 23 ACKNOWLEDGMENT [attached, notary public or other officer completing this ertificate verifies only the identity of the individual ho signed the document to which this certificate is and not the truthfulness, accuracy, or validity of that document. State of California County of San Bernardino On MAV —��2-u� before me, Andrea Scarbrough, Notary Public (insert name and title of the officer) personally appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the person() whose name($) is/qfe subscribed to the within instrument and acknowledged to me that he/sre/jAey executed the same in his/h4r/th it authorized capacity(io), and that by his/h�r/tt%ir signature($) on the instrument the person(F), or the entity upon behalf of which the persons) 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. Signature (Seal) L 0, ANDREA NICOLE SCARBR0UGH Notary Public - California = W San Bernardino County g Commission # 2s"97494 "Po "My Comm. Expires Mar 17, 1016 r 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: Has the Bidder, any officer, has a proprietary interest disqualified, removed, or completing a federal, state 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 or local government project because of regulation? 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 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 San Bernardino On 4 2a Z y before me, Andrea Scarbrough, Notary Public (insert name and title of the officer) personally appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the person ) whose name(i) is/We subscribed to the within instrument and acknowledged to me that he/soe/ ey executed the same in r his/hor/t it authorized capacity(i�s), and that by hislorlth6ir signature(oon the instrument the person( , or the entity upon behalf of which the person(4acted, 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. ` '> ANDREA NICOLE SCARBROUGH WITNESS my hand and official seal. San B rnarPubld - California z W San ( rnardina County g Commission k 2397494 My Comm. Expires Mar 17, 2026 r Signature (Seal) CONTRACTOR'S INDUSTRIAL SAFETY RECORD Project I dent if icat ion Area 4 Residential Neighborhood ADA Curb Ramp Improvement Bid Date May 6, 2024 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 9 20 12 41 6 Total dollar amount of contracts in 1,000,s 3182 12818 7202 23202 3818 No. of lost workday cases 0 0 0 No. of lost work day 0 0 0 0 0 cases involving permanent transfer to another job or termination of employment No. of lost workdays 10 10 10 10 10 *The information required for this item is the same as required for columns 3 to 6, Code 10, Occupational Injuries, Summary - Occupational Injuries and Illnesses, OSHA No. 102. The above information was compiled to me at this time and I declare information is true and accurate records. from the records that are available under penalty of perjury that the within the limitations of these Gentry General Engineering, Inc.^ -- Name of Bidder (Print Signature 320 W. Tropica Rancho Rd. Class A License # 974279 Address State Contractor's Lic. No. & Class Colton, CA 92324 909.330.1128 City Zip Code Telephone 99 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 San Bernardino On MIAU , 9—bZq before me, Andrea Scarbrough, Notary Public (insert name and title of the officer) personally appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the person( ) whose name ) is/ e subscribed to the within instrument and acknowledged to me that he/st A y executed the same in his/he f/t it authorized capacity(i�s), and that by his/hQMhfiir signature( on the instrument the person(�or the entity upon behalf of which the person(g) 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. Signature (Seal) �.,�,� ry ANDREA 111101E SCARBR0u0N Notary Public -California L San Bernardino County Commission # 2397494 41f My Comm. Expires Mar 17, 2026 r AFFIDAVIT FOR CORPORATION BIDDER STATE OF CALIFORNIA ) )SS COUNTY OF LOS ANGELES ) Brenton Gentry duly sworn, deposes and says: That he is President/CEO of, Gentry General Engineering, Inc. being first a corporation which is the party making the foregoing proposal or bid; that such bid is genuine and not collusive or sham; that said bidder has not colluded, conspired, connived or agreed, directly or indirectly, with any other bidder or person to put in a sham bid or that such other person shall refrain from bidding; and has not in any manner sought by collusion to secure any advantage against the City of Diamond Bar or any person interested in the proposed contract, for himself or for any other person. Subscribed and sworn to before me this 6th Signature day of May Please see attached 2024 Signature of Officer Administering Oath (Notary Public) 27 Bond No. CSBA-27105 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 4 RESIDENTIAL NEIGHBORHOOD ADA CURB RAMP IMPROVEMENT PROJECT CDBG PROJECT NO. 602604-23 CIP PROJECT NO. SI24104 WHEREAS Gentry General Engineering Inc. 320 W. Tropica Rancho Road Colton CA 92324 (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 The Ohio Casualty Insurance Company 790 The City Drive South Suite 200 Orange CA 92868 (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 Dollars($10% ), being not less than ten percent (100) of the total bid price, in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal is awarded a contract for the work by City and within the time and in the manner required by the bidding specifications, entered into the written form of contract included with bidding specifications, furnishes the required bonds, one to guarantee faithful performance and the other to guarantee payment for labor and materials, and furnishes the required insurance coverages, then this obligation shall become null and void; otherwise, it shall be and remain in full force and effect. 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: May 2nd, 2024 "Principal" Gentry General Engineering, Inc. 320 W. Tropica Rancho Road, Colton, CA 92324 By:7;..A , Its PreJ,� "1-p NE Its "Surety" The Ohio Casualty Insurance Company 790 The City Drive South, Suite 200, Orange CA 92868 r By: Dwight Reilly Its Attorney -in -Fact Its Note: This bond must be dated, all signatures must be notariz&a, and evidence of the authority of any person signing as attorney -in - fact must be attached. (Sea1) 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 San Bernardino On Mu 2, Z nH before me, Andrea Scarbrough, Notary Public (insert name and title of the officer) personally appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the person( ) whose name(4 is/a subscribed to the within instrument and acknowledged to me that he/sve/t�fey executed the same in his/hey/th*ir authorized capacity(i�s), and that by his/hi�rttF & signature on the instrument the person , or the entity upon behalf of which the person($) 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. Signature (Seal) Tti ANDREA NICOLE SCARBROUGH Notary Public - California W San Bernardino County Commission # 2397494 '� �`My Comm. Expires Mar 17, 2026 r 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 Orange ) On 05/02/2024 before me, Melissa Ann Vaccaro, Notary Public (insert name and title of the officer) personally appeared Dwight Reilly 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 laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature V' Melissa Ann Vaccaro MELISSA ANN VACCARO 1 COMM. #2401942 M Notary Public -California a U. `" »}--: j� ORANGE COUNTY LL My Comm. Expires May 12, 2026 (Seal) Bond No. CSBA-27105 Liberty Mutual, SURETY This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY Certificate No. 8209029-969561 KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duty organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the Slate of Massachusetts, and West American Insurance Company is a corporation duly organized under the taws of the State of Indiana (herein collectively called the 'Companies'), pursuant to and by authority herein set forth, does hereby name, constitute and appoint Arturo Ayala: Daniel Huckabay: Adnan LangrelI Chelsca Liberatore' Frank Morones. R Nappi Dwight Reilly Shaunna Rozellc Ostrom Beu Stong Michael D. Stoll Benjamin Woltc all of the city of Orange state of CA each Individually it there be more than one named. Its true and lawful attorney -in -fact to make, execute, seat, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 21 st day of November 2023 Liberty Mutual Insurance Company P~ INSLg4 ZYwgG 1%Nsug4 The Ohio Casualty Insurance Company �J'`�pu U9� 04•� `J3`pxrao�r�'�Pyy� 'Nest American Insurance Company 1992 " 1919 s 1991�A le N,,, N► a� ^�`y/ /' �. ,�% ��R1 • ��d By: David M Caze Ass l t S to r`a State of PENNSYLVANIA Ss y' ecre ry County of MONTGOMERY Oro this 21 st day of November 2023 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual zed W Company, -The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authoriso to do, execute the foregoing Instrument for the T therein contained by signing on behalf of Ine corporations by himself as a duly authorized officer. r t/1 N IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year firsl above written .-. nor=,"• ti ��yas,w,p �F• Cs C— Wwb d 14" S" IKRSi Pa;cRg9d NwP:JdK Mcrtgomory Cowt4 er! 'Uy amrissm crxrcs rya^.n 2e. XRs By: 'A, =3' :a'irexCn iwrha „29a/4 Teresa Pastella, Notary Public This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: Liberty Mutual ARTICLE IV -OFFICERS: Section 12. Power of Attorney, Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, Shall appoint such attorneys -In -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings. bonds, recognizances and other surety obligations, Such allomeys-in-fact, subject to the hmilatnns set forth in their respective powers of attorney, shall have fun power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation When so executed, such instruments shall be as binding as If signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomeyin-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII- Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such alfomeys-iit-fact, as may be necessary to act in behalf of the Company to make, execute. seal, acknowledge and deliver as surety any and all undertakings, bonds, recogntzances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bin l the Company by their signature and execution of any such instruments and to attach thereto the seat of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of The Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in• fact as may be necessary to act on behalf of the Company to make. execute, seal, acknowledge and deliver as surety any and all undertakings, bands. ter ignizances and other surety obligations. Authorization - By unanimous consent of the Company's Board of directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the some force and efl'ect as though manually affixed. '. Reroee C. Lkw•anyn, the undersigned, Assistant Secretary, The Ohio Casualty insurance Company, Liberty Mutual Insurance Company. and West American Insurance Company do tlei;aby Cer* 6:et Ire original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and -has net beenrevt*s L! TESTI►ACVY. WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 2nd day of May .2024 �3`' om 's1912^ i 1919 c 6 1991 o B ro, Y Renee C. Lleweii n Asastam Secretor • _ 9iy � �,P '''qt t.N d,N . td y . Ty LIVIS-12373 LMIC 0CAC WA!C Muel Co 02rZ, CERTIFICATION OF NON—DISCRIMINATION AND AFFIRMATIVE ACTION As suppliers of goods or services to the City of Diamond Bar, the firm listed below certifies that it does not discriminate in its employment with regards to race, religion, sex, or national origin; that it is in compliance with all federal, state, and local directives and executive orders regarding non-discrimination in employment; and that it will pursue an affirmative course of action as required by the affirmative action guidelines. We agree specifically: 1. To establish or observe employment policies which affirmatively promote opportunities for minority persons at all job levels. 2. To communicate this policy to all persons concerned including all company employees, outside recruiting services, especially those serving minority communities, and to the minority communities at large. 3. To take affirmative steps to hire minority employees within the company. FIRM Gentry General Engineering, Inc. TITLE OF OFFICER SIGNING President/ CEO SIGNATURE �— DATE May 6, 2024 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 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 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. Gentry General Engineering, Inc. (COMPANY) BY: Brenton Gentry President/CEO (TITLE) DATE: May 6 , 2024 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/ CEO the foregoing bid. of Gentry General Engineering, Inc. 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 May 6,2024 [date], at Colton [city] , CA [state] . Gentry General Engineering, Inc.�— Business Name Signature of Bidder (must be notarized) 320 W. Tropica Rancho Rd. Colton, CA 92324 Business Address Attach Notary Acknowledgement Form to this form when submitting 38 ACKNOWLEDGMENT Fotary public or other officer completing this rtificate verifies only the identity of the individual osigned the document to which this certficate is ached, and not the truthfulness, accuracy, or -validity of that document. State of California County of San Bernardino On "(AV to, Z OZy before me, Andrea Scarbrough, Notary Public (insert name and title of the officer) personally appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the person ) whose name(§iis/qfe subscribed to the within instrument and acknowledged to me that he/sloe ti)$y executed the same in his/h4r/t it authorized capacity(ios), and that by hisftkk heir signature(s� on the instrument the person(��or the entity upon behalf of which the person( 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. Signature (Seal) °' >f ANDREA NICOLE SCARBROUGH W Notary Public - California W San Bernardino County Commission # 2397494 Y ��iFOrM +MY Comm. Expires Mar 17, 2026 r 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: ,X 1: County Lobbying Certification X 2: Request for Additional Classification and Rate LX 3: Contractor's List of Proposed Subcontractors FX 4: Worker's Compensation Certification CX 5: Non -Segregated Facilities Certification LX & Past Performance Certification LX 7: Notice of Equal Employment Opportunity Commitment FX & Non Collusion Declaration X 9: Federal Lobbying Certification COUNTY LOBBYIST CODE CHAPTER 2.160 COUNTY ORDINANCE NO. 93-0031 CERTIFICATION Name of Firm: Gentry General Engineering, Inc Address: 320 W Tropica Rancho Rd, Colton State: CA Zip Code: 92324 Telephone Number: ( 909 ) 330-1128 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: Gentry General Engineering, Inc (Contractor/Subcontractor) 6, 2024 (Date) By: (Signature) President ('title) U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT HUD FORM 4230A REPORT OF ADDITIONAL CLASSIFICATION AND RATE OMB Approval Number2501-0011 (Exp. 8/31/2022) 1. FROM (name and address of requesting agency) 2. PROJECT NAME AND NUMBER City of Diamond Bar CDBG Area 4 Curb Ramp Project 602604-23 21810 Copley Dr Diamond Bar, CA 91765 3. LOCATION OF PROJECT (City, County and State) Diamond Bar, Los Angeles Co, CA 4. BRIEF DESCRIPTION OF PROJECT 5. CHARACTER OF CONSTRUCTION ADA ramp 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 2023-2 (CA) August 2023 July 1, 2023 8. WORK CLASSIFICATION(S) HOURLY WAGE RATES BASIC WAGE FRINGE BENEFIT(S) (if any) Cement Mason per decision per decision Teamster per decision per decision Operating Engineer per decision per decision 9. PRIME CONTRACTOR (name, address) 9a. 10. SUBCONTRACTOR/EMPLOYER, IF APPLICABLE Gentry General Engineering, Inc (name, address) 320 W Tropica Rancho Rd, Colton, CA 92324 Agree ❑ Disagree 9b. SIGNATURE DATE .L May 6, 2024 Check All That Appl 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 Log in: (Typed name and signature) Log out: Phone Number HUD-4230A (8-19) PREVIOUS EDITION IS OBSOLETE (6I o m m 0 U 0 J M Lu Z) Lu m O Ln Lu 0 F- aTi � � a c 0 E sz o w v t c v N 0 9 0 U Q Ln rll c S o fn o a v aa) E u_ U J z �y 7 J M c 0 T u v n E rn C. Wiz 10 00 1, .. p M M N � � E D z ao U G H a) (� + F U a) H C1 O E i1 m N O LL In Q TfYO �U')fb O 70�1 <n L CO co41 p o N co Z L� to LUt U O L n J z ^ O.O� n L 0 L ko uID v��' —� E H ra v z m E C: E Z U WORKER'S COMPENSATION CERTIFICATION 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: May 6, 2024 Project Number: Project Name: CDBG Area 4 Curb Ramps Company Name: Gentry General Engineering, Inc Address: 320 W Tropica Rancho Rd, Colton, CA 92324 Print Name: Brenton Gent Title: President Signature: 602604-23 NON -SEGREGATED FACILITIES CERTIFICATION Federally Assisted Construction Projects The federally assisted construction contractor certifies that he/she DOES NOT and WILL NOT: 1. 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: May 6, 2024 Project Number Company: Gentry General Engineering, Inc Address: 320 W Tropica Rancho Rd, Colton, CA 92324 By:_ Title 602604-23 PAST PERFORMANCE CERTIFICATION With regard to performance of previous contracts or subcontracts subject to the Equal Opportunity Clause and filing of required reports The INbidder, ❑proposed sub -contractor, hereby certifies that he/she Nhas, ❑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 Nhas, ❑has 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: May 6, 2024 Project Number: 602604-23 ContractAward: $ tbd Awarding Agency: City of Diamond Bar Contractor Name: Gentry General Engineering, Inc Affiliate Company: n/a By: �:�z6t� Title: President Total Number of Employees 24 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 by; (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: Associated General Contractors (Name of Labor Union, Workers Representative, etc. 6212 Ferris Sq, San Diego, CA Name of Business (Contractor) (Address) Gentry General Engineering, Inc Project Name: CDBG Area 4 Curb Ramps Project Number. 602604-23 The Undersigned currently holds a contract with City of Diamond Bar , 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. Brenton Gentry (Print Name) May 6, 2024 (Date) By: �Z '�-- (Signature) President (Title) 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 Gentry General Engineering, Inc am the ____ of ____, the 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 and correct and that this declaration is executed on ___[date], at ___[city], ___[state]." May 6, 2024 Colton, CA 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 San Bernardino On M ay U 1 2 ()ZLI before me, Andrea Scarbrough, Notary Public (insert name and title of the officer) personally appeared Brenton Gentry who proved to me on the basis of satisfactory evidence to be the person( whose name(b) is/afe subscribed to the within instrument and acknowledged to me that he/sVe/tubby executed the same in his/hef /th Ir authorized capacity(iei), and that by his/h�rttq& signature(p) on the instrument the person( or the entity upon behalf of which the person(9 acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of Califomia that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) °i >y ANDREA NICOLE SCARSROUGH Notary Public • California = w San Bernardino County Commission R 2397494 `'� my Comm. Expires Mar 17, 2026 r FEDERAL LOBBYIST CERTIFICATION Name of Firm: Gentry General Engineering, Inc Address: 320 W Tropica Rancho Rd, Colton State: CA Zip Code: 92324 Telephone Number: ( 909 ) 330-1128 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: Gentry General Engineering, Inc By: (Contractor/Subcontractor) May 6, 2024 (Date) President (Signature) (Title) Form (Rev. March 2024) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Go to www.irs.gov/FormW9 for instructions and the latest information. Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below. Give form to the requester. Do not send to the IRS. 1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/oisregaroeci entity's name on line 2.) General Engineering, Inc 2 Business name/disregarded entity name, if different from above. 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes. ❑ Individual/sole proprietor ❑ C corporation ✓❑ S corporation ❑ Partnership ❑ Trust/estate ❑ LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) . . . . Note: Check the "LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner. ❑ Other (see instructions) 3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P' as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions . . . . . ❑ 5 Address (number, street, and apt. or suite no.). See instructions. 7 List account number(s) here (optional) T on 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any) (Applies to accounts maintained outside the United States.) Requester's name and address (optional) Gity Of DINtAend &?, Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see Now to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter. Certification Under penalties of perjury, I certify that: number or Employer identification number � ©©� 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. What's New Line 3a has been modified to clarify how a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax classification of its owner. Otherwise, it should check the "LLC" box and enter its appropriate tax classification. New line 3b has been added to this form. A flow -through entity is required to complete this ling to indicate that it has direct or indirect foreign partners, owners, or beneficiaries when it provides the Form W-9 to another flow -through entity in which it has an ownership interest. This change is intended to provide a flow -through entity with information regarding the status of its indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1065). Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS is giving you this form because they Cat. No. 10231X Form W-9 (Rev. 3-2024)