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DEPARTMENT OF PUBLIC WORKS
OFFICIAL NOTICE
Request for Bids
AREA 5 RESIDENTIAL NEIGHBORHOOD ADA CURB RAMPS
IMPROVEMENT PROJECT
CDBG PROJECT NO. 602671-24
CIP PROJECT NO. SI254
ADDENDUM NO. 1
The following changes to the Request for Bids (RFB) for the above project shall be
incorporated into the RFB.
The Contractor shall sign this page as acknowledgement of receipt of Addendum No. 1
and attach it to the bid.
David G. Liu, P.E. Date
Director of Public Works/City Engineer
Contractor's Authorized Signature
RMRA Measure M R Local Return Gas Tax
eet Rehab.- Area 1a, 1b, 2 (Design)
n)
ntain Laurel)
anyon to Lemon)
to BCY)
82,779$ 82,779$
om Pathfinder to Mountain Laurel Way) (Const.)1,200,000$ 1,200,000$
eet Rehab - Area 1 (Const.)2,000,000$ 925,000$ 850,000$ 89,0$
en Springs from Brea Canyon to Lemon Ave.) (Const.)900,000$ 500,000$
mp Project (Const.)177,855$
nt Projects 4,360,634$ 1,700,000$ 1,007,779$ 850,000$ 89,0$
250-5510-46412)
Project Description Total FY Budget (109) Measure
M
(111)
Gas Tax
(112)
Prop A
(113)
Prop C
Sign and HSL Replacement (Design)50,000$ 50,000$
Sign and HSL Replacement (Construction)350,000$ 350,000$
al 11 Locations (Design and Construction)380,000$ 90,000$ 100,000$ 190,0$
780,000$ 350,000$ 140,000$ 100,000$ 190,0$
ments (250-5510-46413)
Project Description Total FY Budget (113)
Prop C
Foothill Transit
Grant
60,000$ 60,000$
SD/Calbourne 40,000$ 40,000$
nfrastructure Improvements 100,000$ 60,000$ 40,000$
0-5510-46420)
Project Description Total FY Budget (107) Measure
W
(108)
RMRA
(109)
Measure M
(113)
Prop C
ovements-Phase 3 (Flapjack-Design)65,000$ 65,000$
2/25/2025
15
1293492.1
BIDDER'S PROPOSAL
CITY OF DIAMOND BAR
AREA 5 RESIDENTIAL NEIGHBORHOOD
ADA CURB RAMP IMPROVEMENT PROJECT
CDBG PROJECT NO. 602671-24
CIP PROJECT NO. SI254
Date , 20
To the City Council of the City of Diamond Bar:
The Undersigned hereby declares:
(a) That the only persons or parties interested in this proposal as
principals are the following:
(If the bidder is a corporation, give the name of the corporation
and the name of its president, secretary, treasurer, and manager.
If a co-partnership, give the name, under which the co-partnership
does business, and the names and addresses of all co-partners. If
an individual, state the name under which the contract is to be
drawn.)
(b) That this proposal is made without collusion with any person, firm
or corporation.
(c) That he 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.
March 4 25
Gentry General Engineering, Inc.
16
1293492.1
(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 ($ ).
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 Telephone of Bidder
City Zip Code Signature of Bidder
909.330.1128320 W Tropica Rancho Rd.
Colton 92324
ten percent 10%
17
1293492.1
BID SCHEDULE
CITY OF DIAMOND BAR
CONTRACT DOCUMENTS AND SPECIFICATIONS
AREA 5 RESIDENTIAL NEIGHBORHOOD
ADA CURB RAMP IMPROVEMENT PROJECT
CDBG PROJECT NO. 602671-24
CIP PROJECT NO. SI254
BID SCHEDULE
ITEM
NO.
EST.
QUANT. UNIT
DESCRIPTION
WRITTEN IN WORDS
UNIT
PRICE AMOUNT
1 1 LS CONSTRUCTION STAKING AND
MONUMENT PRESERVATION
2 6 EA
REMOVE EXISTING
IMPROVEMENTS AND CONSTRUCT
CURB RAMP PER SPPWC STD.
PLAN 111-5, INCLUDING
MOBILIZATION, TRAFFIC
CONTROL, AND PUBLIC SAFETY
3 179 LF
REMOVE EXISTING CURB AND
GUTTER AND CONSTRUCT CURB
AND GUTTER PER SPPWC STD.
PLAN 120-3
4 318 SF
REMOVE EXISTING SIDEWALK
AND CONSTRUCT CONCRETE
SIDEWALK PER SPPWC STD
PLAN 113-2
5 818 SF
REMOVE PAVEMENT SURFACE,
BASE, AND SUBGRADE, AND
INSTALL 4-FT WIDE HMA PLUG
6 1 LS
REMOVE EXISTING
CONFLICTING YELLOW
CROSSWALK PAINT AND
RESTORE STRIPING AND RED
CURB PAINT
BID SCHEDULE ITEMS:
TOTAL AMOUNT (IN FIGURES)®
$7,800 $7,800
$7,250 $43,500
$127 $22,733
$27 $8,586
$25 $20,450
$8,600 $8,600
$111,669
18
1293492.1
BID SCHEDULE TOTAL AMOUNT (WRITTEN IN WORDS):
Bid Schedule Note: Bid Price indicated refers to all items illustrated
on the plans and details, and delineated within the specifications
installed and completely in place with all applicable portions of the
construction documents and include all costs connected with such items
including, but to necessarily limited to, materials, transportation,
taxes, insurance, labor, overhead, and profit, for General Contractor
and Subcontractors.
All work called for on the construction documents are to provide a
completed project with all systems operating properly and ready for
use.
Award of the project shall be determined based on the lowest responsible
bidder. Therefore, the Contractor shall completely fill out the Bid
Schedule.
Accompanying this proposal is
(Insert "$ cash",
"cashier's check", "certified check", or "bidder's bond" as
the case may be) in the amount equal to at least ten percent
(10%) of the total bid.
The undersigned further agrees that in case of default in
executing the required contract, with necessary bond, within
ten (10) days, not including Sundays and legal holidays, after
having received notice that the Contract has been awarded and
ready for signature, the proceeds of the security
accompanying his bid shall become the property of the City of
Diamond Bar, and this proposal and the acceptance thereof may
be considered null and void.
NAME OF BIDDER (PRINT) SIGNATURE DATE
ADDRESS
Gentry General Engineering, Inc.
320 W Tropica Rancho Rd.
March 4, 2025
one hundred eleven thousand six hundred sixty-nine dollars
bidder's bond
10%
19
1293492.1
CITY ZIP CODE TELEPHONE
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
Colton 92324 909.330.1128
974279 Class A
20
1293492.1
LIST OF SUBCONTRACTORS *
BID OPENING DATE
PROJECT PROJECT NO.
LOCATION
CLIENT
CONTRACTOR
Name Under
Which
Subcontractor
is
Licensed
License
No.
Address
of
Office, Mail,
or
Shop
Percent
of
Total
Contract
Specific
Description
of
Subcontract
*In compliance with the provisions of the Public Contract Code
Section 4104, the undersigned bidder herewith sets forth the name,
location of the place of business, and California contractor
March 4, 2024
CDBG Area 5 Curb Ramp Project
Gentry General Engineering, Inc.
602671-24
Diamond Bar, CA
City of Diamond Bar
None over $10,000
21
1293492.1
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 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 bid or ten thousand ($10,000.00), whichever is
greater, and the portion of the work which will be done by each
Subcontractor.
22
1293492.1
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
23
1293492.1
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 ________________, 202_, at ___________________ (place of execution).
Signature
Name:
Title:
Name of Contractor:
_____________________________
March 4 5 Colton, California
Brenton Gentry
President/CEO
Gentry General Engineering, Inc.
24
1293492.1
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
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.
X
25
1293492.1
CONTRACTOR'S INDUSTRIAL SAFETY RECORD
Project Identification ___________________________________Bid Date
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 any and all fatalities.
ITEM 3 CALENDAR YEARS
PRIOR TO CURRENT YEAR
CURRENT
YEAR
2022 2023 2024 TOTAL 2025
No. of Contracts
Total dollar amount of
contracts (in 1,000’s)
No. of lost workday
cases
No. of lost work day
cases
involving permanent
transfer to
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 within the limitations of these
records.
______________________________ ________________________________
Name of Bidder (Print Signature
______________________________ ________________________________
Address State Contractor’s Lic. No. & Class
______________________________ ________________________________
City Zip Code Telephone
March 4, 2025
Gentry General Engineering, Inc.Brenton Gentry
320 W Tropica Rancho Rd
Colton 92324
974279 Class A
909.330.1128
602671-24 03/04/25
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
14 12 15 46 5
3600 4100 6100 16000 2200
27
1293492.1
AFFIDAVIT FOR CORPORATION BIDDER
STATE OF CALIFORNIA )
)SS
COUNTY OF LOS ANGELES )
, being first
duly sworn, deposes and says:
That he is
of,
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.
Signature
Subscribed and sworn
to before me this
day of , 20
Signature of Officer Administering Oath
(Notary Public)
San Bernardino
Brenton Gentry
President/CEO
Gentry General Engineering, Inc.
4th March 25
attached
36
1293492.1
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
TITLE OF OFFICER SIGNING
SIGNATURE DATE
Please include any additional information available regarding equal
opportunity employment programs now in effect within your company:
Gentry General Engineering, Inc.
President/CEO
March 4, 2025
37
1293492.1
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 , hereby certifies that
he has , has not , participated in a previous contract or
subcontract subject to the Equal Opportunity Clause, as required by
Executive Orders 10925, 11114, or 11246, and that he has , has not
, filed with the Joint Reporting Committee, the Director of the Office
of Federal Contract Compliance, a Federal Government contracting or
administering agency, or the former President's Committee on Equal
Employment Opportunity, all reports due under the applicable filing
requirements.
(COMPANY)
BY:
(TITLE)
DATE: , 20 .
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.
Gentry General Engineering, Inc.
Gentry General Engineering, Inc.
Brenton Gentry
President/CEO
March 4 25
X
X
X
38
1293492.1
NON-COLLUSION DECLARATION
(TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID)
The undersigned declares:
I 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].
_____________________________ _________________________________
Business Name Signature of Bidder (must be notarized)
________________________________
Business Address
Attach Notary Acknowledgement Form to this form when submitting
President/CEO Gentry General Engineering, Inc.
March 4, 2025
Colton California
Gentry General Engineering, Inc.
320 W Tropica Rancho Rd. Colton, Ca 92324
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 requirementsmay result in a bid being determined incomplete or non-
responsive.
A bidder is required to submit the following Compliance forms with its Bid Proposal:
1: County Lobbying Certification
2: Request for Additional Classification and Rate
3: Contracto List of Proposed Subcontractors
4: Wo Compensation Certification
5: Non-Segregated Facilities Certification
6: Past Performance Certification
7: Notice of Equal Employment Opportunity Commitment
8: Non Collusion Declaration
9: Federal Lobbying Certification
COUNTY LOBBYIST CODE CHAPTER 2.160
COUNTY ORDINANCE NO. 93-0031
CERTIFICATION
Name of Firm: ____________________________________________________________________________________
Address: _____________________________________________________________________________________
State: ___________ Zip Code: _____________ Telephone Number: ( ) _______________________
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:
___________________________________ By: _______________________________________
(Contractor/Subcontractor) (Signature)
___________________________________ _______________________________________
(Date) (Title)
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
REPORT OF ADDITIONAL CLASSIFICATION AND RATE
HUD FORM 4230A
OMB Approval Number 2501-0011
(Exp. 8/31/2022)
1. FROM (name and address of requesting agency)2. PROJECT NAME AND NUMBER
3. LOCATION OF PROJECT (City, County and State)
4. BRIEF DESCRIPTION OF PROJECT 5. CHARACTER OF CONSTRUCTION
Building
Heavy
Highway
Residential
Other (specify)
6. WAGE DECISION NO. (include modification number, if any)
COPY ATTACHED
DATE of WAGE DECISION: 7. WAGE DECISION EFFECTIVE
DATE (LOCK-IN):
8. WORK CLASSIFICATION(S)HOURLY WAGE RATES
BASIC WAGE FRINGE BENEFIT(S) (if any)
9. PRIME CONTRACTOR (name, address)9a.
Agree
Disagree
10. SUBCONTRACTOR/EMPLOYER, IF APPLICABLE
(name, address)
9b. SIGNATURE DATE
Check All That Apply:
The work to be performed by the additional classification(s) is not performed by a classification in the applicable wage decision.
The proposed classification is utilized in the area by the construction industry.
The proposed wage rate(s), including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in
the wage decision.
The interested parties, including the employees or their authorized representatives, agree on the classification(s) and wage rate(s).
Supporting documentation attached, including applicable wage decision.
Check One:
Approved, meets all criteria. DOL confirmation requested.
One or more classifications fail to meet all criteria. DOL decision requested.
FOR HUD USE ONLY
LR2000:
Agency Representative
(Typed name and signature)
Date Log in:
Log out:
Phone Number
HUD-4230A (8-19) PREVIOUS EDITION IS OBSOLETE
No additional classifications requested
City of Diamond Bar
21810 Copley Drive
Diamond Bar, California
91765
CDBG Area 5 Curb Ramp Project
various locations
Diamond Bar, Los Angeles Co, CA
XADA ramps
CA20250022 02/21/2025 02/21/2025
CERTIFICATION
I certify, by my signature below, that I am aware of the provisions of Section 3700 of the
California Labor Code. §3700 requires every employer be insured against liability for
elf-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: ________________ Project Number: ________________________
Project Name: ____________________________________________________________
CompanyName: __________________________________________________________
Address: _______________________________________________________________
Print Name: ______________________________________________________________
Title: __________________________________________________________________
Signature: _______________________________________________________________
602671-24
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: ________________________ Project Number: ________________________
Company: ________________________________________________________________________
Address: _________________________________________________________________________
By: ______________________________________________________________________________
Title: ____________________________________________________________________________
602671-24
PAST PERFORMANCE CERTIFICATION
With regard to performance of previous contracts or subcontracts subject to the Equal Opportunity Clause and filing of required reports
The bidder, proposed sub-contractor, hereby certifies that he/she has, has not, participated
in a previous contract or subcontract subject to the Equal Opportunity Clause, as required by
Executive Orders 10925, 11114, or 11246, and that he/she has, has not, filed with the Joint
Reporting Committee, the Director of the Office of Federal Contract Compliance (OFCCP), a
Equal Employment Opportunity, all reports due under the applicable filing requirements.
Date: __________ Project Number: _____________ Contract Award: $_______________
Awarding Agency: ________________________________________________________________
Contractor Name: ___________________________________ Total Number of Employees______
Affiliate Company: _______________________________________________________________
By: ___________________________________________________________________________
Title: __________________________________________________________________________
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.
602671-24 tbd, not yet awarded
24
X X
X
EQUAL EMPLOYMENT OPPORTUNITY COMMITMENT
602671-24
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:
I 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]."
FEDERAL LOBBYIST CERTIFICATION
Name of Firm: ___________________________________________________________________________
Address: _______________________________________________________________________________
State: ___________ Zip Code: _____________ Telephone Number: ( ) ______________________
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-
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:
___________________________________ By: _______________________________________
(Contractor/Subcontractor) (Signature)
___________________________________ _______________________________________
(Date) (Title)