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Sequel Proposal and Bond
Sequel Contractors Inc BIDDER'S PROPOSAL FOR AREA 4 RESIDENTIAL & COLLECTOR STREETS REHABILITATION AND ARTERIAL STREET REHABILITATION (BREA CAYON CUTOFF ROAD FROM 57 FREEWAY SOUTH OFF RAMP TO NORTH CITY LIMITS AND LEMON AVENUE FROM GOLDEN SPRINGS Date DRIVE TO NORTHERN CITY LIMITS) PROJECT NO. SI251 & SI254 418 , 20 25 ---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: Sequel Contractors Inc Thomas S. Pack President abel Magallanes, Vice President 13546 Imperial Highway, Santa Fe Springs Ca 90670 Michael A. Mahler, Secretary (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 Sequel Contractors Inc (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 Bidders bond(10%) 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. 13546 Imperial Highway (562) 802-7227 er/ ~1~',~~~~-.-9~,;1~.c-~~~l~~~-Address of Bidder Santa Fe Springs , California 90670 City Zip Code Thomas S. Pack President 16 Sequel Contractors Inc BID SCHEDULE FOR AREA 4 RESIDENTIAL & COLLECTOR STREETS REHABILITATION AND ARTERIAL STREET REHABILITATION (BREA CAYON CUTOFF ROAD FROM 57 FREEWAY SOUTH OFF RAMP TO NORTH CITY LIMITS AND LEMON AVENUE FROM GOLDEN SPRINGS DRIVE TO NORTHERN CITY LIMITS) PROJECT NO. SI251 & SI254 BASE BID "SCHEDULE A" -RESIDENTIAL & COLLECTOR STREETS, PROJECT NO. SI251 ITEM EST. DESCRIPTION UNIT NO. QUANT. UNIT WRITTEN IN WORDS PRICE AMOUNT A-1 1 LS MOBILIZATION AND Ot> lJ6. DEMOBILIZATION 5(),0()(), -~t>,O(){), -A-2 1 LS TRAFFIC CONTROL AND oc ~ PUBLIC SAFETY /{7, 000, -/f 7,0DO, -A-3 1 LS WATER POLLUTION CONTROL ()() t:IO /0, 000, -10,000, -A-4 1 LS CONSTRUCTION STAKING AND DI oo MONUMENT PRESERVATION )(),000, -){),006, -A-5 1 LS PUBLIC NOTIFICATION to llO /{) ,000, -/(),000. -A-6 61 EA ADJUST WATER VALVE BOX ~ ~ AND COVER TO GRADE <&oo ... 'fz,<goo, ' A-7 4 EA ADJUST STORM DRAIN MANHOLE FRAME AND COVER Q> -ao l.~00. -f,,ooo, -TO GRADE A-8 46 EA ADJUST SANITARY SEWER MANHOLE FRAME AND COVER 00 00 /,~00, -6tf,OOO I -TO GRADE A-9 1 EA COORDINATE SANITARY SEWER VAULT FRAME AND COVER ()o DO ADJUSTMENT WITH OWNER /()0. -/()(). ~ A-10 2 EA COORDINATE ELECTRICAL MANHOLE FRAME AND COVER b~ {)(!) /00. ). ()()' -ADJUSTMENT WITH OWNER A-11 2 EA COORDINATE TELECOMM MANHOLE FRAME AND COVER D~ ()I) /()0. -()oo -ADJUSTMENT WITH OWNER I 17 Sequel Contractors Inc ITEM EST. DESCRIPTION UNIT NO. QUANT. UNIT WRITTEN IN WORDS PRICE AMOUNT A-12 16 EA REMOVE EXISTING IMPROVEMENTS AND INSTALL NEW ADA COMPLIANT CURB ()(? ~ RAMP PER SPPWC STD. PLAN /, O(}(). -II), OOfJ, 111-5 A-13 50 LF REMOVE EXISTING CURB AND GUTTER AND RECONSTRUCT DO •D PER SPPWC STD. PLAN 120-3 /10. -t,~()(), -(A2-6 or A2-8) A-14 6,133 SF REMOVE EXISTING CROSS GUTTER AND RECONSTRUCT ')7, ~ ~b PER SPPWC STD. PLAN 122-3 I 6 5", ~'JI, -(8" DEPTH) A-15 13,334 SY APPLICATION OF TYPE II SLURRY SEAL AND CRACK .?. ~ ;Jt> SEAL )(), ~6 7. -A-16 30,074 SY APPLICATION OF CAPE SEAL ~· AND CRACK SEAL ~.~ J~;; I 6"' I, -A-17 6,266 SY COLD MILL EXISTING AC (1.5" DEPTH) 9. ~~ ~7,bl./7, ~ A-18 6,870 SY COLD MILL EXISTING AC (2. 0" DEPTH) s-.~ '31, () 9'3, ~ A-19 582 TON CONSTRUCT HMA OVERLAY • Od (1.5" DEPTH) /80, -I 0'-1, 7~o, b A-20 850 TON CONSTRUCT HMA OVERLAY ()< (2.0" DEPTH) /JS-. o~ /06,J5"o, -A-21 10,382 SF BASE REPAIR (6" DEPTH) IJ. ?.! /'JI g-:;-; ~ ' . A-22 11,456 LF MICRO MILLING AC ( 1. 0 DEPTH AND 4' WIDTH) 6. 'f. 70, 'l~LI. ~ A-23 1 LS REMOVE TRAFFIC STRIPING ()e AND MARKINGS (SLURRY SEAL DD //, 000, -I/, OCt> I -AND CAPE SEAL STREETS) A-24 1 LS THERMOPLASTIC TRAFFIC STRIPING, PAVEMENT ()(/) ()I. MARKINGS, MARKERS, CURB ).o, coo. -;)o, ooo. -MARKINGS, AND SIGNPOSTS. A-25 22 EA PAVEMENT CORING PROGRAM Dt> ~00.~ //,<>00, -18 TOTAL AMOUNT BASE BID "SCHEDULE "A" ITEMS (IN FIGURES)~ $ Sequel Contractors Inc /, ] 9 ~, 7 /,{;; . ~ TOTAL AMOUNT BASE BID "SCHEDULE A" (WRITTEN IN WORDS): Otte. ),1;//;0;11 11t/'ee µll'l,..d,...~d AJ111e+7 Etf;~./--'M.o,,,_sp.,,._.j ~evtiA /-1-(/1-\.J/'-£.,/ For./. r '//,.)(? Ptptt IN-S Pv\.e/ Ee 'Bhl-z ~../--;. BASE BID "SCHEDULE B" -ARTERIAL STREETS () , PROJECT NO. SI254 ITEM EST. UNI DESCRIPTION UNIT NO. QUANT. WRITTEN IN WORDS PRICE AMOUNT T B-1 1 LS MOBILIZATION AND DEMOBILIZATION ~O,Ott>, "!!' 6 '10 O,.DOO, -B-2 1 LS TRAFFIC CONTROL AND PUBLIC SAFETY N> 60 62,t>f>l>. -b:frf>t>t>• -B-3 1 LS WATER POLLUTION CONTROL 90 QI g,ooo, · 'g, ot>O, -B-4 1 LS CONSTRUCTION STAKING AND "' 00 MONUMENT PRESERVATION /J.ooo, -1a.ooo. -B-5 1 LS PUBLIC NOTIFICATION 00 CIO fp,ooo, -~,{)()(), B-6 29 EA ADJUST WATER VALVE FRAME 4)0 ;) 00 AND COVER TO GRADE 'goo. -J s, oo. -B-7 11 EA ADJUST STORM DRAIN MANHOLE {)() Q:> FRAME AND COVER TO GRADE /, 500 .... //p,~00. -B-8 13 EA ADJUST SANITARY SEWER MANHOLE FRAME AND COVER TO 'liO 00 //~00, --19, ~oo. -GRADE B-9 4 EA ELECTRICAL MANHOLE FRAME AND COVER COORDINATE DO ()0 /IX>. -400 -ADJUST TO GRADE ' B-10 7 EA TELECOM MANHOLE FRAME AND COVER COORDINATE ADJUST TO ".! ~ /Of>, 7()()' -GRADE B-11 1 EA REMOVE EXISTING ~ "' IMPROVEMENTS AND INSTALL 7,()00, -1, 000. -NEW ADA COMPLIANT CURB 19 ITEM EST. DESCRIPTION NO. QUANT. UNI WRITTEN IN WORDS T RAMP PER SPPWC STD. PLAN 111-5 B-12 130 LF REMOVE EXISTING CURB AND GUTTER AND RECONSTRUCT PER SPPWC STD. PLAN 120-3 (A2-8 or A2-10) B-13 37,705 SY COLD MILL EXISTING PAVEMENT (2. 5" DEPTH) B-14 5,832 TON CONSTRUCT ARHM OVERLAY (2. 5" DEPTH) B-15 26,169 SF BASE REPAIR (8" DEPTH) B-16 63 EA INSTALL TRAFFIC LOOP DETECTOR (TYPE E OR TYPE F) B-17 1 LS THERMOPLASTIC TRAFFIC STRIPING, PAVEMENT MARKINGS, MARKERS, CURB MARKINGS, AND SIGNPOSTS B-18 1 LS COORDINATE VIDEO DETECTION ZONE ADJUSTMENTS B-19 8 EA PAVEMENT CORING PROGRAM B-20 150 SF REMOVE EXISTING SIDEWALK AND RECONSTRUCT PER SPPWC STD. PLANS 112-2 AND 113-2 (4" DEPTH) TOTAL AMOUNT BASE BID "SCHEDULE B" ITEMS (IN FIGURES)-+ $ Sequel Contractors Inc UNIT PRICE AMOUNT 130, ~ Of) It' C/f>O, -3.7! so 119, ~05?, -/lfo. 0~ 0( <611>,'fgo, -I(, °! )g7. <g>CJ. ~ l/.20, ~ 00 J6. 'lhO. -fO DI ~;, (){)(), -~J, 1>00. ,. o• 00 /, {)()(), -~ 000. -500. ~ ()() 1./,000, -)~ D!. IJ(> ], 7S-O, -I,'> 6 'f, ~t;;7. §'~ TOTAL AMOUNT BASE BID "SCHEDULE B" (WRITTEN IN WORDS): 011e )A;/{ ft>,, rltrR H-~red S;xfy ~6'"'-C 1'J... D U S !M,_ _j 1tro Hf/V'.~t't d f;!-l-7 ~e~ UF>Uw-s o--J F;~+f-cf4\-Js 20 TOTAL AMOUNT BASE BID "SCHEDULE A" + "SCHEDULE B" ITEMS IN FIGURES)-+ $ Sequel Contractors Inc J,96 2,0()~ '~ TOTAL AMOUNT BASE BID "SCHEDULE A" + "SCHEDULE B" ITEMS (WRITTEN IN WORDS): rl#o )A,'/( Ion )J{l'.e !fvv...df'e.J <;,1~./-':j-1Are.e /ho M~r;.,...J l/'AJ flt; ~t c(l.. .. 1-s . 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 will be based on the items of Bid Schedule. Therefore, Contractor shall completely fill out Bid Schedule. Accompanying this proposal is Bidders bond(10%) (Insert "$ Bidders bond(10%) 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. 21 Sequel Contractors Inc 4/8/25 NAME OF BIDDER (PRINT) SIGNATURE DATE Thomas S. Pack President 13546 Imperial Highway ADDRESS Santa Fe Springs , California 90670 CITY ZIP CODE ~~ ;J _ '6-oJ -7~'J 7 TELEPHONE 610600A 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 correc with the requirements of California Business and P Section 7028.15. CONTRACTOR SIGNATURE OR AUTHORIZED OFFIC 22 n accordance essional Cod/ Sequel Contractors Inc I o.f. J. LIST OF SUBCONTRACTORS * AREA4RESIDENTIAL&COLLECTOR BID OPENING DATE 4/8/25 STREETS REHABILITATION PROJECT AND ARTERIAL STREET REHABILITATION PROJECT NO. PROJECT NO. Sl251 & Sl254 LOCATION City of Diamond Bar ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CLIENT City of Diamond Bar CONTRACTOR Sequel Contractors Inc Name Under License Address Percent Specific Which No. of of Description Subcontractor Office, Mail, Total of is or Contract Subcontract Licensed Shop 011 Pt>,~ 1-I 9 o '-t;"~ "5e ft..,..e t,., ~ ~w•vayl"'t l S'i!'l '13 <;~i.f-e {)/.fD tJ. 7 '/. ~"' .,..11ey t-€.J ( w..<f t. C4 1:> 1?tt ,AA a ,.fr11e z C/,;) O VJ. f:oo./IA: If 31'1'17/ Azu~o, CA tJ170~ Pee P"u r C<Pt1 cr~./-e S"'.7'/, A-It 4,.._~h .. wi lfop E. )nc./I,. 91-. A-sph~I+ -;. {, 7()7 3 rAr"ttt:/ ~ C/:Z~7 Y If.;;.•/. A-J,Jus-1-}'t.LA-~ s A-fo..~ri~ P.O. 'Jox 7lf Q7 A-$ pfAA It 781./96 9 fb V<?..rS ~ J.,_, t!I. q~ ~ '3 J. ~i, <;;/ (..< l"T·v <;t;.a/ 5 o,,.,/{. A-"'t.r•c.(A./l /()/;)_ 11+1' 5+,.."~-+ , ?A Ve-N--£A f CJ l{ 171;), ),1.p.J.,~-1-o. CA tlr101 f.f. I •/, C(,>,1~ <;.e.~I ~'I sJ..e.,,. s cl) n-101'/\i ti, !'!ob). ~ 'Tose ,41/ ?otHs; t>(\a,/ 7'f '3 C/07 La. Pu.4-IQ.. ctt q,7L{g &. g~/. Loots [~. * 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 23 Sequel Contractors Inc LIST OF SUBCONTRACTORS * ~ o-f ~ AREA4RESIDENTIAL&COLLECTOR BID OPENING DATE 4/8/25 STREETS REHABILITATION PROJECT AND ARTERIAL STREET REHABILITATION PROJECT NO. PROJECT NO. Sl251 & 81254 LOCATION City of Diamond Bar CLIENT City of Diamond Bar CONTRACTOR Sequel Contractors Inc Name Under License Address Percent Specific Which No. of of Description Subcontractor Office, Mail, Total of is or Contract Subcontract Licensed Shop Cit ri~f Co. ;)J8"o ~. L;l1:t! A-ve. 'J7'! 6oo /]fooµ.cA<..h(1, CA ;J.~i. Sf,..;p~ -1211(.. I o;"fo S'P\'\ <;ev"' f,,u f.R.5. 5"691'"~ :T~r111.p4 VA/ /~v_c:,A 7.& ·r, C()1J Pl.it< , ( qns--;.. * 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 23 Sequel Contractors Inc 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 ~otal 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 l 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. 24 Sequel Contractors Inc EXPERIENCE STATEMENT To be responsive, the bidder must list below a minimum of three public agencies for which bidder has performed similar work within the past three years. Only projects in excess of $2,500,000 each qualify as similar for this project. 1 . Project Tit le -----------------Contract Amount Type of Work Client Agency Project Manager~-----------Phone ________ _ Date Completed ____________ _ % Subcontracted 2. Project Title -----------------Contract Amount Type of Work See Attached Client Agency Project Manager ------------Phone.~--------Date Completed ____________ _ % Subcontracted 3 . Project Title -----------------Contract Amount Type of Work Client Agency Project Manager ___________ _ Phone ---------Date Completed ____________ _ % Subcontracted NOTE: shall furnish a certified 10 SEQUEL CONTRACTORS, INC. Fax (562) 802-7499 I. OWNER: ADDRESS: PHONE NO.: CONTACT: PROJECT: PROJECT AMOUNT: COMPLETION DATE 2. OWNER: ADDRESS: PHONE NO.: CONTACT: PROJECT: PROJECT AMOUNT: COMPLETION DATE 3. OWNER: ADDRESS: PHONE NO.: CONTACT: PROJECT: PROJECT AMOUNT: COMPLETION DA TE 4. OWNER: ADDRESS: PHONE NO.: CONTACT: PROJECT: PROJECT AMOUNT: COMPLETION DATE 5. OWNER: ADDRESS: PHONE NO.: CONTACT: PROJECT: PROJECT AMOUNT: COMPLETION DATE ST. LIC #610600A 13546 IMPERIAL HWY SANT A FE SPRINGS, CA 90670 (562) 802-7227 Office STATEMENT OF EXPERIENCE CITY OF DOWNEY 11111 BROOKSHIRE A VE. DOWNEY, CA 9024 l (562) 904-7710 DESI GUTIERREZ RESIDENTIAL STREET PAVEMENT REHAB $2,897,00.00 JULY 2023 CITY OF BELLFOWER 16600 CIVIC CENTER DR. BELLFLOWER, CA 90706 (562) 755-7158 FRANK PRECIADO BELLFLOWER BL VD. STREET IMPROVEMENTS $1,717,236.00 OCTOBER 2023 CITY OF SOUTH GA TE 8650 CALIFORNIA A VENUE SOUTH GATE, CA 90280 (323) 562-9574 KEN TUONG RESIDENTIAL STREET REHAB PHASE I-ill $7,450,000 JANUARY 2024 CITY OF GARDENA 1700 w. 162ND ST. GARDENA, CA 90247 (310) 217-9528 FRANK SANCHEZ BUDLONG A VE. STREET IMPROVEMENTS $1,597 ,200.00 OCTOBER 2023 CITY OF LYNWOOD 11330 BULLIS RD. LYNWOOD, CA 90262 (310) 603-0220 MIRFATTAHI CIP PRIORITY 2 STREET IMPROVEMENTS $1,148,000.00 MAY 2023 SEQUEL CONTRACTORS, INC. Fax (562) 802-7499 6. OWNER: ADDRESS: PHONE NO.: CONTACT: PROJECT: PROJECT AMOUNT: COMPLETION DA TE 7. OWNER: ADDRESS: PHONE NO.: CONTACT: PROJECT: PROJECT AMOUNT: COMPLETION DATE 8. OWNER: ADDRESS: PHONE NO.: CONTACT: PROJECT: PROJECT AMOUNT: COMPLETION DA TE 9. OWNER: ADDRESS: PHONE NO.: CONTACT: PROJECT: PROJECT AMOUNT: COMPLETION DATE 10. OWNER: ADDRESS: PHONE NO.: CONTACT: PROJECT: PROJECT AMOUNT: COMPLETION DATE: ST. LIC #610600A 13546 IMPERIAL HWY SANT A FE SPRINGS, CA 90670 (562) 802-7227 Office STATEMENT OF EXPERIENCE CITY OF POMONA 505 GAREY A VE POMONA, CA 91766 (909) 532-5061 MICHAEL LEE JAMES PLACE ALLEY IMPROVEMENTS $578,987.00 JUNE 2022 CITY OF CHINO 13200 CENTRAL A VE CHINO, CA91710 (909) 334-3250 MARIA FRASER PIPELINE A VE IMPROVEMENT PROJECT $3,291,250.00 MARCH 2022 CITY OF INDUSTRY 15625 MAYOR DAVE WAY INDUSTRY, CA 91744 (626) 956-8034 JERRY PEREZ ROLAND STREET IMPROVEMENT PROJECT $2,789,000.00 DECEMBER 2023 CITY OF SAN DIMAS 245 BONITA A VE. SAN DIMAS, CA 91773 (909) 477-9137 BRANDON SLATER EA TON ROAD IMPROVEMENTS $784,4 77 .00 MAY 2023 CITY OF WESTMINSTER 8200 WESTMINSTER BLVD. WESTMINSTER, CA 92683 (714) 548-3492 CINDY HUYNH WYOMING ST AND ALLEY IMPROVEMENTS $595,466.00 FEBRUARY 2023 Sequel Contractors Inc 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 1 777. 7 of the California Labor Code, which prohibit a contractor or subcontractor who has been found by the Labor Corrunissioner 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 1777.1or1777.7 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 25 Sequel Contractors Inc 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 California of April 8th under penalty of perjury under the laws of the State of that the foregoing is true and correcy., Executed this day , 202~, at Santa Fe Springs, Californi/ /place of execution) . / ov· ,-•/£ I Thomas S. Pack Title: President Name of Contractor: Sequel Contractors Inc 26 Sequel Contractors Inc BIDDER'S VIOLATION OF LAW/SAFETY QUESTIONNAIRE In accordance with Government Code Section 14310.5 and in conformance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire: QUESTIONNAIRE Has the Bidder, any officer, principal or employee of the Bidder who has a proprietary interest in the business of the Bidder, ever been disqualified, removed, or otherwise prevented from bidding on or completing a federal, state or local government project because of violation of law or a safety regulation? YES NO x ~~~~~~~~-If the answer is yes, explain the circumstances in the following space: STATEMENT In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than on final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two-year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor to comply with an order of the National Labor Relations Board. NOTE: The above Statement and Questionnaire are £art of the Proposal.. Signing this Proposal. on the si~ature portion thereof shal.J. al.so constitute si~ature of this Statement and Questionnaire. Bidders are cautioned that making a fal.se certification may subject the certifier to criminal. prosecution. 27 Sequel Contractors Inc CONTRACTOR'S INDUSTRIAL SAFETY RECORD Project Identification ~~~~~~~~~ PROJECT NO. Sl251 & Sl254 4/8/25 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 CURRENT PRIOR TO CURRENT YEAR YEAR 2022 2023 2024 TOTAL 2025 No. of Contracts 19 20 23 R? 10 Total dollar amount of 20,000 22,000 contracts (in l ,OOO's) 21,000 63,000 12,000 No. of lost workday cases 0 0 0 0 0 No. of lost work day cases involving permanent 0 0 0 0 0 transfer to another job or termination of employment No. of lost workdays 0 0 0 0 0 *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 0:32enal of perjury that tye information is true and accurate within e limita~ons of these records. ~ ../ Sequel Contractors Inc / //t1rnI11/ ~ Name of Bidder (Print 13546 Imperial Highway Address Santa Fe Springs , California 90670 City Zip Code Lie. No. & Class (562) 802-7227 Telephone 28 Sequel Contractors Inc AFFIDAVIT FOR CORPORATION BIDDER STATE OF CALIFORNIA ) )SS COUNTY OF LOS ANGELES ) Thomas S. Pack being first duly sworn, deposes and says: That he is President ~~~~~~~~~~~~~~~~~~~~~ of, Sequel Contractors Inc a corporation which is the party making the foregoing proposal or bid; that such bid is genuine and not collusive or sham; that said bidder has not colluded, conspired, connived or agreed, directly or indirectly, with any other bidder or person to put in a sham bid or that such other person shall refrain from bidding; and has not in any manner sought by collusion to secure any advantage against the City of Diamond Bar or any person interested in the proposed contract, ,JeJr himself or for an/ other person. /'~ } _/ / Subscribed and sworn to before me this Thomas S. Pack President day of , 20 ------SEE ATTACHED Signature of Officer Administering Oath 30 (Notary Public) ~ ' :·:··· .... ..._. -.. ..... _ ..... ~ ...... .._ ... ........_, ... ~-.. _,, ' ~-. : .. I_ -.. ""': l~\~, . -:-~ ....: '"' ....... , ' : :-:::: ':"-...... ~ ..... -, ... ...... ~ ..... _, -::: ......................... ~ ~~ ... -"'_, ' CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 ~~~~'° ·; -~~~d'.X'~~~~ 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 L,> ~...S On ~ before me, naniel Bustamante, Notary Publfc Date /,\ personally appeared \l1o!Mo&.S 5 · ~~ ...... Name(s) of Signer(s) Here Insert Name and Title of the Officer who proved to me on the basis of satisfactory evidence to be the person~ whose name\8j isl.are subscribed to the within instrument and acknowledged to me that he/~/ti:ley'" executed the same in his/~ authorized capacity(~. and that by his/~t~signature~ on the instrument the person~, or the entity upon behalf of which the person~ acted, executed the instrument. Place Notary Seal Above I certify under PENAL TY 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 JJ 2J~ Signature of Notary Public -----------------------------OPTIONAL-----------------------------Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: -----------------------------Document Date: Number of Pages: _____ _ Signer(s) Other Than Named Above: -----------------------Capacity(ies) Claimed by Signer(s) Signer's Name: ___________ _ 0 Corporate Officer -Title(s): ______ _ 0 Partner -0 Limited 0 General Signer's Name:-------------0 Corporate Officer -Title(s): ______ _ 0 Partner -0 Limited 0 General 0 Individual 0 Attorney in Fact 0 Individual 0 Attorney in Fact 0 Trustee 0 Guardian or Conservator 0 Trustee 0 Guardian or Conservator 0 Other: ______________ _ 0 Other: --------------Signer Is Representing: ________ _ Signer Is Representing: ________ _ ~-<;X.~~~<g(.'g(,~~~~~g;~~'g,~'<;;(,~~'C(.,'{X,~~~'QC~~~"G'<,~ ©2016 National Notary Association • www.NationalNotary.org · 1-800-US NOTARY (1-800-876-6827) Item #5907 SEQUEL CONTRACTORS, INC. Fax (562) 802-7499 ST. LIC #610600A 13546 IMPERIAL HWY SANTA FE SPRINGS, CA 90670 (562) 802-7227 Office ACTION BY UNANIMOUS WRITIEN CONSENT OF THE BOARD OF DIRECTORS OF SEQUEL CONTRACTORS, INC. The undersigned being all of the Directors of SEQUEL CONTRA TORS, INC. a California Corporation, do hereby take the following action by this written consent at a meeting of the Board of Directors held on April 4, 2024 in accordance with the Bylaws of the Corporation and the California Corporation Code. WHEREAS, the Board of Directors deems it advisable to authorize the officers of the Corporation, Abe] MagaUanes, Thomas S. Pack and Michael A. Mahler, respectively, to execute bid bonds on behalf of the Corporation with any agency, person, company or municipality; RESOLVED FURTHER, that Abel Magallanes, Thomas S. Pack and Michael A. Mahler are authorized to execute labor, material, and faithful performance bonds in connection with contracts to be entered into with any agency, person, company or municipality; RESOLVED FURTHER, that Abel Magallanes, Thomas S. Pack and Michael A. Mahler are authorized and directed to execute and deliver street improvement contracts and related agreements with any agency, person, company or municipality on such terms conditions as they deem advisable in their sole discretion; RESOLVED FURTHER, that Abel Magallanes, Thomas S. Pack and Michael A. Mahler be, and they hereby are authorized by their sole signatures on any document to bind this corporation to contract, bids, bonds, etc.; RESOLVED FURTHER, that Abel Magallanes, Thomas S. Pack and Michael A Mahler be, and they hereby are authorized and directed to take any and all such other actions and execute such other documents as may be necessary or appropriate to carry out the purposes of the foregoing authorizations. In witness thereof, the undersigned Directors have executed this unanimous written consent to indicate this adoption of the consent of the foregoing resolution and the action set forth therein. Abe1!~ Vice President & Assistant Secretary ~ Director & Secretary "; 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 RESIDEN'l'ZAL & COLLEC'l'OR S'l'REE'l'S REBABILI'l'A'l'ION AND AR'l'ERZAL S'l'REE'l' REBABILI'l'A'l'ION (BREA CAYON CO'l'OFF ROAD FROM 57 FREEWAY SOU'l'H OFF RAMP '1'0 NORTH CI'l'Y LIMITS AND LEMON AVENUE FROM GOLDEN SPRINGS DRIVE '1'0 NOR'l'HERN CI'l'Y LIMI'l'S) PROJECT NO. SI251 & SI254. WHEREAS Sequel Contractors, Inc. 13546 Imperial Highway. Santa Fe Springs. CA 90670 (Name--ana-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 ~~~~~~~~~~-Merchants Bonding Company (Mutual) 6700 Westown Parkway. West Des Moines, IA 50266-7754 (Name and address of Surety) ( i•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 pena 1 s urn of Ten percent of the total amount of the bid Dollars($ 10% ), being not less than ten percent (10%) of the total bid price, in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal is awarded a contract for the work by City and within the time and in the manner required by the bidding specifications, entered into the written form of contract included with bidding specifications, furnishes the required bonds, one to guarantee faithful performance and the other to guarantee payment for labor and materials, and furnishes the required insurance coverages, then this obligation shall become null and void; otherwise, it shall be and remain in full force and effect. 37 ' ,"' 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 aut~ority of its governing body. Oat ed: March 24, 2025 "Principal" "Surety" Sequel Contractors Inc Merchants Bonding Company (Mutual) ::., By: \.../ ~ '='( • f'-.")'~J _..., s.· ---~ By: Its :""' • _. 1 .. ~ :."'-. ~Its ... _ ........ . -' " _,.. -............. __ .. _ .. '-~ .... · -._ ........ Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney-in-fact must be attached. (Seal) (Seal) 38 --,' CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 ~~~JX£.{:~~~~..cr-~~~~.c:G! 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 A~ County of lo.£ -t{ on 3/zg/z-s before me, Daniel Bustamante, Notary PubHc 110 !' Here Insert Name and Title of the Officer personally appeared --r\l-=-= ~-'-":::.__,S'~·-_1,_c~::!!-~ .. ..---------------------Date Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person~ whose name(z) is/.iiWe subscribed to the within instrument and acknowledged to me that he/~/t.Ae'f executed the same in his/~ authorized capacity(~. and that by his/~tl)9+t-signatureke7 on the instrument the person~. or the entity upon behalf of which the person~ acted, executed the instrument. Place Notary Seal Above I certify under PENAL TY OF PERJURY under the Jaws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ~~ ~~~ Signature of Notary Public ~~~~~~~~~~~~~~-OPTIONAL~~~~~~~~~~~~~~ Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: -----------------------------Document Date: Number of Pages: _____ _ Signer(s) Other Than Named Above: -----------------------Capacity(ies) Claimed by Signer(s) Signer's Name: ___________ _ 0 Corporate Officer -Title(s): ______ _ 0 Partner -0 Limited 0 General Signer's Name: ___________ _ 0 Corporate Officer -Title(s): ______ _ LJ Partner -0 Limited 0 General 0 Individual 0 Attorney in Fact LJ Individual 0 Attorney in Fact 0 Trustee O Guardian or Conservator 0 Trustee 0 Guardian or Conservator 0 Other: ______________ _ 0 Other: _____________ _ Signer Is Representing: ________ _ Signer Is Representing: ________ _ ~~~'g(.~~~~~~~'gi,'QCQV'Q{.;.'g,"Q{;.'Q"(.~'{X,~~~'g",~~'c.<..~~ ©2016 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 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 validitv of that document. State of California County of Orange On March 24, 2025 before me, Debra Swanson, Notary Public (insert name and title of the officer) personally appeared Douglas A. Rapp who proved to me on the basis of satisfactory evidence to be the person(ei) whose name(~) is~ subscribed to the within instrument and acknowledged to me that he/el :e:'t~ey executed the same in his/lic;;'ll:ci: authorized capacity~). and that by his/lici/ll:eil signature'8) on the instrument the person~). or the entity upon behalf of which the person(~) acted, executed the instrument. I certify under PENAL TY 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 ~~CY~ ' (Seal) MERCHANTS Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa, d/b/a Merchants National Indemnity Company (in California only) (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, Douglas A Rapp; T)mothy D Rapp their true and lawful Attorney(s)-in-Fact. to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 16, 2015. ''The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." ''The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner-Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 3rd day of February , 2024 ·····~·\o 'N"A'····· •.• ;ii c·... MERCHANTS BONDING COMPANY (MUTUAL) .··~'/-......... ._I. ~··, .• ~~\_ ...... f!4f-'>•. MERCHANTS NATIONAL BONDING, INC. :•"J ·"O~PO!f;i"· o\ :~<:::> .. ~~POJi~'.-?;• d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY :J..,:c, ~-.~':. • .'(., /.',;..L~ ~ . ~ . ~ , ... 0. • C?. ~ ~ • : :_ -o-o~ : .,_;_ -o-0:_. :CC: :.z: •z: ::i:• ¥-':~,\ 2003 /0E :~"· 1933 _.·c::-: By ~ ':."""'"· : .. : • v-. .·":'Y. ·.<J,... ...,.. • 0-:" ... ~<:::-· '•.~h> ............. ~ •. · •. '.;u~· ...... \"\ .• p~ • -11 A .. J • • "' -.C. • 'resident,-STATE OF IOWA COUNTY OF DALLAS ss. • •• ,,, j.-4' ........... • ••••••••• ······· On this 3rd day of February 2024 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors . • ;.: (I' 0 J> z ., 0 ,.-• • IOWP.. Penni Miller Commission Number 787952 My Commission Expires January 20, 2027 (Expiration of notary's commission does not invalidate this instrument) <-~ '~U-~~9l;11,;~ I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand aAd affixed"ihe ;>eal of the Companies on this 24th day of ,,,....... ' ..... \~--..... • ••''\ONA''•• . _..•"~~fto~· • •• ~'I-°' ......... I. ,a~•::---~ • ~ .. P'Q .. _. .. :11-'> •• • ~ " PO " ~: ' .;i-<:'::>' • 0 i:. ,,,. ... "J ...-~~ 1f4··., o:.,; _ -'='· q):·~ l' •1,j:.:_'-1-•• : ,.,_ : c, ~· ... -':. ~ • "" : (., ...... ·. :.L • • :;;e v:.,'. ~ ~ • -.,_;.':>.-, ·¢ii:· • :~:--o--g~~ •J-. .:!: -0-~:~· :CC: =-:--: •z: ·3:°• • ... . -~ • • 4. • 933 .__,. -• .... '. 2003 -: --• • /. ·~ ~ -i ~-<:::-. ~(,)... ;.:·...,~~:.. ·~~~·'-°'" ~~· ·.<J, ·.. . ... , ·"'. •• o-:·.. ~-· ·-~.1~>· .... ~ ..... _ . ".;Jv""'""{\'·· ###;11 ··;:..·· ·':) ••• ~ ~ ... ~-~·~·-. -c:i, ~· .,,, ),..( .... ~ ~ ..... ~ ······· March '2025 . p'~~.fi. Secretary POA 0018 (1/24) Sequel Contractors Inc 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 Sequel Contractors Inc TITLE OF SIGNATURE Please opportun S. Pack President 4/8/25 any additional information available regarding equal employment programs now in effect within your company: n/a 39 Sequel Contractors Inc 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 , 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 Cammi t tee on Equal Employment Opportunity, all reports due under the applicable filing requirements. I Thomas S. Pack President (TITLE) DATE: 4/8 I 20 25 . 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 (EE0-1) 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. 40 Sequel Contractors Inc NON-COLLUSION DECLARATION (TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID) The undersigned declares: I am the President of -----------~ Sequel Contractors Inc 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 California that declaration is Santa Fe Springs Sequel Contractors Inc Business Name penalty of perjury under the laws of the State of the foregoing is true and correct and that this executed on 4/8/25 /"! [date], at [city]' CA ----[state]. / / / / //&¥A ffA.-,,,..... "-notarized) 13546 Imperial Highway, Santa Fe Springs Ca 90 Business Address Attach Notary Acknowiedgement Form to this form when submitting 41 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 ~~~~~~~~~ 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 L. $ A .. ~J& on q/$/t..5 before me, Daniel Busta.mant-e, Notary Public Date ~ ~ (\"{ t Here Insert Name and Title of the Officer personally appeared -~1-'--"'~...._---=::::>'---'-._]A-='-'c..,._~_,.__--------------------Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person~ whose name~ is/All'e subscribed to the within instrument and acknowledged to me that he/~/t.Ae)r' executed the same in his/~ authorized capacity(~. and that by his/.l:!erlt~signature~ on the instrument the person~. or the entity upon behalf of which the person(,at acted, executed the instrument. ~-···········~ ,,~· ''+ DANIEL BUSTAMAN"IT : i ... ._ "'·~~~ Notary Public • California z ~ : ; Los Angeles County ~ ;. . • Commission II 2513546 -My Comm. Expires Mar 1, 2029 Place Notary Seal Above I certify under PENAL TY 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 Dd 2JJ., Signature of Notary Public ~~~~~~~~~~~~~~-opnoNAL-~~-~~-~~~~~~~ Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: ----------------------------Document Date: Number of Pages: _____ _ Signer(s) Other Than Named Above: -----------------------Capacity(ies) Claimed by Signer(s) Signer's Name: ____________ _ Signer's Name: ____________ _ 0 Corporate Officer -Title(s): ______ _ 0 Corporate Officer -Title(s): ______ _ 0 Partner -0 Limited 0 General 0 Partner -0 Limited 0 General 0 Individual 0 Attorney in Fact 0 Individual 0 Attorney in Fact 0 Trustee 0 Guardian or Conservator 0 Trustee 0 Guardian or Conservator 0 Other:---------------0 Other: --------------Signer Is Representing: _________ _ Signer Is Representing: _________ _ ~~'QCg(.~~~~~~~~'g,~'g(;..'g,'Q(.'Q"<.~~~~~~~~~ ©2016 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 Form W•9 (Rev. October 2018) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. .... Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. s~~u ..... el t:.o,.,+/'l)t:,.../-;;r<:. {11c. 2 Business name/disregarded· entity name, if different from above ~ 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): gi following seven boxes. a. c 0 . "' Q) c: D Individual/sole proprietor or single-member LLC D C Corporation [id{ Corporation D Partnership D Trust/estate Exempt payee code (if any) ----c. 0 ~+; u ... :i 0 ... .... 'Iii ·e .:: c. u :e D Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ~ ----Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. Exemption from FATCA reporting code (if any) g D Other (see instructions) "" (Applies to accounts maintained outside the U.S.) /Ji 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) ~ I , --.. ..,,.. >, .. ,I! ....... , '· '"""' [ I "" y I 6 City, state, and ZIP code 5rA-"~ Fe c; CA 9o67o Taxpayer Identification Number (TIN) 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 How to get a TIN, later. Social security number ITIJ -rn -I I I I I or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. [ Employer identification number q 15" I -1 'r' I '.? Io I / I 't' IJ l't Certification Under penalties of perjury, I certify that: 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. I 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. I 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 cros 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 an 1vide son your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secur prop , cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, ot requirei;j.tG-Gjgn the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Here Internal Revenue Code unless otherwise 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. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) Cat. No. 10231X Date~ t)11/o ~ /~s •Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Form W-9 (Rev. 10-2018) Form W-9 (Rev. 10-2018) By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting, later, for further information. Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien; •A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States; • An estate (other than a foreign estate); or • A domestic trust (as defined in Regulations section 301. 7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners' share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income. In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States. • In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity; • In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and • In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items. 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Page2 Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233. Backup Withholding What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, 2. You do not certify your TIN when required (see the instructions for Part II for details), 3. The IRS tells the requester that you furnished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information. Also see Special rules for partnerships, earlier. What is FATCA Reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Form W-9 (Rev. 10-2018) Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return. If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9. a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note: ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040N1040EZ you filed with your application. b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040N1040EZ on line 1. You may enter your business, trade, or "doing business as" (OBA) name on line 2. c. Partnership, LLC that is not a single-member LLC, C corporation, or S corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or OBA name on line2. d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or OBA name on line 2. e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a "disregarded entity." See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, "Business name/disregarded entity name." If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN. Line 2 If you have a business name, trade name, OBA name, or disregarded entity name, you may enter it on line 2. Line3 Check the appropriate box on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3. Page3 IF the entity/person on line 1 is THEN check the box for ... a(n) ... • Corporation Corporation • Individual Individual/sole proprietor or single-• Sole proprietorship, or member LLC • Single-member limited liability company (LLC) owned by an individual and disregarded for U.S. federal tax purposes. • LLC treated as a partnership for Limited liability company and enter U.S. federal tax purposes, the appropriate tax classification. • LLC that has filed Form 8832 or (P= Partnership; C= C corporation; 2553 to be taxed as a corporation, or S= S corporation) or • LLC that is disregarded as an entity separate from its owner but the owner is another LLC that is not disregarded for U.S. federal tax purposes. • Partnership Partnership • TrusVestate TrusVestate Line 4, Exemptions If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you. Exempt payee code. • Generally, individuals (including sole proprietors) are not exempt from backup withholding. • Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends. • Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. • Corporations are not exempt from backup withholding with respect to attorneys' fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC. The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4. 1-An organization exempt from tax under section 501 (a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401 (f)(2) 2-The United States or any of its agencies or instrumentalities 3-A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities 4-A foreign government or any of its political subdivisions, agencies, or instrumentalities 5-A corporation 6-A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession 7-A futures commission merchant registered with the Commodity Futures Trading Commission 8-A real estate investment trust 9-An entity registered at all times during the tax year under the Investment Company Act of 1940 10-A common trust fund operated by a bank under section 584(a) 11-A financial institution 12-A middleman known in the investment community as a nominee or custodian 13-A trust exempt from tax under section 664 or described in section 4947 Form W-9 (Rev. 10-2018) The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13. IF the payment is for .•. THEN the payment is exempt for ... Interest and dividend payments I All exempt payees except for 7 Broker transactions I Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. Barter exchange transactions and I Exempt payees 1 through 4 patronage dividends Payments over $600 required to be I Generally, exempt payees reported and direct sales over 1 through 52 $5,0001 Payments made in settlement of I Exempt payees 1 through 4 payment card or third party network transactions 1 See Form 1099-MISC, Miscellaneous Income, and its instructions. 2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with "Not Applicable" (or any similar indication) written or printed on the line for a FATCA exemption code. A-An organization exempt from tax under section 501 (a) or any individual retirement plan as defined in section 7701 (a)(37) B-The United States or any of its agencies or instrumentalities C-A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities D-A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1 (c)(1 )(i) E-A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1 (c)(1 )(i) F-A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state G-A real estate investment trust H-A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940 I-A common trust fund as defined in section 584(a) J-A bank as defined in section 581 K-A broker L-A trust exempt from tax under section 664 or described in section 4947(a)(1) Page4 M-A tax exempt trust under a section 403(b) plan or section 457(g) plan Note: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed. Line5 Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. If this address differs from the one the requester already has on file, write NEW at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your address in their records. Line 6 Enter your city, state, and ZIP code. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner's SSN (or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC is classified as a corporation or partnership, enter the entity's EIN. Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.SSA.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/Businesses and clicking on Employer Identification Number (EIN) under Starting a Business. Go to www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days. If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note: Entering "Applied For" means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8. Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code, earlier. Signature requirements. Complete the certification as indicated in items 1 through 5 below. Form W-9 (Rev. 10-2018) 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. "Other payments" include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: 1. Individual 2. Two or more individuals Ooint account) other than an account maintained by an FFI 3. Two or more U.S. persons Ooint account maintained by an FFI) 4. Custodial account of a minor (Uniform Gift to Minors Act) 5. a. The usual revocable savings trust (granter is also trustee) b. So-called trust account that is not a legal or valid trust under state law 6. Sole proprietorship or disregarded entity owned by an individual 7. Granter trust filing under Optional Form 1 099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i) (A)) For this type of account: 8. Disregarded entity not owned by an individual 9. A valid trust, estate, or pension trust 10. Corporation or LLC electing corporate status on Form 8832 or Form 2553 11. Association, club, religious, charitable, educational, or other tax-exempt organization 12. Partnership or multi-member LLC 13. A broker or registered nominee Give name and SSN of: The individual The actual owner of the account or, if combined funds, the first individual on the account 1 Each holder of the account The minor2 The granter-trustee 1 The actual owner' The owner3 The granter• Give name and EIN of: The owner Legal entity' The corporation The organization The partnership The broker or nominee Page5 For this type of account: I Give name and EIN of: 14. Account with the Department of I The public entity Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 15. Granter trust filing under the Form I The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.671-4(b)(2)(i)(B)) 1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person's number must be furnished. 2 Circle the minor's name and furnish the minor's SSN. 3 You must show your individual name and you may also enter your business or OBA name on the "Business name/disregarded entity" name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN. 4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships, earlier. *Note: The granter also must provide a Form W-9 to trustee of trust. Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records From Identity Theft Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more information, see Pub. 5027, Identity Theft Information for Taxpayers. Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059. Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. Form W-9 (Rev. 10-2018) The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at spam@uce.gov or report them at www.ftc.gov/compfaint. You can contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, see www.ldentityTheft.gov and Pub. 5027. Visit www.irs.gov/ldentityTheft to learn more about identity theft and how to reduce your risk. Page6 Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.