HomeMy WebLinkAboutBrea Canyon Storm Drain - Sancon ProposalBIDDER'S PROPOSAL
FOR
BREA CANYON STORM DRAIN LINING PROJECT
FY 2024-2025 PROGRAM
PROJECT NO, PW23403
Date AQJ1\ , , 2026
To the City Council of the City of Diamond Bar:
The Undersigned hereby declares:
(a) That the only persons or parties interested in this proposal as
principals are the following:
V o✓ a-t X S2/�� �S U-C �bA S� cow-Ce.c�.� ado �\ eS
(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/she has carefully examined the location of the proposed
work and has familiarized himself/herself with all of the physical
and climatic conditions and makes this bid solely upon his/her
own knowledge.
(d) That by submitting this Bidder's Proposal, he/she acknowledges
receipt and knowledge of the contents of those communications
sent by the City of Diamond Bar to him/her at the address
furnished by him/her to the City of Diamond Bar when this Proposal
Form was obtained.
(e) That he/she has carefully examined the specifications, both
general and detail, and the drawings attached hereto, and
communications sent to him/her as aforesaid, and makes this
proposal in accordance therewith.
9
(f) That, if this bid is accepted, he/she will enter into a written
contract for the performance of the proposed work with the City
of Diamond Bar.
(g) That he/she 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.
Address of Bi
�o n bes�d�
City
g26y�
Zip Code
TeleD of Aidder
of Bidder
BID SCHEDULE
CONTRACT DOCUMENTS AND SPECIFICATIONS
BREA CANYON STORM DRAIN LINING PROJECT #PW23403
BID SCHEDULE OPTION "A"
ITEM
APPROX,
DESCRIPTION
UNIT
NO,
QUANTITY
UNIT
WRITTEN IN WORDS
PRICE
AMOUNT
1
1
LS
MOBILIZATION (5% MAX)
2
1
LS
TRAFFIC CONTROL
CCTV INSPECTION (BEFORE AND AFTER
3
1
LS
CONSTRUCTION) AND PRE -CONSTRUCTION
CLEANING
INSTALL UV -CURED GLASS REINFORCED
4
600
LF
PLASTIC CURED -IN -PLACE (GR P-CIPP) LINER IN
EXISTING 24" CMP
5
I
EA
CONSTRUCT NEW MANHOLE
TOTAL AMOUNT BASE BID SCHEDULE OPTION "A"
IN FIGURES)
TOTAL AMOUNT BASE BID SCHEDULE OPTION "A" (WRITTEN IN WORDS):
10
BID SCHEDULE OPTION "B"
ITEM
APPROX,
DESCRIPTION
UNIT
NO,
QUANTITY
UNIT
WRITTEN IN WORDS
PRICE
AMOUNT
1
1
LS
MOBILIZATION (5% MAX)
t1o�000-
%►o1000 —
2
1
LS
TRAFFIC CONTROL
orio -
$ IS 1000 —
CCTV INSPECTION (BEFORE AND AFTER
—
3
1
LS
CONSTRUCTION) AND PRE -CONSTRUCTION
CLEANING
4
600
LF
INSTALL CIPP LINER IN EXISTING 24" CMP
1 12 —
1031200 -
CONSTRUCT CONCRETE ENCASEMENT
ec
$ISiS
$°14 500-
5
60
LF
(INCLUDES TRENCH REPAIR &PAVEMENT RESTORATION)
6
1
EA
CONSTRUCT NEW MANHOLE
*St
,Soo
TOTAL AMOUNT BASE BID SCHEDULE OPTION "B"
IN FIGURES) $ 21 1 12 _
TOTAL AMOUNT BASE BID SCHEDULE
� 1
OPTION "B" (WRITTEN IN WORn(IIS))
Two IAUAW 2a Jc/�/?/�'� DAZ 1 A0Vr34knA "tM1 eA A0G •`^ ,
The Contract shall be awarded to the lowest responsible bidder based
on TOTAL AMOUNT BASE BID SCHEDULE OPTION "A" OR TOTAL AMOUNT BASE BID
SCHEDULE OPTION "B". Please submit the bid on only one of the options,
4A" or "B»
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 includes 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.
11
S&ACo^ TZc.1vv)`u�1eS
Izs
NAME OF BIDDER ( PRINT ) —/SIGNATURE ll �'1'E
ADDRESS
HV„�,�,�� 6�A��, 01U41 fly-g��-2;23
CITY � ZIP CODE TELEPHONE
h30053 A Ibl3O25
STATE CONTRACTOR LICENSE NO. CLASSIFICATION EXPIRATION DATE
I declare under penalty of Perjury of the laws of the State of
California that the representation made herein are true and correct in
accordance with the requirements of California Business and
Professional Code Section 7028.15.
CONTRACTOR S
ZED OFFICER
12
LIST OF SUBCONTRACTORS * d
BID OPENING DATE
PROJECT 6!e&\ CAN � 5�6�M lr "V\ ul1\yi PROJECT NO. Nw23403
�1 1
LOCATION C k A 4-bl#%Mon0 e^/
CLIENT C1 at
CONTRACTOR SAnCo^ TCcl�nu�oa�tCS
Name Under Which
Subcontractor is
Licensed
License
No
Address
of
Office, Mail,
or
Shop
Percent
of
Total
Contract
Specific Description
of
Subcontract
Sysl�s
CGe\s��C.'h<e\
toy Z'12 3
qqM1 o- is Sk.
41001
cs��c..r�k e.✓tc..Ser�.t
S�wW. rlc
CCA
�lo2go
* Any Subcontractor doing work in excess of one-half (1/2) of one
percent (101) Of the total bid or ten thousand ($10,000.00), whichever
is greater, shall be designated on this form.
l3
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 any other 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
project, and determined that none of them is ineligible to perform
14
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 J.� 2Q5 at 'RyAbnon l7� (place of execution) .
Sigatunn nn'1
Name : (L4v n riJon
Title: V <CAr Q(`eSI
Name of Company:
Sti^Co^oX
15
BIDDER'S VIOLATION OF LAW/SAFETY QUESTIONNAIRE
In accordance with Government Code Section 14310.5, 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:
NOTE: This questionnaire constitutes a hart o£ the Proposal and
signature on the signature portion of this Proposal shall
constitute signature of this questionnaire.
16
CONTRACTOR'S INDUSTRIAL SAFETY RECORD
Project Identification it
Bid Date A I V 1 zcw
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 five 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
5 CALENDAR YEARS
CURRENT
PRIOR TO CURRENT YEAR
YEAR
2020
2021
2022
2023
2024
TOTAL
2025
No. of Contracts
1'�l V
I'54 q
i VvI
Jon
) 5s
;40
Total dollar amount of
$gS.mM
#131.bM
$152.�N1UoC.SM
$101D2.2M
�'I.5 M
contracts(in 1,000's
No. of lost workday
Z
I
Z
p
l�
Q
cases
No. of lost work day
cases
involving permanent
transfer to
3
another job or
termination of
employment
No. of lost workdays
j�P
1
94
C)
3oZ
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, OSEA No. 102.
The above information was compiled
to me at this time and I declare
from the records that are available
Signature
103oo53-A
State Contractor Lic. No. & Class
Ilk -Ml- 23272
Telephone
IN
AFFIDAVIT FOR CO-PARTNERSFIIP FIRM
STATE OF CALIFORNIA )
)SS
COUNTY OF LOS ANGELES )
That he is a member
being first duly sworn, deposes and says:
of the co -partnership firm designated as
which is the parry making the foregoing bid 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.
That he has been and is duly vested with authority to make and sign instruments for the co-
partnership by
who constitute the other members of the co -partnership.
Subscribed and sworn
to before me this
Signature
2025.
Signature of Officer Administering Oath (Notary Public)
[I]
AFFIDAVIT FOR CORPORATION BIDDER
STATE OF CALIFORNIA
COUNTY OF LOS ANGELES
That he is
of,
being first duly sworn, deposes and says:
a corporation which is the party making the foregoing bid or bid; that such bid is genuine and not collusive
or sham; that said bidder has not colluded, conspired, connived or agreed, directly or indirectly, with any
other bidder or person to put in a sham bid or that such other person shall refrain from bidding; and has
not in any manner sought by collusion to secure any advantage against the City of Diamond Bar or any
person interested in the proposed contract, for himself or for any other person.
Subscribed and sworn
to before me this
Signature
2025
Signature of Officer Administering Oath (Notary Public)
19
AFFIDAVIT FOR INDIVIDUAL BIDDER
STATE OF CALIFORNIA )
)SS
COUNTY OF LOS ANGELES )
V Of )efvu 2rsW� being first duly sworn,
deposes and says:
That he is the party malting the foregoing bid or bid; that such bid is genuine and not collusive or sham;
that said bidder has not colluded, conspired, connived or agreed, directly or indirectly, with any other
bidder or person to put in a sham bid or that such other person shall refrain from bidding; and has not in
any manner sought by collusion to secure any advantage against the City of Diamond Bar or any person
interested in the proposed contract, for himself or for any other person.
Subscribed and sworn
to before me this
gnat
HP&j Wamm J�tw P'tfz010q\1
day of , 2025.
Signature of Officer Administering Oath (Notary Public)
20
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Orange
Subscribed and sworn to (or affirmed) before me on this 8th
day of April 20 25 , by Ryan Helmuth
proved to me on the basis of satisfactory evidence to be the
persons) who appeared before me.
NO SEXTON
Notary Public - California
W�, Orange County
Commission N 2437910
��, My Comm. Expires Feb 11, 2127
(Seal) Sig
51ANC N
technologies
A VORTEX COMPANY
CERTIFICATION
(Vortex Services, LLC dba Sancon Technologies)
Date: January 2, 2025
TO WHOM IT MAY CONCERN:
I, the undersigned Senior Vice President and Secretary of Vortex Companies, LLC, a Delaware limited
liability company, hereby certify as follows:
• That Vortex Services, LLC is a wholly -owned subsidiary of Vortex Infrastructure Services, LLC,
which is a wholly -owned subsidiary of Vortex Companies, LLC;
• That Vortex Services, LLC is the successor to Sancon Technologies, Inc.;
• That Sancon Technologies is a trade name of Vortex Services, LLC; and
• That the following individuals are officers and authorized signatories of Vortex Services, LLC dba
Sancon Technologies:
Michael Vellano
Matthew Samford
Ryan Graham
Lou Gastin
B.J. Kerstiens
Quin Breland
Chuck Parsons
Ryan Helmuth
Gary Drew
Chief Executive Officer and Presideut
Chief Financial Officer and Treasurer
Chief Operating Officer
Chief Accounting Officer and Assistant
Secretary
Senior Vice President — Services
Senior Vice President — Shared Services,
General Counsel, and Secretary
Regional Vice President — Sancon
Technologies
Vice President and General Manager —
._....._.. .
Sancon Technologies
Operations Manager — Sancon
Technologies
That each of the foregoing officers is authorized to execute bid packages, contracts, subcontracts, purchase orders,
change orders and all other contract documents on behalf of the Company and fully bind the Company.
This Certification may be relied upon by third parties to confirm the authority of officers to act on behalf of the
Company.
l+VY`1RTBX CCIMPANY
5841 Engineer Dr. I Huntington beach, GA 92649 I wWWsanCOh:com
SANCN
technologies
A VORTEX COMPANY
VORTEX SERVICES, LLC DBA SANCON TECFINOLOGIES
By: Vortex Infrastructure Services, LLC, its sole member
By: Vortex Companies, LLC, its sole member
Quin Breland, its Senior VP and Secretary
A V ��yRTEX COMInANV
5841 EngineeY Dr, � Huntington Btlach, CA 92649 www.sancon,com
AFFIDAVIT FOR .JOINT VENTURE
STATE OF CALIFORNIA )
)SS
COUNTY OF LOS ANGELES )
being first duly sworn,
deposes and says:
That he is
of,
one of the parties submitting the foregoing bid as a joint venture and that he has been and is duly vested
with the authority to make and sign instruments for and on behalf of the parties making said bid who are:
that such bid is genuine and not collusive or sham; that said bidder has not colluded, conspired, connived
or agreed, directly or indirectly, with any other bidder or person to put in a sham bid or that such other
person shall refrain from bidding; and has not in any manner sought by collusion to secure any advantage
against the City of Diamond Bar or any person interested in the proposed contract, for himself or for any
other person.
Subscribed and sworn
to before me this
Signature
day of , 2025.
Signature of Officer Administering Oath (Notary Public)
zt
FAITHFUL PERF RMANCE BOND
N
/qpoV
KNOW ALLMENBY THESE PRESENTS
hereinafter referred to as "Contractor" as PRINCIPAL, and
as SURETY, are held and firmly bound unto the CITY OF DIAMOND BAR, CALIFORNIA hereinafter
referred to as the "City", in the sum of Dollars ($ )
lawful money of the United States of America, for the payment of which sum, will and truly to be made,
we bind ourselves, jointly and several firmly by these presents.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH, that whereas, said contract has been awarded
and is about to enter into the annexed contract with said City for consideration of the work under the
specification entitled BREA CANYON STORM DRAIN LINING PROJECT and is required by said City
to give this bond in connection with the execution of said contract.
NOW, THEREFORE, if said Contractor shall well and truly do and perform all the covenants and
obligations of said contract on his part to be done and performed at the time and in the manner specified
herein; this obligation shall be null and void; otherwise it shall be in full force and effect;
PROVIDED, that any alterations in the work to be done, or the materials to be furnished, which may be
made pursuant to the terms of said Contract shall not in any way release said Contractor or the Surety
thereunder nor shall any extension of item granted under the provisions of said Contract release either said
Contractor or said Surety and notice of such alterations or extensions of the Contract is hereby waived by
such Surety.
In the event suit is brought upon this Bond by the obligee and judgment is recovered, said Surety shall
pay all costs incurred by the City in such suit, including a reasonable attorneys fees to be fixed by the
Court.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of
, 2025.
PRINCIPAL
BY:
(SEAL)
22
SURETY
(SEAL)
LABOR AND MATERIAL BOND
M /�
OW ALL MENBY THESE PRESENTS,TWE
hereinafter referred to as "Contractor" as PRINCIPAL, and
as SURETY, are held and firmly bound unto the CITY OF DIAMOND BAR, CALIFORNIA hereinafter
referred to as the "City", in the sum of DOLLARS ($
) lawful money of the United States of America, for the payment of which sum, well
and truly to be made, we bind ourselves, jointly and several firmly by these presents.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH, that whereas, said Contract has been awarded
and is about to enter into the annexed Contract with said City for construction of the work under City's
specification entitled BREA CANYON STORM DRAIN LINING PROJECT and is required by said City
to give this bond in connection with the execution of said Contract;
NOW, THEREFORE, if said Contractor in said Contract, or subcontractor, fails to pay for any materials,
provisions, provender or other supplies, or for the use of implements or machinery, used in, upon, for or
about the performance of the work contracted to be done, or for any work or labor thereon of any kind, or
for amounts due under the Unemployment Insurance Act with respect to such work or labor, said Surety
will pay for the same in an amount not exceeding the sum specified above, and also in case suit is brought
upon this bond, a reasonable attorney's fee, to be fined by the court. This bond shall immure to the benefit
of any and all persons entitled to file claims under the Code of Civil Procedure of the State of California.
PROVIDED, that any alterations in the work to be done, or the material to be furnished, which may be
made pursuant to, the terms of said Contract, shall not in any way release either said Contractor or said
Surety thereunder nor shall any extensions of time granted under the provisions of said Contract release
either said Contractor or said Surety, and notice of such alterations or extensions of the Contract is hereby
waived by said Surety.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of
. 2025.
BY:
(SEAL)
23
SURETY
(SEAL)
BID BOND
KNOW ALL MEN BY THESE PRESENTS, THAT WE
Vortex Services, LLC dba Sancon Technologies as Principal, and
Swiss Re Corporate Solutions America Insurance Corporation
as Surety, are held and firmly bound unto the City of Diamond Bar in the sum to ten percent (10%) of the
total amount of the bid of the Principal above named, to be paid to the said City or its certain attorney, its
successors and assigns; for which payment will and truly to be made, we bind ourselves, our heirs,
executors and administrators, successors or assigns, jointly and severally, firmly by these presents.
In no case shall the liability of the surety hereunder exceed the sum of
Ten Percent of Total Amount Bid (10% T.A.B.)
THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the
above mentioned bid to the City of Diamond Bar for certain construction specifically described as follows,
for which bids are to be opened in PlanetBids on the date and time specified on PlanetBids, for the BREA
CANYON STORM DRAIN LINING PROJECT.
NOW, THEREFORE, if the aforesaid Principal is awarded the Contract, and within the time and manner
required under the specifications, after the prescribed forms are presented to him for signature, enters into
a written contract, in the prescribed form in accordance with the bid, and files the two bonds with the City
of Diamond Bar, one to guarantee faithful performance and other to guarantee payments for labor and
materials, as required by law, then this obligation shall be null and void; otherwise it shall remain in full
force and effect. In the event suit is brought upon this bond by the obligee and judgment is recovered, the
Surety shall pay all costs incurred by the City in such suit, including a reasonable attorney's fees to be
fixed by the Court.
IN WITNESS WHEREOF, we have hereunto set our hands and seals on this
1st
Vortex Services, LLC dba Sancon Technologies (SEAL)
PRINCIP
SIGN TITLE 97ali W^ , ✓'�
Swiss Re Corporate Solution America Insurance Corporation (SEAL)
SURETY
SIGNATURfAND TITLE Aaron P. Clark, Attorney -in -Fact
NOTE: Signatures of those executing for the Surety must be properly acknowledged.
24
Acknowledgment
A PRINCIPAL
STATE OF
COUNTY OF
before me personally appeared
to me known, who being by
sworn, did depose and say: that she/he is the
duly
of
me
the corporation described in and which executed the foregoing bond as principal; that she/he
knows the seal of the said corporation; that the seal affixed to said instrument is such corporate
seal; that it was so affixed by order of the board of directors of said corporation; and that she/he
signed his name thereto by like order,
Gtk%tGin��>'�
Notary Public
STATE OF TEXAS
COUNTY OF HARRIS
Commission Expires:
Acknowledgement
of SURETY
On the 1 st of April, 2025, before me personally appeared Aaron P. Clark that he/she is the
Attorney -in -Fact of Swiss Re Corporate Solutions America Insurance Corporation, the Surety in
and which executed the foregoing bond; that he/she knows the seal of said Surety; that the seal
affixed to said bond is the corporate seal of the Surety; that it was so affixed by authority of the
Power of e ff^ w3 ^tee Surety; and that he/she signed his/her name thereto by like authority.
Joshua
Commission Expires: 08/28/2028
'r
• rrr„
•�io, JOSHUA WRIGHT
ems°; �;-Notary Public, Stele of Tezee
is"�• += Comm. Expires 08.28,2028
o��•`•"••`�� Notary ID135065300
SW ISS RE CORPORATE SOLUTIONS
SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC")
SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC")
W ESTPORT INSURANCE CORPORATION ("WIC")
CENERALPOW EROF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT SRCSAIC, a corporation duly organized and existing under laws of the State of Missouri, end
having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the Stale of
Missouri and having its principal office in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its
principal allies in the City of Kansas City, Missouri, each does hereby make, constitute and appoint:
ROBERT
F. BOBO,
TIMOTHY F. KELLY, FLORENCE McCLELLAN, RACHEL RICHARDSON, AARON P. CLARK, NICK
PATETTA,
LAURA
KNEITZ,
TERESA D. KELLY, CRAIG C. PAYNE, TAMI JONES, DAISY GREATHOUSE, ERICA
KNEITZ,
KALA KELLY, JOSH WRIGHT, LAUREN RUMSEY, IVETTE BUSTOS, AND WALKER WILKS JOINTLY OR SEVERALLY
Its true end lawful Attomey(s)•in•Fact, to make, execute, seal end deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surely, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of:
FIFTY MILLION (50,000,000.00) DOLLARS
This Power of Attorney is granted A: signed by facsimile under end by the authority of the fbllowing Resolutions adopted by the Boards of
Directors of both SRCSAIC and SRCSPIC at meetings duly called and held on the 18th ofNovember 2021 and WIC by written consent of its
Executive Committee dated July 18, 2011.
"RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any Vice President, the Secretary or any Assistant
Secretary be, and each or any of them hereby is, authorized to execute a Power of Attorney qualifying the attorney named in the given Power of
Attorney to execute on behalf of the Corporation bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to
attest to the execution of any such Power of Attorney and to attach therein the seal of the Corporation; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation may be affixed to any such Power of Attorney or to
any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be
binding uillpon the Corporation when so affixed and in the futurewith regard to any bond, undertaking or contract of surety to which it is attached."
011",pNl000�S AMER'Ooloo %Sea PRe41:961100114M"^ji
ofoa„
ti4 F'•' :�w� F? BY
SEAL = :$:SEAL . .Inry.aT e ZSTGrPresident (n: f�fe SRCRPIC&Senior Viearn orwle
Beiv
to
''•'yANct•,,, 'tvJY,yy;• oJ,,.t•• BY
,,, ' Ca elel Jacques, Senior Vice IS sid IofSftaAt ni Wce President
olatel
urSRCSPIC&Senior Wmaidtiot of WIC
IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunto affixed, and these presents to be signed by their
authorized officers
this 10th day of MARCH _ 20 2025
Swiss Re Corporate Solutions America Insurance Corporation
State of Illinois Swiss Re Corporate Solutions Premier Insurance Corporation
County of Cook {i'estport Insurance Corporation
On this 10th day of MARCH . 20 z°Zs before me, a Notary Public personally appeared David Salary ,Senior Vice President of
SRCSAIC and Senior Vice President of SRCSPIC and Senior Vice President of WIC and Gabriel Jacguez. Senior Vice President of SRCSAIC
and Senior Vice President of SPCSPIC and Senior Vice President of WIC, personally known to me, who being by me only sworn, acknowledged
that they signed the above Power of Attorney as officers of and acknowledged said instrume t to be the voluntary act and deed of their
respective companies.
Karen zweda, Notary
I, Jeffrey Goldberg, the duly elected Senior Vice President and Assistant Secretary of SRCS tC and SRCSPIC and WIC, do hereby, certify that the above and
foregoing is a true and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC and WIC, which is sti9 in full force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 01st day of April • 20 25
too -
OFFICIAL SEAL
KAREN M SZWEDA---
Notary Public, Slate of Illinois Jeffrey Goldberg, Senior Vice President & too
�
Commission No 978628 Assistant Secretary of SRCSAIC and
My Camn6wn Erpires September 26. 702.' SRCSPIC and WIC
;fAVAF®13NIA ACKNOWLEDGMENT
CIVIL CODE § 1IOU
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document
to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Orange
On 04/08/2025
Date
personally appeared Ryar
before me, Mo Sexton Notary Public
Helmuth
Here Insert Name and Title of [he Officer
Names) of Signers)
who proved to me on the basis of satisfactory evidence to be the persons) whose names) is/are subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
MO SEXTON paragraph lsi;k
Notary Public - Ca0lornia
W orange county WITNESS
Commission # 2437910
6 y comm. Expires Feb 11, 2027
Signature
Place Notary Seal and/or Stamp Above ublic
yr s wws+r_
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:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signers)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner— ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer is Representing:
Number of Pages:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner— ❑ Limited ❑ General
❑ Individual
❑ Trustee
❑ Other:
net is Representing:
Sig
El
Attorney in Fact
❑ Guardian or Conservator
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.
To take affirmative steps to hire minority employees within the company.
FIRM JAnGo^ r2G��oluJ
TITLE OF OFFICER SIGN kCZ Pf e lc A
SIGNATURE
DATE �I$� ZS
Please include any additional information available regarding equal opportunity employment programs
now in effect within your company:
25
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 Santo^ TQLl/\nokc t2S proposed subcontractor
Grbc ^ Z\c • hereby certifies t at 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 PresidenEs Committee on Equal Employment Opportunity, all reports
due under the applicable filing requirements.
(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).
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.
t7.
NON -COLLUSION AFFIDAVIT
TO: THE CITY OF DIAMOND BAR:
STATE OF CALIFORNIA
)SS
COUNTY OF
R Ne AA%A�v being first duly sworn,
deposes and says that he or she is \J icA Pe.S of §%^Con Te.cL%nDkMI%t.S
the party making the foregoing bid, tha the bid is
not made in the interest of or on behalf of, any undisclosed person, partnership, company association,
organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not
directly or indirectly induced or solicited and other bidder to put in a false or sham bid, and has not directly
or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid,
or that anyone shall refrain from bidding; that 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,
or to secure any advantage against the public body awarding the contract of anyone interested in the
proposed contract; that all statements contained in the bid are true; and, further, that 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, or paid, and will not pay, any fee to any corporation,
partnership, company association, organization, bid depository, or to any member or agent thereof to
effectuate a collusive or sham bid.
STATE F CALIFIA )
SS
COUNTY LO ANGELES )
Subscribed and worn to before me this
Notary Publi� in and t%i• the County of
S'gnat B' er
day of 2025.
S Z<- A�� � Ce,. 'h-1'� l.'c � State of California
27
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or
validity of that document,
State of California
County of Orange
Subscribed and sworn to (or affirmed) before me on this 8th
day of April 20 25 , by Ryan Helmuth
proved to me on the basis of satisfactory evidence to be the
person(s) who appeared before me.
MO SEXTON
7 ,T. Notary Public - Californ
m Orange County
%Commission # 243791,
y Comm. Expires Feb 11,
(Seal)
Form ■��V
(Rev. March 2024)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Go to www.irs.gov/FormW9 for instructions and the latest information.
Give form to the
requester. Do not
send to the IRS.
Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.
1 Name of entity/individual. An entry Is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded
entity's name on line 2.)
VORTEX
SERVICES
LLC
2 Business name/disregarded entity name, if different from above.
SANCON TECHNOLOGIES
M
3a Check the appropriate box for federal tax classification of the entity/individual whose name Is entered on line 1. Check
4 Exemptions (codes apply only to
only one of the following seven boxes.
certain entities, not individuals;
n
❑✓ Individual/sole proprietor ❑ ❑ ❑ C corporation S corporation Partnership ❑ Trust/estate
see Instructions on page 3):
o
C
❑ U.C. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) . . . .
Exempt payee code Of any)
o
Note: Check the "LLC" box above and, in the entry space, enter the appropriate code IQ S, or P) for the tax
classification of the LLC, unless it is a disregarded entity. A disregarded entity should Instead check the appropriate
Exemption from Foreign Account Tax
`o
box for the tax classification of Its owner.
Compliance Act (FATCA) reporting
t In
❑ Other (see instructions)
code (if any)
IL
!
(Applies to accounts maintained
3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as Its tax classification,
and you are providing this form to a partnership, trust, or estate in which you have an ownership Interest, check El
the United States.)
this box If you have any foreign partners, owners, or beneficiaries. See instructions .
5 Address (number, street, and apt. or suite no.). See Instructions.
Requester's name and address (optional)
7 List account numbers) here (optional)
LOLN Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a FM — m —
resident alien, sole proprietor, or disregarded entity, see the Instructions for Part I, later. For other
entities, It is your employer identification number (EIN). If you do not have a number, see now to gar a OY
TIN, later. % Employer identification number
Note: If the account is in more than one name, see the instructions for line 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enter.
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. 1 am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all Interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage Interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement ORA), and, generally, payments
other than interest and
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to wwvvJrs.gov/FormW9.
What's New
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the
appropriate box for the tax classification of its owner. Otherwise, it
should check the "LLC" box and enter its appropriate tax classification.
Date 01 /02/2025
New line 36 has been added to this form. Aflow-through entity Is
required to complete this line to indicate that it has direct or indirect
foreign partners, owners, or beneficiaries when it provides the Form W-9
to another flow -through entity in which It has an ownership interest. This
change is intended to provide a flow -through entity with information
regarding the status of its Indirect foreign partners, owners, or
beneficiaries, so that it can satisfy any applicable reporting
requlrements. For example, a partnership that has any indirect foreign
partners may be required to complete Schedules K-2 and K-3. Seethe
Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS is giving you this form because they
Cat. No. 10231X Form w-g (Rev. 3-2024)