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HomeMy WebLinkAbout2016-06-14 - AGENDA REPORTS - FED OVERLAY PGRM PROJ M0113 (2)Agenda Item: 12 CITY OF SANTA CLARITA Q) AGENDA REPORT CONSENT CALENDAR i, CITY MANAGER APPROVAL: 1 j=� DATE: June 14, 2016 SUBJECT: 2015-16 FEDERAL OVERLAY PROGRAM, PROJECT M0113 - AWARD CONSTRUCTION CONTRACT DEPARTMENT: Public Works PRESENTER: Damon Letz RECOMMENDED ACTION City Council: 1. Approve the plans and specifications for the 2015-16 Federal Overlay Program, Project MO 113. 2. Award the construction contract to Toro Enterprises, Inc., in the amount of $2,651,123 and authorize a contingency in the amount of $265,113, for a total contract amount not to exceed $2,916,236. 3. Authorize an expenditure in the amount of $261,516 to Twining, Inc., and authorize a contingency in the amount of $26,151, for a total amount not to exceed $287,667 for a professional services contract to provide for project inspection and materials testing. 4. Authorize the transfer of $2,115,000 in Transportation Development Act (TDA) Article 8 funds from the 2015-16 Overlay and Slurry Seal Program expenditure account M0109233- 5161.001 to expenditure account M0113233-5161.001; and authorize the transfer of $100,000 in Measure R Local Return (264) project savings from the 2014-15 Overlay and Slurry Seal Program account M0102264-5161.00 to expenditure account M0113264- 5161.001. 5. Authorize the City Manager or designee to execute all documents, subject to City Attorney approval. BACKGROUND The annual overlay project is an integral part of the City of Santa Clarita's (City) pavement Page 1 PacketPg. 74 management program. Each year, City streets are evaluated and identified to determine pavement preservation and rehabilitation needs. The 2015-16 Federal Overlay project will resurface Soledad Canyon Road, between Camp Plenty Road and Sierra Highway. This treatment will provide a smoother ride for vehicles, enhance the appearance of the roadway and surrounding area, and extend the life of the roadway for a minimum of 15 years. This year's project is expected to begin construction in July 2016 and be completed by the end of October 2016. The Federal Overlay Program is identified as one of the action items included under the Sustaining Public Infrastructure theme within the Santa Clarita 2020 Plan. An invitation to bid was prepared and published three times (April 8, 9, and 13, 2016) and posted on the City's website. Plans and specifications were also sent to area plan rooms for distribution to additional firms. Bids were submitted to the City and opened by Purchasing on May 10, 2016. The results of the bids are shown below: Company Location Bid Amount Toro Enterprises, Inc. Oxnard, CA $2,651,122.21 Sully -Miller Contracting Company Brea, CA $2,712,287.00 Hardy & Harper, Inc. Santa Ana, CA $2,737,000.00 All American Asphalt Corona, CA $2,795,000.00 Palp, Inc., DBA Excel Paving Company Long Beach, CA $2,898,849.10 Staff recommends awarding the construction contract to the lowest responsible bidder, Toro Enterprises, Inc. The contractor possesses a valid state contractor's license and is in good standing with the Contractors State License Board. The bid from Toro Enterprises, Inc., was reviewed for accuracy and conformance to the contract documents and found to be complete. The construction contingency requested will cover the cost for unforeseen site conditions, such as potential utility conflicts, abandoned utilities not shown in record drawings, change order requests made by the contractor, and change orders for additional street resurfacing ordered by the City. To ensure efficient and proper procedures in construction inspection and materials testing, costs for these services were anticipated and identified in the original project budget, and a Request for Proposal (RFP) was sent to five qualified engineering firms. The RFP asked firms to identify their relevant experience in similar projects and demonstrate their approach to this project. The City received proposals from four firms by April 6, 2015. Staff reviewed the proposals and based on their evaluation, scored the firms on a 100 -point scale. Rank Companv Score Location Proposal Amount 1 Twining, Inc. 93.25 Ventura, CA $261,561.00 2 NV5 West, Inc. 90 Ventura, CA Not Opened 3 MTGL, Inc. 67.50 Anaheim, CA Not Opened 4 Smith -Emery 65.75 Los Angeles, CA Not Opened The scoring system was based on the following: recent experience in similar projects, Page 2 Packet Pg. 75 qualification of team and resources, understanding of key development items, quality of proposal and proposed services in relation to the project's scope, scheduling and availability, and references. Based on the City's evaluation process, staff recommends awarding the construction inspection and materials testing services contract to Twining, Inc., in an amount not to exceed $287,667. The proposal rating for Twining, Inc., is a reflection of their experience with similar projects within the City and due diligence during the preparation of their proposal. California Government Code 4526 prescribes selection of architectural and engineering services to be based on demonstrated competence and professional qualifications necessary for the satisfactory performance of the services required, does not authorize the selection of professional architectural and engineering services based on costs, and does not require the cost proposals to be sealed. However, federally funded design projects, such as this, require the City to follow the strict federal guidelines in the Caltrans Local Assistance Procedure Manual (LAPM). In the Consultant Selection section of the LAPM, it clearly states, "Each consultant's cost proposal must remain sealed until negotiations commence with that particular consultant." Therefore, unless the recommended action to award to the top most -qualified firm is not approved, the other cost proposals submitted must remain sealed. Per the federal guidelines of the LAPM, staff opened the sealed cost proposal for Twining, Inc., and negotiated a final contract at a fair and reasonable price for the services requested in the RFP. The current budget will not adequately provide for award of the contracts totaling $3,203,903. Staff is requesting transfers totaling $ 2,215,000 from the 2014-15 and the 2015-16 Overlay and Slurry Seal Programs to create a budget of $3,224,959 for the 2015-16 Federal Overlay Program. The residual funds of $21,056 will be used for project administration, labor compliance, and inspection. ALTERNATIVE ACTION Other action as determined by the City Council. FISCAL IMPACT Funds totaling $1,009,959 are currently appropriated in expenditure accounts M0113202- 5161.001 and M0113233-5161.001. The requested transfers of TDA (233) funds of $2,115,000 from the 2015-16 Overlay and Slurry Seal Program expenditure account M0109233-5161.001 to M0113233-5161.001, and $100,000 in Measure R Local Return (264) project savings from the 2014-15 Overlay and Slurry Seal account M0102264-5161.001 to M0113264-5161.001 create a total 2015-16 Federal Overlay project budget of $3,224,959. These funds will adequately provide for the construction contract, the project inspection and materials testing contract, and miscellaneous costs. ATTACHMENTS Location Map Bid Proposal for Toro Enterprises, Inc. (available in the City Clerk's Reading File) Scope of Services and Costs for Twining, Inc. (available in the City Clerk's Reading File) Page 3 Packet Pg. 76 ' JeIN 1:A Coun l lT _ 2015-16 FEDERAL OVERLAY PROJECT City Project No. M0113 Federal Project No. STPL-5450 (089) Soledad Canyon Road TREATMENT TYPE _ Overlay Street mmerrmes from Rana McNally Updated by City of Santa Clams GIG (copyright 2016) N The City ofSanta Clarts does not warrant racy nb data scum sne Ilomissions a tilrytora y arm Co0 30 ed e � QWRCIECTSPVW66362e1trnxtlWverlay fy1516 C19 9 P1 Vista I^ 6EATHERST o 8b� FpIRW FATHER ST a I 7+11T ST � G HIMBROIIGH Sr 4 a 1._ s a NEWHGGSEST y m 4 0 p _LONE ROCK ST id¢ SHANGRI-LA DR 3R par RYCL.El "'Sr 3 r . f mweaaooewv �T, p ITV a e 2Si NPIHPN HILL ROTV Canyon Spun, a, 44� FH Com uni ty ad School k vlccl sr e _ w £ U Li L M SrILLMORE Sr µ5t �.. C wet,so WEUHAVENsr v� as 9 4is s j R P 939 mal as 2e�l Q raa0ff � �qE 12. Packet Pg. 77 I ADDENDUM NO. 1 May 3, 2016 2015-16 Federal Overlay Project SOLEDAD CANYON ROAD REHABILITATION FEDERAL PROJECT NO. STPL-5450 (089) Bid No. ENG-15-16-MO113 Project No. M0113 City of Santa Clarlta, California This Addendum shall be considered as a part of the bid documents for the subject project as though it had been issued at the same time and shall be incorporated integrally therewith. Where provisions of the following supplementary data differ from those of the original documents, this Addendum shall govern and take precedence. Contractors are hereby notified that they shall make any necessary adjustments in their proposals on account of this Addendum. It will be construed that each proposal is submitted with full knowledge of all modifications and supplemental data specified herein. Contractors shall acknowledge receipt of this Addendum in the appropriate space provided on the Proposal. The following is hereby added and/or amended: PROPOSAL — PROJECT BID SCHEDULE 1 REVISED PROJECT BID SCHEDULE See attached Bid Schedule. Contractor shall use attached revised Bid Schedule for Bid Proposal. SPECIAL PROVISIONS - TECHNICAL Section F2 - Construction Materials and Methods, F2-6.4 Temporary Video Detection Camera Measurement and Payment first paragraph shall read: "Measurement and payment for installation and removal of VIDEO DETECTION SYSTEM (TEMPORARY — INSTALLATION & REMOVAL) shall be based on the contract unit price per each camera. Payment shall include Full compensation for furnishing all labor, materials, F 44 tools, equipment and incidentals and for doing all the work involved to install, connect, and remove VIDEO DETECTION SYSTEM (TEMPORARY — INSTALLATION & REMOVAL), complete in place, as shown on the Plans, as specified in the SSPWC and these Special Provisions, and as directed by the City Representative. PROJECT PLANS STREET PLAN REVISIONS — Sheets 5 thru 7 See attached Plan Sheets. Contractor shall use attached revised Plan Sheets for Bid Proposal. Page 1 of 2 CONTRACTOR QUESTIONS Is High Stability Mix is Caltrans, or Greenbook specification? Response: Please refer to Section F2-6.2 - "Materials". 2 Is there a prebid meeting for this project? Response: No. Bidders shall acknowledge Addendum No. 1 by executing Addendum 1 and returning with the bid. Robert G. Newman, P.E., L.S. Director of Public Works City of Santa Clarita BIDDER'S CERTIFICATE I acknowledge receipt of this Addendum No. 1 and accept the aforementioned. _ .2016 Date Bidde s Signaturex G�jl(o �rCs THIS DOCUMENT TO BE SUBMITTED WITH BID Page 2 of 2 ADDENDUM N(. 22 May 4, 2016 2015-16 Federal Overlay Project SOLEDAD CANYON ROAD REHABILITATION FEDERAL PROJECT NO. STPL-5450 (089) Bid No. ENG-15-16-MO113 Project No. M0113 City of Santa Clarita, California This Addendum shall be considered as a part of the bid documents for the subject project as though it had been issued at the same time and shall be incorporated integrally therewith. Where provisions of the following supplementary data differ from those of the original documents, this Addendum shall govern and take precedence. Contractors are hereby notified that they shall make any necessary adjustments in their proposals on account of this Addendum. It will be construed that each proposal is submitted with full knowledge of all modifications and supplemental data specified herein. Contractors shall acknowledge receipt of this Addendum in the appropriate space provided on the Proposal. The following is hereby added and/or amended: PROPOSAL — PROJECT BID SCHEDULE REVISED PROJECT BID SCHEDULE See attached Bid Schedule. Contractor shall use attached revised Bid Schedule for Bid Proposal. Bidders shall acknowledge Addendum No. 2 by executing Addendum 2 and returning with the bid. i �� Robert G. Newman, P.E., L.S. Director of Public Works City of Santa Clarita BIDDER'S CERTIFICATE I acknowledge receipt of this Addendum No.2 and accept the aforementio _ , 2016 Date 's Signature $tart 6.3A- &I ,lyres. THIS DOCUMENT TO BE SUBMITTED WITIi BID Page 1 of i SECTION C: PROPOSAL FOR 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) TO THE CITY OF SANTA CLARITA, AS AGENCY: In accordance with AGENCY's NOTICE INVITING BIDS, the undersigned BIDDER hereby proposes to furnish all materials, equipment, tools, labor, and incidentals required for the above -stated project as set forth in the plans, specifications, and contract documents therefore, and to perform all work in the manner and time prescribed therein. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, INSTRUCTIONS TO BIDDERS, and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following BID SCHEDULE. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the proposal guarantee accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in BID SCHEDULE are solely for the purpose of comparing bids, and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO INCREASE OR DECREASE THE AMOUNT OF ANY QUANTITY SHOWN AND TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, and fees. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. If awarded the contract, the undersigned further agrees that in the event of the Bidder's default in executing the required contract and filing the necessary bonds and insurance certificates within ten working days after the date of the AGENCY's notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY's option, be considered null and void. Company Name: IQIrO�r%S�S,[ Company Address: \)eA,4y-A W yW . By: 6A. 6 Print Name Title: I� fid' s �-. 0, 0 �/ Signature: �zi�v Z Date: J ! �I h (P City of Santa Clarlta 2015-16 Federal Overlay Project Federal Project Number STPL-5460 (089) BID NO. ENG-15-16-MO113 PROJECT No. M0113 Soledad Cayon Road Rehabilitation May 4, 2016 Item 1 2 Speallication Description Section FI -S IMPLEMENT BMP PLAN AND MAINTAIN SNIPS F2-1 MOBILIZATION Unit LS LS oty. Unit Price Total I $ (0) oob --- 8 O 1 1 $ 1600,— S 1 OQO - $ 15, 600 $' q ' Poo. o- 3 F2-2 MAINTAINING AND CONTROLLING TRAFFIC LS 4 4 F2-4 CRACK SEALING L8 1 $ (�1J� 0o0 - $ &6, 0,C>0 Q 5 F2-6 AC -C2; PG 64.10 TON 10,158 S S /Q� B F2-8 HIGH STABILITY MIX TON 8,358 $ 7 F2-7 ARHM-GG-C; PG e4.16 TON 4,030 S $ 3 2 8 F2 -B COLD -PLANING (MILLING) ASPHALT CONCRETE PAVEMENT (2 -INCH DEPTH) SF 2,058 $ 0. B F2-8 COLD -PLANING (MILLING) ASPHALT CONCRETE PAVEMENT (4 -INCH DEPTH) SF 420,632 $ . $ $ 20) O 3b 10 F2 -e COLD-PLANING(MILLING) ASPHALT CONCRETE PAVEMENT AND BABE MATERIAL _ (10 -INCH DEPTH) SF 148,255 $ 70 $ qy 0 SO 11 F2-10 DIGOUTS (8 -INCH DEPTH) SF 18,687 S $ 75, I6 12 F2-10 OVER -EXCAVATION (REVOCABLE ITEM) SF 1,887 $ ,•$5 S L.1 ` 9aj 13 F2-11 SUBGRADE PREPARATION SF 149,250 $ 0-11 �S $ 51 313. 14 F2-11 BUSGRAOE OVER -EXCAVATION (REVOCABLE ITEM) CY 415 6- - $ 136. $ 53 95- 15 F2-13 INSTALL SPANDREL SF 504 $ l Z. $ 9't Zo' 1a F2-13 INSTALL PCC ACCESS RAMP (VARIOUS CASES) EA 10 $ loot. - S 30OOo�� 17 F2-13 DETECTABLE WARNING SURFACE EA 12 $ '610,- $ q +4b.' 1e F2-16 LOOP DETECTORS (TYPE E) EA 72 $ Z $ Z 19 F2-16 LOOP DETECTORS (TYPE E MODIFIED) EA 19 It S 5 % 0 20 F2-16 VIDEO DETECTION CAMERA (TEMPORARY - INSTALLATION It REMOVAL) EA 10 $ 21 F2.17 THERMOPLASTIC TRAFFIC STRIPING -DETAIL -12 LF 17,791 $ Z� •$23 $ 3 ,?-?•3�. (, 22 F2.17 THERMOPLASTIC TRAFFIC STRIPING -DETAIL -22 LF 27Porto)) F2-17 THERMOPLASTIC TRAFFIC STRIPING - DETAIL - 24 LF 5,460 $24 F2-17 'THERMOPLASTIC TRAFFIC STRIPING -DETAIL -27B LF 85S 5 *S25 F247 THERMOPLASTIC TRAFFIC STRIPING -DETAIL -29 LF 479$46 '=00.�r27 26 F2-17 THERMOPLASTIC TRAFFIC STRIPING -DETAIL -32 LF 1,451 F2-17 THERMOPLASTIC TRAFFIC STRIPING - DETAIL - 37B LF 415$ OS20 F2-17 THERMOPLASTIC TRAFFIC STRIPING - DETAIL - 38 LF 2,020o$ z) Z512. 29 F2.17 THERMOPLASTIC TRAFFIC STRIPING - DETAIL - 30A LF 872 $ 0. (y p $ Q2.� (o 30 F2-17 THERMOPLASTIC TRAFFIC STRIPING - DETAIL - 40 LF 1,004 S 63/4 $ 2r) - Gp 31 F2-17 THERMOPLASTIC TRAFFIC STRIPING - 4" WHITE LINE LF 2,900 $ 9 Z $ ` D 1z. - r 32 F2.17 THERMOPLASTIC TRAFFIC STRIPING -I2 -YELLOW UNE LF 72 S 0 - $ 8b 33 F2.17 THERMOPLASTIC TRAFFIC STRIPING - ADVANCED STOP LINE LF 935 $ 90 $ 34 F2.17 THERMOPLASTIC TRAFFIC STRIPING - WHITE BASIC CROSSWALK LF 207 S O$ 30 vQih 35 F2.17 THERMOPLASTIC PAVEMENT MARKINGS- TYPE IV(L,R) ARROW EA 1 45 S- $ Z) 3(J ✓ 38 F2.17 THERMOPLASTIC PAVEMENT MARKINGS - "STOP' LEGEND EA 1 $ O S " � $ 105.- O37 37 F2.17 NON -THERMOPLASTIC TRAFFIC STRIPING - DETAIL - 12 LF 394 $ " �Z $ 38 F2.17 NON -THERMOPLASTIC TRAFFIC STRIPING - DETAIL - 38 LF 232 $ 53 $ Z q l0 39 F2-15 ADJUST GAS VALVE BOX TO GRADE EA 2 $ '� $ 40 F2.15 ADJUST WATER VALVE BOX TO GRADE EA 31 $ r $ w 41 F2-15 ADJUST 66MH RIM TO GRADE EA 35 $ 5s $ ' 42 F2-15 ADJUST TRAFFIC SIGNAL BOX TO GRADE EA 1 $ $ SL�O 43 F2.17 NOW THERMOPLASTIC PAVEMENT MARKINGS - TYPE IV (L) ARROW EA 3 $ '� $ " 44 F2-17 NON -THERMOPLASTIC TRAFFIC STRIPING - 4" WHITE LINE LF 50 $ 0. ZAP $ .,► 45 F2-17 NON -THERMOPLASTIC TRAFFIC STRIPING - S" WHITE LINE LF B2 $ �0 $ 48 F2-17 NON -THERMOPLASTIC TRAFFIC STRIPING - 12" WHITE LINE LF 40 $ ? 0 $ 47 F2-17 BLUE RAISED FIRE HYDRANT PAVEMENT MARKER EA 25 1 $ f '110 $ " TOTAL BID AMOUNT $2 &Q I12" 2� k TOTAL BID AMOUNT IN FIGURES: ZI li 6/ a / 7- `• TOTAL BID AMOUNT IN WORDS: NOTE: In case of error In extension of price Into the total price column, the unit price will govern The award of contract, if made, will be to the lowest responsible BIDDER determined solely by the AGENCY as follows: The basis for award of contract shall be the Contractors Base Bid. �fI!1►ru�redTw�Fv-Twb Zb/Jk�s i TwE-tirry- oNE �� The AGENCY also reserves the right to add/delete the quantities to the existing bid Items, or delete the entire bid Item If they are found not required by the Agency during the course of the construction, or add new bid Items or scope of work by Contractor Change Order at any time during the project up to the last contract working day. The BIDDER agrees to hold all unit prices in this bid schedule constant throughout the duration of the project up to the last working day. DESIGNATION OF SUBCONTRACTORS 2015-16 Federal Overlay Program, Bid No. ENG -15-16-M0113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) Listed below are the names and locations of the places of business of each subcontractor, supplier, and vendor who will perform work or labor or render service in excess of'/ of 1 percent, or $10,000 (whichever is greater) of the prime contractor's total bid: DBE status, age of firm and annual gross receipts are required if subContractor is participating as a DBE. Subcontractor DBE STATUS: Dollar Value oQhork 0 ra �.�i a Its , 490,3)0.— 90,310.Age Age of firm: I Certifying Agency: Annual Gross Receipts: Zd Al'I%tof-Q I CA Cost Schedule Item Nos: �rNo� Z 21'38 3''f Description of Work Irt sr ki rt q Location and Placg of Business dd Gr` CostSchedule Item Nos: De cription of Work' ork O'(�'� l�d�P �'S'GG fS CR t./7► f44AP.,f �&oft License No. � S Z SAO Exp. Date:' � I Phone O Ah Subcontractor supa .e(, S+>ri't, DBE STATUS: es Dollar Value of Work i U, 743 . - Age of firm: Certifying Agency: Annual Gross Receipts: Age of firm: Certifying Agency: W k& -A 5 Annual Gross Receipts: s Location and Placefof Business Al'I%tof-Q I CA Cost Schedule Item Nos: �rNo� Z 21'38 3''f Description of Work Irt sr ki rt q License No. 3% Exp. Dat ��3�a♦ I, on�t?q' 7.3� Subcontractor DBE STATUS: Dollar Value of Work Age of firm: Certifying Agency: Annual Gross Receipts: Location and Place of Business Cost Schedule Item Nos: Description of Work Exp. Date: Phone License No. C-3 DESIGNATION OF SUBCONTRACTORS 2015-16 Federal Overlay Program, Bid No. ENG -15-16-M0113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089 Subcontractor DBE STATUS: Dollar Value of Work Age of iirm: Certifying Agency: Annual Gross Receipts: Location and Place of Business Cost Schedule Item Nos: Description of Work License No. Exp. Date: Phone Subcontractor DBE STATUS: Dollar Value of Work Age of firm: Certifying Agency: Annual Gross Receipts: Location and Place of Business Cost Schedule Item Nos: Description of Work License No. Exp. Date: Phone Subcontractor DBE STATUS: Dollar Value of Work ge of firm: Certifying Agency: nnual Gross Receipts: Location and Place of Business Cost Schedule Item Nos: Description of Work License No. Exp. Date: Phone NOTE: A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5 of the Labor Code. It is not a violation of this section for an unregistered contractor to submit a bid that is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the contractor is registered to perform public work pursuant to Section 1725.5 of the Labor Code at the time the contract is awarded. (Use additional sheets as needed) C-4 f. W m 0 z O Z C A w m cc O H F Z O m m L6 O F- J H rk W D O m c U r 44 cq w r q q € I w A o V ° o � s a A OO C C C O O C O G C 0 C c)O C O C O C C C C O C O 0J F C ,n C, C aO rf, y 3� 69 a v 69 v ❑® 69 VE]V 69 69 FA If] v 6q 69 V 69 69 V V 69 V 69 A 69 V 6�9 V o 69 V n 6R3 V n 69 A 0❑0 �Q 7 N N cv q q � O W l T gNi4 4 v ly v J-9 ✓ z tl z ti tl z �U c U v1 U q `° w CQ Q rte. C ;z /' ;z W bq ^`,ILLWJI• i \ N � Q i I i.i 6 O t i ° 3 O Q O , O pw V, O A U A E I a 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 _ g 0 a 0 s 0 0 c 69 69 V 69 69 6q V 69 69 69 69 69 69 b9 fy 69 69 69 69 ^ ❑ ®® ❑❑❑ .L1 W a sz c C4 � N � � � c� d U v i cn v v1 U w �i I v�c z z cz) ID v 8 L W C �7 v7 vo o 3 rr o O O U A C q q O q O q O q q q O q O q O q q q O q O q OC q q O q c O O 69 69 b9 (In 69 69 h 69 �i V V V 69 V n V V V 69 V n V V3 V 69 V n 69 Gin 69 V V V 69 69 V n ❑ ElEl❑ El 11 El ❑ ba � 1 �O Q � 9 E N Zi+ ^ v Z f' +0 40 � � U � J y 41 w �i REFERENCES 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450 089 City of Santa Clarita, California The following are the names, addresses, and telephone numbers of three public agencies including Caltrans experience for which BIDDER has performed similar work within the past 3 years: The Contractor is also recommended to list the projects performed in both public agencies and Caltrans on separate sheets. 64& NS 17� 5+r i 4.-t- S4. M S + 5 rR, �o, GA Name and Address of Owner 1 AgencylCaltrans and istrict �LYI f V r Sq -- 5 Name and Telephone Num4gr of Person Familiar with Project 191q ! v . Contract Amount 2. ( I a-� J>Ct AA -k Name and Address of Owner 1 (�1�,�fla,c� Name and Telep ❑ne Number Contract Amount Type ti}" — 239Zo 440t'; +Caltrans and District OP(?la(i Z5-5- 1 � )n Familiar with Project Ill 2311 Date Comr)leted UVB r 1,6', /S /V ifrt► .'Vt Z k- &;Ar, CA 3. vw Na lea d Address of Owner/ Agency/Caltrans and District r r a-ryL (00,65F ) S - 6 Z Name a d Telephone Number of Person Familiar with Project �-6 s f ASI h Contract Amount f Type of Work Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance bonds: i 01 _'I' . A t0 . A n r- �►SES . t P►L Contractors Name TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 DEBARMENT AND SUSPENSION CERTIFICATION 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California The bidder under penalty of perjury, certified that except as noted below, he/she or any person associated therewith in the capacity of owner, partner, director, office manager: is not currently under suspension, debarment, voluntary exclusion or determination of ineligibility by any federal AGENCY; has not been suspended, debarred, voluntarily excluded, or determined ineligible by any federal AGENCY within past three years; does not have a proposed debarment pending; and has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. /�, )O(il- Exceptions will not necessarily result in denial of award, but will be considered in determining bidders' responsibility. For any exception noted above, indicate below to whom it applies, initialing AGENCY, and dates of action. l /,) D l�.S NOTE: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. C-8 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION * * * (Must be filled out by the Bidder and ALL subcontractors over $10,000) * * * 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California This bidderto ¢frxiSes, Txt- , proposed subcontractor , hereby certifies that he has �, has not -, participated in a previous contract or subcontract subject to the equal opportunity clause, as required by Executive Orders 10925.11114, or 11246, and that he has a rJ , has not , filed with the Joint Reporting Committee, and Director of Office of Federal Contract Compliance, a Federal Goyernment contracting or administering AGENCY, or the former President's Committee on Equal E loyment Opportunity, all reports that are under the applicable filing requirements. �% Company: T By: Ito Title: Dater Note: The above certification is required by the Equal Employment Opportunity 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 as set forth in 41 CFR 60-1.5, (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, the 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 or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Note: This form must be received by the AGENCY from all subcontractors no later than 4:00 PM on the 4th business day after the bid opening. Prime contractor is to submit certificate at bid opening. C-9 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION * * * (Must be filled out by the Bidder and ALL subcontractors over $10,000) * * * 2015-16 Federal Overlay Program, Bid No. ENG -15-16-M0113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California This bidder i5e,proposed subcontractorpGf ( Ir "447e hereby certifies that he has. PA6 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, and Director of Office of Federal Contract Compliance, a Federal Government contracting or administering AGENCY, or the former President's Committee on Equal Employment Opportunity, all reports that are under the applicable filing requirements. Company: i t By: Title: -5j � [ fero Date: Note: The above certification is required by the Equal Employment Opportunity 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 as set forth in 41 CFR 60-1.5, (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, the 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 or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Note: This form must be received by the AGENCY from all subcontractors no later than 4:00 PM on the 4th business day after the bid opening. Prime contractor is to submit certificate at bid opening. C-9 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION * * * (Must be filled out by the Bidder and ALL subcontractors over $10,000) * * * 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California This bidder /Oire t&C✓prim0;,,, proposed subcontractor Aafk &P5 C&MAthereby certifies TV W, that he has PA, 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 HA -, has not . filed with the Joint Reporting Committee, and Director of Office of Federal Contract Compliance, a Federal Government contracting or administering AGENCY, or the former President's Committee on Equal Employment Opportunity, all reports that are under the applicable filing requirements. Company: By: Title: r i �K /�(i_jugv yeo- Date: e�� Lo) ?,Otto d Note: The above certification is required by the Equal Employment Opportunity 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 as set forth in 41 CFR 60-1.5, (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, the 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 or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Note: This form must be received by the AGENCY from all subcontractors no later than 4:00 PM on the 4th business day after the bid opening. Prime contractor is to submit certificate at bid opening. C-9 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION * * * (Must be filled out by the Bidder and ALL subcontractors over $10,000) * * * 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California This bidderproposed subcontractor _, hereby certifies that he has , has not , participated in a previous contract or subcontract subject to the equal opportunity clause, as required by Executive Orders 10925.11114, or 11246, and that he has has not , filed with the Joint Reporting Committee, and Director of Office of Federal Contract Compliance, a Federal Government contracting or administering AGENCY, or the former President's Committee on Equal Employment Opportunity, all reports that are under the applicable filing requirements. Company: By: Title: Date: D z a t Co Note: The above certification is required by the Equal Employment Opportunity 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 as set forth in 41 CFR 60-1.5, (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, the 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 or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Note: This form must be received by the AGENCY from all subcontractors no later than 4:00 PM on the 4th business day after the bid opening. Prime contractor is to submit certificate at bid opening. C-9 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION * * * (Must be filled out by the Bidder and ALL subcontractors over $10,000) * * * 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California This bidder lora E�t,�.-or►'ses, �srt proposed subcontractor ., hereby certifies that he has , has not , participated in a previous contract or subcontract subject to the equal opportunity clause, as required by Executive Orders 10925.11114, or 11246, and that he has has not , filed with the Joint Reporting Committee, and Director of Office of Federal Contract Compliance, a Federal Government contracting or administering AGENCY, or the former President's Committee on Equal Employment Opportunity, all reports that are under the applicable filing requirements. Company: By: Title: Date:a Ca Note: The above certification is required by the Equal Employment Opportunity 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 as set forth in 41 CFR 60-1.5, (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, the 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 or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Note: This form must be received by the AGENCY from all subcontractors no later than 4:00 PM on the 4th business day after the bid opening. Prime contractor is to submit certificate at bid opening. C-9 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION * * * (Must be filled out by the Bidder and ALL subcontractors over $10,000) * * * 2015-16 Federal Overlay Program, Bid No. ENG -15-16-M0113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089 City of Santa Clarita, California This bidder �o &&(pcL-V-5 �li , , proposed subcontractor , hereby certifies that he has , has not , participated in a previous contract or subcontract subject to the equal opportunity clause, as required by Executive Orders 10925.11114, or 11246, and that he has has not , filed with the Joint Reporting Committee, and Director of Office of Federal Contract Compliance, a Federal Government contracting or administering AGENCY, or the former President's Committee on Equal Employment Opportunity, all reports that are under the applicable filing requirements. Company: By: Title: Date: Note: The above certification is required by the Equal Employment Opportunity 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 as set forth in 41 CFR 60-1.5, (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, the 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 or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Note: This form must be received by the AGENCY from all subcontractors no later than 4:00 PM on the 0' business day after the bid opening. Prime contractor is to submit certificate at bid opening. C-9 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION * * * (Must be filled out by the Bidder and ALL subcontractors over $10,000) * * * 2015-16 Federal Overlay Program, Bid No. ENG -15-16-M0113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California This bidder Toro t;&,ar ae1. 7-A fproposed subcontractor hereby certifies that he has has not , participated in a previous contract or subcontract subject to the equal opportunity clause, as required by Executive Orders 10925.11114, or 11246, and that he has has not , filed with the Joint Reporting Committee, and Director of Office of Federal Contract Compliance, a Federal Government contracting or administering AGENCY, or the former President's Committee on Equal Employment Opportunity, all reports that are under the applicable filing requirements. Company: _ By: Title: Date: D L (o Note: The above certification is required by the Equal Employment Opportunity 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 as set forth in 41 CFR 60-1.5, (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, the 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 or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Note: This form must be received by the AGENCY from all subcontractors no later than 4:00 PM on the 4th business day after the bid opening. Prime contractor is to submit certificate at bid opening. C-9 BIDDER'S INFORMATION AND CERTIFICATION Bidder certifies that the representations of the bid are true and correct and made under penalty of perjury. EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE Bidder certifies that in all previous contracts or subcontracts, all reports which may have been due under the requirements of any AGENCY, State, or Federal equal employment opportunity orders have been satisfactorily filed, and that no such reports are currently outstanding. AFFIRMATIVE ACTION CERTIFICATION Bidder certifies that affirmative action has been taken to seek out and consider minority business enterprises for those portions of the work to be subcontracted, and that such affirmative actions have been fully documented, that said documentation is open to inspection, and that said affirmative action will remain in effect for the life of any contract awarded hereunder. Furthermore, Bidder certifies that affirmative action will be taken to meet all equal employment opportunity requirements of the contract documents. Bidder's Name: Toro Ent@rDrIS@S. Inc. Business Address:?, E- V"fa 13JVd.. _Q?[tinrJ, Chi g303(g Telephone No.: CSSg 3- y_ I State CONTRACTOR's License No. & Class: Tt osE0 " A Original Date: 8' I [ 4 S Expiration Date: / I I The following are the names, titles, addresses, and phone numbers of all individuals, firm members, partners, joint venturers, and/or corporate officers having a principal interest in this proposal: cash le.rry H&rtnt it&n.- L -e -re, 21 b 6-0- SI Vd, f-.3 b,60 The dates of any voluntary or involuntary bankruptcy judgments against any principal having an interest in this proposal, or any firm, corporation, partnership or joint venture of which any principal having an interest in this proposal was an owner, corporate officer, partner or joint venture are as follows: All current and prior DBAs, alias, and/or fictitious business names for any principal having an interest in this proposal are as follows: C-10 IN WITNESS WHEREOF, BIDDER executes and submits this proposal with the names, title, hands, and seals of all aforementioned principals th' day of Af 2016. BIDDER: Signature . sg4�4 -N (10 -��esi -� Name and Title of Signatory Leghl Name of Bidder U&tIya xnad' C�ids Address (Sb5)qf-;' -d 6 jka3 Telephone Number Federal Tax I.D. No. 9z a'�-a-tW SIGNATURES MUST BE MADE AND NOTARY ACKNOWLEDGMENTS OF EXECUTION OF BIDDER MUST BE ATTACHE!]. Subscribed and sworn to this Notary Public day of 2016. C-11 (SEAL) 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 Ventura On May 9, 2016 before me, Renee Cruz, Notary Public _ Date Here Insert Name and Title of the Officer personally appeared Sean Castillo Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(i) whose name(O is/ara- subscribed to the within instrument and acknowledged to me that he/94QAhey executed the same in his/badtha4r authorized capacitygaa, -and that by his/hwAheirsignature(� on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. RENEE CRUZ WITNESS my hand `.,a d official seal. Commission # 2011344 a w Notary Public - California r f Ventura County Signature pny Cornm I.xp+rra AiSr 6. 2017 gna ignature of Notary Pc hlic Place Notary Seal Above --------------------------------------------------------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: Bidder's Information and Certification for 2015-16 Federal Overlay Date: 5/9/16 Project Soledad Canyon Road Rehabilitation Federal Project No. STPL-5450 (089) Number of Pages:_2_ Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name Sean Castillo Signer's Name: N Corporate Officer — Title(s): President ❑ Corporate Officer — Title(s): []Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Trustee ❑Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing Signer Is Representing- �3�c:�z:�:etie��:�tti:C:�c�:'��r�:�[.�cL�-x:"�4*�z�cq;csc�.'c4�c:�r;d��c^�:Y:[.'r±�:�G�c>�e�,�t>�'x�rry ©2014 National Notary Association • www. NationaiNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5907 BID SECURITY FORMS FOR CHECK OR BOND TO ACCOMPANY BID NOTE: The following form ed incase chec accompanies bid. Accompanying this Proposal is a *cashier's check payable to the order of the City of Santa Clarita for: , ertifidlcdollars ($ ), this amount being not less than ten percent (10%) of the tota amount of the bid. The proceeds of this check shall become the property of said AGENCY provided this Proposal shall be accepted by said AGENCY through action of its legally constituted contracting authorities, and the undersigned shall fail to execute a contract and furnish the required bonds within the stipulated time; otherwise, the check shall be returned to the undersigned. Project Name: 2015-16 Federal Overlay Project City Project M0113 Federal -Aid No. STPL-5450(089) Bidder's Signature CONTRACTOR Address City, State, zi.p�-Cade f * lete the inapplicable work. NOTE: If the bidder desires to use a bond instead of a check, the following form shall be executed. The sum of this bond shall be not less than ten percent (10%) of the total amount of the bid. C-12 PROPOSAL GUARANTEE BID BOND 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California KNOW ALL MEN BY THESE PRESENTS that TORO ENTERPRISES, INC. , as BIDDER, and TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA as SURETY, are held and firmly bound unto the City of Santa Clarita, as AGENCY, in the penal sum �i Ten Percent of Amount Bid dollars ($ ),which is ten percent (10%) of the total amount bid by BIDDER to AGENCY for the above -stated project, for the payment of which sum, BIDDER and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas BIDDER is about to submit a bid to AGENCY for the above -stated project, if said bid is rejected, or if said bid is accepted and the contract is awarded and entered into by BIDDER in the manner and time specified, then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor of AGENCY. IN WITNESS WHEREAS, the parties h re ave set their names, titles, hands, and seals, this 6th day of a 12016 TORO ENTERPRISES, INC. BIDDER: _ Signature ��++ Name and Title of Signatory P.O, Box 6285, Oxnard, CA 93031 Address SURETY* TRAVELERS CASUALTY AND SURETY COMPANY OF AMER One Tower Square, Hartford, CT 06183 (213) 630-3200 and sworn to this NOTARY PUBLIC SEE ATTACHED JURAT By: Name End Title: Dar day of SEAL) *Provide BIDDER and SURETY name, address, and telephone number and the name, title, address, and telephone number for authorized representative. IMPORTANT - Surety Companies executing Bonds must appear on the Treasury Department's most current list Circular 570, as amended and be authorized to transact business in the State where the project is located. C-13 CALIFORNIA JURAT A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Francisco Subscribed and sworn to (or affirmed) before me on this 6t" day of May, 2016 by Daravy Mady, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. (seal) AMESNOSS COMM, M4813 N LosAGli�ymia �I Comm, 1 . 2016 Signature . James Ross, Notary Public I WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER POWER OF ATTORNEY TRAVELERSFarmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 228903 Certificate No. 006558624 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint John T. Lettieri, Tom Branigan, John Gilliland, James Ross, Nathan Varnold, and Daravy Mady of the City of Sall Francisco State of Caltfornid their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory 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. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this day of January 2016 Farmington Casualty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. St. Paul Fire and Marine Insurance Company St. Paul Guardian Insurance Company 6th St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company G�6V.1[ Vyi+�R4 �H�..��;54 R 4Rl� r��Y 'WO �ypE7F[Iy iY� Q+ �, �, q MCORPiONATED y. �itGXraR,,��,FOR0.tf.[4in R HACONN. n0.fifFflfq 77 1896 s a 1951 a•lSt!: t1t, J4 �: SB]LL,%a oNN. 6`c�" a � *as FM1uct €o fid'•.... ;ala` o: ,, f d a� �N ,�R,�a} State of Connecticut City of Hartford ss. By: Robert L. Raney, remor Vice President On this the 6th day of Janu try 2016 before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof, I hereunto set my hand and official seal.co,R My Commission expires the 30th day of June, 2016. 1G it Marie C. Teueault, Notary Public 58440-8-12 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER 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 Ventura On May 9, 2016 before me, Renee Cruz, Notary Public Date Here Insert Name and Title of the Officer personally appeared Sean Castillo Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(g5 whose name(a'j is/ars: subscribed to the within instrument and acknowledged to me that he/siaaAl:# ey executed the same in his/herAheir authorized capacityEiesr and that by hisA4efAfteir signature( on the instrument the person, or the entity upon behalf of which the person(, acted, executed the instrument. RFNEE CRUZ t Commission # 2011344 Noir..r, „ c Public - California Ventura County ' My Comm. wes r 6, 2017 , I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my had and official seal. Signature �& � MkI C�l Signature of Nota ublic Place Notary Seal Above -------------- - --------------------------- 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: Bid Bond for 2015-16 Federal Overlay Project Soledad Canyan_Date: 5/6/16 Road Rehabilitation Federal Project No. STPL-5450 (089) Number of Pages:_1_ Signer(s) Other Than Named Above: Capacity(lies) Claimed by Signer(s) Signer's Name Sean Castillo Corporate Officer -- Title(s): President ❑Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name_ ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee []Guardian or Conservator ❑ Other: Signer Is Representing: ©2014 National Notary Association • www.NationaiNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907 NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) 2015-16 Federal Overlay Program, Bid No. ENG -15-16-M0113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450[089 City of Santa Clarita, California To the CITY OF SANTA CLARITA: In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106, the Bidder declares that 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 any 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. THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THE "BIDDER'S CERTIFICATION" SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH FORM A PART OF THE PROPOSAL. BIDDERS ARE CAUTIONED THAT MAKING A FALSE CERTIFICATION MAY SUBJECT THE CERTIFIER TO CRIMINAL PROSECUTION. C-14 NON -COLLUSION AFFIDAVIT 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(0891 City of Santa Clarita, California TO BE EXECUTED BY EACH BIDDER OF A PRINCIPAL CONTRACT STATE OF CALIFORNIA ) COUNTY OF LOS ANGELES }} § 3eo-vt I16 being first duly sworn deposes and says that he is YC (sole owner, a partner, president, etc.) of or'o ; 2 cthe party making the foregoing bid; that such bid is n t made in the interest of or behalf of any undisclosed person, partnership, company, association, organization or corporation, that such bid is genuine and not collusive or sham, that said BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, or that anyone shall refrain from bidding, that said BIDDER has not in any manner, directly or indirectly sought by agreements, communication or conference with anyone to fix the bid price of said BIDDER or of any other BIDDER, or to fix the overhead, profit, or cost element of such bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the Contract or anyone interested in the proposed Contract; that all statements contained in such bid are true, and further, that said BIDDER has not, directly or indirectly, submitted his bid price, or any breakdown thereof, or the contents thereof, or divulged information or date relative thereto, or paid and will not pay any fee in connection, therewith to any corporation, partnership, company, association, organization, bid depository, or to any member or AGENCY thereof, or to any other individual information or date relative thereto, or paid and will not pay any fee in connection, therewith to any corporation, partnership, company association, organization, bid depository, or to any member or AGENCY hereof, or to any other individual, except to such person or persons as have a partnership or othWirolcial interest with said BIDDER in his general business. Bidder: /!/Ill/ Signature � jet 66-h #0 Title S ilwl_- 5et Sub i'llbed-an o'r\n to and before me this , day of , 20 Seal of Notary C-15 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 66 See Attached Document (Notary to cross out lines 1-6 below) O See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 a Signature of Document Signer No. 2 (if any) 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 Calif* County of MAYA, RENEE CRUZ :r. Commission #Z 2011344 Notary Public - California x' Ventura County My Comm. Exj :.o,:- A3 r 6 2017 Seal Place Notary Seal Above Subscribed and sworn to (Q affirmed} before me on this , {` _ day of WW '20 - by 20 -by Date M th Year (1) 6ean *Air (and (2) Name(s) of Signer(s) proved to me on the basis of satisfactory evidence to be the person(,; who appeared before me. Signature I c� Signature of Nota 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 j / Title or Type of Gum nt: - A� I D Av x015 I �Docume t Date: tx rrr r U . rl(p-M 0113��.ttr�lVol BTPL-545UCG�' Number of Pages: J Signer th:rThJ Named oar e. 02014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5910 BIDDER'S QUESTIONNAIRE 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California If the bidder has answered the questionnaire within the past year and there are no significant changes in the information requested, then the bidder need not file a new questionnaire. If there are changes, indicate those changes. Should the space provided not be adequate, so indicate and complete information on a separate page(s) and attach hereto. * 6 1 1 _ _/W�i 1. Submitted by: Telephone: - Principal Office Address: _ 2. Type of Firm: _ Corporate:_ Individual: Partnership: 3a. If a corporation, answer these questions: Date of Incorporation: President's Name: Vice -President's Name: Secretary or Clerk's Name: Treasurer's Name: 3b. If a partnership, answer these questions: Date of organization: 4. Other: State of Incorporation: State Organized in: Name of all partners holding more than a 10% interest: Designate which are General or Managing Partners. Name of person holding CONTRACTOR's license: License number: Class: Expiration Date: 5. CONTRACTOR's Representative: Title: _ Alternate: Title: 0 List the major construction projects your organization has in progress as of this date: Owner: (A) _ _ (B) Project Location: Type of Project: C-16 CERTIFICATION OF NON -SEGREGATED FACILITIES 2015-16 Federal Overlay Program, Bid No. ENG -15-16-M0113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California The CONTRACTOR certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The CONTRACTOR certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The CONTRACTOR agrees that a breach of this certification is a violation of the Equal Opportunity clause in this Contract. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, rest rooms, and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because of habit, local custom, or otherwise. The CONTRACTOR agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause, and that he will retain such certifications in his files. Faro Enterprises, Inc. CONTRACTOR Required by the May 19, 1967 order on Elimination of Segregated Facilities, by the Secretary of Labor — 32 F.R. 7439, May 19, 1967 (F.R. Vol. 33, No. 33 — Friday, February 16, 1968 — p. 3065). C-17 NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS 2015-16 Federal Overlay Program, Bid No. ENG-15-16-MO113 Project No. M0113 FEDERAL -AID PROJECT NO. STPL-5450(089) City of Santa Clarita, California The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub -recipients shall certify and disclose accordingly. THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THE "BIDDER'S CERTIFICATION" SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH FORM A PART OF THE PROPOSAL, BIDDERS ARE CAUTIONED THAT MAKING A FALSE CERTIFICATION MAY SUBJECT THE CERTIFIER TO CRIMINAL PROSECUTION. C-18 DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352 1. Type of Federal Action: 2. Status of Federal Action: /Prime: t Type: F] a. contract ❑ a. bid/offer/application ialb. grant b. initial award terial changec. cooperative agreement c. post -award d. loan rial C nge Only:e. loan guarantee quarterf. loan insurance ast report4. Name and Address of Reporting Entity 5. If Reporting Eis Subawardee,Enter Name anPrime: Prime � Subawardee Tier if known Congressional District, if known 6. Federal Department/Agency: 8. Federal Action Number, if known: 0 10. a. Name and Address of Lobby Entity (If individual, last name, first name, MI) Cong ssional District, if known 7. Fc ral Program Name/Description: CFDA Number, if applicable 9. Award Amount, if known: Ab.Individuals Performing Services (including address if different from No. I Oa) (last name, first name, MI) (attac Continuation Sheet(s) if necessary) 11. Amount of Payment (check all tha apply) 13. Type of Payment (check all that apply) $ actual planned a. retainer b. one-time fee 12. Form of Payment (check all at apply): c. commission e a. cash d. contingent fee b. in-kind; speci nature a deferred U/ f. other, specify 14. Brief Description of rvices Performed or to be performed and Date(s) of Service, including officer(s), employe ), or member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if 15. Continua on Sheet(s) attached: Yes No l6. Intbrmatio requested through this form is authorized by Title 31 11.S.0 action 1352. This disclosure of lobbying reliance Signature: was p A by the tier above when his transaction was made or entc into. This disclosure is required pursuant to 31 U.S.C. Print Name: Jen14 L.1tb-n"0 135 This information will be reported to Congress N fannually and will be available for public inspection. Any D on who fails to file the required disclosure shall be subject Title; o a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Telephone No.: &0-5) to 2, q515, Date: 5 Q Authorized for Local Reproduction Use C-19 Standard Form - LLL PIA INSTRUCTIONS FOR COMPLETION OF SF -LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of covered Federal action or a material change to previous filing pursuant to title 31 U.S.C. section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered Federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered Federal action. 2. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP -DE -90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered Federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with Federal officials. Identify the Federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form, print his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. SF -LLL -Instructions Rev. 06-04-90aENDIF» C-20 rA 0 c+, ;q k" 3 y O b r3 cn �O U) CA 4dL;l ° o U p � 3 o cqj En pDyNy N bA to .. U lob U CIJ J 'cd c z c I- o gib° V cd O Q M \O U N cd v v ZM V•- cd cd 01 O `d cd 'o, + cd cd L+� O U'o cd o W cO O H Q,cd � 0 0 cd LL + co �O O cd Q! N �O x N � >,^ b•� v� Lbw Q, as b CIS o 4 O w cd cd Y'o N b~9 N �' V OC t", y V— N �Qy, r_rJ' O cd O �-•� rA M • ii•} -r -,I -I bA i,, f i • Cd C• --IQ (4 Cd O w G N G' O' U N O U"IR c� El C,3 G�H U U(1) cd tai o Cj '" � G ,� � •� � �, ° '� ' � cd 'd 00 � ° ��i A N of N O Cd C�d o o U) °� M _ cd — O N ° Z al�U�¢ �h r M U F� ti N M U 4° 4° Cd Cd rs 5 U � v' a r, Ell a � � w � � U U � � CN Y � U U X N M N X M rq M y M t N M \O U py Cd D U10 U .1 v� U rn a !! u C\ v O b y 0 b Cd 4. O v cd Y 'b w rn 0 ti a J N M"N OU N O M W 1 N O M V� Ol � +. !H M V U5 O d' m M v U c v U U Ly y0 r� •� 0 � 0 � Y ~ 4 Z O N V O O Z O E N ssyy O O a O0 Z 0 0 id z 0 0 z �,d.� �d•°� 42 wpb U� N A VI U U U C- V] U U F- N M C/] U ti N M U a OAT W I N I N G Q Is Work Statement & schedule It is our understanding that the project consists of providing quality assurance construction materials testing and inspection services for phase II of the City's overlay program. We understand that we will be responsible for the testing of asphalt and concrete as well as providing project inspection. The following is our proposed plan of study. TASK 1: ENGINEERING SUPPORT DURING OVERLAY PROJECT • Subtask 1: On-call support to the City's Project Manager Output: Available from project's inception through completion via phone, email, and in person meetings in order to provide the City's Project Manager answers to his questions that come up during the project. These services are provided through Amir and Matthew Conarroe. Schedule: As needed • Subtask 2: Submittal Review for materials to be used by the contractor on the project. Output: Timely turnaround of materials submittal reviews. The City's project manager provides contractor submittals to Amir for his review and acceptance with respect to the project specifications and plans. Schedule: The submittals will be reviewed and returned to the City's project manager within 72 hours. • Subtask 3: Attend meetings throughout the project. Output: Amir and Matthew will be available and will attend meetings with the City's project team whenever requested during the project. Schedule: Twining propose to have weekly meetings to go over the job progress and QA results for the past week. • Subtask 4: Timely review of inspection and testing results during the project. Preparation of Daily reports for the City's Project Manager. Output: Amir will schedule lab tests promptly and will review and provide testing and inspection reports to the City's Project Manager. Any non-compliant results will be highlighted, and discussion/ recommendations will be provided to the City when requested or when necessary. Schedule: Test results will be returned to the City's project manager within 24 hours unless, the test is Asphalt extraction or R -Value which will be reported within 96 hours. TASK 2: FIELD SUPPORT DURING OVERLAY PROJECT • Subtask 1: Public Works Inspection Services. Output: Available throughout the project to support the City's Project Manager and Inspection team with any supplemental inspection services during the project. These services have been provided during past overlay projects with the City and can be provided at whenever the City deems it necessary. Schedule: Daily activities will be recorded in a report and will be submitted to the city within 24 hours. 16 AT W I N I N G Werk Statement & Schedule • Subtask 2: Asphalt Inspection Services. Output: Twining will provide laydown inspection and compaction testing of the asphalt paving activities throughout the Overlay project. If the City requires observation during grinding operations, we will provide resources during this time, as well. The inspection team will observe and document all pavement activities at the City's request and in accordance with the project specifications. Plant inspection will be conducted simultaneously throughout the paving day and samples of the asphalt will be obtained at coordinated intervals from both the plant and the field and transported to our lab for all the necessary testing. Plant Inspection will ensure that production of asphalt is being conducted per the project specifications and meets Greenbook and Caltrans standards. Schedule: Daily activities will be recorded in a report and will be submitted to the city within 24 hours • Subtask 3: Asphalt Coring and Testing. Output: Twining will provide a technician to core the asphalt once per 250 tons and transport the cores to the lab for timely testing to calculate the daily compaction of the asphalt material being placed. Schedule: Core densities will be submitted to the City within 24 hours TASK 3: MATERIALS TESTING DURING OVERLAY PROJECT • Subtask 1: Laboratory Testing of Asphalt Material. Output: Twining's certified laboratory will be responsible for providing testing of the asphalt material to ensure it meets the specifications of the project. The material will be tested for Asphalt Content, Gradation, Moisture Content, Density, Stability, Air Voids, and Sand Equivalency (raw aggregate at the Plant). Acceptance of the material is typically based on Asphalt Content, Gradation, and Stability testing. Core testing will be provided daily to ensure that asphalt compaction requirements are being met. Schedule: Test results will be returned to the City's project manager within 24 hours unless, the test is Asphalt extraction or R -Value which will be reported within 96 hours. TASK 4: CIA DOCUMENTATION AND REPORTING • Subtask 1: Daily and Final QA reporting Output: Amir will be responsible for reviewing daily field and lab activities and preparing reports and providing all documentation to the City's Project Manager. Upon completion of the project, a Final QA report will be prepared and provided to the City for it records. Schedule: The test results and filed reports will be reviewed on daily basis and will be submitted to the City's project manager within 24 hours. The final QA report will be prepared and submitted within 10 days after completion of the project. 17 ATwINING Fee Schedule M Cr r C Wp Z m CD as N C m Z E 0 as IMd C C W 7 C O r L L cc Ci d C cc O d v c E c JI CF CC QVC) O a C .2 �i C 00 C) O O 00 O O O O w 61 O O OD OD OD O N O N O N N LnO M H N N N OrI N �y] r1 H rI I N O d � m V 7 y O O O O O O CD O Q N v 2 U1 U1 Ln Ln Ln Ln Ln Ln N ri N r -A N r -I N r -I N r -I N ri N r -I N cn Ln m0 Ln Ln Ln Ln Co Ln Ln Co un ao w Ln ri H 0 LI YJ fd y, Y r I rel yl 7G ^i,„a yri II' �r� ri ri r -i ri � m z LD v> C o is E a ro E G� .8° o U m o iii ? c o a e a 7 ? c° c n y u+ N r od C N« N W -0 v 'L .fix C E .� C x C E N r- C —`3 s a Q1 ' ° _ N O� yL _ •t17 O� yL 01� � FL y W ro fl y Nf��C (D 1� .Lh `y :Vi .� N d C N 1[p(C7� 07 C f(C1 y I T� C C C .. � ggq�Co �10 .. cc �� Q1 :�S O F, ro � :: OG yy :? 0 OC z y Q .p Z� 9` N `�� ro N $ 0 c LU 00 .A g�, Co aYc� © O � vro a33� cc > C a 0 �Cm 4 a 0) oro fS C Q L Cn ° 12 o o cc�a a E 0'15 a c E c° .5 .= y ro.o° �� c8' �m 3 � ° ,� o c sp m tS ro, Eo Epn � p `� m� m m� m y qC CL a J +� E a .5 U E CL C .2 �i C AT -w I N I N G Fee Schedule O aoo O O o O d o01)0 0 0 0 0 0 cp UUUUUU O Ln O Ln O Lf) Lfl o Ln Ln 0 O0 0 C H r -I H I` r -I OD N N 7 � N N N n N N N N O H F m a x N N N w N N N N i w O J �O n n n N n n n n i — B 21 CL E b s� of a O O � 0. d C E0 f0 E IL n. d d a v � LU I x %TIMI N ENG �* Statement of Offer & Si nature 00 9 This proposal is a firm offer for a 90-day period, and the proposed work will be performed at a "not-to- exceed" price. Twining has reviewed the City's professional services agreement and does not take any issues with the contract presented. Edward M. Aining, Jr. CEO i� im TwtNtN Insurance Requirements Twining currently holds insurance that meets the requirements outlined in the RFP. If selected, we will obtain insurance with The City of Santa Clarita as the name insured. Below is a copy of our current insurance limits. DATE '`�14�K'�' CERTIFICATE OF LIABILITY INSURANCE 1/29/2016D ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER Dealey, Renton &Associates DRA License 0020739 P. O. Box 10550 CONTACT _ NMIA_PHONE714.427fi810 FAX 714-427-6816 t!uc-"°y EimsL PNSURURgn AFFORDING CWERAG4 NAIcs Santa Ana CA 92711-0550 msURERA:Travelers Property Casualty Co of A 25674 2/1/2016 INSURER e -Commerce & Industry Ins. Co. EACH OCCURRENCE $1.000.000 INSURED Twining, Inc. INSURER c:Atlantic Specialty Insurance Com an GENERAL AGGREGATE $2,000.000 PO BOX 47 INSURER D: A Long Beach CA 90801 INSURER E Y 8101EO74049 INSURER F; 2/1/2017 ISA....... n. F:9Kn99AAA THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ' POLICY NUMBER tAMM ACCORDANCE WITH THE POLICY PROVISIONS. LIMITS A X COMMERCIALGENERALLIABILITY CLAIMS -MADE Lil OCCUR GFPrL AGONEGATE LIMIT APPLIES PER: POLICY O PRO- JECT ❑ LOC OTHER: Y Y 6301E077062 2/1/2016 2/1/2017 EACH OCCURRENCE $1.000.000 p�3PK u�yen- $300,000 h!Xo {Any nra pmm�l $5000 PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000.000 PRODUCTS-COry1P/OP AGG $2,000,000 $ A AUTOMOBILE LIABIDTY X ANY AUTO AUTOWNED AUTOS HIREDAUTOS AUTOSWNED Y Y 8101EO74049 2/1/2016 2/1/2017 Ea«ocyeon< $1.000.000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Per acudan $ $ A X UMBRELLA LIAB X OCCUR EXCESS LIAB �CWMS4AKDe CUPIE077052 2/1/2016 2/1/2017 EAQHOCCVRRENCE $9.000,000 AGGREGATE $8,000,000 DEC R5i.TFNTIQN$,5 B WORHERB COMPENSATION AND EMPLOYERS' UABILITY Y ANY OFFICERIMERAUR Fi=%JDEU7 imonctockvin NHI IF S= t/u W Dt ON OF OPERATIONSbolow N/A y WC069BB2635 2/1/2016 2/1/2017 X PtH ER E EACH ACCIDENT $1,000,000 E-LDISEASE - EA EMPLOY $1,000,000 EL DISEASE - POLICY UNIT $1,000,000 C Professional Liability Claims Made DPL510216 12/1/2016 2/1/2017 $2,000,000 per claim $2,000,000 annl. aggr. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is requlred) General Liability policy excludes claims arising out of the performance of professional services. C'FRTIFIf-.ATF H01 nFR C:AN('FI I ATNSM 31) Dov NC)C/11) Dav tof NOnPav of F'rem &71980.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Proposal Only ACCORDANCE WITH THE POLICY PROVISIONS. OR ZED REPRESENTATIVE &71980.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 64, AT - - 1N_G �i �+ Forms ATTACHMENT A CITY OF SANTA CLARITA DISCLOSURE STATEMENT The following information must be disclosed: �.J go 1, List the names of all persons having a financial interest in the Request for Proposal. go Twining, Inc. 40 0 2. If any person identified pursuant to No. 1 above is a corporation or partnership, list the Re names of all individuals owning more than ten percent of the shares in the corporation or owning any partnership interest in the partnership. Robert Ryan, President Edward M. Twining, Jr., CEO 3. If any person identified pursuant to No. 1 above is a non-profit organization or a trust, list the names of any persons serving as a director of the non-profit organization or as a trustee or beneficiary or trustor of the trust. N/A 40 4. Has the offeror had more than $250.00 worth of business transacted with any member of 06 the City of Santa Clarita staff, boards, commissions, committees, and Council within the 00 past twelve months? If yes, please indicate the person(s) with whom you have conducted d0 business. No 0 NO r Attach additional pages as cessary. ignature of Offer Edward M. Twining, Jr. Print or Type Name of Offeror 04/06/16 Date 20 AT W I NIN G Forms ATTACHMENT B EQUAL OPPORTUNITY/AFFIRMATIVE ACTION STATEMENT The offeror hereafte? described will not discriminate against any employee or applicant for employment because of race/color, national origin, sex, sexual preference, religion, age, or handicapped status in employment or the provisions of services. cz Signature Edward M. Twining, Jr., CEO Typed Name and Title 21 TWINING 14 A FORMS ATTACHMENT C HOLD HARMLESS AGREEMENT Offeror agrees to indemnify and hold harmless the City of Santa Clarita against and from any and all damages to property or injuries to or death of any person or persons, including employees or agents of the City, and shall defend, indemnify and hold harmless the City, its officers, agents and employees, from any and all claims, demands, suits, actions or proceedings of any kind or nature, of or by anyone whomsoever, in any way resulting from or arising out of the negligent or intention all acts, errors, or omissions of the offeror or any of its officers, agents, or employees. f Signature do Edward M. Twining, Jr., CEO Typed Name and Title 22 Ia A.TwINING Forms ATTACHMENT D EXHIBIT 10-F CERTIFICATION OF CONSULTANT, COMMISSIONS & FEES I HEREBY CERTIFY that I am the CEO representative of the firm of Twining, Inc. 2883 East Spring Street, Suite 300, Long Beach, CA 90806 and duly authorized whose address is , and that, except as hereby expressly stated, neither I nor the above firm that I represent have: (a) employed or retained for a commission, percentage, brokerage, contingent fee, or other consideration, any firm or person (other than a bona fide employee working solely for me or the above consultant) to solicit or secure this contract; nor �i (b) agreed, as an express or implied condition for obtaining this contract, to employ or retain the A services of any firm or person in connection with carrying out the contract; nor d� (c) paid, or agreed to pay, to any firm, organization or person (other than a bona fide employee working solely for me or the above consultant) any fee, contribution, donation, or consideration of any kind, for or in connection with, procuring or carrying out this contract. I acknowledge that this Certificate is to be made available to the California Department of Transportation (Caltrans) in connection with this contract involving participation of federal -aid highway funds, and is subject to applicable state and federal laws, both ,cr',141al and civil. 04/06/16 (Date) (Signature) 23 Forms ATTACHMENT F EXHIBIT 10-01 CONSULTANT PROPOSAL DBE COMMITMENT (Inclusive of all DBEs listed at bid proposal. Refer to instructions on the reverse side of this form) Consultant to Complete this Section City of Santa Clarita 1. Local Agency Name: _ Santa Clarita, CA 2. Project Location: Quality Assurance, Material Testing, Inspection 3. Project Description: 4. Consultant Name: Twining, Inc. 5. Contract DBE Goal %: 0.0 DBE Commitment Information 6. Description of Services to be Provided 7. DBE Firm Contact information 8. DBE Cert. 9. DBE % Number N/A - DBE Participation is not re uir ids for this submission. We will provide our services without the id of a subconsultant. Local Agency to Complete this Section 10. Total % Claimed n n % —�- 16. Local Agency Contract Number: 17. Federal -aid Project Number: 18. Proposed Contract Execution Date: Local Agency certifies that all DBE certifications are valid and the information on this form is complete and accurate: 11. Prtr r;igt�tufA' 'Edwatd M. Twining, Jr. 12. Preparer's Name (Print) CEO 19. Local Agency Representative Name (Print) 20. Local Agency Representative Signature 21. Date 22. Local Agency Representative Title 23. (Area Code) Tel. No. 13. Preparer's Title 04/06/16 562.426.3355 14. Date 15. (Area Code) Tel. No. Distribution: (1) Original—Consultant submits to local agency with proposal (2) Copy — Local Agency files 24 AT W IN C NG Forms ATTACHMENT G EXHIBIT 15-H DBE INFORMATION —GOOD FAITH EFFORTS Federal -aid Project No. DBE INFORMATION - GOOD FAITH EFFORTS STPL 5450 (089) Bid Opening Date 04/06116 ['he City of Santa Clarita established a Disadvantaged Business Enterprise (DBE) goal of 0.0 %Q for this project. The information provided herein shows that a good faith effort was made. Lowest, second lowest and third lowest bidders shall submit the following information to document adequate good faith efforts. Bidders should submit the following information even if the "Local Agency Bidder DBE Commitment" form indicates that the bidder has met the DBE goal. This will protect the bidder's eligibility for award of the contract if the administering agency determines that the bidder failed to meet the goal for various reasons, e.g., a DBE firm was not certified at bid opening, or the bidder made a mathematical error. Submittal of only the "Local Agency Bidder DBE Commitment" form may not provide sufficient documentation to demonstrate that adequate good faith efforts were made. The following items are listed in the Section entitled "Submission of DBE Commitment" of the Special Provisions: A. The names and dates of each publication in which a request for DBE participation for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications N/A - DBE participation is not required. Dates of Advertisement B. The names and dates of written notices sent to certified DBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the DBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation N/A - DBE participation is not required. t�! 25 w Forms C. The items of work which the bidder made available to DBE firms including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation was made available to DBE firms. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item Items N Of (Y/N) Contract N/A - DBE participation is not required. D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each DBE if the selected firm is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: N/A - DBE participation is not required. Names, addresses and phone numbers of firms selected for the work above: N/A - DBE participation is not required. E. Efforts made to assist interested DBEs in obtaining bonding, lines of credit or insurance, and any technical assistance or information related to the plans, specifications and requirements for the work which was provided to DBEs: N/A - DBE participation is not required. 26 a i A,TW I N ING Forms F. Efforts made to assist interested DBEs in obtaining necessary equipment, supplies, materials or related assistance or services, excluding supplies and equipment the DBE subcontractor purchases or leases from the prime contractor or its affiliate: N/A - DBE participation is not required. G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using DBE firms (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.): Name of Agency/Organization Method/Date of Contact Results N/A - DBE participation is not required. H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): N/A - DBE participation is not required. NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. 27 Forms ATTACHMENT H EXHIBIT 10-02 CONSULTANT CONTRACT DBE INFORMATION (Inclusive of all DBEs listed at contract award. Refer to instructions on the reverse side of this form) Consultant to Complete this Section 1. Local Agency Name: City of Santa Clarita 2. Project Location: Santa Clarita 3. Project Description: Quality Assurance, Materials Testing, Inspection Services 4. Total Contract Award Amount: $ N/A 5. Consultant Name: Twining, Inc. 6. Contract DBE Goal %: 0.0 7. Total Dollar Amount for all Subconsultants: $ 0 8. Total Number of all Subconsultants: 0 Award DBE/DBE Information 9. Description of Services to be Provided 10. DBE/DBE Firm 11. DBE Cert. 12. DBE Dollar Contact Information Number Amount N/A - DBE Participation is not reauireds for this submission. We Will provide our services without th aid of a subconsultant. 13. Total Dollars Local Agency to Complete this Section 20. Local Agency Contract Number: Claimed QO 21. Federal -aid Project Number: 14. Total 22. Contract Execution Date: % Claimed 0.0 Local Agency certifies that all DBE certifications are valid and the information on this form is complete and accurate: 23. Local Agency Representative Name (Print) 24. Local Agency Representative Signature 25. Date 26. Local Agency Representative Title 27. (Area Code) Tel. No. 15. Pscpati s Snmurc {/ Edward M. TWlrling, Jr. f 16. Preparer's Name (Print) CEO 17. Preparer's Title Caltrans to Com tete this Section Caltrans District Local Assistance Engineer (DLAE) certifies that this form has been reviewed for completeness: 04/06/16 562.426.3355 18. Date 19. (Area Code) Tel. No. 28. DLAE Name (Print) 29. DLAE Signature 30. Date Distribution: ([)Copy -Email a copy to the Caltrans District Local Assistance Engineer (DLAE) within 30 days of contract award. Failure to send acopy to the DLAE within 30 days of contract award may result in delay of payment. 28 TWINING Forms ATTACHMENT J EXHIBIT 10-Q DISCLOSURE OF LOBBYING ACTIVITIES COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract ❑ a. bid/offer/application ❑ a. initial b. grant b. initial award b. material change c. cooperative agreement c. post -award d. loan e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity For Material Change Only: year quarter date of last report_ 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Prime ❑ Subawardee Tier , if known Congressional District, if known N/Congressional District, if known 6. Federal Department/Agency: 7. Federal Program Name/Description: FDA Number, if applicable 8. Federal Action Number, if known: 9. Award Amount, if known: 10. Name and Address of Lobby Entity 11. Individuals Performing Services (including (If individual, last name, first name, MI) address if different from No. 10a) (last name, first name. MI) (attach Continuation Sheet(s) if necessary) 12. Amount of Payment (check all that apply) 14. Type of Payment (check all that apply) $ ❑ actual ❑ planned a. retainer b. one-time fee 13. Form of Payment (check all that apply): c. commission ❑a. cash d. contingent fee b. in-kind; specify: nature e deferred Value f, other, specify 15. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if necessary) 16. Continuation Sheet(s) attached: Yes ❑ No ❑ K-- 17, Information requested through this form is authorized by Title ✓ 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. Edward M. Twining, Jr. 1352. This information will be reported to Congress Print Name: semiannually and will be available for public inspection. Any CEO person who fails to file the required disclosure shall be subject Title: to a civil penalty of not less than $10,000 and not more than 562.426.3355 04/06116 $100,000 for each such failure. Telephone No.: Date: Federal Use Only: mlanl Fnr I.T T. Rv 0d_9R_t)r Authorized for Local Reproduction Standard Form - LLL 29 i AT W I N I N G 4 14 Forms ATTACHMENT K DEBARMENT AND SUSPENSION CERTIFICATION TITLE 2, CODE OF FEDERAL REGULATIONS, PARTS 180 & 1200 The Consultant, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager: (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency; (2) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (a)(2) of this certification; and (4) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. Where the prospective participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Exceptions will not necessarily result in denial of award, but will be considered in determining proposer responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. 30