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2017-05-23 - AGENDA REPORTS - HSIP C0043 CONSTRUCTION CONTR (2)
Agenda Item: 6 CITY OF SANTA CLARITA AGENDA REPORT MR CONSENT CALENDAR a. CITY MANAGER APPROVAL: fAl DATE: May 23, 2017 SUBJECT: HIGHWAY SAFETY IMPROVEMENT PROGRAM, PROJECT C0043 - AWARD CONSTRUCTION CONTRACT DEPARTMENT: Public Works PRESENTER: Damon Letz RECOMMENDED ACTION City Council: 1. Approve the plans and specifications for the Highway Safety Improvement Program, Federal -Aid Project HSIPL-5450(085), City Project C0043. 2. Award the construction contract to Toro Enterprises, Inc., in the amount of $1,043,930 and authorize a ten percent contingency in the amount of $104,393, for a total contract amount not to exceed $1,148,323. 3. Appropriate Miscellaneous Federal Grant funds (229) in the amount of $1985678 to expenditure account C0043229-5161.001 and increase revenues in account 229-4424.009 by $198,678. 4. Authorize the City Manager or designee to execute all necessary documents, subject to the approval of the City Attorney. BACKGROUND This Highway Safety Improvement Program (HSIP) federal grant -funded project involves improvements to the following three intersections: Orchard Village Road at Wiley Canyon Road, Seco Canyon Road at Pamplico Drive, and Soledad Canyon Road at the State Route 14/Sand Canyon Road southbound ramps. These projects will increase traffic flow and improve operations at the following three intersections: Yl Page 1 Packet Pg. 41 Yl Orchard Village Road at Wiley Canyon Road - The vehicles in the northbound left -turn pocket on Orchard Village often exceed the capacity of the existing turn pocket, forcing vehicles to stack in the number one lane. The turn pocket extension will increase vehicle capacity, and the signal modification will improve the flow by changing the permissive left turn into a protected left turn phasing on both directions along Orchard Village Road. Improvements also include upgrades to the ramp to comply with the Americans with Disabilities Act (ADA). Seco Canyon Road at Pamplico Drive - Improvements to the intersection include changing the signal phasing, upgrades to the signal infrastructure, adding a protected left -turn operation, construction of pedestrian access ramps compliant with ADA, and roadway improvements to the adjacent road to remove dips in the intersection. The improvements also include installation of a catch basin to address drainage problems at this intersection. Soledad Canyon Road at State Route 14 southbound ramps - The proposed improvements at the intersection will modify the existing permissive westbound left turn from Soledad Canyon to the State Route 14 on-ramp to a protected left turn, a new traffic signal mast arm will be installed, and the left -turn pocket will be extended to accommodate the new protected left -turn phasing. This project supports the Santa Clarita 2020 theme of Sustaining Public Infrastructure. An invitation to bid was published three times: February 8, 18, and 28, 2017, and posted on the City of Santa Clarita (City) website. Six bids were submitted to the City and opened by Purchasing on March 20, 2017. The results are shown below: Company Leonida Builders, Inc. Sully -Miller Contracting Toro Enterprises, Inc. Granite Construction Company Palp Inc., DBA Excel Paving R.C. Becker & Son, Inc. Location Bid Amount Glendora, CA $ 868,716.00 Enterprises, hie., Brea, CA $1,012,530.60 is 39.2 percent. Oxnard, CA $1,043,930.22 Lancaster, CA $1,027,482.00 Long Beach, CA $19293,071.50 Santa Clarita, CA $1,311,867.55 After reviewing the bids, staff determined the bid from the first low bidder, Leonida Builders, Inc., and the second low bidder, Sully -Miller Contracting, were non-responsive. These two bidders failed to meet the Disadvantage Business Enterprise (DBE) goal of 12 percent, as specified in the contract documents for this federally funded project. Therefore, staff recommends awarding this construction contract to Toro Enterprises, hie., the lowest responsive bidder. Toro Enterprises, Inc., possesses a valid state contractor's license and is in good standing with the Contractors State License Board. The contractor's bid was reviewed for accuracy and conformance to the contract documents and found to be complete. Additionally, Toro Enterprises, hie., DBE commitment for this project is 39.2 percent. The requested contingency of $104,393 will cover costs for unforeseen conditions or conflicts uncovered during construction. While the City maintains a "Support of Local Businesses" policy that can be utilized by the City Council when warranted, the City is governed by the State Public Contract Code with regard to Page 2 Packet Pg. 42 public works project procurement. In these types of procurements, the Public Contract Code does not permit a City to utilize a "Support of Local Businesses" policy and instead requires the contract to be awarded to the "Lowest Responsive Bidder." Since the lowest responsive bidder was higher than the engineer's estimate, City staff requested additional federal HSIP funds from the California Department of Transportation and received a commitment to increase federal funding by $198,678. The additional funds will be used for construction and staff oversight related to construction and project management, including public works inspection, technical support, labor compliance, material testing, and other project -related costs. ALTERNATIVE ACTION Other action as determined by the City Council. FISCAL IMPACT Upon approval of the recommended action, adequate funds will be available to support the recommended contract. ATTACHMENTS Location Map Bid Proposal for Toro Enterprises, Inc. (available in the City Clerk's Reading File) Page 3 Packet Pg. 43 11 %�,_, _,_._ _� _, s.a % _r a- limn i L ' 1 r'• i —�'' ^ _ No `• ; -- y �T 11 O $ECO CANYONIRD —� Ti_ � at PAMPLICO DR F,, / w ro HN,e. o f 0 F •� .� I A �C R 2 lose • Q py p _ pL T OANYON r n — O L_ coca .} V I a Ir A I No e e r rc n Z 'tWci1,yo.. p SOLEDAD-CANYON RD/SAND�C N N RD w ° LU SOUTHBOUND RAMPS U�yT Pkwy _ SOLEDAD,CANVON RD yv � ���� W > f { L 0 D A ■� a L O ? -%9 "..I— ©ss ORC IARD''VILLAGE'RD t` =5 m LE�U) ata s t 99 1 0 CAN Yo/,9. 2 i 0_ 'LYONS IN,tI 7eO NFy L' ' � I N 4A 'Nocca _ I ias., coca 00 a ii -r'—I No No o --11 i'lI ' _.- I cityMSANTA CLARITA i Project Location Map loss % - i _No '•+ Legend A .c s, U y • 0.5 0 0.5 < �Y'' _ • Project Locations ®Mile: Q Santa Clara Riverr o n` tl amissrms or ,V o nV coca IN __ FOOTHI —� City of Santa Clanta boundary `n a Packet Pg. 44 QAPROJECTSP=M ADDENDUM NO. 1 HIGHWAY SAFETY IMPROVEMENT PROGRAM Seco Cyn Rd at Pamplico Dr Orchard Village Rd at Wiley Cyn Rd Soledad Cyn Rd/Sand Cyn Rd at SR -14 Southbound ramps Federal -Aid Project HSIPL-5450(085) City Bid ENG-16-17-CO043 City Project C0043 March 8, 2017 This Addendum includes two (2) pages as a part of the Contract Documents for the above -identified project and modifies the original Specifications and Contract Documents, as noted below. Portions of the Contract, not specifically mentioned in this Addendum, remain in force. All trades affected shall be fully advised of these changes, deletions, and additions. SPECIFICATIONS Page G-16 BID ITEM 6 MEASUREMENT AND PAYMENT— Replace entire paragraph with the following: Payment for BID ITEM 6 shall be paid for at the contract unit price per each. The curb ramp limits will be from beginning of curb return to end of curb return. Payment shall include removal of existing sidewalk, curb and gutter, spandrel, excavation, subgrade preparation, construction of the curb ramp including new 4" PCC sidewalk, new curb and spandrel (poured separately), removal and replacement of one foot (1') wide asphalt concrete pavement section adjacent to gutter and all materials, tools, equipment, forms and labor necessary to perform the work. No additional compensation will be allowed. Page G-23 BID ITEM 21 MEASUREMENT AND PAYMENT - Replace entire paragraph with the following: Payment for BID ITEM 21 shall be paid for at the contract unit price per each. The curb ramp limits will be from beginning of curb return to end of curb return. Payment shall include removal of existing sidewalk, curb and gutter, excavation, subgrade preparation, construction of the curb ramp including new 4" PCC sidewalk, new curb, removal and replacement of one foot (1') wide asphalt concrete pavement section adjacent to gutter and all materials, tools, equipment, forms and labor necessary to perform the work. No additional compensation will be allowed. Page G-30 BID ITEM 48 MEASUREMENT AND PAYMENT - Add the following to bullet item 2: The curb ramp limit will be from ECR to BCR. The contract price shall include removal and replacement of one foot (1') for wide asphalt concrete pavement section. Section D. Capital Improvement Project Agreement - replace Exhibit "B" with the attached updated Federal Wage Determination for this project. Appendix B, Federal Prevailing Wages - replace entire section with the attached updated Federal Wage Determination for this project. QUESTIONS & ANSWERS Question 1 Is the contractor responsible for any permit and or inspection fees for the County of Los Angeles? Answerl Plan Sheet 2 of 15 Street Improvement Plan — Standard Note 6 states: "A permit must be obtained from the Los Angeles County Department of Public Works, Construction Division, (626) 458-3129 for all Strom Drain connections. A copy of the permit must be given to the City Public Works Inspector prior to start of work. Question 2 Is the contractor responsible for any permit and or inspections fees for Caltrans? Answer 2 Plan Sheet 2 of 15 Street Improvement Plan — Standard Note 7 states: For all work within CALTRANS and/or Los Angeles County right-of-way, obtain a permit from the appropriate jurisdiction prior to construction within right-of-way. Question 3 Items 12 & 74 of the Caltrans permit states that "typically working hours and traffic control are authorized only be- tween 0900 and 1500" which is in conflict with the City's project hours of 10,00 PM to 5:00 AM. Can you please clarify this issue? Answer 3 The City will coordinate with Caltrans so that the project hours remain between 10:00 PM and 5:00 AM. BIDDER'S CERTIFICATE 1 acknowledge receipt of this Addendum No. 1 and accept 1// ACW 0 2017 Date Robert G. Newman Director of Public Works City of Santa Clarita r,¢Esivcn�� THIS DOCUMENT TO BE SUBMITTED WITH BID ADDENDUM NO. 2 HIGHWAY SAFETY IMPROVEMENT PROGRAM Seco Cyn Rd at Pamplico Dr Orchard Village Rd at Wiley Cyn Rd Soledad Cyn Rd/Sand Cyn Rd at SR -14 Southbound Ramps Federal -Aid Project HSIPL-5450(085) City Bid ENG-16-17-CO043 City Project C0043 March 9, 2017 This Addendum includes three (3) pages as a part of the Contract Documents for the above -identified project and modifies the original Specifications and Contract Documents, as noted below. Portions of the Contract, not specifically mentioned in this Addendum, remain in force. All trades affected shall be fully advised of these changes, deletions, and additions. Section - A: Notice Inviting Bids - Page A-1 Change the following: "For further information, call Mona Awad, Project Manager at: (661) 255-4989" To the following: "For further information, call Monica Heredia at: (661) 255-4332" 2. Section - A: Notice Inviting Bids — Page A-3 Change the following: City Project Manager: Mona Awad Contact Number: (661) 255-4989 Email address: mawad0santa-clarita.com To the following: City Project Manager: Monica Heredia Contact Number: (661) 255-4332 Email address: mherediaCftanta-clarite. com 3. Section 7.5 PERMITS - Page F-20 • Revise "PCFL 201401240" to "PCFL 201402572 and PCFL 201502665" in the second paragraph • Revise "Appendix F' to "Appendix E" in the second paragraph • Revise "Appendix G" to "Appendix F" and add the following sentence to the third paragraph: The Contractor shall pay a permit fee of $13,120 to CALTRANS in order to obtain the double permit. This amount should be included as part of Bid Item 1 - Mobilization, including bonds, and Insurance. Revise the following in the fourth paragraph: "The AGENCY will reimburse the CONTRACTOR permit fees associated with the contract." to "The AGENCY will reimburse the CONTRACTOR permit fees associated with the contract exceeding the amount of $131120.0 4. Appendix E - County of Los Angeles DPW Flood Control Permit Add the following: Permit PCLF 20142572 (connection to the storm drain along Seco Canyon Road) The City is in the process of extending the expiration dates for all permits (PCLF20142572, PCLF 201502665 and 715-NSN-1314). UY obe G. Newman Director of Public Works City of Santa Clarita BIDDER'S CERTIFICATE I acknowledge receipt of this Addendum No. 1 and accept the aforementioned 03/13 ,2017 Date SEAN CASTILLO, PRESIDENT THIS DOCUMENT TO BE SUBMITTED WITH BID ADDENDUM NO. 3 HIGHWAY SAFETY IMPROVEMENT PROGRAM Seco Cyn Rd at Pamplico Dr Orchard Village Rd at Wiley Cyn Rd Soledad Cyn Rd/Sand Cyn Rd at SR -14 Southbound ramps Federal -Aid Project HSIPL-5450(085) City Bid ENG -16-17-00043 City Project C0043 March 14, 2017 This Addendum includes one (1) page as a part of the Contract Documents for the above -identified project and modifies the original Specifications and Contract Documents, as noted below. Portions of the Contract, not specifically mentioned in this Addendum, remain in force. All trades affected shall be fully advised of these changes, deletions, and additions. SPECIFICATIONS Page A-1, NOTICE INVITING BIDS — Bid Opening date has been extended to Monday, March 20, 2017 at 11:00 a.m. �0 S), �' Robert G. Newman Director of Public Works City of Santa Clarita BIDDER'S CERTIFICATE I acknowledge receipt of this Addendum No. 3 and accept the aforemention d. 03/17,2017 Date Bidder's Sighature SEAN CASTILLO, PRESIDENT t THIS DOCUMENT TO BE SUBMITTED WITH BID ADDENDUM NO.4 HIGHWAY SAFETY IMPROVEMENT PROGRAM Seco Cyn Rd at Pamplico Dr Orchard Village Rd at Wiley Cyn Rd Soledad Cyn Rd/Sand Cyn Rd at SR -14 Southbound Ramps Federal -Aid Project HSIPL-5450(085) City Bid ENG-16-17-CO043 City Project C0043 March 14, 2017 This Addendum includes two (2) pages as a part of the Contract Documents for the above -identified project and modifies the original Specifications and Contract Documents, as noted below. Portions of the Contract, not specifically mentioned in this Addendum, remain in force. All trades affected shall be fully advised of these changes, deletions, and additions. SPECIFICATIONS 1. Page C-2 BID SCHEDULE —Replace entire Bid Schedule with the attached Revised Bid Schedule. (3 pages) 2. Page G-16 BID ITEM 6 MEASUREMENT AND PAYMENT —Replace entire paragraph with the following: Payment for BID ITEM 6 shall be paid for at the contract unit price per each and shall be full compensation for furnishing all labor, material, tools, equipment and for performing all work involved including sawcut and removal of existing ramps and sidewalks (BCR to ECR) and construct new ramps complete in place, per these special provisions and as directed by the Engineer. 3. Section D, Capital Improvement Project Agreement - replace Exhibit "B" with the attached updated Federal Wage Determination for this project. (23 pages) 4. Exhibit A, SPECS FOR PAVERS A. First Page, Section B MATERIALS - delete the last sentence and add the following paragraph: PCC (Portland cement concrete) paver base shall be Type II 560-C-2500 and shall comply with the requirements set forth in 201-1 of the SSPWC, Reinforcement shall be 1.5 Ib. of reinforcing fiber per cubic yard of concrete. Fiber to be Supernet Fiber as provided by Forta Corp. or equal. Setting bed bond coat shall be applied to the finished surface of the P.C.C. before the cement/mortar setting bed is installed. Setting bed bond coat shall consist of a mixture of cement, sand and water or liquid latex additive. Typical proportions of sand and cement are equal parts of each material with water or latex added so that a creamy consistency is achieved, suitable for brushing onto the con- crete. B. Third Page, Section D MEASUREMENT AND PAYMENT - Replace the last sentence with the following: Base Material including compacted base, concrete base and mortar bedding shall be included in the price paid for concrete pavers. Page 1 of 2 5. Appendix B, Federal Prevailing Wages - replace entire section with the attached updated Federal Wage Determination for this project. (23 pages) il) A � Robert . ewman Director of Public Works City of Santa Clarita BIDDER'S CERTIFICATE I acknowledge receipt of this Addendum No. 4 and accept the aforementioned 3-IZ, 2017 Date Bidde s Signatu a C&I hltptPrGSicJ it} THIS DOCUMENT TO BE SUBMITTED WITH BID Page 2 of 2 SECTION - C Proposal SECTION C: PROPOSAL HIGHWAY SAFETY IMPROVEMENT PROGRAM Seco Cyn Rd at Pamplico Dr Orchard Village Rd at Wiley Cyn Rd Soledad Cyn Rd/Sand Cyn Rd at SR -14 Southbound ramps Federal -Aid Project HSIPL5450(085) City Project C0043 City of Santa Clarita, California 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 Bidders default in executing the required contract and filing the necessary bonds and insurance certificates within ten working days after the date of the AGENCYs 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. • - t• \ t't \ Company Address: 2101 E. VENTURA BLVD, OXNARD, CA, 93036 By: SEAN CASTILLO Print Name Title: 1>RESI[Zj' Signature' SEAN CASTILLO, PRESIDENT Date: 03/13/2017 C-1 REVISED BID SCHEDULE HIGHWAY SAFETY IMPROVEMENT PROGRAM Seco Cyn Rd at Pamplico Dr Orchard Village Rd at Wiley Cyn Rd Soledad Cyn RdlSand Cyn Rd at SR -14 Southbound Ramps Federal -Aid Project HSIPL-5450(085) City Project C0043 ITEM NO. ITEM DESCRIPTION — --UNIT QTY IT 1 34 000 30.0000 1 Mobilization, including bonds, and Insurance (not to exceed LS 3% of total bid) Traffic Control 1 f 2Sfo00 /Z5, 00 1 000 o00 �r 2 LS 3 Water Pollution Control and implement Best Management LS Practices (BMP's) SECO CANYON ROAD AT PAMPLICO DRIVE 4 Sawcut, Remove Existing & Construct PCC Curb & Gutter LF 180 y 7 , ( q 81 q bS .2 5 Sawcut and Remove existing Fill - In Concrete and Construct SF 685 � l o' b 0 4" PCC Sidewalk • � 6 Sawcut, Remove Existing Ramp & Sidewalk & Construct new EA 4 PCC Sidewalk and Curb Ramp from BCR to ECR , 7 Sawcut and Remove Existing and Construct New PCC Cross EA 2 y 134.21. S,468•4q Gutter 8 Sawcut and Remove Existing & Construct 12° Wide x "Slot SF 313 j q ,5 Z (o IO'. 8°Thick Full Depth AC Paving° , 9 Crushed Aggregate Base CY 24 2$y.5"L 10 Cold mill 2" Min and construct variable thickness ARHM SF 51865 3, 5I 2011 S?i. pavement overlay 11 Construct Local Depression EA 1 11 324.14 I, 32 4.9 12 Construct Catch Basin (W=3.5') EA 1 ` 6%q.g4 Gr05'q.I 13 Install 18" RCP & Construct Catch basin connection LS 1 cj oc,5Qq4, q f 050.4 14 Construct Junction Structure EA 1 to qy 1. Sq 6,q4(. $ 15 Construct (Type A) ADA Curb Ramp EA 1 11 01A .3j3 I 1 024.36 16 Install truncated domes EA 6 3q b, (a ?.(Sq 1.84 17 Adjust Gate Valve to Grade EA 3 f: - e -i (19 l 7, 2) 18 Traffic Signal ModificationLS 1 L2Z,1 s4. 1 2 19 1 Signing & Striping LS 1 11,9070rz M507.46 C-2 ORCHARD VILLAGE ROAD AT WILEY CANYON ROAD 20 Sawcut and remove existing AC pavement SF 21035 , rb qi %2q.0 21 Remove & construct new curb ramp EA 4 Zr� 1 e. I y Ifir R2, 5140 22 Remove existing curb & gutter LF 805 ti . ty 31M.40 23 Remove landscaping & irrigation SF 21837 1,01 2, 69 3.1 24 Remove catch basin/grate and cap storm drain line EA 1 I , $ y 2.41 I, 9 y2 . y ( 25 Concrete Unit Pavers with Bedding and Joint Sand SF 11515 3q. 6r1 S2, 555.5 26 Install joint seal LS 1 2,, yU 0 2,L100 27 Construct 6" curb LF B00 12 . 18, L24 28 AC pavement TON 136 11Z .SO (S,300 29 Crushed Aggregate Base CY 79 1160 IZ, b 4 0 30 Install truncated domes EA 4 400 11(000 31 Traffic Signal Modification LS 1 1L5,100 W5,100 32 Signing & Striping LS 1 x,500 8,5-00 SOLEDAD CANYON ROAD AT SR -14 ON - RAMP 33 Sawcut Pavement LF 625 Z.8(P I�fi9f,oS 34 Demo Curb and Gutter LF 623 15 . L(D 9199 y , zo 35 Demo Existing Median Stamped Concrete SF 2,887 j , 1 G( '� y 35. S 36 Remove Existing Base Material (assume 1.6'thickness) Cy 37 9 6. L{} 'j1541.501 37 Remove Existing AC Pavement SF 625 S . b Lf 3 4, 50 i 38 Remove Existing Signs and post (two signs on one post) LS 1 1145.44 215.6 re 39 Remove Existing Storm Drain Catch Basin EA 1is n 1t 6 y0 40 Remove Traffic Signal Pull Box EA 1 64 Z, $6 Z 41 Remove Irrigation Control Valves EA 6 5 q 3 ?.11 42 Remove Existing Tree EA 19 21 O 3 170 43 Remove Existing Landscape SF 31395 -70 2r 376 -- 44 Remove Landscape Boulders EA 3 1, b% 45 Demo and remove existing curb ramp EA 1 3 (a Z (a Z 46 Cold Mill Pavement SF 31200 2 6r q d 0 47 Concrete Curb LF 622 2S I,S5-0 C-3 48 Curb Ramp EA 1 It g so 11150 49 Install Median Stamp Concrete SF 1,961 17.25- Zy, 02*. 50 0.20' Rubberized Hot Mix Asphalt (RHMA-G) SF 81505 2.150 211262. 51 0.35' Hot Mix Asphalt TYPE A SF 51086 5P feyj L5T6 52 0.55' Lean Concrete Base CY 104 2 Lf 0 2 41 &16 0 53 Aggregate Base Class 3 CY 198 1175 7 -27 574 / 54 4" Crushed Aggregate Base CY 24 21 S 151 t 66 55 Catch Basin with Local Depression (per plan) EA 1 71 <{OO 71 y 00 56 18" Reinforced Concrete Pipe LF 4 /1 COO t,7/ p 0o 57 Concrete Collar EA 1 /, 5700 /.0 1500 58 Traffic Signal Modification LS 1 12,500 q 21500 59 Signing & Striping LS 1 710700 7,700 **TOTAL BID IN WORDS: CA TOTAL BID IN FIGURES $ I 11CH 31930. ZZ Local Asssstance Procedures 'Manual Exhibit 12-B Bidder's List of Subcontractors (DBE and N70'\ -DRE) Exhibit 12-B Bidder's List of subcontractor (DBE and Non -DBE) As of March 1, 2015 Contractors (and sub -contractors) wishing to bid on public works contracts shall be registered with the State Diciuon of Industrial Relations and certified to bid on Public Works contracts. Please mgister at: httDs aJetiliq¢.dir_CB aFovJPWCaJActiRnServlEt?aC'too,�=CisolaypiNCRee:?efon�arn': In accordance with Title 44. Section 26.11 of the Code of Federal Regulations, and Section 4104 of the Public Contract C'.ode of the State of California, as amended. the following information is regtured fot each sob -contractor who will perform work amc untiug to more than one half of ane percent (0.5%) of the Total Base Bid or 510.000 rw•hicbecer is greaten- Photoconr this form for additional firms. Subcontractor Name and Location Cine Rem & Description Subcontract Amount Percentage of Bid Rem Sub- watracted Contractor License Number DBE (YIN) DBE Cert Number Annual Gross Receipts DIR Reg Numbet n� A Name 6 flf"t 5 I- . C 0 S'f�j(P(/V C, M�C�4�-1 N 5tC9 (N5 S 7 �j2jf��o ` �� 4f 1 10 O O 'N 451 million c55 m16on Ci- , State- ( LOGtJ1lNCy-j(1V C F} <$10 motion �o0D000,jorp -515 million rs. Age of Firm: _ yrs- 7a Name faR�ly�S7>'dfi'L UN (1 IaAVCi �-$ 7 Yip 90 S v �� ° 1Zd qq j W I �/ <5lmillion 115 md1#on City, State: Za�LIeFr�rG� .110 million joaoao 4�4y '.115 million Age of Fmm _ yrs. Name ( e . City, Stater C 7QRFPIC N'OpS t�t/0�, 75y 7 y u ° /Q/ i9 7 �p� 4d- - '�-r7- jaa600Y$� SIZ�� <11 mtilwn <5smdgin :510 motion <515 million Age of Firm yrs. Name _r.-_--'_- - ---_--'ff E3 <$1 million Q <$Smdfion Cay, stare :510 million <:115 million Age of firm _ yrs. Name - - - <$1 million 0 <55 million Cay, State 50 2,#11! 2 mil 45115 mon Age of Fim; _ yrs Name --- -- - - _ <$1 million e55 million City. State a53D million •515 motion Age of firm yrs_ Distribution: 1) Original -Local Agency File 2) Copy-DLAE wJ Award Package Page 1 of 1 C-5 September 2016 Local Assotance Procedures Manual Exhibit 12-B Bidder's List of Subcoarractors (DBE and \O\ -DBE) Exhibit 12-B Bidder's List of subcontractor (DBE and Non -DBE) As of March 1, 2015 Contractors (and sub -contractors) wishing to bid =public works contracts shall be registered with the State Dnasion of Iudttstrtal Relations and certifmdtobidon PubhcWodcsconvacts. Please register at:ht!Dsa/efifin¢.dir.c&.¢OY/pW<F1Ac?ion5ervlet?action=cisolavpWCRee: ?.at!on=onn 1n accordance with Title 44. Section 26.11 of the Code of Federal Regulations. and Section 4104 of the Public Contract Code of the State of California, as amended. the followiag information is required for each sub -contactor who willperform work amounting to more than one half of one percent (0.50,'a) of the Total Base Bid or 510.000 (whichever is greater). Photocopr this form for additional firms. Subcontractor Name and Location Line Rem 6 Description Subcontract Amount Percentage of Bid nem Sub Contracted Contractor License Number DBE )Y/N) DBE Cert Number Amulet Gross Receipts Dill Reg Number Name <51 million 455 million U 4510 million Cay, State 4$15 million e of Firm: pts. Name <$1 mO n 455 million City, State. :510 million <S15 million Age of Finn _. yrs. Name Vim•. State - - - :51 million El <SS minion 4$10 Motion El 4$15 million +age of firm . _ yrs. Name - <$1 million ❑ <$S million city, State <$10 million <$SS million of Firm _ yrs. Name <$1 million 45 5 million I I <510 million Ory, State 4$15 million Ate of Fir: _ yrs Name - <$1 million <55 million City, State 4$10 million <515 million Age of Firm ., yrs_ Distribution: 1) Original -Local Agency File 2) Copy-DLAE w/ Award Package Page 1 of 1 C-5 September :016 HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal -Aid Project HSIPL-5450(085) City Project C0043 City of Santa Clarita, California The following are the names, addresses, and telephone numbers of three public agencies for which BIDDER has performed similar work within the past 3 years: 1. *PLEASE SEE ATTACHED" Name and Address of Owner / Agency Name and Telephone Number of Person Familiar with Project Contract Amount Type of Work Date Completed 2. *PLEASE SEE ATTACHED* Name and Address of Owner/ Agency Name and Telephone Number of Person Familiar with Project Contract Amount Type of Work Date Completed 3. *PLEASE SEE ATTACHED* Name and Address of Owner / Agency Name and Telephone Number of Person Familiar with Project Contract Amount 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: AON RISK SERVICES, 425 MARKET ST. SUITE 2800. SAN FRANCISCO. CA 94105.(951)233-0516 ----------TRAVELERS CASUALTY a SURETY COMPANY 21688 GATEWAY CENTER DRIVE, DIAMOND BAR, CA, 91765, (213)630-326 C-6 GENERAL ENGINEERING COONTRACTORS REFERENCE LIST Contract With: City of Oxnard - 305 W. Third Street, Oxnard, CA 93030 Contact: Raymond Williams (805) 385-7902 Description: ARHM 7,643TN, AC 2,61 ITN, Cold Mill, 600 LF C&G Project: Del Norte Blvd. Improvements Owner: City of Oxnard Contract Amount: $1,776,547.00 Completed: 1/14 Contract With: County of Ventura Contact: Irma Vasquez Description: Road widening and realignment Project: Donlon Road Alignment Blvd Owner: County of Ventura Contract Amount: $2,221,092.00 Completed: 08/01/2016 Contract With: City of Santa Clarita - 23920 Valencia Blvd. Santa Clarita, CA 91355 Contact: Bill Whitlach (661) 255-4933 Description: 18,547TN ARHM, (TMO) 7,573TN, AC 5,500TN Project: 2012-2013 Overlay -Slurry Seal Project Owner: City of Santa Clarita Contract Amount: $3,892,036.00 Completed: 2/14 GENERAL ENGINEERING CONTRACTORS REFERENCE LIST CONCRETE PROJECTS Contract With: Leisure Village Association Contact: Judy Young(805)484-2861 Brief Description: R&R Driveways, Sidewalks, Gutters Project: 2013/14 Concrete Replacement Owner: Leisure Village Association Contract Amount: $69,757.00 Completed: 1/28/14 Contract With: City of South Pasadena - 1414 Mission St, South Pasadena, CA 91030 Contact: Thomas Amare Brief Description: Installation of 4" PCC Sidewalks Project: Sidewalk Replacement Project Owner: City of South Pasadena Contract Amount: $124,929.38 Completed: 6/15 Contract With: City of South Pasadena - 1414 Mission St, South Pasadena, CA 91030 Contact: Shin Fuwukawa Brief Description: Remove and Replace C&G, Sidewalks, Ramps Project: 2013/14 Sidewalk Replacement Project Owner: City of South Pasadena Contract Amount: $106,963.80 Completed:10/14 Contract With: City of Burbank - 310 E. Olive Ave. Burbank, CA 91502 Contact: Karen Little Brief Description: Sawcut and R&R Sidewalks, Curbs, Ramps 8" PCC Project: Residential Street Improvements Owner: City of Burbank Contract Amount: $2,415,950.00 Completed: 12/15 GENERAL ENGINEERING CONTRACTORS Contract With: City of Simi Valley - 2929 Tapo Canyon Rd., Simi Valley, CA 93063 Contact: Sarah Sheshebor Brief Description: R&R Sidewalks, Curbs, Gutters, Ramps Project: Madera Road Widening Owner: City of Simi Valley Contract Amount: $805,979.04 Completed: 6/15 GENERAL ENGINEERING CQNTRACTORS REFERENCE LIST UNDERGROUND UTILITIES Contract With: County of Los Angeles - 900 S. Fremont Ave. Alhambra, CA 91803 Contact: Colin McCarter (626) 458-5100 Desription: Watermain Installation and AC Paving Project: Ave "K" 36" Transmission Main Phase 2 Owner: County of Los Angeles Contract Amount: $3,573,980.00 Completed: 1/2014 Contract With: City of Camarillo - 601 Carmen Dr., Camarillo, Ca 93010 Contact: Richard Nack (805) 388-5340 Description: 16" Pipeline, 350 TN AC Pavement, 24" HDPE Project: Pancho Road Reclaimed Pipeline Owner: City of Camarillo Contract Amount: $2,275,592.00 Completed: 5/15/15 Contract With: City of Santa Paula Contact: Raul Gitan Description: Harvard Blvd Sewer Trunk Replacement Project Project Name: Seventh Street Sewer Main Replacement Owner: City of Santa Paula Contract Amount: $787,055.35 Completed: 3/15/16 Contract With: City of Ventura - 501 Poli St. Ventura, CA Contact: Ernie Ferrer (805) 677-3905 Description: R&R Approx. 7425LF of 8", 12" & 16" Waterline Construction Project: Waterline Replacement - Harbor Blvd. Contract Amount: $1,606,352.86 Completed: 12/14 TORO ENTERPRISES. INC. Contractors Name DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal -Aid Project HSIPL-5450(085) City Project C0043 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. 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. N/A 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-7 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION * * * (Must be filled out by the Bidder and ALL subcontractors over $10,000) * * * HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal -Aid Project HSIPL-5450(085) City Project C0043 City of Santa Clarita, California This bidder TORO ENTERPRISES, INC. , proposed subcontractor TBD , hereby certifies that he has 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 , 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 EmplAyment Opportunity, all reports that are under the applicable filing requirements. / r Company: TORO ENTE P ISEVC_ N By: SEAN CASTILLO, PRESIDENT Title: PRESIDENT Date: 03/13/2017 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. W:3 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 ENTERPRISES, INC. Business Address: 2101 E. VENTURA BLVD, OXNARD, CA, 93036 Telephone No.: (805)483-4515 State CONTRACTOR's License No. & Class: 710580/ CLASS: A Original Date: 08/1/1995 Expiration Date: 0813l/2017 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: SEAN CASTILLO- PRESIDENT, JERRRY HANNIGAN-SECRETARY 2101 E. VENTURA BLVD, OXNARD, CA, 93036 (805)483-4515 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 orjoint venture are as follows: ML All current and prior DBAs, alias, and/or fictitious business names for any principal having an interest in this proposal are as follows: NONE IN WITNESS WHEREOF, BIDDE executes and submits this proposal with the names, title, hands, and seals of all aforementioned pr- ci Is this 137H day of MAR 20 17. BIDDER: Signature SLAN CASPILLO, PRESIDLYr SEAN CASTILLO, PRESIDENT Name and Title of Signatory TORO ENTERPRISES, INC. Legal Name of Bidder 2101, E. VENTURA BLVD, OXNARD, CA, 93036 Address (805)483-4515 77-0396663 Telephone Number Federal Tax I.D. No. SIGNATURES MUST BE MADE AND NOTARY ACKNOWLEDGMENTS OF EXECUTION OF BIDDER MUST BE ATTACHED Subscn -andsworn-to-this_ day of 20_ Notary Public C-10 (SEAL) CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 ,rvct:,•rr�ora czcer�tNrn�a�crr .�raN..c,.�o�r�e..�ra�eee� cacasr,.er�resras�er.� 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. J State of California County of Ventura On March 13 2017 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 whose named is/erg subscribed to the within instrument and acknowledged to me that he/s executed the same in his/hem authorized capacity(iW, and that, by his/heMheir signature(pfon the instrument the person(4,, or the entity upon behalf of which the person(P 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. R'ENEE CRUZ }} COmrni55ion # 4011344 a , is "7 Notary Pua c Cali'lornia Z Ve Mum County - Signature My �-aComm. I ;fres A;a a, 2017 Signature of Nota Public ., Place Notary Sea/ Above ------------------------ ........... -.... ---- ... nonnuel----------------------------------------------------- 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 Highway Safety Improve. Date: 3/6/17 Program; Federal Aid Project HSIPL-5450 (085); City Bid ENG-16-17-CO043 Number of Pages:_2_ Signer (s) Other Than Named Above: Capacity(ies) Claimed by S igner(s) Signer's Name Sean Castillo Signer's Name: _ Corporate Officer — Title(s): President 0 Corporate Officer — ❑Partner — 0 Limited 0 General 0 Individual 0 Trustee ❑Other: 0 Attorney in Fact 0 Guardian or Conservator Signer Is Representing: 0 Partner — 0 Limited 0 General 0 Individual 0 Attorney in Fact 0 Trustee 0 Other: ❑Guardian or Conservator Signer Is Representing: k.`G(f2C:¢[)ilG��iP.�.'ZSGnFM+"G'.SFi C:�Xi(.'E'<b'S//.>4v'C.r(74b'�%4'.4-%l�%C`b:(i44`Ew6`k%V'S+S V^f:4`4.2r'�4'`�6'C-fid."'k:L"4'+.Gr•'�r'.'<'v't�4'C+6'F(%!%�i2i4'�%C:CL`CC:'4[:i�:�4Z.4 02014 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 shall be used in case check accompanies bid. Accompanying this Proposal is a 'certified/cashier's check payable to the order of the City of Santa Clarita for: 1046 OP TO'T'AL BID dollars ($ 10% OF BID, this amount being not less than ten percent (10%) of the total 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. 'PROVIDING BIDDERS BOND*** Project Name: HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal•Aid Project HSIPLS450(085) N/A City Project C0043 3Cii5 �ipDERs Bat�D1 Bidder's Signature CONTRACTOR Address City, State, Zip Code Delete 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-lt PROPOSAL GUARANTEE BID BOND HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal -Aid Project HSIPL-5450(085) City Project C0043 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 of TM Percent of Total Amount Bid dollars ($ 10°%ofBid ),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 hereto have set their nameb, titles, hands, and seals, this 7th BIDDER: day of March TORO ENTERPRISES, INC Signature 56410 615711.co i?rteSlgetiT- Name and Title of Signatory 2101 E. Ventura Blvd., Oxnard, CA 93031 PH: 805-483-4515 Address SURETY* TRAVELERS CASUALTY AND SURETY COMPANY OF One Tower Square Bond/5PB Hartford, CT 06183 PH: 415-486-7000 and sworn to this NOTARY Attorney -In -Pact Of 20_ **" See Attached California Jurat (SEAL) *Provide BIDDER and SURETY e, address, and telephone number and the name, title, address, and telephone number for authorized repre tative. IMPORTANT - Surety Companies executing s must appear on the Treasury Department's most current list (Circular 570, as amended) and be aut ed to transact business in the State where the project is located. C-12 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 Los Angeles Subscribed and sworn to (or affirmed) before me on March 7, 2017 , by April Martinez , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. BEWOE"' ALHIAN Si afore \ I MM2162246 = gnLCO otaryPublicCalfornia er de a Aleman, Notary Public Los AngelesCounComm. Expires Aug, , 2020 P OF ATTORNEY IS INVALID WITHOUT THE RED BORDER ,::ii. POWER OF ATTORNEY TRAVELERS J Farmington 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 Stales Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 230610 Certificate No. 007058488 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 Slate 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 Tracy Aston, Kristine Mendez, KD Conrad, Simone Gerhard, Edward C. Spector, Lisa K. Crail, B. Aleman, Misty Wright, Renato F. Reyes, April Martinez, and Marina Tapia of the City of Los Angeles , State of California , their line and lawful Attomey(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 andexecuting 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 2nd day of December . 2016 Farmington Casualty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. Sl. Paul Fire and Marine Insurance Company St. Paul Guardian Insurance Company Sl. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casually and Surety Company of America United Slates Fidelity and Guaranty Company �`p^rao�ytT ` {,ID[y DIDN IM6pq ,N„xIDV9y �'.rv.4,x` JfWIp ynrY.r� a 3' 6 n tl nCOpglnAlFo �. � a!t°arw�ir�$ �W"ronnr�.n : � I9aI O ul ,^ s, . altnWm, coin 1 �\ssxn;, en°t g�xrarwm� �•,p ..s„a` yOEx 'gyp'. R T` CS. aN r.._.. ' tj Aq AM State of Connecticut City of Hartford as. By: Robert L. Raney, Senior Vim President On this the 2nd day of December 1 2016before 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., SL Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, SL 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. p,TFT In Witness Whereof, I hereunto set my hand and official seal. v�* My Commission expires the 30th day of June, 2021. �h pUBU�' �M L' gHEOpp. 58440-5-16 Printed in U.S.A. `Ac Ai k c. �,�st* Marie C. Tetreault, Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farrington 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, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attomeys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -In -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attomeys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary, of Farrington 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 Garan cannily Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this day of M R i 201 120 Kevin E. Hughes, Assistant Sec tary c, parr dp9aB' s aslM..iMg�� ,as ,laa� �ll�v flee W*mnl �yrlYMy pi a O t ' ! enol �r6ay 3` fie 197 wcaroroarm rt,'l .,pnralte':n ^i 1962 0 � t`[ )n 6earNim, a191rMm. $ �e� 1951 �iii 581LL •i r.Se 16066 ,c+7 y'.--•/il'' To verify the authenticity of this Power of Attorney, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attorney -In -Fact number, the above-named individuals and the details of the bond to which the power is attached. 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, orvalidity of that document. State of California County of Ventura On March 13. 2017 before me, Renee Cruz, Notary Public Date Here Insert Name and Title of the Officer personally appeared Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the personv whose nameW islam subscribed to the within instrument and acknowledged to me that he/sheRhey executed the same in his/herkheir authorized capacity(ies�, and tha by his/hsi:M:i r signaturexon the instrument the personV,, 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 Qv��.eff RENEECRUUi is true and correct. Commission # 2011344Not_ry Put;llc - Calitumia 'zD ti/ Ventura County 11ty Comm. Eg)ires flpr 3, 2017 -•wwrvw-ate v �� • Signature rgnature of Notary Aublic Place Notary Seal Above ............ -.... --...... ----------OPTIONAL--------------------------------------------------------- Though this section is optional, completing this information can deter alteration of the document or ❑ Guardian or Conservator fraudulent reattachment of this form to an unintended document Description of Attached Document Title or Type of Document: Bid Bond for for Highway Safety Improve. Program: Federal Aid Date: 3/7/17 Project HSIPL-5450 (085); City Bid ENG-16-17-CO043 Number of Pages:_1_ Signer (s) Other Than Named Above: Capacity(les) Claimed by S igner(s) Signer's Name Sean Castillo [.Corporate Officer —Title(s): President ❑Partner — ❑ Limited ❑ General ❑ Individual ❑ Trustee ❑ Other: Signer's Name: ❑ Corporate Officer — ❑ Attorney in Fact ❑ Partner — ❑ Limited ❑ General ❑ Guardian or Conservator ❑ Individual ❑ Attorney in Fact Signer Is Representing: ❑ Trustee ❑Guardian or Conservator ❑ Other: Signer Is Representing: :e�,:c.cc.•ux;enccR:e.�cc,Fez^s:e^sic^c,c.�cw:c.•s„c.�,'u.�.c^�;es.:u^4ex;.e.��:craresticr�.�.^e%era���c4z�:�ev,�c_t.`�.�crx;�cxct 02014 National Notary Association www.NationaiNotary.org•1-800-USNOTARY (1-800-876-6827) Item#5907 HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal-Ald Project HSIPL-5450(085) City Project C0043 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 FORMA PART OF THE PROPOSAL. BIDDERS ARE CAUTIONED THAT MAKING A FALSE CERTIFICATION MAY SUBJECT THE CERTIFIER TO CRIMINAL PROSECUTION. C-13 NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal-Ald Project HSIPL-5450(085) City Project C0043 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 FORMA PART OF THE PROPOSAL. BIDDERS ARE CAUTIONED THAT MAKING A FALSE CERTIFICATION MAY SUBJECT THE CERTIFIER TO CRIMINAL PROSECUTION. C-13 NON -COLLUSION AFFIDAVIT HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal -Aid Project HSIPL-5450(085) City Project C0043 City of Santa Clarita, California TO BE EXECUTED BY EACH BIDDER OF A PRINCIPAL CONTRACT STATE OF CALIFORNIA COUNTY OF LOS ANGELES SEAN CASTILLO, being first duly sworn deposes and says that he is the PRESIDEN[` (sole owner, a partner, president, etc.) of TORO ENTERPRISES. INC the party making the foregoing bid, that such bid is not 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 thereof, or to any other individual, except to such person or persons asave a partnership or other financial interest with said BIDDER in his general business. / // Bidder: Title PRESIDENT Subscribed and sworn to and be ore rne-this----, _ day of 20_ C-14 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 - W See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer(s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (f 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 Califor a County of �✓� RENEE CI',Ut Cominisslan N 20113A4 aW'R)N; 1cClic-Ventura County My Comm. rxpires Apr -3,2017 %> Seal Place Notary Seat Above Subscribed and sworn to (cr-eigrrped) before /m7e on this 13A day of � 20 Il by D jteMon Year (1) ' �"„ .4a d (and Name(s) of Signer(s) proved to me on the basis of satisfactory evidence to be the perso who appeared before me. Signature Signature of Nota Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this 5 unintended document. Signature of Document Signer No. 1 Signature of Document Signer No. 2 (f 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 Califor a County of �✓� RENEE CI',Ut Cominisslan N 20113A4 aW'R)N; 1cClic-Ventura County My Comm. rxpires Apr -3,2017 %> Seal Place Notary Seat Above Subscribed and sworn to (cr-eigrrped) before /m7e on this 13A day of � 20 Il by D jteMon Year (1) ' �"„ .4a d (and Name(s) of Signer(s) proved to me on the basis of satisfactory evidence to be the perso who appeared before me. Signature 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 ,L Title or Typ¢ pf Docu fc nt: on W lvSl aK t IT7 lGt[4�rf fir tN�tgfllvp.� S. eiw, /�gYA�x Numberof i'agesf�_.,6igne (s) t erT aNNa rX=bvie ftl" Dw1ce gn D 5IPL- oto ��tff ROOM i _ ni<�w evha v<�. eihai aiA N� _ .v0.5 i:�q:<::<�w ygvge. r.Rei (VYAI • 1• • • <• 1 1 irr o iir r BIDDER'S QUESTIONNAIRE HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal -Aid Project HSIPL-5450(085) City Project C0043 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. 1. Submitted by: SEAN CASTILLO Telephone: (805)483-4515 Principal Office Address: 2101 E. VENTURA BLVD, OXNARD. CA, 93036 2. Type of Firm: CORPORATE - GENERAL ENGINEERING Corporate: CORPORATION Other: N/A Individual: N/A Partnership: N/A 3a. If a corporation, answer these questions Date of Incorporation: 12/1994 State of Incorporation: CALIFORNIA President's Name: SEAN CASTILLO, PRESIDENT Vice -President's Name: N/A Secretary or Clerk's Name: JERRY HANNIGAN Treasurer's Name: N/A 3b. If a partnership, answer these questions: Date of organization: N/A State Organized in. Name of all partners holding more than a 10% interest: Designate which are General or Managing Partners. 4. Name of person holding CONTRACTOR's license: SEAN CASTILLO, PRESIDENT License number: 710580 Class: A Expiration Date: 08/31/2017 5. CONTRACTOR's Representative: SEAN CASTILLO, Title: PRESIDENT A@ernate: JERRY HANNIGAN Title: SECRETARY 6. List the major construction projects your organization has in progress as of this date: Owner: (A) .OMSTOCKHOMES (B) COUNTY OF LOS ANGELES Project Location: GOLETA LOS ANGELES Type of Project: GRADING, C&G, UTILifIES, R&R CONCRETE/ASPHALT, RECONST. STORM & SEWER SIDEWALKS C-15 CERTIFICATION OF NONSEGREGATED FACILITIES HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal -Aid Project HSIPL-5450(085) City Project C0043 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 speck 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. TORO 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-16 NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS HIGHWAY SAFETY IMPROVEMENT PROGRAM Federal -Aid Project HSIPL-5450(085) City Project C0043 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-17 DISCLOSURE OF LOBBYING ACTIVITIES 1. Type of Federal Action: [!fa contract b. grant c. cooperative agreement d. loan e. loan guarantee E loan insurance 2. Status of Federal Action: ❑ a. bid/offer/application b. initial award c. post -award 4. Name and Address of Reporting Entity Prime rl Subawardce Tier , if known Congressional District, if known 6. Federal DepartmentlAgency: 8. Federal Action Number, if known: 10. a. Name and Address of Lobby Entity (If individual, last time, first time, MI) 3. Report Type: a. initial b. material change For Material Change Only: /rogmmNamODescriptlon: ear_ aver_ date ofI report g Entity in No. 4 i ubawardee. e and Address rimy. District, if known gmm NamODescription:ber, ifapplicableunt, if known: b. Individuals Performing Services (including address if different from No. 10a) (lest name, first name, MI) Continuation Sheets) if necessary) 11. Amount of Payment (check all)lfat apply) 13. Type of Payment (check all that apply) $/,specify: win planned a. retainer b. one-time fee 12. Formall that apply): c. commission 8 d. contingent fee cify: nature a deferred value C other, specify 14. Brief rvices Performed or to be performed and Dates) of Service, including office, or members) contacted, for Payment Indicated in Item 11: (attach Continuation Sheets) if necessary) )0( Continuation Sheets) anached: Yes 11 No 16. Information requested through this torn is authorized by Tide 31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature: was placed by the tier above when his transaction was made or emered into. This disclosure is required pursuant to 3l print Name: SEAN CASTILLO, U, S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any Title: PR F.STT)F.NT person who fails to file the required disclosure shall be subject to a civil penalty of not Ips than $10,000 and not mom than St00,0o0for each such fiilure. TelephoneNo.: �(805)483-45.15 _ Date:03/13/17 Authorized for Local Reproduction ederal Use Only: Standard Form - LLL C-18 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 Por 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 awardlloan 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 sheets) 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-UL-Insevetiom Rev 06-04.90"ENmF" Local Assistance Procedures Manual Final Report -Utilization of Disadvantaged Business Enterprises (DBE) and First -Tier Subcontractors EXHIBIT 17-F FINAL RE RT -UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES (DBE) AND FIRST-TIER SUBCONTRACTORS To V I DED oy"OrV c 0Af L.6r10N of Exhibit 17-F . Local Agency Contract Number . F-WMFAkl Project Number . Local Agency . Contract Completion Dale . Contractor/CorBulanl . Business Address . Final Contract Amount a. Contract Item Number 9. Description of Work, Service, or Materials Supplied 10. Company Name and Business Address 11. DOE ��on Number 12. Contract Payments 13. Date Work Completed 14. Date of Final Payment on -DBE DBE 15. ORIGINAL DBE COMMITMENT AMOUNT 16. TOTAL List all first-tier subcantractorslaub-wnwltants and DBEs regardiess of tier whetheror not the firma were or4rualytistodfor goal credit. I actual DBE utilization (or item of wwk) was different than that approved at the time of award. crovde arnments on an additional owe, list actual amount NO to each entf y. a M subcontraCforVzub�wftants were used on the contract. indKele on me form. CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT 7. Contractor/Consuaant Representative's Signature 8. Contractor/Consultant Representative's Name 9. Plane 0. Date CERTIFY THAT THE CONTRACTING RECORDS AND ON-SITE PERFORMANCE OF THE DBE(S) HAS BEEN MONITORED 1. Lail Agency Representative's Signature . Local Agency Representative's Name 3. Phone 4. Date DISTRIBUTION: Original — Lod Agency, Copy—Caltrans District Local Assistance Engineer. Include with Final Report of Expenditures ADA NOTICE: Forindividuals with sensorydtsabihfie , this document is available in alternate formals. For information, dl (919) 445-1233, Local Assistance Procedures Manual TTY 711, or writeto Records and Forma Management, 1120 N Street, MS -89, Sacramento, CA 95814. C-26 NSIPL-545odel) Project C0043 INSTRUCTIONS— FINAL REPORT -UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES (DBE) AND FIRST-TIER SUBCONTRACTORS 1. Local Agency Contract Number - Enter the Local Agency contract number or identifier. 2. Federal -Aid Project Number - Enter the Federal -Aid Project Number. 3. Local Agency - Enter the name of the local or regional agency that is funding the contract. 4. Contract Completion Date - Enter the date the contract was completed. 5. Contractor/Consultant - Enter the contractor/consultant's firm name. 6. Business Address - Enter the contractor/consultant's business address. 7. Final Contract Amount - Enter the total final amount for the contract. 8. Contract Item Number - Enter contract item for work, services, or materials supplied provided. Not applicable for consultant contracts - 9. Description of Work, Services, or Materials Supplied - Enter description of work, services, or materials provided. Indicate all work to be performed by DBEs including work performed by the prime contractor/consultant's own forces, if the prime is a DBE. If 100% of the item is not to be performed or furnished by the DBE, describe the exact portion to be performed or furnished by the DBE. See LAPM Chapter 9 to determine how to count the participation of DBE firms. 10. Company Name and Business Address - Enter the name, address, and phone number of all subcontracted contractors/consultants. Also, enter the prime contractor/consultant's name and phone number, if the prime is a DBE. 11. DBE Certification Number - Enter the DBE's Certification Identification Number. Leave blank if subcontractor is not a DBE. 12. Contract Payments - Enter the subcontracted dollar amount of the work performed or service provided. Include the prime contractor/consultant if the prime is a DBE. The Non -DBE column is used to enter the dollar value of work performed by firms that are not certified DBE or for work after a DBE becomes decertified. 13. Date Work Completed - Enter the date the subcontractor/sub consultant's item work was completed. 14. Date of Final Payment - Enter the date when the prime contractor/consultant made the final payment to the subcontractor/sub consultant for the portion of work listed as being completed. 15. Original DBE Commitment Amount - Enter the `"Total Claimed DBE Participation Dollars" from Exhibits 15-G or 10-02 for the contract. 16. Total - Enter the sum of the "Contract Payments" Non -DBE and DBE columns. 17. Contractor/Consultant Representative's Signature - The person completing the form on behalf of the contractor/consultant's firm must sign their name. 18. Contractor/Consultant Representative's Name - Enter the name of the person preparing and signing the form. 19. Phone - Enter the area code and telephone number of the person signing the form. 20. Date - Enter the date the form is signed by the contractor's preparer. 11. Local Agency Representative's Signature - A Local Agency Representative must sign their name to certify that the contracting records and on-site performance of the DBE(s) has been monitored. 22. Local Agency Representative's Name - Enter the name of the Local Agency Representative signing the form. 23. Phone - Enter the area code and telephone number of the person signing the form. 24. Date - Enter the date the form is signed by the Local Agency Representative - C -27 HSIPL-5450(085) Project C0043 Local assistance Procedures Manual Exhibit 17-0 Disadvantaged Business Enterprises (DBE) Certification Status Change EXHIBIT 17-0 DISADVANTAGED BUSINESS ENTERPRISES (DBE) CERTIFICATION STATUS CHANGE P*To W A&v1 nGw UPON %f&AFneu oc P'0�[3- 1. Local Agenry Contract Number 2. Fades id PrgeU Number 3. L M Agenry 4. Contract Completion Date 5. Conaacta rmC ant 6, Business Address 7 Final Contras Amount B. Contract Mon Number 9. DBE Contact Information 10. DBE CeNBcation Number 11 Amount Paid While Crtifled 12 Certification/ Decertification Date LederAtrached) 13. Comments If Ihrewrs no climpas in Me DBEcoMR on olsuecontracteNsuMmaulan6, indicate on me term. I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT 14. Conaector/Cgnwnent Representative's Signelura 15. Conlrecta/ConwNeat Represmletive's Name 16. PNOrre 17. Date 1 CERTIFY THAT THE CONTRACTING RECORDS AND ON-SRE PERFORMANCE OF TRE WEtS) NAB BEEN MONITORED 18. Local Agency Represeraative's Signature 19. Local Agency Representatives Name T6- 21. Date DISTRIBUTION: Orynal— Local Agency. Copy —Caltrans District local As alone Engineer. Include with Fund Repot of Erpendaures ADA NOTICE: For n6ndualswith sensory disabtifies, this document is aralaoe in announce aumuts. Fr, mfomwdm, call (916) "55-1259, Local Assistance Procedures Manual TTY 711, or ware ad Records and Frons ManegemenL 1120 N Street, MS99, Saremsad9 C/i 95814, Page 1 of 2 July 23, 2015 HSIPL-5150(0&5) Project COD13 C-28 W Pr Local Assistance Procedures Manual Exhibit 17-0 Disadvantaged Business Enterprises (DBE) Certification Status Change INSTRUCTIONS —DISADVANTAGED BUSINESS ENTERPRISES (DBE) CERTIFICATION STATUS CHANGE 1. Local Agency Contract Number - Enter the Local Agency contract number or identifier. 2. Federal -Aid Project Number - Enter the Federal -Aid Project Number. 3. Local Agency - Enter the name of the local or regional agency that is funding the contract. 4. Contract Completion Date - Enter the date the contract was completed. 5. Contractor/Consultant - Enter the contractor/consultant's firm name. 6. Business Address - Enter the contractoriconsultant's business address. 7. Final Contract Amount - Enter the total final amount for the contract. S. Contract Item Number - Enter contract item for work, services, or materials supplied provided. Not applicable for consultant contracts. 9. DBE Contact Information - Enter the name, address, and phone number of all DBE subcontracted contractors/consultants. 10. DBE Certification Number - Enter the DBE's Certification Identification Number. 11. Amount Paid While Certified - Enter the actual dollar value of the work performed by those subcontractors/subconsultants during the time period they are certified as a DBE. 12. Certification/Decertification Date (Letter Attached) - Enter either the date of the Decertification Letter sent out by the Office of Business and Economic Opportunity (OBEO) or the date of the Certification Certificate mailed out by OBEO. 13. Comments - If needed, provide any additional information in this section regarding any of the above certification status changes. 14. Contractor/Consultant Representative's Signature - The person completing the form on behalf of the contractor/consultant's firm must sign their name. 15. Contractor/Consultant Representative's Name - Enter the name of the person preparing and signing the form. 16. Phone - Enter the area code and telephone number of the person signing the form. 17. Date - Enter the date the form is signed by the contractor's preparer. 18. Local Agency Representative's Signature - A Local Agency Representative must sign their name to certify that the contracting records and on-site performance of the DBE(s) has been monitored. 19. Local Agency Representative's Name - Enter the name of the Local Agency Representative signing the form. 20. Phone - Enter the area code and telephone number of the person signing the form. 21. Date - Enter the date the form is signed by the Local Agency Representative. C-29 Page 2 of 2 July 23 201.4; CONTRACTORS P.O. Box 6285 Oxnard, CA 93031 s4MAD B� t.i� OF ..r�+.{{(M P� t1KI i 1 CITY CLERKS OFMF. '21111 MAR 20'M 1N;'_t up� HWA,1 S*Fe7 el;[o pf, orcAard Vill"e rL�•�W.(e C�OLsofluv.F�(. " � ul ►� Szwly 6�d. ,fid Md H S pt, I94o5n(085) 1c Ne. G;0rue%-Itow)?- CoogS 23 Zo VRL.J6Nc4 $wa, SWrn ca a I to�;5