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Home My WebLink About2015-01-27 - AGENDA REPORTS - BRIDGE MAINT PROJ M0093 (2)Agenda Item: 4 CITY OF SANTA CLARITA AGENDA REPORT CONSENT CALENDAR CITY MANAGER APPROVAL: DATE: January 27, 2015 SUBJECT: ANNUAL BRIDGE PREVENTIVE MAINTENANCE PROGRAM, PROJECT M0093 - AWARD CONSTRUCTION CONTRACT DEPARTMENT: Public Works PRESENTER: Damon Letz RECOMMENDED ACTION City Council: 1. Approve the plans and specifications for the Annual Bridge Preventive Maintenance Program, Project M0093. 2. Award the construction contract to Peterson -Chase General Engineering Construction, Inc., in the amount of $183,856, and authorize a contingency in the amount of $27,579, for a total contract amount not to exceed $211,435. 3. Authorize the City Manager or designee to execute all documents, subject to City Attorney approval. BACKGROUND This project will provide preventive maintenance and repairs, including sealing the bridge decks, patch spalling, and replacing expansion joints and sealants on the following City of Santa Clarita (City) bridges: Sierra Highway over United Pacific Railroad; Pamplico Drive over Dry Canyon Channel; 14th Street over Newhall Creek; Sand Canyon Road over Santa Clara River; and Golden Valley Road over Soledad Canyon Road and Southern Pacific Railroad. An invitation to bid was prepared and published three times, November 2, November 12, and November 22, 2014, and was posted on the City's website. Five bids were submitted to the City and opened on December 3, 2014. The results of the bid are shown below: Company Location Bid Amount O'Donnell Construction, Inc. San Dimas, CA $178,532 (non-responsive) Peterson -Chase General Engineering, Inc. Irvine, CA $183,856 APPROVED Pa Packet Pg. 33 Truesdell Corporation West Coast Structures, Inc. CPO Enterprises, Inc. Tempe, AZ $185,185 Riverside, CA $193,593 Covina, CA $198,189 After reviewing the bids, staff determined the bid proposal submitted by the apparent low -bidder, O'Donnell Construction, Inc., failed to provide the subcontractor bid item and amount information required by law per Section 4104 of the Public Contract Code and did not re - advertise to seek disadvantaged business enterprise firms. Therefore, the bid is determined to be non-responsive and was rejected. Staff recommends the project be awarded to Peterson -Chase General Engineering Construction, Inc., the lowest responsive bidder. This contractor possesses the required state contractor's license and is in good standing with the Contractors State License Board. The contractor's bid has been reviewed for accuracy and conformance to the contract documents and was found to be complete. The current budget will provide for construction, labor compliance services, staff oversight, construction engineering, inspection, and project management. ALTERNATIVE ACTION Other action as determined by the City Council. FISCAL IMPACT Adequate Federal HBR Grant funds (229) and Gas Tax funds (230) are available in expenditure accounts M0093229-5161.001 and M0093230-5161.001 for the award of the construction contract and all anticipated project costs. ATTACHMENTS Bridge Location Map Rejected Bid Proposal for O'Donnell Construction, Inc. (available in the City Clerk's Reading File) Contract for Peterson -Chase General Engineering Construction, Inc. (available in the City Clerk's Reading File) Page 2 Packet Pg. 34 f° EIp)a,mCpnIrn- . No. 53C 1550 i 14 ' N - —• ," ty Br. No 2345- a o i o Drover nEcoao OR o Channel N � i --- ------------""' SL Br. No 53C-0992 NEWHALL RANCH RD / GPr r / - - - County Br. No 3537 �—Rd Santa ClaraRir as w�g L j St. Br. No.`53C-1993 � o- -- County Br. No. 4002 Goltlelie tl over SOLEDAD CANYON RD - 0 n Vay Ri Soled atl GynlS PR \ Zi z l II \rte, a St. Br. No. 53C-1776 C/o/unty Br. No. 1929 Y %--'L��i sir. �` - ter(` i"(• �\I'W:pnl CESg�J�! Sierra over UPRR ° 7 Y�- I� � 9 LAN i -- /1 'Got D%t`ALLEY to o° St. Br. No. 53CIS 5 -- ----------- S+Mrn (lnarrn r 9` County SOD No. 3277 Annual Bridge Preventive Maintenance Progran a p 141n sl over - Project M0093 o Newhall Creek Legend Bridge N .. mM,.A.,,...,... Wafer 0 0.25 0.5 '• CPN i Miles Packet Pg 35 32. PRECONSTRUCTION DOCUMENTS CHECKLIST The following documents are required to be completed and submitted by the Contractor at the times specified by an X opposite each title. If no column is marked, document will not be required. With Bid Proposal (All Bidders) IWith Agreement (Awardee only) Prior to Starting Construction (Awardec only) Post Starting Construction (Awardee only) X Proposal Forms (Cover Sheet, Bid Schedule, References, Bidders Information and Certification) X Non -collusion Affidavit, Non -lobbing Certification and Disclosure, Certification of Non- segregated Facilities X Debarment and Suspension Certifications X Addendums (If any) X Designation of Subcontractors X Local Agency Bidder DBE Commitment (Construction Contracts)- Exhibit 15-G (or by 4:00 PM of 4' business day after bid opening) X DBE Utilization report and Good Faith Effort (or by 4:00 PM of 4'" business day after bid opening) X EEO Certification (or by 4:00 PM of 4ih business day after bid opening) X Bidder's Bond or Bidder's Security X Contract Agreement X Bond for Faithful Performance X Payment Bond (for Labor and Material) X Certification of Public Liability and Property Damage Insurance X Certification of Worker's Compensation Insurance X Construction Schedule — Due One Week Prior to Preconstruction Meeting X SWPPP/Water Pollution Control Program X Traffic Control Plan X List of all Subcontractors X Subcontractor's Certification with Regard to the Performance of Previous Contracts or Subcontractors (Required for all Subcontracts over $10,000) X Subcontracting Request Form — Exhibit 16-B X Materials List and Manufacturer's Brochures (As Required) X Permits & Emergency Contact Information X Construction and Demolition Materials Management Plan X Final Report — DBE B-1 S M0093 F 12 13 5,WN Meveniive W,M.na,. R,,am Federal NWB is B 50 (080) SECTION C: PROPOSAL FOR FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) 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: O'Donnell Construction. Inc. Company Address: 559 W. Covina 131vd. San Dimas, CA 91773 By. Neil T. O'Donnell Print Name Title: President Signature: Date: IZ�Z/ ¢- C-1 W093 FY 12-13 &dge Maintenance Program Pa WM PrOMW BHLS-5150(080) BID SCHEDULE FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) BRIDGE 1929 — Sierra Highway over Solemint & SPTCO 1 Prepare concrete bridge deck surface 10,800 SF ,72 3, 45(0. 00 2 Treat bridge deck 10,800 SF , (QC) (01 If 0C), D0 3 Furnish bridge deck treatment material 120 GAL 5-6.00 (0,720. 00 4 Remove and Replace Pavement Striping 1 LS 3"000.00 3000.00 5 Public Safety Plan 1 LS 300.00 300.00 6 Traffic Control 1 LS /, 900r 00 It 906. 00 7 Storm Water Pollution Prevention (SWPP) 1 LS 200.00 20000 Subtotal 22 65-6.00 BRIDGE 2345 — Pamplico Drive over Dry Canyon Channel 1 Prepare concrete bridge deck surface 1,800 SF .32- 576.00 2 Treat bridge deck 1,800 SF /.00 11800,00 3 Furnish bridge deck treatment material 20 GAL 5-6,00 /� 120, 0D 4 Repair Spalling Concrete 4 SF 300,06 11;7-00. 00 5 Public Safety Plan 1 LS '300.00 300,60 6 Traffic Control 1 LS q60, 00 400. 00 7 Storm Water Pollution Prevention (SWPP) 1 LS Z.60.00 200, 00 Subtotal 5;5796.00 C-2 M0093 FY 1213 Bridge Miery e0ame Program Federal Project BHLS 5450(NO) BID SCHEDULE FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) BRIDGE 3277 — 14tb Street over Newhall Creek 1 Remove brick & replace with concrete 6 SF b'00, 00 4 t00, 00 2 Repair Spalling Concrete 4 SF 656. 00 2, 2 00.00 3 Remove expansion joint seal 48 LF 20.00 960, 00 4 Install Type "A" Joint Seal (MR 1") 48 LF 357,00 6 80 0 o 5 Traffic Control 1 LS 5'00.00 500, 00 6 Storm Water Pollution Prevention (SWPP) 1 d LS 200.00 200.00 200, 00 Subtotal 3S, 090.00 Subtotal f0)3110.00 BID SCHEDULE BRIDGE 3537 - Sand Canyon Rd over Santa Clara River 1 Prepare concrete bridge deck surface 20,300 SF 30 (p, 090, DO 2 Treat bridge deck 20,300 SF .90 SI/26-00 3 Furnish bridge deck treatment material 230 GAL 50,00 2, 8d 0.00 4 Remove and Replace Pavement Striping 1 LS /1900.00 /, g0 0, 00 5 Remove and Replace Pavement Markers 1 LS Z 200, 00 2-1200.06 6 Public Safety Plan I LS ,300, 00 30 0, 00 7 Traffic Control I LS 3500,00 3 500.00 8 Storm Water Pollution Prevention (SWPP) 1 LS 20Q,00 200, 00 Subtotal 3S, 090.00 C-3 M0093 F 12-13 Bridge Maintenance ROgmm Federal Proiml BHLS-5450(080) FY 12.13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) BRIDGE 4002 - Golden Valley Road over Soledad Canyon Road & SPRR 1 Prepare concrete bridge deck surface 31,000 SF 0. /S (oSb , OD 2 Treat bridge deck 31,000 SF 0_y0 �Z� yD�.00 3 Furnish bridge deck treatment material 350 GAL 6-(p 00 Iq oQ O0 4 Public Safety Plan 1 LS 300,00 300.00 5 Remove expansion joint seal 30 LF 20,00 600.00 6 Install Type "A" Joint Seal (MR 1") 30 LF 40,00 /17-00,100 7 Remove and Replace Pavement Striping 1 LS 2f000.00 2 000.00 8 Remove and Replace Pavement Markers 1 LS 3,300.00 3,300.00 9 Concrete 3 CY 11,000.00 33,000,00 10 Reinforcing Steel 480 LB /0.00 4 800,00 11 Repair concrete surface 102 SF 100,00 lo, 2.00, 00 12 Traffic Control 1 LS /3, 100 -DD 200.00 13 Storm Water Pollution Prevention (SWPP) 1 LS 200.00 2.00. 00 Subtotal /O& ysd _ OD TOTAL BID IN FIGURES 1/ i8, 53Z, 00 1 TOTAL BID IN WORDS: rvf- h4wOX46 C-4 W093 FY 12-13 WiOge M inlay a Program Federal Mo)ed BHLS-5450(000) DESIGNATION OF SUBCONTRACTORS Exhibit 12-B Bidder's List of Subcontractors (DBE and Non -DBE) Part I The bidder shall list all subcontractors (both DBE and non -DBE) in accordance with Section 2-1.054 of the Standard Specifications and per Title 49, Section 26.11 of the Code of Federal Regulations. This listing is required in addition to listing DBE Subcontractors elsewhere in the proposal. Photocopy this form for additional firms. Firm Name/ Phone/ Address/ City, State, ZIP Fax Annual Gross Receipts Description of Portion of Work to be Performed (include the bid item number and the bid amount) Name Ez y (1Iem e- Tress i)�, Sys+eMC31� Phone -qgZ—a101 < $1 million g<$5million Y, l.- Address -752. al[C-PIOMD ❑<$10million Fax 7057 `U-3/rj0 C:]<$15 million City State ZIP Ca m Q V%i ❑>$15 million X13012 CA Name (,(,per Seel 5fi►r' � Phone g QCJ 5 24 - 345 ❑ <$1 million < $5 trillion Address 5 (d A- 5trif ❑ < $10 million Fax q05 ❑ < $15 million 5a4-1 g City State ZIP Fi I II Yvio rCf CA ❑ > $15 million 9-301(0 0— C-5 M0093 F 1213 Bridge Maintenance Program Federal Project BHLS-5450(080) Distribution: 1) Original -local Agency File Ci -S W093 " 12-13 Mdge MPoMenanq Program Federal P njoct 9HLS5a50(090) DESIGNATION OF SUBCONTRACTORS Exhibit 12-B Bidder's List of Subcontractors (DBE and Non -DBE) Part I1 The bidder shall list all subcontractors who provided a quote or bid but were not selected to participate as a subcontractor on this project. This is required for compliance with Title 49, Section 26 of the Code of Federal Regulations. Photocopy this form for additional firms. Firm Namel Phone? [ Address/ Fax Annual Gross Receipts Description of Portion of Work to be Performed (Include the bid item number and the bid amount) City. State. ZIP'' Name S�'��t �,�� Phone U�O ❑<$Imillion ' 4Vlno E1/+-Trise5 - - 91991 K<$5million Address 11861 zravAyd ❑<$10 million Fax g 1 0 EJL�_S(01S lSJ O ❑ <$15 million City stale ZIP �UVJV�al'Lfy ❑>$15million CFl � 1352 Name C.Inri �vnpc�ny J Phonegoq ❑<$I million -- �- c�� 7+ 3S ❑<$Smillion Address -17 S. J • L) I a c A<$10 million / AVe-- Fax 1Qq 74I —Oi y j.,� TSP �l ❑c$15 million City State ZIP � I00 �/ i n34o v, ❑ > $15 million CA x231 G I M C-7 M0093 FY 12-13 Brioge Wm` --roe Program Federal Project 8Hta.5650(080) Name Phone ❑ <$1 million ❑ < $5 million Address ❑ < $10 million Fax Phone ❑ < $15 million City State ZIP Name ❑ > $15 million ❑ < $1 million ❑ < $5 million Address ❑ < $10 million Fax ❑ <$15 million City State ZIP ❑ > $15 million Distribution: 1) Original - Local Agency File C-8 M0033 F 1243 fridge MAIM..C. Pro01e11 Federal Project BHL&5950(080) REFERENCES FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14-15-M0093 City Project M0093 Federal -Aid Project BHLS-5450(080) 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. Caltrans 18730 S. Wilmington Ave., Ste 103, Rahcho Dominguez, CA fWame and Address of Owner / Agency 90220 Sam Galardo 310-609-0264 (Resident Engineer) Name and Telephone Number of Person Familiar with Project #07-1W3104 $1,148,509. Methacrylate, Replace Slabs & it Seals 05/2014 2 Caltrans 4030 Occidental Rd. #A, Santa Rosa, CA 95401 Name and Address of �Owner / Agency Nghia Nguyen 707-566-3947 (Resident Engineer) Name and Telephone Number of Person Familiar with Project #04-2E6904 $543,474. Methacrylate & it Seals 06/2013 Contract Amount Type of Work Date Completed 3 Caltrans 902 San Gabriel Blvd., Rosemead, CA 91770 Name and Address of Owner / Agency Pravin Patel 626-572-6702 (Resident Engineer) $624,502. Treat Bridge neck & Repair it Seals 05/2012 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: BB&T Insurance Services 2400 E. KatelA Ave., Ste 1100 Anaheim, CA 92806 714-941-2800 O'Donnell Construction, Inc. Contractors Name C-9 M0093 FY 12-13 B dgo Malnlenanc Program FeEeral Projec1014L5-5050(000) DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) 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. 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-10 M0093 FY 12-13 BrAp M nlonence P,..... FeEe Fovea BH S-5 50(050) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION a ' ` (Must be filled out by the Bidder and ALL subcontractors over $10,000) ' " FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) City of Santa Clarita, California O'Donnell Thisbidder construction, Tnc 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 V/ 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: O'Donne ll cOatrUction, Inc. By: Title: President Date: lZ/Z l e 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 tiled 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. C-11 W093 F 12-13 Bridge Maintenance Program Feeerai Project BHLS-5450(080) Osc 02 2014 04:53PM Extreme Pressure Systems 8054e23750 page 4 % 102 s?:4s "ev corstruction OPOORTUllliFri MUM EQUAL EMPLOYMENT be filled out by the Bidder and ALL submintra i FYIIItlill BRIDGE PREVENTIVE 0AA*4T*HMCSP1R Bid No ENG -114-15-111111110113A I to 4; Federal -Al o HLS;6400(000) fl City of Barite Clarria, C Ila 01 0�114*o,*CW &*6 proposed suiloron se,: " required by EA —7F � filed with the Joint a iderall Gmrnment on Equal Fmplt3vmsint a 1 In F I loovo conification Is required by the Equal Employment Op MUrQ1 Of! 4 21V and must be �Vouby ars and ' 111 Ontrads and subcontraoft which a bject,to the aqul - (Goner* crily conmtracts r su nt of$10,000ior u -1) 13 the Only report required b It! luill" indard Form 100 (EEO ;ONTRACTCHS and subcontractor& who have panto In 41prWA0 aa4 pct to the Executive C)fdw4 ard have i not flied the raquttrd n forav" the award of oantracta and *uboo"aPIS Uri the citillimquent period or such otherribd 0 114 Fe by the Director, Offloe of Federal Contract 4amplianCir ant I A Me" i Il� oils it 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: O'Donnell Construction, Inc. Business Address: 559 W. Covina Blvd., San Dimas, CA 91773 Telephone No.: 909-394-4510 State CONTRACTOR's License No. & Class: 772905 A Original Date: 10/31/1999 Expiration Date: 12/31/2015 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: Neil T. O'Donnell, President/Secretary/Treasurer, 1239 Liverpool Ct. San Dimas, CA 91773 909-772-5042 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: N/A C-12 WW3 F 12-13 Bridge M nlemne Program F daral Pro(ecl BHLS-U5 (No) All current and prior DBAs, alias, and/or fictitious business names for any principal having an interest in this proposal are as follows: IN WITNESS WHEREOF, BIDDER execute nd submits this roposal th the names, title, hands, and seals of all aforementioned principals this day of� 20� BIDDER: Signature L_ 0 Name and Title of Signatory O'Donnell Construction, Inc. Legal Name of Bidder 559 W. Covina Blvd., San Dimas, CA 91773 Address 909-394-4510 Telephone Number 95-4767749 Federal Tax I.D. No. SIGNATURES MUST BE MADE AND NOTARY ACKNOWLEDGMENTS OF EXECUTION OF BIDDER MUST BE ATTACHED Subscribed and sworn to this _ -- day of Notary C-13 MW93 FY 12-13 Br ge Maintenance Pmgr Federal N jal BHL5 5450(080) _, 20_ (SEAL) CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 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 (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 California County of — ' IUAEY N.';=2 < arc Cpmmlmlpn s 19120 �. Nulpry 9pNlc CaIllprnY Em Mt... Cwnip ,� N Comm. Eapirm WE6. 2015 Seal Place Notary Seal Above Subscribed and sworn to (or affirmed) before me on this 2Ak day of p(Z(,2m Ve-- 20-[tf -, by Date Month Year (1) RU. I CrJUU-li ) (and (2)_ Name(s) of Signer(s) proved to me on the basis of satisfactory evidence to be the (pers�on(s) who appeared before me. Signature � / " ` Signature of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signer(s) Other Than Named Above: Document Date: 02014 National Notary Association • www.NationalNotaty.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5910 Bid Bond No. 1000838998-56 PROPOSAL GUARANTEE BID BOND FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) City of Santa Clarita, California KNOW ALL MEN BY THESE PRESENTS that O'Donnell Construction, Inc. as BIDDER, and U.S. Specialty Insurance Company as SURETY, are held and ,I en Percent of the Total Amount firmly bound unto the City of Santa Clarita, as AGENCY, in the penal sum of of the Bid dollars ($ 10%----- ), 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 names, titles, hands, and seals, this I St of December =. o 2014 BIDDER: O'Donnell Construction, Inc. Signature L_ Name a d Title of Signa I10&✓4'_ 559 W Covina Blvd San Dimas,.CA 91773; 909-394-4510 Address SURETY' U.S. Specialty Inpurance Company; 625 The City Drive South, Suite 130, Orange, CA 92869; 714-740-70W Adnan Velcnzuela, Attumey-In-Fact BB&T Imurance Smites Of CA., lm.;2400M. KAMM, Suite 1100, Anaheim, CA 92806; 714 -MI -2800 Subscribed and sworn to this _ (day20_ NOTARY PUBLIC (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-15 W093 FY 12-13 Bridge hblM~C& PlagraT Federal Pl l a BMLS N59(099) POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company, a California corporation, United States Surety Company, a Maryland corporation and U.S. Specialty Insurance Company, a Texas corporation (collectively, the "Companies'), do by those presents make, constitute and appoint: Lourdes Lando, Adriana Valenzuela,Mark Rosekopf or Michael Castaneda of Anaheim California its true and lawful Attorncy(s)-in-fact, tach in their separate capacity if more than one is named above, wish full power and authority hereby conferred in its more, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include riders, amendments, and consents of surety, providing the bund penalty dots not exceed *****Three Million***** Dollars ($ **3,00;000.00*'}, - This Power of Attorney shall expire without further action on December OS, 2016. This Power of Attorney is granted under and by authority of the following resolutions adopted by the Boards of Directors of the Companies: 6e it Resolved, dou rhe President, any Vice -President, any Assistant Vicc-President, any Secretary or any Assistant .Secretary shall be and is hereby vested with full Rower and authonty to appoint any one or more suitable persons as Aaomey(s)-m-Pact to represent and writer ani on bdrulf of the Company subject to the following provisions: - dnnrtreP in-Facf may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver. any mal 4111 bonds, recognirances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including say and all consents for the mleau of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the`Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall he binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. It, it Romlw d. that the signature of any mallarimd officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any ceni6catr relating thereto by facsimile, and any prover of attorney or certificate paring facsimile signature or facsimib seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. IN WITNESS WHEREOF, The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this Unit day of December, 2012. AMERICAN CONTRACTORS INDEMNITY COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY Corporate Seals '4 to s°es. =OtSff ¢rly^�`i r• 30 1i@ t.E * }8e" Daniel P. Aguilar, t tee i'residcnt State of California ```,'„*�'„'Sf'r a,,,,.„x� County ofLos Angeles SS: On 10th day of December, 2012, before me, Vanessa Wright, a notary public, personally appeared Daniel P. Aguilar, Vice President of American Contractors Indemnity Company, United States Surety Company and U.S. Specialty Insurance Company who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his. signature on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify: under PENALTY OF PERJURY under the taws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal` C*rtanafYe • iNaita Signature --�. ._ (Seal) xm•,Wak-C•a*rea i Lar Mta•u t:a•aT M Caa�in.E me.r a. fora 17eaqpni>;=j-pe,: MsAstant Secretary._afAmuicaiiCODtracturs Indemnity Company, United States Surety Company arid U.S. Specially. Insurance Vom`aan'y, do hereby certify that th>r above=and foregoing is a true and correct copy of a Power of Attorney, executed by _— said Companies, which is still in full force and effect; furthermore, the resolutions of Ore Boards of Directors, set out in the Power of Attorney are in full force and effect. L In wt��l��ess Whereof 1 i vc hereunt set my hand and affixed the seals of said Companies at Los Angeles, California this ' S day of tx eW —7 Corporate Seainllst��Q rt ar,*mwt*y soar.,, vt ::r>'�” — t 1 ,, nW 0 J� �a� 7`* Bond No, r�i zo 'z' ' e ' '_ Jeannie Lee, ssistant Secretary No. 8450 .Agency 'Hry nn M' W u. you State of California County of Orange Subscribed and sworn to (or affirmed) before me on this ist day of December 2014 by Adrianyalenzuela , proved to me on the bases of satisfactory evidence to be the person(s) who appeared before me. _ REBECCA KAREN SALOANA ` Commission ;1 2049077 ,•: <? �:� Notary Public - California Orange County 2017 My Comm. Expires Nav 16, (SEAL) NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) 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-16 M 0 FY 12-10 Midge Harvie e,nc Program Fedmai Prolecl MALS -54!3M090) NON -COLLUSION AFFIDAVIT FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) City of Santa Clarita, California TO BE EXECUTED BY EACH BIDDER OF A PRINCIPAL CONTRACT STATE OF CALIFORNIA )) COUNTY OF LOS ANGELES ) § Neil T. O'Donnell _ being first duly sworn deposes and says that he is the President (sole owner, a partner, president, etc.) of O'Donnell Cons ruc ion, nc. 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 as have a partnership or other financial interest with said BIDDER in his general business. Bidder: __z�4z Signature Title President Subscribed and sworn to and before me this day of 20_ Seal of Notary C-17 MOM FY 1213 Mdge Malnlanm¢ Program Fe al P,ejK1 BHLS-4W(080) CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 See Attached Document (Notary to cross out lines 1-6 below) /See Statement Below (Lines 1-6 to be complete -d -Only by document signer[s], not Notary) Signature of Document Signer No. 1 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 California County of _ 65 /�t1GC� C=01 A N" YUflaP,plti 41M- s W92P]B < A'{` NMLr P01k CUI TN' lm M9eki Coun sh comm. a+oaos M+r s. z9is Subscribed and sworn to (or affirmed) before me on this )-VR day of CPf4m4G� 201` by Date Month Year (1) rWt T. +Z�i (and Names) of Signers) proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Signature Signature of Notary Public Seal 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: Document Date: Number of Pages: Signer(s) Other Than Named Above: bG�rX:G�>. ,._.__'4�Ksr5si'.'�=L�L�'('.Q%`*✓s�':ir^5=s^ce�.'�"�sY'(i&�5�v� .. ._ .. 02014 National Notary Association • www.NationaiNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5910 BIDDER'S QUESTIONNAIRE FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14-15-M0093 City Project M0093 Federal -Aid Project BHLS-5450(080) 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. i. Submitted by: Neil T. O'Donnell Telephone- 909-394-4510 Principal Office Address: 559 N. Covina Blvs. , San Dimas, CA 91 773 2. Type of Firm: Corporation Corporate: S Other: Individual: 3a. If a corporation, answer these questions: Date of Incorporation: 1999 State of Incorporation: CA President's Name: Neil T. O'Donnell Vice -President's Name: N A Secretary or Clerk's Name: Neil T. O'Donnell Treasurer's Name: Neil T. O'Donnell 3b. If a partnership, answer these questions: Date of organization: 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: Neil T. O'Donnell License number: 772905 Class: A Expiration Date: 12/31/2015 5. CONTRACTOR's Representative: Title: President Alternate: Kolbe O'Do) Title: Project_ En( Neil O'Donnell 6. List the major construction projects your organization has in progress as of this date: Owner: (A) Caltrans (B) Caltrans Project Location: Rte 10,605 LA Co. Rte 49 Mariposa Co. Type of Project: Methacrylate & Bridge Deck Overlay Joint Seals C-18 M0093"12-13 BfIdg. Manlena Program Fatlaral Proja OKS-5a50(w) CERTIFICATION OF NON -SEGREGATED FACILITIES FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14.15-11010093-A City Project M0093 Federal -Aid Project BHLS-5450(080) 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. O'Donnell Construction, 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-19 W083 F 1243 @itlge Maintenance Program Fe eral Project BHl -WO(080) NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) 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 BIDDERS EXECUTION ON THE SIGNATURE PORTION OF THE "BIDDERS 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-20 W095 FY 12-13 &idge Mwntenance PFa mm Fede,91 Project HHt -5450(000) DISCLOSURE OF LOBBYING ACTIVITIES 1. Type of Federal Action: EJ a. contract b. grant c. cooperative agreement d. loan e. loan guarantee f, 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 Subawardee Tier , if known Congressional District, if known 6. Federal Department/Agency: S. Federal Action Number, if known: 5. If Reporting Enter Name 7. V 3. Rep irl Type: Qa. initial b. material change For Materialngc Only: ydar quarter date m report y in No is Subawardee, Adrag�of Prim - effoual District, if known Program Name/Description: CFDA Number, if applicable Award Amount, if known: 10. a. Name and Address of Lobby Entity b. Individuals Performing Services (including (if individual, last name, first name, MI) address if different from Na IOa) (last name, first name, MI) (a h Continuation Sheets) if necessary) 11. Amount of Payment (check all at apply) 13. Type of Payrtmnt (cheek all that apply) $ �.autha planned a. retainer b. one-time fee 12. Form of Payment(ehId. that apply): c. commission Ba. cash conlingentfee b. in-kind; s "fr. nature a deferred value f. other, specify. 14. Brief JIM officer(s), micas Performed or to be performed and Date(s) of Service, including or member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if necessary) 15. Cont slim Sheet(s) attached: Yes 11 No 16. In ' ton requested through this form is authorized by Title 31 U... Section 1352. This disclosure of lobbying reliance Signature: was aced by the tier above when his transaction was made or tered into. This disclosure is inquired pursuant to 31 Print Name: .C. 1352. This information will be reported to Congress - — -- - - cmiennually and will be available for public inspection. Any Title: .,person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not mom than $IOO,WO for each such failure. Telephone No.: Date: Authorized for Local Reproduction ederal Use Only: Standard Form - LLL C-21 WON "12-13 Bridge Maintenance "ram Federal Projacl BHLS-5450(080) Standard P. L L Rcv. 09-12-97 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. I. 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 fust 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 awardAoan commitments for the prime entity identified in item 4 or S. 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-t.t.Ltrotrucdom Rev. 06-04-90.aNDtF" C-22 MM93 F 12-13 Bridge MafM M Program Federal Pmjerl Inks 545D(080) CAPITAL IMPROVEMENT PROJECT AGREEMENT Contract 15-00004 FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14-15-M0093 City Project M0093 Federal Aid Project BHLS-5450(080) This AGREEMENT is made and entered into for the above -stated project this day of 20 , BY AND BETWEEN the City of Santa Clarita, as CITY, and Chase General Engineering Construction, Inc., as CONTRACTOR. CITY and CONTRACTOR have mutually agreed as follows: ARTICLE I That contract documents for the aforesaid project shall consist of the Notice Inviting Bids, Instructions to Bidders, Proposal, General Specifications, Standard Specifications, Special Provisions, Plans, and all referenced specifications, details, standard drawings, special drawings, appendices, and City's Labor Compliance Program; together with this AGREEMENT and all required bonds, insurance certificates, permits, notices, and affidavits; and also including any and all addenda or supplemental agreements clarifying or extending the work contemplated as may be required to insure its completion in an acceptable manner. All of the provisions of said AGREEMENT documents are made a part hereof as though fully set forth herein. ARTICLE II For and in consideration of the payments and agreements to be made and performed by CITY, CONTRACTOR agrees to furnish all materials and perform all work required for the above -stated project, and to fulfill all other obligations as set forth in the aforesaid contract documents. ARTICLE III CONTRACTOR agrees to receive and accept the prices set forth in the Proposal as full compensation for furnishing all materials, performing all work, and fulfilling all obligations hereunder. Said compensation shall cover all expenses, losses, damages, and consequences arising out of the nature of the work during its progress or prior to its acceptance including those for well and faithfully completing the work and the whole thereof in the manner and time specified in the aforesaid contract documents; and also including those arising from actions of the elements, unforeseen difficulties or obstructions encountered in the prosecution of the work, suspension or discontinuance of the work, and all other unknowns or risks of any description connected with the work. D-1 M00(i3 F 12-13 & dge Prev bw Malntenarce Program Fetl Project BHLS-5450(080) Revised April 2014 ARTICLE IV CITY hereby promises and agrees to employ, and does hereby employ, CONTRACTOR to provide the materials, do the work, and fulfill the obligations according to the terms and conditions herein contained and referred to, for the prices aforesaid, and hereby contracts to pay the same at the time, in the manner, and upon the conditions set forth in the contract documents. ARTICLE V City and its respective elected and appointed boards, officials, officers, agents, employees, and volunteers (individually and collectively, "Indemnitees") shall have no liability to CONTRACTOR or any other person for, and CONTRACTOR shall indemnify, defend, protect, and hold harmless Indemnitees from and against, any and all liabilities, claims, actions, causes of action, proceedings, suits, damages, judgments, liens, levies, costs, and expenses of whatever nature, including reasonable attorney's fees and disbursements (collectively, "Claims"), which Indemnitees may suffer or incur or to which Indemnitees may become subject by reason of or arising out of any injury to or death of any person(s), damage to property, loss of use of property, economic loss, or otherwise occurring as a result of or allegedly caused by the CONTRACTOR'S performance of or failure to perform any services under this Agreement, or by the negligent or willful acts or omissions of CONTRACTOR, its agents, officers, directors, or employees, committed in performing any of the services under this Agreement. If any action or proceeding is brought against Indemnitees by reason of any of the matters against which CONTRACTOR has agreed to indemnify Indemnitees as provided above, CONTRACTOR, upon notice from City, shall defend Indemnitees at its expense by counsel acceptable to City, such acceptance not to be unreasonably withheld. Indemnitees need not have first paid for any of the matters to which Indemnitees are entitled to indemnification in order to be so indemnified. The limits of the insurance required to be maintained by CONTRACTOR in this Agreement shall not limit the liability of CONTRACTOR hereunder. The provisions of this section shall survive the expiration or earlier termination of this agreement. The provisions of this section do not apply to Claims occurring as a result of the City's active negligence or acts of omission. ARTICLE VI CONTRACTOR affirms that the signatures set forth hereinafter in execution of this AGREEMENT represent all individuals, firm members, partners, joint venturers, or corporate officers having principal interest herein. ARTICLE VII Nature of Relationship CONTRACTOR shall not be subject to day-to-day supervision and control by CITY employees or officials. CONTRACTOR shall perform services in accordance with the rules, regulations and D-2 M 3 M2-13 Wdge Preventive Maintenance Program FWProjW BHLS- 50(030) Revised April 2014 policies of CITY respecting such services, and in accordance with appropriate standards of professional conduct, if any, applicable to the services provided. CITY shall not be responsible for withholding any payroll or other taxes on behalf of CONTRACTOR. It is understood and agreed that the CONTRACTOR is, and at all times shall be, an independent CONTRACTOR and nothing contained herein shall be construed as making the CONTRACTOR, or any individual whose compensation for services is paid by the CONTRACTOR, an agent or employee of the CITY, or authorizing the CONTRACTOR to create or assume any obligation of liability for or on behalf of the CITY. ARTICLE VIII CONTRACTOR shall maintain and submit certificates of all applicable insurance including, but not limited to, the following and as otherwise required by law. The terms of the insurance policy or policies issued to provide the above insurance coverage shall provide that said insurance may not be amended or canceled by the carrier, for non-payment of premiums or otherwise, without thirty (30) days prior written notice of amendment or cancellation to the CITY. Liabilitv Insurance During the entire term of this agreement, the CONTRACTOR agrees to procure and maintain General Liability insurance at its sole expense to protect against loss from liability imposed by law for damages on account of bodily injury, including death therefrom, suffered or alleged to be suffered by any person or persons whomsoever, resulting directly or indirectly from any act or activities, errors or omissions, of the CITY, or CONTRACTOR or any person acting for the CITY, or under its control or direction, and also to protect against loss from liability imposed by law for damages to any property of any person caused directly or indirectly by or from acts or activities of the CITY, or CONTRACTOR or any person acting for the CITY, or under its control or direction. Such public liability and property damage insurance shall also provide for and protect the CITY against incurring any legal cost in defending claims for alleged loss. Should CONTRACTOR, for any reason, fail to obtain and maintain the insurance required by this Agreement. City may obtain coverage at CONTARCTOR'S expense and deduct the cost of such insurance from pavments due to CONTRACTOR under this Agreement or terminate. In the alternative, should CONTRACTOR fail to meet any of the insurance requirements under this agreement, City may cancel the Agreement immediately with no penalty. Should Contractor's insurance required by this Agreement be cancelled at any point prior to expiration of the policy, CONTRACTOR must notify City within 24 hours of receipt of notice of cancellation. Furthermore. CONTRACTOR must obtain replacement coverage that meets all contractual requirements within 10 days of the prior insurer's issuance of notice of cancellation. CONTRACTOR must ensure that there is no lapse in coverage. Such General, Public and Professional liability, and property damage insurance shall be maintained in full force and effect throughout the term of the AGREEMENT and any extension thereof in the amount indicated above or the following minimum limits: D-3 M00g3 FY12-13 Wdge Pre bve MairRe�m Program FeCeral Pmle BHLS-4W(080) Revised April 2014 A combined single limit liability policy in the amount of $2,000,000 or a commercial general liability policy with a $2,000,000 occurrence limit and a $4,000,000 aggregate limit will be considered equivalent to the required minimum limits. All of such insurance shall be primary insurance and, shall name the City of Santa Clarita as additional insured. A Certificate of Insurance and an additional insured endorsement (for general and automobile liability), evidencing the above insurance coverage with a company acceptable to the City's Risk Manager shall be submitted to City prior to execution of this Agreement on behalf of the City. If the operation under this Agreement results in an increased or decreased risk in the opinion of the City Manager, then the CONTRACTOR agrees that the minimum limits herein above designated shall be changed accordingly upon request by the City Manager. The CONTRACTOR agrees that provisions of this paragraph as to maintenance of insurance shall not be construed as limiting in any way the extent to which the CONTRACTOR may be held responsible for the payment of damages to persons or property resulting from the CONTRACTOR's activities or the activities of any person or persons for which the CONTRACTOR is otherwise responsible. Worker's Compensation Insurance The CONTRACTOR shall procure and maintain, at its sole expense, Worker's Compensation Insurance in the amount of $1,000,000 per occurrence or in such amount as will fully comply with the laws of the State of California and which shall indemnify, inure and provide legal defense for both the CONTRACTOR and the CITY against any loss, claim or damage arising from any injuries or occupational diseases happening to any worker employed by the CONTRACTOR in the course of carrying out the work within the AGREEMENT. Such insurance shall also contain a waiver of subrogation naming the City of Santa Clarita. Automotive Insurance The CONTRACTOR shall procure and maintain, at its sole expense, throughout the term of this AGREEMENT, and any extension thereof, public liability and property damage insurance coverage for automotive equipment with coverage limits of not less than $1,000,000 combined single limit. All such insurance shall be primary insurance and shall name the City of Santa Clarita as an additional insured. Fire and Extended Coverage Insurance (Services involving real property only) CONTRACTOR also agrees to procure and maintain, at its sole expense, during the term of this Agreement, and any extension thereof, a policy of fire, extended coverage and vandalism insurance. D-4 MOO)3 F 12-13 Bridge Pm Iiw Maintenance Pmgmm Fetteml Project BHLS5450(030) Revised April 2014 ARTICLE IX Pursuant to Senate Bill 542, chaptered in 1999, the Employment Development Department (EDD) of the State of California requires that a W-9 Form be filed by all vendors for all AGREEMENTS entered into with the City. CONTRACTOR agrees to complete all required forms necessary to comply with EDD regulations. ARTICLE X Tenn This AGREEMENT shall be effective for a period beginning on the date shown in the Notice to Proceed, and ending on 35 days after the date of recordation of the Notice of Completion unless sooner terminated. Modification/Termination No modification, amendment or other change in this AGREEMENT or any provision hereof shall be effective for any purpose unless specifically set forth in writing and signed by duly authorized representatives of the parties hereto. This AGREEMENT may be terminated with or without cause by CITY giving CONTRACTOR thirty (30) days advance written notice. Any reduction of services shall require thirty (30) days advance written notice unless otherwise agreed in writing between CONTRACTOR and CITY. In the event of termination, CONTRACTOR shall be entitled to compensation for all satisfactory services completed and materials provided to the date of the notice of termination. Non -Effect Waiver CONTRACTOR's or CITY's failure to insist upon the performance of any or all of the terms, covenants, or conditions of this Agreement, or failure to exercise any rights or remedies hereunder, shall not be construed as a waiver or relinquishment of the future performance of any such terms, covenants, or conditions, or of future exercise of such rights or remedies, unless otherwise provided for herein. Severability In the event that any one or more of the provisions contained in this AGREEMENT shall for any reason be held to be unenforceable in any respect by a court of competent jurisdiction, such holding shall not affect any other provisions of this AGREEMENT, and the AGREEMENT shall then be construed as if such unenforceable provisions are not a part hereof. Governine Law This AGREEMENT shall be construed and interpreted and the legal relations created thereby shall be determined in accordance with the laws of the State of California. D-5 M00g3 F 12-13 fridge Preventive Maintenance Program Federal PrajW BHLS5450(O80) Revised April 2014 Compliance with Law CONTRACTOR shall comply with all applicable laws, ordinances, codes, and regulations of the federal, state, and local government, including City's Labor Compliance Program (LCP). CONTRACTOR shall comply with all aspects of the National Pollutant Discharge Elimination System (NPDES) in order to prevent pollution to local waterways. Failure to implement NPDES Requirements shall result in project delays through City issued Stop Work Notices and/or fines levied against the CONTRACTOR. If this AGREEMENT is funded by the United States Department of Transportation, Federal Highway Administration under Title 23 of the United States Code (excluding emergency contracts solely intended for debris removal), CONTRACTOR shall comply with form FHWA-1273 (attached hereto in its entirety as Exhibit "A" which is hereby incorporated by reference as though fully set forth here). CONTRACTOR must insert this form in each subcontract and further require its inclusion in all lower tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services). Conflict of Interest CONSULTANT will comply with all conflict of interest laws and regulations including, without limitation, CITY'S conflict of interest regulations. Prevailing Wages As required by applicable state law including, without limitation Labor Code §§ 1720 (as amended by AB 975 (2001)), 1771, 1774, 1775, and 1776, CONTRACTOR must pay its workers prevailing wages. It is CONTRACTOR's responsibility to interpret and implement any prevailing wage requirements and CONTRACTOR agrees to pay any penalty or civil damages resulting from a violation of the prevailing wage laws. In accordance with Labor Code § 1773.2, copies of the prevailing rate of per diem wages are available at the website for State of California prevailing wage determinations at http://www.dir.ca.gov/OPRL/DPreWageDeterfnination.htm. A copy of the prevailing rate of per diem wages must be posted at the job site. This contract is subject to both federal and state prevailing wage requirements of the California Labor Code including Sections 1770 and 1773, the Davis -Bacon and Related Acts and the City's California Department of Industrial Relations (DIR) approved Labor Compliance Program. All covered work classifications required in performance of this contract will be subject to prevailing wage provisions. If there is a difference between the federal and state wage rates, the Contract and its subcontractors shall pay not less than the higher wage rate. Contractor shall further adhere to the requirements contained in the City's Labor Compliance Program. A copy of the Labor Compliance Program is part of the project specifications and is also available for review upon request at the Office of the City Clerk. All pertinent federal and State of California statues and regulations, including, but not limited to those referred to in this contract and in the City's Labor Compliance Program, are incorporated herein as though set forth in their entirety. Additionally, the Contractor is responsible for obtaining a current edition of all applicable federal and State of California statues and regulations and adhering to the latest editions of such. D-6 M00g3 FY12-13 Bridge Prev fiY Maintenance Pmgmm Fed" Project BHLS-4WJM) Revised April 2014 Protection of Resident Workers The City of Santa Clarita actively supports the Immigration and Nationality Act (INA), which includes provisions addressing employment eligibility, employment verification, and nondiscrimination. Under the INA, employers may hire only persons who may legally work in the United States (i.e., citizens and nationals of the U.S.) and aliens authorized to work in the U.S. The employer must verify the identity and employment eligibility of anyone to be hired, which includes completing the Employment Eligibility Verification Form (I-9). The Contractor shall establish appropriate procedures and controls so no services or products under the Contract Documents will be performed or manufactured by any worker who is not legally eligible to perform such services or employment. Federal Prevailing Wages The work being done pursuant to this Contract is paid for in part by the United States of America. Therefore, pursuant to the provisions applicable to such federal assistance, Contractor acknowledges and agrees that the services, construction, and maintenance pursuant to this Contract is, or may become, subject to certain federal laws and regulations, including, but not limited to, provisions of the Davis -Bacon Act, and particularly 29 Code of Federal Regulations Section 5.5 in part as follows: (a) The Agency head shall cause or require the contracting officer to insert in full in any contract in excess of $2,000 which is entered into for the actual construction, alteration and/or repair, including painting and decorating, of a public building or public work, or building or work financed in whole or in part from federal funds or in accordance with guarantees of a federal agency or financed from funds obtained by pledge of any contract of a federal agency to make a loan, grant or annual contribution (except where a different meaning is expressly indicated), and which is subject to the labor standards provisions of any of the acts listed in Section 5.1, the following clauses (or any modifications thereof to meet the particular needs of the agency provided that such modifications are first approved by the Department of Labor): (1) Minimum wages. (i) All laborers and mechanics employed or working upon the site of the work (or under the United States Housing Act of 1937 or under the Housing Act of 1949 in the construction or development of the project), will be paid unconditionally and not less often than once a week, and without subsequent deduction or rebate on any account (except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act (29 CFR Part 3)), the full amount of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment computed at rates not less than those contained in the wage determination of the Secretary of Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics. Contributions made or costs reasonably anticipated for bona fide fringe benefits under Section I(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of paragraph (a)(1)(iv) of this section; also, regular contributions made or costs incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs which cover the particular D-7 MOO93 FY12-13 Badge Preventive Maintenance Program Federal Project 8HL55450(MO) Revised April 2014 weekly period, are deemed to be constructively made or incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to skill, except as provided in Section 5.5(a)(4). Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein: provided that the employer's payroll records accurately set forth the time spent in each classification in which work is performed. The wage determination (including any additional classification and wage rates conformed under paragraph (a)(1)(ii) of this section) and the Davis - Bacon poster (WH -1321) shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. (ii)(A) The contracting officer shall require that any class of laborers or mechanics, including helpers, which is not listed in the wage determination and which is to be employed under the contract shall be classified in conformance with the wage determination. The contracting officer shall approve an additional classification and wage rate and fringe benefits therefore only when the following criteria have been met: (1) The work to be performed by the classification requested is not performed by a classification in the wage determination; and (2) The classification is utilized in the area by the construction industry; and (3) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (B) If the contractor and the laborers and mechanics to be employed in the classification (if known), or their representatives, and the contracting officer agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate), a report of the action taken shall be sent by the contracting officer to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor, Washington, DC 20210. The Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30 -day period that additional time is necessary. (C) In the event the contractor, the laborers or mechanics to be employed in the classification or their representatives, and the contracting officer do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions, including the views of all interested parties and the recommendation of the contracting officer, to the Administrator for determination. The Administrator, or an authorized representative, will issue a determination within 30 days of receipt and so advice the contracting officer or will notify the contracting officer within the 30 -day period that additional time is necessary. (D) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs (a)(I)(ii) (B) or (C) of this section, shall be paid to all workers performing work in the classification under this contract from the first day on which work is performed in the classification. (iii) Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate, the contractor shall either pay the benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. (iv) If the contractor does not make payments to a trustee or other third person, the contractor may consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona fide fringe benefits under a plan or program, provided that the Secretary of Labor has found, upon the written request of the contractor, that the applicable standards of the Davis -Bacon Act have been met. The Secretary of Labor may require the contractor to set aside in a separate account assets for the meeting of obligations under the plan or program. 1W-1 M0 3 FY12-13 Mdge Prev bw Maintenance Program Fed" Pr.IW BHLS-5450(M) Revised April 2014 (2) Withholding. The CITY shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld from the contractor under this contract or any other federal contract with the same prime contractor, or any other federally -assisted contract subject to Davis -Bacon prevailing wage requirements, which is held by the same prime contractor, so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees, and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, including any apprentice, trainee, or helper, employed or working on the site of the work (or under the United States Housing Act of 1937 or under the Housing Act of 1949 in the construction or development of the project), all or part of the wages required by the contract, the CITY may, after written notice to the contractor, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. (3) Payrolls and basic records. (i) Payrolls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all laborers and mechanics working at the site of the work (or under the United States Housing Act of 1937, or under the Housing Act of 1949, in the construction or development of the project). Such records shall contain the name, address, and social security number of each such worker, his or her correct classification, hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in section 1(b)(2)(B) of the Davis -Bacon Act), daily and weekly number of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv) that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in Section I (b)(2)(B) of the Davis -Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred in providing such benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs, the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. (ii)(A) The contractor shall submit weekly for each week in which any contract work is performed a copy of all payrolls to the City. The payrolls submitted shall set out accurately and completely all of the information required to be maintained under Section 5.5(a)(3)(i) of Regulations 29 CFR Part 5. This information may be submitted in any form desired. Optional Form WH -347 is available for this purpose and may be purchased from the Superintendent of Documents (federal stock number 029-005-00014-1), U.S. Government Printing Office, Washington, DC 20402. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. (B) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (1) That the payroll for the payroll period contains the information required to be maintained under Section 5.5(a)(3)(i) of Regulations 29 CFR Part 5 and that such information is correct and complete; (2) That each laborer or mechanic (including each helper, apprentice, and trainee) employed on the contract during the payroll period has been paid the full weekly wages earned, without rebate, either directly or indirectly, and that no D-9 M0093 FY12-13 Bridge Pmwe ve Ma"ene Program Fedeal Pmil B LS -5450(0801 Revised April 2014 deductions have been made either directly or indirectly from the full wages earned, other than permissible deductions as set forth in Regulations 29 CFR Part 3; (3) That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or cash equivalents for the classification of work performed, as specified in the applicable wage determination incorporated into the contract. (C) The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH -347 shall satisfy the requirement for submission of the "Statement of Compliance" required by paragraph (a)(3)(ii)(B) of this section. (D) The falsification of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code. (iii) The contractor or subcontractor shall make the records required under paragraph (a)(3)r) of this section available for inspection, copying, or transcription by authorized representatives of the CITY or Department of Labor, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records or to make them available, the CITY may, after written notice to the contractor, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. (4) Apprentices and trainees --(i) Apprentices. Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or if a person is employed in his or her first 90 days of probationary employment as an apprentice in such an apprenticeship program, who is not individually registered in the program, but who has been certified by the Office of Apprenticeship Training, Employer and Labor Services and a State Apprenticeship Agency to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices to journeymen on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any worker listed on a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor is performing construction on a project in a locality other than that in which its program is registered, the ratios and wage rates (expressed in percentages of the journeyman's hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's level of progress, expressed as a percentage of the journeymen hourly rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with the provisions of the apprenticeship program. If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an D-10 M0093 FY12-13 Badge Preventive Maintenar Program Federal Pr*d 13HLS-5450(OBO) Revised April 2014 apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved. (ii) Trainees. Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified in the approved program for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who is not registered and participating in a training plan approved by the Employment and Training Administration shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any trainee performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. (iii) Equal employment opportunity. The utilization of apprentices, trainees, and journeymen under this part shall be in conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR Part 30. (5) Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR Part 3, which are incorporated by reference in this contract. (6) Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses contained in 29 CFR 5.5(a)(1) through (10) and such other clauses as the FHWA may by appropriate instructions require, and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR 5.5. (7) Contract termination: debarment. A breach of the contract clauses in 29 CFR 5.5 may be grounds for termination of the contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR 5.12. (8) Compliance with Davis -Bacon and Related Act requirements. All rulings and interpretations of the Davis -Bacon and Related Acts contained in 29 CFR Parts 1, 3, and 5 are herein incorporated by reference in this contract. (9) Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall not be subject to the general disputes clause of this contract. Such disputes shall D-11 MM3 FY12-13 Badge Preventive Mairilenarice Program Federal PmjW SHLS-5450(030) Revised April 2014 be resolved in accordance with the procedures of the Department of Labor set forth in 29 CFR Parts 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, the U.S. Department of Labor, or the employees or their representatives. (10) Certification of eligibility. (i) By entering into this contract, the contractor certifies that neither it (nor he or she) nor any person or firm who has an interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). (ii) No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract by virtue of Section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). (iii) The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. (b) Contract Work Hours and Safety Standards Act. The Agency Head shall cause or require the contracting officer to insert the following clauses set forth in paragraphs (b)(1), (2), (3), and (4) of this section in full in any contract in an amount in excess of $100,000 and subject to the overtime provisions of the Contract Work Hours and Safety Standards Act. These clauses shall be inserted in addition to the clauses required by Section 5.5(a) or 4.6 of Part 4 of this title. As used in this paragraph, the terms laborers and mechanics include watchmen and guards. (1) Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek. (2) Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (b)(1) of this section, the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. (3) Withholding for unpaid wages and liquidated damages. The CITY shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other federal contract with the same prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph (b)(2) of this section. (4) Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (b)(1) through (4) of this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (b)(1) through (4) of this section. Electronic Transmission of Contract and Shmatures The Parties agree that this Agreement may be transmitted and signed by electronic mail by either/any or both/all Parties, and that such signatures shall have the same force and effect as original signatures, in accordance with California Government Code section 16.5 and Civil Code section 1633.7. D-12 M0093 FY12-13 Badge Pmventive Maeena Program FeEerel Project BHLSb 50(080) Revised April 2014 The parties hereto for themselves, their heirs, executors, administrators, successors, and assigns do hereby agree to the full performance of the covenants herein contained and have caused this AGREEMENT to be executed in duplicate by setting hereunto their names and titles this day Of 20 CONTRACTOR: CONTRACTOR Name: Address: Phone & Fax No. ALL SIGNATURES MUST BE Signed By: WITNESSED BY NOTARY CITY: Attest: Approved as to Form: Print Name & Title: CONTRACTOR's License No. Class Mayor/City Manager of the City of Santa Clarita City Clerk of the City of Santa Clarita City Attorney of the City of Santa Clarita D-13 M0 FY12-13 BrWr Pray bw Maintenenoa Prognm Fetleral Projed BHLS-5460(080) Date: Date: Date: Revised April 2014 EXHIBIT "A" FHWA-1273 -- Revised May 1, 2012 REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS I. General II. Nondiscrimination III. Nonsegregated Facilities fV. Davis -Bacon and Related Act Provisions V. Contract Work Hours and Safety Standards Act Provisions VI. Subletting or Assigning the Contract VII. Safety: Accident Prevention VIII. False Statements Concerning Highway Projects D:. Implementation of Clean Air Act and Federal Water Pollution Control Act X. Compliance with Governmentwide Suspension and Debarment Requirements XI. Certification Regarding Use of Contract Funds for Lobbying ATTACHMENTS A. Employment and Materials Preference for Appalachian Development Highway System or Appalachian Local Access Road Contracts (included in Appalachian contracts only) I. GENERAL 1. Form FHWA-1273 must be physically incorporated in each construction contract funded under Title 23 (excluding emergency contracts solely intended for debris removal). The contractor (or subcontractor) must insert this form in each subcontract and further require its inclusion in all lower tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services). The applicable requirements of Form FHWA-1273 are incorporated by reference for work done under any purchase order, rental agreement or agreement for other services. The prime contractor shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Form FHWA-1273 must be included in all Federal -aid design -build contracts, in all subcontracts and in lower tier subcontracts (excluding subcontracts for design services, purchase orders, rental agreements and other agreements for supplies or services). The design -builder shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. D-14 M0 3 FY12-13 Bridge Preventive MelMenmKe Program Federal Pqj BHL55450(080) Revised April 2014 Contracting agencies may reference Form FHWA-1273 in bid proposal or request for proposal documents, however, the Form FHWA-1273 must be physically incorporated (not referenced) in all contracts, subcontracts and lower -tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services related to a construction contract). 2. Subject to the applicability criteria noted in the following sections, these contract provisions shall apply to all work performed on the contract by the contractor's own organization and with the assistance of workers under the contractor's immediate superintendence and to all work performed on the contract by piecework, station work, or by subcontract. 3. A breach of any of the stipulations contained in these Required Contract Provisions may be sufficient grounds for withholding of progress payments, withholding of final payment, termination of the contract, suspension / debarment or any other action determined to be appropriate by the contracting agency and FHWA. 4. Selection of Labor: During the performance of this contract, the contractor shall not use convict labor for any purpose within the limits of a construction project on a Federal -aid highway unless it is labor performed by convicts who are on parole, supervised release, or probation. The term Federal -aid highway does not include roadways functionally classified as local roads or rural minor collectors. II. NONDISCRH IINATION The provisions of this section related to 23 CFR Part 230 are applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The provisions of 23 CFR Part 230 are not applicable to material supply, engineering, or architectural service contracts. In addition, the contractor and all subcontractors must comply with the following policies: Executive Order 11246, 41 CFR 60,29 CFR 1625-1627, Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. The contractor and all subcontractors must comply with: the requirements of the Equal Opportunity Clause in 41 CFR 60-1.4(b) and, for all construction contracts exceeding $10,000, the Standard Federal Equal Employment Opportunity Construction Contract Specifications in 41 CFR 60-4.3. Note: The U.S. Department of Labor has exclusive authority to determine compliance with Executive Order 11246 and the policies of the Secretary of Labor including 41 CFR 60, and 29 CFR 1625-1627. The contracting agency and the FHWA have the authority and the responsibility to ensure compliance with Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), and Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. D-15 M0093 FY12-13 Bridge Prever dw MelatenMlce Pmgrme Federal PrOJW BHLSS450(OBO) Revised April 2014 The following provision is adopted from 23 CFR 230, Appendix A, with appropriate revisions to conform to the U.S. Department of Labor (US DOL) and FHWA requirements. 1. Equal Employment Opportunity: Equal employment opportunity (EEO) requirements not to discriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, rules, regulations (28 CFR 35, 29 CFR 1630, 29 CFR 1625-1627, 41 CFR 60 and 49 CFR 27) and orders of the Secretary of Labor as modified by the provisions prescribed herein, and imposed pursuant to 23 U.S.C. 140 shall constitute the EEO and specific affirmative action standards for the contractor's project activities under this contract. The provisions of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) set forth under 28 CFR 35 and 29 CFR 1630 are incorporated by reference in this contract. In the execution of this contract, the contractor agrees to comply with the following minimum specific requirement activities of EEO: a. The contractor will work with the contracting agency and the Federal Government to ensure that it has made every good faith effort to provide equal opportunity with respect to all of its terms and conditions of employment and in their review of activities under the contract. b. The contractor will accept as its operating policy the following statement: "It is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age or disability. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre -apprenticeship, and/or on-the-job training." 2. EEO Officer: The contractor will designate and make known to the contracting officers an EEO Officer who will have the responsibility for and must be capable of effectively administering and promoting an active EEO program and who must be assigned adequate authority and responsibility to do so. 3. Dissemination of Policy: All members of the contractor's staff who are authorized to hire, supervise, promote, and discharge employees, or who recommend such action, or who are substantially involved in such action, will be made fully cognizant of, and will implement, the contractor's EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above agreement will be met, the following actions will be taken as a minimum: a. Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and then not less often than once every six months, at which time the contractor's EEO policy and its implementation will be reviewed and explained. The meetings will be conducted by the EEO Officer. D-16 MOOg3 M2-13 & dqe PrevenOw Maintenance Program FeCeral Projed WLS-5450(080) Revised April 2014 b. All new supervisory or personnel office employees will be given a thorough indoctrination by the EEO Officer, covering all major aspects of the contractors EEO obligations within thirty days following their reporting for duty with the contractor. c. All personnel who are engaged in direct recruitment for the project will be instructed by the EEO Officer in the contractor's procedures for locating and hiring minorities and women. d. Notices and posters setting forth the contractor's EEO policy will be placed in areas readily accessible to employees, applicants for employment and potential employees. e. The contractor's EEO policy and the procedures to implement such policy will be brought to the attention of employees by means of meetings, employee handbooks, or other appropriate means. 4. Recruitment: When advertising for employees, the contractor will include in all advertisements for employees the notation: "An Equal Opportunity Employer." All such advertisements will be placed in publications having a large circulation among minorities and women in the area from which the project work force would normally be derived. a. The contractor will, unless precluded by a valid bargaining agreement, conduct systematic and direct recruitment through public and private employee referral sources likely to yield qualified minorities and women. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such identified sources procedures whereby minority and women applicants may be referred to the contractor for employment consideration. b. In the event the contractor has a valid bargaining agreement providing for exclusive hiring hall referrals, the contractor is expected to observe the provisions of that agreement to the extent that the system meets the contractor's compliance with EEO contract provisions. Where implementation of such an agreement has the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Federal nondiscrimination provisions. c. The contractor will encourage its present employees to refer minorities and women as applicants for employment. Information and procedures with regard to referring such applicants will be discussed with employees. 5. Personnel Actions: Wages, working conditions, and employee benefits shall be established and administered, and personnel actions of every type, including hiring, upgrading, promotion, transfer, demotion, layoff, and termination, shall be taken without regard to race, color, religion, sex, national origin, age or disability. The following procedures shall be followed: a. The contractor will conduct periodic inspections of project sites to insure that working conditions and employee facilities do not indicate discriminatory treatment of project site personnel. D-17 MC M3 FY12-13 Widge Pmnfim Maintenance Program Fermi P,*d BMS -5450(080) Revised April 2014 b. The contractor will periodically evaluate the spread of wages paid within each classification to determine any evidence of discriminatory wage practices. c. The contractor will periodically review selected personnel actions in depth to determine whether there is evidence of discrimination. Where evidence is found, the contractor will promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all affected persons. d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor in connection with its obligations under this contract, will attempt to resolve such complaints, and will take appropriate corrective action within a reasonable time. If the investigation indicates that the discrimination may affect persons other than the complainant, such corrective action shall include such other persons. Upon completion of each investigation, the contractor will inform every complainant of all of their avenues of appeal. 6. Training and Promotion: a. The contractor will assist in locating, qualifying, and increasing the skills of minorities and women who are applicants for employment or current employees. Such efforts should be aimed at developing full journey level status employees in the type of trade or job classification involved. b. Consistent with the contractor's work force requirements and as permissible under Federal and State regulations, the contractor shall make full use of training programs, i.e., apprenticeship, and on-the-job training programs for the geographical area of contract performance. In the event a special provision for training is provided under this contract, this subparagraph will be superseded as indicated in the special provision. The contracting agency may reserve training positions for persons who receive welfare assistance in accordance with 23 U.S.C. 140(a). c. The contractor will advise employees and applicants for employment of available training programs and entrance requirements for each. d. The contractor will periodically review the training and promotion potential of employees who are minorities and women and will encourage eligible employees to apply for such training and promotion. 7. Unions: If the contractor relies in whole or in part upon unions as a source of employees, the contractor will use good faith efforts to obtain the cooperation of such unions to increase opportunities for minorities and women. Actions by the contractor, either directly or through a contractor's association acting as agent, will include the procedures set forth below: a. The contractor will use good faith efforts to develop, in cooperation with the unions, joint training programs aimed toward qualifying more minorities and women for membership in the unions and increasing the skills of minorities and women so that they may qualify for higher paying employment. D-18 MW93 PY12-13 Bnege Prevenfive Maintenance Program Federal Project BHLS-5450(080) Revised April 2014 b. The contractor will use good faith efforts to incorporate an EEO clause into each union agreement to the end that such union will be contractually bound to refer applicants without regard to their race, color, religion, sex, national origin, age or disability. c. The contractor is to obtain information as to the referral practices and policies of the labor union except that to the extent such information is within the exclusive possession of the labor union and such labor union refuses to furnish such information to the contractor, the contractor shall so certify to the contracting agency and shall set forth what efforts have been made to obtain such information. d. In the event the union is unable to provide the contractor with a reasonable flow of referrals within the time limit set forth in the collective bargaining agreement, the contractor will, through independent recruitment efforts, fill the employment vacancies without regard to race, color, religion, sex, national origin, age or disability; making full efforts to obtain qualified and/or qualifiable minorities and women. The failure of a union to provide sufficient referrals (even though it is obligated to provide exclusive referrals under the terns of a collective bargaining agreement) does not relieve the contractor from the requirements of this paragraph. In the event the union referral practice prevents the contractor from meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, such contractor shall immediately notify the contracting agency. S. Reasonable Accommodation for Applicants / Employees with Disabilities: The contractor must be familiar with the requirements for and comply with the Americans with Disabilities Act and all rules and regulations established there under. Employers must provide reasonable accommodation in all employment activities unless to do so would cause an undue hardship. 9. Selection of Subcontractors, Procurement of Materials and Leasing of Equipment: The contractor shall not discriminate on the grounds of race, color, religion, sex, national origin, age or disability in the selection and retention of subcontractors, including procurement of materials and leases of equipment. The contractor shall take all necessary and reasonable steps to ensure nondiscrimination in the administration of this contract. a. The contractor shall notify all potential subcontractors and suppliers and lessors of their EEO obligations under this contract. b. The contractor will use good faith efforts to ensure subcontractor compliance with their EEO obligations. 10. Assurance Required by 49 CFR 26.13(b): a. The requirements of 49 CFR Part 26 and the State DOT's U.S. DOT -approved DBE program are incorporated by reference. b. The contractor or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The contractor shall carry out D-19 Mg 3 M2.13 Bridge Ploy hn Maintenance Program Federal Projea BHLS-5450(080) Revised April 2014 applicable requirements of 49 CFR Part 26 in the award and administration of DOT -assisted contracts. Failure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as the contracting agency deems appropriate. 11. Records and Reports: The contractor shall keep such records as necessary to document compliance with the EEO requirements. Such records shall be retained for a period of three years following the date of the final payment to the contractor for all contract work and shall be available at reasonable times and places for inspection by authorized representatives of the contracting agency and the FHWA. a. The records kept by the contractor shall document the following: (1) The number and work hours of minority and non -minority group members and women employed in each work classification on the project; (2) The progress and efforts being made in cooperation with unions, when applicable, to increase employment opportunities for minorities and women; and (3) The progress and efforts being made in locating, hiring, training, qualifying, and upgrading minorities and women; b. The contractors and subcontractors will submit an annual report to the contracting agency each July for the duration of the project, indicating the number of minority, women, and non - minority group employees currently engaged in each work classification required by the contract work. This information is to be reported on Form FHWA-1391. The staffing data should represent the project work force on board in all or any part of the last payroll period preceding the end of July. If on-the-job training is being required by special provision, the contractor will be required to collect and report training data. The employment data should reflect the work force on board during all or any part of the last payroll period preceding the end of July. III. NONSEGREGATED FACILITIES This provision is applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The contractor must ensure that facilities provided for employees are provided in such a manner that segregation on the basis of race, color, religion, sex, or national origin cannot result. The contractor may neither require such segregated use by written or oral policies nor tolerate such use by employee custom. The contractor's obligation extends further to ensure that its employees are not assigned to perform their services at any location, under the contractor's control, where the facilities are segregated. The term "facilities" includes waiting rooms, work areas, restaurants and other eating areas, time clocks, restrooms, washrooms, locker rooms, and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, D-20 MOOg3 M2-13 Badge P ei w MaadeeaeCe Program Federal Project BHLS-5450(080) Revised April 2014 and housing provided for employees. The contractor shall provide separate or single -user restrooms and necessary dressing or sleeping areas to assure privacy between sexes. IV. DAVIS-BACON AND RELATED ACT PROVISIONS This section is applicable to all Federal -aid construction projects exceeding $2,000 and to all related subcontracts and lower -tier subcontracts (regardless of subcontract size). The requirements apply to all projects located within the right-of-way of a roadway that is functionally classified as Federal -aid highway. This excludes roadways functionally classified as local roads or rural minor collectors, which are exempt. Contracting agencies may elect to apply these requirements to other projects. The following provisions are from the U.S. Department of Labor regulations in 29 CFR 5.5 "Contract provisions and related matters" with minor revisions to conform to the FHWA-1273 format and FHWA program requirements. 1. Minimum wages a. All laborers and mechanics employed or working upon the site of the work, will be paid unconditionally and not less often than once a week, and without subsequent deduction or rebate on any account (except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act (29 CFR part 3)), the full amount of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment computed at rates not less than those contained in the wage determination of the Secretary of Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics. Contributions made or costs reasonably anticipated for bona fide fringe benefits under section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of paragraph l .d. of this section; also, regular contributions made or costs incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs which cover the particular weekly period, are deemed to be constructively made or incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to skill, except as provided in 29 CFR 5.5(a)(4). Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein: Provided, That the employer's payroll records accurately set forth the time spent in each classification in which work is performed. The wage determination (including any additional classification and wage rates conformed under paragraph Lb. of this section) and the Davis - Bacon poster (WH -1321) shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. D-21 M0003 FY12-13 Bridge Preventive Maintenance Rogrem Federal Pmje BH S-5450(080) Revised April 2014 b. (1) The contracting officer shall require that any class of laborers or mechanics, including helpers, which is not listed in the wage determination and which is to be employed under the contract shall be classified in conformance with the wage determination. The contracting officer shall approve an additional classification and wage rate and fringe benefits therefore only when the following criteria have been met: (i) The work to be performed by the classification requested is not performed by a classification in the wage determination; and (ii) The classification is utilized in the area by the construction industry; and (iii) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (2) If the contractor and the laborers and mechanics to be employed in the classification (if known), or their representatives, and the contracting officer agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate), a report of the action taken shall be sent by the contracting officer to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor, Washington, DC 20210. The Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30 -day period that additional time is necessary. (3) In the event the contractor, the laborers or mechanics to be employed in the classification or their representatives, and the contracting officer do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions, including the views of all interested parties and the recommendation of the contracting officer, to the Wage and Hour Administrator for determination. The Wage and Hour Administrator, or an authorized representative, will issue a determination within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30 -day period that additional time is necessary. (4) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs l.b.(2) or I .b.(3) of this section, shall be paid to all workers performing work in the classification under this contract from the first day on which work is performed in the classification. c. Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate, the contractor shall either pay the benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. d. If the contractor does not make payments to a trustee or other third person, the contractor may consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona fide fringe benefits under a plan or program, Provided, That the D-22 MM93F 1243 Bncge Preventive Maintenance Program Fetleeal P101W SHLS-5450(080) Revised April 2014 Secretary of Labor has found, upon the written request of the contractor, that the applicable standards of the Davis -Bacon Act have been met. The Secretary of labor may require the contractor to set aside in a separate account assets for the meeting of obligations under the plan or program. 2. Withholding The contracting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor, withhold or cause to be withheld from the contractor under this contract, or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to Davis -Bacon prevailing wage requirements, which is held by the same prime contractor, so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees, and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, including any apprentice, trainee, or helper, employed or working on the site of the work, all or part of the wages required by the contract, the contracting agency may, after written notice to the contractor, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. 3. Payrolls and basic records a. Payrolls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all laborers and mechanics working at the site of the work. Such records shall contain the name, address, and social security number of each such worker, his or her correct classification, hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in section I (b)(2)(B) of the Davis -Bacon Act), daily and weekly number of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv) that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in section I (b)(2)(B) of the Davis -Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred in providing such benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs, the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. b. (1) The contractor shall submit weekly for each week in which any contract work is performed a copy of all payrolls to the contracting agency. The payrolls submitted shall set out accurately and completely all of the information required to be maintained under 29 CFR 5.5(a)(3)(i), except that full social security numbers and home addresses shall not be included on weekly transmittals. Instead the payrolls shall only need to include an individually identifying number for each employee ( e.g. , the last four digits of the employee's social security number). D-23 MCM M2.13 Bridge Prey d" MantenvKro Program FeOeral Pra)W BHLS- %(0e0) Revised April 2014 The required weekly payroll information may be submitted in any form desired. Optional Form WH -347 is available for this purpose from the Wage and Hour Division Web site at http://www.dol.gov/esa/whd/fonns/wh347instr.htm or its successor site. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the full social security number and current address of each covered worker, and shall provide them upon request to the contracting agency for transmission to the State DOT, the FHWA or the Wage and Hour Division of the Department of Labor for purposes of an investigation or audit of compliance with prevailing wage requirements. It is not a violation of this section for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for its own records, without weekly submission to the contracting agency.. (2) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (i) That the payroll for the payroll period contains the information required to be provided under §5.5 (a)(3)(ii) of Regulations, 29 CFR part 5, the appropriate information is being maintained under §5.5 (a)(3)(i) of Regulations, 29 CFR part 5, and that such information is correct and complete; (ii) That each laborer or mechanic (including each helper, apprentice, and trainee) employed on the contract during the payroll period has been paid the full weekly wages earned, without rebate, either directly or indirectly, and that no deductions have been made either directly or indirectly from the full wages earned, other than permissible deductions as set forth in Regulations, 29 CFR part 3; (iii) That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or cash equivalents for the classification of work performed, as specified in the applicable wage determination incorporated into the contract. (3) The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH -347 shall satisfy the requirement for submission of the "Statement of Compliance" required by paragraph 3.b.(2) of this section. (4) The falsification of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under section 1001 of title 18 and section 231 of title 31 of the United States Code. c. The contractor or subcontractor shall make the records required under paragraph 3.a. of this section available for inspection, copying, or transcription by authorized representatives of the contracting agency, the State DOT, the FHWA, or the Department of Labor, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records or to make them available, the FHWA may, after written notice to the contractor, the contracting agency or the State DOT, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. D-24 MOD93 FYI 2-13 Badge Prev Ow Mainlenenoa Program Fadaral P,ojW MLS5 O(OBg) Revised April 2014 Furthermore, failure to submit the required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. 4. Apprentices and trainees a. Apprentices (programs of the USDOL) Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or if a person is employed in his or her first 90 days of probationary employment as an apprentice in such an apprenticeship program, who is not individually registered in the program, but who has been certified by the Office of Apprenticeship Training, Employer and Labor Services or a State Apprenticeship Agency (where appropriate) to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices to journeymen on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any worker listed on a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor is performing construction on a project in a locality other than that in which its program is registered, the ratios and wage rates (expressed in percentages of the journeyman's hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's level of progress, expressed as a percentage of the journeymen hourly rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with the provisions of the apprenticeship program. If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved. b. Trainees (programs of the USDOL). D-25 Mg 3 FY12-13 fridge Pr five MatMenawe Program FedeMl PMjW MLSb (Oae) Revised April 2014 Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified in the approved program for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who is not registered and participating in a training plan approved by the Employment and Training Administration shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any trainee performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. c. Equal employment opportunity. The utilization of apprentices, trainees and journeymen under this part shall be in conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR part 30. d. Apprentices and Trainees (programs of the U.S. DOT). Apprentices and trainees working under apprenticeship and skill training programs which have been certified by the Secretary of Transportation as promoting EEO in connection with Federal - aid highway construction programs are not subject to the requirements of paragraph 4 of this Section IV. The straight time hourly wage rates for apprentices and trainees under such programs will be established by the particular programs. The ratio of apprentices and trainees to journeymen shall not be greater than permitted by the terms of the particular program. 5. Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR part 3, which are incorporated by reference in this contract. 6. Subcontracts. The contractor or subcontractor shall insert Form FHWA-1273 in any subcontracts and also require the subcontractors to include Form FHWA-1273 in any lower tier D-26 MM3 FY12-13 Bntlge Preventive Maintenance Program Fetle Proje BHL55450(080) Revised April 2014 subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR 5.5. 7. Contract termination: debarment. A breach of the contract clauses in 29 CFR 5.5 may be grounds for termination of the contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR 5.12. 8. Compliance with Davis -Bacon and Related Act requirements. All rulings and interpretations of the Davis -Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in this contract. 9. Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall not be subject to the general disputes clause of this contract. Such disputes shall be resolved in accordance with the procedures of the Department of Labor set forth in 29 CFR parts 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, the U.S. Department of Labor, or the employees or their representatives. 10. Certification of eligibility. a. By entering into this contract, the contractor certifies that neither it (nor he or she) nor any person or firm who has an interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). b. No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). c. The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. V. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT The following clauses apply to any Federal -aid construction contract in an amount in excess of $100,000 and subject to the overtime provisions of the Contract Work Hours and Safety Standards Act. These clauses shall be inserted in addition to the clauses required by 29 CFR 5.5(a) or 29 CFR 4.6. As used in this paragraph, the terms laborers and mechanics include watchmen and guards. 1. Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic D-27 M0 "12-13 Wdge Preventive M "ers Program reaera Prgea eHis-sas (l ) Revised April 2014 receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek. 2. Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (L) of this section, the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (1.) of this section, in the sum of $10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (1.) of this section. 3. Withholding for unpaid wages and liquidated damages. The FHWA or the contacting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph (2.) of this section. 4. Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (1.) through (4.) of this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (1.) through (4.) of this section. VI. SUBLETTING OR ASSIGNING THE CONTRACT This provision is applicable to all Federal -aid construction contracts on the National Highway System. 1. The contractor shall perform with its own organization contract work amounting to not less than 30 percent (or a greater percentage if specified elsewhere in the contract) of the total original contract price, excluding any specialty items designated by the contracting agency. Specialty items may be performed by subcontract and the amount of any such specialty items performed may be deducted from the total original contract price before computing the amount of work required to be performed by the contractor's own organization (23 CFR 635.116). D-28 M0093 FY12-13 Bridge PrrmAw MBMeneKB PMWM Feder PMJW MLS -5150(080) Revised April 2014 a. The term "perform work with its own organization' refers to workers employed or leased by the prime contractor, and equipment owned or rented by the prime contractor, with or without operators. Such term does not include employees or equipment of a subcontractor or lower tier subcontractor, agents of the prime contractor, or any other assignees. The term may include payments for the costs of hiring leased employees from an employee leasing firm meeting all relevant Federal and State regulatory requirements. Leased employees may only be included in this term if the prime contractor meets all of the following conditions: (1) the prime contractor maintains control over the supervision of the day -today activities of the leased employees; (2) the prime contractor remains responsible for the quality of the work of the leased employees; (3) the prime contractor retains all power to accept or exclude individual employees from work on the project; and (4) the prime contractor remains ultimately responsible for the payment of predetermined minimum wages, the submission of payrolls, statements of compliance and all other Federal regulatory requirements. b. "Specialty Items" shall be construed to be limited to work that requires highly specialized knowledge, abilities, or equipment not ordinarily available in the type of contracting organizations qualified and expected to bid or propose on the contract as a whole and in general are to be limited to minor components of the overall contract. 2. The contract amount upon which the requirements set forth in paragraph (1) of Section VI is computed includes the cost of material and manufactured products which are to be purchased or produced by the contractor under the contract provisions. 3. The contractor shall furnish (a) a competent superintendent or supervisor who is employed by the firm, has full authority to direct performance of the work in accordance with the contract requirements, and is in charge of all construction operations (regardless of who performs the work) and (b) such other of its own organizational resources (supervision, management, and engineering services) as the contracting officer determines is necessary to assure the performance of the contract. 4. No portion of the contract shall be sublet, assigned or otherwise disposed of except with the written consent of the contracting officer, or authorized representative, and such consent when given shall not be construed to relieve the contractor of any responsibility for the fulfillment of the contract. Written consent will be given only after the contracting agency has assured that each subcontract is evidenced in writing and that it contains all pertinent provisions and requirements of the prime contract. 5. The 30% self -performance requirement of paragraph (1) is not applicable to design -build contracts; however, contracting agencies may establish their own self -performance requirements. D-29 M0093 FY12-13 Bndge Pmvenbve Maintenarcs PMgMM FMeral Purled SHLS- 45 (080) Revised April 2014 VII. SAFETY: ACCIDENT PREVENTION This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. 1. In the performance of this contract the contractor shall comply with all applicable Federal, State, and local laws governing safety, health, and sanitation (23 CFR 635). The contractor shall provide al safeguards, safety devices and protective equipment and take any other needed actions as it determines, or as the contracting officer may determine, to be reasonably necessary to protect the life and health of employees on the job and the safety of the public and to protect property in connection with the performance of the work covered by the contract. 2. It is a condition of this contract, and shall be made a condition of each subcontract, which the contractor enters into pursuant to this contract, that the contractor and any subcontractor shall not permit any employee, in performance of the contract, to work in surroundings or under conditions which are unsanitary, hazardous or dangerous to his/her health or safety, as determined under construction safety and health standards (29 CFR 1926) promulgated by the Secretary of Labor, in accordance with Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 3704). 3. Pursuant to 29 CFR 1926.3, it is a condition of this contract that the Secretary of Labor or authorized representative thereof, shall have right of entry to any site of contract performance to inspect or investigate the matter of compliance with the construction safety and health standards and to cant' out the duties of the Secretary under Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C.3704). VIII. FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. In order to assure high quality and durable construction in conformity with approved plans and specifications and a high degree of reliability on statements and representations made by engineers, contractors, suppliers, and workers on Federal -aid highway projects, it is essential that all persons concerned with the project perform their functions as carefully, thoroughly, and honestly as possible. Willful falsification, distortion, or misrepresentation with respect to any facts related to the project is a violation of Federal law. To prevent any misunderstanding regarding the seriousness of these and similar acts, Form FHWA-1022 shall be posted on each Federal -aid highway project (23 CFR 635) in one or more places where it is readily available to all persons concerned with the project: D-30 M0083 F 12.13 Bridge Prevenbve Maintenance Program Federal ProjeO BHLS-5450(080) Revised April 2014 18 U.S.C. 1020 reads as follows: "Whoever, being an officer, agent, or employee of the United States, or of any State or Territory, or whoever, whether a person, association, firm, or corporation, knowingly makes any false statement, false representation, or false report as to the character, quality, quantity, or cost of the material used or to be used, or the quantity or quality of the work performed or to be performed, or the cost thereof in connection with the submission of plans, maps, specifications, contracts, or costs of construction on any highway or related project submitted for approval to the Secretary of Transportation; or Whoever knowingly makes any false statement, false representation, false report or false claim with respect to the character, quality, quantity, or cost of any work performed or to be performed, or materials famished or to be furnished, in connection with the construction of any highway or related project approved by the Secretary of Transportation; or Whoever knowingly makes any false statement or false representation as to material fact in any statement, certificate, or report submitted pursuant to provisions of the Federal -aid Roads Act approved July 1, 1916, (39 Stat. 355), as amended and supplemented; Shall be fined under this title or imprisoned not more than 5 years or both." IX. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. By submission of this bid/proposal or the execution of this contract, or subcontract, as appropriate, the bidder, proposer, Federal -aid construction contractor, or subcontractor, as appropriate, will be deemed to have stipulated as follows: 1. That any person who is or will be utilized in the performance of this contract is not prohibited from receiving an award due to a violation of Section 508 of the Clean Water Act or Section 306 of the Clean Air Act. 2. That the contractor agrees to include or cause to be included the requirements of paragraph (1) of this Section X in every subcontract, and further agrees to take such action as the contracting agency may direct as a means of enforcing such requirements. X. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION This provision is applicable to all Federal -aid construction contracts, design -build contracts, subcontracts, lower -tier subcontracts, purchase orders, lease agreements, consultant contracts or D-31 MOM3 M243 BWp PrewrA. Mrilxures PrOgr Fed" Project BHLS545g0M Revised April 2014 any other covered transaction requiring FHWA approval or that is estimated to cost $25,000 or more — as defined in 2 CFR Parts 180 and 1200. 1. Instructions for Certification — First Tier Participants: a. By signing and submitting this proposal, the prospective first tier participant is providing the certification set out below. b. The inability of a person to provide the certification set out below will not necessarily result in denial of participation in this covered transaction. The prospective first tier participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective first tier participant to furnish a certification or an explanation shall disqualify such a person from participation in this transaction. c. The certification in this clause is a material representation of fact upon which reliance was placed when the contracting agency determined to enter into this transaction. If it is later determined that the prospective participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the contracting agency may terminate this transaction for cause of default. d. The prospective first tier participant shall provide immediate written notice to the contracting agency to whom this proposal is submitted if any time the prospective first tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. e. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200. "First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). f. The prospective first tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. D-32 MOM FY12-1391Ege Pres b" Maintenance Program Fed" Pmjn M S,-AWO80) Revised April 2014 g. The prospective first tier participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions," provided by the department or contracting agency, entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. h. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (https://www.ei)ls.govn, which is compiled by the General Services Administration. i. Nothing contained in the foregoing shall be construed to require the establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of the prospective participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. j. Except for transactions authorized under paragraph (f) of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 2. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — First Tier Participants: a. The prospective first tier participant certifies to the best of its knowledge and belief, that it and its principals: (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; D-33 teems FY12-13 ®lope Prevent. Program Federal PMJW BHLs5e50(030) Revised April 2014 (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. b. 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. 2. Instructions for Certification - Lower Tier Participants: (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200) a. By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department, or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. c. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. "First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). e. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. D-34 M0 3 F 12-13 & dge Prev the Maintenance Program Federal Prged B LS -5450(11811) Revised April 2014 f. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. g. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (hgps://www.eyis.govn, which is compiled by the General Services Administration. It. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. i. Except for transactions authorized under paragraph a of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion— Lower Tier Participants: 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. XI. CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING D-35 M0 3 R 1213 B dge Preventive Maintenance Program Fedeml Pmjed BHLB-5450(080) Revised April 2014 This provision is applicable to all Federal -aid construction contracts and to all related subcontracts which exceed $100,000 (49 CFR 20). 1. The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: a. 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. b. 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 Form to Report Lobbying," in accordance with its instructions. 2. 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 31 U.S.C. 1352. 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. 3. The prospective participant also agrees by submitting its bid or proposal that the participant shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such recipients shall certify and disclose accordingly. D-36 M0 3 FV 12-13 Budge Preventive Maintenance Program Federal PMed BHLS-5450(080) Revised April 2014 ATTACHMENT A - EMPLOYMENT AND MATERIALS PREFERENCE FOR APPALACHIAN DEVELOPMENT HIGHWAY SYSTEM OR APPALACHIAN LOCAL ACCESS ROAD CONTRACTS This provision is applicable to all Federal -aid projects funded under the Appalachian Regional Development Act of 1965. 1. During the performance of this contract, the contractor undertaking to do work which is, or reasonably may be, done as on-site work, shall give preference to qualified persons who regularly reside in the labor area as designated by the DOL wherein the contract work is situated, or the subregion, or the Appalachian counties of the State wherein the contract work is situated, except: a. To the extent that qualified persons regularly residing in the area are not available. b. For the reasonable needs of the contractor to employ supervisory or specially experienced personnel necessary to assure an efficient execution of the contract work. c. For the obligation of the contractor to offer employment to present or former employees as the result of a lawful collective bargaining contract, provided that the number of nonresident persons employed under this subparagraph (lc) shall not exceed 20 percent of the total number of employees employed by the contractor on the contract work, except as provided in subparagraph (4) below. 2. The contractor shall place a job order with the State Employment Service indicating (a) the classifications of the laborers, mechanics and other employees required to perform the contract work, (b) the number of employees required in each classification, (c) the date on which the participant estimates such employees will be required, and (d) any other pertinent information required by the State Employment Service to complete the job order form. The job order maybe placed with the State Employment Service in writing or by telephone. If during the course of the contract work, the information submitted by the contractor in the original job order is substantially modified, the participant shall promptly notify the State Employment Service. 3. The contractor shall give full consideration to all qualified job applicants referred to him by the State Employment Service. The contractor is not required to grant employment to any job applicants who, in his opinion, are not qualified to perform the classification of work required. 4. If, within one week following the placing of a job order by the contractor with the State Employment Service, the State Employment Service is unable to refer any qualified job applicants to the contractor, or less than the number requested, the State Employment Service will forward a certificate to the contractor indicating the unavailability of applicants. Such certificate shall be made a part of the contractor's permanent project records. Upon receipt of this certificate, the contractor may employ persons who do not normally reside in the labor area to fill positions covered by the certificate, notwithstanding the provisions of subparagraph (lc) above. D-37 M0 3 F 12A3 fridge Prev bn Maintenance Prog2m Federal P,ed BHLS U4 (O ) Revised April 2014 5. The provisions of 23 CFR 633.207(e) allow the contracting agency to provide a contractual preference for the use of mineral resource materials native to the Appalachian region. 6. The contractor shall include the provisions of Sections 1 through 4 of this Attachment A in every subcontract for work which is, or reasonably may be, done as on-site work. D-38 MO 3 FY12-13 Bndge Prwv the Maintenance Pmgram Federal PrcjW BHLS- AW(M) Revised April 2014 SECTION C: PROPOSAL FOR FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) 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: Peterson -Chase General Engineering Construction, Inc. Company Address: 1792 Kaiser Ave By: Dick W. Vogels Print Name Title: Vice President Signature: Date: %; A G C-1 MMM FY 1213 & 90 MehtenAn Pmg'em FV .I.t Fro t81 Ls_ Wlaeo) BID SCHEDULE FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) BRIDGE 1929 - Sierra Highway over Solemint & SPTCO - Item Description Unit p Qty Unit Price Amount 1 Prepare concrete bridge deck surface 10,800 SF 0.19 2,052.00 2 Treat bridge deck 10,800 SF 0.41 4,428.00 3 Furnish bridge deck treatment material 120 GAL 46.00 5,520.00 4 Remove and Replace Pavement Striping 1 LS 3,200.00 3,200.00 5 Public Safety Plan 1 1S 1,800.00 1,800.00 6 Traffic Control 1 LS 3,600.00 3.600.00 7 Storm Water Pollution Prevention (SWPP) 1 LS 1,160.00 1,160.00 Subtotal $21,760.00 BRIDGE 2345 - Pamplico Drive over Dry Canyon Channel Item 1 Deaoripttcsn Prepare concrete bridge deck surface tj#1=.., 1,800 Limit SF It Prim:Amount 0.18 324.00 2 Treat bridge deck 1,800 SF 0.41 738.00 3 Furnish bridge deck treatment material 20 GAL 46.00 920.00 4 Repair Spalling Concrete 4 SF 560.00 2,240.00 5 Public Safety Plan 1 LS 128.00 128,00 6 Traffic Control 1 LS 2,200.00 Z200.00 7 Storm Water Pollution Prevention (SWPP) 1 LS 1,050.00 1,050.00 Subtotal $7,600.00 C•2 M 93 F 1213 Brdga b jnlan a Program Fetl W Proja BH Sd15g(OW) BID SCHEDULE FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) BRIDGE 3277 - 141b Street over Newhall Creek Item Description 1 Remove brick & replace with concrete Qty 6 Unit SF Unit Price i 1,930.00 Amount 11,580.00 2 Repair Spalling Concrete 4 SF 490.00 1,960.00 3 Remove expansion joint seal 2 LF 80.00 3,840.00 4 Install Type "A" Joint Seal (MR 1") 3 26.00 1,248.00 5 Traffic Control q48LF LS 4,200.00 4,200.00 6 Storm Water Pollution Prevention (SWPP) 5 LS 1 210.00 LS 2,500.00 2,500.00 6 Public Safety Plan Subtotal LS 1,460.00 1,460.00 7 Traffic Control 1 $24.038.00 BID SCHEDULE BRIDGE 3537 - Sand Canyon Rd over Santa Clara River Item Description QtyUnit 120,301SF Unit Price Amount 1 Prepare concrete bridge deck surface 0.19 3,857.00 2 Treat bridge deck �^ 20,300 SF 0.41 8,323.00 3 Furnish bridge deck treatment material 230 GAL 45.00 10,350.00 4 Remove and Replace Pavement Striping 1 LS 2,100.00 2,100.00 5 Remove and Replace Pavement Markers 1 LS 2,500.00 2,500.00 6 Public Safety Plan 1 LS 1,460.00 1,460.00 7 Traffic Control 1 LS 5,900.00 5,900.00 8 Storm Water Pollution Prevention (SWPP) 1 LS 1,100.00 1,100.00 Subtotal $35,590.00 W C-3 MM3 "12'3 Sr. ge Malnmaxa Program F d ,.J N.,0 HHL$-8 38(888) FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project SHLS-5450(080) BRIDGE 4002 - Golden Valley Road over Soledad Canyon Road & SPRR Item Description Qty Unit Unit Price Amount 1 Prepare concrete bridge deck surface 31,000 SF 0.19 5,890.00 2 Treat bridge deck 31,000 SF 0.41 12,710.00 3 Furnish bridge deck treatment material 350 GAL 45.00 15,750.00 4 Public Safety Plan 1 LS 3,200.00 3,200.00 5 Remove expansion joint seal 30 LF 41.00 1,230.00 6 Install Type "A" Joint Seal (MR 1") 30 LF 30.00 900.00 7 Remove and Replace Pavement Striping l LS 2,200.00 2,200.00 8 Remove and Replace Pavement Markers 1 LS 3,900.00 3,900.00 9 Concrete 3 CY 8,000.00 24,000.00 10 Reinforcing Steel 480 LB 4.40 2,112.00 11 Repair concrete surface 102 SF 68.00 6,936.00 12 Traffic Control 1 LS 14,500.00 14,500.00 13 Storm Water Pollution Prevention (SWPP) 1 LS 1,540.00 1,540.00 Subtotal $94,868.00 TOTAL BID IN FIGURES 1 $183,856.00 1 TOTAL BID IN WORDS: One hundred eighty-three thousand, eight hundred fifty-six dollars C-4 M 3 FY 12-13 Br" Maintenance PrN am Federal Rojed BHLS.54%(W) DESIGNATION OF SUBCONTRACTORS Exhibit 12-B Bidder's List of Subcontractors (DBE and Non -DBE) Part I The bidder shall list all subcontractors (both DBE and non -DBE) in accordance with Section 2-1.054 of the Standard Specifications and per Title 49, Section 26.11 of the Code of Federal Regulations. This listing is required in addition to listing DBE Subcontractors elsewhere in the proposal. Photocopy this form for additional firms. Firm Name/ Phone/ --- Dotal Aaencc Use - Annual Gross Description of Portion of Work to be Performed Zinly Address/ Fax Receipts (Include the bid item number and the bid amount) (Certified UBk'?) City, Slate, ZIP C Now Super Seal & Stripe Phone ❑ <$1 million DYES <$5 million Item 4 (Bridge 3537) $1,705.00 Item 5(Bridge 3537) $2,045.00 (805) 524-7345 524-7345 [:]NO j If YES list DBE #: Address ❑ < $10 million 310 A Street, P.O. Box 755 Age of Finn (Yrs.) Fax❑ (805) 524-7428 <$]5 million Item 7 (Bridge 4002) $1,819.00 1 City State ZIP E] > $15 million item 8 (Bridge 4002) $3,186.00 Fillmore, CA 93016 Name Phone ❑ <$1 million ❑YES ❑ <$5 million — -...❑NO . If YES list DBE #: Address ❑ < $10 million Fax ❑ <$15 million I Age of Firm (Yrs) City State ZIP ❑ > $15 million C-5 MOOW Y12-13 BrMpe MMntenan Progum F,de.J NqW BHLS-SC OW) DESIGNATION OF SUBCONTRACTORS Exhibit 12-B Bidder's List of Subcontractors (DBE and Non -DBE) Part 11 The bidder shall list all subcontractors who provided a quote or bid but were not selected to participate as a subcontractor on this project. This is required for compliance with Title 49, Section 26 of the Code of Federal Regulations. Photocopy this form for additional firms. Firm Name/ Phone/ Address/Fax Annual Gross I Local Aeencv _U_se OWy Description of Portion of Work to be Performed Receipts (Include the bid item number and the bid amount) I (Certified DRE?) City, State, ZIP Name Phone ❑ <$1 million Item 4 (Bridge 1929) $2,800.00 ❑YES Stemdahl Enterprises, Inc. --- ---' - -- (818) 834-8199 <$5 million Item 4 (Bridge 3537) $3,800.00 ❑NO Address ❑ <$10 million Item 5(Bridge 3537) $500.00 If YF_4 fist DRE #, Fax ❑ <$15 million 11861 Branford Street Item 7 (Bridge 4002) $500.00 Item 8 (Bridge 4002) $4.100.00 ARc of Firm (Yrs.) City State ZIP El> $IS million (818)834 8618 Sun Valley, CA 91352 i Name Phone ❑<$1 million ❑YFq ❑ <$5 million ❑NO..... ! If YES fist DBE #; Address ❑ <$10 million Fax ❑ <$15 million { ,. I Age of Firm (Yrs.) ; City State ZIP ❑ > $15 million C-7 M0093 F 12-1] B,b . Maintenance Program Federal Project BHL5 54WOW7 REFERENCES FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) 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. City of Santa Clarita - 23920 Valencia Blvd_., Ste 120, Santa Clarita, CA 91355 Name and Address of Owner / Agency Monica Heredia - (661) 255-4332 Name and Telephone Number of Person Familiar with Project X154 277 00 Bridge Preventive Maintenance 5/3 112 0 1 3 Contract Amount Type of Work Date Completed 2. City of Santa Clarita - 23920 Valencia Blvd., Ste 120, Santa Clarita, CA 91355 Name and Address of Owner / Agency Monica Heredia - (661) 255-4332 Name and Telephone Number of Person Familiar with Project $237,403.00 Bridge Preventive Maintenance 5/20/2012 Contract Amount Type of Work Date Completed 3, Caltrans - 1120 N Street, Sacramento, CA 9.5814 Name and Address of Owner / Agency Anthonv Granados - (530) 527-8417 Name and Telephone Number of Person Familiar with Project $1,022,733.20 Bridge Maintenance 11/06/2012 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: Great American Insurance Group - 301 E. 3rd Street, Cincinnati, OH 45202 (513) 869-5000 Spencer Flake, Richard A. Coon Culbertsons Insurance Services - 5500 E. Santa Ana Canyon Rd., #201, Anaheim, CA (714) 921-0530 David Culbertson Peterson -Chase General Engineering Construction, Inc. Contractors Name C-9 MO093 FY 12 t3811oye Melntenance ProOmm Federal Project HHLs-56601060) DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) 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. 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-10 Fef ra FYj !9HLS MtW)ance Program FeOe,elProjec!BHL6�5650!O60i EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION "' (Must be filled out by the Bidder and ALL subcontractors over $10,000) `" FY 12.13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) City of Santa Clarita, California This bidder Peterson -Chase G.E.C.,Inc. 'proposed subcontractor hereby certifies that he has x , has not , participated in a previous contract or subcontract subject to the equal opportunity clause, as required by Executive Orders 10925.11114, or 11246, and that he has x , 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: Peterson -Chase General Engineering Construction Inc. By: Dirk W Vo®el¢ Title: Vice President 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. C-11 M0003 FY 12-13 BM,ie Mwtenarc PIOWQM Fe ..l Project SHL5 6a5 (OW) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION (Must be filled out by the Bidder and ALL subcontractors over $10,000) ... FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) City of Santa Clarita, California This bidder , proposed subcontractor Super Seal & Stripe , 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 -y_- 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: Super Seal & Stripe By: Rob Van Antwerp Title: Pctimatnr Date: 12-2-14 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. C-11 MW93 FY 1213 5rid0a Malnlenac a Pmgiam Federal PIOIBCI B LS 5450(050) 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: Peterson -Chase General Engineering Construction, Inc___ Business Address: 1792 Kaiser Ave Irvine CA 92614 Telephone No.: 949-252-0441 State CONTRACTOR's License No. & Class: 615876 - A, C13, C32. B Original Date: 3/23/1991 Expiration Date: 3/31/2015 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: Greg Chase -President - 25 Marbella Monarch Beach CA 92629 (949) 292-5779 Dick W. Vogels - Vice President/Secretary(Treasurer - 22632 Sweetmeadow, Mission Viejo CA 92692 (949)292-5819 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: NONE C-12 MM93 FY 1213 Bridge Meinleni, g Program Federal Propel MLS W(oBo) All current and prior DBAs, alias, and/or fictitious business names for any principal having an interest in this proposal are as follows: IN WITNESS WHEREOF, BIDDER executes and submits this proposal with the names, title, hands, and seals of all aforementioned principals this day of De—_ 20 t� BIDDER: Peterson -Chase 1 Engineering Construction Legal Name of Bidder 1792 Kaiser Ave- Irvine- CA 4 614 Address 949-252-0441 33-0445961 Telephone Number Federal Tax I.D. No. SIGNATURES MUST BE MADE AND NOTARY ACKNOWLEDGMENTS OF EXECUTION OF BIDDER MUST BE ATTACHED Subscribed and sworn to this Notary "93 F 12.13 WdpO MainUnence Pr,,. Federal Fl,a BHLS-S (Wj day of —,20—. C-13 (SEAL) CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 xcr�rocrerxmcrcaes+,�2ccneneresc+��ceasc..c,�'.nastnreeseocsrrcx�srsrcccre�C,r.netx;r��r�csecesccT t .,:,-.,-:, *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 (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 California County of Orange Seal Place Notary Seat Above Subscribed and sworn to (or affirmed) before me on this _7— day of Decemher 2014_, by Date Month Year (1) Dick W Vogels (and Name(a) of Signer(s) proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. OPTIONAL Signature of Notary Public 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 Infor and Certification Document Date: 12/0112014 Number of Pages: 2 Signer(s) Other Than Named Above: None avcuss. .. wc^sw..:c � �.�ti•.:c�:c�?:cww+:cw:c+��:r�:�+�c.��x�rw:zesw�asrxxwwr�twzsew^s:��+,�wa+,u>ew^e�,'4z�uxxacxacv 02014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5910 BOND 110284226 PREMIUM NIL PROPOSAL GUARANTEE BID BOND FY 12.13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -1415 -M0093 -A City Project M0093 Federal-Ald Project BHLS-5450(080) City of Santa Clarita, California PETERSON -CHASE GENERAL KNOW ALL MEN BY THESE PRESENTS that ENGINEERING CONSTRUCTION, INC. , as BIDDER, and GREAT AMERICAN INSURANCE COMPANY as SURETY, are held and firmly bound unto the City of Santa Clarita, as AGENCY, in the penal sum of TEN PERCENT of AMOUNT BID dollars (S 107 ).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, firmty 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 I 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 names, titles, hands, and seals, this 6TH day of NOVEMBER 20 14 ON, INC. BIDDER: BY: re Name and Title of 1792 KAISER AVENUE, IRVINE, CA 92614 TEL. (949)252-0041 Address 750 THE CITY DRIVE SOUTH 5470 SURETY' GREAT AMERICAN INSURANCE COMPANY ORANGE, CA 92868 TEL. (714)740-2400 SPEf10ER FI.AKE(ATTORNEY-IN-FACT Subscribed and sworn to this day of s20 NOTARY PUBLIC (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. AGENT: CULBERTSON INSURANCE SERVICES, INC. C-15 M0000 FY 121]9riEBe MWnunenm Propnm 5500 E. SANTA ANA CANYON ROAD 5201 Fe IW Prgwi YNLII.1400100D) ANAHEIM, CA 92807 TEL. (714)921-0530 CALIFORNIA JURAT WITH AFFIANT STATEMENT X See Attached Document (Notary to cross out lines 1-6 below) F-1 See Statement Below (Lines 1-5 to be completed only by document signer[s], not Notary) Sgreture of Document Signer No 1 State of California County of ORANGE i* JAN C. MORAN PC i , COMM. #1967021 r9 F f"^„r NOTARY PUBLIC • CgLIFORNIA Seer 1 y ORANGE COUNTY '� > Comm. Exp. FEB. 17, 2018 Place Notary seal Above Sgnature of DoeulneM Signer No. 2 (11 any) Subscribed and sworn to (or affirmed) before me on this 6TH day of NOVEMBER _ 2014 by Date Monts year (1) SPENCER FLAKE. Name m proved to me on the basis of satisfactory evidence to be the person who appeared before me (.) (,) (and - (2) — Name of Signer proved to me on the basis of satisfactory evidence to be the person who yappeared before b�eforre me.) signature _'` fY,y �/R/ slgratura of Notary Pubfic JAW C. MORAN OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying orr the document and could prevent fraudulent removal and reattachment of this form to another document. Further Description of Any Attached Document Tide or Type of Document Date: Sigmr(s) Other Than Named Above: Number of Pages: RIGHTTHUMBPRINT RIGMTTMUfdBPRINi OF SIGNER al OF SIGNER a2 3�'L”4R.n�-.�tXA'..'.C'i'Z'X-'b`�rC.'4�5�:{%`c%C'7Wru. iR'i�r.'Y�i3fT4�%<.v,4"c4`1=5.•c:i.'e%Vsc.:�'Q.'`4"4�,"�r,:4'e:L^eLz%C,'�.'isL`r.TC7c;C.`u)r%C.'c'(>c-2.'et:Y: 02001 Na1oral Nobry Also uCan•e35B DaSoto Aw.,P.O.Bav 2CO2•ChetswaM,CA 913132402•wxw'.NeEaalloleryag Ean I�10 Reatlar CallTdFF�ea lEnue�Sa,e2� GREAT AMERICAN INSURANCE COMPANY® Administrative Office: 301 E 4TH STREET a CINCINNATI, OHIO 46202 a 813-369-5000 a FAX 513.723-2740 The number of persons authorized by this power of attorney is not mote than FIVE No.0 14901 POWER OFATTORNEY KNOW ALL MEN BYTHESE PRESENTS: That the GREATAMERICAN INSURANCE COMPANY, a corporation organized and existing under and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than one is named, its true and lawful attorney-in-fact, for it and in its time, place and stead in execute on behalf of the said Company, as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof provided that the liability of the said Company on any such bond, undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below. Name Address Limit of Power DAVID L. CULBERTSONJ RICHARD A. COON ALL OF ALL CHARLES L. FLAKE LEXIE SHERWOOD ANAHEIM, $100,000,000.00 SPENCER FLAKE CALIFORNIA This Power of Attorney revokes all previous Lowers issued on behalf of the attomey(s)-in-fact named above. IN WITNESS WHEREOF the GREATAMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate officers and its corporate seal hereunto affixed this 9TH day of JUNE 1 2014 Attest GREAT AMERICAN INSURANCECOMPANY Aseivaa Secrnary Uivlslanal Senior Noe Prtsiden! STATE OF OHIO, COUNTY OF HAMILTON - n' DAVID C. KiTCHiN 1977-377-240-9 On this 9TH day of JUNE 2014 , before me personally appeared DAVID C. KITCHIN, to me known, being duly sworn, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great American Insurance Company, the Company described in and which executed the above instrument; that be knows the seal of the said Company; that the seal affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his time thereto by like authority. This Power ofAttomey is granted by authority of the following resolutions adopted by the Board of Directors of Great American Insurance Company by unanimous written consent dated June 9.2008. RESOLVED: That the Dwreumal President, the severedDivisiaml Senior Vac Presidents, Dtvistoml Yce Preardents gird Div conal Assistant Vice Presidents, or any one (f them, be and hereby is authorized,fronns time to (ime, to appoint one or more Ahorneye-hr-Fact to execute an behalf of the Company, as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof,' to prescribe their respective duties and the respective limits of their authority; and to revoke any such appointment at any time. RESOLVED FURTHER That the Company seal and the signature of arty of the aforesaid offtcers and any Secretary or Assistant Secretary of the Company may be affceed by facsimile to any power ofaltorney or certhcale of either given for the execution of any bond undertaking, contract of mm yshrp, or other written obligation in the mature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature of such gffaer and the original seal of the Company to be valid and binding upon the Company with the same force and effect ar though mamally affixed CERTIFICATION 1, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do herby certify that the foregoing Power ofAttomey and the Resolutions of the Board of Directors of lune 9, 2008 have not been revoked and are now in full force and cited, Signed mid scaled this 6TH day of NOVEMBER 2014 @ t'*1111 ! �'- e..w� A.vuranr Srt+emr)• 51029!)(12/13) CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 r3M.M,C,f,4iYxXSF,^,GK'.Gt2CC.ciicfd�;GtitY'.c(':CB,�Ck.V^.C:CwKa'fsY?Cf:c,{^.a4)i':hczAM.<:n.cccxx.(x;CVC:cfr:.^<(sL�'.x^1.:�r:a'ae',GCXM`.t^f.�".� X See Attached Document (Notary to cross out lines 1-6 below) _, See Statement Below (Lines 1-6 to be completed only by document signerfsj, not Notary) Signature of Document Signer No. 1 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 California County of Orange KALI GOGLANIAN �(( Commission N 1924860 L 1=`s Notary Public - California i r t l Orange County n M Comm. Expires Mar 9, 2015 Seal Place Notary Seal Above Subscribed and sworn to (or affirmed) before me on this 1 day of Darambar 2014 by Date Month Year =I— (and Names) of Signer(s) proved to me on the basis of satisfactory evidence to be the pers n(s) who,41ppearo before me. Signat *Signature of Not Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signers) Other Than Named Above: Document Date: @2014 National Notary Association • www.NationalNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5910 NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) 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-16 W093 12-19 Bridge Meb,lenaice Pm,em Federal Pman BHLS WC(080) NON -COLLUSION AFFIDAVIT FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) City of Santa Clarita, California TO BE EXECUTED BY EACH BIDDER OF A PRINCIPAL CONTRACT STATE OF CALIFORNIA } COUNTY OF LOSANGELES }) § ORANGE Dick W. Voaels being first duly sworn deposes and says that he is the Vice President (sole owner, a partner, president, etc.) of Peterson -Ch General Engineer ng Construction, Ince the party making the foregoing bid: that such bid is not made in the interest of or behalf off 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 as have a partnership or other financial interest with said BIDDER in his general business. Bidder: 1y� Sign re Title V t �YXQ U Subscribed and sworn to and before me this day of 120 Seal of Notary C-17 M0093 FV 1243 Bridge Maintenance Program Federal Project BM.S-5d50(060) CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 ;�,., -.. _ .- ..:.rresarsramesra�.euarsrt�e,rrcusr ® See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signegs], not Notary) Signature of Document Signer No. 1 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 California County of Orange KAUGOOLANIAN Commission # -19-246 50Notary Public - California Orange County ON19 Comm. Eapirta Mar 9. 7015 - Subscribed and swom to (or affirmed) before me on this 1 day of nenemher 2014 by Date Month Year ..- (and Names) of Signers) proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Sign tur Signature of t tary Public Seal 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: Document Date: Number of Pages: Signers) Other Than Named Above: 02014 National Notary Association • www,NationalNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item (15910 BIDDER'S QUESTIONNAIRE FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) 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: Dick W. Vogels Telephone: 949-252-0441 Principal Office Address: 1792 Kaiser Ave Irvine CA 92614 2. Type of Firm: Corporation Corporate: Other: Individual: 3a. If a corporation, answer these questions Date of Incorporation: 1/03/1991 -- _State of Incorporation: California President's Name: Greg Chase Vice -President's Name: Dick W. Vogels Secretary or Clerk's Name: Dick w Vogels Treasurer's Name: irk W Vogelg 3b. If a partnership, answer these questions: Date of organization: —State Organized in: Name of all partners holding more than a 101/6 interest: Designate which are General or Managing Partners, 4. Name of person holding CONTRACTOR's license: —Qreg Chase License number: ,615876 Class: A C13 C32 B Expiration Date: 313112015 5. CONTRACTOR's Representative: Dick W. Vogels Title: Vice President Alternate: Kati e1]gt9nlan Title: 6. List the major construction projects your organization has in progress as of this date: Owner: (A)Caltrans o4 -3A7774 (B) Caltrans 07-295704 Project Location: Alameda/Contra Costa Los Angeles County Type of Project: Install Overhead Sian Structures Reply Concrete Cold Plane and Place HMA &Traffic Operation Systems C-18 MOm FY 12-13 Or'ldge Meinlename Pragrem Federal Projatl SHLS 5 50(000) CERTIFICATION OF NON -SEGREGATED FACILITIES FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14.15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) City of Santa Clarlta, 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. Required by the May 19, 1967 order on Eliminate O — 32 F.R. 7439, May 19, 1967 (F.R. Vol. 33, No. C-19 MOOO FY 12-03 Bridge Mmmomece Program Fade,.] N.Jed WLS-50.50(080) sated Facilities, by February 16, 1968 3065), of Labor NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS FY 12-13 BRIDGE PREVENTIVE MAINTENANCE PROGRAM Bid No ENG -14 -15 -M0093 -A City Project M0093 Federal -Aid Project BHLS-5450(080) 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: (I) 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-20 "93 F 12 13 BritlBe enauneneme Pruyrem FMemf Pr*rt BHL&5 50(0W) DISCLOSURE OF LOBBYING ACTIVITIES 2. Status of Federal Action: ❑ a. bid/offer/application b. initial award c. post -award 4. Name and Address of Reporting Entity ❑ Prime ❑ Subawardee Tier _ , if known Congressional District, if known 6. Federal Department/Agency: 3. Report Type: Da. initial b. material change For Material Change Only: yen- -- quarter_ date of last report 5. If Reporting Entity in No. 4 is Subawardee, Enter Nam and Address of Prime: Congressional District, if (mown 7. Federal Program Name/Description: CFDA Number, if applicable 8. Federal Action , •ho Eff mount, if known: 10. a. Name and. flees. Enti ls Performing Services (including (If itdivid ..Iasi. q . Firs , MI) different from No. ills) (last name, first name, MI) (attach Continuation Sheets) if necessary) 11. Amount of Payment (check all that apply) 13. Type of Payment (check all that apply) $ actual planned a. retainer b. one-time fee 12. Form of Payment (check all that apply): c. commission ea. cash d. contingent fee b. in-kind; specify: nature a deferred value f. other, specify 14. Brief Description of Services Performed or to be perforated and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated In Item 11: (attach Continuation Shect(s) if necessary) 15. Continuation Sheet(s) attached: Yes [] No I6. Information requested through this terra 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 Print Name: U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall he subject Title: to a civil penalty of not less than $10,000 and not mote than $100.000 for each such failure. Telephone No.: ___Date: Authorized for Local Reproduction ederal Use Only: Standard Form - LLL C-21 WOO FV 1213 areas Mambenarce Program Federal Prmlael BHL.S-6450(06a) Uutvrrr.estE rn16 rve 1. Type of Federal Action: © a. contract b. grant C. cooperative agreement d. loan c. loan guarantee f. 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 ❑ Subawardee Tier _ , if known Congressional District, if known 6. Federal Department/Agency: 3. Report Type: Da. initial b. material change For Material Change Only: yen- -- quarter_ date of last report 5. If Reporting Entity in No. 4 is Subawardee, Enter Nam and Address of Prime: Congressional District, if (mown 7. Federal Program Name/Description: CFDA Number, if applicable 8. Federal Action , •ho Eff mount, if known: 10. a. Name and. flees. Enti ls Performing Services (including (If itdivid ..Iasi. q . Firs , MI) different from No. ills) (last name, first name, MI) (attach Continuation Sheets) if necessary) 11. Amount of Payment (check all that apply) 13. Type of Payment (check all that apply) $ actual planned a. retainer b. one-time fee 12. Form of Payment (check all that apply): c. commission ea. cash d. contingent fee b. in-kind; specify: nature a deferred value f. other, specify 14. Brief Description of Services Performed or to be perforated and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated In Item 11: (attach Continuation Shect(s) if necessary) 15. Continuation Sheet(s) attached: Yes [] No I6. Information requested through this terra 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 Print Name: U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall he subject Title: to a civil penalty of not less than $10,000 and not mote than $100.000 for each such failure. Telephone No.: ___Date: Authorized for Local Reproduction ederal Use Only: Standard Form - LLL C-21 WOO FV 1213 areas Mambenarce Program Federal Prmlael BHL.S-6450(06a)