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BOSCO CONSTRUCTORS, INC.
Recording Requested By, And When Recorded Mail To: Recorded in Official Records, Orange County Clerk of the Council,City of Santa Ana 20 Civic Center Plaza,F.O.Box 1988 Hugh Nguyen, Clerk-Recorder Santa Ana,CA 92702 ICI III IIIII IIII III llli l II I I I I I I I IIII I I III NO F E E * $ R 0 0 1 1 4 1 4 1 9 6 $ * 2020000017126 8:13 am 01/15120 7 417 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.000.000.00 0.00 m_ _ (g T T NOTICE OF COMPLETION NOTICE IS HEREBY GIVEN that the undersigned City of Santa Ana, California, a municipal corporation, with the address of City Hall, 20 Civic Center Plaza, Santa Ana, California, 92701, is the owner of the property hereinafter described, that said owner has caused a construction of C-5-F Channel Repair under contract entered into on 06/18/2019 . Uwith Bosco Constructors Inc. , on which contract Hartford Fire Insurance Company_ is w surety. The property on which such work improvement was placed is in the City of Santa Ana, W ® County of Orange, State of California, and described as Project No. 18-6613 located at: o z south of First Street and north of McFadden Avenue . The work improvement on said Aproperty was accepted as completed on 08/29/2019. oW ulU CITY OF SANTA ANA,A MU 1CIPAL CORPORATION o by z Z Dated: a-fJ UG'�i C/l� TITLE ----------------------------------------------•__.-_._____-_------------------------------- CG, VERIFICATION p"1qA_W � I, the undersigned, say: I am the G w Y LL0,Pf616f the City of Santa Ana, California; I executed the foregoing N tice' f Completion acting on behalf of the owner of the property therein described; I make this verification on behalf of said corporation by authorization of the City Council of the City of Santa Ana; I have read said notice and know the contents thereof; and I declare under penalty of perjury that the facts therein stated are true. Executed on � "'� at Santa , California -l -- �7 (Signature of individual swearing that the contents of Notice of Completion are true.) THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10)DAYS AFTER COMPLETION California Newspaper Service Bureauo Dally Journal Corporalion Public Notice Advertising Since 193A Tel 1-800-788-7840 n Fax 1-800-474-9444 Lo'llow'"s aw Rrmenwem in: t.e Amer Santa AU, S.0 Mott, Hlowdwo. tinePraacis+va, oakianii,5wr I.W. Sac lww SpMO $vo,itvs A,Mble in Pfi,.flk I am a resident of Los Angeles County, over the age of eighteen years and not a party to any or interested in the matter noticed. The notice, of which the annexed is a printed copy appeared in the: REGISTER On the following dates: Apr. 30 & May 7,2019 I certify (or declare) under penalty of perjury that the foregoing is true and correct Dated at Los Angeles, California, this Zth day of _May 2019 Signature 3248437 "Tile only Public Notice which isjusiffi'able fio"t e., onovri-and ibepubtre inferest, is that which reaches these who are q1rectiv? In, it a. 04,15 Ury J...1 Oqvwkn 'A 5 1;.,,l Ro Suer, U,, MOo, CA 9W 12 * A a OS1 7 8 0 0 MAYOR Miguel Pulldo MAYOR PRO TEM JuanYllegas COUNCIL MEMBERS Cedlfalglealas David Penslote moenteSarmiento. 40se solono CITY OF SANTA ANA PLANNING &BUILDING AGENCY 20 Civic center Plata (M-20) P O. BOX 1998. Santa Ana,_Celifaoia 92702 (714) 067 2700 • Fax (714) 973.1461 www.santa•ana:org. CITY MANAGER Krialine Ridge CITY.ATTORNEY Sonia R.&arialho ACTING CLERK OF THE COUNCIL Norma Mitre -Ramirez m JUL 0 2 2019 ORANGECOUMYCLE COMER DEPARTMENT NOTICE OF EXEMPTION By: AEPM From the Requirements of the California Environmental dualltyAct (CEQA) Fee Exemption per California Government Code Section 6103 TO: COUNTY CLERK County of Orange P.O. Box 238 Santa Ana, CA 92702 ProjectTkle: C-5-F Channel Repair ProjectNumber(s): PWA-2019-849-CIP Project Location: 609 S Newhope St From: City of Santa Ana Planning & Building Agency 20 Civic Center Plaza M-20 SantaAna, CA 92702 pate of Approval: 06118/2019 City: Santa Ana County: Orange ER Numbers ER-201948 Project Description: Scope of work involves excavation, gracing, removal & replacement of Portland cement concrete.. Applicant Name: Tyrone Chesanek, City of Santa Ana Public Works Agency Applicant Addreas: 20 Civic Center Plaza M-22 SANTA ANA, CA 92701 Name of Public Agency Approving Project: City Council Name of Person or Agency Carrying Out project: Chesanek, Tryrone Exempt statue: 0 Ministerial (Seo.16966) 13 Declared Emergency (Sec. 15269 (a)) • Emergency Project (Sec.15269 (b'through e)) • General Rule (Sec 15W1(b)(3)/(5)) • Statutory Exemption: • Categorical Exemption: 15301(b) Reason(s) Why Project Is Exempt From CECA: Repair of existing facility. City Contact: Robert Aguirre Signature: Title: JUL 0 2 2N ORAaG6COUNTY OLER �4i/ CCGRO6RMPMM6NT Recorded In orrictaf Records, Orange County Hu h Nuyen, Clerk -Recorder III111111111111111111111111111111111111111111111111111111 NO FEE A $ R 0 0 1 0 A 4 6 1 1 $ * 20198500065210:25 am 07102/19 323 304 Z01 0.00 60.00 0.00 0.00 0.00 0.00 0.00 0.00 Telephone: (714) 647-5051 .19811AX44 LAMM Date: SANTAANA CITY COUNCIL MI"X FUMO durlVaegaa -,: vincante sanolento Jose S*& vacant '; DAM pwwe Cecas wool" M"w MftwPmT".Wwd5 Wwd1 Ward Wrd4 ;.. Wad ;: Ward -Yermlentoftreanlaene:am Isolwfa/9wMrane.ra..: ' - : *. eoenelmatlCunbru rn i tJutaAlaa®srea.aallre INSURANCE NOT ON FILE WORK MAY 01 PROCEED CLERK OF COUNCIL 6s, DATE: 6-47-19 CITY OF SANTA ANA Cj . pyvo ('a) CONSTRUCTION CONTRACT Z,,,��'"dym. C� PROJECT 18-6613 �'' `'' C-5-F CHANNEL REPAIR This CONSTRUCTION CONTRACT is made and entered into this 18th day of June, 2019 by and between the City of Santa Ana, California, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "CITY"), and Bosco Constructors, Inc. (hereinafter "CONTRACTOR"), WITNESSETH: The CITY and the CONTRACTOR, for the consideration hereinafter named, mutually agree as follows: CONTRACTOR agrees to perform all the work and furnish all the materials at its own cost and expense necessary to construct and complete in a good and workmanlike manner and to the satisfaction of the City Engineer of the CITY, the C-5-F Channel Repair Project (hereinafter referred to as the "WORK OF IMPROVEMENT") identified in and in accordance with the Contract Documents prepared by the City's Public Works Agency and approved by the City Council. The complete Construction Contract consists of the "Contract Documents" as defined by the Standard Specifications for Public Works Construction and which include the following: • Notice Inviting Bids • Information to Bidders • Bid Proposal • Bid Bond • Contract Form • Conti -act Bonds • General Provisions • Special Provisions • Technical Provisions and Project Plans • Community Workforce Agreement • Appendices In case of conflict between the Contract Documents, the precedence of documents shall be as established in the Standard Specifications for Public Works Construction. CITY agrees to pay and CONTRACTOR agrees to accept in full payment to complete the WORK OF IMPROVEMENT the sum total amount not to exceed One Hundred Sixteen Thousand Dollars ($116,000.00), as set forth and identified in the BID PROPOSAL, which is attached hereto and incorporated herein as Exhibit "A." The BID PROPOSAL contains a schedule of unit price(s) or lump sum(s) based on approximate quantities only, and the City does not expressly or by implication agree that the actual amount of work will correspond therewith, but reserves the right to increase or decrease the amount of any class or portion of the work or to omit portions of the work as may be deemed necessary or advisable. rev. 09/01/2017 Page 1. of 4. CONTRACTOR agrees to complete the WORK OF IMPROVEMENT within the time specified in the Time for Completion of Improvements section of the BID PROPOSAL (Exhibit "A") including commencing construction within the timefiame therein specified after issuance of a Notice to Proceed. 5. The CONTRACTOR will pay, and will require all subcontractors to pay, all employees on the WORK OF IMPROVEMENT a salary or wage at least equal to the prevailing salary or wage established for such work as set forth in the wage determinations for this work in accordance with applicable State and Federal law. . 6. If applicable, the CONTRACTOR shall adhere to the CITY'S Community Workforce Agreement (CWA), a pre -hire collective bargaining agreement, which establishes the labor relations policies and procedures for CONTRACTOR to follow in the crafts persons employed to complete the WORK OF IMPROVEMENT as more fully described in the CWA. The CWA may be found on the City's website at: ham://www.sani,i-ana.ora/ova/docurneiits/C`WA.ndf 7. CONTRACTOR shall, after award of this Contract, furnish two bonds to be approved by the CITY, one in the amount of One Hundred Percent (100%) of the Contract price, to guarantee the faithful performance of the work (Performance Bond), and one in the amount of One Hundred Percent (100%) of the Contract price to guarantee payment of all claims for labor and materials furnished (Payment Bond). This Contract shall not become effective until such bonds are supplied to and approved by the CITY. CONTRACTOR shall, prior to the release of the performance and payment bonds or the retention payment, furnish a warranty performance and payment bond (Warranty Bond). Said Warranty Bond shall also be required as a condition of project acceptance. For projects up to Five Hundred Thousand Dollars ($500,000), the Warranty Bond amount shall be the greater of Ten Thousand Dollars ($10,000) or Twenty Percent (20%) of the final contract price. For projects above Five Hundred Thousand Dollars ($500,000), the Warranty Bond arnount shall be the greater of One Hundred Thousand Dollars ($100,000) or Ten Percent (10%) of the final contract price. 9. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability Insurance and Worker's Compensation Insurance as outlined in the General Provisions, to be approved by the CITY. // Page 2 of 3 IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: /4f, l WIN FUNK Assistant City Attorney FUAD SA) Executive Public We FOR APPROVAL: PE, PLS Agency CITY OF SANTA ANA KRISTINE RIDGE City Manager CONTRACTOR: Bosco Constructors, Inc. PATRICK ROBINSON President/Secretary/Treasurer Page 3 of 3 City of Santa Ana C-5-F Channel Repair (18-6613), bidding on May 21, 2019 2:00 PM (Pacific) Exhibit A Page 1 Printed 05/21/2019 Bid Results Bidder Details Vendor Name Bosco Constructors Inc Address 21353 Mayall $t Chatsworth, CA 91311 United States Respondee Patrick Robinson Respondee Title President Phone 818-700-0304 Ext. Email bosco.constructor@gmail.com Vendor Type SBE,CADIR License # 972065 CA DIR Bid Detail Bid Format Electronic Submitted May 21, 2019 12:51:42 PM (Pacific) Delivery Method Bid Responsive Bid Status Submitted Confirmation # 178539 Ranking 0 Respondee Comment Buyer Comment Attachments File Title General Forms Ownership Affidavit Bid Bond Guaranty Non -Collusion Affidavit Line Items File Name General Forms.pdf Ownership Affidavit.pdf Bid Bond Guaranty.pdf Non -Collusion Affidavit.pdf File Type General Forms Ownership Affidavit (Notary Public) - REQ Original Hard Copy Submittal in Addition Bid Bond Guaranty (Notary Public) - REQ Original Hard Copy Submittal in Addition Non -Collusion Affidavit (Notary Public) - REQ Original Hard Copy Submittal in Addition Type Item Code UOM Qty Unit Price Line Total Comment Section 1 1 Remove and Construct PCC Slab (T-4") SF 8000 $14.00 $112,000.00 2 2 Sack Slurry Backfill CV 10 $400.00 $4,000.00 Subtotal $116,000.00 Total $116,000.00 PlanetBids, Inc. CITY OF SANTA ANA PROPOSAL PROJECT NO.: 1 8-6613 C-5-P CHANNEL REPAIR BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: 'Boveo # ansh + C. rir' � )nC.. REQUIREMENT: The undersigned bidder declares that they have carefully examined the location of the proposed work, that they have examined the Contract Documents in its entirety and hereby proposes to furnish all material and do all the work required to complete the said work in accordance with said plans (if any) and the specifications for the unit price(s) or lump sum(s) set forth in the following schedule: Item Description Qic Unit Unit Price Amount t Removcand Construct PCCSlab (T-4" l 8>000 Su $ 14.00 $ '112,000.00 2 2SaekS1urry1BaekFiu to 400.00 4,000.00 TOTAL SASE :BID $ 116,000.00 The lowest responsible bidder shall be selected based on the total base bid. The City reserves the right to award the Base Bid, and any, all, or none of the add -alternate bid items (if any). TIME FOR COMPLETION OF IMPROVEMENTS AND LIQUIDATED DAMAGES The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, within twenty-five (251 working ac�,ys after the commencement date stated in the Notice to Proceed. The liquidated damages amount, in lieu of the amount specified in Subsection 6-4 of the Standard Specifications, shall be $1,000 per calendar day. Name of Firm S 0'; c Q CO v,s i-r x -(, Wf -Q , In C Signature of BIDDER Titlesi'evt �cre { d"est,r (If an individual, so state. If a firm or co partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) P-1 ofP-l5 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 18-6613 C-5-F CHANNEL REPAIR OWNERSHIP AFFIDAVIT STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS: CITY OF SAgANTA ANA 11���� ) N4rtCK Lrl f� Sao , being duly sworn, deposes and says: ❑ INDIVIDUAL That he/she is the party making the foregoing proposal: %./� ❑ PARTNERSHIP That he/she is a member of the co -partnership firm designated as: and who has been and is duly vested with the authority to make and execute instruments for the co -partnership by: Pa— who constitute the other members of the co -partnership, CORPORATION That yhhee is of: (.,,_ �_ ) �,� ,±^ C;GCC% COVt.S '\Y 4l..0 "r Sty (wo-le a corporation which is making the foregoing proposal: ❑ JOINT VENTURE That he is of. 01/� one of the parties making the foregoing proposal as a joint venture, and the he/she has been and is duly vested with the authority to execute instruments for an on behalf of the parties making said bid who are: yr /a - that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion to secure any advantage against the City of Santa Ana or any person interested in the r " osed contract, for himself or any other person. f Signature of Bidder Subscribed and sworn to before me this day of �_ 20 1 Signature of officer Administering O r (Notary otary Public) P-5 ofP-15 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 c� .a•sae .rcr -ce m -.ae � .¢ c...ca•-arm �.. .ate./'_ �.v e-c..r— � c. : z�....¢x. x� -.e ....•a..e. a nR• 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 1. 'D5 On /�® Ir% 1 �% before me, 9-a," fan Se co - I -No { � �r i o A�/ �- Date Here insert Name and Tltle of the Officer personally appeared 1)s V\ C 6Y) Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the Instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. . _ . WITNESS my hand and official seal. i . RAFAEL rONSCCA 1R. Notary Puhlt LosAncjt4 Cu,ptly SIgnatur C �•� / /! Commission M 111'U1N +--� `'-' C"'•" My Comm. Expirr I n, an, zozz _ ` SignatuFe of Notary Public 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: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Sign®r(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner— ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: L1-t/. '✓4`.4•✓ •u4\':6L:Gu '✓4"� � .�� .� .�� .� .. 4C:,4L;4' 4':•/�• _- .�..41y'�4�✓,4L{'✓ -.v4C�: 'y4�,5�: a ur`:4 a �✓ CITY OF SANTA ANA PROPOSAL PROJECT NO. 18-6613 C-5-F Channel Repair KNOW ALL PRESENT that, Bosco Constructors Inc. , as BIDDER, and Hartford Fire Insurance Company , as SURETY, are held and firmly bound unto the CITY OF SANTA ANA, as AGENCY, in the penal sum of Ten Percent of Amount 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 a 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 WHEREOF the parties hereto have set their names, titles, hands, and seal this 16th day of May , 2019 , 21353 Mayall Street 818-306-3884 SURETY* Hartford Fire Insurance Company BC One Hartford Plaza Marie Hartford, CT 06155-0001 7�n i Subscribed and sworn to before me Signature: Notary Public in and for the County of this day of See attached ACKNOWLEDGMENT ,State of *Provide BIDDER/ SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. P-6 OF P-15 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT Civil Code § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. State of California ) ss County of Los Angeles ) On .MAY 16 ZU19 , before me, Patricia Arana, Notary Public, personally appeared Maria Pena who proved to me on the basis of satisfactory evidence to be the person44whose name{-s) is/are subscribed to the within instrument and acknowledged to me that 4e�sheA4ey executed the same in 44+ her/the;F authorized capacity4e-s4, and that by 4+s/herA, 4,e4- signature�o on the instrument the person{s4, or the entity upon behalf of which the person(o acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. m:�,aa�7Fr,P&�'"''A Wb &IAotaPubliciaLos• AngeleCommission1 Ply Comm. Expiros Nov 5, 2021 (Seal) Signature: Patriciaa, Notary Public Direct Inquiries/Claims to: POWER OF ATTORNEY TOne EHAffodPORD laza Hartford, Connecticut 06155 Bond,Chums(ithehartfortl con call: 888.266.3488 or fax: 860.757.5835) KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Code: SurePath XD Hartford Fire Insurance Company, a corporation duly organized under the laws of the State of Connecticut 0 Hartford Casualty Insurance Company, a corporation duly organized underthe laws of the State of Indiana Hartford Accident and Indemnity Company, a corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut 0 Twin City Fire Insurance Company, a corporation duly organized under the laws of the State of Indiana 0 Hartford insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois Q Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida having their home office in Hartford, Connecticut (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint Maria Pena of Los Angeles, CA their true and lawful Attorney -in -Fact, to sign its name as surety(les) only as delineated above by ®, and to execute, seal and acknowledge the following bond, undertaking, contract or written instrument: Bond No. Bid Bond on behalf of Bosco Constructors Inc. naming City of Santa Ana as Obligee in the amount of See Bond Form on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted In any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 6, 2015 the Companies have caused these presents to be signed by its Senior Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. 1}rr ry` app�n , y %pos,i'b tyq'h� Oz. V197a� John Gray, Assistant Secretary M. Ross Fisher, Senior Vice President STATE OF CONNECTICUT j } ss. Hartford COUNTY OF HARTFO RD } On this Ilth day of January, 2016, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and say: that he resides in the County of Hartford, State of Connecticut; that he is the Senior Vice President of the Companies, the corporations described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his name thereto by like authority. s',0 T. w 'y r4V/"I�CULCt IN PUBl1U O $, Kathleen T. Maynard eo NNE "' o Notary Publio CERTIFICATE My Commission Expires July 31, 2021 I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing Is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force effective as of May 16, 2019 Signed and sealed at the City of Hartford. r .�, swarnn.rr:1S 64✓!7n - _ e a''r'uu.'� a. �b1L+ :.v �: fine B� r. JraIMnR 197% R` i9• 1pr 7 It I.t'e 1 ^'Ry wy„ ;lam f 34T9 Kevin Heckman, Assistant Vice President SurePath POA 2016 • -NIA ALL-PURPOSE ACKNOWLEDGMENTOD .,a �e�a�c>a; %ca`eceea _ .r-ecarc�as�a.cx_w.r..au<..rcaa.•....•.� .c�a.�—..c.a-.v�.ac�a!<.aawc>...cv_a•_-..v�e_c..avcas. .� _.•�a�saa.v. 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 valldity of that document. State of California ) County of �-v -S PVka _eAA ) On S/-' 0/e6) � beforeme, ram, Y"e-,4 RZAI �et"ee -7'1^ Iy6%fy PM41 rc Date �} Herein rt Name and Title of the Officer personally appeared IDS CZ i�1 Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same In his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. RAFAEI rONSECA 1R. F`,�,°:. ` Notary Publlr C•�IfNniA `� � z S i �I Los Angeles County CommisslonA 21291dFl +rn� My Comm. Expires J+n 2 R, �t1dd I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. 1 Signature-�d"�����/'• � �� Signature of Notary Public 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: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner— ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: ., v ut..Jx .Y A t tn..... s �� CITY OF SANTA ANA PROPOSAL PROJECT NO.: 18-6613 C-5-17 CHANNEL REPAIR NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) 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. Note: The above Non -collusion Affidavit is part of the Proposal. BIDDERS are cautioned that making a false certification may subject the certifier to criminal Signed State of California Q�� County of Ltx, 14 ��_ $ubscribeA and sworn to (or affirmed) before me on this `V"'day of �, 20 �`P by Gt'i}1Cf� )hSDYI. , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me c� 3-7 Notary Public Signature r calCOUTAY cNsecn env Com n. LxPi�uy l�n Z820u P-10 ofP-15 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 ..¢be•.�. _ ,vCa..nX <. da... .�..n�..<�.... �eSeSJ- 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 _ La4 e Le , ) p On G /2.b I'ZO 1 I before me, f /} r _LP rc %1 C Iia0 )w✓�/ %�/h1/� Date Here Insert Name and Title of the Officer personally appeared �� C .b Jetty bv\ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. .- RAFA, EL F 0 N S I I IR. Notary P❑brir Los An9•ICs�r,U * ° Cornmission It ll?'' M ivly Comm. Explcts Jan 1H, Flll I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. ,y Signature ` e 1`z a Signature of Notary Public 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 Date: Signer(s) Other Document: Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Titie(s): ❑ Partner— ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: "y ✓tiS mi'✓-✓.�6C✓4'✓'u':g.•{.yti .•y�.y�.y ... .✓'yG✓i.`ua y.'✓.�. vr. rC:.' rL.:uS-u:'✓4•✓4L.5[✓.6't�S': r" 4L.5'✓:�':K�1.r'✓r✓.' CITY OF SANTA ANA PROPOSAL, PROJECT NO.: 18.6613 C-5-F CHANNEL REPAIR. TO: CITYCOUNCIL OF THE CITY OF SANTA ANA 0 The undersigned bidder declares that they have carefully examined the location of the proposed work, that they have examined the Contract Documents in its entirety and hereby proposes to famish all material and do all the work required to complete the said work in accordance with said plans (if any) and the specifications for the unit price(s) or lump sum(s) set forth in the following schedule: -Xtem Description Qty Unit Unit Price Amount I Remove and Construct ?CC Stab (T-4') 8,000 SF $ 14.00 $ 112,000.00 2 25ackSlurryBaakflll 10 C` $ 400.00 $ 4,000.00 TOTAL BASTE BID S 116,000.00 The lowest responsible bidder shall be selected based on the total base bid. The City reserves the right to award the Base Bid, and any, all; or none of the add -alternate bid items (if any). TIME FOR COMPLETION OF IMPROVEMENTS AND 1I0DIDATED DAMAGES The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, within twenty-five (25) working days after the commencement date stated in the Notice to Proceed. The liquidated damages amount, in lieu of the amount specified in Subsection 6.9 of the Standard Specifications, shall be $1,000 per calendar day. Name of Firm 'B 0e o CC vts i-rut, kur S, . 1n e. Signature of BIDDER Title Nr ;`cle V 1 `aecpt,8ry J-1"A.Q'% y4r (If an individual, so stated firm or co -partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) P-1 ofP-15 CITY OF SANTAANA PROPOSAL PROJECT NO . 18-6613 C-5-P CHANNEL REPAIR BIDDER'S STATEMEN BIDDER understands and agrees that: this Bid Proposal, Contract Documents and subsequent Construction Contract Agreement shalt constitute the entire agreement between BIDDER and the AGENCY only after it has been accepted by the City Council, endorsed by the Clerk of. the Council with her signature and official seal noting hereon the action of approval of the Council, signed by the Public Works Agency Executive Director or his/her duty authorized agent; and signed by the City Attorney, denoting his approval of the form of this document, and its execution, and when it or an exact copy of it has been either delivered to BIDDER or deposited with the United States Postal Service properly addressed to the BIDDER with the correct postage affixed thereto. BIDDER further agrees that upon delivery (as defined above) of the accepted agreement he/she will furnish AGENCY all required bonds and certificate of liability insurance within ten (10) business days or the funds; check, draft, or 13IDDEP S bond substituted in lieu thereof accompanying this proposal shall become the property of the AGENCY and shall be considered as payment of damages due to the delay and other causes suffered by:AGENCY because of the failure to furnish the necessary bonds: and because it is distinctly agreed that the proof of damages actually suffered is difficult to ascertain; otherwise said funds, check, drafts, or BIDDER'S bond substituted in lieu thereof shall be returned to the undersigned.. BIDDER understands that a'bid is required for the entire work, the estimated quantities set forth in the 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 BIDDER also certifies that the bid is a balanced bid. In accordance with Section 7028.15 of the California Business and Professions Code; the undersigned certifies under penalty of perjury that the foregoing is true and correct. Nameoflifini _._--(cvroraAc41 v a� Title r 5 t&Lh k I" r 1`Otw Y t 1 htth, S rte#" (If an individual, so state. If a firm or co -partnership, state the firm naive and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation,. and names of President, Secretary, Treasurer and'Manager, thereof.) P-2 ofP-15 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 18-6613 C-5-F CHANNEL REPAIR CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she and all his/her subcontractors are registered with the State of California Department of Industrial .Relations (DIR), and that the following is true and correct;. Contractor's Name: S p5 C 0 coy- S "t i" c A-C T s , In c . Business Address: 1'aa �i r�l S�, 1 S Wcc t t h CA 91311 Business E-flail Address: V S C?. W in S,4 r kk4% YYkA,1 l . C: o Vv'� Telephone: _ (: b 10.) r10 d " O'3 o q State Contractor's License No, and Class: © 1 A $ 15 License Expiration Date: j t ;L 0 State Dept. of Industrial Relations (DIR) Registration No.: 10 (D C) 0 ',)- 03 � Q State Dept. of Industrial Relations (DIR) Registration Expiration Date: Signed: Title: 012.011 P-3 ofP-15 -r(v S u CITY OF SANT'A ANA PROPOSAL PROJECT NO,: 18-6613 .. PROJECT C-S-F CHANNEL REPAIR PREVAILING WAGE COMPLIANCE AND MONITORING STATEMENT Contractor is aware of the requirements of California Labor Code Section 1720,;et seq., as well as California Code of Regulations, Title 8, Section 16,000, et seq., ("Prevailing 'Wage Laws'), which require the payment of prevailing; wage rates and the performance of other requirements on "public works" and "maintenance" projects. Since the services are being performed as part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and since the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at the commencement of this Agreement. Contractor shall make copies of the prevailing rates of per diem wages for each craft, classification or type of worker needed to execute the services available to interested parties upon request, and shall post copies at the Contractor's principal place of business and at the project site. Contractor shall defend, .indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out :of any failure or alleged failure to comply with the Prevailing Wage Laws; The undersigned certifies that the foregoing is true and correct. f Name of Firm P?0SC0 n'sA-rV C k0,(-S LIYIC« rtFarc� 10A Signature of BIDDER Title {if an P-4 of P-15 CITY OF SANTA ANA PROPOSAL PROJECT NO,: 18.6613 C-5-17 CHANNEL REPAIR OWNERSHIP AFFIDAVIT STATE OF CALirORNIA j COUNTY OF ORANGE j SS: CITY OF SANTA ANA 1 a'�1�'! ►�! ,26�1� , being duly: sworn, deposes and says:. ❑ INDIVIDUAL That he/she is the party making the foregoing proposal: Af — [] PARTNERSHIP That he/she is member of the co-parmership firm designated asi tLJ✓ and who has been and is duly vested with theauthority to make andexecute instruments for the copartnership by: who constitute the other members of the co -partnership, /CORPORATION That is of; fJ co a corporation which is making the foregoing proposal: ❑ JOINT VENTURE That he is of. ,> -,G F.uUa makng me roregoing proposal as a joint venture, and the he/she has and Is duly vested with the authority to execute instruments for an on behalf of the that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion to secure any advantage against the City of Santa Ana or any person interested in the Sro',ed contract, for i i •elfor any other person. -�t�:��.rASignaure of Bidder Subscribed and sworn to before me this 90 kM day of MAV 20 1 c% Signature of offiear Administering 061Ci (Notary public) P-5 ofP-15 ALL-PURPOSECALIPORNIA ,, .. A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certifioate'is attached, and not the truthfulness, accuracy,: or validity of that document, State of California county of-712t � } On s /u f w s- ;before ms, a t"o, -r^ -� Date , Here in art Name and This of the personally appeared PLAA v t C 1 a yj ,. who proved to me on the basis of satisfactory evidence to be the parson(s) whose name(s) istare subscribed to the within instrument and acknowledged to ms that he/she/they executed the same in his/her/their authorized capacityges}, and that by hts/hsrAhetralgnature(s) on the Instrument the person($), or the entity upon behalf of which the person(s) acted, executed the instrument, Nflt y 4 FONSECXle. NotarPublic-p8fumfa *MyCo ies C,ouMy 222.4728 trmA n28, 2e2T I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph Is true and oorrect. WITNESS my hand and official seal. Signature Signature of Notary Public Place (votary Seat Above OPffONAL Though this section Is optional, completing this information can dater alteration of the document or fraudulent reattachment of this form to an unintended document - Description of Attached Document' Titla or Type of booumenf: Document'pete: Number of Pages: Slgner(a) Other Than Named Above: Capacitypes) Claimed by Signer(s) • Partne Cl Individ • Trusts, • Other: Signer Is Signer"s Name: rr -- Tttla(s): n Corporate Officer — Title(s): nited q Qenerai ❑ Partner — E7 Limlted 0 General • Attorney in Fact 11 Individual C] Attorney In Fact • Guardian or Conservator 0 Trustee Ci Guardian or Conservator 0 Other: sting: Signer is Representing: 02016 National Notary Association . www,NationsiNotery.org -1.800•US NOTARY(1.800.876.6827) item#5907 1 C, CITY OF 5ANTA ANA PROPOSAL PROJECT NO. 18-6613 C-5-F Channel Repair KNOW ALL PRESENT that, Basco Constructors Inc, as BIDDER, and Hartford Fire Insurance Company as SURETY, are held and firmly bound unto the CITY OF SANTAANA, as AGENCY, In the penal sum of Ten Percent of Amount Bid Dollars ($ 1D"/u ), 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 a 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 WHEREOF the parties hereto have set their names, titles, hands, and.$eai this... 16th day of May 2019 BIDDER* t fIrTP, t 21353 Mayall Street Subscribed and sworn to before me this lay -of D Signature: See attached ACKNOWLEDGMENT Notary Public in and forthe County of , State of *Provide BIDDER/ SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. P-6 OF P-15 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT Civil Code § 1169 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 l j ss County of Los Angeles On 'MAY 16 2019 before me, Patricia Arana NotarvPublic, personally appeared Maria Pena �, who proved to me on the basis of satisfactory evidenteto be the person(S)whose name(4 Is/afe subscribed to the within instrument and acknowledged to me that h0she*ey executed the same in 44i herAheir authorized capacityfW4, and that by 44qherA4& signature} on the instrument the person¢s}, or the entity upon behalf of which the persons} acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official -seal. PATweinnwa+n NWarj Pubk-C"rnia s tasM9e�es CWMy CMml3abnY2220T61 My COMM. EWM Navy, 2021 (Seal) Signature; Patricia a, Notary Public Direct Inqulrles/Clalms to: POWER. OF' ATTORNEY TOne eH rRTdPlaza ORD Bond T•12 Hartford, Connecticut 06165 Boad.Ciaimaatbehanford,c m call; 880-266.3488 orfax: 860.757.6835) KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Code: SursPath tw��nw��sw��w�i�satwinswmaoiuuwouowrramwrmoomouuiomwuuauunnnmwomooitw mmni �ow�w��arwrwrww Hartford Fire Insurance Company, a corporation duly organized under the laws of the State of Connecticut Q Hartford Casualty Insurance Company, a corporation duly organized under the laws ofthe State oMdlana Hartford Accident and Indemnity Company, a corporation duly organized under the laws of the state of Connecticut ® Hartford u ridorwritors insured ca Company, a corporation duly organized under the laws of the State of Connecticut 0 Twin City Firo Insurance Company, a corporation duly organized under the laws of the State oflndiana ® Hartford insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois Hartford insurance Company of the Midwest, a corporation duly organized under the laws of The Statebf Indiana F -1 Hartford insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida altimeter collectively referred to as me -i Maria Pena of Los Angeles, CA their true and lawful Attorneydn•Fact, to sign Its name as surety(les) only as delineated above by 0,'and to execute, seal and acknowledge the following bond, undertaking, contract or written instrument; Bond No. Bid Bond on behalf of Bosco Constructors Inc. naming City of Santa Ana as Obligee In the amount of See Bond Form on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted In any actions or proceedings allowed by law, In Witness caused these preset Secretary. Further, I and will be bound by any mechanically applied signatures applied to this Power of Attorney,. fy. y 3�"` gg a�Yavr�* S ►vst a� � av"�"a it ,g e t�aiw.: �I �• 7,Jhnr r,v "aiwF c l079 c fa7s ,ye R411.- � j�.ta..s�s� t° •1 iwn *'hnN..s_ to to Of In Companies have by ifs Assistant John Gray, Assistant Secretary M. Ross Fisher, Senior Vice President STATE 01 CON N ECTICUT ss. Hartford COUNTY OFHARTFORD On this 11th day of January, 2016, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and say: that he resides In the County of Hartford, State of Connecticut; that he is the Senior Vice President of the Companies, the corporations described in and which executed theabove instrument; that he knows the seals of the said corporations; thatthe seals affixed to the said Instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of sold corporations and that he signed his name thereto bylike authority. ssfi"tb, •r •°unN�'. Kathleen T. M"rd �+necn Notary Public CERTIFICATE My Commission Expires July 31,2021 I, the undersigned, Assistant Vice President of the Companies, p0 HEREBY CERTIFY that the above and foregoing Is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force affective as of May 16, 2019 Signed and seated at the City of Hartford. w.n t "'�� 7lrinnra.f x hera+e r•,i fATO� y�fa7e� re7� 4r -A-,.. Kevin Heckman, Assistant Vice president SurePath POA 2016 OALIFORNIA ,< 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 Galt ornia } County of S On lO �2d) before me;Zi S'r' r rs, fir^ Gate t ere In ert Name and TJtla of th( personally appeared 171M,t)✓1 who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Is/are subscribed to the within Instrument nnri ank AWI rinaA +n M. +1"+ ewr:— - I- RAiAE NotagVublfr-California - LusAngeles County I Commission P 122Q728 MyComm.Expiroslan Y8,2eYy I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal, Signature egi - 9 Signature of Notary PuhlJo Place Notary Seal Above Op9" AM Though this section is optional, completing this information can dater afterstlon 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: Named Above: Gapacitypea) Clalmed by Signers) Signer's Name: 0 Corporate Officer - Titie(s): 11 Partner = El Limited d General C] Individual ❑ Attorney in Fact El Trustee ❑ Guardian or Conservator is Other. Signer is Representing: Signer's Nams: - Cl Corporate Officer Title(s)t 0 Partner -- CI Limited 0 General individuai 0 Attorney in Fact ❑ Trustee C1 Guardian or Conservator IJ Other: - Signer Is Representing: ------------,.. Notary Association • www.NatlonalNotary.org • 1.800•US NOTARY (1.800.876-6827) Item Ji6907 Jc CITY OF SANTA ANA PROPOSAL PROJECT NO.: 18-6613 C-5-F CHANNEL REPAIR LIST OF SUB -CONTRACTORS Section 41.00 et seq. of the Public Contract Code requires listing of all subcontractors with the bid for all subcontract work exceeding the following amount: o Streets, highways including bridge projects: '/A%ofthe bid or$10,000,whichever isgreater o Buildings, parks, or other projects: %a%of the bid Section 1725.5 of the Public Contract Code requires all Subcontractors be registered with the State Department of Industrial Relations (DIR). BIDDER proposes to subcontract certain portions of the work to the firms listed below: Name No Subcontractors License #/Exp. DIR Reg. #/Exp. Location Phone Type Of Work Amount $ Name License #/Exp. DIR Reg. #/Exp. License # Location Phone Type Of Work Amount$ Name License #/Exp. DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ -G Name License #/Exp. DIR Reg. #/Exp. Location Phone Type Of Work Amount $ Name License #/Exp. DIR Reg, #/Exp. License # Location Phone Type Of Work Amount $ Name License #/Exp. DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ P-7 of P-15 CITY OF SANTA ANA PROPOSAL, PROJECT NO.:18-6613 C-5-17CHANN LREPAIR The following are the names, addresses, and telephone numbers for J,,,,,,M E public agencies for which the BIDDER has performed similarwork within the past three ea . 1. h' Drviit e �GE+'krtiP ,l- �rtan uc�ri 4i�bn lam' 1St-, % OQk'2- Name and Address of owner. W A' *a,?y 6 VAtiCA Contract Amount Type of Wor c t %�b i Date Completed (3 /I Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. P-8 of P-15 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 18-6613 C-5-F CHANNEL REPAIR PaDDITIONAL REFERENCES The following are the names, addresses, and telephone numbers for which the BIDDER or Subcontractor has performed similar Work 'n vz o,"Y-\'t N.1 2, C1'kl 0- " J?bfV Contract Amount 3. i� _,lss',=I t,.*�16) ,7q&---qz:o ierson amiliarwith project: Type of Work ier+son familiar ``with project. agencies for / n-016 Date Completed 67 Lza, R Date Completed a Mn a. L Avtp, 1 i�d3 0, -120ie l "a Q wlllvw cu The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. WVS P-9 of P-15 qq S-ayp CITY OF SANTA ANA PROPOSAL PROJECT NO.: 1$-6613 C-5-F CHANNEL REPAIR NON- ODUS QN "gyp„ IDAY11 (Title 23 United States Code Section 112 and Public Contract Code Section 7106) In conformance with Title 23 United States Code Section 112 and Public Contract Coda 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 Bx 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. Note; The above Non -collusion Affidavit is part of the Proposal. BIDDERS are cautioned that making a false certification May subject the certifier to criminal riYne�ihtim. Signed State of California County of li°�', ubscribe and sworn to (or affirmed) before me on this r_h day of 2� by C/G �SOn_ _ _ , proved to me on the basis of satisfactory evidence to be the persons) who appeared before me Notary Public Signature Notary S a RAFAEL FON5ECAM. Notary Public - California lOs Angeles Coonty - Commission a 2229720 My Comm. Expires Jon 28, 2022 P-10 ofP-15 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 Cf .. ,'id. v\3S •:.ti i - Y.t ii ..\'. - .� Jhw aS u\ .. / w. w ...nu id ' Ki�3.mvs\ .c:✓ritA� t\<: \ / JaY...v...F 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 LI& St � 1 On J ko / 2y-y -6 i cl before me, �'� -� �(` � e e-e,-Tr , iy ti fe;� r Date Here Insert Name and r1de of the Officer Personally appeared'1 who proved to me on the basis of subscribed to the within Instrument i his/her/their authorized capacity(les), E or the entity upon behalf of which the QRAFAEL P0N5ECA JR.. MYCOMM.Ex Notary Public -California LasAngeles County _ Commisslon N Pines222J"I972a2022 i evidence to be the person(s) whose name(s) Is/are edged to me that he/she/they executed the same in 3/her/their slgnature(s) on the Instrument the oereonfsl. ;ted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph Is true and correct, WITNESS my hand and official seal, Signature_r 41. Signature of Notary Public 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: . Signers) Other Than Named Above: Capscity(fes) Claimed by Signer(a) Signer's Name: • Corporate Officer - Title(s); • Partner * ❑ Limited © General •Individual 13 Attorney In Fact ❑ Trustee p Guardian or Conservator • Other: Signer Is Wepresenting: Number of Pages: Signer's Name: Corporate Officer — Titie(s): Partner — O Limited 0 General b Individual J Attorney In Fact ❑ Trustee ❑ Guardian or Conservator 13 Other: Signer Is Representing; W2016 Natlonal Notary Assoclatlon - www,NationalNotary.org 1-800-US NOTARY (1- -800878.6827) Item 45907 CITE' OF SANTA ANA PROPOSAL PROJECT NO.: 18-6613 C-5-1F CHANNEL REPAIR NON-DISCRIMINATION CERTIFICATE The undersigned contractor or corporate officer, during the: performanceof 'this contract; certifies as follows: I. The Contractor shall not discriminate against any employee or applicant for employment because of race; color, religion, sex, or national origin. The Contractor shall take affirmative action to ensure that applicants are employed, and that employees are 'treated during employment without, regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to, the following: cmployment, 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. The Contractor agrees to post in conspicuous places,, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause: 2. The Contractor shall, in all solicitations or advertisements for employces placed by or on behalf of the Contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. 3. The Contractor shall send to each labor union or representative of workers with which he/she has :a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 4. The Contractor shall comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rates, regulations, and relevant orders of the Secretary of Labor. S. The Contractor shall furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with such rules, regulations, and orders. 6, In the event of the Contractor's nova -compliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole or in part and the Contractor may be declared ineligible for further Government contracts or federally assisted construction contracts: in accordance with procedures authorized in Execution Order 1 I Z46 of September 24,1965, and such other sanctions maybe imposed and remedies invoked as provided in Executive Order 11246 of September 24 1965, or by rule,regulations, or order of the Secretary of Labor, or as otherwise provided by lase. P-1 I of P-15 CITY OF SANTA ANA PROPOSAL PROJECT NO. 18-6613 C-5-17 CHANNEL REPAIR. The Contractor shall include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontract or purchase order as the administering agency may direct as means of enforcing such provisions, including sanctions for noncompliance; provided, however, that in the event the Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, the Contractor may request that the United States enter into such litigation to protect the interests of the United. States. 8. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as amended, no discrimination shall be made in the employment of persons upon public works because of race, religious creed, color, national origin, ancestry, physical handicaps, mental condition, marital status, or sex of such persons, except as provided in Section 1420, and any contractor of public works violating this Section is subject to all the penalties imposed for a violation of the Chapter. Signed: l -a f� ..< Title: py-t0>1.n+ ' Firm: O&C O C o'Y�SwLt C. k T s rn C, Date:�'d� P-12 ofP-15 CITY OF SANTA ANA PROPOSAL PROJECT NO..18-6613 C-5-17 CHANNEL REPAIR SIAMffiNT Mq&MING APPRE nUSHLPRP UI . — TS The undersigned BIDDER is familiar with the requirements of Section 1777.5 of the State Labor Code regarding employment of apprentices, and understands that contractors on contracts exceeding $30,000 or 20 working days shall: 1. Apply to the joint apprenticeship committee administering the apprenticeship standards of the craft or trade in the area of the site of the public work for a certificate approving the contractor under the apprenticeship standards for the employment and training of apprentices in the area or industry affected. 2. Employ the number of apprentices or the ratio of apprentices to journeymen stipulated in the apprenticeship standards. 1 Contribute to the fund or funds in each craft or trade in which he/she employs, journeymen or apprentices on the public work, in the same amount or upon the same basis and in the saint manner as the other contractors, except contractors not signatory to the trust agreement shall pay'a like amount to the California Apprenticeship Council. Signed: � � Title: WV;4 S Firm: fi Date: EAD j201 P-13 ofP-15 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 18-6613 C-5-F CHANNEL REPAIR STATEMENT REGARDING "ANTI -KICKBACK REQUIREMENTS The undersigned is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the Copeland "Anti -Kickback" Act (18 USC 74) as supplemented in the Department of Labor regulations (29 CFR, Part 3). This act provides that each contractor or subcontractor shall be prohibited from inducing, by any means, any person employed in the construction or repair of public work, to give up any part of the compensation to which he/she is otherwise entitled. Signed; �_ t g` k Title: } �.5 Firm: ac&c ry Date: � b o f aq P-14 ofP-15 CITY OF SANTA ANA PROPOSAL PROJECTNO : 18-0613 C-5-F CHANNEL REPAIR C CONTRACT CODE SECTION 10162 OUESTIONNA, In conformance with Public Contract Code Section 10162, the BIDDER shall complete, under penalty of perjury, the following questionnaire: Ilas the BIDDER, any officer of the BIDDER, or any employee of the 13IDDBR who has a proprietary interest in the BIDDER, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local ;government project because of a violation of law or a safety regulation? Yes _ No 1 If the answer is yes, explain the circumstances in the following space: P-15 ofP-15 MAYOR Miguel A. Pulido MAYOR PRO TEM Juan Ville as COUNCILM@MSERS Cacllta Iglesias David Penaloza Vleents Sarmiento Jose solodo PUBLIC WORKS AGENCY 20 Civic Center Plaza (M-22) Santa Ana, California 92701 W9yw aenla•ane oP4 May 15, 2019 •t►: UIPPIkyj♦ e SUBJECT: PROJECT NO.1B-6613: C-S-F CHANNEL REPAIR The following changes have been made for the subject project:: "� 1. Replace plan sheets 2 of 4, 3 of 4, and 4 of 4. All other terms and conditions remain the same, FOR THEE Sad`( OF SANTAANA M Civil SANTA ANA CITY COUNCIL CITY MANAGER Krlttlne Ridge CITYATTORNEY Sonia R. Carvaiho :ACTING CLERK OF THE COUNCIL Norma Mitre �► t+'ra�g�—_ M10" A PWMa June Vllagna taunt. Sara unto Paid Pension Joe# Bolono vaunt Caua 10,413, Maw Mayor Pro I. Woos Ward Want Waro3 Waldo Wmle ryjuatuJiltaitn2.uneout gag(faan n(ffiaeMa.ana nra aOl UQUalaim m 22la±aeGAWWAUSta MAYOR Miguel A. Pultdo MAYOR PRO TEM Juan Villegas COUNCILMEMSERS Cecilia Iglesias David Panaloza Vicento Sarmlento Jose soiorb CITY OF SANTA ANA PUBUC WORKS AGENCY` 20 We Cellar Plaza (M 22) Santa Ana, Cellic mla W701 wwwsanta-ar ears May 13, 20'19 r•-��I kyj 11110 loxQ SUBJECT: PROJECT NO.18.6613: C-6-F'CHANNEL REPAIR The following changes have been made for the subject project; Revision 1. Replace all pages of Appendix G, Wage Rate. All other terms and Conditions remain the same. FOR THE CITY OF SANTA ANA T no Chesanek; P.E. Principal Civil Engineer SANTA ANA CITY COUNCIL CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho ACTING CLERK OF THE COUNCIL Norma: Mitre ftW A: PWIdo .AHn Vftn Vicente aermiema antes Peoalaes im s"o Vaunt C.eCae 1pWas eiayor Mryor Pro Tan,Wwds wellt WWI wards Wrdit wattle IX9 tlmetl p nana=n,-...�. Bosco Constructors, Inc. 21353 Mayall St. Chatsworth CA, 91311 C-S-F Channel Repair Project No. 18-6613 Bid Due 5/21/2019 @2PM "Bid Bond, Ownership Affidavit and Non -Collusion Affidavit" City of Santa Ana Public Works Agency 3,d Floor Ross Annex, 20 Civic Center Plaza Santa Ana, CA 92701 CITY OF SANTA ANA BONDS PROJECT NO.: 18-6613 Bond No.: 72BCSHK5927 C-5-F CHANNEL REPAIR PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS that Bosco Constructors Inc. as CONTRACTOR, and Hartford Fire Insurance Company a corporation, organized and existing under the laws of the State, and duly authorized to transact business under the laws of the State of California, as SURETY, are held and firmly bound unto the City of Santa Ana, as AGENCY, in the penal sum of One Hundred Sixteen Thousand and No/100 Dollars ($ 116,000.00 ), which is 100 percent of the total contract amount for the above stated project, for the payment of which ,sum, CONTRACTOR and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated June 18, 2019 for Project No.: 18-6613 C-5-F Channel Repair if CONTRACTOR or any subcontractor fails to pay for any labor or material of any kind used in the performance of the Work of Improvement to be done under said Contract Agreement, or fails to submit amounts due under the State Unemployment Insurance Act with respect to said labor, SURETY will pay for the same in an amount not exceeding the sum set forth above, which amount shall insure to the benefit of all persons entitled to file claims under the State Code of Civil Procedures; provided that any alterations in the work to be done, materials to be furnished, or time for completion made pursuant to the terms of the contract documents shall not in any way release either CONTRACTOR or SURETY, and notice of said alterations is hereby waived by SURETY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 27th day of June 20 19 Bosco Constructors Inc. CONTRACTOR* 21353 Mayall Street. Chatsworth, CA 91311/818-306-3884 Hartford Fire Insurance Company SURETY* 'Oggl?n�te Drive• Brea, CA 92821/714-674-1307 Subscribed and sworn to before me, See attached ACKNOWLEDGMENT this day of 20 Signature: 7M Notary Public in and for the County of , State of Rate of premium on this bond is $ Included on tee Faunae Performance Bond per thousand. Total amount of premium charge is $ N/A . To be filled in by Surety *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. 2 of 3 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT Civil Code § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. State of California ) ss County of Los Angeles ) On J'UN 2 7 ?011 before me, Patricia Arana, Notary Public, personally appeared Maria Pena , who proved to me on the basis of satisfactory evidence to be the persons}whose name(3 is/aee subscribed to the within instrument and acknowledged to me that 4e{she/44ey executed the same in N&/her4heif authorized capacitykes, and that by 4ighery 4ei* signature(- on the instrument the personks}, or the entity upon behalf of which the person{s4 acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. re-7"I PATRIGIAARANA z Notary Public - Calilornia 'va• ^� Los Angeles GOO o •` � CemmisslonR 22207812021 [ 7]Y�'"f. My Comm. Expires Nov 5, 1� (Seal) ve Signature: �r Pa °ct Arana, Notary Public Direct Inquiries/Claims to: THE HARTFORD BOND, T-12 POWER OF ATTORNEY HartfOne ord, Connecticut 06155 Bond.Cl aim sCalthehadford. icon call. 888-266-3488 or fax. 860-757-5835 Agency Name: ALLIANT INSURANCE SERVICES INC KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Code: 72-256704 0 Hartford Fire Insurance Company, a corporation duly organized under the laws of the State of Connecticut 0 Hartford Casualty Insurance Company, a corporation duly organized under the laws of the State of Indiana Hartford Accident and Indemnity Company, a corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut Twin City Fire Insurance Company, a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois Hartford Insurance Company of the Midwest, a corporation duty organized under the laws of the State of Indiana Hartford Insurance Company of the Southeast, it corporation duly organized under the laws of the State of Florida having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint, up to the amount of Unlimited : E. S. Albrecht Jr., Patricia S. Arena, Tiffany Coronado, C.K. Nakamura, Maria Pena, Noemi Quiroz, Jeffrey Strassner, Lisa L. Thornton, Tim M. Combo, Natalie K. Trofimoff of LOS ANGELES. California their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 6, 2015 the Companies have caused these presents to be signed by its Senior Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. 01 ♦ t r � !,'� an Ja" ra twA� ., tgisi'S 1179 F\�i 914 ''� � ..qv '«w..o .p x'rg• non Ik John Gray, Assistant Secretary STATE OF CONNECTICUT Hartford COUNTY OFHARTFORD M. Ross Fisher, Senior Vice President On this I Ith day of January, 2016, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and say: that he resides in the County of Hartford, State of Connecticut; that he is the Senior Vice President of the Companies, the corporations described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his name thereto by like authority. r NoraNL Sa mlm NotaryPublic CERTIFICATE My Commission E,n,r Mnch 31, 2018 I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and fore oing is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force effective as of pf pR.! Signed and sealed at the City of Hartford. JUN toµ''4i as'.rw, elm; "cmn'"m ins. I67 Kevin Heckman, Assistant Vice President ron"IG CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the Identity of the individual who signed the document to which this certificate Is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Los Angeles On 3 Z�I — before me, _ Date Here Insert Name and Title of the Officer personally appeared Patrick Robinson Rafael Fonseca Jr - Notary Public Name(s) of Signers) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same In his/her/their authorized capacity(les), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the persons) acted, executed the instrument. RAFAEL FONSECA JR. -; Notary Public - California z Los Angeles County r Commission # 2229728 My Comm. Expires Jan 28, 2022 111 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph Is true and correct. WITNESS my hand and official seal. Signature Signature of Notary Public 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: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Tifle(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: Number of Pages: Signer's Name: ❑ Corporate Officer — Titie(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: _ 02016 National Notary Association - www,NatlonalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 CITY OF SANTA ANA BONDS PROJECT NO.: 18-6613 C-5-F CHANNEL REPAIR FAITHFUL PERFORMANCE BOND Bond No.: 72BCSHK5927 Premium: $1,573.00 KNOW ALL MEN BY THESE PRESENTS that Bosco Constructors Inc. as CONTRACTOR, and Hartford Fire Insurance Company a corporation, organized and existing under the laws of the State, and duly authorized to transact business under the laws of the State of California, as SURETY, are held and firmly bound unto the City of Santa Ana, as AGENCY, in the penal sum of One Hundred Sixteen Thousand and No/100 Dollars ($ 116.000,00 1, which is 100 percent of the total contract amount for the above stated project, for the payment of which sum, CONTRACTOR and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated June 18, 2019 for Project No.: 18-6613 C-5-17 Channel Repair if CONTRACTOR faithfully performs and fulfills all obligations in the performance of the Work of Improvement to be done under said Contract Agreement in the manner and time specified therein, then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor of AGENCY; provided that any alterations in the obligations or time for completion made pursuant to the terms of the contract documents shall not in any way release either CONTRACTOR or SURETY, and notice of such alterations is hereby waived by SURETY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 27th day of June 2019 Bosco Constructors Inc. CONTRACTOR* 21353 Mayall Street, Chatsworth, CA 9131.1/818-306-3884 Subscribed and sworn to before me, See attached ACKNOWLEDGMENT , this day of Signature:��� Notary Public in and for the County of Rate of premium on this bond is $ _ Total amount of premium charge is $ State of perthousand. To be,filled in by Surety *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. 1 of 3 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT Civil Code § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. State of California ) ss County of Los Angeles ) On JUU `dam° 7 201 before me, Patricia Arana, Notary Public, personally appeared Maria Pena , who proved to me on the basis ofsatisfactory evidence to be the personf4whose namek4 isAal�e subscribed to the within instrument and acknowledged to me that he/she they executed the same in 4isfherA4e4 authorized capacity4es4, and that by 4is/her74hem signature(} on the instrument the personk4, or the entity upon behalf of which the person{s4 acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. PAT��ANAI Notary Public-Celilornia °r. S Los Angeles County i -' Commission k 2220761 My Comm. Expires Nov 5, 2021 (Seal) r— Signature: Pat si Arana, Notary Public CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary publlc or other officer completing this certificate verifies only the Identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Los Angeles On % 9 hZO f I before me, _ Date Here Insert Name and Title of the Officer personally appeared Rafael Fonseca Jr - Notary Public Patrick Robinson Name(s) of Signer(S) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within Instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(les), and that by hls/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. RAFAEL FONSECAJR. Notary Public - California i ; < Los Angeles County Commission q 222972l1 My Comm, Expires Jan 28, 2022 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph Is true and correct. WITNESS my hand and official seal. 1 Signature Signature of Notary Public 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: Signers) Other Than Named Above: Capaclty(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 02016 National Notary Association - www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 To: From: Kristine Ridge City Manager Nabil Saba, Acting Executive Director Public Works Agency Subject: Project No. 18-6613: C-5-F Channel Repair _Change Order No 1 Date: January 9, 2020 CONTRACTOR: Bosco Constructors, Inc. 21353 Mayall Street Chatsworth, CA 91311 PROJECT DESCRIPTION: Project No. 18-6613: C-5-F Channel Repair CHANGE ORDER NUMBER: 1 ACCOUNTING UNIT -ACCOUNT -ACTIVITY NUMBER: JUSTIFICATION EXTRA WORK AT AGREED PRICE CHANGE ORDER AMOUNT: $11,000.00 12217331-66220-18661303028 1. During construction it was found that certain sections of the existing concrete channel walls were thicker than anticipated and required additional excavation. To compensate the contractor for the additional wall thickness removal. ACCOUNTING UNIT COSTANALYSIS Funding source 1 muergency and Health Grants Fund CONTRACT COST SUMMARY Account Unit 12217331-66, Amount Original Contract Total $ 116,000.00 Construction Contingency $ 11,011.00 Previous Change Orders $ 0.00 Change Order#1 $ 11,000.00 Adjusted Contract Total $ 127,000.00 Increase AGREED PRICE: $11,000.o0 TOTAL Amount $11,000.00 11 000.0 % of Contract 0.00% Q AAo% 9.48% CITY OF SANTA ANA PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project No. 18-6613: C-5-F Channel Repair Change Order Number 1 To Bosco Constructors, Inc. Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise staled, rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by EXTRA WORK AT AGREED PRICE PUBLIC WORKS AGENCY 1. Remove existing additional concrete channel wall thickness. AGREED PRICE: $11,000.00 The compensation both time and cost set forth in this change order comprises the total compensation due the Contractor, all Subcontractors, and all Suppliers for all work performed per this change order, including impact on unchanged work. By signing this change order, the Contractor acknowledges and agrees on behalf of himself, all Subcontractors, and all Suppliers, that the stipulated compensation includes payment for all work contained in this change order, plus all payment for interruption of schedules, extended field overhead, home office overhead, profit, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract. The signing of this change order constitutes full mutual accord and satisfaction for all changes and work performed on this project, and that the time and cost paid per this change order constitutes the total equitable adjustments owed the Contractor, all Subcontractors, and all Suppliers for all work performed on this project. The Contractor on behalf of himself, all Subcontractors, and all Suppliers agrees to waive all rights, without exception or reservation of any whatsoever to file any further claim related to this project. TOTAL COST THIS CHANGE ORDER: DECREASE $ INCREASE $ 11,000.00 By reason of this order the CONTRACT TIME completion will be adjusted as follows: Ten (10) Working Days We the undersigned contractor have given careful consideration to the change proposed and hereby agree, If this proposal is approved, that we will provide all equipment, furnish all materials, except as may otherwise be noted above, and perform all service necessary for the work above specified, and will accept as full payment therefor the prices shown above. . Accepte Date t ( contractor Bosco Constructors, Inc. By � Title F5 (�GY P cr Approval recommended by4 //'� k- C. ----t `V G 1, r Date t 717aZ6 PUBLIC WORKS AGENCY EXECUTIVE DIRECTOR Approved by it Date CITY MANAGER Page 1 of 1