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iBUILD SPECTRUM (2)
�J Recording Requested By, And When Recorded Mail To; Recorded in Official Records, Orange County City of Santa Ana Public Works Agency,M-22 Hugh Nguyen, Clerk-RecorderI I 11111 III III III'11 'i11 IlI IIII�� II'�'II El 1111111N° ��� 20 Civic Center Plaza Santa Ana,CA 92701 * $I R 0 0 1 1 6 4 3 5 0 6 s * 2020000186913 12:07 pm 04/24120 93 410A N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.000.,000.00 0.00 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 construction of SARTC SOUTH RESTROOM RENOVATION under contract entered into on 06/18/19, with Turn Around Communication dba. iBuild Spectrum, on which contract Old vA Republic Surety Company is surety. The property on which such work improvement was placed is in the City of Santa Ana, County of Orange, State of California, and described as Project No. o z 20-7531 located at: Santa Ana Regional Transportation Center. The work improvement on said A X property was accepted as completed on 09/13/19. CITY OF SANTA ANA,A MUNICIP CORPORATION o by z Dated: ��`�r!�° Senior Civil Engineer—Michael O r� TrrLE wOaG ------------------------------------------------------------------------------------------- CC VERIFICATION 1, the undersigned, say: I am the City Engineer - Edwin"William"Galvez of the City of Santa Ana, California; I executed the foregoing Notice of 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 �` �' ���d ,at Santa Ana,California (Signature of individual sweari t the contents of Notice of Conipleti are true.) CEIVED �AA„T1 E OF MPLETION MUST BE RECORDED WITHIN TEN(10)DAYS AFTER COMPLETION 77Y: The Orange County Register 2190 S. Towne Centre Place Suite 100 Anaheim, CA 92806 714-796-2209 6211379 CNSB / CNSB-ACCOMMODATIONS 915E1STST ORDER EXPEDITING LOSANGELES, CA 90012-4050 FILE NO.3248469 AFFIDAVIT OF PUBLICATION STATE OF CALIFORNIA, SS. County of Orange I am a citizen of the United States and a resident of the County aforesaid; I am over the age of eighteen years, and not a party to or Interested in the above entitled matter. I am the principal clerk of The Orange County Register, a newspaper of general circulation, published in the city of Santa Ana, County of Orange, and which newspaper has been adjudged to be a newspaper of general circulation by the Superior Court of the County of Orange, State of California, under the date of November 19,1905, Case No. A-21046, that the notice, of which the annexed is a true printed copy, has been published in each regular and entire issue of said newspaper and not in any supplement thereof on the following dates, to wit: 04130/2019, 05/07/2019 I certify (or declare) under the penalty of perjury under the laws of the State of California that the foregoing is true and correct: Executed at Anaheim, Orange County, California, on Date: May 07, 2019. Signature PROOF OF PUBLICATION Legal No. 0011264457 illllllllll lull lull 0lill0 llll�llll lull lull lllllllll lull llllllli� a».,vsne MAYOR Miguel A. Pulido MAYOR PRO TEM Juan Villages COUNCIL MEMBERS Cecilia Iglesias €David Penaloza Vicente Sarmiento Jose Solorlo CITY OF SANTAANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza (M-20) P.O. BOX 1988-Santa Ana, California 92702 (714) 667-2700 • Fax (714) 973.1461 v santa-ana.org NOTICE OF EXEMPTION CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Canralho ACTING CLERK OF THE COUNCIL Nonna Mitre -Ramirez 1 083TED JUL I 1 2019 ORANGE COUNTY OLERKInECOROEN ORPAIMMINT BY., From the Requirements of the California Environmental Quality Act (CE0A) To: COUNTY CLERK From City of Santa Ana County of Orange Planning & Building Agency P.O. Box 238 20 Civic Center Plaza M-20 Santa Ana, CA92702 Santa Ana, CA92702 Project Title: SA Regional Transportation Ctr South RR Date of Approval 07/02/2019 ProjectNumber(s): PWA-2019-994-CIP Project Location: 1 Ci[ Wide (Partial) City: Santa Ana County: Orange ER Number: ER-2019-55 Project Description: Minor alteration of existing facility Applicant Name: Suzi Furjanic Applicant Address: 20 Civic Center Piz SANTA ANA, CA 92701 Name of Public Agency Approving Project: City Council Name of Person or Agency Carrying Out Project: Furjanic, Suzi Exempt Status: El Ministerial (Sec. 15268) • Declared Emergency (Sec. 15269 (a)) • Emergency Project (Sec. 15269 (b through e)) • General Rule (Sec. 15061(b)(3)/(5)) Q Statutory Exemption: • Categorical Exemption: 15301 Reason(s) Why Project is Exempt From CEQA: Renovation does not expand use FILED JUL 11 2019 ORANGE COUNTY CLEPA-REECC�ORDER DEPARTNENT BY: 8 Yf F DEPUTY Recorded in Official Records, Orange county Hu h Nguyen, Clerk -Recorder IIIIIIIIIIIN IIIIIIIIIIJEJ11Jill IIIIIIIII1NIII1I NO FEE *$ R 0 0 1 0 9 6 6 7 5 9 s 20198600067410:03 am 07/11/19 323 304 Z01 0.00 60.00 0,00 0.00 0.00 0.00 0.00 0.00 City Contact: Suzi Furjanic Telephone: (714) 571-4241 G} Signature: .✓ Title: 6✓SGL, f%6 /°/4'"Ap_ Date: ZA - A7. �/- SANTA ANA CITY COUNCIL Miguel A Pulido Juan Vlllegas Vincente Ssnniento Jose Soloro Mayor Mayor Pro Tom, Wards Ward Werda muuiidoftmlaa-one am iyjll�a�(�n=n ro vsarmlen[aCmsanta-ana.oro j 15Rorlo/�Santaana.nra Vacant David Penaloza Ce6lia tglesias Ward4 Ward Ward Ong,���n1a-ana.oracialesiss/afraMa-ana om hSURANCE NO'r ON FILE ORK MAY NOT PROCEED CLERK Of COUNCIL CITY OF SANTA ANA d :PN►p f® DATE: /7 CONSTRUCTION CONTRACT PROJECT 20-7531 RE, GZOIVAL.TRANSPORTATION,CENTER°SOUTH RESTROOM RENOVATION, This CONSTRUCTION CONTRACT is made and entered into this 18`s 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:Catifomia (hereinafter "CITY',, and.iBuild Spectrum (hereinafter "CONTRACTOR"), x ., ATMSSETH: The CITY and,the CONTRACTOR, for the considerat onherefnaf(gr named,,mutually,agree as follows: 1. CONTRACTOR agrees to perform all the work and lfumisia all the materials at its own cost and expanse necessary to construct and complete' in` a,` good, ands workmanlike manner and to the satisfactfon of the City Engineer of the'CITY the Santa Ana' Regional Transportation Center South Restroom Renovation 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. 2. 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 ti • "'Information to Bidders Bid Proposal • Bid:Bond • _Contract Form' gontractBonds , i "*-�GeneralrProvisions 1 , a�14W, ,Special ]Provisions •' , Technical Provisions and Project.Plans , ,,>• Cotnmunity Workforce Agreement Appendices In case of.:conflict between -the Contract Documents,i'the'.precedence °of documents shall be as established in the Standard Specifications for Public Works Construction. 1 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 Eighty -Seven Thousand Dollars and No Cents ($187,000.00), 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 on -tit portions of the work as may be deemed necessary or advisable. rev. 09/01/2017 Page 1 of 3 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 timeframe 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 V ht!p://www.santa-ana.org/2ia/d6cuments/CWA.pdf, 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%5) 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; 8. 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 amount 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: NORMA MITRE Acting Clerk ofthe Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By. i P�1 Vy J EN FUNK AssistaneCity Attorney REC ENDED FOR APPROVAL,; FU WEISS, PE, PLS Executv Director PublicZ ks Agency CITY OF SANTA ANA STTNE RfbGf City Manager CONTRACTOR: iBuild Spectrum �irtba :�v NAME: TITLE; (n� G—o , r—��, Page 3 of 3 City of Santa Ana Pagel ' Santa Ana Regional Transportation Center South Rastmom Renovation (20.7531), bidding on May 21, 2019 2:00 PM Panted 06/21/2019 Bid Results EXHI BIT A Bidder Details Vendor Name iBulld Spectrum Address 540'N. Golden Circle Or STE 201 Santa Ana, CA 92705 UnitedStaten Respondes Farshad Farahanl Respondee Title Director of Operations Phone 714-661.9474 Ext. Email farshad@ibuildspedmm.com Vendor Type CAOIR,Local License # 858446 CA DIR Bid Detail Bid Format Electronic .. Submitted May 21, 2010 12:64:18 PM (Pacific) Delivery Method Bid Responsive _-- Bid Statue Submitted' Confirmation # 178128 Ranking "C Respondes Comment Buyer Comment Attachments F ` File Title File Name - File Type General Forms - Bid Package ftned.pdf General Forms wnership AffadaVlt Ownership AHadavit pdf Ownership Affidavit (Notary Public)- REQ Od9inal Hard Copy Submittal In AddlBcn Bid Bond Guaranty Bid Bond.pdf Bid Bond Guaranty (Notary Public)- REQ Original Hard Copy Submittal In AddIl on Non Collusion Affadevit Non Collusion AifadaylLpdf Non•Cotluslan Affidavit (Notary Public)- REQ CONHard Copy Submittal In Addlilon Line items Type Item Code UOM Qty Unit Paco Line Total Comment Base Bid Items "h' RENOVATION OF SARTC SOUTH RESTROOMS (MEN AND WOMEN) LS 1 $177,000,00 sf77,000.00 2 LABOR OVERSIGHT AGREEMENT LS 1 $10,000,00 $10,000.00 Subtotal $187,000.00 PkmetBlds,Inc. CITY OF SANTA,ANA PROPOSAL' C'.I[T OF SANTA ANA PROPOSAL PRt DJ ECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH R ESTROOM RENOVATION BID PROPOSAL TO: CITY COUNCIL OF THE CITOF SAN'rA ANA FROM: __ ISuiLJ 5.Pec4r0I0 -__-__._-�— 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: BASE BID: Itern -- Description Qty Unit Unit Price Amount 1 RENOVATION OF SARTC 1 L5 $ M, xV7 $ ryr� �o ITy SOUTH RESTROOMS (MEN ODO. ' _ AND WOMEN) _ 2 LABOR OVERSIGHT — 1 LS $10,000 $10,000 ---L AGREEMENT — --- - — TOTAL BASE BID $ f 91, 000 " ADD ALTERNATE BID I 2 EPDXY AND LINE EXIST.iNC I LS TOTAL A"FaI® ALTEI-INATE BID 1 $ 2 Z 9pp°'° ADD ALTERNATE BID 2 3 ELECTRICAL, PLUMBING — AND/OR STRUCTURAL REP/-drl, 2* EA $10,000 $20,000 TOTAL A'10111 ALTERNATE BID 1 $20,000 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, al;, or none ofthe add -alternate bid items (if any). * The quantity for this bid item is shown for bid comparison only. The actual amount for this item will be dictated by the avtu�J quantity used, and the Agency reserves the right to increase or decrease the quantity of his item accordingly. P-1 of P-16 CTT),' OF SANTA ANA PROPOSAL, PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH R'_?STROOM RENOVATION TOTAL BASE BID $ �8 ppp TOTAL ADD A.LTEItNATE BID 1 $ 22 ppo,00 TOTAL A01) ALTERNATE BID 2 $20,000 TIME FOR COMPLETION OF IMPROVEMENTS AND LIQUIDATED DAMAGES The undersigned bidder hereby propos;s to complete the Work for the total base bid amount shown above, within SIXTY 60 „w Aing_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 $500 per calendar day. Name of Firm Signature of EI .� �i✓�101ni Ott2Cad"��i'r'kfV (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-2 of P-16 CJ[T-,'I OF SA NTA ANA PROPOSAL PROJECT NO.: 20-75.31 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH RESTROOM RENOVATION BIDDER'S STATEMENT BIDDER understands and agrees that this Bid Proposal, Contract Documents and subsequent Construction Contract Agreement shall 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 Lxccutive Director or his/her duly 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 Unified 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 BIDDERS 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 Vic 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 psrjury that the foregoing is true and correct. Name of Firm ll�di/.l SRv� laiiw Signature of BIDDERS CG2— TitL- nttni CEo__$oejj-fe&Ah'xLL2 tiu l fg-WJAr (rA--Q - "911 (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 frtn. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) P-3 ofP-16 CIT" l OF SANTA ANA PROPOSAL PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH RESTROOM RENOVATION CONTRACTOR'S LICENSING AND!_IP.EGISTRA,TION STATEMENT The undersigned contractor, or corporate officer, declares tinder 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 Natne: 7(/—fn ,4vwy\� wvwm N�l-ian__IZI 0114 ger— um Business Address: 31i o ql. 1� ��c 1P DYSZ���Q, cAq 9> Business E-Mail Address: �YS{QUiI�S - din m _ Telephone: State Contractor's License No. and Class: l/t�5 q2 License Expiration Date: S 31— State Dept. of Industrial Relations (D1R) Registration No.: /W00 560 62 State Dept. of Industrial Relations (DiR) Registration Expiration Date: Signed: 'title: C P-4 ofP-1.6 CITY OF SANTA ANA PROPOSAL PR-03 ECT NO.: 20-7531 SANT'A ANA REGIONAL TRANSPORTATION CENTER SOUTH Ith.STROOM RENOVATION 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 Name of Finn Signature ofBIJ Title riba gtern (if an individual, so P-5 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 20-7531 SANTA ANA ]REGIONAL TRANSPORTATION CENTER SOUTH R[?STROOM RENOVATION OWNERSHIP AFFIDAVIT STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS: CITY OF SANTA ANA ) R—mihd Al men) _ _ ---being being duly sworn, deposes mid 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 acid is duly vested with the authority to make and execute instruments for the co. partnership by: who constitu l,,the other members of the co. partnership. CORPORATION That he. is oC a corporation which is making the foregoing proposal: ❑ JOINT VENTLRE The[ he is of one of the parties malting the foregoing proposal as a joint venture, :aid 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: 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 Proposed contract, for himse jo any other person. Signature of Bidder Subscribed and sworn to before the this,,-_, 11 ___ day of /0 20 Signature of officer Administering Oath (Notary Public) P-6 of P46 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 &XIwaC ) CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT On licloqto I ✓V before me, Gr �I4/9 L' © c/ ito S Q� (here insert name and title of the officer) personally appeared 7 B A .,a ©& , ,z- "I" who proved to me on the basis of satisfactory evidence to be the person($) whose name(4 is/subscribed to the within instrument and acknowledged to me that Jag/she/they executed the same in 11.8/her/heir authorized capacity(Ws), and that by W/her/t it signature(A on the instrument the person(, or the entity upon behalf of which the personl 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. Signature —. 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State of California County of Subscribed and sworn to (or affirmed) before me on this &day of 20 by proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. d I -Signature OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT &A, &W f a W A Df— IT' Ior description of attached document) �y�y ^ r— (Title or description of attached document continued) Number of Pages _ Document Date Additional information www.NotaryClasses.com 800-673-9865 KATHERINEGRACFA o 47" Cammissron No. 225508A ¢Q NOTARY PUBLIC.cAUFGRNIA yORANGE CGUNtYMY Comm. ENprcec SEPTEMBER 1&. 2024 INSTRUCTIONS The wording of all Jurats completed in California after January 1, 2015 must be in the form as set forth within this Jurat. There are no exceptions. If a Jurat to be completed does not follow this form, the notary must correct the verbiage by using a jurat stamp containing the correct wording or attaching a separate jurat form such as this one with does contain the proper wording. In addition, the notary must require an oath or affirmation from the document signer regarding the truthfulness of the contents of the document The document must be signed AFTER the oath or affirmation. If the document was previously signed, it must be re -signed in front of the notary public during the jurat process. • State and county information must be the state and county where the document signer(s) personally appeared before the notary public. • Date of notarization must be the date the signer(s) personally appeared which must also be the same date the jurat process is completed. • Print the name(s) of the document signer(s) who personally appear at the time of notarization. • Signature of the notary public must match the signature on file with the office of the county clerk. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different jurat form. Additional information Is not required but could help to ensure this jurat is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. • Securely attach this document to the signed document with a staple. 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 IlAa" _P On CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT before me, i, r n VIV X 5o td III "/o/r'"' (here insert name and title of the officer) personally appeared 'i &9 Ible r who proved to me on the basis of satisfactory evidence to be the person(s) whose name(o is/alk subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his"/her/their authorized capacity4,-ti and that by h+S/her/tMir signature(Won the instrument the person(K), or the entity upon behalf of which the person() acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the �t,,,nuulur,„r State of California that the foregoing paragraph is true and correct. e�®.>°��p� E Jel ,r?�r�< WITNESS my hand and official seal. v> Signature _ l� OPTIONAL INFORMATION Although the information in this section is not required by low, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized documentand mayprove useful to persons relying on the attached document. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document I Method of signer Identification titled/for the purpose of containing pages, and dated The signer(s) capacity or authority Is/are as: ❑ Individual(s) ❑ Attorney -in -Fact ❑ Corporate Officer(s) ❑ Guardian/Conservator ❑ Partner - Limited/General ❑ Trustee(s) ❑ Other: representing: Names) of Persons) or EntITy(les) Signer is Representing Proved to me on the basis of satisfactory evidence: TO forma) of Identification O credible witness(es) Notarial event is detailed In notaryjournal on: Page A Entry N Notary contact Other ❑ Additional slgner(s) ❑ Signeys)Thumbprinbs) El 0 Copyright 2007-2014 Notary Rotary, Inc PO Box 41400, Des values, IA 503110507. All Rights Ro,oned. Item Number 101772, Please contact your Authorized Re se l l er to purchase copies of th is form. CIT" +' OF SANTA ANA PROPOSAL, PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH RESTROOM RENOVATION LIST OF SUB -CONTRACTORS Section 4100 et. seq. of the Public Contract Code requires listing of all subcontractors with the bid for all subcontract work exceeding the following amount: Streets, highways including bridge projects: `V2% of the bid or $10,000, whichever is greater Buildings, parks, or other prejccts: Yz% 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 _Q le Ptum(,gip License #/Exp. �__.__._-_. _ DIR. Re 4/Exp.9/ ��/�Q����� Location -92L, y yL gys/- Phone 9 l_ 216-5330_ Type Of Work Amount $ Name _ Mooa, -�1"121r49 DC.__..- License #/F,xp, yf 0-202__L--Y DIR Reg. #/Exp.0006o�19 License # yI g2y 3,4 Location - Phone 2 '-VzLg- 64t l — --------- Type Of Work -J;(B ,��✓¢ _— ------- Amount $ -3� pO-------- Name License 4/Exp.6��I^2o�q_� DIR Reg. #'/Exp. License # g 302 R6 _ Location I�6ae�//1La�e PhoneLaU�32.-5.1e9�-�_�._- _.----- Type Of Work Z�cPsso%GE $e�i3 pia s._-- Amount $ /d.�op,oa Signature of Bidder Name License #/Exp. DIR Reg. 4/Exp. Location Phone Type Of Work Amount $ Name _ License #/Exp. DIR Reg. #/Exp License 4 _ Location Phone _ Type Of Work Amount $ Name License 4/Exp. DIR Reg. #/Exp. License # _ Location _ Phone Type Of Work Amount $ I'•-$ of P-16 CITY" OF SACNTA A NA PROPOSAL PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH RE51 ROOM RENOVATION REFERENCES The following are the names, addresses., and telephone numbers for THREE public agencies for which the BIDDER has performed similar work within the past three years. Name and Address of Owner. Co Lb �-go Cana et Name andTelephone Number c person familiar with project. —P!A6o.go—o- ° r+b f mreme+,� — Contract Amount Type of Work Date Completed 2. Cerro Cos Conege 1\famand JPU h f2r eca? m) e Address of owner. Name and Telephone Number of person familiar with project. ILO Contract Amount Type of Work Date Completed 3. _ °�._ S�clem 7 go Ar�eni da flame and Address of owner. Mom.- haf.�t'm�_(9 z9S25 �282 - __ ---- Name and'Telephone Number of person familiar with project. I?eheb;6i�erj;vY�cnd 'n l>oT4"V �r�eSSiYw __ 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 and bonds. �Gyen �- /�rnu�r��sx�'--- P..9 of P-16 CITY COIF ISANTA ANA PROPOSAL PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH REsTROOM RENOVATION ADDITIONAL REFERENCES The following are the names, addresses, and telephone numbers for THREE public agencies for which the BIDDER or Subcontractor has performed similar work in the past five years. 2. Gi©3,�n na a rx (- 66sa Name and Address of Owner. Name and Telephone Number of person familiar with project. (�2,6Ao•0' U. ra Contract Amount Type of Work Name and Address of owner. Name and Telephone Contract Amount Name and Address of owner. of person familiar with project. Type of Work Name and Telephone Number of person familiar with project. Contract Amount 19foc es6, nc Date Com ted Date Completed 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 i.nsu,ance and bonds. R-10 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH RESTROOM RENOVATION NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 71.06) 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 arty breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any ice 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 prosecution. Signed �— State of California County of cr1?ng2 Subscribed and sworn to (or affirmed) 'before me on this a/ ;gday of , 20L9, by i.6 Awme,u' _, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me ]otary Public Signature Notary Public Seal P - I I ofP-16 l;'ITY OF SANTA ANA PROPOSAL PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH RESTROOM RENOVATION NON-DISCRIMINATION CERTIFICATE The undersigned contractor or corporate officer, during the performance of this contract, certifies as follows: 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: 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. 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 employees 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 applicans for employment. 4. 'Elie Contractor shall comply with alt provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5. 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. to the event of the Contractor's non-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 11246 of September 24, 1965, and such other sanctions may be 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 law. 11-12 of P-16 CITY OF ,SANTA ANAL PROPOSAL PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH RI iSTROOM RENOVATION 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 Stars. 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: -�Dv n 'VoinAi/ _--_ — �— Title: Firm: _/ad/ d 5 G*'um�—__�� Date: S 21-19 P-13 ofP-16 CHI/ OF SAl' TA ANA PROPOSAL PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH m1 s'CROOM RENOVATION STATEMENT REGARDING APPRENTICESHIP REQUIREMENTS 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: 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. 3. Contribute to the fund or funds in e�ieh 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 same ,manner as the other contractors, except contractors not signatory to the trust agreement shall pay a like amount to the California Apprenticeshi cil. Signed: r7v"bp Aoftm tii Title: e 490 Firm: -- Date: P-14 of P-16 CITY OF SAiNTA ANA PROPOSAL PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH RESTROOM RENOVATION STATEMENT REGARDING "AN'FY__1'ICKBACKIRLQ-UIREMENTS 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 wo!!k,o give 'up any part of the compensation to which he/she is otherwise entitled. Signed: rAAhX 4toftivil Title: Firm: —/Au;(d---- Date: 6=21-19 P-15 of P-16 CITE' OF SANTA ANA PROPOSAL, PROJECT NO.: 20-7531 SANTA ANA REGIO[ IAL TRANSPORTATION CENTER SOUTH RESTROOM RENOVATION PUBLIC CONTRACT CODE SECTIOINd 10162 QUESTIONNAIRE In conformance with Public Contract Code Section 10162, the BIDDER shall complete, under penalty of perjury, the following questionnaire: Has the BIDDER, any officer of the BIDDER, or any employee of the BIDDER 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 If the answer is yes, explain the circumstances in the following space. R- 16 of P-16 CITY OF SANTA ANA APPENDIX G PROJECT NO.: 20-7531 SANTA ANA REGIONAL TRANSPORTATION CENTER SOUTH RESTROOM RENOVATION FEDERAL SECTION 3 REQUIREMENTS Federally Required Documents to be Submitted with Your Bid Proposal Packet and Prior to the Award of Contract Specific federal requirements must be met for this U.S. Department of Housing and Urban Development (HUD) funded project. The City of Santa Ana's Contact: Community Development Agency City of Santa Ana 20 Civic Center Plaza, M-25 Santa Ana, CA 92701 Phone (714) 647-5445 Fax (714)647-6549 www.santa-ana.org/ The following document(s) MUST be fully filled out and submitted with the bid Ironosal nackaee: • Proof of registration in the System for Award Management (pvktY@fsam.cWw to be filed by contractor • Proof of registration in the D&B Data Universal Numbering System (hit,ems^//if{pdtxte.drab.coaatf rte enaaznanvlooJcaan.lztm) • Section 3 Contract Clause (Exhibit 1). To be filed by contractor. • New Hire Calculation Form (Exhibit 2). To be filed by contractor. • Contractor's Section 3 Affirmative Action Plan (Exhibit 8). To be filed by contractor. • Section 3 Contract. Award Considerations (Exhibit 9). To be filed by contractor. • Women/Minorhy Business Owned Enterprises Good Faith Efforts (Exhibit 12). To be filed by contractor. • Noncollusion Affidavit (Exhibit 15). To be filed by contractor. • Federal Lobbyist Requirements Certification (Exhibit 16). To be filed by contractor. Certification and Understanding of Authorization (Exhibit 17). To be filed by contractor and subcontractor(s). • *Additional Wage Rate Classification.* If the contractor needs an additional job classification, the contractor must submit with the bid package a written, signed request naming the work classification(s) and the wage rate(s), including any fringe benefits that are proposed. The following document(s) shall be completed by the contractor and/or subcontractor(s), as specified, and filed with the City's Labor/Section 3 Contact prior to award of contract on the project: • Proof of registration in the System for Award Management (wwwsam.eov) to be filed by subcontractor(s) • Section 3 Contract Clause (Exhibit]). To be filed by subcontractor • Project Wage Rate Sheet. To be filed by contractor and any subcontractor(s). The following document(s) shall be completed by the contractor and/or subcontractor(s), as specified, and filed with the City's Labor/Section 3 Contact prior to start of construction on the project: • Section 3 Employment Opportunity Notice (Exhibit 3). To be filed by contractor and any subcontractor(s). • Section 3 Resident Certification Form (Exhibit 4). To be filed by contractor and subcontractor(s). • Section 3 Business Concern Opportunity Notice (Exhibit 5). To be filed by contractor. • Section 3 Business Concern Eligibility Certificate (Exhibit 6). To be filed by contractor and subcontractor(s). • Certirication for Applicable Fringe Benefit Payments (Exhibit 13). To be filed by contractor and any subcontractor(s). • Certification ofNon-Segregated Facilities (Exhibit 14). To be filed by contractor and any subcontractor(s). • Certification with Regard to the Performance of Previous Contracts or Subcontracts Subject to the Equal Opportunity Clause and the Filing of Required Reports. To be filed by contractor and any subcontractor(s). * Note: The prime contractor is responsible for the.full compliance of all employers (subcontractors) in regard to labor standards, Section 3 provisions, and W/MBE provisions applicable to this project. NOTICE: "This is a federally assisted construction project (CDBG funded) and Federal labor standards, including Davis -Bacon &Section 3 requirements, will be enforced." EXHIBIT 1 City of Santa Ana Section 3 Contract Clause These Clauses are to be inserted in all contracts A. The work to be performed under this contract number 2o- 7531 by and between the City of Santa Ana, hereinafter referred to as "City" and i/3�iCd S(�ealium _, hereinafter referred to as "Contractor", is subject to the requirements of Section 3 cf the Housing and Urban Development Act of 1968, as amended 12U.S.C. 1701u (section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated HUD assistance or HUD -assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low -and very low-income persons. B. The parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other constraint that would prevent them from complying with the Part 135 regulations. C. The contractor agrees to send to each labor organization or representative of workers with which the Contractor has an agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the Contractor's commitments under this Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. D. The Contractor agrees to include a Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, upon a finding that the subcontractor is in violation of the regulations in 24 CFR part 135. The Contractor will not subcontract with any subcontractor where the Contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR Part 135. E. The Contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the Contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR part 135 require employment opportunities to be dir ected, were not to circumvent the Contractor's obligations under 24 CFR part 135. Noncompliance with regulations in 24 CFR Part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted projects. The Contractor by this signature affixed hereto declares under penalty of perjury: Contractor has read City requirements and accepts all its requirements contained therein for all of his/her operations within the City of Santa Ana. a />riol@$nl (4"n 521-19 Signature of Contractor Print Name and Title Date 85-94t q5 J A,0Z C - % Of(1233 135 Contractor License Number & Designation Federal DUNS Number Signature of Contractor EXHIBIT 2 City of Santa Ana Section 3 New Hire Calculation Form Project Name:_<�pnaa Arid ansoat+ahTncea+eVsot4h ResfVrxm VeWx�m Project Location: /000E. san4ATto OINK Sari-Ia 4AA Cd 99�bI Street City State Zip Contractor Name: J 13t/h S Pec+yuyn Contractor Contact: Rrshal raya l tlyl) Contractor Telephone Number: (7114M I—W it Contractor Email Address: !a(,s Ittld /bui(d5ft-1Vvm•Gam Total number of Section 3 resident new 5 2/-19 Date hires necessary to comply with contract: 2 EXHIBIT 8 Contractor's Section 3 Affirmative Action Plan 4 2*-75?/ san�G9rlA RP9ianaC iPahsOx}}A �1GenF2f�5o�ih k'e5 � 2 Yo-1wr\ Project Number and Title The undersigned contractor agrees to implement the following affirmative action steps directed at increasing the utilization of lower income residents and business concerns located within the County of Orange. 1. Take affirmative action to ensure that employees or applicants for employment or training are not discriminated against because of race, color, religion, sex or national origin. 2. Send a notice of the contractor's Section 3 commitment to each labor organization or representative of workers and p ost a copy of the notice at a conspicuous place available to employees and appl icants for employment or training. 3. To the greatest extent feasible, make a good faith effort to recruit for employment or training lower income residents from the County, and to award contracts to business concerns which are located in or owned in substantial part by persons residing in the County through use of: local advertising media, signs placed at the project site and notification to community organizations and public or private institutions operating within or serving the project area such as Service Employment and Redevelopment (SER), Opportunities Industrialization Center (OIC), Urban League, Contracted Employment Program, U.S. Employment Service, Chamber of Commerce, labor unions, trade associations and business concerns. 4. Maintain a file of all low-income area residents who applied for employment or training either on their own or on referral from any source, and the action taken with respect to each area resident. 5. Maintain a file of all business concerns located in the County who submitted a bid for work on the project, and the action taken with respect to each bid. 6. Maintain records, including copies of correspondence, memoranda, etc., which document that affirmative action steps have been taken. 7. Incorporate the Se ction 3 clause provisions in a 11 subcontracts, and r equire subcontractor(s) to submit a Section 3 Affirmative Action Plan. 1001 d SP C4Y-um Company Name SNoN-6�ldePtCifUt PlsavNo#}I1A9?`�5 Address: Street, City, State, Zip 0233I35 DUNS Number Signature of Contractor Printed Name CEa Title EXHIBIT 9 City of Santa Ana Section 3 Contract Award Consideration Bidder's Name: z6C//(J S.ftwom Please check the numbered statement that is applicable to your business: My business qualifies as a Section 3 business concern: If you have checked statement NUMBER t please read the attached Section 3 Business Concern Preference - Bidding Requirements. (Please check the applicable qualification for statement number 1) 51% owned by Section 3 residents; or Permanent, full-time employees include at least 30% Section 3 residents; or Will subcontract more than 25% of the dollar award of all subcontracts to be awarded to business concern(s) that meet either of the two preceding qualifications. Note: You are required to list all subcontractors and owner -operators in your bid statement. 2. V�"My business does not qualify as a Section 3 business concern. Note: Section 3 business concern definitions are located in this project's Contract Documents & Specifications Manual within the section titled Section 3 Economic Opportunities Plan. SS2�- )9 Signature of Business Owner Date fie►// ' Mmmmi /CEo Print Name EXHIBIT 12 CITY OF SANTA ANA WOMEN OWNED/MINORITY BUSINESS OWNED ENTERPRISES (W/MBE) GOOD FAITH EFFORTS Project Name: A� i.a Avxa innt Re po ldena^fu. ' Project Number: I 20 Project Location: I 1,o, g' _<ay,44 A yLa. Ig tY . S a 9 Pursuant to 24 CFR Part 85 § 85.36 (e) of Code of Federal Regulations, contractor must take all necessary affirmative steps to assu re that minority business firms, women's business enterprises and labor surplus firms are used whenever possible. Contractor shall submit the following information to demonstrate that a goof faith effort has been made to comply with the above section of the Code of Federal Regulations. Submittal of this form, in and of itself, may not provide sufficient documentation to demonstrate that goof faith effort was made. Documentation such as copies of advertisement, letters of solicitation, telephone logs, rejected quotes, etc. should accompany this form. 1. The names and dates of advertisement of each newspaper, trade paper, and minority -focus paper in which a request for W/MBE participation for this project was placed by the bidder: Names of Newspaper Date of Advertisement 2. The names and dates of written notices sent to W/MBE soliciting bids for this project and methods used for following up initial solicitation to determine with certainty whether the W/MBE were interested. Names of W/MBE Solicited Dates of Solicitation Follow-up Methods and Dates Pun ll vilde/ S--/o_ Lim 3. The items of work which the bidder made available to W/MBE firms, including, where appropriate, any breaking down of the contracts into economically feasible units to facilitate W/MBE participation, and the information furnished to W/MBE such as plans, specifications, and requirements for the work. Items of Work: 141,1114 /q/ Breakdown of Ite111A Information Furnished: F\DOCS\PROPSVCS\HUDFORMS\MBU5804AMB - Section3Specs. DOC EXHIBIT 12 (cont.) 4. Efforts made to assist W/MBE in obtaining bonding, lines of credit or insurance, and any technical assistance related to the plans, specifications and requirements for the work which was provided to W/MBE: 5. Any additional data to support a demonstration of good faith effort, such as contracts with W/MBE assistance agencies: I declare under penalty of perjury that the foregoing information is true and correct to the best of my knowledge. I understand that the City of Santa Ana and/or the U.S. Department of Housing and Urban Development may verify the information provided herein in connection with W/MBE compliance evaluation/audit activities and that failure to fully and truthfully complete this for may result in economic or other sanctions. Signature: �t Name: Myyjeyi Title: Cab Date: — —i 9 Name of Contractor/Subcontractor: ���j�d S�eC FIdM 1 Contractor/Subcontractor Identification �ry� 02 2149 95 V Number: Address (Street, City, State, Zip): sL(o N• 6ot den dr-ck Dr • TC-201 San }a Fhtai (A 92 Z.5 Business Racial/Ethnic/Gender Code: Circle the numeric code which indicates the racial/ethnic/gender character of the owner(s) and controller(s) of 51% of the business. When 51% or more is not owned and controlled by any single racial/ethnicity/gender category, circle the code which seems most appropriate. 1 = White Americans 2 = Black Americans 3 =Native Americans Woman Owned Business: Circle One: Yes or 4 = Hispanic Americans 5 = Asian/Pacific Americans 6 = Hasidic Jews F:\DOCS\PROPSVCS\HUDFORMS\MBU5BO4AMB-Section3Spec DOC EXHIBIT 15 NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the City of Sd n 4a A W DEPARTMENT OF PUBLIC WORKS In accordance with Title 23 United States Code Section 112 and Pahl is 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 fal se 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. /Gail d SV2c 4a m Name of Contractor .SNo M 621 den 6filea f 7E2a 1,1,194d Eft Address �1b A Moi�en i CEo Signature and Title �--2I- 1 Date F.\DOCS\PROPSVCS\HUDFORMS\MBU5BC4AMB - Section3Specs. DOC EXHIBIT 16 FEDERAL LOBBYIST REQUIREMENTS CERTIFICATION Name of Firm: /DUitd 50Lec4YUrl Date: 3-2)_I Address: /}'(1p` 2 2225 State: C4 Zip Code: 991%5 Telephone: 711y1�'6%— 9411.1 Acting on behalf of the above -named firm as its Authorized Official, I make the following Certification to the Department of Housing and Urban Development (HUD) and the Community Development Commission, County of Los Angeles: 1) No Federal appropriated funds have been paid, by or on behalf of the above -named firm to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of C ongress, or an employee of a Member of Congress in co nnection with the awarding of any Federal contract, the making of any Federal grant, loan, or cooperative agreement, and any extension, continuation, renewal, amendment, or modification thereof; and 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 or any 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 above -named firm shall complete and submit Standard Form—LLL, "Disclosure Form to Report Lobbying" in accordance with its instructions; and 3) The above -named firm shall require that the language of this certification be included in the award documents for all sub -awards at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients shall certify and disclose accordingly. 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 the 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 $100,000 for each such failure. Authorized Official: Name: (;�rzbd Mornen, Tittle: C�d /c Signature: _Date: F:\DOCS\PROPSVCS\HUDFORMS\MBU5BO4AMB-Sed.i 3Sp..DOC EXHIBIT 1.7 CERTIFICATION OF UNDERSTANDING AND AUTHORIZATION Project Name: hp& 12.e ipiA(Cenle✓ Sau�l9 il�sdr ✓ZeneYtth 1 Project Number: This is to certify that the principals and the authorized payroll officer, below, have read and understand the labor standards clauses pertaining to the subject project. The following person(s) is designated as the payroll officer for the undersigned and is authorized to sign the Statement of Compliance, which will accompany our weekly certified payroll reports for this project: �5 hue /! nm ha vi 1 Payroll Oft' 's Name Payr s Signature Conteactor/Su bconiractor by Gt Signature -- i�mant----- - - Printed Name Title Date f5yYg5 _--- — - Contractor/SubeXtractor License No. DUNS Number F\DOCS\PROPSVCS\HUDPORMS\MBU5BO4AMB Sechon3Spec.DOC OFUNDER STANDING aezte; _,a Pita Anaaa Ti,asyxirtafiun South Res5kraaakrr Renovations ues cer-iffy tha;�llxe principals and irr-- atr `s ,r€rid t#ayrrarl officei.. Ex;laww, Havre read and understand the labar �dtt Ca. Clwase� pe[taisting to dlesulijtxr t twx: a#e lul;0te9r& r son(s)is deSigtatec"a tdiv ! avioll officer for the undersigned and is as liodwd to sign the re.�er�eorcot stirweddjcerti eApa roll reports for €hisp€aerk: ("(561't€3F$Y7r%t4LkX;V�3tiAdor E,y Slgrrmtuw 1... Printed ame Me A01d� C7a 4WmE�tracfiaer�itti,r.�e�tranttr� Lacectsc,l�la. DONS Nut"a XII1BIT" 17 CF', FIFCaCA V)N OF d_TlN).)ERSTAN DMG ANT 0;/,�,UTHORIZATION "'roiec?: Name: .j , Nuniber: _ this is to acrtify tha'the principals and the autl���rizud payroll officer, below, have read and understand the labor <andav& clauses pertaining to the subject, projer t. the following person(s) is designated as the payroll officer for the undersigned and is authorized to sign the -�tatenlent of Compliance, which will accor_nxiny our weekly certified payroll reports for this project: _..fldrpra..._..fo z��S�ne,crn�vl�i'�- ------ Payroll Officer's Name � � Payroll Officers �j's rgnature nlv►/iy�, SU�nhedv✓ Coni for/Subcontractor by Signa�urc _ Le' ro Printed Nacre Ticks Date 91dDB2 _.-_.._. - - ---- ----....... ------ .. ---- -- 4. c ;Ktor/Subcontractor License No. g5'Os33p,9; DUNS Numbor �DCS3\FFZOPSVCS\HUDFORMS\MBU5BC4AMB-S.d.r3Spxc DOC iBuild Spectrum DESIGN & BUILD 13 iBuild Spectrum 540 N Golden Circle Dr. STE 201 Santa Ana, CA 92705 `S[Ai.,ib EID BOND FOR PlO,: 20-7531SANTA MIA REXAONAL, TMAIIISPORTATlON CENTER sourl-I RESTROOM RFNOVATl(:q'.;" City of Santa Ana Atlxo,o`Jictor So Public Work Agren(y, 'M-22 20 CA,ic Center Plaza; [toss A no ien, rd Flooi Santa Ana, CA 92701