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HomeMy WebLinkAboutEBS GENERAL ENGINEERING, INC Recording Requested By, And When Recorded Mail To: City of Santa Ana Recorded in Official Records, Orange County Public Works Agency,M-22 Hugh Nguyen, Clerk-Recorder 20 Civic Center Plaza 111111111111 1EI 11111111F.I I I I I I I II II NO FEE Santa Ana,CA 92702 { * $ R 0 0 1 1 8 1 4 b 1 7 $ * 202000031675711:35 am 07106/20 363 304A 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 RESIDENTIAL STREET REPAIR AND ALLY IMPROVEMENTS FY 17/18 a M under contract entered into on MAY 21, 2019, with EBS GENERAL ENGINEERING, INC., a on which contract SURETEC INSURANCE COMPANY is surety. The property on which such W 0 work improvement was placed is in the City of Santa Ana, County of Orange, State of California, and described as Project No, 18-7526, 18-7527 & 18-6910 located at: VARIOUS zw a z LOCATIONS. The work improvement on said property was accepted as completed on TUNE c w 12, 2020. Eno &nU W o CITY OF SANTA ANA,A MUNICIPAL.CORPORATION r� z by / r Dated: b r 23 2z Senior Civil Engineer—Michael Ortiz w Tl1'LE ------------------------------------------------------------------------------------------- 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 ony' 1 , at Santa Ana, Californi (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 THE REGISTER 2190 TOWNE CENTER PL, ANAHEIM, CA 92606 Telephone (714) 796-7000 / Fax (714) 796.6059 CNS#: 3217902 CNS-3229,9y2# THE It PROOF OF PUBLICATION (2015.5 C,C.P.) Stateof California ) County of ORANGE ) SS Notice Type: BID - NOTICE INVITING BIDS Ad Description: RESIDENTIAL ST REPAIR PROGRAM R ALLEY IMPROVEMENTS I am a citizen of the United States and a resident of the State of California; 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 printer and publisher of the THE REGISTER, a newspaper published In the English language in the city of SANTA ANA, county of ORANGE, and adjudged a newspaper of general circulation as defined by the laws of the State of California by the Superior Court of the County of ORANGE, State of California, under date 11/19/1905, Case No. A21046. That the notice, of which the annexed is a 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: 0210112019. 02/06/2019 equipment, impementina a canstructlon safety Executed on: 02/06/2019 Pia Pollution Prevention At SANTA ANA ,CA Plan, adtusting utility covers, traffic I certify (or declare) under penalty of perjury that the foregoing Is true and pavement markings correct. and all appurtenant work. In accortlans the the Californiaans of the /1 ^ ode, nia Labor Cade, prevailing wage rates apply. This space for Unit slamp only 1• wnnwclvrcs- I PROJECT NOS.o I I 1&752 T'ii, S2 ' STRpIET REPAIR PROJECT NO 18- 6910ALLEY IMPROVEMENTS . PV 1] N rrtl- rks, ) In - ex• on- ' md..I IM Ll ` struw P I/u. Pon" 9 iaV- .,. , sfr0pes mark= Iurten•,' with of th$ Labor. I I wags. Z � �1 Hu h Ngu en, Clerk.Recordar a POSTE�rl NO �!Rln�l lll�II!�ll�lll IIIIlII$�soli MAR ! 8 2Di9 201985000236 12:03 pm 03/18/19 $80 CR03 Z01 ORANGE CbUNTY CLERK•ftECGRDEH aEPARI'IdC•,t.. 0.00 60.00 0.00 0.00 0.00 0.00 0,00 0.00 eY: OFtpt1'ry MAYACTING CITY MANAGER Miguel A, Pulldo MAYOR PROi�P,',.,,i Juan Villages$ CITY ATTORNEY A. Mendoza '' + Bonle R, cartalho COUNCIL MEMSERS ACTING CLERK OF THE COUNCIL Cecilia Igleslas ••' Nonne Mitre-Remlrez David Penaluza Vicente Bwffganto Jose WOO CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 OMo Center Plaza (M•20) RO, BOX 1900. Santa Ana, Oallfgrnla 02702 (714) WI.2700 - Fax V14) 973.1461 tvw .senta ana.arg NOTICE OF EXEMPTION From the Requirements of the California Environmental Quality Act (CEQA) Fee Exemption per California Government Code Section 6103 To; COUNTY CLERK From: City of Santa Ana County of Orange Planning & Buitding Agency P.O. Sax 238 20 Civic Center Plaza M-20 1 Santa Ana, CA 92702 Santa Ana, CA 92702 Project Title; Residential St Repair & Alley Impr Data of Approval: 03118/2019 Project Number(s); PWA-2019-394-CITY Project Location: 1 CityWide (Partial) 1 City: Santa Ana County: Orange ER Number: ER-2019-20 C Project Descrtptlom The construction will Include the repair of concrete Street segments. Sidewalk, curb & gutter, curb ramps repair necessary to better facility's ADA transportation and all pedestrian users in the referenced (j neighborhood. (Clty Project #1 B-7526/18.7527 & 18.6910) +.. Applicant Name: Jason Gabriel, City of Santa Ana Public Works Agency Applicant Address: 20 Civic Center Plaza Banta Ana, CA 92701 Name of Public Agency Approving Project: City Council FILED Name of person or Agency Carrying Out Project: Gabriel, Jason Exempt Status; MAR 18 2019 ❑ Declared Emergency (S ORANGE COUNTY CLERK -RECORDER DEPARTMENT ❑ Declared Emergency (Sec. 15269 (a)) ❑ Emergency Project (Sec, 16260 (b through a)) BY DEPUTY ❑ General Rule (Sec. 16061(b)(3)/(5)) _ µ ❑ Statutory Exemption: m Categorical Exemption: 15301(b) Reason(s) Why Project is Exempt From CEQA: 16301(b) consists of repalrlmaintenance of existing public facilities, City Contact; &,Zor res (� Telephone: (714) 647-6018 Signature; ,r✓"'�f Title: 7l , i +4"I`a1^I 1-'" ;4eo.A Data; 7 SANTA ANA CITY COUNCIL MWualA. Pulldo Juenvlllegas Nrcante sarmlonlo Jose Gulala Oevld Penaloza Collie Iglesias Mayer Mayor Pro Tam, Ward a V4rdI Ward3 Ward l/�ma.we lvilsaa sente•ona era ytADDlgr4Gr§lemta•anaara Ward Wards IgalacladAagnlails..gc. �lannslazadasa-^Igc^=on;: �ppyia�paa�.�� CITY OF SANTA ANA CONSTRUCTION CONTRACT PROJECT NOS. 18-7526, 18-7527 & 18-6910 RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY IMPROVEMENT FYI 7/18 PROJECT This CONSTRUCTION CONTRACT is made and entered into this 21" day of May, 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 EBS General Engineering, 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 Residential Street Repair Program and Alley Improvement FY17/18 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 • Information to Bidders • Bid Proposal • Bid Bond • Contract Form • Contract 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. 3. 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 Eight Hundred Seventy -Four Thousand Three Hundred Dollars and No Cents ($874,300.00), 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 wort, as may be deemed necessary or advisable. rev. 09ro1/2017 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: http*//www.santa-ana.org/i)wa/documents/CWA.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. 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: r +� 4� NORMA MITRE Acting Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By:. HN FUNK Assistant City Attorney FOR APPROVAL: PE, PLS Works CITY OF SANTA ANA z4l .' KRISTINE RID(Tff City Manager CONTRACTOR: EBS General Engine7g, Inc. �L NAME: Joseph Nanci TITLE: Page 3 of 3 City of Santa Ana Residential Street Repair Program and Alley Improvement FY 17/18 (18-7526,18.7527 & 18-0010), bidding on February Bid Results Bidder Details Vendor Name El GENERAL ENGINEERING INC Address 1320 E SIXTH ST STE 100 CORONA, CA 92879 United States Respondee JOSEPH A. NANCI Respondee Title PRESIDENT Phone 951-279-6869 Ext. Email BIDSCEBSGENERAL.COM Vendor Type License 0 CA DIR Bid Detail Bid Format Electronic Submitted February 20, 2019 1:34:48 PM (Peoific) Delivery Method Bid Responsive Bid Status Submitted Confirmation 0 167649 Ranking 0 Respondee Comment Buyer Comment Attachments File Title EBS Proposal OWNERSHIP BID BOND NON -COLLUSION Line Items Type Item Cade Base Bid Proposal 1 Unclassified Excavation 2 Asphalt Concrete (AC) Pavement File Name Combined Proposal.pdf OWNERSHIP.PDF BID BOND.PDF NON-COLLUSION.PDF UOM Qty Cy 430 TN 40 pianatBlds, Inc. Unit Price $135.00 $260.00 Page 1 Printed 03/01/2019 EXHIBIT A File Type General Forms Ownership Affidavit (Notary Public) - RED Original Hard Copy Submittal In Addition Did Bond Guaranty (Notary Public) - RED Original Hard Copy Submittal In Addition Nan-Colluslon Affidavit (Notary Public) - RED Original Hard Copy Submittal in Addition Line Total Comment $58,060.00 $10,000.00 City Of Santa Ana Page 2 Residential Street Repair Program and Alley Improvement FY 17118 (1$-7526,18-7627 & 18.6910), bidding on February Printed 03/0112019 Bid Results EXHIBIT A Type Item Code UOM city Unit Price Line Total Comment 3 Aggregate Base TN 100 $45.00 $4,500.00 4 Removal of 6" PCC at Various Locations CY 1120 $136.00 $151,200A0 5 Construct 8" PCC Pavement with (3-day) Cure Including Dowels CY 1120 $230,00 $257,600.00 6 Crack Seal with Deere Super Gray LF 30000 $4.26 $127,500.00 7 Construct PCC Sidewalk (T=4") SF 0100 $5.00 $30.500.00 8 Construct PCC Driveway Approach (T=6")* SF 900 $7.00 $6,300.00 9 Construct PCC Curb Ramp SF $000 $11.00 $56,000.00 10 Construct PCC Curb and Gutter (A-2-6) .. .... ..... LF 100 $35.00 $3.600.00 19 Construct PCC Curb and Gutter (BA) LF 400 $35.00 $14,000.00 12 Construct PCC Alley Apron(T=8") SF 400 $10.00 $4,000.00 13 Construct PCC Alley (T=8") with (3-Day) Cure CY 100 $330.00 $52,000.00 14 Construct PCC Cross -Gutter (Local Street) SF 2200 $9.00 $19,600.00 15 Grind PCC LF 300 $30.00 $9,000.00 16 Root Shave EA 16 $400.00 $6,400.00 17 Adjust Sewer Manhole Frame and Cover to Finished Grade EA 15 $500.00 $7,600.00 1a Furnish and Install Water Valve Frame and Cover to Grade EA 15 $650.00 $9,760.00 Planetalds, Inc. City of Santa Ana Page 3 Residential Street Repalr Program and Alley improvement PY 17118 (1 &7526,18.7527 & 18-6910), bidding on February Printed 03/01/2010 Bid Results EXHIBIT A Type Item Code UOM City Unit Price Line Total Comment 19 Furnish and Install 112" Thick by 16" Wide Polyfoam LF 100 $25.00 $2,500.00 20 Signing and Striping LS 1 $21,000.00 $21,000.00 21 Project Advertising Sign EA 2 $1.200.00 $2,400.00 22 Labor Agreement Oversight LS 1 $10,000.00 $10,000.00 Subtotal $874,300.00 Total $874,300,00 PlanotSida, Inc. CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 EXHIBIT TOTAL BASE BID $ 874,300.00 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). * The quantity for this bid item is shown for bid comparison only. This bid item shall not be subject to the "25%" limit as stated in Section 3-2 of the Standard Specifications. The actual amount for this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. This bid item is considered a Specialty Item per Section 2-3.2 of the Standard Specifications. 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 fifty (50) 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 $1,500 per calendar day. Name of Firm EBS General Engineering, Inc. Signature of BIDDER 4-1 - Title President (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-14 of P-28 City of Santa Ana Page 1 Residential Street Repair Program and Alley Improvement FY 17/18 (18-7526,18-7527 & 18-6910), bidding on February Printed 03/01/2019 Bid Results Bidder Details Vendor Name EBB GENERAL ENGINEERING INC Address 1320 E SIXTH ST STE 100 CORONA, CA 92879 United States Respondee JOSEPH A. NANCI Respondee Title PRESIDENT Phone 951-279-6869 Ext. Email BIDS@EBSGENERAL.COM Vendor Type License # CA DIR Bid Detail Bid Format Electronic Submitted February 20, 2019 1:34:48 PM (Pacific) Delivery Method Bid Responsive Bid Status Submitted Confirmation # 167649 Ranking 0 Respondee Comment Buyer Comment Attachments File Title File Name File Type EBB Proposal Combined Proposal.pdf General Forms OWNERSHIP OWNERSHIP.PDF Ownership Affidavit (Notary Public) - REQ Original Hard Copy Submittal in Addition BID BOND BID BOND.PDF Bid Bond Guaranty (Notary Public) - REQ Original Hard Copy Submittal in Addition NON -COLLUSION NON-COLLUSION.PDF Non -Collusion Affidavit - (Notary Public) - REQ Original Hard Copy Submittal In Addition Line Items Type Item Code UOM city Unit Price Line Total Comment Base Bid Proposal 1 Unclassified Excavation CY 430 $135.00 $58,050.00 2 Asphalt Concrete (AC) Pavement TN 40 $250.00 $10,000.00 PlanetBids, Inc. City of Santa Ana Page 2 Residential Street Repair Program and Alley Improvement FY 17118 (18-7526,18-7527 & 18-6910), bidding on February Printed 03/0112019 Bid Results Type Item Code UDM Qty Unit Price Line Total Comment 3 Aggregate Base TN 100 $45.00 $4,500.00 4 Removal of 6" PCC at Various Locations CY 1120 $135.00 $151,200.00 5 Construct 6" PCC Pavement with (3-day) Cure Including Dowels CY 1120 $230.00 $257,600.00 6 Crack Seal with Deere Super Gray LF 30000 $4.25 $127,600.00 7 Construct PCC Sidewalk (T=4") SF 6100 $5.00 $30,500.00 8 Construct PCC Driveway Approach (T=6")* SF 900 $7.00 $6,300.00 9 Construct PCC Curb Ramp SF 6000 $11.00 $66,000.00 10 Construct PCC Curb and Gutter (A-2-6) LF 100 $35.00 $3,500.00 11 Construct PCC Curb and Gutter (B-1) LF 400 $35.00 $14,000.00 12 Construct PCC Alley Apron (T=8") SF 400 $10.00 $4,000.00 13 Construct PCC Alley (T=8") with (3-Day) Cure CY 160 $330.00 $52,800.00 14 Construct PCC Cross -Gutter (Local Street) SF 2200 $9.00 $19,800.00 15 Grind PCC LF 300 $30.00 $9,000.00 16 Root Shave EA 16 $400.00 $6,400.00 17 Adjust Sewer Manhole Frame and Cover to Finished Grade EA 15 $500.00 $7,600.00 18 Furnish and Install Water Valve Frame and Cover to Grade EA 15 $650.00 $9,750.00 PlanetBids, Inc. City of Santa Ana Page 3 Residential Street Repair Program and Alley Improvement FY 17/18 (18-7526,18-7527 & 18-6910), bidding on February Printed 03/01/2019 Bid Results Type Item Code UOM MY Unit Price Line Total Comment 19 Furnish and Install 1/2" Thick by 16" Wide Polyfoam LF 100 $25.00 $2,500.00 20 Signing and Striping LS 1 $21.000.00 $21,000.00 21 Project Advertising Sign EA 2 $1,200.00 $2,400.00 22 Labor Agreement Oversight LS 1 $10,000.00 $10,000.00 Subtotal $874,300.00 Total $874,300.00 PlanetBids, Inc. CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 ID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: EBS General Engineering, Inc. 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 Qty Unit Unit Price Amount 1 Unclassified Excavation* 430 CY $ $ 135 58,050 2 Asphalt Concrete (AC) Pavement* 40 TN $ $ 250 10,000 3 Aggregate Base* 100 TN $ $ 45 4500 4 Removal of 6" PCC at Various Locations* 1,120 CY $ $ 135 151,200 5 Construct 6" PCC Pavement with (3-day) 1,120 CY $ 230 $ 257,600 Cure including Dowels* 6 Crack Seal with Deere Super Gray* 30,000 LF $ $ 4.25 127,500 7 Construct PCC Sidewalk (14")* 6,100 SF $ $ 5.00 30,500 8 Construct PCC Driveway Approach 900 SF $ 7.00 $ 6300 (T=6")* 9 Construct PCC Curb Ramp 6,000 SF $ $ 11 66,000 10 Construct PCC Curb and Gutter (A-2-6)* 100 LF $ $ 35 3500 11 Construct PCC Curb and Gutter (B-1)* 400 LF $ $ 35 14,000 12 Construct PCC Alley Apron (T=8") 400 SF $ $ 10 4000 13 Construct PCC Alley (T=8") with (3-Day) 160 CY $ 330 $ 52,800 Cure 14 Construct PCC Cross -Gutter (Local Street) 2,200 SF $ $ 9.00 19,800 P-12 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 Item Description Qty Unit Unit Price Amount 15 Grind PCC 300 LF $ $ 30 9000 16 Root Shave 16 EA $ $ 400 6400 17 Adjust Sewer Manhole Frame and Cover to 15 EA $ $ Finished Grade 500 7500 18 Furnish and Install Water Valve Frame and 15 EA $ $ Cover to Grade 650 9750 19 Furnish and Install %" Thick by 16" Wide 100 LF Polyfoam 25 2500 20 Signing and Striping I LS $ 21,000 $ 21,000 21 Project Advertising Sign 2 EA $ 1200 $ 2400 22 Labor Agreement Oversight I LS $ 10,000 $ 10,000 P-13 ofP-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 TOTAL BASE BID $ 874,300.00 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). * The quantity for this bid item is shown for bid comparison only. This bid item shall not be subject to the "25%" limit as stated in Section 3-2 of the Standard Specifications. The actual amount for this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. j This bid item is considered a Specialty Item per Section 2-3.2 of the Standard Specifications. 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 fifty (50) 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 $1,500 per calendar day. Name of Firm EBS General Engineering, Inc. Signature of BIDDER G- Title President (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-14 of P-28 ACTION AND USOLUTION.BY THE BOARD OF DIRECTOR OF EBS G> NERALNGiNEER1NCa; INC A CALIFORNIA CORPORATION All of dieBoasd ofDirectors ofEES Gencral Engineering, lno„ desiring to insure that all the proper and authotized individuals, who have corporate authority to bind the said corporation to any and_contracts executed by such autborizcd individuals, Kaye been approved by"the board of directors of EBS General Engineering, held a meeting on The Board, following a review of the "foregoing matter; and upon motion made and seconded, the Board of Diceetors hereby determines and votes unanimously as Follows; BE IT Tl- EUVORE RESOLVED that Joseph Nan -,I is hereby designated, authorized and empowered,,to be duly authorized with all the attendant powers and authorizations related thereto, to bind, obligate and commitBBS General Engineering, Inc, toany,and all contracts executed by and betweenEBS General I ngineering, Tnc and 7nyother contracting party, There being`ho further or pending business before the Board, the :meeting wac adjourned. BOARD OF DIRECTORS Date: January 3 2010, Josep anci, Roe Director ATTESTA;TIOI j I, being tine Secretary of the above referenced corporation, do hereby certify that the above resolution; is the resolution of the corporation. Dated: ! 3 !+p Jo sep anci, Secretary CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 1.8-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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 Executive 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 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 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 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. Name of Firm EBS General Engineering, Inc. Signature of BIDDER G ,tiG Title President (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-15 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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: EBS General Engineering, Inc. Business Address: 1320 E. Sixth St., Ste 100 Corona CA 92879 Business E-Mail Address: bids@ebsgeneral.com Telephone 951-279-6869 State Contractor's License No. and Class: 720016 A License Expiration Date: 3/31/20 State Dept. of Industrial Relations (DIR) Registration No.: 1000005295 State Dept. of Industrial Relations (DIR) Registration Expiration Date: Signed: 4-1 ----. Title: President 19 P-16 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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 Firm EBS General Engineering, Inc. Signature of BIDDER G Title President (if an individual, so state) P-17 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 OWNERSHIP AFFIDAVIT STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS: CITY OF SANTA ANA ) Joseph A _ Nanci , 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 turn designated as: and who has been and is duly vested with the authority to make and execute instruments for the co -partnership by: who constitute the other members of the co -partnership. j(CORPORATION That he is of EBS General Engineering, Inc. a corporation which is making the foregoing proposal: ❑ JOINT VENTURE That he is of 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: 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 himself�orpily other person. Signature of BZorn — Joseph A. Nanci, President ubscribed San to�fore me this i % day of 20 o Oath (Notary Public) K. FAIRWEATHER Notary Public - California aa Riverside County zzCommission N 2149313 My Comm. Expires A r 21, 2020 P-18 ofP-28 BOND #3-B CITY OF SANTA ANA PREMIUM: NIL PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 KNOW ALL PRESENT that, EBS GENERAL ENGINEERING, INC. as BIDDER, and SURETEC INSURANCE COMPANY as SURETY, are held and firmly bound unto the CITY OF SANTA ANA, as AGENCY, in the penal sum of \tn �ex�ea,:- o� Al 0,,at- P>;b Dollars ($ D %, ), 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 13TH day of FEBRUARY ,2019. BIDDER* EBS GENERAL ENGINEERING, INC. BY: 1320 E. SIXTH ST. , #100 jusepn A. rvanci, rrestaent CORONA, CA 92879 (951) 279-6869 SURETY* 3131 CAMINO DEL RIO N., I11450 SPOCER FLAKE, ATTORNEY —IN —FACT SAN DIEGO, CA 92108 (619) 400-4100 Subscribed and sworn to before me this day of , 20_ Signature: Notary Public in and for the County of , State of * Provide BIDDER/ SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. AUTHORIZED REPRESENTATIVE: CULBERTSON INSURANCE SERVICES, INC. 5500 E. SANTA ANA CANYON RD., #201 ANAHEIM, CA 92807 (714) 921-0530 P- 19 of P-28 CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT 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 Riverside ) On February 19, 2019 befo Dote me, Public, personally appeared Joseph Nanci Nome(s) of Signer(s) K. Fairweather Insert Name and Title of the officer 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 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. K. FAIRWEATHER WITNESS my ha d and official seal. Notary Public - California i ;'® Riverside County i z ' Commission # 2149313 My Comm. Expires Apr 21, 2020 -------------------------- ----------------- --------- OPTIONAL ------------------------------------------------------------ Though this section is optional, completing this information can deter alteration of the document or fraudulent attachment of this form to on unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signers Name: ❑ Corporate Officer — Title(s) ❑ Partner - ❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Trustee ❑Guardian or Conservator ❑ Other: Signer is Representing: Signers Name: ❑ Corporate Officer—Title(s) ❑ Partner -❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Trustee ❑Guardian or Conservator ❑ Other: Signer is Representing: JURAT FORM A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA COUNTY OF ORANGE Subscribed and sworn to (or affirmed) before me on this 13TH day of FEBRUARY ,20 19 by SPENCER FLAKE proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. LEXIE SHERWOOD (NOTARY SEAL - COMM. # 2203287 ! �— l" NOTARY PUBLIC• CAUFORNIA 'n NOTARY PUBLIC SIGNATURE ORANGE COUNTY COMM. EXP. JULY 27, 2021 OPTIONAL INFORMATION THIS OPTIONAL INFORMATION SECTION IS NOT REQUIRED BY LAW BUT MAY BE BENEFICIAL TO PERSONS RELYING ON THIS NOTARIZED DOCUMENT. TITLE OR TYPE OF DOCUMENT DATE OF DOCUMENT When executing a jurat, a notary shall administer an oath of affirmation to the affiant and shall determine, from satisfactory evidence, that the affiant is the person executing the document. The affiant shall sign the document in the presence of the notary. To order supplies, please contact McGlone Insurance Services, Inc. at (916) 484 0804. p0 Ait: 510123 SureTec Insurance Company LIMITED POWER OF ATTORNEY Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and. having its principal office in Houston, Harris County, Texas, does by these presents make, constitute and appoint Charles L. Flake, David L. Culbertson, Spencer Flake, Heather Willis its true and lawful Attorney -in -fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for, providing the bond penalty does not exceed Ten Million and 00/100 Dollars ($10,000,000,00) and to bind the Company thereby as fully and to the same extent as if such bond were signed by the CEO, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney -in -Fact may do in the premises. Said appointment is made under and by authority of the following resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved, that the President; any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney -in -Fact may be given full power and authority for and in the name of and of behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attomey-in-Fact shall be binding upon the Company as if signed by the President and sealed andeffected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held on 20 of April, 1999.) In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its CEO, and its corporate seal to be hereto affixed this 28th day of September , A.D. 2018 . AN SURWJo PANY SURAN�F"'S. V� ,X......,..NCA\ta wr S t3.= BY: w i w pr State of Texas ss:I County of Barris `R ^•• �� On this 28th day of September , A.D. 2018 before me personally came John Knox Jr., to me known, who, being by me duly sworn, did depose and say, that he resides in Houston, Texas, that he is CEO of SURETEC INSURANCE COMPANY, the company described in and which executed the above instrument; that he knows the sealof said Company; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said Company; andthat he signed his name thereto by like order. „o`irrif..... . µ� XFNIA CHAUFC :.c, Netary Public. Stalo of Toxas Com rn. Expires 09-10-2020 '%'t o �ia� Notary ID 119117659 �hTp„ Xet ' avez, Notary Public III commission expires September 1 , 2020 1, M. Brent Beaty, Assistant Secretary of SURETEC INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Company, which is still in full force and effect; and furthermore, the resolutions of the Board of Directors, set out in the Power of Attorney are in full force and effect. Given under my hand and the seal of said Company at Houston, Texas this 13TH day of FE VAR 2019, A.D. Bre ttf 3eaTy, Areta Any instrument Issued in excess of the penalty stated above is totally void and without any validity. For verification of the authority of this power you may call (713) 812.0800 any business day between 8:30 am and 5:00 pm CST. CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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: o Streets, highways including bridge projects: %z% of the bid or $10,000, whichever is greater o Buildings, parks, or other projects: %z% 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 License #/Exp. LS 8231 DIR Reg.#/Exp. 1000007166 Location Corona, CA Phone 909-484-4200 Type Of Work survey Amount $ $9600 Name License #/Exp. DIR Reg. #/Exp. Location Phone Type Of Work Amount $ Name Orange County Striping Service Name License #/Exp. 346095 License #/Exp. DIR Reg. #/Exp. 1000005547 DIR Reg. #/Exp. License # License # Location Orange, CA Phone 714-639-4550 Type Of Work striping Amount $ 19,615 Name License #/Exp. DIR Reg. #/Exp. License Location Phone Type Of Work Amount $ Signature of Bidder Location Phone Type Of Work Amount $ Name License #/Exp. DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ P-20 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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. 1. See attached reference list Name and Address of Owner. 2. 3. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Name and Address of owner. Type of Work Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed Date Completed 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. Culbertson Insurance Services: 5500 E. Santa Ana Canyon Rd., Ste 201 Anaheim CA 92807 714-921-0530 Invensure Insurance Brokers: 17991 Cowan Irvine CA 92614 (949) 756-4100 P-21 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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. 1 See attached reference list Name and Address of Owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed 2. Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed 3. Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. See info on P-21 P-22 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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 prosecution. / 1 r Signed A. Nanci, President State of C 'fprinia County of \ �, �bscribed and sworn to (or affirmed) before me on this �O `/I day of k 20�, by J��V�-� proved to me on the basis of satisfactory evidence to be the who appeared before me Public Signatuke Notary Public _- K. FAIRWEATHER Notary Public - California z's Riverside County z Z Commission # 2149313 '— MyComm. Expires Apr 21, 2020 P-23 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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 applicants for employment. 4. The Contractor shall comply with all 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. In 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. P-24 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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 Cap/ter. Signed: ✓'"�-J^ Title: President Firm: EBS General Engineering, Inc. Date: 2/19/19 P-25 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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 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 same manner as the other contractors, except contractors not signatory to the trust agreement shall pay a like amount to the California Apprenticeship Council. Signed: G e,el �- Title: President Firm: EBS Genearl Engineering, Inc. Date: 2/19/19 P-26 of P-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 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: G Title: President Firm: EBS General Engineering, Inc. Date: 2/19/19 P-27 ofP-28 CITY OF SANTA ANA PROPOSAL PROJECT NOS.: 18-7526 & 18-7527 RESIDENTIAL STREET REPAIR PROGRAM PROJECT NO. 18-6910 ALLEY IMPROVEMENT FY 17/18 PUBLIC CONTRACT CODE SECTION 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 V If the answer is yes, explain the circumstances in the following space. P-28 of P-28 generalogineering Nc 1320 E. SIXTH, SUITE 100 • CORONA, CA 92879-1700 Tel: (951) 279-6869 • FAX: (951) 279-6832 City of Santa Ana Public Works Agency 20 Civic Center Plaza, Ross Annex M-22, Third Floor Santa Ana CA 92701 Attn: Victor So 6 EaBNary 11.20'9 2 pm SEF'I Bi0oCN0FOR RESIOENTIAISTREETRE9IRIROGRAM F90JECTNOS V52EM7,527A-LFIIIAPRC'VEME`1-SEV'7116. AG t) CERTIFICATE OF LIABILITY INSURANCE 05128/2019YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LIC #OE28842 1-949-756-4100 Invensure Insurance Brokers, Inc. 17991 Cowan CONTACT T Kathryn Lopez NAME:N. L81),949-756-412ve3 FpAX No: 949-756-4199 E-MAIL klo ez@innsure. corn AOORE55: H INSURERS AFFORDING COVERAGE NAIC# Irvine, CA 92614 INSURERA: LIBERTY NUT FIRE INS CO 23035 INSURED EBB General Engineering, Inc. INSURER B: FIRST LIBERTY INS CORP 33588 INSURER C : LIBERTY INS CORP 42404 INSURER D: 1320 E. Sixth St, #100 INSURER E : Corona, CA 92879 INSURER F: COVERAGES CERTIFICATE NNMRER• 56263086 OaTNmnu nil MBER. _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPEOFINSURANCE ADOL5 BR POLICY NUMBER FF PWDDNYFF ME POLICYEXP MML1C YYYY LIMITS A X I COMMERCIALGENERALLIABILITY CLAIMS -MADE F7X OCCUR X TB2-Z91-454286-018 09/28/18 09/28/3-9 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RETT—ED PREMSES(E. occurrance — $ 100,000 X MED EXP (Any one person) $ 5,000 $2,500 Deductible PERSONAL B ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY � BE� 1-1 LOC GENERALAGGREGATE $ 2,000,000 GENT PRODUCTS - COMPlOP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY A86-Z91-454286-028 09/28/18 09/28/19 COMBINED SINGLE LIMIT _ Ea accident $ 1,000,000 X ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) — --- IS X HIRED AUTOS ONLY X AUTOS ONLDV PROPERTY DAMAGE -(Per accR ru l $ _ C X DMBRELLALIAB X OCCUR TH7-Z91-454286-048 09/28/18 09/28/19 EACFI OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 4,000,000 DED RETENTION$ $ B WORKERS COMPENSATION ANDENIPRIETORPART EMITY YIN ANYICERUMETORJPARTNE(UE%ECUTIVE OEEICEtuq NIA WC2-Z91-454286-038 09/28/18 09/28/19 X STATUTE ERH ELEACHACCIDENT $ 1,000,000 E, L. DISEASEEAEMPLOYEE - $ 1,000,000 In NERE%CLUDED4 0 yes, describe Ityes,dorybeund EL.DISEASE-POLICY LIMIT J$ 1,000,000 OF O DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD Im, Additional Remarks Schedule, may be attached it more space is required) Primary wording CO 20 01 04 13 applies per attached form. Certificate holder"+ in additional insured per attached CG 2010 04 13 and CO 2037 04 13, **City of Santa Ana is additional insured. Projects PROJECT NOS. 18-7526, 18-7527 & 18-6910; RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY IMPROVEMENT FY17/18 PROJECT EBB Job #19063 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Management I ACCORDANCE WITH THE POLICY PROVISIONS. 0 Civic Center Plaza AUTHORIZED REPRESENTATIVE Ana, CA 92702 p /7 I USA ,�e-r� (/-u y- 988-2015 ACORD CORPORATION. All ACORD 25 (2016I03) The ACORD name and logo are registered marks of ACORD klopez 56263086 POLICY NUMBER: TB2-Z91-454286-018 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work' out of which the injury or damage arises has been put to Its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © ISO Properties, Inc., 2012 Page 1 of 2 ❑ SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations All Persons or organizations with whom you have All locations as required by written contract or entered into a written contract or agreement, prior to agreement entered into prior to an "occurrence" an `occurrence" or offense, to provide additional or offense. Insured status. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER: TB2-Z91-454286-018 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All Persons or organizations with whom you have All locations as required by written contract or entered into a written contract or agreement, prior agreement entered into prior to an "occurrence" or to an "occurrence" or offense, to provide additional offense. insured status Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to required by a contract or will pay on behalf of the amount of insurance: the additional insured is agreement, the most we additional insured is the 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Policy No. TB2-Z91-454286-018 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 0104 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 PUBLIC WORKS CONTRACT AWARD INFORMATION Contract award information must be sent to your Apprenticeship Committee if you are approved to train, tt you are not approved to train, you must send the information (which may be this form) to ALL applicable Apprenticeship Committees in your craft or trade in the area of the site of the public work, Go to: http://www.dir.ca.gov/das/Publ!cWorksForms.htmfor information about programs in your area and trade. You may also consult your local Division of Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under California, State of, Industrial Relations, Division of Apprenticeship Standards. Do not send this form to the Division of Apprenticeship Standards. NAME OF YOUR COMPANY EBS General Engineering, Inc CONTRACTORS STATE LICENSE NO 720016 MAILING ADDRESS- NUMBER 8 STREET, CITY, ZIP CODE 1320 E. Sixth St. #100 Corona,Ca. 92879 AREA CODE 8 TELEPHONE NO. 951-279-6869 NAME &ADDRESS OF PUBLIC WORI(S PROJECT DATE YOUR CONTRACT EXECUTED RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY 5/21/19 IMPROVEMENT FY17/18 PROJECT DATE OF EXPECTED OR ACTUAL START OF PROJECT Various, City of Santa Ana 6/10/19 HAM 8 ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT ESTIMATED NUMBER OF JOURNEYMEN HOURS City of Santa Ana 189 20 Civic Center Plaza OCCUPATION OF APPRENTICE Santa Ana, CA 92701 Operator THIS FORM IS BEING SENT TO: (NAME & ADDRESS OF APPRENTICESHIP PROGRAM(S)) ESTIMATED NUMBER OF APPRENTICE HOURS 38 Southern CA Operating Engineers JAC APPRGkIMATE DATES TO BE ENPLOYED 2190 S. Pelllssler Place Whittier CA 90601 6/10/19 thru 7/31/19 t: 562-695-0611 f: 562-695-4676 This is not a request for dispatch of apprentices. Contractors must make a separate request for actual dispatch, in accordance with Section 230.1(a) California Code of Regulations Check One Of The Boxes Below 1. 7 We are already approved to train apprentices by the Operating Engineers Apprenticeship Committee. We will employ and train under their Standards. Enter name of the committee 2. ❑ We will comply with the standards of Apprenticeship Committee for the duration of this job only. Enter name of the 3. We will employ and train apprentices in accordance with the California Apprenticeship Council regulations, including § 230.1 (c) which requires that apprentices employed on public projects can only be assigned to perform work of the craft or trade to which the apprentice is registered and that the apprentices must at all times work with or under the direct supervision of journeyman/men. Signature ( Date 1511- 3 / y 01 Typed Name Cristina Whitcher Title Contracts Administrator State of California - Department of Industrial Relations DIVISION OAS IQ (REV. 1104) OF APPRENTICESHIP STANDARDS REQUEST FOR DISPATCH OF AN APPRENTICE — DAS 142 FORM iW DO NOT SEND THIS FORM TO DAS You may use this form to request dispatch of an apprentice from the Apprenticeship Committee in the craft ar trade in the area of the public work. Go to: http://www.dir.ca.gov/DAS/PublicWorksForms.htm for information about programs in your area and trade. You may also consult your local Division Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under California, State of, Industrial Relations, Division of Apprenticeship Standards. Except for proiects with less than 40 hours of journeyman work, you must reauest and employ apprentices in no less than 8 hour increments Date: Contractor Requesting Dispatch: 5123/19 Name: EBS General Engineering, Inc. To Applicable Apprenticeship Committee: 1320 E. Sixth St. #100 Engineers Name:Operating Address: Address:2190 S. Pellissier Place Corona, Ca. 92879 Whittier CA 90601 720016 License No. _ Tel. No. 562-695-0611 Fax No. 562-695-4676 Tel. No. Fax No. 951 279-6869 951 279-6832 Project Information: PROJECT NOS. 18-7526, 18-7527 & 18-6910 Contract No. Name of the Project: RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY IMPROVEMENT FY17/18 Address:yarious, City of Santa Ana Dispatch Request Information: 1 O pe rato r Number of Apprentice(s) Needed: Craft or Trade: 6/1 0/1 9 7.30 AM Date Apprentice(s) to Report: (72 hrs. notice required) Time to Report: Dave S U l I iC Name of Person to Report to: 1320 E. SIXTH ST., STE 100 Address to Report to: CORONA CA 92879 You may use this form to make your written request for the dispatch of an apprentice. Requests for dispatch must be in writing and submitted at least 72 hours in advance (excluding weekends and holidays) via first class mail, fax or email. Proof of submission may be required. Please take note of California Code of Regulations, Title 8, § 230,1(a) for all applicable requirements regarding apprenticeship requests and/or visit http://www.dir.ca.gov/DAS/DASApprenticesOnPublicWorksSummaaOfRecluirements htm DAS 142 (Revised 12111) PUBLIC WORKS CONTRACT AWARD INFORMATION Contract award Information must be sent to your Apprenticeship Committee if you are approved to train. If you are not approved to train, you must send the Information (which may be this form) to ALL applicable Apprenticeship Committees In your craft or trade In the area of the site of the public work. Go to: http://www.dir.ca.gov/das/PublieWorksForms.htmfor Information about programs in your area and trade. You may also consult your local Division of Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under California, Slate of, Industrial Relations, Division of Apprenticeship Standards. Do not send this form to the Division of Apprenticeship Standards. NAME OF YOUR COMPANY EBS General Engineering, Inc. CONTRACTOR'S STATE LICENSE NO 720016 MAILING ADDRESS -NUMBER 8 STREET, On. ZIP CODE 1320 E. Sixth St. #100 Corona,Ca. 92879 AREA CODE 8 TELEPHONE NO. 951-279-6869 NAME B ADDRESS OF PUBLIC WORKS PROJECT DATE YOUR CONTRACT EXECUTED RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY 5/21/19 IMPROVEMENT FY17/18 PROJECT DATE OF EXPECTED OR ACTUAL START OF PROJECT Various, City of Santa Ana 6/10/19 NAME 8 ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT ESTIMATED NUMBER OF JOURNEYMEN HOURS City of Santa Ana 605 20 Civic Center Plaza OCCUPATION OF APPRENTICE Santa Ana, CA 92701 Laborer THIS FORM IS SEND SENT TO: (NAME & ADDRESS OF APPRENTICESHIP PROGRAM(S)) ESTIMATED NUMBER OF APPRENTICE HOURS 121 Laborers Southern CA JAC 1385 West Sierra Madre Ave APPROXIMATE DATES TO BE ENPLD ED Azusa CA 91702 6/10/19 thru 7131/19 t: 626-610-1700 f: 626-633-0204 This is not a request for dispatch of apprentices. Contractors must make a separate request for actual dispatch, in accordance with Section 230.1(a) California Code of Regulations Check One Of The Boxes Below 1. ® We are already approved to train apprentices by the Construction Laborers of Southern California Apprenticeship Committee. We will employ and train under their Standards. Enter name of the committee 2. ❑ We will comply with the standards of Apprenticeship Committee for the duration of this job only. Enter name of the committee 3. ❑ We will employ and train apprentices in accordance with the California Apprenticeship Council regulations, including § 230.1 (c) which requires that apprentices employed on public projects can only be assigned to perform work of the craft or trade to which the apprentice is registered and that the apprentices must at all times work with or under the direct supervision of journeyman/men. Signature e^^ Date 5 f`7-3 Aq Typed Name Cristina Whitcher Title Contracts Administrator State of California - Department of Industrial Relations DIVISION CAB 140(REV. 1/04) OF APPRENTICESHIP STANDARDS REQUEST FOR DISPATCH OF AN APPRENTICE — DAS 142 FORM Wi DO NOT SEND THIS FORM TO DAS You may use this form to request dispatch of an apprentice from the Apprenticeship Committee in the craft or trade in the area of the public work. Go to: http://www.dir.ca.gov/DAS/PublicWorksForms.htm for information about programs in your area and trade. You may also consult your local Division Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under California, State of, Industrial Relations, Division of Apprenticeship Standards. Except for prolects with less than 40 hours of journeyman work, you must request and employ apprentices in no less than 8 hour increments Date: Contractor Requesting Dispatch: 5/23/19 Name: EBS General Engineering, Inc. ToAppucable—Apprenticeship Committee: E. Sixth St. #100 Southern CA JAC Name:Laborers Address:1320 Address:1385 West Sierra Madre Ave Corona, Ca. 92879 Azusa CA 91702 License No. 720016 626-610-1700 626-633-0204 Tel. No. Fax No. 951279-6869 951279-6832 Tel. No. Fax No. Project Information: PROJECT NOS. 18-7526, 18-7527 & 18-6910 Contract No. Name of the Project: RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY IMPROVEMENT FY17/18 Address:Various, City of Santa Ana Dispatch Request Information: Number 1 LABORER of Apprentice(s) Needed: Craft or Trade: Date A to Report: 6/10/19 7:30 AM Apprentice(s) hrs. s notice required) Time to Report: () p (72 Dave Suilk Name of Person toReportto: 1320 E. Sixth St., Ste 100 Address to Report to: Corona CA 92879 You may use this form to make your written request for the dispatch of an apprentice. Requests for dispatch must be in writing and submitted at least 72 hours in advance (excluding weekends and holidays) via first class mail, fax or email. Proof of submission may be required. Please take note of California Code of Regulations, Title 8, § 230.1(a) for all applicable requirements regarding apprenticeship requests and/or visit http://wwwdirca.00v/DAS/DASAaprenticesOnPublicWorksSummarvOfReouirements htm DAS 142 (Revised 12111) PUBLIC WORKS CONTRACT AWARD INFORMATION Contract award Information must be sent to your Apprenticeship Committee if you are approved to train. If you are not approved to train, you must send the Information (which may be this form) to ALL applicable Apprenticeship Committees in your craft or trade in the area of the site of the public work. Go to: http:Nwww,dir.ca.gov/das/Publ!cWorksForms.htmfor Information about programs in your area and trade. You may also consult your local Division of Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under California, State of, Industrial Relations, Division of Apprenticeship Standards. Do not send this form to the Division of Apprenticeship Standards. NAME OF YOUR COMPANY EBS General Engineering, Inc CONTRACTORS STATE LICENSE NO 720016 MAILINGADDRESS. NUMBER 8 STREET, CITY, ZIP CODE 1320 E. Sixth St. #100 Corona, CA 92879 AREA CODE 8 TELEPHONE No 951-279-6869 NAME 8 ADDRESS OF PUBLIC WORKS PROJECT DATE YOUR CONTRACT EXECUTED RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY 5/21/19 IMPROVEMENT FY17/18 PROJECT DATE OF EXPECTED OR ACTUAL START OF PROJECT Various, City of Santa Ana 6/10/19 NAME 8 ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT ESTIMATED NUMBER OF JOURNEYMEN HOURS City of Santa Ana 1358 20 Civic Center Plaza OCCUPATION OF APPRENTICE Santa Ana, CA 92701 Cement Mason THIS FORM IS BEING SENT TO: (NAME 8 ADDRESS OF APPRENTICESHIP PROGRAM(S)) ESTIMATED NUMBER OF APPRENTICE HOURS Southern CA Cement Mason JAC 272 5417 Peck Road APPROXIMATE DATES TO BE EMPLOYED Arcadia CA 91006 6/10/19 thru 7/31/19 t: 626-444-4600 f: 626-258-4092 This is not a request for dispatch of apprentices. Contractors must make a separate request for actual dispatch, in accordance with Section 230.1(a) California Code of Regulations Check One Of The Boxes Below 1. x We are already approved to train apprentices by the Cement Masons Apprenticeship Committee. We will employ and train under their Standards. Enter name of the 2. ❑ We will comply with the standards of Apprenticeship Committee for the duration of this job only. Enter name of the committee 3. ❑ We will employ and train apprentices in accordance with the California Apprenticeship Council regulations, including § 230.1 (c) which requires that apprentices employed on public projects can only be assigned to perform work of the craft or trade to which the apprentice is registered and that the apprentices must at all times work with or under the direct supervision of journeyman/men. Signature t/l_� Date �r23d\�l Typed Name Title Cristina Whitcher Contracts Administrator State of California - Department of Industrial Relations DIVISION OAS 140 (REV. t04) OF APPRENTICESHIP STANDARDS REQUEST FOR DISPATCH OF AN APPRENTICE — DAS 142 FORM 6W DO NOT SEND THIS FORM TO DAS You may use this form to request dispatch of an apprentice from the Apprenticeship Committee in the craft or trade in the area of the public work. Go to: http://www.dir.ca.gov/DAS/PublicWorksForms.htm for information about programs in your area and trade. You may also consult your local Division Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under California, State of, Industrial Relations, Division of Apprenticeship Standards. Except for projects with less than 40 hours of journeyman work, you must request and employ apprentices in no less than 8 hour increments Date: Contractor Requesting Dispatch: 5/23/19 Name: EBS General Engineering, Inc. To Applicable Apprenticeship Committee; 1320 E. Sixth St. #100 Southern CA Cement Mason JAC Name: Address: Address:5417 Peck Rd Corona, Ca. 92879 Arcadia CA 91006 720016 License No. _ 626-444-4600 Fax No. 626-258-4092 Tel. No. 951279-6869 951279-6832 Tel. No. Fax No. Project Information: PROJECT NOS. 18-7526, 18-7527 & 18-6910 ContractNo. Name of the Project: RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY IMPROVEMENT FY17118 Various, City of Santa Ana Address: Dispatch Request Information: Number of Apprentice(s) Needed: 1 CraftorTrade: Cement Mason Date Apprentice(s) to Report: 611 0/1 9 7.30 AM hrs. (72 notice required) Time to Report: Dave Sulk Name of Person to Report to: E. Sixth St., Ste 100 Address to Report to:1320 Corona CA 92879 You may use this form to make your written request for the dispatch of an apprentice. Requests for dispatch must be in writing and submitted at least 72 hours in advance (excluding weekends and holidays) via first class mail, fax or email. Proof of submission may be required. Please take note of California Code of Regulations, Title 8, § 230.1(a) for all applicable requirements regarding apprenticeship requests and/or visit htfp.//www.dirca.gov/DAS/DASApprenticesOnPublicWorksSummarvOfRequirements htm DAS 142 (Revised 12111) ACTIVITY REPORT TIME : 05/23/2019 07:49 NAME : EBS INC FAX : 9512796832 TEL : 9512796869 SER.# : BROEBJ804245 NO. DATE TIME FAX NO./NAME DURATION PAGE(S) RESULT COMMENT 05/16 20:12 7 47 01 OK RX ECM 05/16 20:14 9 48 01 OK RX ECM 05/16 20:16 9 45 01 OK RX ECM 05/16 20:20 11 46 01 OK RX ECM 05/16 20:22 14 49 01 OK RX ECM 05/16 20:23 13 46 01 OK RX ECM #396 05/17 10:03 19492222940 14:31 01 NG TX ECM #397 05/17 15:31 17145427855 49 02 OK TX ECM 05/17 16:58 02:01 03 OK RX ECM 05/17 19:50 16 47 01 OK RX ECM 05/17 19:51 12 47 01 OK RX ECM 05/17 19:53 12 47 01 OK RX ECM 05/18 08:51 01:40 03 OK RX ECM #398 05/20 15:25 15624215964 18 01 OK TX ECM #399 05/20 15:32 15624215964 18 01 OK TX ECM 05/20 16:01 01:20 03 OK RX ECM 05/20 19:50 11 45 01 OK RX ECM 05/20 19:52 7 01:09 02 OK RX ECM 05/20 19:54 7 49 01 OK RX ECM 05/20 19:56 7 47 01 OK RX ECM 05/20 19:57 7 46 01 OK RX ECM 05/20 19:59 7 46 01 OK RX ECM 05/20 20:01 7 47 01 OK RX ECM 05/20 20:02 12 47 01 OK RX ECM 05/21 04:40 31 01 OK RX 05/21 06:28 714 516 1053 01:11 04 OK RX ECM 05/21 09:31 28 01 OK RX ECM 05/21 12:31 19096942258 01:31 02 OK RX 05/21 15:44 51 02 OK RX ECM 05/21 19:53 13 51 01 OK RX ECM 05/21 19:58 15 45 01 OK RX ECM 05/22 07:54 22 01 OK RX ECM 05/22 19:50 11 01:07 02 OK RX ECM 05/23 05:54 +1 714 921 2096 32 04 OK RX ECM #400 05/23 07:36 16262584092 48 02 OK TX ECM 0402 05/23 07:43 15626954676 01:48 02 OK TX #401 05/23 07:47 16266330204 01:03 02 OK TX ECM BUSY: BUSY/ND RESPONSE NG POOR LINE CONDITION / OUT OF MEMORY CV COVERPAGE POL POLLING RET RETRIEVAL CITY OF SANTA ANA BONDS BONDII 4427835 PREMIUM: $7,915 PROJECT NO.: 18-7526, 18-7527 & 18-6910 FAITHFUL PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS that EBS GENERAL ENGINEERING, INC. as CONTRACTOR, and SURETEC INSURANCE COMPANY a corporation, organized and existing under the laws of the State and duly authorized to transact business under the laws of the State of California, as SURETY, are held and firmly bound unto the City of Santa Ana, as AGENCY, in the penal sum of EIGHT HUNDRED SEVENTY-FOUR THOUSAND THREE HUNDRED & NO/ 100' S Dollars ($ 874, 300.00 ), 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. * TEXAS 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 MAY 21, 2019 for RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY IMPROVEMENT ** 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. ** PY17/18 PROJECT IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 23RD day of MAY 20 19. ^� 1320 E. SIXTH ST., STE. 100 CONTRACTOR*, GENERA ENGINEERING, INC. CORONA, CA 92879 951-279-6869 BY: -' _ , t. l & Iv_ .... D. IA I n L CHARLES L. FLAKE / ATTORNEY -IN -FACT Subscribed and sworn to before me, 20 Signature: 3131 CAMINO DEL RIO N., STE. 1450 this day of Notary Public in and for the County of State of Rate ofpremiumonthisbond is$ to.8o/$6.72 per thousand. Total amount of premium charge is $ 7,915 . 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. AUTHORIZED REPRESENTAYIVE: CULBERTSON INSURANCE SERVICES, INC. 5500 E SANTA ANA CANYON ROAD, STE. 201 ANAHEIM, CA 92807 714-921-0530 1 of 3 CALIFORNIA JURAT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document, to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA COUNTYOF Riverside Subscribed and sworn to (or affirmed) before me on this 28th day of May 2019 Date Month Year by Joseph Anthony Nanci Name of Signers proved to me on the basis of satisfactory evidence to be the persons) who appeared before me. Signature: Sj nature of AlKtary Public JESSICA LICEA Notary Public - California 3 @My RiversideCountyCommission X 2211630 Comm. Expires Oct 21, 2021 Seal Place Notary Seal Above --------------------------------------------------- OPTIONAL --------------------------------------------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent attachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Number of Signer(s) Other Than Named JURAT FORM L notary public or other officer completing this certificate verifies only the entity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA COUNTY OF ORANGE ) Subscribed and swom to (or affirmed) before me on this 23RD day of MAY 20 19 by CHARLES L. FLAKE proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. LEXIE SHERWOOD COMM. # 2203287 3 gNOTARY PUBLIC OUNTYCALIFORNIA ORANGE COUNTY —' (NOTARY SEAL) Comm. Exp. JULY 27. 2021 OTARY PUBLIC SIGNATURE OPTIONAL INFORMATION THIS OPTIONAL INFORMATION SECTION IS NOT REQUIRED BY LAW BUT MAY BE BENEFICIAL TO PERSONS RELYING ON THIS NOTARIZED DOCUMENT. TITLE OR TYPE OF DOCUMENT a : 1 • ) • JuMMA When executing a jurat, a notary shall administer an oath of affirmation to the affiant and shall determine, from satisfactory evidence, that the affiant is the person executing the document. The affiant shall sign the document in the presence of the notary. To order supplies, please contact McGlone Insurance Services, Inc, at (916) 484 0804. p0A p; 510123 SureTec Insurance Company LIMITED ]POWER OF ATTORNEY Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and. having its principal office in Houston, Harris County, Texas, does by these presents make, constitute and appoiat Charles L. Flake, David L. Culbertson, Spencer Flake, Heather Willis its true and lawful Attorney -in -fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for, providing the bond penalty does not exceed Ten Million and 001100 Dollars ($10,000,000.00) and to bind the Company thereby as fully and to the same extent as if such bond were signed by the CEO, sealed with the corporate seal of the Company and duly attested by its Secretary; hereby ratifying and confirming all that the said Attorney -in -Fact may do in the premises. Said appointment is made under and by authority of the following resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney -in -Fact may be given fullpower and authority for and in the name of and of behalf of the Company, to execute, acknowledge and deliver, any andall bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attomeytn-Fact shall be binding upon the Company as if signed by the President and sealed andeffected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seat of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company withrespect to any bond or undertaking to which it is attached. (Adopted at a meeting held on 20'h of April, 1999.) In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its CEO, and its corporate seal to be hereto affixed this 28th day of September , A.D. Zola , RANOF JUK�dliC: UHA (;L�' WAIN ..........,, o iu; X 9 103 By: a (t w 5 M John K Jr., C? State of Texas ss: •��+, •d ; :'.r County of Harris •••••' On this 28th day of September , A.D. 2018 before me personally came John Knox Jr., to me known, who, being by me duly sworn, did depose and say, that he resides in Houston, Texas, that he is CEO of SURETEC INSURANCE COMPANY, the company described in and which executed the above instrument; that he knows the sealof said Company; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said Company;. andthat he signed his name thereto by like order. ., �.. Pdotary Public, State ot'iexas �:p: Comm. Expires 08.10-2020 "n°l,•_�+`�� Notary IO 129[170G9 Xe ' avez, Notary Public �_W commission expires September I , 2020 I, M. Brent Beaty, Assistant Secretary of SURETEC INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said. Company, which is still in full force and effect; and furthermore, the resolutions of the Board of Directors, set out in the Power of Attorney are in frill force and effect. Given under my hand and the seal of said Company at Houston, Texas this 23RD dof Y 2019 A.D Pary eaty, Ass! taut Secrets Any instrument Issued in excess of the penalty stated above is totally void and without any validity. For verification of the authority of this power you may call (713) 812.0800 any business day between 11:30 am and 5:00 pm CST. BOND# 4427835 CITY OF SANTA ANA PREMIUM: INCLUDED IN PERFORMANCE BOND BONDS PROJECT NO.: 18-7526, 18-7527 & 18-6910 PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS that EBS GENERAL ENGINEERING. INC. as CONTRACTOR, and SURETEC 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 EIGHT HUNDRED SEVENTY-FOUR THOUSAND THREE HUNDRED & NO/100'S Dollars ($ 874, 300.00 ), 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. * TEXAS 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 MAY 21, 2019 for RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY IMPRQVEMENT ** 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. ** FY 17/18 PROJECT IN WITNESS WHERE O the parties hereto have set their names, titles, hands, and seal this 23RD day of MAY 120 19 1320 E. SIXTH ST., STE. 100 CONTRACTOR* BS CFNERA9 ENGINEERING INC. CORONA CA 92879 951-279-68f BY: n 9 3131 CAMI O DEL RIO N., STE. 1450 SU ETC U ANY SAN DIEGO, CA 92108 619-400-4100 BY: CHAR S L. FLAKE / ATTORNEY -IN -FACT Subscribed and sworn to before me, this ,day of 20 Signature: Notary Public in and for the County of State of Rate of premium on this bond is $ Nil. per thousand. Total amount of prendurn charge is $ NTr. . To be ftllgd in by Surety *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. AUTHORIZED REPRESENTATIVE: CULBERTSON INSURANCE SERVICES, INC. 5500 E SANTA ANA CANYON ROAD, STE 201 ANAHEIMofgA 92807 714-921-0530 CALIFORNIA JURAT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document, to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA COUNTY OF Riverside Subscribed and sworn to (or affirmed) before me on this 28th day of . May 2011) Dote Month Yenr by Joseph Anthony Nanci Name of Signers proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Signature: A .r. %.— , Si nature of Not6ry Public JESSICA LICEA ._,r.., Notary Public -California Niwrside County S - Commission a 2215630 My Comm. Expires Oct 21, 2021 Seal Place Notary Seal Above --------------------------------------------------- OPTIONAL --------------------------------------------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent attachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Number of Signer(s) Other Than Named JURAT FORM A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA COUNTY OF ORANGE Subscribed and sworn to (or affirmed) before me on this 23RD day of MAY 20 19 by CHARLES L. FLAKE proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. LEXIE SH�ERWO D CO #? 3 � �/ g NOTARY PUBLIC• CAUFORNIA n OTARY SEAL ORANGE COUNT GE COUNTY Comm. Exp. DULY 27, 2021 NARY PUBLIC SIGNATURE OPTIONAL INFORMATION THIS OPTIONAL INFORMATION SECTION IS NOT REQUIRED BY LAW BUT MAY BE BENEFICIAL TO PERSONS RELYING ON THIS NOTARIZED DOCUMENT. TIME OR TYPE OF DOCUMENT DATE OF DOCUMENT When executing a jurat, a notary shall administer an oath of affirmation to the affiant and shall determine, from satisfactory evidence, that the affiant is the person executing the document. The affiant shall sign the document in the presence of the notary. To order supplies, please contact McGlone Insurance Services, Inc. at (91 6) 484 0804. eon M: 510123 SureTec Insurance Company LIMITED POWER OF ATTORNEY Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents make, constitute and appoint Charles L. Flake, David L. Culbertson, Spencer Flake, Heather Willis its true and lawful Attorney -in -fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for, providing the bond penalty does not exceed Ten Million and 001100 Dollars ($10,000,000.00) and to bind the Company thereby as fully and to the same extent as if such bond were signed by the CEO, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney -in -Fact may do in the premises. Said appointment is made under and by authority of the following resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attomey(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney -in -Fact may be given full power and authority for and in the name of and of behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed andeffected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to. which it is attached. (Adopted at a meeting held on 201h of April, 1999.) In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its CEO, and its corporate seal to be hereto affixed this gem day of September , A.D. 2018 . SURAMQE SURETEC CE PANY WU �:,,•x x.....,;c,0 q ��. By: of w l9€ John Jr.,C 4 State of Texas ss: c• ;•' County of Harris • ••••• , °'ar On this 28th day of September , A.D. 2018 before me personally came John Knox Jr., to me known, who, being by me duly sworn, diddepose and say, that he resides in Houston, Texas, that he is CEO of SURETEC INSURANCE COMPANY, the company described in and which executed the above instrument; that he knows the seal of said Company; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said Company; and that he signed his name thereto by like order. xe • tavez, Notary Public commission expires September 1 , 2020 I, M. Brent Beaty, Assistant Secretary of SURETEC INSURANCE COMPANY; do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Company, which is still in full force and effect; and furthermore, the resolutions of the Board of Directors, set out in the Power, of Attorney are in full force and effect. Given under my hand and the seal of said Company at Houston, Texas this 23RD day of 201 A.D. Br t ealy, Assi taut Secreta Any Instrument issued in excess of the penalty stated above is totally void and without any validity. For verification of the authority of this power you may call (713) 812-0800 any business day between 8:30 am and 6:00 pm CST.