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HomeMy WebLinkAboutINTERNATIONAL LINE BUILDERS, INC. RecordingRequested B q Y, And When Recorded Mail To: City of Santa Ana,Public Works Agency M22 Recorded in Official Records, Orange County 20 Civic Center Plaza,P,O.Box 1988 laugh Nguyen, Clerk-Recorder Santa Ana,CA 92702 111111 1�1111111111111111111 11111 1Il[]III 11111 11111 11111 11111 11I1111 NO FEE * $ R 0 0 1 2 8 2 8 2 9 6 $ * 2021000327297 9:35 am 0511812/ 9 RW11A N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.000.000.00 0.00 AO 5 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 c construction of CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES under contract a entered into on JANUARY 21, 2020, with INTERNATIONAL LINE BUILDERS, INC., on w which contract LIBERTY MUTUAL INSURANCE COMPANY is surety. The property on 0 which such work improvement was placed is in the City of Santa Ana, County of Orange, State o of California, and described as Project No. 17-6875 EHSIPL-5063(188)1 located at: VARIOUS Qg LOCATIONS. The work improvement on said property was accepted as completed on a FEBRUARY 26, 2021. C o CITY OF SANTA ANA, A MUNICIPAL CORPORATION � v w0 w E., w �z By � 0 Dated: S`/ ?�� Principal Ci it Engineer—Jason Gabriel w TITLE ------------------------------------------------------------------------------------------- VERIFICATION I, 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; d I declare under penalty of perjury that the facts therein stated are true. Executed on �g i '` , at Santa Ana, Califo City Engineer—Edwin"William"Galvez THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10)DAYS AFTER COMPLETION INSURANCE ON FILE a WORK MAY PROCEED UNTIL INSURANCE EXPIRES N CLERK OF COUNCIL CITY OF SANTA ANA N DATE: CONSTRUCTION CONTRACT , PROJECT 17-6875 ® CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES [HSIPL4063(188)] This CONSTRUCTION CONTRACT is made and entered into this 2111 day of January, 2020 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 "international Line Builders, Inc, fhereinafter "CONTRACToWl. The CITY and the CONTRACTOR, for the consideration hereinafter named, mutually agree as follows: 1. 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 Citywide Traffic Signal Vehicle ]read Upgrades 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,Coimmcil. 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 Worldorce 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 Three Hundred Eight Thousand Fiftynine Dollars and No Cents ($308,059.00), as set forth and identified in the BID PROPOSAL, which is attached hereto and incorporated herein as Exhibit "A." The BID PROPOSAL contains a schedule of unit price(s) or lump sum(s) based on approximate quantities only, and the City does not expressly or by implication agree that the actual amount of work will correspond therewith, but reserves the right to increase or decrease the amount of any class or portion of the work or to omit portions of the work as may be deemed necessary or advisable. rev. 09/0W017 Page 1 of 3 A. COV RACTOR 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. i, 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: httn://www.santa-ana.orR/owa/documents/CWA.Ddf 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%ti) 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 CIT1'. 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 Band amount shall be the greater of One Hundred Thousand Dollars ($100,000) or Ten Percent (101/9) of the final contract price. 9.. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability Insurance and Worker's Compensation Insurance as outlined in the General Provisions, to be approved by the CITY. Page 2 of 3 IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: CITY OF SANTA ANA DAISY KISTINE lll�.DI!P ,Clerk of the Council City Manager APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: '�" -f. �4' JOftN FUNK Assistant City Attorney FOR APPROVAL: NABIL SABA, PE Acting Executive Director Public Works Agency CONTRACTOR: Intemati Line Builders, Inc. NAME:E'u2rWI- Aj¢orvn TITLE:' t)wiaoin- jry �h+l UiJ Page 3 of 3 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FRoM: international line Builder's, Inc. REQUIREMENT: The undersigned bidder declares that they have carefully examined the location of the proposed work, that they have examined the Contract Documents in its entirety and hereby proposes to furnish all material and do all the work required to complete the said work in accordance with said plans (if any) and the specifications for the unit price(s) or lump sum($) set forth in the following schedule: Ttenr T?escription Qty Unit Unit Price Amount 1 Replace Side Mounted 3-Section Traffic 194 EA Ti i44 00 $1W3, tp.00 T� Signal Vehicle Bead Assembly 2 Replace Side Mounted S-Section Traffic 2 EA Signal Vehicle Head Assembly 3 Replace Top Mounted 3-Section raffle 119 EA Signal Vehicle Head Assembly 4 Replace Top Mounted 4-Section Traffic 4 EA $Gi dc30p $ � Signal Vehicle Read Assembly S Replace Top Mounted 5-Section Traffic 1 EA sl -'�r5n, W $ 1 r7 U QO Signal Vehicle Head Assembly 6 Replace Mast Arm Mounted Traffic 42 EA $`fl IB.W S 30' (71a Up Signal Vehicle Head Assembly 7 Labor Agreement Oversight 1 LS S5,000 $5,000 P-1 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) TOTAL BASE DIA S 0 3tJ �, 05�1. ors The lowest responsible bidder shall be selected based on the total base bid. The City reserves the right to award the Base Hid, and any, all, or none of the add -alternate bid items (if any). * The quantity for this bird 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. t 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 gigh!y (80) working days after the commencement date stated in the Notice to Proceed. The liquidated damages amount, in lieu of the amount specified in Subsection 6-9 of the Standard Specifications, shall be $1,000 per calendar day. Name of Firm Signature of BE Tide (If an individual, so state. If a firm or co -partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) P-2 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROTECT NO, HSIPL 5063(188) BIDDER'S 'ATEMENT 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 famish 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 Signature of BI Title (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-3 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) CONTRACTOR'S LTCENSING AND REGISTRATION STATEMENT The tmdersigned 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: International Line Builder's, Inc. Business Address: 3955 Temescal Canyon Road Coruna, CA 92883 Business E-Mail Address: Omar.Echeyerri ilbinc.com Telephone: 951 6$2 2982 State Contractor's License No. and Class: 782515 A-C10 License Expiration Date: 08/31 /2020 State Dept. of Industrial Relations (DIR) Registration No.: 1000007032 State Dept. of Indus tri elations (DIR) Registration Expiratio D te: 06/30/201 Signed: Title:�PyAhdf" ,P6 jCal P-4 ofP-38 CITY OF SANTA ANA PROPOSAL PROJECT NO,: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) L'REVAILING 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, or seq., ("Prevailing Wage Laws"), wbich 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 $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at the commencement of this Agreement, Contractor shall make copies of the prevailing rates of per diem wages for each craft, classification or type of worker needed to execute the services available to interested parties upon request, and shall post copies at the Contractor's principal place of business and at the project site, Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. The undersigned certifies that the foregoing is true and correct. Name of Firm Signature of BTl Title �i4 nur�Glerli , (� (if au individual, so state) v P-5 ofP-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.; 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) OWNERSffiP AFFIDAVIT STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS: CITY OF SANTA ANAE�ey ) Q,je &adh.. i P.1'i l" ��d ) DtY' . , being duly sworn, deposes and says: 0 INDIVIDUAL That he/she is the party making the foregoing proposal: ❑ PARTNERSHIP That be/she is a member of the co -partnership fimt designated as: and who has been and is duty vested with the authority to make andexecute instruments for the co -partnership by; who constitute iho othermembcrs ofthe copartnership. ®COILPORATION is rnajil)nal Ling Builder"$ Inn 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 be/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 shale, and has not in any manner sought by collusi secure any advantage against the City of Santa Ana or any person interested in the propos d ontract, fgr •myself or any other person. Signature of Bidder Subscribed and sworn to before me tbis day of 20 �Admfinisterfingj—(Oath �2�'✓ c4eclSignature ofyffa (Notary Public) P-6 of P-38 notary public or other officer completing this irtificate verifies only the identity of the Individua 10 signed the document to which this certificate attached, and not the truthfulness, accuracy. or State of California County of Riverside Subscribed and sworn to (or affirmed) before me on this. _„° day of hMr . 20 19 by Earnest Brown proved to me on the basis of satisfactory evidence to person(s) who appeared before me. rr 0My BRENOAMCNMNEY ! Notary Public - California & Riverside County INNE I Commission M 2218125 Comm. Expires Feb 50, 2023 (Seat) Signature Yr�rmrt CITY OF SANTA ANA PROPOSAL, PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) BID BOND KNOW ALL PRESENT that, International Line Builders Inc. as BIDDER, and Li 7eny Mutual Insurance Company as SURETY, are held and firmly bound unto the CITY OF SANTA ANA, as AGENCY, in the penal sum of, Ten Percent of Amount Bid Dollars ($ l0°70 }, which is ten percent (1011%) 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 tba% 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 30th day of _ October 2Q.19.1 Subscribed: and sworn to before me, Kelly 'Nicole Bruirgentan this 30th_ day of October , 20A. Signature: Notary Public in and for the County of HMR221n ; State of Minnesota * Provide BIDDER/ SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. WNO LY NIGOLE BRUGGEMAN "Willis Towers Watson Midwest, Inc. rARYDUsue- sots8400 Normandale Lake Blvd., Suite 1700, Bloomington, MN 55437MMISSIon Nurber a,orssra Phone: 763-302-7154 om� =saaEzarerJanuary91,V P-7 of P-38 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 validityof that document. State of California County of Riverside On Utq before me. Brenda McKinney, Notary Public (insert name and title of the officer) personally appeared Earnest Brown, President So Cal Div, who proved to me on the basis of satisfactory evidence to be the person(4whose name(a) Ware subscribed to the within Instrument and acknowledged to me that hek&Mhey executed the same in his/hedthelrauthorized capacity(les). and that by hIs/ *rAheirsignature(s)on the Instrument the person(s). or the entity upon behalf of which the person(s) acted, executed the Instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) a w, BRENDA MCXINMEY Notary Public ^ California ' Riverside County #� Commission a 2278125 My Comm, Expires Feb. 19, 2023 ° This Power of Attomoyllmlto the acts of those named herein,. and they have no authority to bled the Company except Inthe marmot and to the extent herein stated. — Liber Libafty Mutual Insurance Company Mutual. The CIAO Casualty Insurance Company CeNficate No:6198930.190003 SURETY West American Insurance Company POWER OF ATTORNEY execute, Seat; acknowedge and delwer;:for and en its, behalf as Surely and as its ad and deed, any and all undertakings, bonds, r"nlzarices and Othastdetyobligatkms,.in pursuance of these.prssents and Snag be as binding upon the Companies as Ifthey have been dutysigned by the president and attersted: by the seetataryof the Compaues in then mar proper Parsons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by cub authorized officer or official of the Companies and the corporate seals of one Companies hove been affixed merst4thiis 28th daygf September , 2018 , Liberty Mutual Insurance Company 0(se lwapPa panUq'qThe Ohio Casualty Insurance Company °w,6Rey sg w�r�West American Insurance Company 19 ns 199i +o 1+w* �D�Y 3MoueI.N D�y1 , ass+s D M + D Devltl M. CareY. AsSistam Saxetan �' sa WITNESS WHEREOF, I have horeunls subscribed my now and abed my notarial seal at King df Prussia, Pennsylvania, an the day and year first above written PA ddklMpNYn:ALTN dPPPNNEYr,YANIA Toort P Normp Nwio ORM henronTOP.Mmxaaamq Can? ts., By: �ubgd_ My cmrbMar�ty�m�ar*t T�eraPasiega, Not" a Power of Attorney is made end executed pursuant to and by aumodty or the following Bylaws and Authorizations of The Chia Casualty Insurance Compaq, tibaiy aance, Company, and. West Americanlnsmatce Company whM resolutions am nowin full Ance and effect reading aslblows: or other official of the by the Chairman ad In behalf of l any and all undertakings, bonds, recogmzances EA other Surey obligations Such attomeysdrrfacf, subject to the gmHagonei $at fort In g novafullPowertobind the Corydmlan by their Signature and execution of arty such Instruments and to mulch thereto the. seal or the instruments shall be as bknGng as if signed by the President and masted is bytheSocrelary, Any power or aNhody, granted to any rep] provisions of this al" may be roOnal starry line by the Said, the Chabman,.The President or by the officer oroMors granting such puv as the Chralrman or Ige and deliver as so ARTICLEXIII—Execution of Contracts: Section 6. Surety Bonds and Undertakings. Anyofficer of the Company authorized for that purpose 1n writing by the dieaman orthe president, and subject to such limitations as the chairman or the president may proscribe, Shelf appoint such althmays4irfact, as may be necessary to 0 In behalf of the Company to make, execute, seal, ardenowiedge and deliver as surety arty and all undertakings, bands, recognlzaras and other surety obligations. Such aldmeysintact subject to the limitations set tort in their respective powers of attorney, shall have NO power to bind the Company by their signature and execution o1 any such InaWmonm and to attachtha8to the seal of the Company. When so executed such Instruments shall be as binding as g signed bythe president and adested by the setratary". Corli icata of:Denigration —The President of the Company, acting pursomm to the Bylaws of the Compaq, authorizes David to Carey, Assistant Secretary to appoint such aaameyskr, fact as may be necessary to act on behalf of the Company to make, Execute, seal, acknowledge. and deliver as surety army and all undertakings; bonds, "Irizances and other surety obligations. Authorizations -By unanimous consent of the ComparysBoard of Directors, the Company consents that tacsimbe in mechanically reproduced signature of any assistant seastayofthe Company, whe avarappearirg upon a cabled copy of any power of atte mey issued by the Compaq in connection with surety bards, shag be Ya and binding upon 0% Company with the same f me and eft¢Ct as though menuallyaffixed, I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casuaay Insurance Company, Ubedy Mutual Insurance Company, and West American Insurance Company do hereby wiry that the odgtnoi paver of a0omey of which the "oliig is afull, true and correct copy of lie Power or Attorney executed by said Canpantes, is In full fours and elect and has not been (evoked. IN TESTIMONY WHEREOF, I have, homunto set my hand and ofgxed thaSeais of said Companies this 30th day m Ocioba , 1019 , (9(90 ow oxyRtyGP4oaroR+rq�Yn °o t,y�3 °o is,1919 � �� 1991 0` f"�Mx,4nes DYs3 Mo,nx�N.aD;�y,Renee C. cretary ,--_._._.._.....�....._ t 3 D M r.� LMa-02813 LMIC OCIC WAIL M91d Ca_ne2016. 5 4 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) LIST OF SUB-CONTR !CCTORS Section 4100 et. seq. of the Public Contract Code requires listing of all subcontractors with the bid for all subcontract work exceeding the fallowing amount: o Streets, highways including bridge projects: Yz% of the bid or $10,000, whichever is greater o Buildings, parks, or other projects: '/z°lo 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 h`mns listed below: Name NIvt License #/Exp. DIR Reg. #/Exp. Location Phone Type Of Work Annotmt $ Name License #/Exp, DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ Nance License #/Exp. DIR Reg. #/Exp. License # Location Phone Type Of Work Signature of Bidder Name _ License #(Fxp. DIR Reg. #/Exp. Location Phone Type Of Work Amount $ Name License #/Exp,, DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ Name License #/Exp. DIR Reg. #/Exp, License # Location Phone Type Of Work Amount $ P-8 ofP-38 CITY OF SANTA ANA PROPOSAL PROTECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(1 88) 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. and Name. and Telephone Nun $1,037,161.62 Contract Amount of person familiar with project. LED Convgrsion 01/05/2019 Type of Work Date Completed 2. City of Riverside/ 3900 Main Name and Address of owner. Julian Cardenas/ (951) 826:5397 Name and Telephone Number of person familiar with project. $1,967,698.83 Street Light Relocation 04/30/2018 Contract Amount Type of Work Date Completed 3. City of Anaheim/ 200 S. Anaheim Blvd Anaheim, CA 92805 Name and Address of owner. Name and Telephone Number of person familiar with project. QQ��599 286.95 Street Li ht. installation 10/31 /2018 Contract Amount Type of Work Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. Willis of Minnesota 8400 Normandale Lake Blvd., Suite 1790 BloomingtonyMN 55437 Heather Goedtel #(763) 02-7159_ Nicole Langer #(763) 302-7214 P-9 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) ADDITIONAL REFERENCES The following are the names, addresses, and telephone numbers for THREE public agencies for which the BIDDER or Subc ntractor has performed similar work in the past five years. and Address of Owner. Name and Telephone Number of person familiar with project. 1,98$,327.00 Street Lighting, Site Electrlcal, Traffic Signal Contract Amount Type of Work 04/30/2018 Date Completed z. City of Alhambra/ 111 S. First St Alhambra CA 91801 _ Name and Address of owner. 3. Name and Telephone Number of person familiar with project. 670 780� .96Scree #ght C©nverslon 08/30/2017 Contract Amount Type of Work Date Completed Name and Address of owner. Name and Telephone Number of person familiar with project. 3,441 059.84 Street Light Installation 03/13/2016 Contract Amount Type of Work Date Completed The fallowing are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. P-10 of P-38 CITY OF SANTA ANA PROPOSAL PROJECTNO:; 17-6875 CTTYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO; HSIPL5063(188) NON-C,QLLUSION AFFIDAVY (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 slid 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-sliall refrain from bidding; that the BIDDER has not in any mariner, 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 fib 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 riot 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. BIDIDERS are cautioned tl"aking a false certification may subject the certifier to criminal Signed State of California County of Xt , 1 ouJ Subscribed and sworn to (or afhtnted) before me on this day of , 20_ ,, by proved to me on the basis of satisfactory evidence to be the person(s) whoa ed before me Notary Public Signature Notary Public Seal P-11 ofP-38 t public or other officer completing this to verifies only the identity of the individual ned the document to which this certificate ted. and not the truthfulness. accuracy. or State of California County of Riverside scribed and sworn to (or affirmed) before me on this of DCIZb>ee . 2019 . by Earnest Brown proved to me on the basis of satisfactory evidence to be person(s) who appeared before me. ...+w.rarywENDAMKINNEY r�{ 1 a 4RENDAMCKINNEY cc Notary Public . California Riverside County Commission 0 1278 125 My Comm. Expires Feb M 2023 (Seal) Signature CITY OF SANTA ANA PROPOSAL PROJECT NO,: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) NO -J�INATION CLR FLCATE 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. Tile 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 firrnish 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 firrther 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 role, regulations, or order of the Secretary of Labor, or as otherwise provided by law. P-12 of P-38 CITY OF SAl'VTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE BEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) The Contractor shall include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontract or purchase order as the administering agency may direct as means of enforcing such provisions, including sanctions for noncompliance; provided, however, that in the event the Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, the Contractor may request that the United States enter into such litigation to protect the interests of the United States, 8. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as amended, no discrimination shall be made in the employment of persons upon public works because of race, religious creed, color, national origin, ancestry, physical handicaps, mental condition, marital status or sex of such persons, except as provided in Section 1420, and any contractor of public ork violating this Section is subject to all the penalties imposed for a violation of the Cha ter. Signed: Title: G dt- 6eavn- 1.A Finn: International Dine Builders Inc. Date: 10/30/2019 P-13 ofP-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17.6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAL) UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) STATEMENT REGARDINCj APMENTICESHIP 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: 1. Apply to the joint apprenticeship committee administering the apprenticeship standards of the craft or trade in the area of the site of the public work for a certificate approving the contractor under the apprenticeship standards for the employment and training of apprentices in the area or industry affected. 2. Employ the number of apprentices or the ratio of apprentices to journeymen stipulated in the apprenticeship standards. 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 hi the same manner as the other n actors, except contractors not signatory to the trust agreement shall pay a like amount the alif4orqia renticeship Council. Signed: Firm: International Line Builder's Inc. Date: 10/30/2019 P-14 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) iTATEMFNT REGARDING "ANTI-TCItyKBACK" REOUIREMENTS 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 subcopkIactor shall be prohibited from inducing, by any means, any person employed in the const ctio or repair of public work, to give up any part of the compensation to which he/she is otherwt ntitled. Signed: Firm: International Line Builder's Inc. Date: 10/30/2019 P-15 ofP-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO. HSIPL 5063(188) PUBLIC CONTR&QT CODE SEC IQN 10162 , LESTIONNAIItE 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. X __.._.. If the answer is yes, explain the circumstances in the following space. P-16 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) BIDDER'S STATEMENJ'RBGARDING REQUIRED FEDERAL CONTRACT PROVISIONS (FORM FHWA- I 2M The undersigned, is submitting this 'proposal for performing by contract the work required by these bid documents agmesito comply with the required Federal Contract Provision (Form FHWA-1273) as shown in appendix Pkie Special Provisions of this vroiect. Signed = Firm International Line Builder's, Inc. Date 10/30/2019 P- 17 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) EQUAL EMPLOYMENT OEPORTUNITY CERTIFICATION The bidder International Line Builder's Inc. proposed subcontractor hereby certifies that he has X , has not _____, participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements, Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Adminis on or by the Director, Office of Federal Contract Compliance, U.S. Department ofLaboI Signed Fim, International Line Builder's, Inc. Date 10/30/2019 P-18 of P-38 CITY OF SANT'A ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT hi conformance with Public Contract Code Section 10285.1 (Chapter 376, Stars. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has _ , has not A been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University, The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1, Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that make false certification may subject the certifier to criminal prosecution. Signed Firm International Line Builder's Inc. Date 10/30/2019 P-19 ofP-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE: HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) PUBLIC CONTRACT CODE SrCTION 19232 STATEMENT In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor to comply with an order of the National Labor Relations Board, Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution, Signed Firm International Line Builder's Inc Date 10/30/2019 P-20 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) The bidder under penalty of perjury, certifies that except as noted below, he/she or any person associated therewith in the capacity of owner, partner, director, officer, manager: is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; has not suspended, debarred, voluntarily excluded, or determined ineligible by any federal agency within past three years; has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder's responsibility. For any exception noted above, indicate below to whom it applies, initialing agency, and crates of action. Note; Providing false information may result in criminal prosecution or administrative sanctions. The above certification thereof shall also consti( Signed of the Proposal. Signing this Proposal on the signature portion ture oiis Certification. ,� ► Firm International Line Builder's Inc Date 10/30/2019 P-21 ofP-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) NON-LO BYING CERTLFLQATiON FQR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that. (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influence or attempting to influence all officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriate funds have been paid or will be paid to any person for influencing or� attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant; loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, ".Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code, Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the Ian g of this certification be included in all lower tier subcontracts, which exceed $100,000 and at I such s -recipients shall certify and disclose accordingly. Signed Title +LYteit- %�1v1» } p.n r1h SO bal DrV, Firm International Line Builder's Inc. Date 10/30/2019 + Standard Forin LLL may be obtained from Caltrans and FHWA offices. P-22 of11-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) DISCLOSURE OF LOBBYING ACMITJES LOBBYINGDISCLOSURE OF i.TypeoTfederal Attion: Z Status of M's"nd A coon: B. RepsdTWv ©y 0b. and grant b. matedalobarrge a o0operatift earm"" t a ""Word For MaNrrtai Champs.6nty= d. ban yaar,„„�,,, ,quarMr w ban 0"aramtao dace Blatt report ` "!" I.loaf b"nsanoe a. Name and Address of Reporting Cnby- S. If liepoMmg Entity in No. t is a Subawartim Enter Matme [bona, c3 and Address of Prban. "Cunr,„T,..,.,, NArvvnrr. icong,essional District IFkmrwn:CAMMressIonst Mbiat, #`kn mr: 8. federal Oepar nmentift;eney. 7. federal program r rtton:. S. federal Action dumber, 9*w": S. Amsad Anwani P{4trcarrs ffi 10. a. fla m and Address of Ergily kKIIV bmafa POVID(MIMS SWWOes ( ig (IftndiWrW, lastnama Asiname.;ttik MWent &%mNv Ift) lb. (fast name, "I name. 1~0wiftobw SR" a If. Amount of Paymen(dmadr as OW appy): #. Type of Paynnerd(dwok as inataymty): S M What O p"now ❑& stain 1Y. Form of payment (Breda aB btat-0Aplyy Cl cwMaintan Claawn L7acoatowdm ❑ n inuntspeew p a. daxrsd vahm qs ana rg: ia. Brief Dasmiptian of SerYlass onto be Perf mmd and Mists) of SeTYIoe, inoludkq oHirxr(s), employee(s), or Mombec(s) 000twated, for Payment brdtcated In #tam ii: 3FtiLL 4 15. Contimuation: s tfdl.tA atiartted: Yes Na f6.sar. ` ` 0,w ww tik it vsct dgra. w�+ewrarv.aw.parawrrra weao-a «,revue ter. ww ..ware a ri uaa r mr pdnt Name: 91t7i`?E',f i-.,_s,�iZGV�Y) '•abeywararwaSwyww &rot Wrivarab r,aw +M twwre war r ass s» a.aarr rwa Cr 7ftle: I� �tl ` 7Ci( J31ti .�*'« aexa»ae rsrmrsr.�.xrrersusa. TeiepMmeNo.: 951} 682-2982 Iaata:l�C3�L2Q.L9 federal Use Orr.- . asiacaR r�das�amtu Rtr.7.0 P-23 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(I88) INSTRUCTIONS FOR CQMPLETIONI,OF SF-LL, DISCLOSURE OF LOBBYING ACTIVITIES INSTRUCTIONS FOR. COMPLETION OF SF-LLt, UtSGI.OS R#E OF LOGUYN16 ACTIVIT 6 t. iJenGry alat}padoa4arW rprMaodoq farNtaCHilWbyag aNvi4ykariarornnbaen ia&diucetce9teaaAwmeata ae#bn. 2. MHalry'@Ia it�Gd6 crows feat"aka b. tma uasuroaEmMbtgrn}wa, it tau a raaasWTSImtra al by meenalnwipefo9�e attan,ana,ar Ynaa�.enlar scam. 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Ttr aaabiaxw wo wdd"aae tam, pmttbienffrnma, aiia am Ammo, htiae Wpenwra Fat,samaneaQfxtpanaxare btrecpmabamdetAlanb4t�raa�anWnsattANptayaavaAatSAffi Gti11rd taaroar. tre vaaaowe aaWd nrraaiafif awc aaanmaoa tR GMfl aro. tuaaaaie, i3ipae repofWg aaaeo ma bm aaaamuamn nneed" mW 3@ rnttuGtapaiaq 3negaariDBmalbrre+nee�9mafaRUa+c. ceanY'Hyle r4 mhsanas. g>ehearq Arai m>MtarM+4aYatl #ftma ala! wmvpleen9 aotl tQA6 tr 9Te oaaDc/M IN aeairte o MuW9WA agitran9 are drMm edMiate a Wry aiaaaaped W an Meaaa M Utter braRa3tr�W%jeWua tW Ruaen9 atle wWsu kiSMe fXaot of Ms+a9en+ntaea &ayd.papaty+tvaHedaattmirm7�t a el, t'4aa L P-24 of P-38 CITI' OF SANTA ANA PROPOSAL PROJECT NO,: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE DEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT 1.:Local Agency:. City of Santa Ana 2. Contract. DBE Goal 8% 3. Project Description: Citywide Traffic Signal Vehicle Head Upgrades _ 4, Project. Location; 5. Bidder's Name; International Line Builder's, Inc. 6. Prime Certified DBE: I] 7, Bid Amount: 4300 050'ap 8. Total Dollar Amount for ALL Subcontractors: g, Total Number of ALL Subcontractors: f 10 Bid Itom Number 11, Description of Work. Service. or Materials Supplied 12 DBE Certification Number � 13. DBE Contact Information (Must be certified on the date bids are opened) 14. DBE Dollar Amount. F1P-dy (.,V1 "Clletl44If go5go 16114— ar ��� ",rm LP uLtlitY Itzll��t��4'2rGD• la $taLo,w 0A qb =$�I,"18�f, Local 4Agency to Complete this Section upon Ezacutionnf Award 16. TOTAL CLAIMED DBE PARTICIPATION �`��'� 27. Local Agency Contract Number; � 22. Federal-Ald Project Number: HSIPL 6063(188) 23. Bid Opening Date: October 30 2019 ___. ` a� ._...._.._........ .,_......._........_.._. IMPORTANT. Identify all DBE firms being claimed for credit, 24. Contract Award Date:- 25, Award: Amount: regardless of tier. Names of the First Tier DBE Subcontractors and respeclly ilem(s) of work listed above must be consistent. where appal le with the names and Items of the work In the ' Subcontr t List" su Itted with your bid. Written oonifrmaHon of each list E is r quire :.� _ Local Agency certifies that all DBE certifications are valid and Information on this form is complete, and accurate. 10/30/2019 26. Local Agency Representative's,Signature 27, Date 16. Preparer's Signature 17, Date gc an,intl•• $ _ (51 $2-2982 28. Local Agency Representative's. Name 29, Phone 19, Phone 18. Preparer's Namely _ �y D,IIC�a'tl" o l.xlt nth'. J 30..Local Agency Representative's Title 20, Preparer's Title DISTRIBUTION: 1.Original — Local Agency 2. Copy— Coltrane District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days. of contract execution mayresult In de-obtigaflon of federal funds on contract. 3. Include additional copy with award package. ADA.Notice: For Individuals with sensory disabilities. this document Is available In alternate formals. For Information tali (918) 664-6410 or TDD (916) 654-3880 or write Records. and Forms Management. 1120 N Street. MS-89. Sacramento. CA 95814, P-25 of P-38 Pt) BOX 2096 Y6rba Linda, CA 92895 Ph,(714)336-0536 Fax (714) 694-01.16 Email:ikim.TEKServ@,,gmaiLcom Name /Address lac 3055 Temoscal Canyon Corona,. CA 92888 Date Quote 10/30/2019 0349 Ship To I City of Santa Ana ProjectNo.: I7-6875 Lead Time Terms Rep Project Name/# 5-8 Weeks Net 30 JK 0-6875' Description Qty Each Price Total 3 Section 12" Vehicle Signal with Visors,. Backplate and'rop Mount Framework 119 EA 560.00 66,640:00T Delivery: 6 to 8 Weeks AR6 8c'Submittal Appro_vat Qoote valid for 30 Days, Terms: Net 30, Pending.. Credit Verification Price subject to change, if order not released. within 60 days I%mn the -purchase -order date. Freight: Included Subtotal $66,640.00 Sales Tax (9.25%) $6,164,20 Total $72,904.20 Skin to Main Content Back To Query Form (IicenseForm.html M Thu Oct 31 14:27:40 PDT 2019 QuW Criteria Certification Typos: DBE Firm 10: 40540 Firm ID 40540 DBA Name TEK SERVICES, LLC Firm Name TEK, SERVICES,'LLC Address Line1 5680 VAN GOGH WAY Address LIne2 City YORBA:LINDA State CA Zip Code1 92887 Zip Code2 Mailing Address Line1 5680 VAN GOGH WAY Mailing Address Lino2 Mailing City YORBA LINDA Mailing State CA Mailing Zip Coda1 92887 Mailing Zip Code2 Certification Type DBE EMail kim.tekserv@Gmail.com Contact Name KIM KING Area Code 714 Phone Number 336-0536 Extension Alt Area Code Alt Phone Number Extension Fax Area Code 714 Fax Phone Number 694-0116 Agency Name LOS ANGELES COUNTY METRO TRANSPORTATION AUTHORITY (MTA) Counties 19; 30; 33; 37; Districts 07; 08; 11; 12; DBE NAICS 423610; 423840; ACDBE NAICS' Work Codes C0600 MISC SUPPLIERS; C0686 ELECTRICAL & SIGNALS SUPPLIER; Licenses Trucks Gender E Ethnicity CAUCASIAN Firm Typo DsE CITY OF SANTA ANA PROPQSAL, PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) INSTRUCTIONS CONSTRUCTION CONTRACT DBE COMMITMENT VLNTRAC.T R SECTION 1. Local Agency - Enter the name of the Iocal agency that is administering the contract. 2. Contract DBE Coal -Enter the contract DBE goal percentage as it appears on the project advertisement. 3, Project Location -Enter the projectlocation(s) as. it appears on the project advertisement. 4. Project Description . Enter the project description as it appeals oritbe project advertlseurem(Bridge Rehab, Seismic Rehab, Overlay,Vvddening, etc). S. Bidder's Name - Enter the contractor's firm name, 6. Prime Certified DBE . Check box ifprimc contractor is a certified DBE. 7. Sid Amount - Enter the total contract bid dollar amount for the prime contractor; S. Total Dollar Amount for ALL Subcontractors — Enter the total dollar amount for all subcontracted contractors. SUM= (DBEs + all .Non -DBEs), Do not include file prime contractor information in this count. 9. Total number of ALLLL subcontractors — Enter fire total number of all subcontracted coutractors, SUM— (D$Es +all Non - DBEs), Do not Include the prime contractor information in this count. 10, Bid Item Number-Bnterbid item number for work, services, or materials supplied to be provided. .1I. Descriptiion of Work, Services, or Materials Supplied -Enter description of work, services, or materials to be provided, indicate all work to be performed by DBEs including work performed by the prime contractor's own forces, if the prime is a 'DBE. If 100%of the item is not to be performed of tomished by the DBE, describe the exact portion to be performed or furnished by the DBE. See LAPM Chapter 9 to determine how to count the participation ofDBE f ins. 12. DBE Certifleadon Number - Enter the DBE's Certification Identification Number. All DBEs must be certified on the (late bids are'opened, 13, DBIR Contact Information - Enter the name, address, and plume number of all DBE subcontracted contractors. Also, enter the prime contractor's naine and phone pumbec, ifthe prime is a DBE, 14. DBEDollar Amount -'Bator the subcontracted dollar amount of the work to be perfemred or service tape provided, include the prime contractor if the prime is DBE. See LAPM Chapter 91irr how to coot Tull/partial participation. 15, Total Claimed DBE Participation - $: Enter the total dollar amounts entered in the "DRE Dollar Amount" columm. %l , Filter the total DBE participation claimed.("Total Claimed DBE Participation Dollars" divided by item "Bid Amount"), If the total "Yo claimed is less than item "Contract DBE Goal," an adequately documented Good Faith Effort (OFE) is required (see Exhibit 15- H,DBE Information - Good Faith Efforts of the LAPM). 16. Preparer's Signature - The person completing the DBE commitment form on behalf of the contractor's firm must sign their name. 17. Date - Enter the dale the DBE commitment form is signed bythe .coon actor's preparers III. Preparer's Name - Enter the name ofthe person preparing and signing the. contractor's DBE -commitment form. 19. Phone- rotor the area code and phone number of the person signing the contractor's DBE commitment form. 26. Preparer's Title - Enter the position/dile of tile person signing the contractor's DBE commitment form. LOCAL: AGENCY SECTION 21. Local Agency Coutract Nurnber -Ewer the Local Agency controot number or identifjer. 22, Federal -Aid Project Number -Eme the Fedarai-Aid ProjectNumber(s). 23, Bid Opening Date - Enter the date contract bids were opened, 24, Contract. Award Date- Enter the date the contract was executed. 25. Award Amount - Enter the contract award amount as stated in the executed contract. 26, Local Agency Reproserrtative's Signature - The person completing this section of the form for the Local Agency must sign their nameto certify that the information In this and die Contractor Section of this form is complete and accurate: 27, Date -Enter the date the DBE commitment form is signed by the Local Agency Representative. 28. Local Agency Representative's Name - Enter the name of the Local Agency Representative certifying the contractor's DBE commitment form. 29. Phone - Enter die area code and phone number of the person signing the contractor's DBE commitment form. 30. Local Agency Representative Title -.Enter the position/title of the Local Agency Representative certifying the contractor's. DBE commitment form, P-26 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) EXHIBIT 15-11 DBE INFORMATION —.GOOD FAITH EFFORTS Federal -aid Project No(s). HS1PL 5063 It ) Bid Opening Date y etcher 30. 291 _ The City of Santa Ana established a Disadvantaged Business Enterprise (DBE) goal of_$_ %o for this contract. The information provided herein shows the required good faith efforts to meet or exceed the DBE contract goal. Proposers or bidders submit the following inforination to document their good faith efforts within five (5) business days from bid opening. Proposers and bidders are recommended to submit the following information event if the Exhibit 10-01 s Consultant Proposal DBE Com`nvtments or Exhibitl5-G: Construction Contract DBE Commitment indicate that the proposer or bidder has met the DBE goal, This form protects the proposer's or bidder's eligibility for award of the contract if the administering agency determines that the -bidder failed to meet the goal for various reasons, e.g., a DBE firm was not certified at bid opening, or the bidder made a mathematical error. The following items are listed in the Section entitled "Submission of D13E Commitment" of%he Special Provisions, please attach additional Sheets as needed: A. The names and dates of each publication in which a request for DBE participation for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): B. The names and dates of written notices sent to certified DBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the DBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of DBEs Solicited Date of Initial Follow Up Methods and Dates Solicitation C. The items of work made available to DBE firms including those unbundled contract work items into economically feasible units to facilitate DBE participation. It is the bidder's P-27 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: I7-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) responsibility to demonstrate that sufficient work to facilitate DBE participation in order to met or exceed tho-DBB contract.goal. Items of Work Bidder Normally Breakdown of Amount Percentage Performs Item (YIN) Items M Of D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work (please attach, copies of quotes from the firms involved), and the price difference for each DBE if the selected firm. is not a DBE: Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs: pt./ ,bAF=* ("ndl "a. Names, addresses and phone nuilbers of firms selected.for the work above:, E. Efforts (e.g, in advertisements and solicitations) made to assist interested DBEs in obtaining information related to the plans, specifications and requirements for the work which was provided to .DBEs; >y�-, la���faiaUt ►-1�, F. Efforts (e.g. in advertisements and solicitations) made to assist interested DBEs in obtaining bonding, lines of credit or insurance, necessary equipment, supplies, materials, or related assistance or services, excluding supplies and equipment the DBE subcontractor purchases or Ieases from the prime contractor or its affiliate: Nj,q, f oci) i- ek --- P-28 of P-38 CITY Or SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(189) G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using DBE firms (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.): Naive of Method/Date of Results Agenoy/Organization _Contact H. Any additional data to support a demonstration of good faith efforts: NOTE: USE ADDITIONAL SHEETS OF PAPER, IF NECESSARY, P-29 of P-38 FY 20-21 SUPPLEMENTAL BUDGET REQUEST (Please fill out one form per request) Department: 17 - Public Works Change Request Type: Supplemental Budget Request 1) Item requested: (max. 100 characters) FIRE STATION #79 WINDOWS, FAQADE AND STAIRS REPLACEMENT Replace old windows with double pane, energy efficient and sound reducing windows. Replace rain gutters and exterior wood fagade. 2) Please provide a description and associated service level benefits of the request. Due to the close proximity of the fire station's front windows to Warner, street side windows are an issue for crews sleeping at night due to noise coming through. Rain gutters also need replacement since many have rotted out. 3) If this request is a General Fund Item, please rank in priority based on other General Fund requests being submitted by your Agency (ex. #1, 2, 3): Priority Rank: 2 4) Estimated Cost One-time Xl On -going = General Fund I Non General Fund Accounting Unit(s): FY 20.21 Personnel (including benefits): Operations (contractuals, office supplies & equipment): Internal Service Fund Impact: Capital Facility Improvements: Total Estimated Cost: Describe expenditure impacts (base, employee benefits, internal service funds, indirects, office supplies, etc): Unless the replacements exceed $100,000, it would be a contractual expense. 5) Does this request provide offsetting revenues? If yes, please provide estimate and associated assumptions. Please describe funding sources and estimates for FY 20121: No offsetting revenues. 6) Is this request a state or grant Mandate? YES No X If yes, please provide regulatory section and explain. 7) Is the request directly linked to the Strategic Plan? Please list the goal, objective, and strategy (i.e. Strategic Plan No. 4, 1b-1c) and explain. Goal 6-Community Facilities & Infrastructure: Ic_Invest resources... to extend service life, 1e Community Investment Program, lf_monitor/update assest condition and ensure funding, 1g_Develop and implement CIP with Community Investment & Deferred Maintenance. 8) If not, identify driver of the request. The noise due to the level of traffic on Warner. Traffic congestion will only increase due to Warner's widening. The metal stairs .... Exterior fagade is .... 9) What other alternatives can be considered if this request is not approved? Leave as is. Meanwhile, continue to look for funding sources and request again in subsequent years. CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) i 2 i • • • / n M i PART I The bidder shall list all subcontractors (both DBE and non -DBE) in accordance with Section2-1.054 of the Standard Specifications and per Title 49, Section 26.11 of the Code of Federal Regulations. This listing is required in addition to listing DUE Subcontractors elsewhere in the proposal. Photocopy this form for additional firms. heal Assistant# Procedures Mannai Exhibit 12-1) As or March 1, 2415 Contractors (and sub•contractorg) wishing to bid on pttblio w orks oommets shall be rcgistarod with the State pivision of Industrial Relations and codified to bid on Public Works contracts. Pleaserogisterat:htlos.11www.dir.c�.Pov/Public-WorkslContraetor�Rahistrationhtml In accordance with Tina 49, Section 25.11 or the Cade of Federal Regulations, and Section 4104 of the Public Contact Coda of the State or California, as amended, the following information is required for each sub contractor who will perform work emanating to more than ono balform r percent (6.5%) of the Total Base Rid or S 0,9e4 (whichever is greater). Photocopy this form for additional firms, Federal Profcet Number; j cu Page 1 of 2 January 2019 P-30 ofP-38 CITY OF SANTA ANA. PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) EXHIBIT 1_g-3 BIDDER'S LIST OF SijBCONTRACTOR,S(DBE AND NON- 7BE,) - PART IT PART II The bidder shall list all subcontractors who provided a quote or bid but were not selected to participate as a subcontractor on this project. This is required for compliance with Title 49, Section 26 of the Code of Federal Regulations. Photocopy this form for additional firms. Local Assistance Procedures Manual Exhibit MO In accordance with Tit1e49, Section 26 of the Code of Federal Regulations, the Bidder shall list all subcontractor who Provided a quote or bid but we a no s [acted to participate as a subcommotoronthisproject, Photocopy This form for additional firms. Factual Project Number: l�$j l i nlstrlbunon: it Qrlgina6Loeai Agency File 21 topy-010 w(Award Package Page 2 of 2 January 2019 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) OMPT PAYMENT OF FUNDS WITHHELD— TO SUBCONTRACTORS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the following: The agency shall hold retainage froth the prime contractor and shall make prompt and regular incremental acceptances of portions, as determined by the agency, of the contract work, and pay retainage to the prime contractor based on these acceptances. The prime contractor, or subcontractor, shall return all monies withheld in retention from a subcontractor within 30 days after receiving payment for work satisfactorily Completed and accepted including incremental acceptances of portions of the contract work by the agency. Federal law (49CFR26.29) requires that any delay or postponement of payment over 30 days may take place only for good cause and with the agency's prior written approval. Any violation of this provision shall subject the violating prime contractor or subcontractor to the penalties, sanctions and other remedies specified in Section 7108.5 of the Business and Professions Code. These requirements shall not be construed to limit or impair any contractual, administrative, or judicial remedies otherwise available to the prime contractor or subcog1raptor in the event of a dispute involving late payment or nonpayment by the pri co ractor, deficient subcontract performance, or noncompliance by a s co actor. Signed Firm International Line Builder's Inc. Date_ 10/30/2019 P-32 ofP-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) EXHIBIT 16-B — SUBCONTRACI t Yi REC�UE"T Local Assistance Procedures Manual Exhibit 16-D CONTRACrORNAME n1 t2rlGih'cna� Ut-1 1 iAdeWl it1J<�• COUNTY �,ytyl(�Q 18.#4 ROUTR BUSINESSADDRESS CONTRAerNUMBER 84M5 ^ram✓ c cr eo d 1 ea- tdcv, 1 - CITYANDSTATE ZIrCoDE FEDERALYAIDPRO)ECrNUMBER 44. cIr�"{!PJ HJ' P A. 5uHooN1'RAGTDH B. BIDITEM C PERCINTAG90F D. SUBLLSTED E.CERTBSED P.. DESCRIBE WORK G.DOLLARAAIOUNT (Neme;Bua4re4sAd4rew,Rhanej NuMBER(S) BID ITEM ATBB?TIME WE WHSNLE%THAN BAsenoNTn6BID SUBCONrRACM 100% OR WORK is AMOUNT SUBCONTRACTED Yes No Yes No Yes No Yes No ❑ ❑ ❑ ❑ Yes No Yes No ❑ ❑ 1 ❑ ❑ Yes No Yes No ❑ ❑ ❑ ❑ Yes No Yes No ❑ ❑ ❑ ❑ Yes No Yes No certify at: The Standard Provisions for labor set forth in the contract apply to the subcontracted work. If applicable, Form FI3W A- 3 of the Special Provisions has been inserted in the subcontracts and should be incorporated in any low -tier ubcontract. Written contracts have been executed for the above noted subcontracted work. This section Is to be completed by the resident engineer. 1. Total of bid items 2. Ceau:tractor must perform with own forces(line l X contract req,%) 3. Bid items previously subcontracted (taken from previously approved 16-13) 4. Bid items subcontracted (this request) $. Total bid items subcontracted (line 3plus 4) 6. Balance of work contractor to perform (line I minus 5) WADIINT ENGINEWSSIGNATURE Copy Distribution: Origlna6Contractor Copy. Resident Engineer $ $ $ 324,1949 Page 1 of 2 January 2018 P-33 of P-38 CITY OF SANTA ANA PROPOSAL, PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) Local Assistance Procedures Manual Exhibit 16-B Subcontracting Request INSTRUCTIONS FOR COMPLETING SUBCONTRACTING REQUEST FORM All first -tier subcontractors must be Included on a subcontractor request, Before subcontracting work starts, the contractor will submit an original CEM 1201 for approval according to the Standard Specifications. After approval, the RE returns the original to the contractor and complete the remaining distribution as listed on the bottom of the form. D. If subcontractor was listed at bid time per the Fair Practices Act, check yes, otherwise check no. E. If subcontractor is, a certified DBE contractor, check yes, otherwise check no. F and G. When a portion of an item is subcontracted, describe the portion and show the percentage of the bid item and value. G. When an entire item is subcontracted, show the full bid item value: THIS FORM IS NOT TO BE USED FOR SUBSTITUTIONS OF SUBCONTRACTORS AND UDBE, DVBE OR SMALL BUSINESS ENTITIES. Page 2 of 2 July 2018 P-34 ofP-38 CITY OF SANTA ANA PROPOSAL PROJECTNO., 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE BEAD UPGRADES FEDERAL PROJECT NO; HSIPL 9063(188) DIFFERING SITE CONDITIONS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the following: a, Contractor's Notification Promptly notify the Agency's Engineer if you find either of the following conditions: I. Physical conditions differing materially from either of the following: • Contract documents • Job site examination 2. Physical conditions of an unusual nature, differing materially from those ordinarily encountered and generally recognized as inherent in the work provided for in the Contract Include details explaining the information you relied on and the material differences you discovered. If you fail to promptly notify the Engineer, you waive the differing site condition claim for the period between your discovery of the differing site condition and your notification to the Engineer. If you disturb the site after discovery and before the Enginecr's investigation, you waive the differing site condition claim. b. E'rzgineer's Investlgatfon axut Decision Upon your notification, the Engineer investigates job site conditions and: I. Notifies you whether to resume affected work 2. Decides whet he condition differs materially and is cause for an adjustment of tim , payment, or both Signed Title Firm International Line Builder's Inc. _; Date 10/30/2019 P-35 of P-38 +CITY OF SANTA ANA PROPOSAL PROJECT NO,: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) BIDDER'S CERTIFICATE OF COMPLIANCE REGARDING "BUY AMERICA„ REQUIREMENTS FOR STEEL QR MANUFACIURFD PRODUCTS The undersigned, is these bid documents, the Surface Transpor project, Signed submitting this proposal for performing by contract the work required by certi to comply with the "Buy America" requirements of Section 165 of tatMsistance Act of 1982 and as shown in the special provisions of this InternationalFirm Builder's. Date 10/30/2019 P-36 of 11-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: I4SIPL 5063(188) NEPA.,.COMPLIANCE FOR FEDERAL AID CONTRACTS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the Categorical Exemption/Categorical Exclusion Determination Form including and not limited to the National Environmental Policy Act (NEPA) requirements and environmental commitments found in the appendix: of the Contract Documents of this project, Signed Firm International Line Builder's Inc Date 10/30/2019 P-37 of P-38 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) TMP COMPLIANCE FOR FEDERAL AID CONTRACT The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to ply with the Traffic Management Plan (TMP) commitments found in the appendix of the ntr ctDoeum of this project. Signed Title GcK�,t`Lr1-�hQwt- rtCi� �aM �� l' Qw . Firm International Line Builder's Inc. Date 10/30/2019 P-38 ofP-38 O MAYOR Miguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCIL MEMBERS P. David Benavides Vicente 6armlento Jose Solodo Sal Tlnajero Juan Villages 1\V'bVl VOV rrl vfu41G1 M.U4'MW, v. glld6 VVun4y Hu h N uyen, Clerk -Recorder III III III IIII II III II IIIII III INIIII NO FEE * $ R 0 0 1 0 0 0 4 6 6 E 20188500046610:66 am 05/07/18 366 304 Z01 0100 60.00 0.00 0.00 0.00 0,00 0.00 0.00 CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza (M-20) P.O. BOX 1988 • Santa Ana, California 92702 (714) 667-2700 • Fax (714) 978-1461 www.sania-ana.org CITY MANAGER Raul Godinez II CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Marla D. Holzer NOTICE OF EXEMPTION From the Requirements of the California Environmental Quality Act (CEQA) Fee Exemption per California Government Code Section 6103 To: COUNTY CLERK County of Orange P,O. Box 238 Santa Ana, CA 92702 Project Title: Citywide Traffic Signal Vehicle Head Upg ProjectNumber(s): PWA-2018-648-CITY Protect Location: 1 CltyWide (Partial) From: City of Santa Ana Planning & Building Agency 20 Civic Center Plaza M-20 Santa Ana, CA 92702 Date of Approval: 07/05/2016 City: Santa Ana County: Orange ER Number: ER-2018-65 Project Description: Replace traffic signal vehicle heads and associated hardware throughout City of Santa Ana, Applicant Name: Cesar Rodriguez, City of Santa Ana Public Works Agency Applicant Address: 20 Civic Center Plaza M-43 SANTA ANA, CA 92702 Name of Public Agency Approving Project: City Council Name of Person or Agency Carrying Out Project: Rodrlguez, Cesar Exempt Status: Cl Ministerial (Sec. 15268) O Declared Emergency (Sec. 16269 (a)) 13 Emergency Project (Sec. 15269 (b through a)) Ci General Rule (Sec. 15061(b)(3)/(6)) Statutory Exemption: * Categorical Exemption: 16301(b) Reason(s) Why Project is Exempt From CEQA: 15301(b) consists of repalr/maintenance of existing public facilities. FILED MAY 0 7 2018 ORANGE COUNTY C -RECORDER DEPARTMENT BY: DEPUTY POSTED MAY 0 7 2018 HUGH NGUYE�N, CLERK -RECORDER BY:-- ( 1 ,,,, -'__DEPUTY City Contact: Cesar Rodriguez Telephone: (714) 647-5626 ' r AcnMr -%o GlUIGENel#FX S�71 Signature: -- —� �x Title: Date: SANTA ANA CITY COUNCIL Miguel A. Pulido Michele Martinez Vinoente Sarmlento I Jose Solorlo I P. David Benavitles Juan Vlllepas Eel 7lnaJero Mayor Mayor Pro Tem, Ward 2 Ward Ward Ward Ward6. Wards ropulldo2same-ana.ora mlmadlnozrMsanta-arLora Isolodo0sante-snore �d6ana Idea Santa-ana.ora IY TggaS�santa•ana oro stln�Jato(4asanta•ana oro I THE REGISTER this spacofor nnmif stamp only: • 2190 TOWNE CENTERPL, ANAHEIM, CA 928M Telephone (714)190.7000 / PBx (714) 790.0059: - `CNS#': 3300818' - than tan ercont " -" CE IS I.gY GIVENN City. tlasd of tRa bid o99regate, as a ' guuuurantee that: the. - ' - ai the of Santa Ana 1111 Sldder Into me will enter eproposed r face Ve Bids 91p rpnldccddllY via contract 1 awarded. If 1 e same. The Planetalde, an 3�9natuderre of the am the houror e PROOF OF PUBLICATION. Dole or �; �her '�c„�;¢d. a , must he eneclru2a ionon B{u' ' ° submitaql will ,be. acR8ted!sr: subfninals Bidders- Shall delver an ` (20164 C.r .R) PROJECT N0.: 11- geolnolhard copy of • State of • Callfonnia -6875 6 TTYyW DE ;TRA�FIC �I'C he Bid. Proposal CuarantY. For ' further, lastructlons Count of ORANGE y )Ss VEHICLE HVQ UPGRADES regarding oriofnal. ' Bid Proposal ' N0110a e: 910-NOTICE INVITING BIDS FEDER L• SIPILS�T'(IG: PROJType: Guaranty Submittal, etoids p tflyrer to o pronfl Fayultedla provide - ' AllpplapTNO 6paciflgarfi$ons are fable document$ with Bid ' Ad Description: how ova an Planetoids. Porfurther In cause the to bo deemed To pensive bid mm� , 17a,076CITYWIDETRAFFIC SIGNAL VEHICLE HEAD uPGRADES Information on how terdorwltasa tryyg CN>i-3i008illER io 5n4 „ Vandorw refertof PB hmijra% 8 REG 8 r ' [am a: cl0zen of the United States and a resident the State of California; ! am nwoAatdo- dppa.00rj arid dine n ormat an.a , _ over the age of eighteen years,and not a party to or interested In the above Da rafceil .entitled matter, lam the principal aterk of the printer and publisher of the THE purcaas no Division ° REGISTER, a newspaper published In the English language Inthecity of regard{ Public: workjects. Y. SANTA ooun of ORANGE; and ad ud ed a newspaper of eneral AtVA, ty ) 99 Projects. circulation as defined by the laws df the State of Cal forma by the Superior scone ofix work , Court of the County m ORANGE, State of CelHomla, under data 19/191t905; ncu os- epacng outdated traffic. Case No. A210d6., That the notice, ofwhich the annexedtsapdntedcopy,has n1ciaelnehicle heads ` bean published in each regular and entire Moo of'aeid newspaper and not In bacxpla%; Visors, my supplement thereof on the fpliowin dates, toot: PP 0 LED modules and oueinvnardwpre. re' s ' po sc e lubwolkllrY,.S 1010012010,1011612019 B °` .award, Tildiiera • must po secs or obtain a valsto - Califor(1lo ' • - Cll cntractor'slicense ia , • EXewtecron: 10/15/2019 dt uarog ehal°lo5e At SANTA ANA,CA. ' 9Ppro Piarretable with project ofoon9 bid. Via (or declare) under penalty of psrJury that the foregoing is true and Progosc shall be Guaranty In the form ccertify cofraaL. - of qq cgabler's %r aertifletl chec: .. payable -to the city of Sama Ana; or Bid Bond Issued svretty in an amount: not (ass ; ignature. I * A O '0 II (( 0 0 0 5 2 3 5' 2 5 IIII I 0,* EmsD CITY OF SANTA ANA BONDS PROJECT NO.: 17-6875 FAITHFUL PERFORMANCE BOND Bond No. 190044595/107174853 KNOW ALL MEN BY THESE PRESENTS that International Line Builders, Inc. as CONTRACTOR, and Liberty Mutual Insurance Company & Travelers Casualty and Surety Company of America 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 Three Hundred Eight Thousand Fifty Nine and 00/100 Dollars ($ 308,059.00 ), which is 100 percent of the total contract amount for the above stated project, for the payment of which sum, CONTRACTOR and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated January 21, 2020 for Citywide Traffic Signal Vehicle Head Upgrades fHSIPL-5063(188)1 , if CONTRACTOR faithfully performs and fulfills all obligations in the performance of the Work of Improvement to be done under said Contract Agreement in the manner and time specified therein, then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor of AGENCY; provided that any alterations in the obligations or time for completion made pursuant to the terms of the contract documents shall not in any way release either CONTRACTOR or SURETY, and notice of such alterations is hereby waived by SURETY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 24th day of January , 2020 . Mutual Insurance Company,175 Towers Watson MidwesMnc.. 8400 Normandale Lake Street, Boston, MA 02116, Phone: (617) 357-9500 & 700, Bloomington, MN 55437, Phone: Subscribed and sworn to before me, Michelle Diane Halter this 24th day of January 2020 . Signature: MICHELLE DIANE HALTER Notary Public M.in,=sota Notary Public in and for the County of Hennepin State of Minnesota Rate of premium on this bond is S 4.70 per thousand. Total amount of premium charge is $ 1,448.00 . To be filled in by Surety *Provide CONTRACTOR I ADMITTED SURETY name, address, and telephone member and the name, title, address, and telephone number of authorized representative. 1 of 3 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&inuaeu'a-8,,2-o-ro before me. Brenda McKinney, Notary Public (insert name and title of the officer) personally appeared Arnold Arias, Vice President who proved to me on the basis of satisfactory evidence to be the persons) whose name(s) isfare subscribed to the within instrument and acknowledged to me that he/sheAhey executed the same in his/I--,�r4teir authorized capacity(ies-). and that by his/- fermi signature(e) on the instrument the person(a). or the entity upon behalf of which the person( acted. executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. BRENDA MCKPINEY Notary Public -California Riverside County _ Commission 0 2278125 My Comm, Expires Feb 19, 2023 Signature (Seal) O oLiberty Mutual® SURETY This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except In the manner and to the extent herein stated. Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY Certificate No: 8202635-190003 KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Blake S. Bohlig, Brian D. Carpenter Kelly Nicole Enghauser, Heather R. Goedtel, Michelle Halter, Jessica Hoff Nicole Langer Craig Olmstead Laurie Pflug all of the city of Bloomington state of Minnesota each individually if them be more than one named, its two and lawful atomey-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 21 st day of November , 2019 . Liberty Mutual InsuranceCompany P�\NSUv� �,ZY INSU N \NSUgq The Ohio Casualty Insurance Company joaaoe r�2m ryaForfyro'Pgyn �P=opaouyoyo West American Insurance Company 7912 � 1919 1991 n d�g�%�o 4�) *Us Nda o Nxd*es*�a r��o*n AAa BY� n„sd AA ss this 21st day of November , 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance npany, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes ,am contained by signing an behalf of the corporations by himself as a duly authorized officer. WHEREOF I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. SN PAS? FQ,u�MONWp (shy COMMONWEALTHOFPENNSYLVANIA Nolalial Seal OF Teresa Paslella, Notary Public Upper Menon Twp., Mtaomery County By: �p MyCommissionExpimeMaml,28,2021 �NP �G MembeCPennsylvanla AssoalafunofNoWnes eresa Foretells, Notary Public ANy Pub" This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV — OFFICERS: Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in wrung by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE All — Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescTim shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -tact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such atomeys-m- fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, We and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 24th day of January, , 2020 . Y INSUoarogyr�n(0(9 1919 a n�o�M1'NnMvo`xe D;y1 + hYl \NSU/f OPaoMogyr-y9 ' s'I_ � 1991 6 B Ys�A'tao*a F�a; y Renee C. Llewellyn, Assistant Secretary W LMS-12873 LMIC CCIC WAIL MUIU CO 062018 Travelers Casualty and Surety Company of America ilA Travelers Casualty and Surety Company TRAVELERS J St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Blake S. Bohlig of BLOOMINGTON Minnesota , their We and lawful Attomey-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 3rd day of February, 2017. os") MOE, awao, ' State of Connecticut City of Hartford ss. Robert L. Raney, Se or Vice President On this the 3rd day of February, 2017, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof, I hereunto set my hand and official seal. 6�f�� My Commission expires the 30th day of June, 2021 Made C. Tetreault, Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Madne Insurance Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Execufive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attomeys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any etnifcate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Madne Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which remains in full force and effect. Dated this 24th day of January , 2020 W 61Wr). Mir NO E caw. K c«w. f' 3 pa S Kev n E. Hughes, Assstant Secretary To verify the authenticity of this Power of Attomey, please callus at 1-800-421-3880. Please refer to the above -named Attorney -in -Fad and the details of the bond to which the power is attached. CITY OF SANTA ANA Bond No. 190044595/107174853 BONDS PROJECT NO.: 17-6875 PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS that International Line Builders Inc. as CONTRACTOR, and Dbertv Mutual Insurance Company & Travelers Casualty and Surety Company of America , 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 Three Hundred Eight Thousand Fifty Nine and 00/100 Dollars ($ 308,059.00 ), which is 100 percent of the total contract amount for the above stated project, for the payment of which sum, CONTRACTOR and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated January 21, 2020 for Citvwide Traffc Signal Vehicle Head Upgrades fHSIPL-5063(188)1 if CONTRACTOR or any subcontractor fails to pay for any labor or material of any kind used in the performance of the Work of Improvement to be done under said Contract Agreement, or fails to submit amounts due under the State Unemployment Insurance Act with respect to said labor, SURETY will pay for the same in an amount not exceeding the sum set forth above, which amount shall insure to the benefit of all persons entitled to file claims under the State Code of Civil Procedures; provided that any alterations in the work to be done, materials to be furnished, or time for completion made pursuant to the terms of the contract documents shall not in any way release either CONTRACTOR or SURETY, and notice of said alterations is hereby waived by SURETY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 24th day of January 12020 . Mutual Insurance Company, 175 MA 02116, Phone: (617) 357-9500 & 3ouare. Hartford. CT 06183. Phone: I Normandale Lake Blvd, Suite 1700, Bloomington, Subscribed and sworn to before me, January 2020 . Signature: Michelle Diane Halter Notary Public in and for the County of Hennepin $ MICHEL LE DIANE H A.LTER Notary Puhlic 1 s`- Mmn—ota My Commis -on Expires p Jan 31 E023 Rate of premium on this bond is $ 4.70 per thousand. Total amount of premium charge is $ 1_448.00 . To be filled in by Surety of *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number- and the name, title, address, and telephone number of authorized representative. 2 of 3 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-clnUC1W 2- ,-Z1-o2-y before me. Brenda McKinney, Notary Public (insert name and title of the officer) personally appeared Earnest Brown, President So Cal Div. who proved to me on the basis of satisfactory evidence to be the persons) whose name(s) is/sre subscribed to the within instrument and acknowledged to me that he/64eAhey executed the same in his/ker•/ M* authorized capacity0es). and that by hisiheFAheir signatures) on the instrument the person(&). or the entity upon behalf of which the person(s) acted. executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) BRENDAMCRINNEY s ` y NotaryRiverside County ��o.. Riverside County Commission # 2278125 My Comm. Expires Feb 19, 2023 Ml N c m M This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein staled. _ Liberty Liberty Mutual Insurance Company Mutual:, The Ohio Casualty Insurance Company Cadficate No: 8202635-190003 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Blake S. Bohlig, Brian D. Carpenter, Kelly Nicole Enghauser, Heather R. Goedtel, Michelle Halter, Jessica Hoff, Nicolc Langer, Craig Olmstead, Lauric Pflug all of the city of Bloomington stale of Minnesota each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 21st dayef Novcmbc,r 2019 . Liberty Mutual Insurance Company PV \NSOgq PVSY INSU a The Ohio Casualty Insurance Company joorm°naroymim eyJ3rpaPOngl� yn West American Insurance Company 1912 r+ 1919 ao nrs e�;is e"ordpy`ancau9 ao �srnxrs°da B/y ♦ 1•�''H1 ♦ xNBy: State of PENNSYLVANIA County of MONTGOMERY ss On this 21 st day of November , 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance O Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to de, execute the foregoing instrument for the purposes r�—i therein contained by signing on behalf of the corporations by himself as a duly authorized officer. L7 W IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. p Pq tQj FQQo MONW�jS(9 COMMONWEALTH OF PENNSYLVANIA lif Notarial Seel OF Teresa PaetellriTwp., Notary PUNic v /y lC6 Ablulli My Co Merssion E,ireotM County Y My Commission Expires Mam�9.202�- y� Lar".o Penn,i.rila Memlm, Asswiauoo or Neieries Teresa Paslella, Notary Public 4Ny P� 8 m This Power of Attomey Is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE W — OFFICERS: Section 12. Power of Attorney. +g Any officer or other official of the Corporation authorized for that purpose in wrifing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -tact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all R 0 undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attomey, shall have full IT power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall 'FC� be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the provisions of this t article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, F shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execulon of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation —The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attomeys-in- fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, We and coned copy of the Power of Attomey executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 24th day of January 2020 . C00)(U`ZY INSU�p/�gy�'Ycat•4O0.PDeyl §-rq'%c`"0 1nc > `"o nFo 1wu m2 �a 1919 W o 0sF a't=oxn*r *N,paFayD BY Renee C. Llewellyn, Assistant Secretary LMS-128M LMIC OCIC WAIC Motu Co 062018 Travelers Casualty and Surety Company of America Ate• Travelers Casualty and Surety Company TRAVELERS J St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marne Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Blake S. Bohlig of BLOOMINGTON Minnesota , their true and lawful Attorney -in -Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 3rd day of February, 2017. yx eVA �, sF o Slate of Connecticut City of Hartford as. Robert L. Raney, Se or Vice President On this the 3rd day of February, 2017, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marne Insurance Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof, I hereunto set my hand and official seal. p 1h My Commission expires the 30th day of June, 2021 o AUe* rc + Marie C. Tetreault, Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marne Insurance Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is fled in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attomeys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which remains in full force and effect. Dated this 24th day of January , 2020 l�WgiY� 9YtiY 4h0 �� q@kA�li.'xR� e` MiA1F0R�, 9 �y� i91fKrJltt ry + K V� Hughes, Assistant Secretary To verify the authenticity of this Power of Attorney, please call us at 1-800-421-3880. Please refer to the above-namedAttorney-in-Fact and the details of the hand to which the power is attached. 4CC?Rp� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) V IFJILVCU 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED PmAslons or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the Polley, cerfaln polices may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such 0 dorsoment(s). PRODUCER Marsh USA Ic. n CONTACT N Minneap lis, MN 5e4 2240000 PHONE -(BrG.B xo VAX o: E-MAIL A REB IN9URER(e)AFFORDINe CgVERAGE NAICry_ 99309-ILBR-GAWX-20-21 IINSURED NSURE INsuRERA Llbertv Mutual Flre Ins Co 23035 International620 Line Builders INsuRERa-NIA _N/A 2520Rubidoux Blvd. PO Box 3039 __ mauRER c; Libetl InsurenceC ration 42404 INSURERo: RIYErall CA 92609 INSURER E COVERAGES CFaTlalr n•re unnao em. N9URER F: __. --- ------ •-•• Onruw•weueo-ui THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED KEVISION NUMBER: NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED DOCUMENT WITH RESPECT TO WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED HEREIN IS SUBJECT TO AL L THE TERMS, BY PAID CLAIMS. TYPEOFINSURANCE INSD -SUBS POLICY NUMBER POLICY EVE MLICCYYEP T82-641-005097-040 01/0112020 0ligV2021EACH LIMITS gCCURRENCE $ 2,000,000 WMS-MADE OCCVR PREMISES Eaacco e— tfMED TXCOMMERCIALGENERALLIABILITY EXP IAPERSONAL S ADV INJURY $ 2,00%000 EGATE LIMITAPPLIES PER: JECOT LODPRODUCTS-COMPIOPAGG GENERAL AGGREGATE If 4,000,000 S 4,000,000 $ A AUTOMOBILE LIABILITY AI2-641-0050 7050 61101120 00 g110112021 COMBINED INGLELIMIT X ANY AUrO JE. eccidnl $ 2,000.900 SCHEDULED BODILY INJURY (Per parson) $ AUTOS X X NOW OWNED _ BODILY INJURY(Pereccldsae $ AUTOS ONLY PReOaE�R ^DAMAGE S J OCCUR EXCESSCLAIM9-MADE EACH OCCURRENCE $ AGGREGATE If ENTION$ — C WORKERS COMPENSATION WA7-64D075097 .010 AOS ( ) 010112021 X PER OTH- $ ANDEMPLOY Y!N ANWROPRIETORIPARTNER/EXECUTIVE "Includes°Step-Gap" STATUTE ER E.L. EACH ACCIDENT S 1.000.000 OFFICER/MEMBEREXCLUDEDa -] NIA IMendatory In NN) E.L. DISEASE - EA EMPLOYEE S 1.000,000 If yes, describe under 1= DESCRIPTION OF OPERATIONS below — E.L. DISEASE •POLICY LIMIT § 1,000,000 DESCRIPTION OFOPERATIONSILOCATIONS/VEHICLES (ACORD101,Addlllomi Ramarae Schedule, may be attached If mom space larvqu(md) Re: Citywide Traffic Signal Vehicle Head Upgrades (HSIPL-5062(iB8)) Project No. 17.6876. CIIy of Santa Ana, Its officers, employees, agents and volunteers Were included as additional Insured under general liability per the attached CG 2010 and CG 2037 endorsements and doesn't Include professional Ilabllitycoverage, Blanket Additional Insured for Automobile Uabllltyis Included per attached designated Insured Endorsemem CA 2048. Primary and Non-Contdiumory apples fur General Llabllity per CG 2001 attached. n n r CERTIFICATE City of Santa Ana Risk Management Division, 41h Floor 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLIOIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc, Manashi Mukher)ee ...M.nsnawar,L U riahts --- 1--1—••-1 1 nc r wnw name one logo are registered marks of ACORD POLICY NUMBER: Al2-641-005097-050 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies Insurance provided under the fallowing: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement Identifies person(s) or organizations) who are "Insureds" far Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided In the Coverage Form. SCHEDULE Any person or organization whom you have agreed In writing to add as an additional Insured, but only to coverage and minimum limits of Insurance required by the written agreement, and in no event to exceed either the scope of coverage or the limits of Insurance provided In this policy. will be primary and non-contributory to any like Insurance the person or organization noted above, information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule Is an "Insured" for Covered Autos LlabliityCoverage, but only to the extent that person or organization qualifies as an "Insured" under the Who IsAn Insured provision contained In Paragraph A.I. of Section II - Covered Autos Liability Coverage In the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. REVIEWED & APPROVED B yPA CAL: DIVISION tiC T-I.EISTRA CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 PolloyNumber: A12-641-005097-050 Issued By: Liberty Mutual Fire insurance Co. THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF -INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Name of Other Person(s)1 Organization(s): Email Address or mailing address: Number Days Notice: Per schedule of certificate holders on file with the Company Per schedule of certificate holders on file with the Company 90 A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the emall or mailing address listed above at least 10 days, or the number of days listed above, If any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named Insured. S. This advance notification of a pending cancellation of coverage Is Intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remaln unchanged. LIM 99 01 0511 0 2011, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. IQ 6P POLICY NUMBER: TB2-641-005097-040 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. - , W Dili 1111111:1 - w a a 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 perscn(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 ants 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 "properiydamage" occurring after: 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 apart 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: SCHEDULE 1. Required bythe 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 2010 0413 ® Insurance Services Office, Inc., 2012 Page of 2 T�iiI, SCHEDULE (continued) Name Of Additional Insured Person(s) Or Organization(s): Anyperson or organization with whom you have agreed In writing in acontract or agreement, prior to an "occurrence" or "offense", that such person or organization be added as an additional insured on your policy; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in item (1) above. Locatlon(s) Of Covered Operations All locations as required by a written contract or agreement entered into prior to an "occurrence" or offense. Information required to complete this Schedule, if not shown above, will be shown In the Declarations. CG 2010 0413 © Insurance SerNces Office, Inc., 2012 Page 2 of4�) 2 POLICY NUMBER: TB2.641-005097-040 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. .!� 1k 0. i •' • il This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS 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' or "property damage" caused, in whole or in part, by "your work' at the location designated and described in the Schedule or 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 edent 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 pravide for such additional insured. Name Of Additional Insured Person(s) Or Organizatlon(s): 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 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 bythe contract or agreement: or 2. Available under the applicable Limits of Insurance shown in the Declarations: whichever is less. This endorsement shell not increase the applicable Limits of Insurance shown in the Declarations. P141Ct011111l:4 Any person or organization for whom you hate agreed in writing in a contract or agreement, prior to an "occurrence" or "offense", that such person or organization be added as an additional insured on your policy, and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in item (1) above. Location And Description Of Completed Operations All locations as required by a written contract or agreement entered Into prior to an "occurrence" or offense. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of Policy Number TB2-641-005097-040 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided underthe following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF -INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY— UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) / Or anization s Email Address or mailing address: Number Days Notice: Per Schedule of certificate holders on file with the Company 90 A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is Intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 01 05 11 © 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. DOE NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effective, In no event does the notice to the third party exceed the notice to the first named Insured. B. This advance notification of a pending cancellation of coverage is Intended as a courtasy only. Our failure to provide such advance notification will not extend the policy cancellation data nor negate cancellation of the policy. Schedule Name of Other Persons) f Email Address or mailing address: Number Days Notice: Organization{s): Schedule on file wlth the Schedule on file with the 90 company company All other terms and conditions of this policy remain unchanged. Issued by Liberty Insurance Corporation 21614 For attachment to Policy No. WA7.64D-006097.010 Effective Date Premium $ Issued to Centennial Energy Holdings, Inc. WC 99 20 79 Ed.1210112016 02016 Liberty Mutual Insurance Page 1 of 1 CITY OF SANTA ANA PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project No. 17-6875 Citywide Traffic Sig Vehicle Head Upgrade Change Order Number 1 (HSIPL 5063 (188)) To International Line Builder's, Inc. Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated, rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by PUBLIC WORKS AGENCY EXTRA WORK AT AGREED PRICE To compensate the contractor for remobilization to complete additional work, per City's request. (PCO #01) TOTAL AGREED PRICE = $1,300.00 The compensation both time and cost set forth in this change order comprises the total compensation due the Contractor, all Subcontractors, and all Suppliers for all work performed per this change order, including impact on unchanged work. By signing this change order, the Contractor acknowledges and agrees on behalf of himself, all Subcontractors, and all Suppliers, that the stipulated compensation includes payment for all work contained in this change order, plus all payment for interruption of schedules, extended field overhead, home office overhead, profit, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract. The signing of this change order constitutes full mutual accord and satisfaction for all changes and work performed on this project, and that the time and cost paid per this change order constitutes the total equitable adjustments owed the Contractor, all Subcontractors, and all Suppliers for all work performed on this project. The Contractor on behalf of himself, all Subcontractors, and all Suppliers agrees to waive all rights, without exception or reservation of any whatsoever to file any further claim related to this project. TOTAL COST THIS CHANGE ORDER: DECREASE $ _______________ INCREASE $ 1,300.00 By reason of this order the CONTRACT TIME completion will be adjusted as follows: None We the undersigned contractor have given careful consideration to the change proposed and hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials, except as may otherwise be noted above, and perform all service necessary for the work above specified, and will accept as full payment therefor th pd s shown above. Accepted, �J�1� Contractor International Line Builder's, Inc. By I Title �% Lj �✓f/jr✓,����'Z Approval recommended by M e. I , A% Date �J �I I I 2PJZ) PUBLIC WORKS AGENCY EXECUTIVE DIRECTOR Approved by ,� ,.�. Date ::Z&2 � CITYMANAGER Page 1 of 1 MEMORANDUM Kristine Ridge To: City Manager Date: May 7, 2021 Nabil Saba, Executive Director From: Public Works Agency Project No. 17-6875; Citywide Traffic Sig Vehicle Head Upgrade (HSIPL 5063 (188)) Subject: Change Order No, 1 CONTRACTOR: International Line Builder's, Inc. 3955 Temescal Canyon Rd. Corona, CA 92283 PROJECT DESCRIPTION: Project No. 17-6875; Citywide Traffic Sig Vehicle Head Upgrade (HSIPL 5063 (188)) CHANGE ORDER NUMBER: 1 CHANGE ORDER AMOUNT: $1,300.00 ACCOUNTING UNIT -ACCOUNT -ACTIVITY NUMBER: 14717611-66220-17687501028 JUSTIFICATION 1. To compensate contractor for remobilization to complete additional work, AGREED PRICE per City's request. (PCO #1) $1,300.00 CONTRACT COST SUMMARY Amount % of Contract Original Contract Total $308,059.00 Construction Contin Council Authorized budget 60,541.00 52.1 Amount % of Contract Original Contract Total $308,059.00 Change Order#1 $1,300.00 Increase 0.42% Adjusted Contract Total $309,359.00 0.42% SCHEDULEIMPACT one. Nabil Saba, PE; Executive Director Public Works Agency APPROVED AS TO FUNDS AND ACCOUNTS: Kathryn Downs, CPA; Executive Director Finance & Management Services Agency MEMORANDUM Kristine Ridge To: City Manager Date: May 7, 2021 Nabil Saba, Executive Director From: Public Works Agency Project No. 17-6875; Citywide Traffic Sig Vehicle Head Upgrade (HSIPL 5063 (188)) Subject: Change Order No. 1 CONTRACTOR: International Line Builder's, Inc. 3955 Temescal Canyon Rd. Corona, CA 92283 PROJECT DESCRIPTION: Project No. 17-6875; Citywide Traffic Sig Vehicle Head Upgrade (HSIPL 5063 (188)) CHANGE ORDER NUMBER: 1 CHANGE ORDER AMOUNT: $1,300.00 ACCOUNTING UNIr-AccoUNT-ACTIVITY NUMBER: 14717611-66220-17687501028 JUSTIFICATION To compensate contractor for remobilization to complete additional work, AGREED PRICE per City's request. (PCO #1) $1,300.00 CONTRACT COST SUMMARY Original Contract Total Amount $308,059.00 % of Construction Contingency $160,541.00 52.11% Council Authorized budget $468,600.00 Amount % of Contract Original Contract Total $308,059.00 Change Order #1 $1,300.00 Increase 0.42% Adjusted Contract Total $309,359.00 0.42% SCHEDULEIMPACT one. Nabil Saba, PE; Executive Director Public Works Agency APPROVED AS TO FUNDS AND ACCOUNTS: Kathryn Downs, CPA; Executive Director Finance & Management Services Agency