HomeMy WebLinkAboutELECNOR BELCO ELECTRIC, INC. (2) 45
Recording Requested By,
And When Recorded Mail To:
Clerk of the Council,City of Santa Ana Recorded in Official Records, Orange County
20 Civic Center Plaza,P.O.Box 1988 Hugh Nguyen,
n, Clerk-Recorder
Santa Ana,CA 92702 I NO F E E
illll$ 11 I IIII II I IIII II III I II II IIIII III I I I I III
R 0 0 1 3 4 9 3 0 0 2 $
2022000034284 9:57 am 01/26/22
93 RW11A N12 1
0.00 0.00 0.00 0.00 0.00 0.00 0.000.000.00 0.00
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NOTICE OF COMPLETION
NOTICE IS HEREBY GIVEN that the undersigned City of Santa Ana, California, a
municipal corporation,with the address of City Hall,20 Civic Center Plaza, Santa Ana,California,
92701, is the owner of the property hereinafter described, that said owner has caused construction
a of Flower Street Bikeway [HSIPL-5063(187)1 under contract entered into on Au ug_st
w
18, 2020 with Elecnor Belco Electric. Inc. , on which contract Fidelity and Deposit
M
UCompany of Maryland-is surety. The property on which such work improvement was placed is in
O the City of Santa Ana, County of Orange, State of California, and described as Project no.17-6897
o z located on: Flower Street Bikeway HISPL (IEj The work improvement on said property was
aaccepted as completed on December 15, 2021.
o �
0 CITY OF SANTA ANA,A MUNICIPAL CORPORATION
by
Dated: 19/2Z— Principal Civil Engineer-Jason Gabriel
TITLE
O � -------------------------------------------------------------------------------------------
ex
VERIFICATION
1, the undersigned, say: I am the Acting City Engineer - Zdenek Kekula of the City of Santa
Ana, California; I executed the foregoing Notice of Completion acting on behalf of the owner of
the property therein described; I make this verification on behalf of said corporation by
authorization of the City Council of the City of Santa Ana; I have read said notice and know the
contents thereof; and I declare under penalty of perjury that the facts therein stated are true.
Executed on f , at Santa Ana, California
(Signature of individual swearing that the
contents of Notice of Completion are true.)
THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10)DAYS AFTER COMPLETION
I
o_ PUJ4(CZ) C)� �
SEP 0 n 2020
CITY OF SANTA ANA
CONSTRUCTION CONTRACT
PROJECT 17-6897_,
FLOWER STREET BIKEWAY
FEDERAL NUMBER [HSIPL-5063(187)]
This CONSTRUCTION CONTRACT is made and entered into this 18`h day of August, 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 "
Belco Electric, Inc. (hereinafter "CONTRACTOR").
WITNESSETH:
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 Flower Street Bikeway Project (hereinafter
referred to as the "WORK OF IMPROVEMENT") identified in and in accordance with the Contract
Documents prepared by the City's Public Works Agency and approved by the City Council.
2. The complete Construction Contract consists of the "Contract Documents" as defined by the
Standard Specifications for Public Works Construction and which include the following:
• Notice Inviting Bids
• Information to Bidders
• Bid Proposal
• Bid Bond
• Contract Form
• Contract Bonds
• General Provisions
• Special Provisions
• Technical Provisions and Project Plans
• Community Workforce Agreement
• Appendices
In case of conflict between the Contract Documents, the precedence of documents shall be as
established in the Standard Specifications for Public Works Construction.
3. CITY agrees to pay and CONTRACTOR agrees to accept in full payment to complete the WORK
OF IMPROVEMENT the sum total amount not -to exceed Seven,:Hundred.Eleven Thousand Six
Hundred Eighty -Two Dollars and No. Cents ($711,68200), 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.
mv. 09/01/2017 Page I of 3
IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and
year first above written.
ATTEST: Afk
6-1-f 2
DAISY GOMEZ
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By: 791, TV�L
J FUNK
Assistant City Attorney
FOR APPROVAL:
kl "'y a
IL SABA, PE
xtive Director
c Works Agency
CITY OF SANTA ANA
K bg NE RIDG
City Manager
CONTRACTOR:
Elecnor Belco Electric, Inc.
wi3_
or
k,11-1
l
' •
Page 3 of 3
City of Santa Ana
Page 2
Flower
Street Bkoway (17-6897 (HSIPL 5063(187))), bidding on May 27, 2020 2:00 PM (Pacific)
Printed 06/0912020
Bid Results
EXHIBIT A
Type
Item Code UOM
City
Unit Price
Line Total
Comment
4
GTT Cpticom EVP System at Edinger &Flower
LS
1
$10,689,00
$10,689.00
5
Instal 2" PVC per plan
LF
470
$32.00
$15,040.00
6
Instal 3" PVC per plan
LF
225
$40.00
$9,000.00
7
Instal 4" PVC per plan
LF
580
$60.00
$34,800.00
8
No. 8Pullbox
EA
10
$692.00
$6,920.00
9
No. 6E Pullbox
EA
2
$868.00
$1,736.00
10
Instal Video Detection System at Edinger Ave & Flower St
LS
1
$33,337.00
$33,337.00
11
Instal Video Detection System atMcFadden Ave & Flower St
IS
1
$33,337.00
$33,337.00
12
24 Strand SMFO Cable
LF
3150
$2.20
$6,930.00
13
Fusion Splice 1 Strand SMFO
EA
48
$35.00
$1,680.00
14
IP Communication System at McFadden Ave & Flower St
LS
1
$16,000.00
$16,000.00
15
Construct ADA Curb Ramp Per Plan
S F
300
$47.00
$14,100.00
16
Pothole For Utility Not Shown on Plan
EA
10
$1,115.00
$11,150.00
17
Pothole For Utility for Traffic Signal Pole Locations
EA
8
$875.00
$7,000.00
18
Unclassified Excavation
CY
10
$1,116.00
$11,160.00
19
Temporary Overhead Wiring at Edinger Ave & Flower St
LS
1
$7,600.00
$7,600.00
PlanetBids, Inc.
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6997 EXHIBIT A
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
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 number (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 $400.00 per calendar day.
Name of Finn
Signature of BIDDER
TitlePreqt
(If an individual, so state. UaTirm. or diampazwErship, 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.)
Alberto Garcia de Ins Angeles - President
Pedro End le - Secretary
P-3 of P-52
John Wong - Vice President
Jeroni Gervilla - Treasurer
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
BID PROPOSAL
TO: CITY COUNCIL OF THE CITY OF SANTA ANA
FROM: Elecnor Belco Electric. Inc.
REQUIREMENT:
The undersigned bidder declares that they have carefully examined the location of the proposed
work, that they have examined the Contract Documents in its entirety and hereby proposes to
furnish all material and do all the work required to complete the said work in accordance with said
plans (if any) and the specifications for the unit price(s) or lump sum(s) set forth in the following
schedule:
Item
Description
Qty
Unit
Unit Price
Amount
1
Mobilization
I
LS
Nr"
Cb' �
$,
r `
V�
I
2
Traffic Signal Modification at Edinger
Ave and Flower St
I
LS$
ICI U' OcU
$ Iti GI Goo
3
Traffic Signal Modification at
Ave and Flower St
1
LS
$ O
$ 6COMcFadden
(� I, 0
4
GTT Opticom EVP System at Edinger &
Flower
1
LS
$ �l') 1 bq
$ 1Gl C-Lkej
5
Install 2" PVC per plan
470
LF
$
$ I S
6
Install 3" PVC per plan
225
LF
$
$ 01 I OQC%
7
Install 4"PVC per plan
580
LF
$
$'N eOO
l
8
No. 6 Pullbox
10
EA
$ (p�j Z
$
l
9
No. 6E Pullbox
2
EA
$�'
$
10
Install Video Detection System at
Edinger Ave & Flower St
I
LS
$ ?�7j i3 ��
_
$ -3'2'1 33
I I
Install Video Detection System at
McFadden Ave & Flower St
1
LS
$ 33133-Z
12
24 Strand SMFO Cable
3,150
LF
$ '%-ZC%
$(D C00
13
Fusion Splice 1 Strand SMFO
48
EA
$ `�.-�`7
$
7
P-I ofP-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
Item
Description
Qty
Unit
Unit Price
Amount
14
IP Communication System at McFadden
Ave & Flower St
1
LS
$'(qo U
$ [(pt �)GU
15
Construct ADA Curb Ramp Per Plan
300
SF
$ q -f-
$'w
16
Pothole For Utility Not Shown on Plan
10
EA
$
I
r
�
17
Pothole For Utility for Traffic Signal
Pole Locations
8
EA
$
18
Unclassified Excavation
10
CY
I'
$ I' (� ty
$ (1(�
19
Temporary Overhead Wiring at Edinger
Ave & Flower
1
LS
$�-(C'f)
$�- �•60
St
1
20
Temporary Overhead Wiring at
McFadden Ave & Flower St
1
LS
$ 51 j 00
$ sl �O O
21
Install Type " Bike Loop
13
EA
6
0
22
Install Type "E" & Type "D" Bike Loop
120
EA
$ T5 �
$ . I N'c
23
Signing and Striping
1
LS
$I 1315T3
1
24
Labor Agreement Oversight
1
LS
$10,000
$10,000
TOTAL BASE B
I 11�,L0�2
The lowest responsible bidder shall be selected based on the Total Base Bid. The City reserves
the right to award the Base Bid, and any, all, or none of the add -alternate bid items (if any).
The quantity for this bid item is shown for bid comparison only. This bid item shall not be
subject to the "25%" limit as stated in Section 3-2 of the Standard Specifications. The actual
P-2 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
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 number (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 $400.00 per calendar day.
Name of Firm
Signature of BIDDER
John
Title Vie President
(If an individual, so state. firm or - rship, 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.)
Alberto Garcia de los Angeles - President John Wong - Vice President
Pedro Enrile - Secretary Jeroni Gervilla - Treasurer
P-3 of P-52
UNANIMOUS WRITTEN CONSENT IN LIEU OF
2019 ANNUAL MEETING OF THE BOARD OF DIRECTORS
OF
ELECNOR BELCO ELECTRIC, INC.
January 1, 2019
The undersigned, being all of the members of the Board of Directors (the `Board") of Eleenor Belco
Electric, Inc., a California corporation (the "Company"), in lieu of holding a meeting of the Board, hereby
take the following actions and adopt the following resolutions by unanimous written consent:
WHEREAS, the Board has determined that it is in the Company's best interests to appoint a
revised slate of Officers of the Company.
NOW, THEREFORE, BE IT RESOLVED, that the following persons be, and hereby are,
elected to the offices set forth opposite their respective names, to hold such offices until their respective
successors are elected and qualified at or before the next annual meeting of the Board, or until their earlier
respective deaths, resignations or removals:
President and Chief Executive Officer
Alberto Garcia De Los Angeles
Chief Financial Officer
Jeroni Gervilla
Senior Vice President, General Counsel
Roger DeVito
and Assistant Secretary
Vice President for Construction
John Wong
Secretary
Pedro Emile
FURTHER RESOLVED, that Alberto Garcia De Los Angeles, Jeroni Gervilla, Alberto Garcia
and Roger DeVito in their respective capacities (listed above) subject to such supervisory powers of the
Board of Directors, hereby are authorized and directed to perform all the duties commonly incident to that
office; shall have authority to execute in the name of the Company contracts, leases and other written
instruments to be executed by the Company; and, shall perform such other duties as the Board of
Directors may from time to time determine.
FURTHER RESOLVED, that the President and Chief Executive Officer may delegate authority
to any Chief Financial Officer or Chief Operating Officer or Senior Vice President or Vice President as
and within their authority levels as set forth in the Company's Bylaws, as the same may be amended from
time to time;
FURTHER RESOLVED, that Roger DeVito, in his capacity of Senior Vice President, is
hereby authorized and directed to:
1. Negotiate, sign, amend and terminate agreements in connection with the purpose of the Company,
for all contracts up to $250,000.00, and acting jointly with Alberto Garcia De Los Angeles or
Jeroni Gervilla for all contracts in amounts greater than $250,000.00.
2. Execute, amend and finalize bid proposals in connection with the propose of the Company, for all
proposals up to $1,000,000.00, and acting jointly with Alberto Garcia De Los Angeles or Jeroni
Gervilla for all proposals in amounts greater than $1,000,000.00.
3. Acting jointly with Alberto Garcia Do Los Angeles or Jeroni Gervilla, execute, amend and finalize
purchase orders for materials and equipment in connection with the purpose ofthe Company.
4. Acting jointly with Alberto Garcia De Los Angeles or Jeroni Gervilla, execute, amend and
terminate agreements for the lease of real estate to be used as offices or job related temporary
yards.
S. Acting jointly with Alberto Garcia Do Los Angeles or Jeroni Gervilla, execute, amend and
terminate insurance and/or bid bonds arrangements in connection with the purpose of the Company.
6. Acting jointly with Alberto Garcia Do Los Angeles or Jeroni Gervilla, hire, suspend, impose
sanctions and dismiss the administrative personnel of the Company, setting forth their
employment terms and conditions, obligations and remuneration.
7. Acting jointly with Alberto Garcia De Los Angeles or Jeroni Gervilla, settle and claims on behalf
of the Company.
AND IT IS FURTHER RESOLVED, that all actions heretofore taken by the officers of the
Company on behalf of and in the name of the Company, relating to the conduct of the business of the
Company, the expenditure of money, the making of contracts and all other acts taken or omitted in the
performance of their duties to the Company be, and the same hereby are, in all respects, approved, ratified
and affirmed, as of the date taken, done or omitted, respectively.
The actions taken by the Board Consent shall have the same force and effect as if taken by the
undersigned at a meeting of the Board of Directors, duly called and constituted pursuant to the Bylaws of
the Company and the laws of the State of California. This Board Consent may be executed in
counterparts, each of which shall be deemed an original, but all of which together shall constitute one and
the same document.
IN WITNESS WHEREOF, the undersigned, being all of the members of the Board of Directors
of Eleanor Belie Electric, Inc., have executed these actions by written consent as of the date first written
above.
Luis Alcibar, Director
Alexander Arola, Director
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
BIDDER'S STATEMENT
BIDDER understands and agrees that this Bid Proposal, Contract Documents and subsequent
Construction Contract Agreement shall constitute the entire agreement between BIDDER and the
AGENCY only after it has been accepted by the City Council, endorsed by the Clerk of the Council
with her signature and official seal noting hereon the action of approval of the Council, signed by
the Public Works Agency Executive Director or his/her duly authorized agent, and signed by the
City Attorney, denoting his approval of the form of this document, and its execution, and when it
or an exact copy of it has been either delivered to BIDDER or deposited with the United States
Postal Service properly addressed to the BIDDER with the correct postage affixed thereto.
BIDDER further agrees that upon delivery (as defined above) of the accepted agreement he/she
will furnish AGENCY all required bonds and certificate of liability insurance within ten (10)
business days or the funds, check, draft, or BIDDERS bond substituted in lieu thereof
accompanying this proposal shall become the property of the AGENCY and shall be considered
as payment of damages due to the delay and other causes suffered by AGENCY because of the
failure to furnish the necessary bonds and because it is distinctly agreed that the proof of damages
actually suffered is difficult to ascertain; otherwise said funds, check, drafts, or BIDDER'S bond
substituted in lieu thereof shall be returned to the undersigned.
BIDDER understands that a bid is required for the entire work, the estimated quantities set forth
in the bid schedule are solely for the purpose of comparing bids, and that final compensation under
the contract will be based upon the actual quantities of work satisfactorily completed. The
BIDDER also certifies that the bid is a balanced bid.
In accordance with Section 7028.15 of the California Business and Professions Code, the
undersigned certifies under penalty of perjury that the foregoing is true and correct.
Name of Firm Elecnor Belco nutric, Inc. /
Signature of BIDDER
Title
(If an individual, so state. irm or -p ership, state the Fi m 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.)
Alberto Garcia de Ins Angeles - President John Wong - Vice President
Pedro Enrile - Secretary Jeroni Gervilla - Treasurer
P-4 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT
The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she and
all his/her subcontractors are registered with the State of California Department of Industrial
Relations (DIR), and that the following is true and correct.
Contractor's Name: Elecnor Belco Electric. Inc.
Business Address: 14320 Albers Way, Chino, CA 91710
Business E-Mail Address: iwonea,c1cenor.com
Telephone: 909-993-5470
State Contractor's License No. and Class: 738518 A, B,C-I0
License Expiration Date:
State Dept. of Industrial Relations (DIR)
Registration No.: 1000004804
State Dept. of Industrial Relations (DIR)
Registration Expirati ate: 6/30/22
Signed: ,John
Title: Vice President
P-5 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
PREVAILING WAGE COMPLIANCE AND MONITORING STATEMENT
Contractor is aware of the requirements of California Labor Code Section 1720, et seq., as well as
California Code of Regulations, Title 8, Section 16,000, et seq., ("Prevailing Wage Laws"), which
require the payment of prevailing wage rates and the performance of other requirements on "public
works" and "maintenance" projects. Since the services are being performed as part of an applicable
"public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and since the
total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing
Wage Laws.
City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at the
commencement of this Agreement. Contractor shall make copies of the prevailing rates of per
diem wages for each craft, classification or type of worker needed to execute the services available
to interested parties upon request, and shall post copies at the Contractor's principal place of
business and at the project site.
Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and
agents free and harmless from any claim or liability arising out of any failure or alleged failure to
comply with the Prevailing Wage Laws.
The undersigned certifies that the foregoing is true and correct.
Name of Finn Elecnor
Signature of BIDDER
Title
(if an individual, so state)
John
P-6 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
OWNERSHIP AFFIDAVIT
STATE OF CALIFORNIA
)
COUNTY OF ORANGE
) SS:
CITY OF SANFA ANA
)
John Wong
, being duly swom, deposes and says:
❑ INDIVIDUAL
That he/she is the party making the foregoing proposal:
❑ PARTNERSHIP
That he/she is a member of the co -partnership firm designated as:
and who has been and is duly vested with the authority to make and execute instruments
for the co -partnership by:
who constitute the other members of the co -partnership.
[RCORPORATION
That he is of'.
Vice President
a corporation which is making the foregoing proposal:
❑ JOINT VENTURE
That he is of:
one of the parties making the foregoing proposal as ajoint venture, and the he/she has been
and is duly vested with the authority to execute instruments for an on behalf of the parties
making said bid who are:
that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion
to secure any advantage against the City of Santa Ana or any person interested in the proposed
contract/fpr hirri4elf or any other person.
gom to before me this I'll" day of _M20 V
16119q 00�) USIA
of officer Administering Oath (Notary Public)
A notary p
it or other officer completing
this carllficatverifies only the identity of
the Individuall who signed the document to
which this cerlifkate is attached, and not
the truthfulness, aauracy, or validity of
that document.
a.... ELISA BETH LiM
ComNo. 2281637
NOTARY PuatIC.CALIFORNIA
sAN eERNARgpO COUNTY
my Cam'. Ev'i .MARCH 21, 2023
P-7 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
KNOW ALL PRESENT that,
Elecnor Belco
as BIDDER, and
Fidelity and Deposit Company of Maryland , as SURETY,
are held and firmly bound unto the CITY OF SANTA ANA, as AGENCY, in the penal sum of _
Ten Percent of Amount Bid Dollars ($ 10% ), which is ten percent (10%)
of the total amount bid by BIDDER to AGENCY for the above -stated project, for the payment of
which sum, BIDDER and SURETY agree to be bound, jointly and severally, firmly by these
presents.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas BIDDER is about to
submit a bid to AGENCY for the above -stated project, if said bid is rejected, or if said bid is
accepted and a contract is awarded and entered into by BIDDER in the manner and time specified,
then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor
of AGENCY.
IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this
19th day of Mav 12020
BIDDER*
J:2Donna M. Planets Attorney -in -Fact
Subscribed and sworn to before me
,20
Signature:
Notary Public in and for the County of
, State of
this day of
* Provide BIDDER/ SURETY name, address, and telephone number and the name, title, address,
and telephone number of authorized representative.
P-8 of P-52
CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT
Civil Code § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfullness, accuracy or validity of that document.
♦♦eeee�ee�eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeoeeeeee�e
State of _ N*bVMtC4
County of CSGIh bP•goA) py
On _" 2-9. t?p2e before me, ✓tom WA JAt-) Notary Public
Dete NenM anE Tale o(Ndery
personally appeared bhb_hIQV197
Name
Who proved to me on the basis of satisfactory evidence
to be the persorl(3f whose nam,) is/o subscribed
to the within instrument and acknowledged to me that
help lilpfy xecuted the same in his/ r/Weir authorized
capaci es), and that by his/�4r/ Ir signatureXon the
instrument the persorg , or the entity upon behalf of
which the persorfWacted, 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 han
ELISA BETH LIM
No. 228/937
.tom •Commission
NOTARY PUBLIC-MIFORNIA
SAN BERNARDWO COUNTY
j
My Comm. Ewires IMRCH 21, 2023
Signature
Notary Public Signature Place Notery Public Seal Above
OPTIONAL
Though the information below is not required by law, it may prove valuable to the persons relying on the document and could prevent fraudulent removal
and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document U "C
Document Date
Signer's Name:
❑ Individual
❑ Corporate Officer — Title(s):
❑ Partner - ❑ Limited ❑ General
❑ Guardian or Conservator Top of lhumb
❑ Attorney -in -Fact
❑ Trustee
❑ Other:
Signer is representing
Number of Pages:
❑ Individual
❑ Corporate Officer — Title(s):
❑ Partner - ❑ Limited ❑ General
❑ Guardian or Conservator Top of ibanb
❑ Attorney -in -Fact
❑ Trustee
❑ Other.
Signer is representing
0000eeoe000eeee000ee000eeeeoe00000e000eee0000eoeeoee000eeeee000eeoo
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
validitv of that document.
State of 6aidori9ax
County of Hartford
On May 19, 2020
before me, Brendan Fletcher, Notary Public
(insert name and title of the officer)
personally appeared Donna M. Planets
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature
Public
(Seal)
BRENDAN FLETCHER
NOTARY PUBLIC- CT 180835
My Commission Expires Feb. 28, 2025
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by
Robert D. Murray, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which we
set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute,
and appoint, Donna M. PLANETA, Joshua SANFORD, Aimee R. PERONDINE, Danielle D. JOHNSON,
Michelle Anne MCMAHON, Bethany STEVENSON, Bryan M. CANESCHI, Kristopher PISANO, Rebecca
M. STEVENSON, Nicholas TURECAMO and Tanya NGUYEN, all of Hartford, Connecticut, EACH, its true and
lawful agent and Attomey-in-Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all
bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said
Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected
officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected
officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper
persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of
the By -Laws of said Companies, and is now in force.
IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 4th day of October, A.D. 2019.
s `
"s o:
*S"a\ rocs fi;ri in. ,ti � 7
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By: Robert D. Murray
Vice President
By., Dawn E. Brown
Secretary
State of Maryland
County of Baltimore
On this 4th day of October, A.D. 2019, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, Robert D.
Murray, Vice President and Dawn E. Brown, Secretary of the Companies, to me personally known to be the individuals and officers described in and who
executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith, that he/she is the said officer of
the Company aforesaid, and that the seals affixed to the preceding instrument arc the Corporate Seals of said Companies, and that the said Corporate Seals and
the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written.
Constance A. Do., Notary Public
. �
"
My Commission Expires: July 9, 2023
,;'
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, Attomevs-in-Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attorneys -in -fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney -in -fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of
the By -Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney ... Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the I Oth day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this tern day of May 2020
�ayy cytr tasv'°*
ggq,,,'''���ss+� � �'h :•St:.W'°W�i� i•,-y'Y/ry,.ayo
Brian M. Hodges, Vice President
TO REPORT A CLAIM WITH REGARD TO A SURETY BOND, PLEASE SUBMIT A COMPLETE DESCRIPTION
OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND, THE BOND NUMBER, AND YOUR CONTACT
INFORMATION TO:
Zurich Surety Claims
1299 Zurich Way
Schaumburg, IL 60196-1056
www.reaoctsfclaims@,4z irichna.com
800-626-4577
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
LIST OF SUB -CONTRACTORS
Section 4100 et. seq. of the Public Contract Code requires listing of all subcontractors with the bid for all
subcontract work exceeding the following amount:
o Streets, highways including bridge projects: ''/z% of the bid or $10,000, whichever is greater
o Buildings, parks, or other projects: '/a% of the bid
Section 1725.5 of the Public Contract Code requires all Subcontractors be registered with the State
Department of Industrial Relations (DIR).
BIDDER proposes to subcontract certain portions of the work to the firms listed below:
Name 5YA'isto R�C ac Name
License #/Exp. b I L1510 3 1� 11171 License
DIR Reg. #/Exp. IWOOON 0 1 C DIR Re€
Location AYIG to Locatior
Phone _",SS(n Phone
Type Of Work 0 5 Type Of
Amount $ 7�?�� SOD Amount
Name C11VA'
License #/Exp.
DIR Reg. #/Exp.
�1
License #
Location AU
Phone Q61-
Type Of Work
Amount $ 41
Name
License #/Exp.
DIR Reg. #/Exp.
License # _
Location _
Phone
Type Of Work
Amount $
L�Vn nos
Name
License #/Exp.
0CCVC030(o 4I;o 70
DIR Reg.#/Exp.
A
License #
N iA
Location
Phone
MG `mil nh
Type Of Work
S
Amount $
Name
License #/Exp.
DIR Reg. #/Exp.
License #
Location
Phone
Type Of Work
Amount $
P-9 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
REFERENCES
The following are the names, addresses, and telephone numbers for THREE public agencies for
which the BIDDER has performed similar work within the past three years.
City of Victoiville 14343 Civic Center Dr. Victorville, CA 92392
Name and Address of Owner.
Greg Heldreth 760-243-6360
Name and Telephone Number of person familiar with project.
$445,220 Traffic Signals & Fiber Optics March 2018
Contract Amount Type of Work Date Completed
2• City of Diamond Bar 21810 Copley Dr. Diamond Bar, Ca 91765
Name and Address of owner.
Christian Malpica 909-839-7042
Name and Telephone Number of person familiar with project.
$389,928 Traffic Signals & Fiber Optics September 2018
Contract Amount
Type of Work
3• City of Mission Vieio 200 Civic Center, Mission Vieio, CA 92691
Name and Address of owner.
Phillip Nitollama 949470-3068
Name and Telephone Number of person familiar with project.
$357.100
Contract Amount
Tragic Signals
Type of Work
Date Completed
September 2018
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 Towers Watson
10 State House Square, Floor I I
Hartford, CT 06103
Erin Kieman 860-843-5404
Zurich American Insurance Company
777 S. Figueroa St, Suite 3900
Los Angeles, CA 90017
Margaret Hentz 213-270-0757
P-10 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
ADDITIONAL REFERENCES
The following are the names, addresses, and telephone numbers for THREE public agencies for
which the BIDDER or Subcontractor has performed similar work in the past five years.
1 • City of Glendale 633 E. Broadway, Glendale, CA 91206
Name and Address of Owner.
Sarkis Oeanesvan 818-548-3945
Name and Telephone Number of person familiar with project.
$600,000 Traffic Signals, Fiber & Interconnect March 2018
Contract Amount
Type of Work
2. 013y of La Mirada 15515 Phoebe Ave - La Mirada _ CA 9063
Name and Address of owner.
Date Completed
Eric Villagarcia 562-902-2385
Name and Telephone Number of person familiar with project.
$299,490 Traffic Signal Installation September 2017
Contract Amount Type of Work Date Completed
City of Azusa 213 E. Foothill Blvd, Azusa, CA 91710
Name and Address of owner.
_ Cody I -lowing 909-594-9702
Name and Telephone Number of person familiar with project.
$352,269 Traffic Signals & Fiber Optics December 2017
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 Towers Watson Zurich American Insurance Company
10 State House Square, Floor 1 I
Hartford, CT 06103
Erin Kiernan 860-843-5404
777 S. Figueroa St, Suite 3900
Los Angeles, CA 90017
Margaret Hentz 213-270-0757
P-11 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
NON -COLLUSION AFFIDAVIT
(Title 23 United States Code Section 112 and Public Contract Code Section 7106)
In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the
BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed
person, partnership, company, association, organization, or corporation; that the bid is genuine and
not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other
BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired,
connived, or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall
refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by
agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any
other BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any
other BIDDER, or to secure any advantage against the public body awarding the contract of anyone
interested in the proposed contract; that all statements contained in the bid are true; and, further,
that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown
thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will
not pay, any fee to any corporation, partnership, company association, organization, bid
depository, or to any member or agent thereof to effectuate a collusive or sham bid.
Note: The above Non-collu on Affidavit is part of the Proposal. BIDDERS are cautioned
rgg that makia falslcrtification may subject the certifier to criminal prosecution.
Signed
State of C�
County of
Subscribed and sworn to (or affirmed) before me on this HM day of MaH 2(2_, by
cl *y%INOVt9X proved to me on the basis of satisfactory evidence to 8e the person(s)
who appearedVf6re me
�luu
ary Public Signature
Mublic or other officer completing
ate verifies only the Identity of
ual who signed the document to
certificate is attached, and not
ness, accuracyor validity of
ent.
Notary Public Seal
.,, ELISA BETH LIM
Commission No. 2281g
�1® NOTARY PUBLIC-CALIFORNIA ti
SAN BERNARDINO COUNTY
My Comm. Expires AVMH 21, 202B
P-12 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
NON-DISCRIMINATION CERTIFICATE
The undersigned contractor or corporate officer, during the performance of this contract, certifies
as follows:
The Contractor shall not discriminate against any employee or applicant for employment
because of race, color, religion, sex, or national origin. The Contractor shall take affirmative
action to ensure that applicants are employed, and that employees are treated during
employment without, regard to their race, color, religion, sex, or national origin. Such action
shall include, but not be limited to, the following: employment, upgrading, demotion, or
transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other
forms of compensation; and selection for training, including apprenticeship. The Contractor
agrees to post in conspicuous places, available to employees and applicants for employment,
notices to be provided setting forth the provisions of this nondiscrimination clause.
2. The Contractor shall, in all solicitations or advertisements for employees placed by or on behalf
of the Contractor, state that all qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, or national origin.
3. The Contractor shall send to each labor union or representative of workers with which he/she
has a collective bargaining agreement or other contract or understanding, a notice to be
provided advising the said labor union or workers' representatives of the Contractor's
commitments under this section, and shall post copies of the notice in conspicuous places
available to employees and applicants for employment.
4. The Contractor shall comply with all provisions of Executive Order 11246 of September 24,
1965, and of the rules, regulations, and relevant orders of the Secretary of Labor.
5. The Contractor shall furnish all information and reports required by Executive Order 11246 of
September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant
thereto, and will permit access to his/her books, records, and accounts by the administering
agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with
such rules, regulations, and orders.
6. In the event of the Contractor's non-compliance with the nondiscrimination clauses of this
contract or with any of the said rules, regulations, or orders, the contract may be canceled,
terminated, or suspended in whole or in part and the Contractor may be declared ineligible for
further Government contracts or federally assisted construction contracts in accordance with
procedures authorized in Execution Order 11246 of September 24, 1965, and such other
sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of
September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise
provided by law.
P-13 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
7. 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.
Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as
amended, no discrimination shall be made in the employment of persons upon public works
because of race, religious creed, color, national origin, ancestry, physical handicaps, mental
condition, marital status, or sex of such persons, except as provided in Section 1420, and any
contractor of public works violating this Section is subject to all the penalties imposed for a
violation
Signed:
Title:
Firm:
Date:
May 19, 2020
P-14 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
STATEMENT REGARDING APPRENTICESHIP REQUIREMENTS
The undersigned BIDDER is familiar with the requirements of Section 1777.5 of the State Labor
Code regarding employment of apprentices, and understands that contractors on contracts
exceeding $30,000 or 20 working days shall:
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 in the same
manner as the other c tractors, except contractors not signatory to the trust agreement shall
pay a like amount t� Califoynia Apprenticeship Council.
Signed: John Wong
Title: i 1 Vice President
Firm: `,� Elecnor Belco Electric. Inc.
Date: Mav 19, 2020
P-15 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
STATEMENT REGARDING "ANTI -KICKBACK" REQUIREMENTS
The undersigned is submitting this proposal for performing by contract the work required by these
bid documents, agrees to comply with the Copeland "Anti -Kickback" Act (18 USC 74) as
supplemented in the Department of Labor regulations (29 CFR, Part 3). This act provides that
each contractor or subcontractor shall be prohibited from inducing, by any means, any person
employed in the construction or repair of public work, to give up any part of the compensation to
which he/she is otherwise cntiitled.
Signed:
Title:
Firm:
Elecnor Belco Electric, Inc.
Date: May 19, 2020
P-16 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE
In conformance with Public Contract Code Section 10162, the BIDDER shall complete,
under penalty of perjury, the following questionnaire:
Has the BIDDER, any officer of the BIDDER, or any employee of the BIDDER who has a
proprietary interest in the BIDDER, ever been disqualified, removed, or otherwise prevented from
bidding on, or completing a federal, state, or local government project because of a violation of
law or a safety regulation?
Yes No X
If the answer is yes, explain the circumstances in the following space.
P-17 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
BIDDER'S STATEMENT REGARDING REQUIRED FEDERAL CONTRACT PROVISIONS
(FORM FHWA-1273)
The undersigned, is submitting this proposal for performing by contract the work required by these
bid documents, agrees to comply with the attached required Federal Contract Provision (Form
FHWA-1273) . /1
Signed
Title
Firm
Date
, John We
Vice President
Elecnor Belco Electric, Inc.
May 19, 2020
P-18 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
REQUIRED CONTRACT PROVISIONS
FEDERAL4 W CONSTRUCTION CONTRACTS
I. General
It Nondiscrimination
Ill. Nonsegregated Facilities
IV Davis-Sation and Related Ad Provisions
V. CortmctWork Hours and SatelySsndards Ad
Provisions
Vt. Subletting a Assigning the Contract
VII. Safety: Accident Prevention
MIL False Statements Concerning flghway Projects
IX. Implementation of peen AhrAct and Federal Water
Pollution Control Ad
X. Compliance with Govemmantwide Suspension and
DebarmentRegulremants
XI. Certification Regarding Use of Contract Funds for
Lobbying
ATTACHMENTS
A. Employment and Materials Pmfwmw for Appalachian
Development Highway System or Appalachian Local Access
Road Contacts {included in Appalachian contracts only)
I. GENERAL
1. Form FHWA•1273 nest be physically incorporated in each
construction cortradfunded underrrtla 23 (excluding
emergency contracts eddy Intended fordebds removal). The
Contractor (" subcontractor) must insert the form in each
subcontract and further moire its inclusion it all lower tier
subcontracts (excluding purchase orders, rental agreements
and other agmemerts for supplies orsemces).
The applicable requkemens of Farm FHWA-1273 am
Incorporated by reference forworkdone under any purchase
order, rental agreement oragmamenl f"other services. The
prime contractor shall be responsible for compliance by ary
subco nkacbr, lower4ler subcontract" "service provider.
Fam FH WA-1273 must be included In at Federal-eid design.
Wlid contracts, In of subcontracts, and in lower tier
subconiads(excludirg subcontracts for design services,
purchase orders, rental agreements and otheragreementsfor
supplies or services). The design -builder shag be responsible
for compliance by any subcontmdw, bwardiersubcorlracta
orservice provider.
Contracting agencies may reference Farm FHWA-1273 in bid
proposal or request for propose] documents, however, the
Form FHWA-1273 must be physically incorporated (not
referenced) In all contacts, subcontracts and laver-Oer
subcontracts (excluding purchase orders, rental agreements
and other agreements for supples or services related to a
construction contract).
2. Subject to the applicability aleda noted In the following
sections, these contract provisions shot apply b all work
performed on the contract by the contractors own organization
and with the assistance of workers under the contractor's
Immediate superintendence and to all walk performed on the
contract bypiwemrk, station work or by subco bect
FMA-1273 -- Revised May 1, 2012
3. A breach of any d the elipulaftf contained in these
Requked Contract Provisions maybe sufliiclert grounds for
wfialdilg of pmgess paymants, wilhhoking of fiat
Payment, tennnatlon of the contract, suspension Idebarment
or any other action dde"Ined to be appropriate by the
contracting agency and FHWA.
4. Selection of Labor. Dudng the pedomince d this contract
the codrectorshal I not use convict labor for any purpose
within the Wnds of a construction project on a Federal -aid
highway unless It Is labor performed by convicts who am on
parde, supervised release,"probation. The temp Faderai-aid
highway does not Include roadways functionally classified as
local mads a rural minor collectors.
The povisions of this section related to 23 CFR Part 230 are
applicable to al Fedaol-aid instruction contracts and to al
misled consimdbn mbcmbacts of 51QODo" more. The
povisbm of 23 CFR Pad 230 are rot applicable to materiel
supply. engineering, "architectural service contracts.
In addition, the contradw and al suboontmdws must comply
with the following policies. Executive Order 11246, 41 CFR 60,
29 CFR 1625-1627, Tile 23 USC Section 140, the
Rehabilitation Act of 1973, as amended (29 USC 794), Title VI
of the CM Rights Act of 1964, as amended, and related .
regulations Including 49 CFR Parts 21, 26 and 27; and 23 CFR
Parts 200. 230, and 633.
The contract"and all subconbadors mustoomply with: the
mqukemanls of the Equal O{porturly pause In 41 CFR 60-
1.4(b) and for al constriction cortmets emc dhg $10,000,
the Standard Federal Equal Employment Opportunity
Corsirudion Contact Spedtcalos in 41 CFR 60.4.3.
Note: The U.S. Department of tabor has exclusive authority to
delermine complance with Execut Order 11246 and Ire
policies of the Secretary of labor Including 41 CFR 60, and 29
CFR 1625-1627. The contracting agencyand the FHWAhave
the authority andthe responsibility b ensure carnplance with
Tile 23 USC Section 140, the Rehabilitation Act of 1973, as
amended (29 USC 794), and Title VI of the CINI Rights Ad d
1964, as amended, and related regulations including 49 CFR
Pas 21, 26 and 27; and 23 CFR Pads 2D0, 23D, and 633
The following pmvisim is adopted from 23 CFR 230, Append%
A, with appropriate revisions to conform to the U.S.
Department of Labor (US DOL) and FHWA requirements.
1. Equal Employment Equal employment
oppmtmity (EEO) requiemeds notto discriminate and to take
aS.mative action to assure equal opportunity as set forth
under Ism, executive orders, rates, regulations (26 CFR 35,
29 CFR 1630, 29 CFR 1625.1627.41 CFR60 and 49 CFR27)
and orders of the Secretary of labor as modified by the
Provisions prescribed herein, arid Imposed pursuant to 23
US.C. 140 shelf constitute the EEO and specific affirmative
aclon standards for the contractors project actkiles under
P-19 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
this contract. The provisions of it* Americans with Disabilities
Ad of 1990 (42 U.S.C. 121g1 at sail.) safforlh under 2$ CFR
35 and 29 CFR 1630 are incorporated by reference in this
contract. in the execution of this contract the contractor
agrees to comply with the falbw3ng mninum specdc
requirement actmt as of EEO.
a. The contmdorwl work with the contracting agency and
the Federal Government to ensure that it has made every
goodlaign effort toprovide equal opportunity with respect to all
of its locos and conditions of employment and in their review
of activities under the contract.
b. The contractor will accept as is operating poleythe
following statement:
It is the policy of this Company b assure that applicants
we employed, and that employees are treated during
employment, without rage to their race, religion, sax, color,
national origin, age a disablity. Such action shag Include:
employment, upgrading, demotion, or transfer, recruitment or
recrritrnentadvertfsing; layoff a termination; rates d pay or
other forms of compensation; and selection fa training,
including apprenticeship, pmsppmnWeshp, andloron4he.
job training.'
2. EEO Officer. The wntractorwill designate and make
known to the contracting offcas an EEO Officer who will have
the responsibility for and must be capable of effectively
administering and promoting an active EEO program and who
must be assigned adequate author ty and responsibly to do
SO.
3. Ol ssamination of Policy: AI members of the contractors
staff who am authorized to hin s, supervise, proma1e, and
discharge employees, a who recommendsuch action, or who
am substantially Involved in suchaction will be made fully
cognizant of, and will implement, the contractors EEO policy
and contractual responsibilities to provide EEO in each grade
and dassificagon of employment. To ensure that the above
agreanent will be met, the following actions will be taken as a
minimum
a. Periodic meetings of superviwry and personnel office
employees will be conducted before the start of work and then
rot less often than once every six months, at which lime the
contractors EEO policy and its implementation Will be
reviewed and explained. The meetings will be conducted by
the EEO Officer.
b. All new supervisory or personnel office employees will be
given a thorough indoctrination by the EEO Office, covering
all majoraspects of the contractors EEO obligations within
dudydays following the'rrepatng for duty with the contractor.
c. Al personnel who are engaged in direct recruitment for
the project wit be Instructed by the EEO Officer in the
cortracbr's pmoaclums for locating and hiring minorities and
women.
d. Notices and posters selling faith the contracct's EEO
policy will be placed in areas madly accessible to employees,
applicants fo r employment and potential employs".
e. The contractors EEO policy and the procedures to
Implement such policy wit be brought to the attention of
employees by means of meetings, employee handbooks, or
other appropriate means.
4. Recruitment When advertising for employees, the
conbacltt will include in al advertisements for employees the
notation: "An Equal Opportunity Employer' AI such
advemsornenB will be placed in publications having a large
cicalaion among minadfies and woman in the area from
which the prcjwtwork force would namlly be derived.
a. Thecontractorvrl,unlesspredudedbya"id
bargaining agreement. conduct systematic and direct
mcrutment through public and private employee referral
sources Ikey to yueldgmlifled mincriies and women. To
meet this requirement the contractor will identify wuroes of
potential mnonty, gap employees, and establish win such
identiled sources procedures whereby minority and women
applicants may be referred to the wntractorfor employment
consideration,
to In the event theconfractor has a valid bargaining
agreement providing (of exclusive hiring hall referrals, the
contractor is expected to abserve the previsions of that
agreement to the extent that the system meets the contractors
canplancewith EEOwntract pmvisors. Where
Implementation of such an agreement has the died of
discriminating against minorities orwomen, a obligates the
contractor to do the same, such Implamentalionviolales
Federal nondiscrimination provisions.
c. The contractorwil encourage its present employees to
refer minorlims and women as applicants fa employment.
Inbrmation and procedures with regard to referring such
applicants will be dmarssed with employees.
6. Parsorrnd Actions: Wages. working conditions, and
empbyee benefits shall be established and administered, and
personnel actions of every type, nduding tiring, upgrading
promotion, bans(', demotion, layoff, and termination shell be
taken without regard to race, cola, religion, sex, national
odgin,ageordsablly. Thefolowingtorocedunesshallbe
followed:
a The contractor wfl conduct periodic Inspections of project
sibs to nsum that waalrng conditions and employee facilities
do not indicate discriminatory treatment of project site
personnel.
to, The contractor will periodically evaluate the spread of
wages pad within each classification to determine any
evidence ofdisoini natory wage practices.
c. The contractor wif periodically neviewselected personnel
actions in depth to determine whether them is evkferceof
dlscrinination. Whom evidenceis found, the cohtraclorwill
prompty, take corrective action. If the review indicates that the
discrimination may extend beyond the actions reviewed, such
co ecltve action shal include all affected persons.
d. The contractor will promptly investigate all comgairls of
staged discrimination made to the contractor in connection
with is obligations under this contract, will attempt to resolve
such complaints, and will take appropriate corrective action
within a reasonable time. l the investigation indicates that the
discrimination may affectpersons of herthan the complainant,
such caredive action stet include such other persons. Upon
completion of each investigation the contractor will inform
every complainant of all of their avenues of appeal.
6. Training and Promotion:
a. Thecontradorwil assistinlowling, qumlfying, and
Increasing the skills of minorities and woman who am
P-20 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
applicants fa employment or anent employees. Such elons
should be amed at developingful journey lewd stabs
employees in the "a of trade a job classification involved.
b. Consistent with the contractor's work face requirements
and as permissible under Federal and State regulations, she
contractor shall make full use of Ira" programs. I.e.,
apprenticeship, and on-11he4orb training programs for the
geographical area of contract performance. In the event a
special provWon for training is provided under this contract,
this subparagraph will be superseded as indicated in the
special provision. The contracting agency mayreserve
traintg positions for persons who receive welfare assistance
in accordance with 23 U.S.C. 140(a),
c. The contractor wiladvise enployaes and applicants for
ecpiuyment of available training programs and entrance
reguimmenls foreach.
d The contactor will periodicalyreview the training and
promotion potential of employees who are minorities and
women and will encourage eligible employees to apply for
such training and promotion.
7. Unions lithe contractor relies in whale of in pan upon
unions as a source of employees, the contractor will use good
faith efforts to obtain the cooperation of such unions to
increase opportunities for minorities and woman Actions by
the contactor, either directly a trough a contredoes
association acting as agent, will include the procedures set
forth below:
a The contractor will use good faith Worts to develop, in
cooperation with the unions, Joint training programs aimed
toward qualifying more miwdties and women for membership
in tre unions and increasing the shills of minorities and women
so thal they may qualify for higher paying employment.
b. The baltraclorwht use good kith efforts loincorpaate an
EEO douse into each union agreement to the and that such
union will be contractually band to rcter applicants without
rapid to their race, Dolor, religion, sex, national origin, age or
disability.
c. The contractor is to obtain information as to the referral
practices and policies of the labor union except that to the
extent such information is within the exclusive possession of
she laborun»on and such labor union refuses to furnish such
information to the contractor, she contractor ahel So car* to
she canbading agency and shal sal faith whet atforts hewer
been made to obtain such infonmation
d In the event the union is unable to provide the contractor
with a masonable low of referrals within the time Imit set forth
in dhe collective bargaining agreement the corlrador will,
though independent recruitment efforts, fir the employment
vacancies without regard to race, cdor, religion, sex, national
origin, age of disability. making full effals to obtain 4haified
and/or qualiroble mihorises and women. The faium d a union
to provide sufficient referrals (even though it is ci frgated to
provide exclusive referrals under the terms of a collective
bargaining agreement) does not relieve the contractor from the
regJiemeds olthis paragraph. In the evert the union referral
practice prowls the contractor from meeting the oblgations
pursuant b Exewtive Order 11246. as amended, and these
special provfsims, such eontrada shall immediately rotly the
contracting agency.
IL Reasonable Accommodation for Applicants t
Employees with Disabilities: The contractor must be farm err
with the requirements for and campy with the Americans with
Disabilities Act and as rules and regulations established there
under. Errybyersmust provide reasonable accommodation in
at employment activities unless to do so would cause an
undue hardship.
9. Selection of Subcontractons,Pfocurament of Materials
and Leasing of Equipment: The contractorshall not
discriminate on the gmunds of fees, cdor, religion, sex,
nalionalodgrt age ordaabitdy in he selected and retention
of subcontractors, including procurement ofmaterials and
lease4 d equipment. The Contraeler that fake all necessary
and reasonable steps to ensure nordisainirmhon in the
administration d this contract.
a. The contractor shall nosy allpotential subcodractorsand
suppliers andlessom of their EEO obligations under this
contract.
It. The contractor will use good faith efforts to ensure
suboontractorci mpsance with their EEO obligations.
10. Assurance Required by 49 CFR 26.13(by.
a The requirements of 49 CFR Part 26 and the State
DOf's US DOT,appraed DBE program am incorporated by
referent.
b. The contractororsubmntractorshall not dnxoirrirete on
the bass d race, color, national origin or sex in the
performance of this contract. The contractor sell carry out
applicable requirements of 49 CFR Part 26 in the award and
administration dDOTassisled contracts. Failure by the
contractorloeany out these requirements is a material breach
of this contract, which prey resua in the terminason of this
contract or such other remedy as the contracting agency
deems appropriate
it. Records and Reports: The contractor shall keep such
records as necessaiyto dacumem cenpsancs with the EEO
requirements. Such records shall be retained fora period of
three years fc lowing the date of the foal payment to the
contractor for at contract work and shel be available at
reasonable lines and places for inspection by authorized
representatves of the redtactig agency and the FIAVA
a. The records kept by the contractor shall dxxtmonl the
folowfng:
(1) The number and work tours of minority and non -
minority group members and women employed in each work
dasslcation on the project
(2) The progress and efforts being made in cooperation
wile unions, wired applicable, to increase employment
opport nd es fa minorities and women; and
(3) The progress and efforts being made in locating hiring,
training, qualifying, and upgrading minorities and wanes
h The contractors and subcontractorswtl submit "annual
report to the contracting agency each July for the duration of
the project, Indicating the number of dinorfty, women, and
nonminonty gmup employees currently engaged in each work
dassyncabon required by the contend work. The inormation a
to be reported on Form FHWA-1391. The staling data should
represent the project work face on board in all many part of
the last payroll period preceding IM and o(July. If onths4ob
training is being required by special provision, the contractor
P-21 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
VA be required n collect and mpori training data. The
employment data should reflect he work farce on board during
at or any pat of the last paymd period precedig the end of
July.
IN. NONSEGREGATED FACILITIES
This prmvWm is applicable to el Federal -aid construction
contracts and to an related ounsbuctionsubcocractsof
$10,000 or more.
The contractor must insure that fad Mies provided lor
employees are provided in wcb a manner that segregation on
he basis of mce, color, m➢gien, sex, or national origin cannot
resin. The contractor may nether require such segregated
use by written or oral policies nor tolerate such use by
employee custom The cantmcofs obligation extends further
to ensure that its employees are not assigned to perform their
services at any location, under the contractor's control, where
thefad'iies are segregated. The ten 'fadMles' includes
waiting nonce, work areas, restaurants and other using areas,
lime clocks, resbooms, washrooms, locker roams, and other
storage or dressing areas, parking lots, drinking fomtans.
recreation or entertainment areas, transportation, and housing
provided for employees. The contractor shell provide separate
orsingle-user mshooms and necessary dressing a sleeping
areas loassum privacy between sexes.
IV. DAVIS-DACON AND RELATED ACT PROVISIONS
Thffi section is oppgcade to at Fedam4ed construction
projects exceeding $2,000 and to at related subcontracts and
lower-tiersubconlmcts(regardlossofsubcontract size). The
requirements apply to a projects located within the dgh4d.
vary of roadway that is funclmaly classified as Federal -aid
highway. This excludes roadways functionally classified as
local mad$ or rural minorco➢eclors, which are exempt.
Contracting agencies may elect to apply these requirements to
other projects.
The following provisions are from he U.S. Deportnent of
Labor regulations 11129 CFR 6.5 tontaet can ivls(ms and
related matters' with minor revisions le eonformto the FIiWA-
1273 formal and FHWA program requirements.
1. Minimum wages
a. AM laborers and mechanics employed or working upon
the site of the work wil be paid unconditionally and not less
often than once a week, and without subsequent deduction or
rebate on any account (except such payroll deductions as am
pernitted by regulations issued by the Secretary of Label
under the Copeland Ad (29 CFR pail 3)), the full amount of
wages and bona We fringe benefits (or cash equivalents
thereof) due at time of payment computed at miss not less
than those contained in the wage determnitim of he
Secretary of Labor which is attached hereto and made a part
fiereof, regardless of any contractual relationship which may
be alleged to exist between the contractor and such laborers
and mechanics.
Contributions made or costs reasonably anticipated for bona
fde fringe benefits under section 1(b)(2) of the Davis -Bacon
Act on behalf of laborers wmechanics am considered wages
paid to such laborers a mechanics, subject to he provisions
of paragraph 1.d. of this secliorx also, regular contributions
made orcosts incurred for more than a meldy period (but not
Ism often than quarlary) under plans, funds, or programs
which cover the particular moldy period, are deemed to be
constructively made orircurred during such weekly period.
Such labomm and mechanics shag be paid the appropriate
wage rate and fringe benefits on the wage determination for
he dassihicafwn of work actually performed, w ODul regard to
skill, except as provided in 29 CFR 5.5(ax4). Laborers or
mechanics performing work in more rian one classification
may be compensated at he rate specified for each
classification for the time actually worked thamin: Provided,
That the employa's payroll records accurately sot forth he
time spent in each dassiication lnwhidn work is parfonned.
The wage daterninalion pnduding any additional classification
and wage rates conformed under pamgraph 1.b. of this
saet'on)and the Davis -Eaton poster (WH-1321) shag be
posted at at lines by the contractor and its subcontracbrs at
the silo of the walk in a prominent and accessible place where
4 can be easily seen by the workers,
b.(1) The contracting oficer shot require that any class of
labomm or mectimim ind Wing hdpers, which is not fisledin
Ifie wage determination and which is to be employed under he
contract shag be classified in conformance with the wage
determination. The contracting oficer shag approve an
additional classification and wage mle and fringe benefits
therefore only when the following criteria have been met:
p) The work to be performed by the ctassificaim
requested is not performed by a classifcation in the wage
detemmnation: and
(i) The classification is utRzed in he area by the
construction ndusby, and
(III) The proposed wage rate, inducing any bona fide
fringe benells, beam reasonable relationship to the
wage rates contained in the wage determination
(2) If the contractor and the laborers and mechanics to be
employed in the classification (t known), or their
representatives, and he contracting officer agree on he
dassifk:abon and wag role (ndu ding the amount
designated for fringe benefits where appropriate), a report of
he action taken stag be sent by he corimdig officer to the
Administrator of the Wage and HourOrvision, Employment
Standards Adniustmtion, U.S. Department of Labor,
Washington, DC 2021Q The Administrator, oran adhorized
representative, will approve, mody. or disapprove every
additional classification action within 30 days of recept and
so advise the contracting officer or wit notify the contracting
officer within he 30-day period that additional lime is
necessary.
(3) In the event the contractor, the laborers or mechanics
to be employed in the classification or their representatives,
and the contracting of icer do not agree on he Proposed
clawdication and wage role (including the amount
designated for fringe benefits, whom appropriate), he
contracting office shag refer the questions, including he
views of all interested parties and he mcommendatlon of the
contracting officer, to the Wage and Hour Adm'idsimbr for
determination. The Wage and flourAdmnistmlor, a an
ouhonzed representative, YA lssue a defern'ndton within
30 days of receipt and so advise the contracting dicer or
P-22 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
will notify the cortracting officer within fee 36day period that
additional time Is necessary.
(4)The wage into (including fringe benefits whore
appropriate) determined pursuant b paragraphs 1.b.(2) or
1 A(3) of this section, shall I be paid to all workers performing
work h the classification under this contract from the first
day on which work is performed in the classification.
c. Whenever the minimum wage rate prescribed in the
contract fora class of laborers or mectrrnics Includes a fringe
benefitwhtch is not expressed as an hourly rate, the contactor
shall either pay the benefit as sided in iota wage determination
or shall pay another bona fide fringe benefit or an lroudy cash
equivalent thereof.
d If the contractor does not make paymenisto a trustee or
Otherthird persorr, the contractor maycoastder as part of the
wages of any laborer ormedhanic the amount of any costs
reasonably anticipated in providing bona fide fringe benefds
under plan or program, Provided, That the Secretary of
Labor has found, upon Ire written request of the contractor,
that the applicable standards of the DavisBac on Act havo
bem cod. The Secretary of Labor may require the contactor
to set aside in a separate account assets for the meeting of
obligations under the pan or program.
2. Withholding
The contracting agency she upon its own action or upon
written request of an authorized representative of the
Departahenl of Labor, withhold "cause labs withheld from
the contractor under this contact, a any other Federal
contact with the same prkne contract", orary other federally•
assisted contract subject to Davis Bacon prevailing wage
requirements, whkh is held by the same prime ountractor, se
much of the accrued payments or advances as may be
considered necessary to pay laborers and mechanics,
including apprentices, panes, and helpers, employed by the
contractor or my subcontractor the full amount of wages
required by the contract in the event of failum to pay my
laborer or mechanic, including any apprentice, bakiee, of
helper, employed or walking on the site d the work, all or pan
of the wages required by the contract, the contracting agency
may, aterwrUlen notice to the contractor, take such action as
may be necessary b cause the suspension of any further
payment, advance, or guarantee of funds unti such vidatiors
havecemed.
3. Payrolls and basic records
a Payrolls and bask records relating thereto steal be
maintained by the contractor during the course of the work and
preserved for a period of three yeas thereafter for all laborers
and mechanics woddng at the she of the work. Such records
shall canton the name, address, and social security number of
eachsuch worker, his or her coaedclassifrcaton, hourly miss
of wages paid (including miss d contributions or costs
anticipated for bona fide fringe benefits "cash equivalents
thereof of the types described in section 1(bx2)(B) of the
Davis-BaconAcl), daily and weekly numberof hours waked,
deductknsmade and actual wages pad Whenever the
Secretory of Labor has found under 29 CFR 5.5(axf J(iv) that
the wages of any laborer or mechanic include the amount of
any costs reasonably anticipated in providing benefits under a
plan or program described in section 1(b(2)(B) of tie Davin
Bacon Act. be contractor she maintain rowrds which stow
that the commitment to povkla such bmefls is enforceable,
that the plan or program is Inandaily responsible, and that the
plan m program has been communicated In writing to the
laborers or mechanics affected, and records which show the
oasis anticipated or the actual cost inaned In providing such
benefits. Contractors amploydng apprentices or bameas under
approved programs shall maintain written evidence of the
registration of appmnfeeship programs and cedlflcation of
trainee programs, the registration of the apprentices and
trainees, and the miles and wage rates pmscrbed In the
applicable programs.
le(1)The contactor shag submit weekly for each weak in
which any contract work is performed a copy of all payroll to
the contracting agency. The payrolls sutmlledshal set out
accurately and completely al d the Information required to be
maintained under 29 CFR 5.5(ax3XI), exceptthal full social
security numbers and homeadd'esses shall not be included
in weekly Individually
Inetoad the Payrolls seal any need 10
include an kndividualy Identifying number for each employee
e.g. , the last four digits of the enpioyee's soda security
number). The required weekly payroll Information may be
submited in any form dasked. Optional Form WH 347 is
avallable for this puposefram the Wage and Hour Division
Web site at ht4rMvww.dd.gwksa%vtdtfoamsfwtn3471neU.hln
or its successor site. The prime coniracbr is responsible far
the submission of copies of payrolls by al shbcmtactors.
Contractors and subcontractors shall maintain the full social
security number and current address of each covered worker,
and sfial provide them upon request to the contracting agency
for tansmission to the Stale DOT, the FHWA mthe Wage and
Hour Division of the Department of Labor for purposes of an
Investigation or audit of compliance w➢h prevaNrg wage
requirements. It is net a violation of this sacfon for a prime
contractor to require a subcontractor b provide addresses and
soda securitynumbers lots pine contractor far its worn
records, without weekly submission to the contending agency..
(2) Each payroll submhlted shag be accompanied by a
'Statement d Compllarim' signed by the contractor or
subcontractor or his or her agent who pays or supervises the
payment of the persons employed under the contract and shall
cedify the following:
(I) That the payroll for the payroll period contains the
Information required to be provided under §5.5 (ax3)(t) of
Regulations, 29 CFR pat 5, the appropriate Information Is
being mantained under §5.5 (a)(3)(l) of Regulations, 29
CFR part 5, and that such Information Is oared and
complete:
(I) That each laborer or mach ic{Including each
helper, apprentice, and trainee) errybyed m the contract
during the payroll period has been paid the full weekd
wages eamed without rebate, either directly orindtrectly,
and Ind ro deductions have been made ether directly or
indirectly from the ful wages earned, other than
permissible deductions as set faith in Regulations, 29 GFR
pad 3;
(li) That each laborer or mechanic has bem paid not
less than the appileablewage rates and fringe benefits or
cash equivalents for the classification d wok performed,
as specified In the applicable wage delennination
Incorporated into Ire contact.
P-23 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
(3) The weekly submission of a property executed
cortdlcalion set forth on the reverse sideof Optional Form
WIi-347 shelf satisfy the mitukement fasr6missim of the
'Statenert of Compliance required by paragraph 3.b,(2) of
this section.
(4) Thefalsification of any of the above certifications may
subject the cmtrador or subcontractor to civil orcriminal
prosec rtionundersectian 1001 of title 18 and section 231 of
tills 31 of fie United Stales Coda.
c. The contractor a subcontractor shall make the records
required under paragraph 3.a. ofthis section available for
inspect -ion, copying, ortramci ption by authorized
representatives of the contracting agency, the Stale DOT, the
FNMA, or the Department of Labor, and $half permit such
representatives to interview, employees during waking hours
on the job. If fie contractor or subcontractor fails to submit the
required records orb make then available, to FHWAmay,
after written notice to the contractor, the contracting agency or
the State DOT, take such action as may be necessary to
curse the suspension of any fatter payment advance, a
guarantee of funds. Furthermore, failure to submit the required
records upon request or to make such records available may
be grounds for debammenl action pursuant to 29 CFR 5. 12.
4. Apprentices and trainees
a. Apprentices (program U the USDOL).
Apprentices will be permitted to wok at less than the
predetermined rate for the work hey performed when they as
employed pursuant to and Individually registered in a bore fide
apprenticeship program registered with the U.S. Department of
Labor, Employment and Training Administralort Office of
Apprmloestip Training, Employer and Labor Services, awth
a State Apprenticeship Agenoyrecognized by the Office, orif a
person is employed In his a her first 90 days of pobalion rry
employment as an apprertice In such an apprenticeship
program, who Is not hdvidual%registereditn the program, but
who has bean cedfie l by the fficeof ApprenticesHp
Tralnhhg, Employer and Labor Services or a State
Apprenticeship Agency (where appropriate) to be eligible for
probationary erploynent as an apprentice.
The alowablo ratio of apprentices to journeymen of the job
site in any eat classification shell not be greater that the ratio
permitted to the contractor as to the enilre wok face viler
the registered program Any worker fisted on a payroll at an
apprentice wage mte, who is not registered or otherwise
employed as staled above, shelf be paid not loss hen the
applicable wage rate on the wage determination for the
classfcalon o(wode ahoy performed. In addition, any
appmrtice performing wads on the job site in ehcess of the
ratio permitted under the registered program shell be pad not
loss than the applicable wage rate on the wage demorninaton
for the work aclualfy, performed Whom a contractor is
pefurmag cmetnlcUM on apmjed h e locally otter than
flat In which its program is registered, the rates and "go
rates (a+pressed In percentages of the joumeyrron's teurty,
rate) spelled in the corirador's or abcontractofs registered
program shelf be dbwrrved,
Every apprentice rural be paid at not less than the rate
spaded In the registered program for he apprembe's love] of
Progress, expressed as a percentage of the journeymen homy
rate specified in the apptc able wage delamiinatbn.
Apprentices shall be paid fringe benefits in accordance with
the provisions of the apprenticeship program If the
apprenticeship program does not specify fringe bonalits,
apprentices must be paid the full amount of gringo benefits
Iistod on the wage determination for to applicabto
dassfcr tm If the Adrninistrala determines that a different
practice prevails for the applicable apprentice classification,
binges shot be paid in accordance with that determination,
In the eveatlho Office of Apprenticeship Training Employer
and Labor Services, or a Stale Apprenticeship Agency
reoogn¢edby the office, withdraws approval of an
apprentice" program, the contractor wlI no longer to e
permitted to ultiae apprentices at less the nthe appficade
prodeiemired rate for the work performed until an acceptable
program Is atpfwod.
b. Trainees (programs of the USDOL)
Except as provided in 29 C FR 5.16, trainees will not be
permitted o wak at less than the predslarnined rate for the
work performed unless they are employed pursuant to and
individually registered in a program which has received prior
approval, evidenced by formal certification by the U.S.
Depormentof tabor, Employment and Training
Administration.
The ratio of trainees to journeyman on the job site "]not be
greater than permitted uMerthe plan approved by the
Employmenland Training Admhistrmton
Every trainee nest be paid at net less than the rate specified
In he approved program fa the trainee's lavell ofprogress,
expressedas a percentage Ofthojourrsyman hourly rate
specified in the applicable wage determination. Trainees shall
be paid singe benefits in accordance win the prabions of the
trainee program, If the trainee program does not merlon
fdnge benefits, trainees stag be pad the fit amoumtof (rigs
benefits (sled on the wage dolemninaton urioss the
Administrator of he Wage and Hour Division determines that
them is an apprenticeship program associated with the
caesponding )oumeyman wogs rate an the wage
determination which provides ter less than hill !rage benefits
for apprentices. Any employee listed on the payroll ale traroe
rate who Is not registered and participating in a tmlrft plan
approved by the Employment and Training Administration shot
be paid not lass than the applicable wage rate on the wage
determination for the classification of work actually performed.
In addition, any Wines pedorrming work ah he job site 1n
excess of to ratio permitted under the registered program
shelf be paid net less than tie applicable wage rate m the
wage determination for the wok actually performed.
In the event the Employment and Training Adminisaa/on
wilhdraws approval of (mining program, the contractor" no
longer be pemutted to uUbe trainees at loss than the
applicable predetermined rate for the work performed will an
acceptable program is approved.
c. Equal employment oppodWy. The tt67ation of
apprentices, trainees aid )ovreymen under fib pat stet be
in conformity with the equal employment opportunity
mqui ame its of Execttive Order 11246, ss amended, and 29
CFR part 30.
P-24 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
d. Apprentces and Trainees (programs of the U.S. DDT).
Apprentices and trainees wafting under apprenticeship and
sill training programs which have been cert]ed by he
Secretary or Transportation as promoting EEO in correction
with Federal -aid highway construction programs are not
subject to the requirements of paragraph 4 of this Section N.
The stmight time hourly wage fates for apprentices and
trainees under such programs will be established by the
particular programs. The ratio dapprentices and trainees to
journeymen she] not be greater ton permitted by the teams of
the particular pmgmm.
S. Compliance with Copeland Act requirements. The
contractorsha0 comply with the requirements of 29 CFR pad
3, which are Incorporated by reference in this cortmct
&Subcontracts. The coriractororsuhmntracta shaildnsen
Form FHWA-1273 in any subcontracts and also require the
subcontractors to include Form FHWA-1273 in mylower ter
subcontracts. The prime contractor shall be responsible for the
compliance by any subcontractor a lower gar subcontractor
with all the contract douses In 29 CFR 65.
7.Contractlennlna6cn:dobarmont Abreschofhe
corlrad douses in 29 CFR 5.5 maybe grounds for termination
of the contract and for debarment as a contractor and a
subcontractor as provided In 29 CFR 5.12.
8. Compliance with Davis -bacon and Related Act
require mords At rulings and Interpretations of the Davis.
6awn and Related Ads contained in 29 CFR pans 1, 3, and 5
are herein Incorporated by reference in this contract
9. Disputes concerning labor standards. Disputes adsrg
cut of the labor standards prwslons of the contract shal not
besubject to the genemi capdes dause of 9uscortract. Such
disputes shall be resolved in accordance with he procedures
of the Department of Labor set lath in 29 CFR parts 5, 6, and
7. Disputes within the meaning of this clause Include disputes
between the contractor (a any of its subcontractors) and the
contacting agency, the U.S. Department of Labor, athe
enpbyees or their representatives.
10. Cort19callm of eligibility.
a By entering Into this contend, the contmdorcortirms that
neither it (nor he or she) nor ary person or firm who has an
Interest in he contractors farm is a person or Firm Ineligibhe to
be awarded Goverment contracts by virtue of section 3(a) o1
live Davis -Bean Act or 29 CFR 5.12(aXl).
b. No pad ofths contract shag be subcontracted to any person
organ ineligible for award of a Goverrmantcontmd by virtue
of section 3(a) of theDavis-Bacon Act or 29 CFR 5.12(a)(1).
c. The penalty for mailing false statements is prescribed in the
U.S. Criminal Code, 18 U.S.C. 1001,
V. CONTRACTWORK HOURS AND SAFETY
STANDARDS ACT
The following clauses apply to any Fedaal-aid construction
contract In an amount in excess of 5700,000 and shib)ect to the
overtime provisions of the Contract Work Hours and Safety
Standards Act These clauses shall be kusented in addition to
the douses required by 29 CFR 5.5(a) a 29 CFR 4$ As
used Infhts paragraph, the terns laborers and mecMrncs
include watchman and guards.
1.0vortimorequlremoms. Nocontractororsubconhada
contending for any pad of he contact work which may require
or involve the employmert of laborers or mechanics shed]
require or pean8 my such laborer or mochadc In any
workweek in which he or ate Is employed on such work to
work In excess of forty tours in such wadowak uriess such
laborer of mechanic receives compensation at a mfo not less
than one and onahalf tines the basic rate of pay for all haws
waked in excess of forty ham in such wodmoek.
2. Violation, liability for unpodd wagon liquidated
damages. In he event of any violation of the dause set forth
in paragraph (1.)of this section, he comractorand any
submNmctor rmponskie themfor shad be gable fathe
unpaid wages. In addfon, such contmcta and subcodmolm
shall be liable to the Linked Stales (n the case of work done
under contract for the District of Columbia at a territory, to such
District or to such territory), for liquidated damages. Such
liquidated damages shag be computed with respect to each
Individual laborer or mechanic, including watchman and
guards, employed In violation of the clause set forth in
paragraph (1.) of this section, in the sum of S10 for each
calendar day an which such individual was required or
permitted to work in excess of the standard m*week of bay
hours without payment of the overfina wages required by the
deice set forth in paragraph (1.) of this section.
3. Withhok9 rig for unpaid wages and Iquidated damages.
The FHWA a the cortacting agency shelf rpm It awn action
or upon written request of an authorized representative of the
Department of Labor wifmokl acause to be withheld, from
any moneys payable on account of wok pafamed by the
cortractoror subcontractor under and such contract or any
other Federal contract with fine same prime contractor, or any
other fedemlfy-assslad contract subject to the Corlied Work
Fours and Safety Standards Ad, winch Is had by the same
prime contractor, such suns as may be detennned to be
necessary to satisfy any liabilities of such contractor a
subcontractor fa unpaid wages and liquidated damages as
provided In he clause set bath in paragraph (2.) of this
section.
4.6ulocmtracts. The cmtmctor or subcontractor shag insert
in mysubcontactstheciausm set fah in pemgmph (1.)
through (4.) of this section and also a clause requiring the
aubcontmctors to include these clauses in any lower flor
subcantrects. The prime contractor shall be responsible for
conp0arce by any subcontractor orlower la subcontractor
with the clauses setfmh in paragraphs (t.) through (4.) of this
section.
P-25 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
VI. SUBLETTING OR ASSIGNING THE CONTRACT
This provision is applicable to at Faderal-aid construction
cortracts on this Nalioral Highway System,
1. The contractor she] perfomi with its own organization
contract work amounting b not loss than 30 percent (or a
greater percentage A specified elsewhere In the contract) of
the total original contract price, excluding any specialty items
designated by the contracting agency. Specialty items may be
pwil rmsd by subcontract and the amount of cry such
specialty items performed may be deducted from the total
original contract price before conpuing the amount ofwork
required to be performed by the contractors awn organization
(23 CFR 635.116).
a. The term peffarm wOhk wi0h its arm organlzatiorr refire
to workers employed or based by he prime contractor, and
ogLip mart owned or rented by Ire prime contractor, with or
wilhautaparators. Such term does not include employees or
equipment d a suboontmcbror lower Oersuboonhactor,
agents of the prime contractor, or any other assignees. The
term my induct psymeris far the costs of hiring Wand
employees from an employee leasing form mealing all relevant
Federal and State regulatory requirements. Leased
employees may only, be included in this tam if he prime
contractor meats all of the fogowing conditions:
(1)theprime contradormaintalre control overthe
supervision of the day -today activities of the leased
employees;
(2) the prime contractor remains responsible for the quality
of the work of the leased employees;
(3) the prime contractor retains as power b accept or
exclude Individual employees from work on the project; and
(4) if* prime contractor remains ultimately responsible for
the payment of predetermined minimum wages, the
submission of payrolls, slatemants of compliance and all
other Federal regulatory regulmmant&
b.'Spaciatly dome shall becorstrued to be halted to work
That requires highly specialized knowledge, aHlities, or
equipment not ordnarly available in the type of contracting
organizations qualified and expected to bid or prapossonlhe
contract as s wNdk+and in general am to be Ilnlad to minor
components of the ovemll contract.
2. The contract amount upon which the requirements set ford
In pamgmph (1) of Section VI is computed Includes he cast of
material and manufactured products which are to be
purchased or produced by the contractor underthe contract
provisions.
3. The contractorshal furnish (a) a competent superintendent
or supervisor who is employed by fie firm, has fug authority to
direct performance of the work in accordace wife he contract
requirements, and is in large of all construction operations
(regardless of who pedorms the work) and (b) such other of it
worn organizational resoumes (supervision, management, and
engineering services) as the contracting officer determines is
necessay, to assure he performance ofthe contract
4, No portion of the contract shag be srblet, assigned a
otherwise disposed of eocapt with to written consent of the
coAracft officer. or sufdrized representative, ad such
consent when given site" not be construed to relieve he
contractor of any responsibility for the fulgtiment of he
contract Written consent will be given only after the
contracting agency has assured fiat each subcontract Is
evidenced in writing and that it oamams all pertinent provisions
and rewimments of Ire prime contract.
5. The 30% self -performance requirement of paragraph (1) Is
not applicable to design-buld contracts; however, contracting
agencies may establish their own seH-perormance
requirements.
VA. SAFETY: ACCIDENT PREVENTION
This provision is applicable toall Fedaralke d
croslruction contracts and In at related subcontracts.
1. In the porormance d ttiscontract the cortracta shell
comply with all applicable Federal, Stale, and local laws
governing safety, health, and sanitation (23 CFR 635). The
contractor shall provide an safeguards, safetydevicas and
protective equipment a nd take anyolher needed actions as it
datarmnes, or as the contracting of iGer may debmrine, to be
reasonably necessary to proled the fire and health of
employees on the job and the safely of the public and to
protect property in conmclim with the pabrmance of fie
work covered by he contract
2, it is a condition of this contract, and shay be made
condAlan of each subcontract, which he contractor orders into
pursuant to his cairact, that the contractor and any
subcontractor shag nil permit any employee, in performance
of the contract to work In surroundings or under conditions
which we unsanitary, hazardous or dangerous to hisfher
health or safety, as determined underconsbucilon safety and
health standards (29 CFR 1926)promulgated by the Secretary
of Labor, in accordance with Section 107 of the Contract Work
Fours and Safety Standards Act (40 U.S.C. 3704}
3, Pursuant to 29 CFR 19263, it Is a corndtion of this contract
that the Secretaryof Labor or authorized representative
thereof, shag lave right of entry to my sate of contract
parlor mance to inspector investigate the matter of compliance
with the construction safely and heath standards and to carry
out gar duties of he Secretary most Secgon 107 of the
Contract Work Hours and Safety Stands ds Act(40
U.S.C.3704).
VIA. FALSE STATEMENTS CONCERNING HIGHWAY
PROJECTS
T h i s p r o v I s i o n i s applicable to all Faderal•ad
construction contracts and to all related subcontracts.
In orderto assure high quality and durable construction in
conformity with approved plans and specifications and ahigh
degree of reliability on statements and represmtagors made
by engineers, contractors, suppliers, and workers on Federal.
ad highway protects, It is essential that at personsooncemed
with the project perform their functions as carefully, thoroughly,
and honestly as possible. Wilful falsification, distortion, or
misrepresentation with respect In any facts related to the
project is a violation of Federal law. To prevent any
misunderstanding regarding he seriousness of these and
similar acts, Farm FHWA-1022 shag be posted on each
Federabaid highway proect (23CFR 635)in am ormo s
places where it Is madly available to at poisons coneerrod
with the project
16 U.S.C. 1020 reads as folaws:
P-26 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
"Whoever, being an officer, agent, aemployee of the Urited
States, or of any State or Territory, a whoever, whether a
person, association. In. orcorponat on, knowkgty makes any
false statement, false representation, "false report as to the
character, quality. quantity, or cost o the material used a to
be used, or the quantity or qua8yof thework performed or to
be pefored, or be cost thereof in conredion with the
silxn'sslon of plans, maps, specifications, contacts, or costs
of earxilmdion on any highway or mlaled pro)ecl submitted for
approval to he Secretary of Transportation: or
Whoever knowngy makes any false statement. false
representation, false report or false dam with reaped to the
chamder, quality, it entily, err cost of any work performed a to
to performed, or materials furnished or to be furnished, in
connection with the corehs:tion of any highway or related
prejad approved by the Secretary of Transportation; a
Whoever knowingly makes any false slaiamenl afalse
repiesentatlon as to maleral fad in any statement, cerfficate,
or ration submitted pursuant to provision of the Federdaid
Roads Ad approved July 1, 1916, (39 Slat. 355� as amended
and supplemented;
Shari be fined under this OW aimprisoned not more ban 5
years or bah.'
IX. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL
WATER POLLUTION CONTROL ACT
This provision is applicable to all Federal -aid construction
contracts and b all related subcontracts.
By submission of this bWiereposal or he execution of this
contract or subcontract, as appropriate, the bidder, proposer
Federal -aid construction corhuactor, or subcontractor, m
apprapnate, will be deemed to have stipulated as follows
1. Than any person who is or will be utilized in the
performance of In* contract is not prohibited from mceiong an
award due to a violation of Setlon 5D8 of he Clean Water Ad
or Section 306 of he Clean Air Ad.
2. That he contractor agrees to include or cause to be
included the requirements of paragraph (1) of this Section X in
every sulacontrad, and further agrees to take such action as
he contracting agency may direct as a means of enforcing
such requirements.
X.CERTIFICATION REGARDING DEBARMENT,
SUSPENSION, INELIGIBILITY AND VOLUNTARY
EXCLUSION
This provision is applicable to as Federal aid construction
contends, design -build contracts, subcontracts, lowerntier
subcontracts. purchase orders, dace agreements, consultant
contracts or any other covered laeacfon requiring FHWA
approval a that is eslimatedto coal $25,000 or more — as
defined h 2 CFR Pads 180and 1200.
1. Instructions fa Certi ication —First Tier Participants:
a By signing and submitting this proposal, the prospective
first tierparticipars is providing the certification set out below.
b. The inability of a person In provide fro centTmcaem set out
below will net necessarly result in denial of participation in this
covered Varmaction. The prospective first tiff participant shag
submit an explanation of why it cannot provide the certFication
set oil below. The certification or explanafon will be
considered in connection with the department oragencys
determination whether to enter into this transaction. However,
failure of the prospective first her tatlicipant b furnish a
certification or an explanation shall disqualify awh a person
from participation in this transaction.
e. The certification in this dance is a matedalrepresedation
d fad upon which reliance was placed when the contracting
agarcy determined to enter into his transaction. If it is later
determined that be prospective participant knowingly rendered
an emmierius certification, in addAion b other remedies
available to be Federal Govermnent, he contracting agency
may terminate this transaction for cause of default
d. The prospective first tier Participant shall provide
immediate written notice to the contracting agency to whom
this proposal is submitted if any time the prospective first tier
paniripant looms that ils certification was erroncous when
submitted or has become erroneons by mason of changed
circumstances.
e. The tam;'covered traeadiaL"debarred,`
'smpendetl"indigt*,""padicipad,"persal' 'principal,'
and -voluntarily excluded,' as used in this clause, am defned
in 2 CFR Parts 180 and 120D. 'Find Tier Covered
Tennsactlons'ralen to any covered transaction between a
grantee a subgrantee of Federal funds and a participant (such
as fie prme or general contrite. 'Lower Tier Covead
Transedlorn refers to arrycovered transaction under a First
Tier Covered Transaction (such all subeorarads). 'Fist Tier
PaNcpanY refers to the participant who has entered into a
covered transaction wih agrant" or subgrantee of Federal
funds (such as the prime or general catiractor). "Laver Tier
ParfcparI* min any participant wild has entered Mo a
covered transaction will) a First Tier Participant or other Lower
T iar Participants (such as subcontractors and stppiers).
f. The prospective first fie participant agrees by submitting
this proposal that. should the proposed covered transaction be
entered into. it 9nati not knowingly anlor kilo any tower her
covered transaction wlb a person who is debarred,
suspended, declared iridgbte, or vofun adly exluded Ian
participation in this covemd transaction, udess authorized by
the deparlment or agency entering into this transaction
g. The prospective fret tier participant further agrees by
sulbrrttiing this proposal that it will include the clause tiled
'Certification Regarding Deleamient. Suspension, Ineligibility
and Voluntary FxctusbnLower Tier Covered Tmnsadims,"
provided by the department a contracting agency, entering
into this covered transaction, withal modification, in all lower
tier covered transactions and in all sdidla8ors for lower tier
covered Van sacforx exceeding the E25.000 Brres od.
h. A participant in a covered transaction may rely µnon a
certiicatbn of a prospective, partiipard in a lower tier covered
tmnsacfen bat is net debarred, suspended. ineligible, or
voluntarily occluded from the covered transactlort unless it
knows that lhecertificafon is erraeous. Aperfiipantis
responsible for ensuring flat its principals we not suspended,
debarred, orodierwise Ineligible to participate in covered
laeactions. To verify the eligbity of is principals, as wall as
the eligibility of any lower tier prospective participants. each
participentmay, but is not required In, check he Excluded
Palties List System websile LtpsJfwww. opts oowt which is
compiled by the Generei Services Administration.
P-27 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
i. Nothing contained in the foregoing shall be const rued to
require the establishment of a system of records in order to
render in good faith the certification regakedby this clause.
The knowledge and idorrretion of the prospective participant
is not required to exceed that which is normly possessed by
a prudent person in the ordinary terse of business dealings.
j. Except for uansadions sulhodzed under paragraph m of
These InWu diorss, if a padlcpanl in a covered transaction
knowingly enters into a lower tier covered transaction with a
person who is auspended, debarred, indigble, or vduraarity
excluded from participation in this transaction, in addition to
other remedies available to the Federal Govemmed. the
department or agency may terminate this transaction forcame
a default.
2. Certification Regarding Debarment,Suspension,
Ineligibility and Voluntary Exclusion —Firs) Tier
Participants:
a. The prospective twat her participant certifies to the best of
is knowledge and belief, that and its principals:
(1) Ant nel presently debarred, suspended, proposed for
debarmmu, declared neigble, orvolunlarly excluded from
padicipaang in cowed Imnsaetols by an/ Federal
department or agency;
(2) Fiwe rot wihn a three -yea period preceding tus
Proposal beenconvicled of or had a cM judgment rendered
against them forcommission of fraud ora criminal offense in
connection with obtalring, a0empfog to obWn.w perfwmng
apubic(FedemLStalewbal)tramaclonorc ItWunder
a pubic transaction; violation of Federal orState antitrust
statutes a commission of embezzlement thall, forgery,
bribery, fastcation ordestmction of records,making false
statements, orreceiving stolen property:
(3) Are net presently indicted for or oMnwise criminally or
citify charged by a govemmentai ertty (Federal, State or
local) with commission of any of the offenses enumefaled in
paragraph (a)(2) of this unification; and
(4) flaw rid within a three yew period preceding this
appialioNpmposal had we a more pubic transactions
(Fedaai, State orlocal) temhnated ter cause or deati t.
b. Where the prospective participant is unable to cedi fy to
any of he statements n the ceNiatbn, such prospective
participant shall attach an explanation to this puoposet,
2. Instructions for Certifution • Lower Tier Participants:
(Applicable to all subcontracts, purchase orders and other
lower tier transactors regwmg prior FHWA approval or
estimated to cost 525,000 ormore - 2 CFR Pars 180 and
1200)
e Sy signing and submitting this Proposal, he prospective
lower tier is providing the cerffation sel out below.
b. The canilcelion in this clause is a material representation
effect upon which reliance was pieced when this transaction
was entered into. I If is later determined that the prospective
lower bar participant knowingly rendered an erroneous
carffiaim. n addition to other remedies available to the
Federal Govemmert, be deparlmad. or agency with which
ths transaction ongnaled may pumm available remedies.
ipludng suspension and/or debarment.
C. The prospective lower ber participant shall provide
imnediatewritten notice to the person to which this Proposal is
submitted if at any fare the prospective lower tier paricipa t
learns thdb cefOfcabm was erroneousby reasoner
changed circumstances.
d. The tans 'covered transaction :'debarred:
'sueperdel: 'neigble. 'parfapenl,"'person: 'primipal,'
ard'voludsrily extluded,' as used in this clause, ore defned
h 2 CFR parts 180and 1200. You may conlecithe person to
which thispmposal is submitted for assistance in chtaining a
copy of those regulations. First Tier Covered Transactions'
niters to airy covered transaction between a grantee a
subgranee of Federal funds and a participant (such as 0e
prime or gma al cardracp. lower Tier Covered Transactions'
refers to any covered transaction under a FM Tier Covered
Transaction (such as aAcadracts). First TierPar0clpad'
refers to the partippad who has entered into a covered
transaction with agrantee or subgrantee or Federal funds
(such as the prime %general centacor). 'Lower Tier
Participal' filters any participant who has entered Into a
covered transaction with a Fast Tier Participant or ether Lower
Tier Participants (such as subcontractors and suppliers)
e The prospective lower her pargdpenlagran by
submtticg that prcposel that. shoud the proposed covered
transaction be entered into. it shall net knowingly enter into
any lower tier covered transaction with a pawn who is
debarred, suspended, declared ineligible, or voluntarily
excluded from participation in this covered transaction, unless
authorized by the department a agency with which this
trmsactionwginated.
f. The Prospective lover liar participant father agrees by
submilting this proposal that it will ndude this clause titled
'Certification Regarcing Debarment, Suspension, ineligibility
and Volurtary Exclusion -Lower Tier Covered Transaction'
without rta0ifcalion, in all fower tier covered transactions and
in all solicitations for lower tier covered transactions exceeding
the S25,f100 threshold
g. A participant in a covered transaction my rely upon a
cedtiafon of a prospective participant In a lower tiercovered
transaction theirs not debarred, suspended, neigbfe, or
voluntarily excluded from the covered transaction mien it
knows that the rarlifpation is emon rcus. A perliolpart is
responsible for ensuring Iner its principal; as not suspended,
dabs med, a otherwlw ineligible to participate in covered
transectiaa. To verify the eligibility of its pdndpah, as was as
the eligibility of any lower fief prospective participants, each
participant may. but is not required to, daclt the Excluded
Parties List System websle rifles:/hvww.ads.00v/b which is
compiled by the General Services Administration.
h. No" contained In the foregoing shaf be construed to
remare establishment of a system of scans in order to render
in good faith the cedreafon required by fus clause. The
knewiedge and irfometion of participant is not "ked to
exceed that which is nwmaay possessed by a prudent person
In M ordinary course of business, doings.
i. Except for transactions authorized under paragraph a of
these isttctorm, if a participant in a covered transaction
krowYtgy, enters into a lower her covered transaction with a
person who is suspended, debanad. inefgicle, or voluntady
excluded frown parlidpafm in this transaction, in addition to
other remedies available to the Federal Govemmed, the
P-28 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
dapadment oragoncy with which this transactor, A inafed
may pursue available remedus, including suspension andta
debarment.
CargNcatlon Regarding Debarment, Suspension,
Noligibility and Voluntary Exclusion -Lower Tier
Participants:
1. The prospectvo lower gorpadicipari coripos, by
submission of this proposal, that refhari merits pdrelpals Is
prosentty debanod, suspended, proposed for debarment.
declared oelgUlo a voluntarily excluded from participating in
covered transactions; by any Federal department a agency.
2. Where the prospective borer gar participant is unable to
carlfy b any of the statements In this radtication, such
prospectba participant shal attach an expianatlen to M
pmposal.
XI. CERTIFICATION REGARDING USE OF CONTRACT
FUNDS FOR LOBBYING
This provision is sppgmbo Just]Fademlaid construction
contracts ardto all misled subcontracts which exceed
$100,000 (49 CFR 20).
1. The prospective porWicant certifies, by signing and
submitting this bid or proposal, to the best of He or her
knowledge andbele4 that:
a. No Federal appropriated funds have been paid or will be
paid, by or on behalf of the undersigned, to cry parson for
Influencing or attempting to influence an officer or employee of
any Federal agency, a Member of Congress, an officer or
ar poyee of Congress, or an employee of a Member of
Congress in canedon wish the avadig of any Federal
contract, the ma" of any Federal grart, the molding of any
Federml Iron, the entering ido of any cooperative agrearnenl.
and One extension, continuation, renewal, anencmenb or
modifkationof any Federal contract, grant, loan, or
cooperagvealimemart.
b. f any funds other than Federal appropriated funds have
been paid or vA be paid to any person for influencing a
attempting to influence an officer a employee of any Federal
agency, a Member of Cbngmss, an offices a employee of
Congress, or as employee of a Merrbar of Congress in
connection with this Federal contact, grant, kiss, or
cooperative agmemort, the undersigned shal complete acl
submit Standard FOmnLLL, 'Disclosure Fomn to Report
Lobbying.' in accordaree With its iuhuctms.
2. This cerlTiralbn is a material representation of fad upon
which refanco was placed when this transaction was made a
artenadirto. Submissbnofthi3ca0fmgonisapremgtisbe
for matting or entering into this transaction imposed by 31
U.S.C. 1352 Any prim whofails to No the requited
wdlgcaton shal be sujact to a rid penalty of not less than
$%000 and net mora than $100.000 for each such failure.
3. The pmspective participant also agmes by submitting its
bid or proposal list the padoy:ari shall mquie that the
Language of this certification be included in all borer her
subcontracts, which exceed $100,000 and that all such
reciports shal cerfrfy ant disclose accordingly.
P-29 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
ATTACHMENT A- EMPLOYMENT AND MATERIALS
PREFERENCE FOR APPALACHIAN DEVELOPMENT
HIGHWAY SYSTEM OR APPALACHIAN LOCAL ACCESS
ROAD CONTRACTS
This provision is applicable to all Fedeml-aid projects funded
under the Appalachian Regional Development Act of 1965.
1. owing the performance of this contract, the contractor
undeda'king to do work which Is, or reasonably may be, done
as on,sile wok, stag gkre preference to qualified persons who
regularly reside h to lab" am as designated by the DOL
whmain the contract worli is situated, "the subregion, "the
Appalachian counties of the State wherein the contract work is
situated, except:
a. To the extent that qualified persons regularly malting in
the anon am not availatile.
b For the reasonable reeds of the Contractor to employ
supewisory or specially experienced personnel necessary to
assure an efficient execution of to contract work.
c. For the obligation of the contractor to off" employment to
pissed or former employees as he result of a lawful collective
bargaining contract, provided that the number of rimrssidert
priors employed under this subparagraph (1c) shall not
exceed 2D percent of lie total number ofemployees employed
by the contractor on Ihecontmctwork, except as provided in
subparagraph(4) below.
2. The contractor shall place a job order with the Stale
Employment SerWoe indicating (a) the classifications of 60
laborers, madanics and other employees required to porform
the contract work, (b) the number o1 employees required in
each dossllmbon, (c) the dale on which the participant
estimates such amp'cyees will be required, and (d) any other
pertinent information required by the State Employment
Service to complete the job Order foram. Tie jab order may be
placad with the State Employment Service in wrift a by
tolaphone, d dunng the couse Of the cmbact wok, he
Infonnatim snbmilted by the contractor in the original job order
is substantially modified, the participant shag promptly notify
the State Employment Service.
3. The contract" shag give fug consideration lo all qualified
job applicants referred to him by the State Enpoymant
Service. The contracts is not required to grant employment to
any job applicants who, in his opinion, we not qualidied to
perform the classification ofwork required.
4. If, within one week following he placing of ajob orderby
the contract"with the State Employment Service, the Stale
Employment Service is unable to refer any qualified job
applicants to or less than the number
requested the State Employment Service will forward a
certificate to the contractorindsating he unavailability of
applicants. Such certificate shag be made a pert of the
contradoespermanert poled racords. Upon receipt of this
certificate, the contractor may employpersms who do not
namely reside in the lab" am to fill positions oovemd by the
cerfitcate, notwithstanding he provisions of subparagraph (1c)
above.
5. The provisions of 23 CFR633.207(e) alaw he
contracting agency to Provide a contractual preference for the
use of mineral msoume materials native to the Appalachian
region.
6. The contractor shall irekxle the pradskms of Sectors 1
through of this AtfachmentA In every suboerbact for worin
which is, "reasonably maybe, done as on-sile wok.
P-30 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION
The bidder Elecnor Belco Electric, 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 Administration or by the Director, Office of Federal Contract Compliance,
U.S. Department of Labor.
Signed
Title
Firm
Date
Vice President
Elecnor Belco Electric. Inc.
May 19, 2020
P-31 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT
In conformance with Public Contract Code Section 10285.1 (Chapter 376, Slats. 1985), the
bidder hereby declares under penalty of perjury under the laws of the State of California that the
bidder has _ , has not x 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 making a false certification may subject the certifier to criminal
prosecution.
Signed
Title
Vice President
Firm Elecnor Belco Electric, Inc.
Date
P-32 ofP-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
PUBLIC CONTRACT CODE SECTION 10232 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.
Signec
Title
Firm
Date
Elecnor Belco Electric, Inc.
May 19, 2020
P-33 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
TITLE 49, CODE OF FEDERAL REGULATION, PART 29 DEBARMENT AND SUSPENSION
CERTIFICATION
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 dates of action.
Note: Providing false information may result in criminal prosecution or administrative sanctions.
The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof
shall also constitute signature of this Certification.
Signed
Title
Firm
Date
Vice President
Elecnor Belco Electric, Inc.
May 19, 2020
P-34 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
NON -LOBBYING CERTIFICATION FOR 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 an officer or
employee of Congress, or an employee of a Member of Congress in connection
with the awarding of any Federal contract, the making of any Federal grant, the
making of any Federal loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment or modification of any Federal
contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal 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 language of this certification be included in all lower tier subcontracts,
which exceed $100,OOAand that all such sub -recipients shall certify and disclose accordingly.
Signed
Title
Firm
Date
, John We
Vice President
Fleenor Belco Electric, Inc.
May 19, 2020
• Standard Form LLL may be obtained from Caltrans and FHWA offices.
P-35 ofP-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
DISCLOSURE OF LOBBYING ACTIVITIES
DISCLOSURE OF LOBBYING ACTIVITIES Afpe by oue
Campy, this Porn to dmdose lobbying activities pursuant to 31 U_S.C. 1352 ik3aeaaua
See reverse for pubnfic burden disdowre_
.Type of Federal Action-
2 Say.. of Federa4 Action:
3- Report Type:
a_ corrtract
�a- Udtotfer,'applica6om
a. irW.1 filing
b_ gram
b. initial award
b. manorial charge
c. operatmre agreement
c. pcstaward
For Material Change Only:
d-
year qumEer
e_ ban arantee
dam of last report
f I.,race
4. Name and Add s of Reporting Entity:
5_ M Reporting Entity in No_ 4 n a Sub , Erder Name
❑ prloo simanmare
and Address of Prime:
T ffknawn:
C Sio w Dist, ifAwww:
concovessi.1 Distract, ifk ww-
b. Federal De!parft nUAgency:
i_ Federal Program N crfption-
CFdA. N¢mober, W fir"e:
8. Federal Action Number, tirknown-
9_ ward Arwu if knoum-
S
10 a_ Name and Address of Lobbying Entity b_ Indav- Performing Services (vrcfudaag address i3
(rfind vdUall, fast name, orstnarsae. MJ)_ t Nc. 10ay
name. name. A,}t"A'
!cram coanm !+J/�
�4 +APrsre a
I1_ Amount of Payr ent gcheck aN duts appPy):
13. Type of Payment (check ! drat apply9:
S ❑ aeetiul ❑ p
❑> wvftww
❑ Rorw-ilme tee
❑ c-coum,�,cm
12 Form of Payment 4.dreak aP that _
❑ %ew+n
❑ deontlrvganttmr
Elib_ 1—M spewity: na0H2
El9. dateri -j
Ydwne
Elt_ en:0 , ao?c :
11_ Brief Description of Se " s Pealorned ar to be Performed and Dates) of Service, vrdudmg officers
employee(sj, or Mem sl conbcted, fo Payment Indicated m ftem 11:
gram Cmoamuotra M!22j.^. F4 AX
15. ConS .l SF4LLLA attached: Lj You
5 nbure:
sum ,.tio.�gr!Ka.r we.. wr.!n. e.waw. nor
Pdnt Mame'
.I011n AoriA
�Y brwabf M tiCraq�✓♦'snl Y �if6 b
TitJe'
Vice Pr rat
Telephone No_ 909-993-5470 Dam: 5/19/2020
Federal Use Only:
at�mrtaca fx�r°dcum
7�11
P-36 ofP-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (I 87)
INSTRUCTIONS FOR COMPLETION OF SF-LL, DISCLOSURE OF LOBBYING
ACTIVITIES
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
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]M 2Cd13-
P-37 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT
1. Local Agency: City of Santa Ana 2. Contract DBE Goal: 25 k
Installation of bikeway and traffic signal modifications on Edinger Avenue at Flower Street and Mcfaciden Avenue at Flower
3. Project Description: Street
4. Project Location: Flower Street
5. Bidders Name: Fleenor Belco Electric, Inc. 6. Prime Certified DBE: ❑
7. Bid Amount: $711, 682.00
8. Total Dollar Amount for ALL Subcontractors: $203, 037. 00 9, Total Number of ALL Subcontractors:
10. Bid
Item
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
Furnish Traffic Signal Poles and
40540
TEK Services LLC
Various
Equipment
4749 E. Wesley Dr.
178,992.60
Anaheim, CA 92807
60% of $298,321.00
Local Agency to Complete this Section
15. TOTAL CLAIMED DBE PARTICIPATION
178,992.60
21. Local Agency Contract Number: ( ) 22. Federal -Aid Project Number: HSIPL 187 5063
23. Bid Opening Date:
25.1 %
24. Contract Award Date:
IMPORTANT: Identify all DBE firms being claimed for credit,
regardless of tier. Names of the First Tier DBE Subcontractors and
25. Award Amount.
their respective item(s) of work listed above must be consistent,
where applicable with the names and items of the work in the
Local Agency certifies that all DBE certifications are valid and information on
'SuWntractort"ed with your bid. Written confirmation of
this form is complete and accurate.
eac
5/28/2020
26. Local Agency Representative's Signature 27. Date
16 S na re 17. Date
28. Local Agency Representative's Name 29.Phone
prearer's
hn ne909-99i-5470
18.er's N e113 19. Phone
30. Local Agency Representative's Title
Vice President
20. Preparers Title
UIS I RIBU I ION: 1. Original - Local Agency
2. Copy- CaBrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract
execution may result in de -obligation of federal funds on contract.
3. Include additional copy with award package.
ADA Notice: Far individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-
6410 or TDD (916) 654-3880 or write Records and Fortes Management, 1120 N Street, MS-89, Sacramento, CA 95814.
P-38 of P-52
5/28/2020 UCP Web Application - List
Skip to Main Content Back To —Query -Form (lice nseForm.htm)
Search Returned 1 Records
Query Criteria
Thu May 28 14:43:10 PDT 2020
Certification Types: DBE
Firm ID: 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
5680 VAN GOGH WAY
Line1
Mailing Address
Line2
Mailing City
YORBA LINDA
Mailing State
CA
Mailing Zip
92887
Code1
Mailing Zip
Code2
Certification
DBE
Type
EMail
Contact Name
Area Code
Phone Number
Extension
Alt Area Code
Alt Phone
kim.tekserv@Gmail.com
KIM KING
714
336-0536
Number
Extension
Fax Area Code
714
Fax Phone
694-0116
Number
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
C0686 ELECTRICAL & SIGNALS SUPPLIER; C0600 MISC SUPPLIERS;
https://ucp.cJot.ca.gov/querySubmit.htm 1 /2
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
INSTRUCTIONS — CONSTRUCTION CONTRACT DBE COMMITMENT
CONTRACTOR SECTION
1. Local Agency - Enter the name of the local agency that is administering the contract.
2. Contract DBE Goal - Enter the contract DBE goal percentage as it appears on the project advertisement.
3. Project Location - Enter the project location(s) as it appears on the project advertisement.
4. Project Description - Enter the project description as it appears on the project advertisement (Bridge Rehab,
Seismic Rehab, Overlay, Widening, etc).
5. Bidder's Name - Enter the contractor's firm name.
6. Prime Certified DBE - Check box if prime contractor is a certified DBE.
7. Bid 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 the prime contractor information in this count.
9. Total number of ALL subcontractors — Enter the total number of all subcontracted contractors. SUM = (DBEs
+ all Non -DBEs). Do not include the prime contractor information in this count.
10. Bid Item Number - Enter bid item number for work, services, or materials supplied to be provided.
11. Description 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 or furnished 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
of DBE firms.
12. DBE Certification Number - Enter the DBE's Certification Identification Number. All DBEs must be certified
on the date bids are opened.
13. DBE Contact Information - Enter the name, address, and phone number of all DBE subcontracted contractors.
Also, enter the prime contractor's name and phone number, if the prime is a DBE.
14. DBE Dollar Amount - Enter the subcontracted dollar amount of the work to be performed or service to be
provided. Include the prime contractor if the prime is a DBE. See LAPM Chapter 9 for how to count full/partial
participation.
15. Total Claimed DBE Participation - S: Enter the total dollar amounts entered in the "DBE Dollar Amount"
column. %: Enter the total DBE participation claimed ("Total Claimed DBE Participation Dollars" divided by item
"Bid Amount'). If the total % claimed is less than item "Contract DBE Goal," an adequately documented Good
Faith Effort (GFE) 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 date the DBE commitment form is signed by the contractor's preparer.
18. Preparer's Name - Enter the name of the person preparing and signing the contractor's DBE commitment form.
19. Phone - Enter the area code and phone number of the person signing the contractor's DBE commitment form.
20. Preparer's Title - Enter the position/title of the person signing the contractor's DBE commitment form.
LOCAL AGENCY SECTION
21. Local Agency Contract Number - Enter the Local Agency contract number or identifier.
22. Federal -Aid Project Number - Enter the Federal -Aid Project Number(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 Representative's Signature - The person completing this section of the form for the Local
Agency must sign their name to certify that the information in this and the 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 the 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-39 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
EXHIBIT 15-H DBE INFORMATION — GOOD FAITH EFFORTS
DBE INFORMATION - GOOD FAITH EFFORTS
Federal -aid Project No. HSIPL 5063 (187) Bid Opening Date
May 27, 2020
The City of Santa Ana established a Disadvantaged Business Enterprise (DBE) goal of 25 % 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 information to document their good faith efforts within five (5)
business days from bid opening. Proposers and bidders are recommended to submit the following information
even if the Exhibit 10-01: Consultant Proposal DBE Commitments or Exhibit 15-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 DBE Commitment" of the 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):
Publications Dates of Advertisement
DBE Goal Met
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
TEK Services LLC 5/14/20 5/20/20, 5/27/20
Email, Phone
P-40 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
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
responsibility to demonstrate that sufficient work to facilitate DBE participation in order to
met or exceed the DBE contract goal.
Items of Work Bidder Normally Breakdown of Amount Percentage
Performs Item (Y/N) Items M Of
Contract
Furnish Electrical N Various $298,321.00 41.9%
D. The names, addresses and phone numbers of rejected DBE finns, 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:
DBE Goal Met
Names, addresses and phone numbers of firms selected for the work above:
TEK services LLC 4749 E. Wesley Dr. Anaheim, CA 92807 (714) 336-0536
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:
DEE Goal Met
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
leases from the prime contractor or its affiliate:
DEE Goal Met
P-41 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
H. 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.):
Name of Method/Date of Results
Agency/Organization Contact
DBE Goal Met
H. Any additional data to support a demonstration of good faith efforts:
DbE Goal Met
NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY.
P-42 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
EXHIBIT 12-B BIDDER'S LIST OF SUBCONTRACTORS (DBE AND NON -DBE) — PART I
PART
The bidder shall list all subcontractors (both DBE and non -DBE) in accordance with Section 2-1.054 of the Standard
Specifications and per Title 49, Section 26.11 of the Code of Federal Regulations. This listing is required in
addition to listing DBE Subcontractors elsewhere in the proposal. Photocopy this form for additional firms.
Local Assistance Procedures Manual
Bidder's List
Exhibit 12-B
Exhibit 12-B Bidder's List of Subcontractor (DBE and Non -DBE) Part I
As of March 1, 2015 Contractors (and sub -contractors) wishing to bid on public works contracts shall be registered with the State Division of Industrial Relations and
certified to bid on Public Works contracts. Pleasemgisterat:https://www.dir.ca.gov/Public-Works/Contractor-Registration.html
In accordance with Title 49, Section 26.11 of the Code of Federal Regulations, and Section 4104 of the Public Contract Code of the State of California, as amended, the
following information is required for each subcontractor who will perform work amounting to more than one half of one percent (0.50%) of the Total Base Bid or $10,000
(whichever is greater). Photocopy this form for additional firms. Federal Project Number: HSIPL-5063(187)
Submatractor Name and
Location
line Item & Description
subcontract
Amount
Percentage of
Rid Item Sub-
contracted
Contractor
License Number
DBE
(Y/N)
D9ECen
Number
Annual Gross Receipts
Dill Reg Number
1�^�
Name: Sm YISA'1 �WL.L�1G
11 �r
✓ I LI L
Z -3 nI - 2,-
���s
33/5co
�
� I t� sib
❑ <$5"111on
❑ <$5 million
cdy, State:
cr,11 �,,�
1"
),,-, ltlo
❑ <510 million
515million
Ageof Firm: rs.
Name: Y
5 ( I b
6Vi
Ott
`41040
/�
/' /
G/��
` L
❑ 1$1 million
Cry, State:
h�,> L ,L
L1hk rr�1)I:rl
❑ <$5 million
100 �'(F
million
million
: yrs.
Name C t Cyr
Zvi
S'�hlN�j
1521534
y �.
Z�
3 uIGUO
`s,�
illion
City. State
tELJj dlli[c
millionmillion
: ynName:dilion
City. State:
❑ 1$5 million
❑ <$lD million
❑ 4$15 million
Age of Firm: yrs.
Name:
❑ <$1 million
City. state:
❑ <$5 million
❑ <$10 million
❑ <$15m1111on
Ageof Firm: _yrs.
Name:
LJ <$1 million
City, state:
45 mullion
❑ <$10 million
❑ 415 million
Ageof Firm:
Distribution: 1) Original -Local Agency file 2) Copy-DLAE w/Award Package
Page I of 2
January 2019
P-43 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
EXHIBIT 12-B BIDDER'S LIST OF SUBCONTRACTORS(DBE AND NON -DBE) — PART II
PART II
The bidder shall list all subcontractors who provided a quote or bid but were not selected to participate as a
subcontractor on this project. This is required for compliance with Title 49, Section 26 of the Code of Federal
Regulations. Photocopy this form for additional firms.
Local Assistance Procedures Manual
Bidder's
Exhibit 12-B
Exhibit 12-B Bidder's List of Subcontractor (DBE and Non -DBE) Part 2
In accordance with Title 49, Section 26 of the Code of Federal Regulations, the Bidder shall list all subcontractor who provided a quote or bid but were not selected to
participate as a subcontractor on this project Photocopy this form for additional firms. Federal Project Number: HSiPL-5063(187)
Subcontractor Name and
Location
tine Item description
subcontract
Amount
Percentage of
Bid Item Sub-
contracted
Contractor
License Number
OBE
(y/N)
DBE Cert
Number
Annual Gross Receipts
DIN Reg Number
Name:
❑ <$i million
❑ <$5 million
City, Statc
❑ <$10 million
❑ <$15 million
Ageofnrm: _yrs_
Name:
❑ 4$1 million
❑ <$5 milion
ty, State:
❑ <510 million
❑ <$15 million
Age of Firm: yrs.
Name:
❑ <$1 million
c$5 million
City, State
❑ <510 million
❑ <$15 million
Age of Farm: yrs.
Name:
Cl <$1 million
❑ <$5 million
City, state:
❑ Qto million
LJ 615 million
Age of Finn: yrs.
Name:
❑ <$l million
❑ <$5 million
CRY, State:
❑ <$to million
❑ <$15 mi Ilion
Agenf Firm: yrs.
Name:
LJ 1 million
— <$5 million
City, State:
❑ <$IC million
4$i5 million
Age of nme yrs.
Distribution: 1) Original -Local Agency File 2) Copy-DLAE w/Award Package
Page 2 of 2
January 2019
P-44 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
PROMPT 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 from 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, orjudicial remedies otherwise available to the
prime contractor or subcontractor in the event of a dispute involving late payment or
nonpayment by the prime contractor, deficient subcontract performance, or
noncor
Signed
Title
Firm
Date
Fleenor Belco Electric. Inc.
19,2020
P-45 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
EXHIBIT 16-B —SUBCONTRACTING REQUEST
Local Assistance Procedures Manual
Exhibit 16-B
CONTRACrORNAME
COUNTY
ROUTE
Fleenor Belco Electric, Inc.
San Bernardino
BUSWESSADDRESS
CONTRACTNUMBER
14320 Albers Way
CITY AND STATE
ZIPCODE
FEDERAL -AID PRO Cr NUMBER
Chino, CA
91710
HSIPL-5063(1i87)
A. SUBCONTRAC OR
B. BID ITEM
C. PERCENTAGE OF
D. SHE LISTED
E. CERTIFIED
F. DESCRIBE WORK
G. DOLLAR AMOUNT
(Name, Business Address, Phone)
NUMBER(S)
BIDITEM
AT BID TIME
DBE
WHEN LF%THAN
BASEDONTHEBID
SUBCONTRACTED
100% OF WORK LS
AMOUNT
SUBCONTRACTED
Yes No
Yes No
❑ ❑
❑ ❑
Yes No
Yes No
❑ ❑
❑ ❑
Yes No
Yes No
❑ ❑
❑ ❑
Yes No
Yes No
❑ ❑
❑ ❑
Yes No
Yes No
❑ ❑
❑ ❑
Yes No
Yes No
❑ ❑
❑ ❑
I certify that:
• The Standard Provisions for labor set forth in the contract apply to the subcontracted work.
• if applicable, Form FHWA-1273 of the Special Provisions has been inserted in the subcontracts and should be
incorporated in any lows{ -tier subcontract. Written contracts have been executed for the above noted subcontracted
work. n
Contractor Signature , John Wone I Date Mav 19.2020
This section is to be colete by thUesdentcn&eer.
1. Total of bid items2. Contractor must perform with (line 1 X contract req. %)
3. Bid items previously subcontracted (taken from previously approved 16-B)
4. Bid items subcontracted (this request)
5. Total bid items subcontracted (line 3 plus 4)
6. Balance of work contractor to perform (line I minus 7
5
Approved
RESIDENT ENamEER'9 SIGNATURE D.A I F
Copy Distribution: Unginal-Contractor Copy- Resident Engineer Copy- UBEO- smallbusinessadvocateradoot ca. oovv or fax to (916) 324-1949
Page 1 of 2 January 2018
P-46 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
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. B 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 January 2018
P-47 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
The undersigned, is submitting this proposal for performing by contract the work required by these
bid documents, certify to comply with the following:
Signed
Title
a. Contractor's Notification
Promptly notify the Agency's Engineer if you find either of the following conditions:
1. 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 Engineer's investigation, you
waive the differing site condition claim.
b. Engineer's Investigation and Decision
Upon your notification, the Engineer investigates job site conditions and:
1. Notifies you whether to resume affected work
2. Decides whether the condition differs materially and is cause for an
adjustment of time, payment, or both
Vice President
Firm Elecnor Belco Electric, Inc.
Date
May 19, 2020
P-48 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
BIDDER'S CERTIFICATE OF COMPLIANCE REGARDING "BUY AMERICA"
REQUIREMENTS FOR STEEL OR MANUFACTURED PRODUCTS
The undersigned, is submitting this proposal for performing by contract the work required by these
bid documents, certify to comply with the "Buy America" requirements of Section 165 of the
Surface Transportation Assistance Act of 1982 and as shown in the special provisions of this
project.
Signed
Title
Firm
Date
Vice President
Elecnor Belco Electric. Inc.
P-49 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSTPL 5063 (187)
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
Title
Firm
Date
Vice President
Elecnor Belco Electric. Inc.
May 19, 2020
P-50 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
TMP 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 Traffic Management Plan (TMP) commitments found
in the appendix of the Contrpetpocuments of this project.
Signed
Title
Firm
Date
Vice President
Elecnor Belco Electric, Inc.
May 19, 2020
P-51 of P-52
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 17-6897
FLOWER STREET BIKEWAY
FEDERAL PROJECT NO: HSIPL 5063 (187)
STATEMENT REGARDING COMMUNITY WORKFORCE AGREEMENT (CWA)
REOUREMENTS
This is to certify that the undersigned BIDDER, and subcontractors, have read and understood
the CWA entered into by and between the City of Santa Ana, the Los Angeles/Orange Counties
Building and Construction Trades Council, and the signatory Craft Councils and Local Unions,
effective as of September 1, 2017. The CWA is available at:
http://www.santa-ana.ot-iz/pwa/documents/CWA.pd
The undersigned BIDDER hereby agrees to comply with all terms and conditions of the CWA,
and is capable of completing construction of the project continuously, and without interruptions
or delays. If awarded any work covered by the CWA, BIDDER will also be required to sign the
Letter of Assent that appeapns Attachment M to the CWA.
Signed
Title
Firm
Date
Vice President
Elecnor Belco Electric, Inc.
May 19.2020
P-52 of P-52
Recorded in Official Records, Orange County
MAYOR
Miguel A. Pulido
MAYOR PRO TEM
Vincente Sannlenlo
COUNCIL MEMBERS
Angelica Amezcua
P. David Benavides
Michele Martinez
Roman A. Rayne
Sal Tinaiero
Hugh Nguyen, Clerk -Recorder
NO FEE
a$ R 0 0 0 8 2 8 9 6 3 5 $
201685000336 8:47 am 04/12/16
323 304 Z01
0.00 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) 973-1461
vnvw.santa-ana.org
NOTICE OF EXEMPTION
CITY MANAGER
David Cavazos
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
From the Requirements of the California Environmental Quality Act (CEQA)
Fee Exemption per California Government Code Section 6103
To: COUNTY CLERK From: Cityof Santa Ana
County of Orange Planning & Building Agency
P.O. Box 238 20 Civic Center Plaza W20
Santa Ana, CA 92702 Santa Ana, CA 92702
Project Title: Flower Street Bicycle Lanes Date of Approval: 07/05/2016
Project Number(s): PWA-2016-371-CITY
Project Location: 1 CityWide (Partial)
City: Santa Ana County: Orange ER Number: ER-2016-40
Project Description: Construction to install bicycle lanes along Flower Street from Civic Center Drive to Warner Avenue with
bicycle detection. Installation of protected, left turn arrows will be included along Flower Street at
McFadden Avenue and at Edinger Avenue.
Applicant Name: Zdenek Kekula, 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: Kekula, Zdenek
`i
ff
Exempt Status: P
❑ Ministerial (Sec. 15268) F � L E ty..e (+) S T E
❑ Declared Emergency (Sec. 15269 (a)) •
❑ Emergency Project (Sec. 15269 (b through e)) APR 2016 APR 12 2016
❑ General Rule (Sec. 15061(b)(3)/(5)) 1 2
❑ Statutory Exemption: ORANeddOUNTYCLERK-RECORDER DEPARTMENT
HIIGHNGUYEN,CLERK-RECORDER
• Categorical Exemption: 15301(c) BY, (,_DEPUTY BY. �� DEPUTY
Reason(s) Why Project is Exempt From CEQA:
15301(c) consists of the operation, repair, maintenance or minor alteration of existing public facilities such as streets, sidewalks,
gutters, bicycle and pedestrian trails.
City Contact: Zdenek Kekula
Telephone: (714)647-5606
( r
Signature: !� f R-v7t...�rr-2 Title: 0-12 -aAa'rnfi�l Date:
SANTA ANA CITY COUNCIL
Miguel A. Pultdo Vincente Sarmienlo Michele Martinez Angelica Amezcua P David Benavides Raman Reyna Sal Tinalero
Mayor Mayor Pro Tem. Ward i Ward Ward Ward Ward Wald
MPurdo0sanla-ana.o1e VSannientorndsantaanaorg MMartinezgDsanta-anaomAAmezcuagDsantaanaora DB d lM t RR na ta- SJ, - ,M te-
California Newspaper Service Bureau®
Daily Journal Corporation
Public Notice Advertising Since 1934
Tel 1-800-788-7840- Fox 1-800474-9444
Local ORrn and Re oenetadvee in:
Lov Maelee, Sanm.Am San Oiego, Riva.idelsan Berardino,
S. Fraaniem, 0ak1aM, San low. Sauamenra
Special Senviaee Available in Phoenu
DECLARATION
I am a resident of Los Angeles County, over the age
of eighteen years and not a party to any or interested in the
matter noticed.
The notice, of which the annexed is a printed copy
appeared in the:
ORANGE COUNTY REGISTER
On the following dates:
May 6 & 13, 2020
certify (or declare) under penalty of perjury that the
foregoing is true and correct.
Dated at Los Angeles, California, this
13th day of May 2020
AI�k
Signature
Debbie Verkes
3362564
"Die only Public Notice which is justifiable
from the standpoint of1rue economy and the public interest,
is that which reaches those who are affected by it"
Rev. W15Daily loumalCamm>,ion,915R FimSlRe%L sMeeks. A90012 lip11111111111111111111111111111111 p11111111111111p1
* A 0 D 0 0 D 5 4 2 8 2 1 8*
CITY OF SANTA ANA
PUBLIC WORKS AGENCY
CONTRACT CHANGE ORDER
Project Number 17-6897; Change Order Number 1
Flower Street Bikeway [IHSIP 5063(187)] _
To Elecnor Belco Electric Inc, Contractor
You are hereby directed to make the herein changes from the plans and specifloatlons 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
1. Revised traffic signal pole at north-west corner of intersection of AGREED PRICE =
Edinger Avenue and Flower Street per PCQ#02 $1 5577.76
2. Install additional striping and traffic loops along Flower Street from AGREED PRICE =
Warner Avenue to First Street per PCO#04. $48,807.96
TOTAL AGREED PRICE = $60,385.72
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CITY OF SANTA ANA
PUBLIC WORKS AGENCY
CONTRACT CHANGE ORDER
Project Number 17-6897, Change Order Number
Flower Street Bikeway [HSIP 5063(187)]
To Elecnor Belco Electric 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 a actually used and no allowance will be made for idle time.
Change requested by PUBLIC WORKS AGENCY
The compensation set forth in this change order comprises the total amount due to contractor
for the scope of work authorized herein based on estimated quantities. The total final amount
due for this change order will be based on actual quantities of work performed per the
described and itemized listing of work that this change order is based upon. Compensation for
work performed by this change order shall cover all costs including work by Contractor, all
Subcontractors, and all Suppliers. 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 $ 50,385.72
By reason of this order the CONTRACT TIME completion will be adjusted as follows 30 non-compensable working days
We the undersigned contractor have given careful consideration to the change proposed and hereby agree, if this proposal is approved, that we will provide all
equipment, furnish all materials, except as may otherwise be noted above, and perform all service necessary for the work above specified, and will accept as full
payment therefor the prices shown above.
Accepted, Date 7/21/21 Contractor Elecnor Belco Electric Inc.
By Title Qe Alberto Garcia, President/CEO
tit Approval recommended by 1I V a 17 . Date �'! Z zi ? oZl
UBLIC WORKS AGENCY EXECUTIVE DIRECTOR
Approved by (� Date 4 �I
CITYMANAGER
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