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HomeMy WebLinkAboutNOBEST INCORPORATED Recording Requested By, Recorded in Official Records, Orange County And When Recorded Mail To: laugh Nguyen, Clerk-Recorder City of Santa Ana,Public Works Agency M22 y II 11I I � III IIII II III�II III I�I i III I II III NO FEE 20 Civic Center Plaza,P.O.Box 1988 I l Santa Ana,CA 92702 * $ R D Q 1 3 7 4 7 8 b 9 $ 20220001899121:07 pm 05/23/22 371 RW11A N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.000.000.00 0.00 THIS SPACE FOR COUNTY RECORDERS USE ONLY T NOTICE OF COMPLETION I �' N� NOTICE IS HEREBY GIVEN that the undersigned City of Santa Ana, California, a municipal corporation, with the address of City Hall, 20 Civic Center Plaza, Santa Ana, California, 92701, is the owner of the property hereinafter described, that said owner has caused a construction of Local Street Curb Ramp Improvements under contract entered into on December 7, 2021, with Nobest Inco orated, on which contract Merchants Bonding CoLn any (Mutual) is x surety. The property on which such work improvement was placed is in the City of Santa Ana, W o County of Orange, State of California, and described as Project No. 22-7537 located at various o z locations. The work improvement on said property was accepted as completed on April 5, 2022. zw p CITY OF SANTJ ANA, A MUNICIPAL CORPORATION x > By D proF Dated: �� Actin Cit n eer—Jason Gabriel Z TITLE rn 7 ------------- Q a VERIFICATION I, the undersigned, say: I am the Actin City-Engineer—Jason Gabriel 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 A L3 , at Santa Ana, California Acting C40toy Engineer—Jason Gabriel THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10)DAYS AFTER COMPLETION WMT 9LIil((IF 60 CITY OF SANTA ANA CONSTRUCTION CONTRACT AGREEMENT PROJECT NO.: 22-7537 W A ty) Local Street Curb Ramp Improvements ((a1l�t�rCa�' 1w) This CONSTRUCTION CONTRACT is made and entered into this 7'" day of December, 2021 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 Nobest Incorporated (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 Local Street Curb Ramp Improvements (hereinafter referred to as the "WORK OF IMPROVEMENT') identified in and in accordance with the Contracts 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. 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 Two Hundred Ninety -Nine Thousand Ninety and No Cents ($299,090.00), as set forth and identified in the BID PROPOSAL, which is attached hereto and incorporated herein as "Exhibit A." The BID PROPOSAL contains a schedule of unit price(s) or lump sum(s) based on approximate quantities only, and the City does not expressly or by implication agree that the actual amount of work will correspond therewith, but reserves the right to increase or decrease the amount of any class or portion of the work or to omit portions of the work as may be deemed necessary or advisable. 1 of 3 CITY OF SANTA ANA CONSTRUCTION CONTRACT AGREEMENT PROJECT NO,: 22-7537 Local Street Curb Ramp Improvements 4. CONTRACTOR agrees to complete the WORK OF IMPROVEMENT within the time specified in the Time for Completion of Improvements section of the BID PROPOSAL (Exhibit "A") including commencing construction within the timeframe therein specified after issuance of a Notice to Proceed. 5. The CONTRACTOR will pay, and will require all subcontractors to pay, all employees on the WORK OF IMPROVEMENT a salary or wage at least equal to the prevailing salary or wage established for such work as set forth in the wage determinations for this work in accordance with applicable State and Federal law, 6. If applicable, the CONTRACTOR shall adhere to the CITY'S Community Workforce Agreement (CWA), a pre -hire collective bargaining agreement, which establishes the labor relations policies and procedures for CONTRACTOR to follow in the crafts persons employed to complete the WORK OF IMPROVEMENT as more fully described in the CWA, The CWA may be found on the City's website at: http://www.santa-ana org/l)wa/documents/CWA.ndf 7. CONTRACTOR shall, after award of this Contract, furnish two bonds to be approved by the CITY, one in the amount of One Hundred Percent (100%) of the Contract price, to guarantee the faithful performance of the work (Performance Bond), and one in the amotmt of One Hundred Percent (100%) of the Contract price to guarantee payment of all claims for labor and materials furnished (Payment Bond). This Contract shall not become effective until such bonds are supplied to and approved by the CITY. 8. CONTRACTOR shall, prior to the release of the performance and payment bonds or the retention Payment, furnish a warranty performance and payment bond (Warranty Bond). Said Warranty Bond shall also be required as a condition of project acceptance. For projects up to Five Hundred Thousand Dollars ($500,000), the Warranty Bond amount shall be the greater of Ten Thousand Dollars ($10,000) or Twenty Percent (20%) of the final contract price. For projects above Five Hundred Thousand Dollars ($500,000), the Warranty Bond amount shall be the greater of One Hundred Thousand Dollars ($100,000) or Ten Percent (10%) of the final contract price. 9. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability Insurance and Worker's Compensation Insurance as outlined in the General Provisions, to be approved by the CITY. 10. INDEMNIFICATION. To the fullest extent allowed by law, CONTRACTOR and its Subcontractors hereby agree to defend, indemnify, and hold harmless CITY, its City Council, boards and commissions, officers, agents, employees, representatives and volunteers (hereinafter collectively referred to as "hrdemnitees"), through legal counsel acceptable to CITY, from and against any liability, claims, actions, costs, damages or losses, including reasonable costs and attorney's fees, for injury, including death to any person or damage to any property, arising directly or indirectly from, or in any manner relating to, any of the following: (i) Performance or nonperformance of the Work of Improvement by CONTRACTOR or its Subcontractors of any lower tier; (ii) Performance or nonperformance by CONTRACTOR or its Subcontractors of any lower tier, 2 of 3 CITY OF SANTA ANA CONSTRUCTION CONTRACT AGREEMENT PROJECT NO.: 22-7537 Local Street Curb Ramp Improvements of any of the obligations under the Contract Documents; (iii) The construction activities of CONTRACTOR or its Subcontractors of any lower tier, either on the project site or on other properties; (iv) The payment or nonpayment by CONTRACTOR of any of its Subcontractors of any lower tier, for Work of Improvement performed on or off the project site; and (v) Any personal injury, property damage or economic loss to third persons related to and arising from the performance or nonperformance by CONTRACTOR or its Subcontractors of any lower tier, of the Work of Improvement. (vi) The indemnity obligations of Subcontractors provided by this Section shall be included in all subcontract documents issued by CONTRACTOR - Nothing in the Contract Documents shall be construed to give rise to any implied right of indemnity in favor of CONTRACTOR against CITY or any other Indemnitee. IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: CITY OF SANTA ANA APPROVED AS TO FORM: SONIA R. CARVALHO CityAttorey JOHN FUNK Assistant City Attorney RECOMMENDED FORAPPROVAL: NABIL SABA, PE Executive Director Public Works Agency KIdSTINE RIDGE City Manager CONTRACTOR: Hbe Fr )-r e- Company: 3 of 3 EXHIBIT A ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO. 22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS BID PROPOSAL Tn, yrry CnLn rr1L OF T4P Orry OF 0,AWTA Auln FROM: Nobel T hc. 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 Remove and Construct PCC Curb 13,500 SF $ �/� pa $ / Qs Re* 7s+B 2 Remove and Construct PCC 680 SF $ g 00 $ s Sidewalk (T=4")* 3 Remove and Construct FCC Curb & 450 LF $ p0 $ Gutter (A-2-6)* W ` 7 40• 4 Remove and Construct PCC Cross 2,400 SF $ a d, $ 0GuttP40 5 Construction Permit 1 LS $10,000 $101000 TOTAL BASE BID (Bid Items 1-5) The lowest responsible bidder shall be selected based on the total base bid. The City reserves the right to award the Base Bid, and any, all, or none of the add -alternate bid items (if any). * The quantity for this bid item is shown for bid comparison only. This bid item shall not be subject to the "25%" limit as stated in Section 3-2 of the Standard Specifications. The actual amount for this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. f This bid item is considered a Specialty Item per Section 2-3.2 of the Standard Specifications. P-1 of P-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO.224537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS 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 eighty (80) working daXs 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 $750 per calendar day. Name of Firm Signature of BIDDER Title rr e fl ";I en f- (If an individual, so state. If a firm or co -partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) Nob,ei Sne, l-&ray P-2 ofP-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO.22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: Nobe* thC. 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 Remove and Construct PCC Curb Ramp* 13,500 SF $'/J ¢d $ ns8 2 Remove and Construct PCC ') 680 SF $ Sidewallr (T=4 3 Remove and Construct PCC Curb & 450 LF $ pp $ a 74 Gutter (A-2-6)* of 4 Remove and Construct PCC Cross 2,400 SF —$—a--el ¢ $ / s Gutter* r^(w pD&j 5 Construot on Permit 1 LS $10,000 $10,000 TOTAL BASE BID (Bid Items 1-5) 1 $ 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-altemate bid 'items (if any). * The quantity for this bid item is shown for bid comparison only. This bid item shall not be subject to the "25%" limit as stated in Section 3-2 of the Standard Specifications, The actual amount for this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. t This bid item is considered a Specialty Item per Section 2-3.2 of the Standard Specifications, P-1 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 22-7537 ADDENDUM NO. ONE PROJECT NO. 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS 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 eighty (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 $750 per calendar day. Name of Firm N9 Signature of BIDDER Title r r ei, den + (If an individual, so state. If a fine or co -partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) Nobeyt /Sn,-, La/!!y /UP�r�/iz�d- p'PeSideddf� Tle¢Sa�e/' �d✓e/-' P-2 of P-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO. 22.7537 PROPOSAL PROJECT NO,: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS 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 famish 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 Signature of BIDDER 5 Title � pry Pre (If an individual, so state. If a firm or co- artnership, 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.) 90,05-v ,Tint. , ggq y 41adlal d - PI-ef4en io, 1 "sooner P-3 ofP-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO. 22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS 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: &be* 4 yI r. Business Address: -I600 Xe4e,g Ave, , 61atden i�—%Dye, c"y B� Business E-Mail Address: Ir4y t� Asbes : d 2,,/- Telephone: _ �71 q - RR — , j IO State Contractor's License No. and Class: 3 b'6 292 License Expiration Date: 7 - 31- �2 2 State Dept. of Industrial Relations (DIR) Q Registration No.:©Q lJll�� State Dept. of Industrial Relations (DIR) Registration Expiration Date: Signed: Title: P-4 of P-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO. 22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS PREVAILING WAGE COMPLIANCE AND MONITORING STATEMENT Contractor is aware of the requirements of California Labor Code Section 1720, et seq., as well as California Code of Regulations, Title 8, Section 16,000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. Since the services are being performed as part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and since the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at the commencement of this Agreement. Contractor shall make copies of the prevailing rates of per diem wages for each craft, classification or type of worker needed to execute the services available to interested parties upon request, and shall post copies at the Contractor's principal place of business and at the project site. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. The undersigned certifies that the foregoing is true and correct. Name of Firm /11.i Ae {- Signature of BIDDER p Title Yfeadma (if an individual, so state) P-5 of P-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO. 22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS: CITY OF SANTA A ) L4 r/'y /V P 4 being duly swam, 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. [.CORPORATION Tha he is of �rt s�i.tenf a corporation which is making the foregoing proposal: ❑ JOINT VENTURE That he is of one of the parties making the foregoing proposal as a joint venture, and the he/she has been and is duly vested with the authority to execute instruments for an on behalf of the parties making said bid who are: that such a bid is genuine and not collusive sham, and has not in any manner sought by collusion to secure any advantage against th City If Santa Ana or any person interested in the proposed contract, for himself or any other p son. Signature to before me this — 2JP day of AAPr' 20 '1j officer Ai#n�ttlstering Oath (Notary Public) Aunika K. Hugo COMM Y ]355759 iuo'rutr Pratte-�K�:o�+� �5 _' Orarpe COUNTY / MY COMM EXPIR2S Oa12)/2a25 P-6 of P-16 Bond No. CSBA-19034 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO. 22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS KNOW ALL PRESENT that, Nobest Incorporated , as BIDDER, and Merchants Bonding Company (Mutual) , as SURETY, are held and firmly bound unto the CITY OF SANTA ANA, as AGENCY, in the penal sum of _ Ten Percent of the Amount Bid Dollars ($10% I, which is ten percent (10%) of the total amount bid by BIDDER to AGENCY for the above -stated project, for the payment of which sun, 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 22nd day of October , 20 21. BIDDER* 7600 hWZq SURETY* 6700 Westown k0ftan Bondino CQUwai k Mutual) West Des Moir al lumna mwula umrorn,.naomey-in-Tact, 1411 N. Batavia St., suite 201, Orange, CA 92867, (714) 516-1232 Subscribed and sworn to before me this day of Signature: Notary Public in and for the County of , State of ' Provide BIDDER/ SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. P-7 of P-16 notary public or other officer completing this !rtificate verifies only the identity of the individue 7o signed the document to which this certificate attached, and not the truthfulness, accuracy, or State of California - -!- Countyof b_ (any Subscribed and sworn to (or affirmed) before me on this_ dy of a� _ �,' 24�i , by la Ar ! - proved t me on the basis of satisfactory evidence to be the person(s) who appeared before me. Aun� l COMM 0 2366766 NOTARY POOLOra COUNTY MYCOMM E%P E6001 026 (Sea ) Signature ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of _ Orange NE 10/22/2021 before me, Melissa Ann Vaccaro Notary Public (insert name and title of the officer) personally appeared Shaunna Rozelle Ostrom 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. Omy MeussAANNVACCARO� COMM, 42241394Notary Public -California S 3. ORANGECOUNTY Comm, Expires May 12, 2022 Signature Ylh\,CG (vMeal) Melissa Ann Vaccaro MERCHANT Bond No. CSBA-19034 BONDING COMPANY,. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa (herein collectively called the 'Companies) do hereby make, constitute and appoint, individually, Arturo Ayala; Ben String; Daniel Huckabay; Dwight Reilly; Frank Morons; Michael D Stong; R Nappi; Shaunna Rozelle Ostrom their true and lawful Attorney(s)-In-Fad, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidellty of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attomey Is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) an April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of MerchantsNational Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any \ foe President shall have power and authority to appoint Attorneys -In -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of Indemnity and other writings obligatory In the nature thereof." 'The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually foxed." In connection with obligations in favor of the Florida Department of Transportation only, tt is agreed that the power and aul harity hereby given to the Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It Is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or Its assignee, shall not relleve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. InWitness Whereof, the Companies have caused this instrument to be signed and sealed this 11th day of February , 2020 ,Pf10Nq�•�,•• a0\Nd•CQt�•o•. �•y : Q(LPO��.p , :•�O; QpPO/➢A-9,y - CZ MERCHANTS O DBONDING I G1 INC. NY (MUTUAL) .�:,c. MERCHANTNATIONAL ~:2 -o- m. ° .qe etc a: oj3; .Q 2003 ;;A; Wit' 1933 ;cy: By ,••d01 ...;1�.•' •,bgi.. ..•`1a • President STATE OF IOWA •i•°""""•°°�•, •••• °•�•• COUNTY OF DALLAS ss. On [his ilth dayof February 2020 before me appeared Larry Taylor, to me personally known, who being by me duty swom did say that he Is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing Instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. 1 POLLY MASON Sm Commission Number750576 MkQ10-1- My Commission Expires r January 07, 2023 Notary Public (Explmtion of rotary's commission does not Inveldate this instrument) I, Willlam Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing Is a true and correct copy of the POWER -OF -ATTORNEY executed by Bald Companies, which Is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 22nd day of October , 2021 •pun„», °• , ��.OgPOgA eDy: 'x1 2003 q :a 1933 ; e: Secretary '• , ...:p� POA 00 18 (1120) •••w•...... •°•• •,••••••-• CITY OF SANTA ANA ADDENDUM NO. ONE PROJECT NO. 22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS LIST OF SUB -CONTRACTORS Section 4100 et, seq. of the Public Contract Code requires listing of all subcontractors with the bid for all subcontract work exceeding the following amount: o Streets, highways including bridge projects: %z% of the bid or $10,000, whichever is greater o Buildings, parks, or other projects: %z% of the bid Section 1725.5 of the Public Contact 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 Licow DIR A Locati Phone Type Amon Name License #/Exp. DIR Reg. #/Exp. License # _ Location _ Phone Type Of Work Amount $ Name License #/Exp, DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ Signature of 'dde Name License #/Exp. DIR Reg. #/Exp. Location Phone Type Of Work Amount $ Name License #/Exp. DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ Name License #/Exp, DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ P-S of P-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO.22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS 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. il ee 40ae. Name and Address of Owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Name and Address of owner. Date Completed Name and Telephone Number of person familiar with project. Contract Amount _ Type of Work Date Completed 3. Name and Address of owner. Name and Telephone Nurnber of person familiar with project. Contract Amount Type of Work Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. lyll y 6a�avfa ;It Sw,'�c o201,AV? *7iy-N-l23�2 ilei -toff e ✓% pSkYriryCtL' �e 111 sePS P-9 of P-16 NOBEST INCORPORATED REFERENCE LIST Page I o. 1 Project Name/Number: Concrete Replacement Program Project Description: Remove & Replace Curb & Gutter Sidewalk Driveway, and Ramer Approximate Construction Dates: From: 3/2018 To: 8/2018 Agency Name: City of Newport Beach Contact Person: Mike Sinacori Telephone: (949) 644-3342 Original Contract Amount: $784,000 Final Contract Amount: $ 855,000 No. 2 Project Name/Number: Heil Avenue & Indianapolis Street rehabilitation Project Description: Remove & Replace Curb & Gutter $idawall s Driyeways. and Cross Gutter Approximate Construction Dates: From: 7/2018 To: 1/2019 Agency Name: City of Huntington Beach Contact Person: JoJM P, Tele hp one: (714) 536-5431 Original Contract Amount:. 1476,832 Final Contract Amount: $ 539,000 NOBEST REFERENCE LIST Page 2 No. 3 Project Name/Number: Annual Concrete Maintenance Program Project Description: >3 & R Concrete Sidewalks, Curb & Gutter, Drive Approaches. and Curb Ramps Approximate Construction Dates: From: 2/2013 To: Present Agency Name: City of Huntington Beach Contact Person: Dereck Livermore Telephone: (714) 960-8861 Original Contract Amount: $500,000 Final Contract Amount: $ In Progress No.44 Project Name/Number: Replacement of A.11ey,ADA Ramps & Sidewalk Project Description: Remove & Rep11gce Sidewalks. Alley Pavement Curb Ramps and Curb & Crutter Approximate Construction Dates: From: 8/2019 To: 9/2019 Agency Name: City of Los Alamitos Contact Person: Dave Hunt Telephone: (714) 296-5836 Original Contract Amount: $121,050 Final Contract Amount: $ 123,000 NOBEST REFERENCE LIST Page 3 No. 5 Project Name/Number: CIP Project Phase 5 Residential Street Rehabilitation Project Description: Rove & Replace Sidewalk Curb Rains Curb & Gutter, and Cross Gutter Approximate Construction Dates: From: 7/2019 To: Present Agency Name: City of La Mirada Contact Person: Eric Villagarcia Telephone: (562) 902-2373 Original Contract Amount:. 1734 839 Final Contract Amount: $ In Progress No. 6 Project Name/Number: Street Preservations Local Citywide Project Description: R move and Replace Sidewalk Curb & Cutter. Driveways Curb Raxgva aud.Allevs Approximate Construction Dates: From: 10/2018 To: 112019 Agency Name: City of Pomona Contact Person: Matt Pilarz Telephone: (909) 620-3652 Original Contract Amount: $603,406 Final Contract Amount: $ 486 00 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO. 22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS 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 die past five years. 1. f De '? ffac 44 Name and Address of Owner. N Name and Telephone Number of person familiar with project. Contract Amount Type of Work llate Completed Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed 3. Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. �ufe f 9a�67 7iy�i6-�23 tM,ileyoy Jn5,(yrance gel-Weex P-10 of P-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO. 22-7537 PROPOSAL PROJECT NO.; 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) hi conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any other BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Non -collusion Affidavit is part of jhe Proposal. BIDDERS are cautioned that making a false certification may su 'ect the certifier to criminal prosecution. Signed State of California County of VQV) Sub an wornpto (or affirmed) before me on this V day of Di 20L by fir �Q Y proved to me oAlhe bas's f ence to be the person() who appeared before me Aunik6 K. Nupo COMM M "6676Y NCr oy�P,UpgpL a NTH \ % MY Comm B%PIR660927Yt0't6 Notay Public Signa a Notary Public Seal P-1I of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 22-7537 ADDENDUM NO. ONE PROJECT NO. 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS NON-DISCRIMINATION CERTIFICATE The undersigned contractor or corporate officer, during the performance of this contract, certifies as follows: 1. 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 fumish 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 It 246 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-12 ofP-16 ADDENDUM NO. ONE CITY OT SANTA ANA PROJECT NO. 22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP iMPROVEMENTS 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 1.1246 of September 24, 1965, so that such provisions will be binding upon each subcontract or purchase order as the administering agency may direct as means of enforcing such provisions, including sanctions for noncompliance; provided, however, that in the event the Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, the Contractor may request that the United States enter into such litigation to protect the interests of the United States. 8. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as amended, no discrimination shall be made in the employment of persons upon public works because of race, religious creed, color, national origin, ancestry, physical handicaps, mental condition, marital status, or sex of such persons, except as provided in Section 1420, and any contractor of public works violating this Section is subject aa7e penalties imposed for a violation of the Chapter. Signed: Title: Firm: Ndhes� I-hf, Date: t© g6' g f P-13 ofP-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO. 22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS STATEMENT REGARDING APPRENTICESHIP REQUIREMENTS The te Labor Codenre undersigned BIDDER esnt o lhpprentiith ces,r and requirements Section that contractors ontacontracts regarding employment 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 appro 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 apprenticM work, in the same amount or upon the s basis and in the same manner ctors, except contractors not signatory o the st agreement shall pay a likalifornia Apprenticeship Council. Signed:--- Title:fFirm: hpev.-- Date: P-14 ofP-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO.22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS STATEMENT REGARDING "ANTI -KICKBACK" REOUTItEMENT5 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, any means, any person employed in the construction or repair of public work, to give up a y part the compensation to which he/she is otherwise entitled. Signed: `., Title: P�PSJ` ea Finn: !tea✓BCjf C Date: P-15 of P-16 ADDENDUM NO. ONE CITY OF SANTA ANA PROJECT NO.22-7537 PROPOSAL PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS PUBLIC CONTRACT CODE SECTION 10162 OUBSTIONNATItE In conformance with Public Contract Code Section 10162, the BIDDER shall complete, under penalty of perjury, the following questionnaire: Has the BIDDER, any officer of the BIDDER, or any employee of the BIDDER who has a proprietary interest in the BIDDER, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation? Yes No _._ If the answer is yes, explain the circumstances in the following space. P-16 of P-16 Federally Required Documents to be Submitted with Your Bid Proposal Packet and Prior to the Award of Contract Specific federal requirements must be met for this U.S. Department of Housing and Urban Development (HUD) funded project. The City of Santa Ana's Contact: Community Development Agency City of Santa Ana 20 Civic Center Plaza, M-25 Santa Ana, CA 92701 Phone (714) 647-5445 Fax (714)647-6549 www.santa-ano.orW fLi7 Y1l7aTt-&kYt1:It)xow0laww I�t IE ItI;IZil11I Ialut The following documents) MUST be fully filled out and submitted with the bid proposal naelca¢e: r • Proof of registration in the System for Award Management (www am.oy) to be filed by contractor • Proof of registration in the D&B Data Universal Numbering System fhttosZUMdate.dn&comdUndaL4k=,2ar}vlo kun.hnn • Section 3 Contract Clause (Exhibit 1). To be filed by contractor. • New Hire Calculation Form (Exhibit 2). To be filed by contractor. • Contractor's Section 3 Affirmative Action Plan (Exhibit 8). To be filed by contractor. • Section 3 Contract Award Considerations (Exhibit 9). To be fited by contractor. • Women/Minority Business Owned Enterprises Good Faith Efforts (Exhibit 12). To be filed by contractor. • Noncollusion Affidavit (Exhibit 15). To be filed by contractor. • Federal Lobbyist Requirements Certification: (Exhibit 16). To be filed by contractor. • Certification and Understanding ofAuthorizadon (Exhibit 17). To be filed by contractor and subcontractor(s). • * Additional Wage Rate Classification.* If the contractor needs an additional job classification, the contractor must submit with the bid package a written, signed request naming the work classification(s) and the wage rate(s), including any fringe benefits that are proposed. The following document(s) shall be completed by the contractor and/or subcontractor(s), as specified, and filed with the City's Labor/Section 3 Contact prior to award of contract on the project: Proof of registration in the System for Award Management (www.smn.eo) to be filed by subcontractor(s) • Section 3 Contract Clause (Exhibit 1). To be filed by subcontractor • Project Wage Rate Sheet. To be filed by contractor and any subcontractor(s). The following document(s) shall be completed by the contractor and/or subcontractor(s), as specified, and filed with the City's Labor/Section 3 Contact prior to start of construction on the project: • Section 3 Employment Opportunity Notice (Exhibit.?). To be filed by contractor and any subcontractor(s). • Section 3 Resident Certification Form (Exhibit 4). To be filed by contractor and subcontractor(s). • Section 3 Business Concern Opportunity Notice (Exhibit 5). To be filed by contractor. • Section 3 Business Concern Eligibility Certificate (Exhibit 6). To be filed by contractor and subcontractor(s). • Certification for Applicable Fringe Benefit Payments (Exhibit 13). To be filed by contractor and any subcontractor(s). • Certification ofNon-Segregated Facilities (Exhibit 14). To be filed by contractor and any subcontractor(s). • Certification with Regard to the Performance of Previous Contracts or Subcontracts Subject to the Equal Opportunity Clause and the Filing of Required Reports. To be filed by contractor and any subcontractor(s). *Note: The prime contractor is responsible for the full compliance of all employers (subcontractors) in regard to labor standards, Section 3 provisions, and W/MBE provisions applicable to this project. NOTICE:9 "This is a federally assisted construction project (CDBG funded) and Federal labor standards, including Davis -Bacon &Section 3 requirements, will be enforced." EXHIBIT 1 City of Santa Ana Section 3 Contract Clause These Clauses are to be inserted in all contracts A. The work to be performed under this contract number by and between the City of Santa Ana, hereinafter referred to as "City" and -Q- 1 hereinafter referred to as "Contractor", is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1969, as amended 12 U.S.C. 1701u (section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated HUD assistance or HUD -assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low -and very low-income persons. B. The parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135, which implement Section 3. As evidenced by their execution of this contract, the patties to this contract certify that they are under no contractual or other constraint that would prevent them from complying with the Part 135 regulations. C. The contractor agrees to send to each labor organization or representative of workers with which the Contractor has an agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the Contractor's commitments under this Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. D. The Contractor agrees to include a Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, upon a finding that the subcontractor is in violation of the regulations in 24 CFR part 135. The Contractor will not subcontract with any subcontractor where the Contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFRPart 135. E. The Contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the Contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR part 135 require employment opportunities to be dir ected, were not to circumvent the Contractor's obligations under 24 CFR part 135. F. Noncompliance with regulations in 24 CFR Part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted projects. The Contractor by this signature affixed hereto declares under penalty of p erjury: Contractor has read City requirements and accepts all its requirements contained therein for all of his/her operations within the City of Santa Ana. _ Q (P kb,)IaAj P/es,Yan,�. 1 o'a 6-,? r Si rzin ctor Print a and Title Date 3 sfa� s3afos ad Contractor License Number & Designation Federal DUNS Number EXHIBIT 2 City of Santa Ana Section 3 New Hire Calculation Form Project Name: 4OCf/ 7Yre@l Gq1J 0#►ai�j l m Project Location: V Q_r<<&o�_ &ee° -s ✓4✓vv City State Zip Contractor Name: r r 0, �e � -e- 14 [. Contractor Contact: Ka y Contractor Telephone Number: Contractor Email 1- Section 3 Resident Ming Goals Trade/Craft I Number of New Hires Total Number of New Hires: Total number of Section 3 resident new hires necessary to comply with contract: 21 EXHIBIT 3 City of Santa Ana Section 3 Employment Opportunity Notice Pursuant to Section 3 of the Housing and Urban Development Act of 1968, as amended, 12, U.S.C. 174u, the City of Santa Ana is pleased to announce construction employment opportunities for low-income individuals residing in the following area(s) of the City of Santa Ana: PROJECT(S) LOCATION(S): U. /'B`l%wr CONSTRUCTION TRADE EMPLOYMENT OPPORTUNITIES: If you have work experience in the construction trades listed above, and you live in the area(s) listed above, call r i $ ' (contractor's or subcontractor's name), at _: 7 t y -- R 11 (contractors or subcontractors telephone number) for an employment application. For additional information on the City of Santa Ana's Section 3 Economic Opportunities Plan, please call Community Development Agency, at 714-647-5445. E City of Santa Ana SECTION 3 RESIDENT CERTIFICATION FORM (2014 INCOME Guim WES) Resident's Name; S q h ✓h T .4 a 19 A Resident's Address: I hereby certify that I am a Section 3 resident, based on the following qualification(s): 1, ❑ I am a Public Housing Resident (Specify Name of the Public Housing Unit); 2. ❑ I am a low-income resident in the County of in which the Section 3 covered assistance is expended (Specify the Name of the Section 3 covered construction Check your household size, annual income level (from all sources), and specify racial and ethnic background: HOUSEHOLD SIZE INCOME LEVEL ❑ 1 ❑$61,250 or less ❑$61,250,01 ormore ❑ 2 ❑$70,000 or less ❑$70,000.01 or more ❑ 3 ❑$78,750 or less ❑$78,750.01 or more ❑ 4 ❑$87,450 or less 0$87,450.01 or more ❑ 5 ❑$94,450 or less ❑$94,450.01 or more ❑ 6 ❑$101,450 or less ❑$101,450.01 or more ❑ 7 ❑$108,450 or less ❑$108,450.01 or more ❑ 8 ❑$115,450or less ❑$115,450.01 or more RACI.u. BACKanmeio: Mark an "X" below, next to the category that best describes your origin: SINGLE CATEGORIES D411$I.F CATEGORIES ® American Indian/Alaska Native 0 American Indian or Alaska Native AND White ❑ Asian ❑ Asian AND White ❑ Black/ARican American ❑ Black or A@tcan American AND White HNative Hawadan/other Pacific Islander ElAmadcatIndian or Alaska Native AND Black or African American White ❑ Other— for individuals not identified above. ETHMCBACI(OROU": Mark an'W' below, cast to the category that best describes your ethnioity: Hispanic/Latino ❑ Not Hispanic/Latino THE UNDERSIGNED DECLARES THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT. Signature of Section 3 Resident Date To Be Completed by Employer The above -named person Ds a permanent full-time employee or Owes hired on Classification: Name of Employer: To Be Completed by Local Contracting Agency Preference Category: ❑ Targeted Service Area ® Youth build ❑ McKinney Homeless [-]Other Section 3 Income Level: ❑ Low ❑ Very Low Census Tract Number: EXHIBIT 5 City of Santa Ana Section 3 Business Concern Opportunity Notice Pursuant to Section 3 of the Housing and Urban Development Act of 1969, as amended, 12, U.S.C. 170u, the City of Santa Ana is pleased to announce building construction contract and/or subcontract opportunities for qualified Section 3 business concerns located in Santa Ana, or employing low-income Santa Ana Residents. If you reside in the City of Santa Ana, in or near the following location(s), and/or employ low-income individuals residing in or near this area, you may qualify as a Section 3 business concern: PROJECT(S) LOCATION(S): Srh/is-"f Vf CONSTRUCTION CONTRACT ACTISUBCONTRACT ACT OPPORTUNITIES If you are, or would like to be, c ertified by the City of Santa Ana as a S ection 3 business concern, and provide contract services in the construction trades listed above, call (contractor's name), at (contractor's telephone number) for contract or subcontract bidding information. For additional information on this project, call (City of Santa Ana, Project Manager), at (Project Manager's telephone number). For additional information on the City of Santa Ana's Section 3 Economic Opportunities Plan, please call the City's Community Development Department at EXHIBIT 6 City of Santa Ana Section 3 Business Concern Eligibility Certificate Name of Business: % 11 C, Address of Business: -/ /' (�O G Q `�rN U �(� A eft e L �¢il/ Telephone Number: _/I7— 99iz"fry Fax Number: %/0—.7-7? 00�� Type of Business: IJ Corporation []Partnership ❑Sole Proprietorship ❑Joint Venture Section 3 Business Concern Qualifying Basis 1 • 51 % owned by Section 3 low-income residents; or 2•_Permanent, full-time employees that include at least 30% Section 3 low-income or very low- income residents; or 3•___ Written commitment to subcontract with more than 25 % of the dollar award of all subee nstract to be awarded to business concern($) that meet either of the above (1 or 2) Section 3 qualifications. Specify Ethnicity and Gender of Business Ownership (please check one); ❑ American Indian or Alaska Native ❑ Native Hawaiian or Other Pacific Islander ❑ American Indian or Alaska Native and White ❑ Black or African American and white ❑ American Indian or Alaska Native and Black or African American ❑ Balance of Individuals reporting more than one race Gender: Male ❑ Female ❑ Asian ❑ White ❑ Asian and White ❑ Black or African American By this signature affixed hereto, I declare r penalty of perjury that the above information is correct. Print Name �� — e Date EXMBIT 7 City of Santa Ana Section 3 Contractor Compliance Report 1. Name and Address of Reporting Entity 2. Dollar Amount of Award 5. Reporting Period: (Contractor or Subcontractor): %/te� /f fa� /� qW 3.Contact Person: 6. Date Report Submitted: 4. Phone (include area code): Part I: Employment and Training Performance Job Category Total New Hires Section New Hires %of Aggregate Hires Who are Section 3 Hires Racial/Ethnic Code(s) 1 2 3 14151 6 Professionals: Technicians: OfficelClerical: Trade: Trade: Trade: Trade: Trade: Trade: Total: Part II: Contract Award to Section 3 Businesses (Contractors, Subcontractors, Suppliers, Vendors or Service Providers) Racial/Ethnic Codes: 1 = White 2 = American Indian or Alaska Native 3 = Asian 4 = Black or African American 5 = Native Hawaiian or Other Pacific Islander 6 = American Indian or Alaska Native and White 7 =Asian and White 8 = Black or African American and White 9 = American Indian or Alaska Native and Black or African American 10 = Balance of individuals reporting more than one race EXHIBIT 7 (cont.) Instructions This form is to be used to report accomplishments regarding employment, training and contracting opportunities provided to low- and very low-income persons under Section 3 of the Housing and Urban Development Act of 1968, 1. Reporting Entity: Enter the name and address of the recipient, contractor, or subcontractor(s), as appropriate. 2. Dollar Amount of Award: Enter the dollar amount, rounded to the nearest dollar, received by the contractor, or subcontractor(s). 3. & 4. Contact Person/Phone: Enter the name and telephone number of the person with knowledge of the contractor's and/or subcontractor's Section 3 Implementation Plan. 4. Reporting Perio project). d: Indicate the time period this report covers (this would be the length of the construction 5. Date Report Submitted: Enter the appropriate date. Part I: Employment and Training Performance 6. Job Category: Report job categories of newly hired employees. 7. Total New Hires: Report number of new hires by job category. 8. Section 3 New Hires: Report number of Section 3 new hires by job category. 9. Percentage of Aggreeate Hires who are Section 3 Hires: Enter the percentage of Section 3 new hires for each category. 10. RaciaUE is de: Enter the number of Section 3 new hires under appropriate raciallethnic code (1 - 5). Part II: Contract Award to Section 3 Businesses (Contractors, Subcontractors, Suppliers, Vendors or Service Providers) 11. Name of Sect ion 3 Business Concem: Enter the name of each Section 3 business concern who received a contract award, 12. Construction or Non -construction Contrack: Specify if the Section 3 business concern is a construction or non - construction contractor. 13. Contract. Amount: Enter the contract amount awarded to a Section 3 business concern. 14. Racial I Ethnic Code: Enter the number of Section 3 business concerns under appropriate racial/ethnic code (1 - 6) reflecting business ownership. EXHIBIT 8 Contractor's Section 3 Affirmative Action Plan �octl 5etee�l 4/h Ra,�� p as-iS3- Project Number and Title The undersigned contractor agrees to implement the following affirmative action steps directed at increasing the utilization of lower income residents and business concerns located within the County of Orange. 1. Take affirmative action to ensure that employees or applicants for employment or training are not discriminated against because of race, color, religion, sex or national origin. 2. Send a notice of the contractor's Section 3 commitment to each labor organization or representative of workers and p ost a copy of the notice at a conspicuous place available to employees and appl icants for employment or training. 3. To the greatest extent feasible, make a good faith effort to recruit for employment or training lower income residents from the County, and to award contracts to business concerns which are located in or owned in substantial part by persons residing in the County through use of: local advertising media, signs placed at the project site and notification to community organizations and public or private institutions operating within or serving the project area such as Service Employment and Redevelopment (SER), Opportunities Industrialization Center (OIC), Urban League, Contracted Employment Program, U.S. Employment Service, Chamber of Commerce, labor unions, trade associations and business concerns. 4. Maintain a file of all low-income area residents who applied for employment or training either on their own or on referral from any source, and the action taken with respect to each area resident. 5. Maintain a file of all business concerns located in the County who submitted a bid for work on the project, and the action taken with respect to each bid. 6. Maintain records, including copies of correspondence, memoranda, etc., which document that affirmative action steps have been taken. 7. Incorporate the Se ction 3 clause provisions in a 11 subcontracts, and r equire subcontractor(s) to submit a Section 3 Affirmative Action Plan. Company Name 10V AiQGAd Itheo0 Address treetT City, State, Zip UWIXOM G �-`r 4�r�8'4SG� DUNS Number Printed rtesi�6rr-0' Title %ard EXHIBIT 9 City of Santa Ana Section 3 Contract Award Consideration Bidder's Name: lUdbe y Y 17 C Please the the numbered statement that is applicable to your business: 1. My business qualifies as a Section 3 business concern: If you have checked statement NUMBER 1 please read the attached Section 3 Business Concern Preference - Bidding Requirements. (Please check the applicable qualification fur statement number I) yl% owned by Section 3 residents; or Permanent, full-time employees include at least 30% Section 3 residents; or Will subcontract more than 25% of the dollar award of all subcontracts to be awarded to business concem(s) that meet either of the two preceding qualifications. Note: You are required to list all subcontractors and owner -operators in your bid statement, 2. —My business does not qualify as a Section 3 business concern. Note: Section 3 business concern definitions are located in this project's Contract Documents & Spec cations Manual within the section titled Section 3 Equaknic Opportunities Plan, to-RPR c.a rpty po`Al glad _ PrintNa EXHIBIT 10 2018 Income Eligibility Chart for Section 3 Residents Check your household size, annual income level (from all sources): HOUSEHOLD SIZE INCOME LEVEL ❑ 1 ❑$61,250 or less ❑$61,250.01 or more ❑ 2 ❑$70,000 or less ❑$70,000.01 or more ❑ 3 ❑$78,750 or less ❑$78,750.01 or more ❑ 4 ❑$87,450 or less ❑$87,450.01 or more ❑ 5 ❑$94,450 or less ❑$94,450.01 or more ❑ 6 ❑$101,450 or less ❑$101,450.01 or more ❑ 7 ❑$108,450 or less ❑5108,450.01 or more ❑ 8 ❑$115,450 or less ❑$115,450.01 or more EXHIBIT 11 Efforts to Offer Training and Employment Opportunities to Section 3 Residents and Contracts to Section 3 Business Concerns Training and Employment Opportunities for Section 3 Residents • Advertising training and employment positions by distributing flyers (which identify the positions to be filled, the qualifications required, and where to obtain additional information about the application process) in the neighborhood where the Section 3 covered project is located. • Contacting neighborhood councils, resident management corporations, or other resident organizations, where they exist, in the neighborhood where the Section 3 project is located in order to notify residents of the training and employment positions to be filled. • Sponsoring (scheduling, advertising, or financing) a job informational meeting to be conducted by a contractor or representatives at a location in the neighborhood of the Section 3 covered project. • Arranging assistance for completing job applications for Section 3 residents. • Arranging for a location in the neighborhood of the project, where job applications may be delivered to and collected by the contractor or representatives. • Conducting job interviews at the location of the neighborhood where the Section 3 covered project is located. • Consulting with State and local agencies administering training programs funded through JTPA or JOBS, probation and parole agencies, unemployment compensation programs, community organizations and other officials or organizations to assist with recruiting Section 3 residents for contractor's training and employment positions. • Advertising the jobs to be filled through the local media, such as community television networks, newspapers of general circulation, and radio advertising. • Employing a job coordinator, or contracting with a business concern that is licensed in t he field of job placement (preferably one of the See tion 3 business concerns identified in part 135), that will undertake, on behalf of the contractor, the efforts to match eligible and qualified Section 3 residents with the training and employment positions that the contractor intends to fill. • Where there are more qualified Section 3 residents than there are positions to be filled, maintaining a file of eligible qualified Section 3 residents for future employment positions. • Undertaking job counseling, education and related programs in association with local educational institutions. • Undertaking such continued job training efforts as may be necessary to ensure the continued employment of Section 3 Residents previously hired for employment opportunities. • After selection of bidders but prior to execution of contracts, incorporating into the contract a negotiated provision for a specific number of Section 3residents to be trained or employed on the Section 3 covered project. Efforts to Award Contracts to Section 3 Business Concerns • Contacting business assistance agencies, minority contractors associations and community organizations to inform them of contracting opportunities and requesting their assistance in identifying Section 3 businesses which may solicit bids or proposals for contracts for work in connection with Section 3 covered assistance. EXHIBIT 11(cont.) • Providing written notice to all known Section 3 business concerns of the contracting opportunities. This notice should be in sufficient time to allow the Section 3 business concerns to respond to the bid invitations or request for proposals. • Following up with Section 3 business concerns that have expressed interest in the contracting opportunities by contacting them to provide additional information on the contracting opportunities. • Advertising the contracting opportunities through trade association papers and newsletters, and through the local media, such as community television networks, newspapers of general circulation and radio advertising. • Developing a list of eligible Section 3 business concerns. • Establishing numerical goals (number of awards and dollar amount of contracts) for award of contracts to Section 3 business concerns. EXHIBIT 12 CITY OF SANTA ANA WOMEN OWNED/MINORITYBUSINESS OWNED ENTERPRISES (W/MBE) GOOD FAITH EFFORTS Pursuant to 24 CFR Part 85 § 85.36 (e) of Code of Federal Regulations, contractor must take all necessary affirmative steps to assu re that minority business fums, women's business enterprises and labor surplus firms are used whenever possible. Contractor shall submit the following information to demonstrate that a goof faith effort has been made to comply with the above section of the Code of Federal Regulations. Submittal of this form, in and of itself, may not Provide sufficient documentation to demonstrate that goof faith effort was made. Documentation such as copies of advertisement, letters of solicitation, telephone logs, rejected quotes, etc, should accompany this form. 1. The names and dates of advertisement of each newspaper, trade paper, and minority -focus paper in which a request for W/MBE participation for this project was placed by the bidder: 2. 3. Items of Work: Breakdown of Items: Information Furnished: The names and dates of written notices sent to W/MBE soliciting bids for this project and methods used for following up initial solicitation to determine with certainty whether the W/MBE ware interested. "'he items of ich breaking down Oflthe contractsintoeeconomicallyavailable feas feasible iuritBEof firms, itate including, /MBE Participation, appropriate, d the information furnished to W/MBE such as plans, specifications, and requirements for the work. FAVO {PROPBVCM UDFORM&MBUM04AMB. 5 0,0n93pecanOC EXHIBIT 12 (cont.) 4. Efforts made to assist W/MBE in obtaining bonding, lines of credit or insurance, and any technical assistance related to the plans, specifications and requirements for the work which was provided to W/MBE: 5. Any additional data to support a demonstration of good faith effort, such as contracts with W/MBE assistance agencies: I declare under penalty ofperjury that the foregoing information is true and correct to the best of my knowledge. I understand that the City of Santa Ana and/or the US. Department o Housing and Urban Development may verb the information provided herein in connection with WIMBE comp l anc evaluation/audit activities and that failure to fully and truthfully complete this farm may result in economic or et sanettons. - _. _. I�w�,�►�r/t:�.�i'7rr<a�7t9��`_.iii�.-�.r�r�.: Contractor/Subcontractor Identification Number: (Street, City, State, Zip): Business Racial/Ethnic/Gender Code: Circle the numeric code which indicates the racial/ethnic/gender character of the owner(s) and controller(s) of 51% of the business. When 51% or more is not owned and controlled by any single racial/ethnicity/gender category, circle the code which seems most appropriate. 1= White Americans 2 = Black Americans 3 = Native Americans Woman Owned Business: Circle One: F—Ye-91 or IIMMMMA 4 = Hispanic Americans 5 = Asian/Pacific Americans 6 = Hasidic Jews m F90008'PROPSVC3VIUOFORM91M0U5604AMa• 8a WnMpan,000 EXHIBIT 13 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Los Angeles Area Office, Region IX 1615 West Olympic Boulevard Los Angles, California 90015-3801 CERTIFICATION FOR APPLLICABLE FRINGE BENEFIT PAYMENTS Project Name:_ G(/CaI Stleet (,pwh Re V ;�ih a Project Number: 2 " % 9-7 Classificatlnu/Frlugelienefits Provided 1} Health and Welfare $ Pension $ Vacation $ A renticeship /Training $ 2) Health and Welfare $ Pension $ Vacation $ Apprenticeship / Trainina $ 3) Health and Welfare $ Pension $ Vacation $ Apprennceahip /Training $ 4) Health and Welfare $ Pension $ Vacation $ Apprenticeship / Trainina $ OR: (CI-IECK IF APPLICABLE) Name, Address and Telephone Number of Plan/Fund Program — I certify that I do not make payments to approved fringe benefit plans, funds, or programs. Contractor/Subcontractor Date Signature Tide F,'MGS%PROPSVCSWUOFeRMMMBUOBU4AMB. SeoBonUBpooaeee EXHIM 14 CERTIFICATION OF NON -SEGREGATED FACILITIES Federally Assisted Projects The Federally assisted construction contractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their service at any location, under his control, where segregated facilities are maintained. The federally assisted construction contractor certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The Federally assisted construction contractor agrees that a breach of this certification is a violation of the Equal Opportunity clause in this contract. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because of habit local custom or otherwise, The Federally assisted construction contractor agrees that (except where he has obtained identical certifications from proposed subcontractor(s) for specific time periods) he will obtain identical certifications from proposed subcontracter(s) prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the equal Opportunity clause, and that he Witt retain such certifications in his files, NOTE: The penalty for malting false statements in offers is prescribed in 18 U.S.C.1001 Con M Titl Date: d -gk ✓^ oL F:1000swROpsvcouDFORMSAM9e6a84AMB. 6"dIUMISPUC9.aee To the City of EXHIBIT 15 NONCOLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) DEPARTMENT OFPUBLIC 1n accordance 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 orsolicited 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 fiom 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. Name of Contractor A'UD 04 Address i. ode.? Ceave., C Q /a Date F'.1000SWROPSVOMUOFORMS1M8U88U4AMa. Secllo n9Spaw.boe EXHIBIT 16 FEDERAL LOBBYIST REQUIREMENTS CERTIFICATION // Name of Firm: d beg � —1—nC.. Date: Address: �%y (/ a i�� It C!'4 Ave State: _ Cy Zip Code: _7c2o ii Telephone: 7t W" Acting on behalf of the above named firm as its Authorized Official, I make the following Certification to the Department of Housing and Urban Development (HUD) and the Community Development Commission, County of Los Angeles: 1) No Federal appropriated funds have been paid, by or on behalf of the above -named firm to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of C ongress, or an employee of a Member of Congress in co nnection with the awarding of any Federal contract, the making of any Federal grant, loan, or cooperative agreement, and any extension, continuation, renewal, amendment, or modification thereof; and 2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee or any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the above -named firm shall complete and submit Standard Form—LLL, "Disclosure Form to Report Lobbying" in accordance with its instructions; and 3) The above -named firm shall require that the language of this certification be included in the award documents for all sub -awards at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into the transaction imposed by Section 1352 Title 31 U.S, Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Authorized Official: Name: �n r(i ! UO`p� l a',,d Signature: F:IDOCSIPROPSVCS%HUDFORMSIMBU6BU4NVa - Sec11oOSpeea.D00 EXHIBIT 17 CERTIFICATION OF UNDERSTANDING AND AUTHORIZATION ProjectName: I'd of / � rre'e° (tab ka ProjectNumber: _��7s This is to certify that the principals and the authorized payroll officer, below, have read and understand the labor standards clauses pertaining to the subject project, The following person(s) is designated as the payroll officer for the undersigned and is authorized to sign the Statement of Compliance, which will accompany our weekly certified payroll reports for this project; k4 v Alerpeol Payroll fficer's Name / Payrol Of cer's ignature �iden Title to - 9-4,-ou Date Contractor/Subcontractor License No. DUNS Number F:VOOCSWROPSVC$ViU0FORMMMeU6804AMe-SedonMpam.000 Federal Labor Standards Provisions U.S. Department of Housing and Urban Development Office of Labor Relations Applicability The Project or Program to which the construction work covered by this contract pertains is being assisted by the United States of America and the following Federal Labor Standards Provisions are Included in this Contract pursuant to the provisions applicable to such Federal assistance. A. 1. (1) Minimum Wages. All laborers and mechanics employed or working upon the site of the work, will 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 are permitted byr egulations Issued by the Secretary of Labor under theC opeland Act (29 CFR Part 3), the full amount of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment computed at rates not less than[ hose contained in the wage determination of [has ecretary of Labor which is attached hereto and made a part hereof, 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 fide fringe benefits under Section I(b)(2) of the Davis -Bacon Act on behalf oft aborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of 29 CFR 5.5(a)(1)(iv); also, regular contributions made or costs incurred for more than a weekly perlof (but not less oftent han quarterly) under plans, funds, or programs, whichc over the particular weekly perief, are deemed to bec onstructively made or incurred during such weekly periof. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determinationf or the classification of work actually performed, withoutr egard to skill, except as provided in 29 CFR 5.5(a)(4). Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein: Provided, That the employer's payroll records accurately set forth the time spent in each classification In which work is performed. The wage determination (including any additional classification and wage rates conformed under 29 CFR 5.6(a)(1)(II) and the Davis -Bacon poster (WH- 1321) shall be posted at all times by the contractor and its subcontractors at the site of the work In a prominent and accessible, place where It can be easily seen by the workers. (11) (a) Any class of laborers or mechanics which is notl fisted In the wage determination and which is to be employed under the contract shall be classified in conformance with the wage determination. HUD shall approve an additional classification and wage rate andf rings benefits therefor only when the following criteria have been met: (1) The work to be performed by the classificationr squested is not performed by a classification in the wage determination; and (2) The classification is utilized in the area by the construction Industry; and (3) The proposed wage rate, including any bona fidef rings benefits, bears a reasonable relationship to thew age rates contained in the wage determination. (b) If the contractor and the laborers and mechanics to be employed in the classification (if known), or their representatives, and HUD or Its designee agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate), a report of the action taken shall be sent by HUD or its designee to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor, Washington, O.C. 20210. The Administrator, or an authorized representative, will approve, mafify, or disapprove every additional classification action within 30 days of receipt and so advise HUD or Its designee or will notify HUD or its designee within the 30-day period that additional time Is necessary. (Approved by the Office of Management and Budget under OMB control number 1215- 0140.) (c) In the event the contractor, the laborers or mechanics to be employed in the classification or their representatives, and HUD or its designee do not agree ont he proposed classification and wage rate (Including the amount designated for fringe benefits, where appropriate), HUD or Its designee shall refer the questions, includingt he views of all interested parties and the recommendation of HUD or its designee, to the Administrator for determination. The Administrator, or an outhorizedr epresenlative, will Issue a determination within 30 days ofr eceipt and so advise HUD or Its designee or will notify HUD or Its designee within the 30-day period that additional time is necessary. (Approved by the Office of Management and Budget under OMB Control Number 1215.0140.) (d) The wage rate (including fringe benefits where appropriate) determined pursuant to subparagraphs( 1)(ii)(b) or (c) of this paragraph, shall be paid to all workers performing work in the classification under this contract from the first day on which work Is performed in the classification. (ill) Whenever the minimum wage rate prescribed in the Contract for a class of laborers or mechanics Includes a fringe benefit which Is not expressed as an hourly rate, the contractor shall either pay the benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. (iv) If the contractor does not make payments to a trustee or other third person, the contractor may consider as part form HUD4010 (0612009) Previous editions are obsolete Page 1 of 6 ref. Handbook 1344.1 of the wages of any laborer or mechanic the amount of any costs reasonably anticipated In providing bona fide fringe benefits under a plan or program, Provided, That the Secretary of Labor has found, upon the written request oft he contractor, that the applicable standards of the Davis - Bacon Act have been met. The Secretary of Labor may require the contractor to set aside In a separate account assets for the meetfng of obligations under the plan or Program. (Approved by the Office of Management and Budget under OMB Control Number 1215-0140,) 2, Withholding, HUD or Its designee shall upon its own action or upon written request of an au(horizedr apreseniative of the Department of Labor withhold ore ause to be withheld from the contractor under this c ontract or any other Federal contract with the same prime c ontractor, or any other Federally -assisted contract ubjoot to Davis -Bacon prevailing wage requirements,w hich is held by the same prime contractor so much of these trued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees and helpers, employed by the contractor or any subcontractor the full amount of wagesr squired by the contract In the event of failure to pay anyl aborer or mechanic, including any apprentice, trainee or helper, employed or workingon the site of the work, all or part of the wages required by the contract, HUD or Its designee may, after written notice to the contractor, sponsor, applicant, or owner, take such action as may be necessary to cause the suspension of any further Payment, advance, or guarantee of funds until such violations have ceased. HUD or Its designee may, after written notice to the contractor, disburse such amounts withheld for and on account of the contractor or subcontractor to the respective employees to whom they are due, The Comptroller General shall make such disbursements In the case of direct Davis -Bacon Act contracts, 3. (1) Payrolls and basic records. Payrolls and basic records relating thereto shell be maintained by the contractor during the course of the work preserved for a Parfet of three years thereafter for all laborers and mechanics working at the site of the work. Such records shall contain the name, address, and social security number of each such worker, his or her correct classification, hourly rates of wages paid (Including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types descrlbedl n Section I(b)(2)(B) of the Davls-bacon Act), dally andw eekly number of hours worked, deductions made andac tual wages paid. Whenever the Secretary of Labor bast ound under 29 CFR 5.5 (a)(1)(iv) that the wages of any[ aborer or mechanic include the amount of any costs r easonably anticipated In providing benefits under a plan or program described In Seotlon I(b)(2)(B) of the Davis - Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits Is enforceable, that the plan or program is financially responsible, and that the plan or program has been Previous editions are obsolete communicated In writing to the laborers or mechanics affected, and records which show the costs anticipated art he actual cost incurred In providing such benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of that egistration of apprenticeship programs and certification oftr since programs, the registration of the apprentices andtr alnses, and the ratios and wage rates prescribed In the applicable programs. (Approved by the Office of Management and Budget under OMB Control Numbers 1215-0140 and 1215-0017.) (11) (a) The contractor shall submit weekly for each week) n which any contract work Is performed a copy of all payrolls to HUD or Its designee If the agency is a party to the contract, but If the agency is not such a party, the contractor will submit the payrolls to the applicant sponsor, or owner, as the case may be, for transmission to HUD or Its designee. The payrolls submitted shall set out accurately and completely all of the Information requiredl o be maintained under 29 CFR 5.50)(3)(1) except that fulls octal security numbers and home addresses shall not bet ncluded on weekly transmittals. Instead the payrolls shall only need to Include an individually identifying number for each employee (e.g., the last four digits of the employee's social security number). The required weekly payroll Information may be submitted in any form desired. Optional Form WH-347 is available for this purpose fromt he Wage and Hour Division Web site at hg2YIwww dot uv/esa6yhd/forms/wh347in tr htm or Its s uccessor site. The prime contractor is responsible fort he submission of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the full s0e101 security number and current address of each covered worker, and shall provide them upon request to HUD or its designee if the agency Is a party to the contract, but If the agency is not such a party, the contractor will submit the payrolls to the applicant sponsor, or owner, as the 00e0 may be, for transmission to HUD or its designee, the contractor, or the Wage and Hour Division of the Department of Labor for purposes of and nvestigation or audit of compliance with prevailing wager equirements. It Is not a violation of this subparagraph fora Prime contractor to require a subcontractor to provide addresses and $octal security numbers to the prime contractor for its own records, without weekly submealont o HUD or Its designee, (Approved by the Office of Management and Budget under OMB Control Number 1215.0149.) (b) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervlsest he payment of the persons employed under the contract and shall certify the following: (1) That the payroll for the payroll periof contains thel nformation required to be provided under 29 CFR 5.5( the appropriate Information is being maintained under 29 CFR 5.5(a)(3)(I), and that such information is correct and complete; Page 2 of 6�„ Bret. (2) That each laborer or mechanic (including each helper, is not registered or otherwise employed as stated above, apprentice, and trainee) employed on the contract duringt shall be paid not less than the applicable wage rate on the he payroll period has been paid the full weekly wages wage determination for the classification of work actually earned, without rebate, either directly or indirectly, andt performed. In addition, any apprentice performing work onl hat no deductions have been made either directly on he job site In excess of the ratio permitted under they ndlreclly from the full wages earned, other than eglstered program shall be paid not less than the permissible deductions as set forth in 29 CFR Part 3; applicable wage rate on the wage determination for the (3) That each laborer or mechanic has been paid not less work actually performed. Where a contractor is performing than the applicable wage rates and fringe benefits or cash construction on a project in a locality other than that in equivalents for the classification of work performed, as which its program is registered, the ratios and wage rates( specified in the applicable wage determinatloni expressed in percentages of the journeyman's hourlyr ncorporated into the contract. ate) specified In the contractor's or subcontractor'sr egistered program shall be observed. Every apprentice (c) The weekly submission of a properly executed must be paid at not less than the rate specified In thei certification set forth on the reverse side of Optional Form eglstered program for the apprentice's level of progress, e WH-347 shall satisfy the requirement for submission of the` xpressed as a percentage of the journeymen hourly rates Statement of Compliance' required by subparagraphA pacified in the applicable wage determination.A .3.(ii)(b). pprentices shall be paid fringe benefits In accordance (d) The falsification of any of the above certifications may with the provisions of the apprenticeship program. If the subject the contractor or subcontractor to civil or criminal apprenticeship program does not specify fringe benefits, prosecution under Section 1001 of Title 18 and Section apprentices must be paid the full amount of fringe benefits 231 of Title 31 of the United States Cafe. listed on the wage determination for the applicable ([it) The contractor or subcontractor shall make ther classification. If the Administrator determines that a ecords required under subparagraph A.3.(I) available forl different practice prevails for the applicable apprentice nspectlon, copying, or transcription by authorizedr classification, fringes shall be paid in accordance with thal epresentatives of HUD or its designee or the Department determination. In the event the Office of Apprenticeship of Labor, and shall permit such representatives to Training, Employer and Labor Services, or a State Interview employees during working hours on the job. If Apprenticeship Agency recognized by the Office, the contractor or subcontractor fails to submit the requiredr withdraws approval of an apprenticeship program, the ecords or to make them available, HUD or its designee contractor will no longer be permitted to utilize may, after written notice to the contractor, sponsor, apprentices at less than the applicable predetermined rate applicant or owner, take such action as may be necessary for the work performed until an acceptable program Is to cause the suspension of any further payment, advance, approved. or guarantee of funds. Furthermore, failure to submit they (11) Trainees. Except as provided in 29 CFR 5.16.1 squired records upon request or to make such records ralness will not be permitted to work at less than the available may be grounds for debarment action pursuant to predetermined rate for the work performed unless they are 29 CFR 5.12. employed pursuant ',to and individually registered In a 4..Apprentices and Trainees. program which has received prior approval, evidenced byl (I) Apprentices. Apprentices will be permitted to work ail ormal certification by the U.S. Department of Labor, ass than the predetermined rate for the work they Employment and Training Administration. The ratio all performed when they are employed pursuant to and[ rainees to journeymen on the job site shall not be greater) ban permitted under the plan approved by the ndivldually registered in a bona fide apprenticeship Employment and Training Administration. Every trainee program registered with the U.S. Department of Labor, must be geld at not less than the rate specified In the Employment and Training Administration, Office of approved program for the trainee's level of progress, Apprenticeship Training, Employer and Labor Services, or expressed as a percentage of the journeyman hourly rate with a State Apprenticeship Agency recognized by the specified In the applicable wage determination. Trainees Office, or If a person is employed In his or her first 80 shall he paid fringe benefits In accordance with the days of probationary employment as an apprentice In such provisions of the trainee program. If the trainee program an apprenticeship program, who is not individuallyt does not mention fringe benefits, trainees shall be paid egistered in the program, but who has been certified byt the full amount of fringe benefits listed on the wage he Office of Apprenticeship Training, Employer and Labors determination unless the Administrator of the Wage and ervlces or a State Apprenticeship Agency (where Hour Division determines that there Is an apprenticeship appropriate) to be eligible for probationary employment as Program associated with the corresponding journeyman an apprentice. The allowable ratio of apprentices to wage rate the wage which provides for journeymen on the job site In any craft classification shall for ass then full fringe benefits for apprentices. Any full benefits not be greater than the ratio permitted to the contractor eat employee listed on the payroll at a trainee rate who is notr o the entire work force under the registered program. Anyw eglstered and participating in a training plan approved by orker listed on a payroll at an apprentice wage rate, who Previous editions are obsolete form HUD4010 (06=09) Page 3 of 5 ref. Handbook 1344.1 the Employment and Training Administration shall be paid not less then the applicable wage rate on the wage determination for the work actually performed. In add Nlon, any trainee performing work on the job alto In excess oft he ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less thant he applicable predetermined rate for the work performed until an acceptable program is approved. (III) Equal employment opportunity. The utilization of apprentices, trainees and Journeymen under 29 CFR Part 5 shall be in conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR Part 30. 5. Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR Part 3 which are Incorporated by reference in this contract 6. Subcontracts, The contractor or subcontractor will Insert In any subcontracts the clauses contained in subparagraphs 1 through 11 in this paragraph A and such other clauses as HUD or Its designee may by appropriate Instructions require, and a copy of the applicable Prevailing wage decision, and also a clause requiring the subcontractors to Include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in this paragraph. 7. Contract termination; debarment. A breach of the contract clauses In 29 CFR 5.6 may be grounds fort erminatlon of the contract and for debarment as a c ontractor and a subcontractor as provided In 29 CFR 5,12. 8. Compliance with Davis -Bacon and Related Act Requirements. All rulings and Interpretations of the Davis -Bacon and Related Acts contained in 29 CFR Parts 1, 3, and 6 are herein Incorporated by reference in this contract 9. Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall not be subJect to the general disputes clause of this contract. Such disputes shall be resolved In accordance with the procedures of the Department of Labor set forth In 29 CFR Parts 5, 6, and 7. Disputes within the meaning of this clause include disputes betweent he contractor (or any of its subcontractors) and HUD orit s designee, the U.S. Department of Labor, or the employees or their representatives. 10, (1) Certification of Eligibility. By entering Into this contract the contractor certifies that neither It (nor he or she) nor any person or firm who has an Interest In the contractor's firm is a person or firm Ineligible to be awarded Government contracts by virtue of Section 3(a) oft he Davis -Bacon Act or 29 CFR 5.12(a)(1) or to be awarded HUD contracts or participate in HUD programs pursuant to 24 CFR Part 24. (11) No part of this contract shall be subcontracted to any person or firm Ineligible for award of a Government contract by virtue of Section 3(a) of the Davis -Bacon Act or 29 CFR 5,12(a)(1) or to be awarded HUD contracts or participate In HUD programs pursuant to 24 CFR Part 24, (III) The penalty for making false statements is prescribedi In the U.S. Crlmtnal Cofe, 18 u,S.C. 1001. Additionally, U .S. Criminal Cofe, Section 1 01 0, Title 18, U.S.C.,"F ederal Housing Administration transactions`, provides in part: "Whoever, for the purpose of . , . Influencing in any way the action of such Administratlon...., makes, utters or publishes any statement knowing the some to be false..... shall be fined not more than $5,000 or imprisoned not more then two years, or both." 11. Complaints, Proceedings, or Testimony by Employees. No laborer or mechanic to whom the wage, salary, or other labor standards provisions of this Contract are applicable shall be discharged or In any other manner discriminated against by the Contractor or any subcontractor because such employee has filed any complaint or instituted or caused to be Instituted any proceeding or has testified or Is about to testify In any proceeding under or relatingto the labor standards applicable under this Contract to his employer, B. Contract Work Hours and Safety Standards Act. The provisions of this paragraph B are applicable where the amount of the prime contract exceeds $100,000, As used in this paragraph, the terms "laborers" and "mechanics" include watchmen and guards. (1) Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or Involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic In any workweek In which the Individual Is employed on such work to work In excess of 40 hours in such workweek unless such laborer or mechanic receives compensation at a rate not less then one and one-half times the basic rate of pay for all hours worked in excess of 40 hours In such workweek. (2) Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause self Orin In subparagraph (1) of this paragraph, the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each indlvlduall aborer or mechanic, Including watchmen and guards, employed In violation of the clause sat forth In subparagraph (1) of this paragraph, in the sum of $10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of 40 hours vdthcut payment of the overtime wages required by the clause set forth in sub paragraph (1) of this paragraph. Previous editions are obsolete form HUD4010 (0612009) Page 4 of 5 ref. Handbook 1344A (3) Withholding for unpaid wages and liquidated damages. HUD or Its designee shall upon Its own action or upon written request of an authorized representative aft he Department of Labor withhold or cause to be wlthheld,fr om any moneys payable on account of work performed byt he contractor or subcontractor under any such contract or any other Federal contract with the same prime contract, or any other Federally -assisted contract subject to the Contract Work Hours and Safety Standards Act which is hold by the same prime contractor such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages andl iquidated damages as provided in the clause set forth Ins ubparagraph (2) of this paragraph. (4) Subcontracts. The contractor or subcontractor shaltt nsert in any subcontracts the clauses set forth ins ubparagraph (1) through (4) of this paragraph and also so lause requiring the subcontractors to include thesecl auses In any lower tier subcontracts. The primec ontraclor shall be responsible for compliance by anys ubcontractor or lower tier subcontractor with the clausess at forth In subparagraphs (1) through (4) of this paragraph. C. Health and Safety. The provisions of this paragraph C are applicable where the amount of the prime contract exceeds $100,000. (1) No laborer or mechanic shall be required to work in surroundings or under working conditions which are unsanitary, hazardous, or dangerous to his health and safety as determined under construction safety and health standards promulgated by the Secretary of Labor byr egulation. (2) The Contractor shall comply with all regulations! ssued by the Secretary of Labor pursuant to Title 29 Part 1926 and failure to comply may result in imposition of sanctions pursuant to the Contract Work Hours and Safely Standards Act, (Public Law 91.64, 83 Stat 96). 40 USC 3701 at sea. (3) The contractor shall Include the provisions of this paragraph in every subcontract so that such provisions will be binding on each subcontractor. The contractor shall take such action with respect to any subcontractor as the Secretary of Housing and Urban Development or the Secretary of Labor shall direct as a means of enforcing such provisions. Previous editions are obsolete form HUD-4010 (06/2009) Page 5 of 5 rof. Handbook 1344.1 _.._ ..,.r....... 0 Office of Labor Relations (Exp. 09/..30/200) Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. The information Is considered non -sensitive and does not require special protection. This information Is required to obtain benefits. This agency may not collect this Information, and you are not required to complete this form, unless It displays a currentiyvalld OMB control number. Employers engaged on HUD -assisted construction projects subject to Davis -Bacon wage requirements must pay no less than the wages determined to be prevailing by the Secretary of Labor to all laborers and mechanics engaged on the construction work. On occasion, the applicable Davla-Bacon wage decision does not contain all of the work classifications and wage rates needed to complete the construction work. This Information collection facilitates the addition of needed work classifications and wage rates for the construction work involved. This form is used by HUD and local agencies administering HUD programs to report employer requests) for additional classification and wage rates so that an appropriate wage rate can be approved by the Depadment of Labor for the construction work. This Information collection is required by Department of Labor regulations at 29 CFR 5.5. While no assurances of confidentiality are pledged to respondents, HUD generally discloses these data only In response to a Freedom of Information request. Instructions General: Contractors/Employers: Do not need to complete this form. Submit a written, signed request to the responsible contracting agency naming the work classifications and the wage rates, including any fringe benefits, that are proposed. Local Agency Staff: Complete Items 2 through 10. Submit one copy of this form to the responsible HUD Labor Relations Office with a copy of the applicable Davis -Bacon wage decision and the written request from the employer naming the work classifications and wage rates that are proposed. (The employer's request must be made in writing and must be signed.) 1. For HUD or State CDBG Office use. Enter the name and address of HUD Office (or State CDBG office) submitting the report and to which the DOL reply should be sent. 2. Enter the name and number of the project or contract involved. 3. Enter the location of the project involved: city, county and state. 4. Describe the construction involved, e.g., new construction or rehabilitation, number and type of buildings, number of stories, number of units (as applicable). For example, New construction: 3-4-story buildings; 120 units. 6. Enter the character of construction as defined by DOL for Davis -Bacon prevailing wage rate purposes. 6. Enter the number of the Davis -Bacon wage decision applicable to the construction work. Include the number of wage decision modifications (If any) applicable to the work. 7. Enter the effective date of the wage decision for the project. (See DOL regulations at 29 CFR 1.6.) S. Enter the work classifications and corresponding hourly basic wage rates and fringe benefit rates (if any) requested. 9. Self-explanatory. 10, If the requesting employer is not the prime contractor, enter the name and address of the subcontractor/employer making the request. Remainder of Farm; HUD Labor Relations/State CDBG use. HUD Labor Relations/State CDBG Staff: Evaluate the employer's request against the criteria for approval (see DOL Regulations, 29 CFR Part 5, and related contract labor standards provisions). The criteria are reflected in "checklist" form to ensure that each factor Is considered and to ensure that supporting documentation, Including a copy of the applicable wage decision, Is attached. Check the box next to each criterion that Is met; do not check the box next to any criterion that Is not met. If the request meets all criteria, check the appropriate box, enter the name and telephone number of the HUD/State CDBG agency representative, and sign and date the form. Submit one copy of the completed form to the DOL with a copy of the applicable Davis -Bacon wage decision and the written request from the employer Involved. If the request fails to pass all criteria, check the appropriate box, enter agency contact information, and sign and date the form. Submit one copy of the completed form to the DOL with a copy of the applicable Davis -Bacon wage decision, the written request from the employer Involved, and a cover letter explaining how the employer's request failed to meet one or more of the criteria. Submission of Report Completed forms shall be sent to: Branch of Construction Wage Determinations, U.S. Department of Labor, 200 Constitution Avenue, NW, Room S-3014, Washington, DC 20210. HUD-42304 (e-03) PREVIOUS EDITION IS OB$OLEM U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT HUD FORM 4236A REPORT OF ADDITIONAL CLASSIFICATION AND RATE ONIBAppmval Number 001-80" (Exp. 0e1swow) 1. FROM (name and address of requesting agency) a. PROJECT NAME AND NUMBER s. LOCATION OF PROJECT (City, County and State) 4. BRIEF DESCRIPTION OF PROJECT 5. CHARACTER OF CONSTRUCTION ❑ Building ❑ Residential Heavy ❑ Other (specify) Highway 6. WAGE DECISION NO. (Include modl0catlon number, if any) 7. WAGE DECISION EFFECTIVE DATE ❑ COPY ATTACHED g, WORK CLASSIFICATION(S) HOURLY WAGE RATES BASIC WAGE FRINGE BENEFIT(S) (if any) 9. PRIME CONTRACTOR (name, address) 1a. SUBCONTRACTOR/EMPLOYER, IF APPLICABLE (name, address) Check All That Apply. ❑ The work to be performed by the additional classifications) is not performed by a classification In the applicable wage decision. ❑ The proposed cleaslOcation is utilized in the area by the construction Industry. rate($), Including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in ❑ The proposed wage the wage decision. The interested parties, Including the employees or their authorized representatives, agree on the classlflcatlon(s) and wage rate(s). ❑ ❑ Supporting documentation attached, including applicable wage decision. Check On®: El Approved, meets all criteria. DOL confirmation requested. fall to most all criteria as explained In agency referral. DOL decision requested. ❑ One or more Classifications FOR HUD USE ONLY MOW Agency Representative Dare Log in: (Typed name and signature) Log out: Phone Number HU0.6200A (8-08) PREVIOUS EDITION Is EMPLOYEE RIGHTS UNDER THE DAVIS-BACON ACT FOR LABORERS AND MECHANICS EMPLOYED ON FEDERAL OR FEDERALLY ASSISTED CONSTRUCTION PROJECTS THE UNITED STATES DEPARTMENT OF LABOR WAGE AND HOUR DIVISION PREVAILING You must be paid not less than the wage rate listed in the Davis -Bacon WAGES Wage Decision posted with this Notice for the work you perform. OVERTIME You must be paid not less than one and one-half times your basic rate of pay for all hours worked over 40 in a work week. There are few exceptions. ENFORCEMENT Contract payments can be withheld to ensure workers receive wages and overtime pay due, and liquidated damages may apply if overtime pay requirements are not met. Davis -Bacon contract clauses allow contract termination and debarment of contractors from future federal contracts for up to three years. A contractor who falsifies certified payroll records or induces wage kickbacks may be subject to civil or criminal prosecution, fines and/or imprisonment. APPRENTICES Apprentice rates apply only to apprentices properly registered under approved Federal or State apprenticeship programs. PROPER PAY If you do not receive proper pay, or require further Information on the applicable wages, contact the Contracting Officer listed below: or contact the U.S. Department of Labor's Wage and Hour Division. U.S. Department of Labor Employment Standards Administration Wage and Hour Division WH 182r(Rol",i rR 2009) DERECHOS DEL EMPLEADO BAJO LA LEY DAVIS-BACON PARA OBREROS Y MECANICOS EMPLEADOS EN PROYECTOS DE CONSTRUCCION FEDERAL 0 CON ASISTENCIA FEDERAL LA SECCION DE HORAS Y SUELDOS DEL DEPARTAMENTO DETRABAJO DE EEUU Salarios No se le puede pager menos de la tasa de pago indicada on la Decisi6n de Salarios Prevalecientes Davis -Bacon fijada con este Aviso pare el trabajo que Ud. desempena. Sobretiempo Se Is ha de pagar no menos de tiempo y medio de su tasa basica de pago por todas las horas trabajadas an exceso de 40 an una semana laboral. Existen pocas excepciones. Cumplimiento Se pueden retainer pagos por contratos para asegurarse que los obreros reciban los salarios y el pago de sabretlempo debidos, y se podria aplicar Banos y perjuicios si no se cumple con las exigencies del pago de sobretiempo. Las clausulas contractuales de Davis -Bacon permiten la terminaci6n y exclusion de contratistas Dare efectuar futuros contratos federales haste tres anos. El contratista que falsifque los registros certificados de las n6minas de pago o induzca devoluciones de salarios puede ser sujeto a procesamiento civil o criminal, multas y/o encarcelamiento. Aprendices Las tasas de aprendices solo se aplican a aprendices correctamente inscritos bajo programas federales o estatales aprobados. Pago Si Ud. no recibe el pago apropiado, o precise de informaci6n adicional sobre los Apropiado salarios aplicables, p6ngase an contacto con el Contratista Oficlal que aparece abajo: o p6ngase an contacto con la Secci6n de Horas y Sueldos del Departamento de Trabajo de EEUU. Para obtenerinformad61n adicional: 1-866-4-USWAGE WHO(1-866-487-9243 TTY. 1-877-889-5627 WWW.WAGEHOU R.DOL.GOV U.S. Department of Labor I Employment standards Administration I Wage and Hour Division WH 10919PA(Re,o EA 1tl 91 REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS I. General It. Nondiscrimination Ili. Nonsegregated Facilities IV. Davis-Baoon and Related Act Provisions V. Contract Work Hours and Safety Standards Act Provisions VI. Subletting or Assigning the Contract VI I. Safety: Accident Prevention Vlil. False Statements Concerning Highway Projects IX Implementation of Clean Air Act and Federal Water Pollution Control Act X. Compliance with Govemmentwide Suspension and Debarment Requirements XI. Certification Regarding Use of Contract Funds for Lobbying ATTACHMENTS A. Employment and Materials Preference for Appalachian Development Highway System or Appalaohian Local Access Road Contracts (Included in Appalachian contracts only) I. GENERAL 1. Form FHWA4273 must be physically incorporated in each construction contract funded under Title 23 (excluding emergency contracts solely Intended for debris removal), The contractor (or subcontractor) must insert this form in each subcontract and further require Its incluslon In all lower tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services). The applicable requirements of Form FMA-1273 are Incorporated by reference for work done under any purchase order, rental agreement or agreement for other services. The prime contractor shall be responsible for corn planes by any subcontractor, lower -ter subcontractor or service provider. Form FHWA-1273 must be included In all Federal-ald design - build contracts, In all subcontracts and in lower ter subcontracts (excluding subcontracts for design services, purchase orders, rental agreements and other agreements for supplies or services). The design -builder shall be responsible for compliance by any subcontractor, lower -ter subcontractor or service provider. Contracting agencies may reference Form FHWA-1273 in bid proposal or request for proposal documents, however, the Form FHWA-1273 must be physically Incorporated (not referenced) in all contracts, subcontracts and lower -tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services related to a construction contract). 2. Subject to the applicability criteria noted In the following sections, these contract provisions shall apply to all work performed on the contract by the contractor's own organization. and with the assistance of workers under the contractor's Immediate superintendence and to all work performed on the contract by piecework, station work, or by subcontract. FHWA-1273 -- Revised May 1, 2012 3. A breach of any of the stipulations contained In these Required Contract Provisions may be sufficient grounds for withholding of progress payments, withholding of final payment, termination of the contract, suspension / debarment or any other action determined to be appropriate by the contracting agency and FHWA. 4. Selection of Labor: During the performance of this contract, the contractor shall not use convict labor for any purpose within the limits of a construction project on a Federal -aid highway unless it Is labor performed by convicts who are on parole, supervised release, or probation. The term Federal -aid highway does not include roadways functionally classified as local roads or rural minor collectors. 11. NONDISCRIMINATION The provisions of this section related to 23 CFR Part 230 are applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The provisions of 23 OFR Part 230 are not applicable to material supply, engineering, or architectural service contracts. In addition, the contractor and all subcontractors must comply with the following policies: Executive Order 11246, 41 CFR 60, 29 CFR 16215A627, The 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), Title VI of the Civil 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 contractor and all subcontractors must comply with: the requirements of the Equal Opportunity Clause in 41 CFR 60- 1.4(b) and, for all construction contracts exceeding $10,000, the Standard Federal Equal Employment Opportunity Construction Contract Specifications In 41 CFR 60-4.3. Note: The U.S. Department of Labor has exclusive authority to determine compliance with Executive Order 11246 and the policies of the Secretary of Labor Including 41 CFR 60, and 29 CFR 1626-1627. The contracting agency and the FHWA have the authority and the responsibility to ensure compliance with Title 23 USC Section 140, the Rehabilitation Act of 1973, as emended (29 USC 794), and Title VI of the Civil 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 following provision Is adopted from 23 CFR 230, Appendix A, with appropriate revisions to conform to the U.S. Department of Labor (US DOL) and FHWA requirements. 1. Equal Employment Opportunity: Equal employment opportunity (EEO) requirements not to diacriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, rules, regulations (26 CFR 35, 29 CFR 1030, 29 CFR 1625-1627, 41 CFR 60 and 49 CFR 27) and orders of the Secretary of Labor as modified by the provisions prescribed heroin, and imposed pursuant to 23 U.S.C. 140 shall constitute the EEO and specific affirmative action standards for the contractor's project activities under this contract. The provisions of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 at seq.) set forth under 28 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 following minimum specific requirement activities of EEO: a. The contractor will work with the contracting agency and the Federal Government to ensure that it has made every good faith effort to provide equal opportunity with respect to all of b terms and conditions of employment and in their review of activities under the contract. b. The contractor will accept as its operating policy the following statement: "It Is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age or disability. Such action shall Include: employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other fors of compensation; and selection for training, Including apprenticeship, pre -apprenticeship, and/or on-the- job training " 2. EEO Officer. The contractorwill designate and make known to the contracting officers 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 authority and responsibility to do SO. 3. Dissemination of Policy: All members of the contractor's staff who are authorized to hire, supervise, promote, and discharge employees, orwho recommend such action, or who are substantially Involved in such action, will be made fully cognizant or, and will implement, the contractors EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above agreement will be met, the following actions will be taken as a minimum: a. Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and then not less often than once every six months, at which time 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 Officer, covering all major aspects of the contractors EEO obligations within thirty days following their reporting for duty with the contractor. c. All personnel who are engaged In direct recruitment for the project will be Instructed by the EEO Officer in the contractors procedures for locating and hiring minorities and women. d. Notices and posters setting forth the contractors EEO policy will be placed In areas readily accessible to employees, applicants for employment and potential employees. e. The contractors EEO policy and the procedures to implement such policy will be brought to the attention of employees by means of meetings, employee handbooks, or other appropriate means. 4, Recruitment When advertising for employees, the contractor will include in all advertisements for employees the notation: "An Equal Opportunity Employer." All such advertisements will be placed In publications having a large circulation among minorities and women In the area from which the project work force would normally be derived. a. The contractor will, unless precluded by a valid bargaining agreement, conduct systematic and direct recruitment through public and private employee referral sources likely to yield qualified minorities and women. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such Identified sources procedures whereby minority and women applicants may be referred to the contractor for employment consideration. b. In the event the contractor has a valid bargaining agreement providing for exclusive hiring hall referrals, the contractor is expected to observe the provisions of that agreement to the extent that the system meets the contractors compliance with EEO contract provisions. Where Implementation of such an agreement has the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Federal nondiscrimination provisions. c. The contractor will encourage Its present employees to refer minorities and women as applicants for employment. Information and procedures with regard to referring such applicants will be discussed with employees. 5. Personnel Actions: Wages, working conditions, and employee benefits shall be established and administered, and personnel actions of every type, including hiring, upgrading, promotion, transfer, demotion, layoff, and termination, shall be taken without regard to race, color, religion, sex, national origin, age or disability. The following procedures shall be followed: a. The contractor will conduct periodic Inspections of project sites to insure that working conditions and employee facilities do not indicate discriminatory treatment of project site personnel. b. The contractor will periodically evaluate the spread of wages paid within each dasslncation to determine any evidence of discriminatory wage practices. c. The contractor will periodically review selected personnel actions in depth to determine whether them is evidence of discrimination. Where evidence is found, the contractor will promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all affected persons. d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor in connection with Its obligations under this contract, will attempt to resolve such complaints, and will take appropriate corrective action within a reasonable time. If the Investigation Indicates that the discrimination may affect persons other than the complainant, such corrective action shall 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. The contractor will assist in locating, qualifying, and Increasing the skills of minorities and women who are applicants for employment or current employees, Suchefforts should be aimed at developing full journey level status employees In the type of trade or]ob classification involved. b. Consistent with the contractors work force requirements and as permissible under Federal and State regulations, the contractor shall make full use of training programs, I.e., apprenticeship, and on-thegob training programs for the geographical area of contract performance. In the event a speclal provision for training is provided under this contract, this subparagraph will be superseded as Indicated in the special provision. The contracting agency may reserve training positions for persons who receive welfare assistance In accordance with 23 U.S,C, 140(a). c. The contractor will advise employees and applicants for employment of available training programs and entrance requirements for each. d. The contractor will periodically review 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: If the contractor relies In whole or in part upon unions as a source of employees, the contractor will use good faith efforts to obtain the cooperation of such unlons to increase opportuni0es for minorities and women. Actions by the contractor, either directly or through a contractor's association acting as agent, will Include the procedures set forth below: a. The contractor will use good faith efforts to develop, In cooperation with the unions, joint training programs aimed toward qualifying more minorities and women for membership In the unions andincreasing the skills of minorities and women so that they may qualify for higher paying employment. b. The contractor will use good faith efforts to Incorporate an EEO clauseinto each union agreement to the end that such union will be contractually bound to refer applicants without regard to their race, color, religion, sex, nationalorigin, 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 the labor union and such labor union refuses to furnish such Information to the contractor, the contractor shall so certify to the contracting agency and shall set forth what efforts have been made to obtain such Information. d. In the event the union is unable to provide the contractor with a reasonable flow of referrals within the time limit set Forth In the collective bargaining agreement, the contractor will, through independent recruitment efforts, fill the employment vacancies without regard to race, color, religion, sex, national origin, age or disability; making full efforts to obtain qualified andlor qualifiable minorities and woman. The failure of a union to provide sufficient referrals (oven though It Is obligated to provide exclusive referrals under the terms of a collective bargaining agreement) does not relleve the contractor from the requirements of this paragraph. In the event the union referral practice prevents the contractor from meeting the obligations pursuant to Executive Omer 11246, as amended, and these special provisions, such contractor shall Immediately notify the contracting agency. 8. Reasonable Accommodation for Applicants / Employees with Disabilities; The contractor must be familiar with the requirements for and comply with the Americans with Disabilities Act and all rules and regulations established there under. Employers must provide reasonable accommodation In all employment activities unless to do so would cause an undue hardship. . 9. Selection of Subcontractors, Procurement of Materials and teasing of Equipment: The contractor shall not discriminate on the grounds of race, color, religion, sex, national origin, age or dlaabllly, In the selection and retention of subcontractors, Including procurement of materials and leases of equipment. The contractor shall take all necessary and reasonable steps to ensure nondiscrimination in the administration of this contract. a. The contractor shall notify all potential subcontractors and suppliers and lessors of their EEO obligations under this contract. b. The contractor will use good faith efforts to ensure subcontractor compliance with their EEO obligations, 10. Assurance Required by 49 CFR 20.13(b): a. The requirements of 49 CFR Part 26 and the State , DOTS U.S. DOT -approved DBE program are incorporated by reference. b. The contractor or subcontractor shall not discriminate on the basis of moo, color, national origin, or sex in the Performance of this contract. The contractor shall carry out applicable requirements of 49 CFR Part 26 in the award and administration of DOT -assisted contracts. Failure by the contractor to carry out these requirements is a material breach of this contract, which may result In the termination of this contract or such other remedy as the contracting agency deems appropriate. 11. Records and Reports: The contractor shall keep such records as necessary to document compliance with the EEO requirements. Such records shall be retained for a period of three years following the date of the final payment to the contractor for all contract work and shall be available at reasonable times and places for Inspection by authorized representatives of the contracting agency and the FHWA. a. The records kept by the contractor shall document the following: (1) The number and Work hours of minority and non. minority group members and women employed In each work classification on the project; (2) The progress and efforts being made In cooperation vAh unions, when applicable, to Increase employment opportunities for minorities and women; and (3) The progress and efforts being made In locating, hiring, training, qualifying, and upgrading minorities and women; b, The contractors and subcontractors will submit an annual report to the contracting agency each July for the duration of the project, Indicating the number of minority, women, and non•minorty group employees currently engaged In each work classification required by the contract work. This information Is to be reported on Form FHW6•1391. The staffing data should represent the project work force on board in all or any part of the last payroll period preceding the end of July. If on-the-job tmlhing Is being required by special provision, the contractor will be required to collect and report training data. The employment data should reflect the work force on board during all or any part of the last payroll period preceding the end of July. Ill. NONSEGREGATED FACILITIES This provision is applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The contractor must ensure that Facilities provided for employees are provided In such a manner that segregation on the basis of race, color, religion, sex, or national origin cannot result. The contractor may neither require such segregated use by written or oral policies nor tolerate such use by employee custom. The contractors obligation extends further to ensure that its employees are not assigned to perform their services at any location, under the contractor's control, where the facilities are segregated. The tens "facilities" Includes waiting rooms, work areas, restaurants and other eating areas, time docks, restrooms, washrooms, locker moms, and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing provided for employees. The contractor shall provide separate or single -user restroonts and necessary dressing or sleeping areas to assure privacy between sexes. IV. DAVIS-BACON AND RELATED ACT PROVISIONS This section Is applicable to all Federal -aid construction projects exceeding $2,000 and to all related subcontracts and lower -der subcontracts (regardless of subcontract size). The requirements apply to all projects located within the right-of- way of a roadway that is functionally classified as Federal -aid highway. This excludes roadways functionally classified as local roads or rural minor collectors, which are exempt Contracting agencies may elect to apply these requirements to other projects. The following provisions am from the U.S. Department of Labor regulations In 29 CFR 5.5 "Contract provisions and related matters°with minor revisions to conform to the FHWA- 1273 format and FHWA program requirements. 1. Minimum wages a. All laborers and mechanics employed or working upon the site of the work, will 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 are permitted by regulations Issued by the Secretary of Labor under the Copeland Act (29 CFR part 3)), the full amount of wages and bona fide fringe benelfls (or cash equivalents thereof) due at time of payment computed at rates not less than those contained In the wage determination of the Secretary of Labor which Is attached hereto and made a part hereof, 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 fide fringe benefits under section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of paragraph 1.d. of this section; also, regular contributions made or costs Incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs which cover the particular weekly period, are deemed to be constructively made or Incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to skill, except as provided In 29 CFR 5.5(a)(4). Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein: Provided, That the employer's payroll records accurately set forth the time spent in each classification in which work Is performed. The wage determination (Including any additional classification and wage rates conformed under paragraph 1.b. of this section) and the Davis -Saran poster (WH-1321) shall be posted at all times by the contractor and its subcontractom at the site of the work in a prominent and accessible place where It can be easily seen by the workers. b.(1) The contracting officer shall require that any class of laborers or mechanics, Including helpers, which Is not listed in the wage determination and which is to be employed under the contract shall be classified in conformance with the wage deternlnallon. The contracting officer shall approve an additional classification and wage rate and fringe benefits therefore only when the following criteria have been met: (1) The work to be performed by the classification requested is not performed by a classification in the wage determination; and (11) The classification is utilized in the area by the construction Industry; and Oil) The proposed wage rate, Including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (2) It the contractor and the laborers and mechanics to be employed in the classification (if known), or their representatives, and the contracting officer agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate), a report of the action taken shall be sent by the contracting officer to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor, Washington, DC 20210. The Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30-day period that additional time is necessary. (3) In the event the contractor, the laborers or mechanics to be employed in the classification or their representatives, and the contracting officer do not agree on the proposed classification and wage rate [Including the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions, Including the views of all interested parties and the recommendallon of the contracting officer, to the Wage and Hour Administrator for determination. The Wage and Hour Administrator, or an authorized representative, will Issue a determination within 30 days of receipt and so advise the contracting officer or will notify the contracting of eorwithin the 30-day period that additional time Is necessary. (4) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs 1.b.(2) or 1.b.(3) of this section, shall be paid to all workers performing work in the ciasslncation 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 for a Gass of laborers or mechanics Includes a fringe benefit which Is not expressed as an houdy rate, the contractor shall edher pay the benefit as stated In the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. d. If the contractor does not make payments to a trustee or other third person, the contractor may consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona tide fringe benefits under a plan or program, Provided, That the Secretary of Labor has found, upon the written request of the contractor, that the applicable standards of the Davis -Bacon Act have been met. The Secretary of Labor may require the contractor to set aside in a separate account assets for the meeting of Obligations under the plan or program. 2. Withholding The contracting agency shell upon Its own action or upon written request of an authorized representafive of the Department of Labor, withhold or cause to be withheld hors the contractor under this contract, or any other Federal contract with Nte same prime contractor, ar any other faderally- asslstW contract subject is Davis -Bacon prevailing wage rsquirements, which Is held by the same prima contractor, so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, Including appremices, trainees, and helpers, employed by the wntractor or any subcontractor the full amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, Including any apprentice, trainee, or helper, employed or working on the site of the work, all or part of the wages required by the contract, the contracting agency may, after written notice to the contractor, take such action as may be necessary to cause the suspension of any further Payment, advance, of guarantee of funds until such violations have ceased. 3. Payrolls and basic records a. Payrolls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all laborers and mechanics working at the site of the work. Such records shall contain the name, address, and social security number of each such worker, his or her correct clasSi ication, hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe beneflts or cash equivalents thereof of the types described In section 1(b)(2)(B) of the Davis -Bacon Act), daily and weekly number of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1 )(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)(S) of the Davls- Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits Is enforceable, that the plan or program is financially responsible, and that the plan or program has been communicated In writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost Incurred in providing such benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs, the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applleable programs. b.(1) The contractor shall submit weekly for each week In which any contract work is performed a copy of all payrolls to the contracting agency. The payrolls submitted shall set out accurately and completely all of the information required to be maintained under 29 CFR 5.5(e)(3)(I), except that full social security numbers end home addresses shall not be included on weekly transmlttals. Instead the payrolls shall only need to Include an individually Identifying number for each employee the last four digits of the employeo'5 soots) securty number). The required weeky payroll information may be submlited In any form desired. Optional Form W H-3471s available for this purpose from the Wage end Hour Division Web Gte at httpa/ww,v.do6gov/esa/whd/forms/wh3471nstr.htm or its successor afte. Tha prime contractor is rasponslble for Me submission of copies of payroll, by all subcontractors. Contractors and subcontractors shall maintain the full social security number and current address of each covered worker, and shall provide them upon request to the contracting agency I transmission to the State DOT, the FHWA or the Wage and Hour Division of the Department of Labor for purposes of an investlgation or audit of compliance with prevailing wage requirements. It is not a violation or this section for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for Its own records, without weekly submisslon to the contracting agency.. (2) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractoror his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (1) That the payroll for the payroll period contains the information required to be provided under §5.6 (a)(3)(fi) of Regulations, 29 CFR part 5, the appropriate Information is being maintained under §5.5 (a)(3)(1) of Regulations, 29 CFR part 5, and that such Information is correct and complete; (II) That each laborer or mechanic (Including each helper, apprentice, and trainee) employed on the contract during the payroll period has been paid the full weekly wages earned, without rebate, either directly or Indirectly, and that no deductions have been made either directly or indirectly, from the full wages earned, other than Permissible deductions as set forth In Regulations, 29 CFR part 3; (ill) That each laborer or mechanic has been pall not less than the applicable wage rates and fringe benefits or cash equivalents for the classification of work performed, as specified In the applicable wage determination Incorporated into the contract. (3) The weekly submission of a property executed certification set forth on the reverse side of Optlonal Form WH-347 shall satisfy the requirement for submission of the 'Statement of Compliance' required by paragraph 3.b.(2) of this section. (4) The falsfication of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under section 1001 of title 18 and section 231 of title 31 of the United States Code. C. The contractor or subcontractor shall make the records required under paragraph 3.a. of this section available for inspection, copying, or transcription by authorized representatives of the contracting agency, the State DOT, the FHWA, or the Department of Labor, and shall permit such representatives to interview employees during working hours on the job. if the contractor or subcontractor fails to submit the required records orto make them available, the FHWA may, after written notice to the contractor, the contracting agency or the State DOT, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12, 4. Apprentices and trainees a. Apprentices (programs of the USDOL). Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered In a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticaship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or If a person is employed in his or her first 90 days of probationary employment as an apprentice in such an apprenticeship program, who is not Individually registered in the program, but who has been certified by the Office of Apprenticeship Training, Employer and Labor Services or a State Apprenticeship Agency (where appropriate) to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices to journeymen on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work fame under the registered program. Any worker listed on a payroll at an apprentice wage rate, who Is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the redo permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor is performing constructlon on a project in a locality other than that in which its program is registered, the ratios and wage rates (expressed In percentages of the journeyman's hourly rate) specified in the contractors or subcontractor's registered program shall be observed. Every apprentice must be paid at not less than the rate specified In the registered program for the apprentice's level of progress, expressed as a percentage of the journeymen hourly rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with the provisions of the apprenticeship program. IF the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetemrined rate for the work performed until an acceptable program is approved. b. Trainees (programs of the USDOL). Except as provided In 29 CFR 6.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to end individually registered in a program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified In the approved program for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified In the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the previsions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there Is an apprenticeship program associated with the corresponding journeyman wage rate an the wage determination which provides for less than full fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who Is not registered and participating in a training plan approved by the Employment and Training Administration shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any trainee performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less than the applicable predetemmined rate for the work performed until an acceptable program is approved. c. Equal employment opportunity. The utilization of apprentices, trainees and journeymen under this part shall be in contonnity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR part 30. d. Apprentices and Trainees (programs of the U.S. DOT). Apprentices and trainees working under apprenticeship and skill training programs which have been certified by the 3eraetary of Transportation as promoting EEO in connection wgh Federal -aid highway construction programs are not subject to the requirements of paragraph 4 of this Section IV. The straight time hourly wage rates for apprentices and trainees under such programs will be established by the particular programs. The ratio of apprentices and trainees to Journeymen shall not be greater than permitted by the terms of the particular program. 5. Complianoe with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR part 3, which are incorporated by reference In this contract. 6. Subcontracts. The contractor or subcontractor shall insert Form FHWA-12731n any subcontracts and also require the subcontractors to Include Form FHWA-1273 in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR 5,5. 7. Contract termination: debarment. A breach of the contract clauses in 29 CFR 5.5 may be grounds for terminatlon of the contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR 6.12, 6. Compliance with Davis -Bacon and Related Act requirements. All rulings and Interpretations of the Davis - Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in [hie contract. % Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall not be subject to the general disputes clause of this contract. Such disputes shall be resolved In accordance with the procedures of the Department of Labor set forth In 29 CFR parts 5, 6, end 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, the U,S. Department of Labor, or the employees or their representatives. 10. Certification of eligibility. a. By entering into this contract, the contractor certifies that neither It (nor he or she) nor any person or firm who has an Interest in the contractors firm Is a personor firm ineligible to be awarded Government contracts by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 6.12(a)(1). b. No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract by virtue of section 3(a) of the Davis-Baoun Act or 29 CFR 6,12(a)(1). c. The penalty for making false statements is prescribed in the U.S. Criminal Code, 16 U.S.C, 1001. V. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT The following clauses apply to any Federal-ald construction contract In an amount in excess of $100,000 and subject to the overtime provisions of the Contract Work Hours and Safety Standards Act. These pauses shall be inserted In addition to the clauses required by 29 CFR 6.6(a) or 29 CFR 4A. As used in this paragraph, the terms laborers and mechanics Include watchmen and guards. 1. Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or Involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic In any workweek In which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours In such workweek. 2. Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth In paragraph (1.) of this section, the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for Iiquldated damages. Such liquidated damages shall be computed with respect to each Individual laborer or mechanic, including watchmen and guards, employed In violation of the clause set forth in paragraph (1.) of this section, in the sum of $10 for each calendar day on which such individual was required or permitted to work In excess of the standard workweek of forty hours out payment of the overtime wages required by the clause set forth In paragraph (1.) of this section. 3, Withholding for unpaid wages and liquidated damages. The FHWA or the contacting agency shall upon Its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the some prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is hold by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paregraph (2.) of this section. 4. Subcontracts. The contractor or subcontractor shall insert In any subcontracts the clauses set forth In paragraph (1.) through (4.) of this section and also a clause requiring the subcontractors to Include these clauses In any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth In paragraphs (1.) through (4.) of this section. VI. SUBLETTING OR ASSIGNING THE CONTRACT This provision is applicable to all Federal -aid construction contracts on the National Highway System. 1. The contractor shall perform with its own organization contract work amounting to not less than 30 percent (or a greater percentage if specified elsewhere in the contract) of the total original contract price, excluding any specialty hems designated by the contracting agency. Specialty hems may be performed by subcontract and the amount of any such specialty hems performed may be deducted from the total original contract price before computing the amount of work required to be performed by the contractors own organization (23 CFR 635.116). a. The term "perform work with its own organization* refers to workers employed or leased by the prime contractor, and equipment owned or rented by the prime contractor, with or without operators. Such term does not Include employees or equipment of a subcontractor or lower tier subcontractor, agents of the prime contractor, or any other assignees. The term may include payments for the costs of hiring leased employees from an employee leasing firm meeting all relevant Federal and State regulatory requirements. Leased employees may only be included in this term If the prime contractor meals all of the following conditions: (1) the prime contractor maintains control over the 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 all power to accept or exclude individual employees from work on the project; and (4) the prime contractor remains ultimately responsible for the payment of predetermined minimum wages, the submission of payrolls, statements of compliance and all other Federal regulatory requirements. b. "Specialty hems" shall be construed to be limited to work that requires highly specialized knowledge, abilities, or equipment not ordinarily available in the type of contracting organizations qualified and expected to bid or propose on the contract as a whole and in general are to be limited to minor components of the overall contract. 2. The contract amount upon which the requirements set forth in paragraph (1) of Section VI Is computed includes the cost of material and manufactured products which are to be purchased or produced by the contractor under the contract provisions. 3. The contractor shall furnish (a) a competent superintendent or supervisor who Is employed by the firm, has full authority to direct performance of the work in accordance with the contract requirements, and is in charge of all construction operations (regardless of who performs the work) and (b) such other of its own organizational resources (supervision, management, and engineering services) as the contracting officer determines is necessary to assure the performance of the contract. 4. No portion of the contract shell be sublet, assigned or otherwise disposed of except with the written consent of the contracting officer, or authorized representative, and such consent when given shall not be construed to relieve the contractor of any responsibility for the fulfiliment of the contract. Written consent will be given only after the contracting agency has assured that each subcontract is evidenced in writing and that it contains all pertinent provisions and requirements of the prime contract. 5. The 30%self-performance requirement of paragraph (1) is not applicable to design -build contracts; however, contracting agencies may establish their own self -performance requirements. VII. SAFETY: ACCIDENT PREVENTION T h i s p r o v i s i o n I s applicable to all Federal -aid construction contracts and to all related subcontracts. 1. In the performance of this contract the contractor shall comply with all applicable Federal, State, and local laws governing safety, health, and sanitation (23 CFR 635). The contractor shall provide all safeguards, safety devices and protective equipment and take any other needed actions as It determines, or as the contracting officer may determine, to be reasonably necessary to protect the life and health of employees on the job and the safety of the public and to protect property in connection with the performance of the work covered by the contract. 2. It Is a condition of this contract, and shall be made a condition of each subcontract, which the contractor enters Into pursuant to this contract, that the contractor and any subcontractor shall not permit any employee, in performance of the contract, to work in surroundings or under conditions which are unsanitary, hazardous or dangerous to his/her health or safety, as determined under construction safety and health standards (29 CFR 1926) promulgated by the Secretary of Labor, In accordance with Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 3704). 3. Pursuant to 29 CFR 1926.3, it is a condition of this contract that the Secretary of Labor or authorized representative thereof, shall have right of entry to any site of contract performance to inspect or investigate the matter of compliance with the constnrctlon safety and health standards and to carry out the duties of the Secretary under Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C.3704). VIII, FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS T h F c p r a v I s f o n i s applicable to all Federal-eld construction contracts and to all misted subcontracts. In order to assure high quality and durable construction in conformity with approved plans and specifications and a high degree of reliability on statements and representations made by engineers, contractors, suppliers, and workers on Federal - aid highway projects, It Is essential that all persons concerned with the project perform theirfunctions as carefully, thoroughly, and honestly as possible. Willful falsification, distortion, or misrepresentation with respect to any facts related to the project is a violation of Federal law. To prevent any misunderstanding regarding the seriousness of these and similar acts, Form FHWA-f022 shall be posted on each Federal-ald highway project (23 CFR 635) In one or more places where it is readily available to all persons concerned with the project: 16 U.S.C. 1020 reads as follows: "Whoever, being an officer, agent, or employee of the United States, or of any State or Territory, or whoever, whether a Person, association, Brm, or corporation, knowingly makes any false statement, false representation, or false report as to the character, quality, quantity, or cost of the material used or to be used, or the quantity or quality of the work performed or to be performed, or the cost thereof In connection with the submission of plans, maps, specifications, contracts, or costs of construction on any highway or related project submitted for approval to the Secretary of Transportation; or Whoever knowingly makes any false statement, false. representation, false report or false Claim with respect to the character, quality, quantity, or cost of any work performed or to be performed, or materials furnished or to be furnished, in connection with the construction of any highway or related project approved by the Secretary of Transportation; or Whoever knowingly makes any false statement or false representation as to material fact In any statement, certificate, or report submitted pursuant to provisions of the Federal -aid Roads Act approved July 1, 1916, (39 Stat. 355), as amended and supplemented; Shall be fined under this title or Imprisoned not more than 5 Years or both." IX. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. By submission of this bld/proposal or the execution of this contract, or subcontract, as appropriate, the bidder, proposer, Federalaid construction contractor, or subcontractor, as appropriate, will be deemed to have stipulated as follows: 1. That any person who is orwill be utilized in the Performance of this contract is not prohibited from receiving an award due to a vtafation of Section 608 of the Clean Water Act or Section 306 of the Clean Air Act. 2. That the contractor agrees to include or cause to be Included the requirements of paragraph (1)ofthis Section X In every subcontract, and further agrees to take such action as the 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 all Federal -aid Construction contracts, design -build contracts, subcontracts, lower -tier subcontracts, purchase orders, lease agreements, consultant contracts or any other covered transaction requiring FHWA approval or that Is estimated to cost $25,000 or more — as defined In 2 CFR Parts 180 and 1200, 1. Instructions for Certification — First Tier Participants; a. By signing and submitting this proposal, the prospective first tier participant Is providing the certification set out below. b. The Inability of a person to provide the certification set out below will not necessarily result in dental of participation In this covered transaction. The prospective first tier participant shall submit an explanation of why It cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter Into this transaction. However, failure of the prospective first tier participant to furnish a certlficatlon or an explanation shall disqualify such a person from participation In this transaction. o. The certification In this clause is a material representation of fact upon which reliance was placed when the contracting agency determined to enter into this transaction. If It is later determined that the prospective participant knowingly rendered an erroneous certification, In addition to other remedies available to the Federal Government, the 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 participant learns that Its Certification was erroneous when submitted or has become erroneous by reason of changed circumstances. e. The terms "covered transaction," "debarred," suspended,""ineligible,""participant,""person," "principal," and "voluntarily excluded," as used In this clads. are defined in 2 CFR Parts 180 and 1200. "First Tfer Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Pardelpanr refers to the participant who has entered Into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tler Participant" refers any participant who has entered Into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). If. The prospective first tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter Into any lower tier covered transaction with a person who Is debarred, suspended, declared ineligible, or voluntarily excluded from Participation In this covered transaction, unless authorized by the department or agency entering Into this transaction, g. The prospective first tier participant further agrees by submitting this proposal that It will Include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exeluslon-Lower Tier Covered Transactions," provided by the department or contracting agency, entering Into this covered transaction, without modification, in all lower tier covered transactions and In all solicitations for lower tier covered transactions exceeding the $26,000 threshold. h. A participant In a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneoue, A participant is responsible for ensuring that Its principals are not suspended, debarred, or otherwise ineligible to participate In covered transactions, To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each Participant may, but Is not required to, check the Excluded Parties List System webske (httna•/fwww eols oov/), which Is complied by the General Services Administration, 1. Nothing contained in the foregoing shall be construed to require the establishment of a system of records in order to render in good fahh the certification required by this clause. The knowledge and Information of the prospective participant is not required to exceed that which Is normally possessed by a prudent person in the ordinary course of business dealings. j. Except for transactions authorized under paragraph (f) of these Instructions, if a participant in a covered transaction knowingly enters Into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, In addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 2. Certification Regarding Debarment, Suspension, ineligibility and Voluntary Exclusion —First Tier Participants: a. The prospective first tier participant certifies to the best of its knowledge and belief, that it and Its principals: (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency; (2) Have not within a three-year pedod preceding this proposal been convicted of or had a civil Judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen pmperty; (3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated In paragraph (a)(2) of this certification; and (4) Have not within a three-year period preceding this applicadonlproposal had one or more public transactions (Federal, State or local) terminated for cause or default. b. Where the prospective participant Is unable to certify to any of the statements In this certification, such prospective participant shall attach an explanation to this proposal. 2. Instructions for Certification - Lower Tier Participants: (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200) a. By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b. The certification in this clause Is a material representation of fact upon which reliance was placed when this transaction was entered Into. If It Is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department, or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. c. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted M at any time the prospective lower tier participant learns that its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended," "ineliglble,"'participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200. You may contact the person to which this proposal Is submitted for assistance In obtaining a copy of those regulations. "First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Ter Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered Into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participantwho has entered Into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). e. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter Into any lower Her covered transaction with a person who is debarred, suspended, declared Ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. f. The prospective lower der participant further agrees by submitting this proposal that it will Include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and In all solicitations for lower her covered transactions exceeding the $25,000 threshold. g. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntadly excluded from the covered transaction, unless It knows that the certification Is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate In covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower der prospective participants, each participant may, but Is not required to, check the Excluded Parties List System website (httpsJ/www.eiAs.!3ov/ , which is complied by the General Services Administretlon. h. Nothing contained In the foregoing shall be construed to require establishment of a system of records In order to render in good faith the certification required by this clause. The knowledge and information of participant Is not required to exceed that which Is normally possessed by a prudent person In the ordinary course of business dealings. I. Except for transactions authorized under paragraph a of these Instructions. M a participant In a covered transaction knowingly enters Into a lower der covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation In this transaction, In addition to other remedies available to the Federal Government, the 10 department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion —Lower Tier Participants: 1. The prospective lower tier participant canines, by submission of this proposal, that neither it nor Its principals Is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating In covered transactions by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements In this certification, such Prospective participant shall attach an explanation to this proposal. XI, CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING This provision Is applicable to all Federal -aid consbuction contracts and to all related subcontracts which exceed $100.000 (49 CFR 20). 1. The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: a. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to Influence an of0cer 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 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. b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to Influence an officer or employee 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 Form to Report Lobbying," in accordance with Its instructions, 2. 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 31 U.S.C. 1352. Any person who falls 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. S. The prospective participant also agrees by submitting its bid or proposal that the participant shall require that the languageof this certification be Included In all lower tier subcontracts, which exceed $100,000 and that all such recipients shall certify and disclose accordingly. 11 CITY OF SANTA ANA APPENDIX I PROJECT NO.: 22-7537 LOCAL STREET CURB RAMP IMPROVEMENTS IMPROVEMENT LOCATIONS rrecorueu In VI'FIGH21 INeVVLubi vruuyn Vvaaney 10111111111Clerk-Recorder it ll ioiiii�11N7 FEE1l 202185000917 3:25 pm 11/03/21 $63 Vitindx Z01 0.00 60.00 0.00 0.00 0.00 0.00 0,00 0.00 MAYOR CITY MANAGER Vinanle sarmlento Kristin Ridge MAYORPROTEM CITYATTORNEY David Penalazs •,yr' 'J .s Sonia R, Carvalho COUNCIL MEMDERS CLERK OF THE COUNCIL Phil Domino Delay Gomez Johnothan Ryan Hemandez Joasla Lopez •• Nellda Mandate Thal Met Phan PUBLIC WORKS AGENCY 20 CNio Center Plaza (M-30) P.O. BOX 1008. Date Ana, California 02702 (714) 647-a00D • Fax (714) 047.5523 w .santa-anaam NOTICE OF EXEMPTION From the Requirements of the California Environmental Quality Act (CEQA) Fee Exemption per California Government Code Section 61D3 To: COUNTY CLERIC From: Cityof Sants Ana County of Orange Public Works Agency P.O. Sax 238 20 Ctvic Cantor Plaza (M-38) Saints Ana, CA 92702 Santa Ana, CA 02702 �^^ Prajeat Tllle: Project Number(s): Project Location: City: Santa Ana ^. Project Description: M Applrcard Name: ^� Applicant Addrasa: ti Local Street Curb Ramp Improvements 22-7637 Santa Anita;Winsor Village North; Centennial Park&New Horizon neighborhoods County: Orange ER Number: ER•2021-114 Date of Approval: Scope of work involves removal & replacement of Portland Cement Concrete City of Santa Ana, Public Works Agency 20 Civic Center Plaza M-36 Saints Ana, CA 02702 It Name of Public Agency Approving Project: city Council „may Name of Agency Carrying Out Project: Public Works Agency Y, Examptstatus: M Ministerial (Sac. 15268) Lt Declared Emergency (Sao, 15269 (a)) CI Emergency Project (Sec.15269 (b through a)) 0 General Rule (Sec, 15061(b)(3)1(6)) ON04/2021 FILED NOV 0 3 2021 ORANGE COUNTY C DERDEPARTMENT RY: DEPUTY POSTED NOV 0 3 2021 L7 Statutory Exemption: ORANGE COUNTY CLE ^R'ECORDER DEPARTMENT 0 Categorical Exemption: 163D1(c) gY;W DEPUTY Reason(s) Why Pmjoct to Exempt From CEQA: 16301(c) consists of existing highways and streets, sidewalks, gutters, bloyde and pedestrian trails, and similar facilities City Contact; Victor So Title: Assistant Engineer Telephone: (714) 647-6076 Signature: SANTAANA CITY COUNCIL Date: t1�5�2Yt�_ Yelearb eamllento eavw Permlow Rai VIOL Phan Jesaio Lopez PhMa"Waa Johnalhsn RyanHomandez NOW MOMM May Maya PmTem,Ward2 Ward V M3 MM4 Ward Ward ysarminnbl&a¢Mamna ma; ¢B6MIIITraCoasenmana am ;IgIMn(daenlaana „m ; n0 ,6aeenlaana.em : ohaoena saMe.enn.om irvanhemnrxfexaaennta•anoam pmmCL0z9L%eaMn•anaom The Orange Countil Register 1771 S. Lewis Street Anaheim, CA92805 714-796-2209 5211379 CNSB / CNSB-ACCOMMODATIONS 915 E 15T ST ORDER EXPEDITING LOS ANGELES, CA 90012-4050 FILE NO. CNS-3515302 AFFIDAVIT OF PUBLICATION STATE OF CALIFORNIA, SS. County of Orange I am a citizen of the United States and a resident of the County aforesaid; I am over the age of eighteen years, and not a party to or interested in the above entitled matter. I am the principal clerk of The Orange County Register, a newspaper of general circulation, published in the city of Santa Ana, County of Orange, and which newspaper has been adjudged to be a newspaper of general circulation by the Superior Court of the County of Orange, State of California, under the date of November 19, 1905, Case No. A-21046, that the notice, of which the annexed is a true printed copy, has been published in each regular and entire issue of said newspaper and not In any supplement thereof on the following dates, to wit; 09/2912021, 10106/2021 I certify (or declare) under the penalty of perjury under the laws of the State of California that the foregoing is true and correct: Executed at Anaheim, Orange County, California, on Date: October 06, 2021. Signature is Glv- city I will Bids Y via M or and Bids. For .-intorma- n how to r a a ven- er a: htto ore or PROOF OF PUBLICATION Legal No. 0011490702 � A 0 0 0 0 0 5 8 4 7 5 8 2� enrer Info Ine prap65e41 con• tract it the some is awarded. The sigaoture of the bidder On the bid cause to be non-