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Home My WebLink AboutBEN'S ASPHALT, INC. (3) Recording Requested By, Recorded in OfYlclal Records, Orange County And When Recorded Mail To: Tom Daly, Clerk-Recorder Clerk of the Council, City of Santa Ana I IIIII I 1111111 III IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII I I III IIII NO FEE 20 Civic Center Plaza, P.O. Box 1988 + i R 0 0 0 4 9 6 5 6 2 4 S Santa Ana, cA 92702 2012000395073 11:02 am 07/12/12 90 4'14 N ? 2 ? 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 I THIS SPACE FOR COUNTY RECORDERS USE ONLY O. .. r ?O -?, C.j_ ?;' NOTICE OF COMPLETION ,,?_.._ _? I?>?TICE 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 ' 1 construction of PARKING LOT AND PARKS IMPROVEMENTS under contract entered into ' Yl v on MAY 16. 2011 with BEN S ASPHALT INC., on which contract FIDELITY AND DEPOSIT ? o COMPANY OF MARYLAND is surety. The property on which such work improvement was ?,'? = w placed is in the City of Santa Ana, County of Orange, State of California, and described as ? °o Project No. 11-7530 located at: VARIOUS LOCATIONS_ The work improvement on said m ? 0 property was accepted as completed on JUNE 1. 2012. z w o ? CITY SANTA, A ML)NICIPAL CORPORATION ? o by ? CCC 4A`Ll ('?nnJ` O Dated: 2- Interim City Engineer cW F- TITLE z z -------------- ------- ° 0. VERIFICATION I, the undersigned, say: I am the Interim Citv En>ineer 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 ?? ? ?? ?? at Santa Ana, California ?,? [,Ln?t ?. (Sig?a[ure of individual swearing that the contents of Notice of Completion aze true.) THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN (10) DAYS AFTER COMPLETION CLERK OF COUNCIL USE ONLY: MAY 16, 2011 TITLE: PARKING LOT AND PARKS IMPROVEMENTS (PROJECT NOS. 117530, 118014, 107560, 107559, 112607, 117529, 117534 AND 1 17535) AND COOPERATIVE AGREEMENT CITY MANAGER APPROVED `?? ? 6 " ? ??? ? sas Recommended 03!4 ? As Amended 0 Ordinance on 15` Reading 0 Ordinance on 2"' Reading ? Implementing Resolution ? Set Public Hearing For CONTINUED TO FILE NUMBER RECOMMENDED ACTION Award a contract to Ben's Asphalt, Inc., the lowest responsible bidder, in accordance with unit bid prices in the estimated amount of $879,621.50 for construction of Parking Lot and Parks Improvements, and authorize the City Manager to execute change orders in an amount up to the approved contingency amount. 2. Approve a Funding Analysis with a total estimated construction cost of $1,120,000. 3. Approve an Appropriation Adjustment recognizing $55,286 in the Parks Acquisition & Development Fund Account (3131 3260-66220) for Sandpointe Park Pavement Improvements. 4. Authorize the City Manager and the Clerk of the Council to execute the attached Cooperative Agreement with the Community Redevelopment Agency of the City of Santa Ana (Agency) in the amount of $262,725, subject to non-substantive changes approved by the City Manager and City Attorney. DISCUSSION The parking lots at Campesino, EI Salvador, and Rosita Parks, the Southwest Senior Center, and northeast corner of 3rd and Bush Streets in the Downtown have deteriorated due to weather, age, and usage. The same has happened to walkways at Memorial, Madison and Sandpointe Parks and to sports courts at Memorial Park (Exhibit 1 ). This project is to provide slurry seal, asphalt concrete overlay or reconstruction of parking lots, walkways and sports courts. In addition, the 3rd and Bush Streets parking lot lighting will be upgraded to comply with current lighting codes_ Once completed, these improvements will enhance the surface quality and visual appearance of the parking lots, sports courts, and walkways. The public metered surface parking lot at 3rd and Bush Streets is owned by the Community Redevelopment Agency; therefore, the cooperative agreement provides for the Agency to fund the cost of the improvements to the public parking lot. Based on the terms of the cooperative Parking Lot and Park Improvements May 16, 2011 Page 2 agreement, the Redevelopment Agency will reimburse the City for all improvements to the parking lot, including the future landscaping and upgraded irrigation which will be contracted for separately. The public parking lot is located within the Merged Project Area. The Notice Inviting Bids was advertised on March 30, 201 1 , and bids were opened on April 20, 2011. A summary of the bid invitations mailed, the bids received, and the bid results follows. Santa Ana Contractors receiving notices: 13 Contractors requesting bidding documents: 20 Bids received: 5 Bids received from Santa Ana Contractors: 2 NAME OF RESPONSIVE BIDDER CITY BID AMOUNT 1 . Ben's Asphalt, Inc. Santa Ana $879,621 .50 2. Unique Performance Const_ Inc. Costa Mesa $956,020.00 3. Fleming Environmental, Inc- Fullerton $959,722.00 4. Hardy & Harper, Inc. Santa Ana $1 ,1 1 1 ,000.00 5. Excel Paving, Co Long Beach $1 ,238,020.00 Notice Inviting Bids were sent to Santa Ana contractors and two of the contractors submitting bids were Santa Ana contractors. A total of five bids were received and all were responsive- The lowest bid was submitted by Ben's Asphalt, Inc_, a Santa Ana Contractor, for $879,621.50, which is above the Engineer's estimate of $808,494. ENVIRONMENTAL IMPACT Environmental Review Nos. ER-2010-48, ER-2010-50, ER-2011-21 and ER-2011-33 have been completed and Notices of Exemption have been filed for the Projects pursuant to the California Environmental Quality Act. In addition, Certificates of Categorical Exclusion and Statutory Worksheets have been prepared in accordance with the National Environmental Quality Act. FISCAL IMPACT The funding analysis shows a total estimated construction cost of $1,120,000 for the project (Exhibit 2). Funds are available in the Community Development Block Grant Funds (accounting unit 13518783-66220), Capital Improvements Funds (accounting unit 57018830-66220) and Park Acquisition & Development Fees Funds (accounting unit 31313260-66220)_ -? f Raul Godinez II Executive Directo Public Works Agency ??f,? w/e-?-?-, Gerardo Mouet l Executive Director Parks, Recreation, and Community Services Agency Parking Lot and Park Improvements May 16, 2011 Page 3 Nancy T. wards ?I Interim Ex utive Director Community Development Agency RGNVA Exhibit 1: Project Location Map 2: Funding Analysis 3. Cooperative Agreement APPROVED AS TO FUNDS AND ACCOUNTS: Francisco Gutierrez Executive Director Gtr Finance & Management Services Agency EL SALVADOR PARK FIESTA CAMPESINO PLAZA PARK ROSITA 'J `" "E'" E F??? ?E G?Ek PARK ?? _ _ _____r -- _ rL G?o?N z ?___I __ su+T?=co 1 ? ? s r ?'I ?? r-- WESTMINSTE • ? EVENTEENT ? SEV T ENTM ?L? r-1 ?????? ?? CIVIC CENTER R U?a?OOOG?-p gg? ? ??? ?D°°°°oo ?? a.,. ? 2? NTS VITA ? o ' W rc a ?PJ L_J ? ? ? ? o° 0 ??? FIRST IY YeFADDEN ? ? ?? ? ? ? ?? ? ?`. FRWY •- 1 ' r _ _ _ _ _ H / ? ? ? ? ? ucFaDDEN , IN R ? O ? ? ?? ? ? ? ? ? ? ?4 EDwGER ?? N ?C..?. ?. WARNER it ? WARNER ? LJ? Ir ? ? O $EGERSTR ? ???? DYER ? ? ???P ADISON .? y? ,ART g ? r 5?r-?? t?-_ ? _ ? PARK 7 5~P \ G° MEMORIAL PARK , SENIOR SANDPOINTE CENTER PARK EXHIBIT 1 ?N o Alyd` SANTA ANA `. 1 TY COUNC 1 L pgpK?q ??? p?? :r?`? c'i `? AGENDA <.t?OPERA117534 A?? 117 ?AI?? ? ? t V-V /-1 DATE: SHE FORLIG WDXRS ILENEY MAY 16, 2011 FUNDING ANALYSIS PROJECT NOS. 117530, 118014, 107560, 107559, 112607, 117529, 117534 AND 117535 PARKING LOT AND PARK IMPROVEMENTS Construction Contract $879,621 Contract Administration $21 ,870 Inspection and Testing $70,000 Survey Staking $40,000 Contingencies $108,509 TOTAL ESTIMATED CONSTRUCTION COSTS 1.120.000 Exhibit 2 THE REGISTER 625 N GRAND AYE, SANTA ANA, CA 9270'1 Telephone (7'14) 796-7000 /Fax (714) 796-6059 PROOF OF PUBLICATION (20"15.5 C.C.P.) State of California ) County of ORANGE ) ss Notice Type: BID -NOTICE INVITING BIDS Ad Description: Parking Lots and Parks Improvements I am a citizen of the United States and a resident of the State of Califomia; I am over the age of eighteen years, and not a party to or interested in the above entitled matter. I am the principal clerk of the printer and publisher of the THE REGISTER, a newspaper published in the English language in the city of SANTA ANA, county of ORANGE, and adjudged a newspaper of general circulation as defined by the laws of the State of California by the Superior Court of the County of ORANGE, State of Califomia, under date 1'I/f 9/'1905, Case No. A2'I 046. That the notice, of which the annexed is a printed copy, has been published in each regular and entire issue of said newspaper and not in any supplement thereof on the following dates, to-wit: 03/30/20'1 ? .03/3'1 /20'1 1 Executed on: 03/3'1/20'11 At SANTA ANA, California I certify (or declare) under penalty of perjury the[ the foregoing is [rue and correct. Signature 11111111 IIII VIII VIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIII * A 0 0 0 0 0 2 1 1 7 3 7 8? TM1IS space /or filing stamp only C N S #: 207'1 156 NOTICE INVTNG BIDS NOTICE IS HEREBY GIVEN that Ne Clty of Santa Ana, California vvlll receive e[ the City Hall-Rosa Annex, (M- 43), 20 Clvie Center Plaza, Santa Ane, Call/Omia 9201, the Publle W rka Aoenev FouttTi -F on or a ore t e our o p.m. on April 20, 2011 aealetl bitls antl/Or proposals /or No[ica is hereby given BIDDERS [ha[ [his proleM la funtlatl with Community Development Block Gren[ money, antl [hat the rete of wages for each craft or type of work or mechanic employyetl untler this contract shall be as spetifietl untler [he currant tle[enninetlona of the Department o1 Labor as wnere e Iscrepancy exists between Fetlerel and Slate prevailing wage rate, the higher of [he two prevailing wage rates snau eppy. Each bitl shall be eeeompanletl by cash, a cashieYS or rartifietl check payable to the Ciry of Santa Ane, or bltl bontl lesuatl by e corporate surety, for an amount not IaSS Nan ten peroent (10%) of the aggregate of the bid, es a guarantee that Ne BIDDER will enter into Na proposetl conlreet if the same is ewertletl to him. The signature oT the BIDDER on the bltl bontl moat ba notarizerl. The City CounGl reserves the right to rejeM any or alt bitls. Tha successful BIDDER must possess or obtain a valid Califomia Class A Contractors prior to [he schetluletl award data of this contract. Substitution of securities for any monies wllhheltl by the City of Sen[e Ana to ensure pertormance is allowetl in flceortlanee with the Public Contreet Code. now evallable In portable doeumen[tormat (PDF) on a compact disk tCD) Dory. There Is no charge for the Plans sod Speelficetiona on CD. To request a CD by mail, the COOIreCMOI must aubnYt an email request to ror <pro1eM no.> name>. Checks ere DO NOT CALL PURCHASING DIVISION REGARDING AVAILABILITY OF PLANS AND SPECIFICATIONS. 3/30, 3/31/11 CNS-2071156# THE REGISTER n L-L T? f f ? J c CITY OF SANTA ANA PARKING LOT IMPROVEMENTS Project No. 117530 Rosita Park Project No. 117534 Campesino Parlc Project No. 117535 El Salvador Park Project No_ 118014 Fiesta Plaza Project No. 107560 Southwest Senior Center PARK IMPROVEMENTS: Project No_ 10-7559 Madison Park Concrete Walkway Renovation 11-2607 Sandpointe Park Concrete Walkway Renovation Project No. 11-7529 Memorial Park AC Walkway / Sports Court Renovation A,?-,?1? PROPOSAL S?: CONTRACT AGREEMENT BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA REQUIREMENT: The undersigned declares that he/she has carefully examined the location of the proposed work, that he/she has examined the Plans and Specifications and read the accompanying instruction to BIDDERS; and hereby proposes to furnish all material and do all the work required to complete the said work in accordance with said plans, specifications and special provisions, for the unit price(s) or lump sum(s) set forth in the following schedule: Item # Bid Item Unit Quantity Unit Price Amount -c- Bid items 1 to 16 applies to any Parking Lot Improvements or Park Improvements 1. Unclassified Excavation * CY 700 $ \ \? ? $f? ?-`??? 2. AC Pavement * TN 2,650 $ ?? $ ??? ??-2? 3. Remove Excess Dirt* CY 390 $ 3SJ $ 4. Cold Mill Base Material* SF 127,210 $ ,-?J $ ?? `-ICJ 1 ?J 5. Cold Mill* SF 3,400 $ 6. 4" PCC walkway/pavement* SF 8,760 $ 1-{ LA? $ ??.?L1"1 7. 6" PCC walkway* SF 19,730 $ ?9 $_ 1 8. PCC wheelchair ramp* SF 260 $ \ 1 _ $ 9. PCC V-gutter* SF 410 $ `Z"` TO BE INCLUDED IN BID PACKAGE BP I of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: Project No. 117530 Rosita Park Project No. 117634 Campesino Park Project No. 117635 El Salvador Park Project No. 118014 Fiesta Plaza Project No. 107560 Southwest Senior Center PARK IMPROVEMENTS: Project No. ?10-7669 Madison Park Concrete Walkway Renovation 11-2607 Sandpointe Park Concrete Walkway Renovation Project No. 11-7529 Memorial Park AC Walkway /Sports Court Renovation PROPOSAL 8r CONTRACT AGREEMENT BID PROPOSAL Item # Bid Item Unit 1 O. PCC Curb Type B-1 * LF 11. PCC Grind* LF 12. Recycled Plastic Wheel Stops. EA 13. Construct Vegetated Bioswale LF 14. Construct Rip Rap EA 15. Construct Parkway Culvert EA 16. Adjust Water Valve EA Project 112607 Sandpointe Parr Concrete Walkways 17. Root Shave LS 18. Remove PCC pad and replace with SF decomposed granite over compacted grade. Project 107560 Southwest Senior Center 19. Install PCC 6" wide and 6" high curb LS 20. Remove and install new chain link LF fence (including footing) 21. Redwood Header LF Unit Price Amount 91 $ \-1`? $ \ Sys - s $ \?o°? $ SSO 139 $ ?TS? $ ?0 ?-'•Z`? ..? 140 $ 55? $ ?? 2 $ Z°? ? $ 5 °IGCs 1 $ ? ? $ 3? 1 $ ?? $ -?g-S?' - 6,100 $ ?? $ ?S? 300 $ ??? $ ? ?D? 300 $ 1?Z $ `Z??? 465 $ y5i $ Z ?t-1? S.. TO BE INCLT_IDED IN BID PACKAGE BP 2 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: Project No. 117530 Rosita Park Project No. 117534 Campesino Park Project No. 117535 El Salvador Park Project No. 1 18014 Fiesta Plaza Project No. 107560 Southwest Senior Center PARK IMPROVEMENTS: Project No. 10-7559 Madison Park Concrete Walkway Renovation 11-2607 Sandpointe Park Concrete Walkway Renovation Project No. 1 1-7529 Memorial Park AC Walkway /Sports Court Renovation PROPOSAL 8s CONTRACT AGREEMENT BID PROPOSAL Item # .Bid Item Unit Quantity Unit Price Amount 22. Remove Storage Bins and Reinstall 23. Relocate office trailer and reinstall 24. Remove/reinstall trailer, stairs, access ramp, with ADA modifications 25. __. Signing and Striping for Southwest Senior Center parking lot. t Project 117529 Memorial Park 26. Root Shave 27. Adjust water meter 28. Adjust pull box 29. Sports court surfacing and stripingt 30. Remove and reinstall bleachers Project 118014 Fiesta Plaza 3 1 . Furnish and install new pull boxt 32. Concrete Wlieel Stopst 33. Construct 2'x2'x2' PCC footing and 4" PCC pad for future Pay Stations LS 1 $ \?SJO $ \ F?? _ LS 1 $ \? $ ? L5 1 $? pC _ $ \ .? LS 1 $? $?7_,? ____ LS 1 $ ? ?C?r $ S (cyOO ?- ? ? EA 1 $ 3?yQ $ `??yC1 EA 1 $ ? Y? $ x'70 LS 1 $ ZZ`?`? $ ???S`?`? EA 13 $ \(?Q $ 7? `c?SJO EA 2 $ 1-IC? - $ ? - EA 15 $ L16 ? $ Cp00 - LS 1 $ ??? $ ?5? BP 3 of 36 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA PARK_IIVG LOT IMPROVEMENTS: Project No. 117530 Rosita Park Project No. 117534 Campesino Park Project No. 1 17535 El Salvador Park Project No. 118014 Fiesta Plaza Project No. 107560 Southwest Senior Center PARK IMPROVEMENTS: Project No. 10-7559 Madison Park Concrete Walkway Renovation 11-2607 Sandpointe Park Concrete Walkway Renovation Project No. 11-7529 Memorial Park AC Walkway /Sports Court Renovation PROPOSAL 8r CONTRACT AGREEMENT BID PROPOSAL Item # Bid Item 34. Slurry Seal Type II 35. Furnish and install truncated domes 36. Furnish and Install 2" PVC Conduits 37. Furnish and Install Electrical Wires 38. Furnish and Install 240V GFI receptacle s 39. Furnish and Install Parking Lot Lights (include footing) s 40. Remove existing parking meters/light/pole/ftgs and fill with AC 41. Clear and grub 42. Signing and Striping for parking lots Project 117530 Rosita Park 43. Signing and Striping for parking lots Project 117534 Campesino Park 44. Signing and Striping for pazking lots Unit Quantity Unit Price Amount ELT 16 $ C ??J? $ °1? SF 24 $ ?Z $ \ ?8 LF 61 O $ ?-3 ? $ \ Z,ZiX3 LF 710 O $ 1-'tsf $ 3 \°l?- EA 2 $ Z2?` $ 1--?5? EA 32 $ \O? $ 3 ? LS 1 $ ?? $ S? LS 1 $ ?\Q? $ `?\C?i?? LS 1 $ ? $ ? Q LS 1 $ ESL' $ ?? - BP 4 of 36 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: Project No. 117530 Rosita Park Project No_ 117534 Campesino Pazk Project No. 117535 El Salvador Park Project No. 118014 Fiesta Plaza Project No. 107560 Southwest Senior Center PARK IMPROVEMENTS: Project No. 10-7559 Madison Park Concrete Walkway Renovation 11-2607 Sandpointe Park Concrete Walkway Renovation Project No. 11-7529 Memorial Park AC Walkway /Sports Court Renovation PROPOSAL 8r CONTRACT AGREEMENT BID PROPOSAL Item # Bid Item Unit Quantity Unit Price Amount Project 117535 EI Salvador Park 45. Signing and Striping for parking lots TOTAL BID------ LS 1 $?Z`? $ ? ?Z?? --------------------------------------? ??, C? ? ?? ? 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 Standazd Specifications. The actual amount for this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. j' This bid item is considered a Specialty Item per Section 2-3.2 of the Standazd Specifications. PARKING LOT IMPROVEMENTS: Firm Project No. 117530 Rosita Park Project No. 117534 Campesino Park Project No. 117535 El Salvador Park Project No. 107560 Southwest Senior Center Address Project No. 118014 Fiesta Plaza PARK IMPROVEMENTS: Phone Proj.No. 10-7559 Madison Park Conc.Walkway Renov. Proj. No. 11-2607 Sandpointe Park Conc. Walkway Ren.. Project No. 11-7529 Memorial Park AC Walkway /Sports Fax Court Renovation BIDDER ?] \ti- S?iO C??O Email BIDDER Signature TO BI BP 5 of 36 L?O,n,l CITY OF SANTA ANA PARKING LOT IlVIPROVEMENTS: Project No. 117530 Rosita Park Project No. 117534 Campesino Park Project No. 117535 El Salvador Park Project No. 118014 Fiesta Plaza Project No. 107560 Southwest Senior Center PARK IMPROVEMENTS: Project No. 107559 Madison Park Concrete Walkway Renovation 112607 Sandpointe Park Concrete Walkway Renovation Project No. 1 17529 Memorial Park AC Walkway /Sports Court Renovation PROPOSAL AND CONTRACT AGREEMENT LIST OF SUB-CONTRACTORS Section 4100 et_ seq. of the Public Contract Code requires listing of all subcontractors with the bid for all subcontract work exceeding the following amount: - Streets, highways including bridge projects; '/z% of the bid or $10,000, whichever is greater - Buildings, parks, or other projects: '/z% of the bid BIDDER proposes to subcontract certain portions of the work to the firms listed below: NAME ??i?pMrxR+.? ?T LOCATION Lp ?.\Ci?.,? PHONE ? \?-?- ?-?,y\ -OS` -'? TYPE OF WORK ?4??iy"craa $S27 '` - NAME ?c?.???.t??c?-?I?Q?-'???a'c'i,l LOCATION ?,q"Z?@,,?? PHONE Ctz"2..Ca - L`?O - ?'_'??_ a. TYPE OF WORK glyi??.css`__ $ h?'i NAME ppng,??cc??l ?,?? ?? LOCATION ??,..?,p0? V.nn{?,gn,;r2 PHONE ??lq . ?S - \?1 S TYPE OF WORK F? $?'\XX? - NAME ??\ .P-?f? L[a????Sa?Q -`?T?L LOCATION ?_,,,Q,.,??Q __ _ PHONE '-7\`a? Cc> "-1,00 TYPE OF WORK $? 5 NAME ???1?<?X7.?? ?S LOCATION (?`2??q PHONE Cam ? ;3?-??`-1 TYPE OF WORK c`?irr?ctnP $ NAME ????5?. ?i?S LOCATION ?.-,LpQ PHONE ?\y. ??`-1- i?SScoS TYPE OF WORK S r $ o?-scc..t.e NAME LOCATION PHONE TYPE OF WORK $ NAME LOCATION PHONE TYPE OF WORK $ TO BE INCLUDED IN BID PACKAGE BP 6 of 36 CITY OF SANTA ANA PARKING LOT IIVIPROVEMENTS: 117530: 117534; 117535; 118014; 107560 PARK IMPROVEMENTS: 107559; 112607; 117529 PROPOSAL 8? CONTRACT AGREEMENT BIDDER'S STATEMENT BIDDER understands and agrees that this written proposal (or any part thereof specifically designated and accepted by the City of Santa Ana, hereinafter AGENCY) 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 r or his duly authorized agent, and signed by the City Attorney, denoting his approval of the form of this document, and its execution, and when it or an exact copy of it has been either delivered to BIDDER or deposited with the United States Postal Service properly addressed to the BIDDER with the correct postage affixed thereto. BIDDER further agrees that upon delivery (as defined above) of the accepted agreement he/she will furnish AGENCY all required bonds and certificate of liability insurance within ten (1 O) days (excluding Saturdays, Sundays and AGENCY'S legal holidays), 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, that 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. All terms contained in the Specifications, the Certification of Non-Discrimination by Contractors, and the Workers' Compensation Insurance Certificate are to be incorporated by reference into this Agreement and are made specifically as part of this bid. Name of Firm ??n\? ?`??Z ?i?? BIDDER signature Title (? . Y (if an individual, so s TO BE INCLUDED IlV BID PACKAGE BP7of36 CITY OF SANTA ANA PARKING LOT 11VIPROVEMENTS: 117530; 117534; 117535; 118014: 107560 PARK IMPROVEMENTS: 107559: 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT continued (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.) ???? ????-? ? ?C . ???? Src_????? C?c? Awarded to ? ?? on the basis of lowest n'sponsi le and n3sponsive bidder in the amount of $ R?'9, l_ i SU ACTION OF COUNCIL: Date ?!?;/???) ?? 20 ?? ATTEST: CLERK OF THE COU IL APPROVED AS TO FORM: ,,?J ?/s rAAGL-_ ?111?G??/ Y ATTORNEY ACCEPTED FOR THE CITY OF SANTA ANA: 1 ? ?_ EXE IVE DIRE OR PUBLIC WORKS A NCY BP 8 of 36 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530: 117534: 117535: 118014; 107560 PARK IMPROVEMENTS: 107559; 112607: 117529 (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The BIDDER ???NS ??5??1`T ? ti? , proposed subcontractor ??7? ?<?x? (?-- ,hereby certifies that he has , has notes ,participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by BIDDERS and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed Prime Contractors and Subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U_S. Department of Labor. TO BE INCLUDED IN BID PACKAGE BP 9 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534; 117535; 118014; 107560 PARK IMPROVEMENTS: 107559; 112607: 117529 PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION OF NONDISCRIMINATION BY CONTRACTOR 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 aze 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, regazd to race, color, religion, sex, or national origin. 3. The Contractor shall send to each labor union or representative of workers with which he/she has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment_ 4. The Contractor shall comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5. The Contractor shall furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with such rules, regulations, and orders. 6. In the event of the Contractor's non-compliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole or in part and the Contractor may be declazed ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Execution Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law_ TO BE INCLUDED IN BID PACKAGE BP 10 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534; 117535; 118014; 107560 PARK IMPROVEMENTS: 107559; 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION OF NONDISCRIMINATION BY CONTRACTOR (continued) 7. The Contractor shall include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontract or purchase order as the administering agency may direct as means of enforcing such provisions, including sanctions for noncompliance; provided, however, that in the event the Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, the Contractor may request that the United States enter into such litigation to protect the interests of the United States. 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 subjec?to all the penalties imposed for a violation of the Chapter. Signed Title ? V ?) G ? ? ' Firm Date "?t /`??z?_?\\ TO BE INCLUDED IN BID PACKAGE BP 11 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534; 117535; 118014; 107560 PARK IMPROVEMENTS: 107559- 112607. 117529 PROPOSAL AND CONTRACT AGREEMENT WORKERS' COMPENSATION INSURANCE CERTIFICATION As required by California Labor Code Section 1860 and 1861, the Contractor certifies as follows: I am awaze of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of the Code, and I will comply with such provisions before commencing the performance of the work of this contract. If I, as the Contractor, now or at any time during the course of this agreement, qualify as an employer under California Labor Code Section 3300, unless the hired employee(s) is (are) persons excluded by said Labor Code, I shall furnish the City of Santa Ana with an insurance certificate from my workers' compensation insurance carrier certifying that I carry such insurance and that the policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior written notice to the City of Santa Ana. ? Signed Title ? ???? ?- r. o Firm 1 Date ? l\Q ?Z?l \ TO BE INCLUDED IN BID PACKAGE BP 12 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530: 117534: 117535; 118014: 107560 PARK IMPROVEMENTS: 107559: 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT REFERENCES The following are the names, addresses, and telephone numbers for three public agencies for which BIDDER has performed similar work within the past two years. 1. ? - -? Name and Address of Owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed 2. Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed 3. Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. ?ti??-2,??'„? ? Cry ?7??-1- ??\-C??O TO BE INCLUDED IN BID PACKAGE BP 13 of 36 ASPHALTS INC. LICENSE # 668417 PUBLIC WORKS /CITY JOBS CITY City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92702 Edward Torres (714) 647-5018 JOB NAME ls` 8z 5`h St. Rehab Shelton St. Fairview Str. Rehabilitation Fairview/Edinger Ave_ Intersection Widening Warner Ave. Improvements Warner Ave. Rehabilitation Westminster Ave. Widening City of Huntington Beach 2000 Main St. Huntington Beach, ca 92648 Eric Charlonne (714).536-5430 City of Anaheim 200 S. Anaheim Blvd. Anaheim, CA 92805 Mike Woods (714) 765-5176 City of Westminster 8200 Westminster Blvd. Westminster, CA 92683 Kevin Sin (714) 898-3311 City of Tustin 3.00 Centennial Way Tustin, CA 92780 Benny Tenkean (714) 573-3161 City of Lynwood 1 1330 Bullis Rd. Lynwood, CA 90262 Elias Saikaky (310) 603-0220 City of Placentia 401 E. Chapman Ave. Placentia, CA 92870 Art Bergner (714) 993-8245 City of Garden Grove 1 1222 Acacia Parkway Garden Grove, CA 92842 (714) 741-5000 City of Corona 730 Corporation Yard Way Corona, CA 92880 Scott Briggs (909) 736-2454 City of Mission Viejo 200 Civic Cneter Mission Viejo, CA 92692 (949) 470-3000 Warner/Newland Improvements Broadway Str. Improvements Anaheim Blvd_ La Pahna Ave. Str. Improvements La Palma Ave. Str. Rehab Magnolia Ave. Bushard Str. Improvements Tustin Ranch Rd. San Jose, Platt &c Carlin Placentia Ave. Rehabilitation Garden Grove Str Rehab 2002/2003 Pavement Rehab Cabot Road Pavement Rehab 2200 S. Yale St., Santa Ana, CA 92704-4427 Phone (714) 540-1700 Fax (714) 540-1709 1 ASPHALT, INC. LICENSE # 668417 CITY City of La Puente 15900 East Main St. La Puente, CA 91744 (626) 855-1500 City of Newport Beach 3300 Newport Blvd. P.O. Box 1768 Newport Beach, CA 92658-8915 (949)644-331 1 City of Westminster Civic Center 8200 Westminster Blvd. Westminster. CA 92683 (714)898-3311 City of Villa Park 17855 Santiago Blvd. Villa Park, CA 92861-4187 (714)998-1500 City of Chino 13220 Central Ave. Chino, CA 9171 O (909) 464-8367 County of San Bernardino Engineering Department 825 East Third St. San Bernardino, CA 92415-0835 (909) 387-8104 JOB NAME Temple Ave. Reconstruction Francisquito 8z Nelson Aves Monrovia Ave. Newport Heights Pavement Overlay Bushard 8c Magnolia Aves Collins Ave./Wanda Rd. 2003-04 Str. Rehab Various Roads -Chino Area 2200 S. Yale St., Santa Ana, CA 92704-4427 Phone (714) 540-1700 Fax (714) 540-1709 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534; 117535; 118014; 107560 PARK IMPROVEMENTS: 107559; 112607: 117529 PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDIlVG APPRENTICESHIP REQUIREMENTS The undersigned BIDDER is familiar with the requirements of Section 1777.5 of the State Labor Code regarding employment of apprentices, and understands that contractors on contracts exceeding $30,000 or 20 working days shall: 1. Apply to the joint apprenticeship committee administering the apprenticeship standards of the craft or trade in the azea of the site of the public work for a certificate approving the contractor under the apprenticeship standards for the employment and training of apprentices in the area or industry affected. 2. Employ the number of apprentices or the ratio of apprentices to journeymen stipulated in the apprenticeship standazds. 3. Contribute to the fund or funds in each craft or trade in which he/she employs journeymen or apprentices on the public work, in the same amount or upon the same basis and in the same manner as the other contractors, except contractors not signatory to the trust agreement shall pay a like amount to the Ca Signec Title Firm Date TO BE INCLUDED IN BID PACKAGE BP 14 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534: 117535; 118014: 107560 PARK IMPROVEMENTS: 107559; 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT NON-COLLUSION AFFIDAVI"I' (Title 23 United States Code Section 1 12 and Public Contract Code Section 7106) To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declazes 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 BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid_ Note: The above Non-collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non-collusion Affidavit. BIDDERS are cautioned that raking a false certification may subject the certifier to criminal prosecution. Signed State of C: County of Subscribed and sworn to (or affirmed) before me on this ? day of ,?%, 20?, by ,7Jj?s L? cJ?t?/??aca ,proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.? DEBRA ?. FRIEp ComnMSNw? 11Y2A??g NoLry Pub11c - CalgonNa Oranpo Cowq?r Comm. K 2/ Z01 S Notary Public Signature Notary Public Seal TO BE INCLUDED IN BID PACKAGE BP 15 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534; 117535; 118014: 107560 PARK IMPROVEMENTS: 107559; 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING "ANTI-KICKBACK" REQUIREMENTS The undersigned is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the Copeland "Anti-Kickback" Act (18 USC 74) as supplemented in the Department of Labor regulations (29 CFR, Part 3). This act provides that each contractor or subcontractor shall be prohibited from inducing, by any means, any person employed in the construction or repair of public work, ?o give up any part of the compensation to which he/she is otherwise entitled. Signed Title ? ?? ? ?? C - ?'-? Firm Date ? ?\?y 1 7 ?\ \ TO BE INCLUDED ]N BID PACKAGE BP 16 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530: 117534: 117535: 118014: 107560 PARK IMPROVEMENTS: 107559; 112607: 117529 PROPOSAL AND CONTRACT AGREEMENT CONTRACTOR'S LICENSING STATEMENT The undersigned contractor, or corporate officer, declares under penalty of perjury that the following is true and correct. Contractor's Name: ??1?\? ???? 1?? Business Address: ??? ?, ??? ?? C?????? ?Q ? /?J? , Telephone: ? )L -\ - S?-1? - \ ? o State Contractor's License No. and ? Class: ? - ??\Z ? C?.U??`? Expiration Date: Signed: Title: ? \\\\) ?-; _o - _.. TO BE INCLUDED IN BID PACKAGE BP 17 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530: 117534: 117535; 118014; 107560 PARK IMPROVEMENTS: 107559; 112607; 117529 PROPOSAL AND CONTRACT CLAUSES SECTION 3 -CONTRACT CLAUSES A. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C_ 1701u (Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by 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, particularly persons who are recipients of HUD assistance for housing. B. The parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment 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 a collective bargaining 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 the Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this Section 3 clause, 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 of that the subcontractor has been found in violation of the regulations in 24 CFR Part 135. TO BE INCLUDED IN BID PACKAGE BP 18 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534; 117535; 118014; 107560 PARK IMPROVEMENTS: 107559; 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT SECTION 3 -CONTRACT CLAUSE continued 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 directed, were not filled to circumvent the contractor's obligations under 24 CFR Part 135. F_ Noncompliance with HUD's regulations in 24 CFR part 35 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. G. With respect to work performed in connection with Section 3 covered Indian housing assistance, Section (7) b of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450e) also applies to the work to be performed under this contract. Section 7(b) requires that to the greatest extent feasible (I) preference and opportunities for training and employment subcontracts shall be given to Indians, and (ii) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian-owned Economic Enterprises. Parties to this contract that are subject to the provisions of Section 3 and Section 7 (b) agree to comply with Section 3 to the maximum extent feasible, but not in derogation of compliance with Section 7(b). For the purpose of training and employment the primary Section 3 covered project area is the area in closest proximity to the actual construction work site within the U.S. Census Tract in which the project is located. It is understood that priority for employment opportunity is to be given to residents residing within the primary Section 3 area as defined. A Section 3 area resident is any lower income individual residing within the Section 3 area, whose total family income does not exceed 80% of the median income of the metropolitan statistical area in which the project is located (Orange County). A public housing resident is defined by regulations as Section 3 resident, regardless of income. The contractor and each subcontractor certifies that they will provide, to the greatest extent feasible, opportunities for employment to lower income residents (local residents) and job opportunities in connection with projects in their neighborhoods. For fiscal year 1996-97, minimum goal for each project is 30%. TO BE INCLUDED IN BID PACKAGE BP 19 of 36 CITY OF SANTA ANA PARKING LOT IIVIPROVEMENTS: 117530; 117534; 117535; 118014; 107560 PARK IMPROVEMENTS: 107559• 112607. 117529 PROPOSAL AND CONTRACT AGREEMENT SECTION 3 -CONTRACT CLAUSE continued The Contractor/Sub-contractor/Service Provider by the signature affixed hereto declares under penalty of perjury: Contractor/Sub-contractor/Service Provider has read Section 3 requirements and accepts all its requirements contained therein for all of his/her operations within the City of Santa Ana. Si na S ignatu Print Name and Title Print Name and Title Print Name a//nd Title Date Signature TO BE INCLUDED IN BID PACKAGE BP 20 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534: 117535; 118014; 107560 PARK IMPROVEMENTS: 107559; 112607: 117529 PROPOSAL AND CONTRACT AGREEMENT FEDERAL REQUIREMENTS FOR FEDERAL-AID CONSTRUCTION PROJECTS GIIVERAL-The w?lc heceirt p oposacl will be finarrecl in whole or ire pact with Federal funds, aryl thecefcae aIl of [he Hales and regulations pmrrnrlgtrted by the Feder-al Govemn?-rt and applicable to w?c fioanoacl in whole a? in paR with Feda-al funds wIll apply to such wr>rlc 'The `22egtmed CornactProvisions, Fada-al- Aid Crn-shtac-tiort Caathacts, `F'orm FHWA 1273, ace inchrded ire this Section 14. Wlt?eva' ire said required mrttr-act, provisions refaa>c?s ace made m "SHA Contracting officer,,, "SHA aesidart enguaeer,,, or "aanhorned rive of the SHA," suckr refeca?ces shaIl be mrrshared to rman ` f?nginaer" as deSned ua S«aorr 1-1.18 otth Starrla<cl Sperifx?ocrs. PERFORMANCE OF PREVIOUS CONTKACT - In addi¢on m the provisions in Section Ii, `Y?locrtismnnctation," and Section VTS "Stib)etting or Assigning the Contract," of the tegtmed oonhact ptovisiorts, the C?hacua shall comply with the fallowing 'The BIDDER shall evrecu? the CER'ITFICATION WITH RF?C;ARD TO THE PERFORMANCE OF PREVIOUS OONIRACl'S OR SUBCONTRACTS SCTBJECT TO THE EQUAL OPPORTCMI'Y CI RUSE A1?ID TT?E FII1NG OF REQUIl2ID REPOR'T'S bcaanclm the proposal No request for sublettacg or accignina any pcxaorr of the Dorn-act in excess of$10,000 wiIl be eotntderacl ucrkr the ptovi.4ons of Secti«a VII ofhere tecp>ired crn?act provisions unless such request is aowraTenied by the CFd2T1FICATIONrefetredta above, exeaatedby theproposad . NONL?OT 7 ASTON PROVLSIONS - The provisi?s ur this sectiont ace applicableto all oonc-acts exneptmrn-xts forFr?aal Aid Seooixla<ylaojeds. Tffie 23, United States Code, Section 112, aegmes as a condition precedatt to approval by the Federal TTighway Adnnc>ishA? of the ooctlracl. for this wails thaz earn BIDDER fle a sw?-r stateanerrt e?ceortad by, or on behalf ol; the personr, Smb assoc??tion, or oaporation m whom such corvract is to be awarclad, certifying that such person, fmn, as9ooatioca, or corporation has raot, either dQecdy or in-daectly, erred into any ageernatt, pa<tiopea?d in arty oolhrsionr ? otherwise tarn any actiottirmt?-amtoffraewmperiti?biddmginwmcectionwiththesubmittedbid A forzn >o males tl-ie nonoollusion a?clavii sta?rnererrt regtmarl by Section 112 as a oatif>cation urtdapatalty ofpajury railna than as a swoQa sha)rar?t as peunLLtedby 2$ USC; Sec.1746, is inrludedin theptgxsal PARTICIPATION BY DLSADVANTAC=FA BLTSRVFSS FNIIIiPRLSES IN SUBCONTRACTING -Pact 26, Tffie49, Code ofFadaal Regulations supplies to this Fedaalaid project 1??>t sections of said Code ace irmapm?edm part?ua its entaety within other senoras offlrse special provisions. Srrr.fi,teB -7nforrrtation forDerBrrmmagJoirrt VenhueEligcbility. (Tltis form need not be filled in if all joint venture fians are minority owned J 1. Name of joint venture 2. Address of join venture ? ? ` 3. Phone number of joint venture /? 4. Identify the firms which comprise the joint venture. (The DBE partner must complete Schedule A) a. Describe the role of the DBE firm in this joint venture. b. Describe very briefly the experience and business qualifications of each non-VIBE joint venture: 5. Nature of the joint venture's business 6. Provide a copy of the joint venture agreement 7. Wha[ is the claimed percentage of DBE ownership? 8. Chvnenship of joint venture: (This need not be filled in if described in the joint venture agreement, provided by question (6). a. Profi[ and loss sharing b. Capital contributions, including equipment c. Other applicable ownership interests Atlacluzrart F?n"6i3A-FRl 8-07-97 TO BE INCLUDED IN BID PACKAGE BP 21 of 36 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530: 117534; 117535: 118014: 107560 PARK IMPROVEMENTS: 107559; 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT 9. Control of and pazticipation in this contract Iderrtify by name, race, sex, and `Muni' those inclividuals (ard then titles) who are responsible for day-trrday managenBrt and policy decision n?aldng, including, Nameofi'?rrn NameofFimi brx not ]irrrited m, those with prime nspormbility far. a F,?+*,a*,?-ia1 decisions Sig-iatLUe Sigoaaae Name Name b. Management decisions, such as: Titer Title 1, F.ctimating Date Date 2. Ma<3ceting and sales Dam 3. I-lmng and firing of ma ?oPn?art State of Cormty of 4. Purchasing of majariterris or supplies Chr this day of zo befae me appeared (Warne) m rrte personally known, who, being duly swum, did execrrte the c. S?rpavisionoffieklopeaatiors foregoing a8iclavit aryl did state that he ? she was pn?y a?xhrvi?eri by (Name of firm) m exect? the affidavit and did so as his orher flee act aWd deed Note: Iiy aff? filing this Schedule B and befare the completion of the joint verrnue's woiic on the oontr-aet coveaed by this regu]atioq there is arty significant change i<r the infta7rtation submitted, the joint verttrae rrnrst ir>tomi the grantee, either directly or through the prime oorrtractoriftltejointvenhueisasuboonh-a;toz?. Affidavit "Ilte urnasigrted swear Utat the f?egoi?g s?earrrvs are maect aryl include all rrtat?al infaarnation rteoess-pry h? identify and explain the team and opeaation of orzc joint venhne and the interned pa<ticipation by eadx joint ?nhaer' in the tvrlatalang. Flatlta', the urneasgned covenant and agree m provide m grantee ctmen? compleae and aoau-ate infaanation regarding acaral joint vearhue woric and the payatari therefore and any proposed changes in any of tl-ie joint venture an-angemerrts aryl to pearrit the audit and exarrnrtation of the books, raoords, and files of the joint vertaae, by arIIllc>aZed represervatives of the grmuee or the 1'?ecla-al furYlinv agency. Any material ntvs?rs=serttarion will be groiuns far laminarin? any coruract which may be awarded and far inifiafin? acfion urx]aI'?edeaal ? StatE laws oorr?tvng false staLrr>Prrtc" Atl3C)fIIllt?tf F?dubitA-I?322 807-97 Notary Public Corrurris4on ewes [sell Date County of On this _ day of 20 before me appeared (Name) to me pasortally lmown, who being swum, did execrr? the foregoing al?davit and did state that he or she was property a,xf?rvi?eri by (Name of firm) m execute the affidavit and did so as his or her fzae act and deed Notary Public L'pmmi¢cinn explrES ??? BP 22 of 36 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA PROPOSAL AND CONTRACT AGREEMENT PARKING LOT IMPROVEMENTS: 117530: 117534: 117535: 118014: 107560 PARK IMPROVEMENTS: 107559: 112607: 117529 TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 DEBARMENT AND SUSPENSION CERTIFICATION The BIDDER under penalty of perjury, certifies that except as noted below, he/she or any person associated therewith in the capacity of owner, partner, director, officer, manager: is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; has not suspended, debarred, voluntarily excluded, or determined ineligible by any federal agency within past three years; has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of awazd, but will be considered in determining ---- --- ??..-w-.?. BIDDERS responsibility. For any exception noted above, indicate below to whom it applies, initialing agency, and dates of action. Note: Providing false information may result in criminal prosecution or administrative sanctions- The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Name of BIDDER ? ? ?-??ti"C - Signature of BIDD Dat `a /° ?? FED.8-22-88 TO BE INCLUDED IN BID PACKAGE BP 23 of 36 Local Agency BIDDER-DBE (Construction Contracts)-Information ?he successful BIDDER must execute and return the LOCAL AGENCY BIDDER -DBE INFORMATION form, even if no DBE articipation will be reported. AGENCY: ?NT1? s-A\.1F\ `UY1aL \(l??j?,? LOCATION: PROJECT DESCRIPTION: ?\?5?? `?'HQt!'-5 CONTRACT NUMBER: \\80\y FEDERAL-AID PROJECT NUMBER: TOTAL CONTRACT AMOUNT: $ FEDERAL SHARE (For local agency [o complete) : $ BID DATE: Ld\ \ BIDDER'S NAME: ??E ?S AS??T HC ADVF.R TTSFD TIRE C`(INTR Af T AV ATT ARIT iTV AIIViS(lRV Perrenra or.? ONTRACT ITEM NO. EM OF WORK AND DESCRIPTION R SERVICES TO BE SUBCONTRACTED OR MATERIALS O BE P OVIDED' L1OQE BE Cer[. No. - ND EXPIRATION ATE NAME OF DBEs Ji.JD$E (Must be certified on [he date bids ? re opened -include DBE address nd hone number) OLLAR AMOUNT BE' '??? ?? ?.?.51 IM4.7iN S? Cf?\N'. -_ \Z?? +.aP ? ?Z Qi "tom' ? 2ti0 J - 4icc->,rnc \Z?7 a - ?' ?? - ?°? \ \rJ0 ?Z' L? T -03\2?"7 p ?" OZ t-a00 - PORTANT: Identify all DBE Frms being paz[icipa[ing in [he project, regardless of ier. Names of the First Tier DBE Subcontractors and their respective item(s) of work is[ed above should be consistent, where applicable, with the names and items of work in he "Lis[ of Subcontractors" submitted with your bid. Provide copies of the DBEs' uo[es, and if applicable, a copy of joint venture agreements. pursuant to [he Subcontractors Listing Law and the Special Provisions. Total Claimed Participation ? \?? ?Z? ? a ?r3 ?' oJo 1. Enter DBE prime and subcontractors certification number. Prime contractors shall indicate all work [o be performed by DBEs including work performed by its own - forces. If 100% of item is not [o be performed or furnished by DBE, describe exact potion of item to be performed or furnished by DBE gnatu B R _ $ 1i1 C?? 'l J . 3. See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts); to determine how [o count [he participation of DBE firms. Dale (Area Code) Tel. No. Local Agency t51UUCK - UtSC Intormanon (Kev ?/UIN6) Dis[ribu[iom (1) Copy -Fax immediately to [he Caltrans Dis[ric[ Local Assistance Engineer (DLAE) upon award. (2) Copy -Include in awazd package to Caltrans District Local Assistance (3) Original -Local agency £ales BP 24 of 37 Local Agency BIDDER-DBE (Construction Contracts)-Information The successful BIDDER must execute and return the LOCAL AGENCY BIDDER -DBE INFORMATION form, even if no DBE participation will be reported. AGENCY:- 7-?KY?-???'-?--? ?'']?S LOCATION: A PROJECT DESCRIPTION: Rosita Park CONTRACT NUMBER:- \ S FEDERAL-AID PROJECT NUMB R: \? 7 S?1J TOTAL CONTRACT AMOUNT: $ FEDERAL SHARE (For 1 cal a ency to complete) : $ BID DATE: i'1 9u?? O\? BIDDER'S NAM- E? -?LSp n[? S7vaq rT" w n IIiC l1DV De?ru??n ?o? ONTRACT ITEM NO. EM OF WORK AND DESCRIl'TION R SERVICES TO BE SUBCONTRACTED OR MATERIALS O BE PROVIDED ? BE Cert. No. ND EXPIRATION ATE AME OF DBEs ? Mus[ be certified on the date bids re opened -include DBE address and hone number) OLLAR AMOUNT BE ' PORTANT: Identify all DBE firms being participating in [he project, regardless of First Tier DBE Subcontractors and their respective item(s) of work f [h i N Total Claimed ames o e er. is[ed above should be consistent, where applicable, with the names and items of work in he "List of Subcontractors" submitted with your bid. Provide copies of the DBEs' uo[es, and if applicable, a copy of joint venture agreements. pursuant [o [he Subcontractors Listing Law and the Special Provisions. pazticipa[ion fp 1. Enter DBE prime and subcontractors certiF cation number. Prime contractors shall DBEs including work performed by its own erformed b ll work [o be di t i ? y p ca e a n forces. Tf ]00% of item is not [o be performed or famished by DBE, describe exact portion of nished b DBE d fu b f i Si na[ e D t--i Lt ` _ 4 `ur•1 I?J`J y . orme or r tem [o e per . See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts); [o determine how [o count the participation of DBE Firms. Date (Area Code) Tel. No. ?7y_?_ ? /t ???,`T ??C ...,.,... r.d,..._? . Distribution: (1) Copy -Fax immediately [o [he Caltrans Dis[ric[ Local Assistance Engineer (DEAF) upon award. (2) Copy -Include in awazd package [o Ca][rans District Local Assistance (3) Original -Local agency Files BP 24 of 37 Local Agency BIDDER-DBE (Construction Contracts)-Information The successful BIDDER must execute and return the LOCAL AGENCY BIDDER -DBE INFORMATION form, even if no DB? participation will be reported. AGENCY:- ?l?t? Y?kl??? LOCATION: S T? PROJECT DESCRIPTION: Cam esino Pazk CONTRACT NUMBER:- ??7? "? FEDERAL-AID PROJECT NUMBER: \??5?`-\ TOTAL CONTRACT AMOUNT: $ FEDERAL SHARE (For local agencyy to complete) . $ BBJ DATE: V1 -ZCJ- ZO ?? BIDDER'S NAME: "t2,ywS ?-741;1 T \ ?_f- ADVERTISED DBE CONTRACT AVAB_ABILITY ADVISORY Percentane: ONTRACT ITEM NO. EM OF WORK AND DESCRIPTION OR SERVICES TO BE SUBCONTRACTED OR MATERIALS O BE PROVIDED ? BE Cert. No. ND EXPIRATION ATE AME OF DBEs ' Must be certified on [he date bids re opened -include DBE address nd hone number) OLLAR AMOUNT BE' PORTANT: Identify all DBE (inns being participating in the project, regazdless of ier. Names of [he Firs[ Tier DBE Subcontractors and [heir respective item(s) of work Total Claimed fisted above should be consistent, where applicable, with [he names and items of work in he "List of Subcontractors" submitted with your bid. Provide copies of [he DBEs' uo[es, and if applicable, a copy of joint venture agreements. pursuant [o [he Subcon[racmn Listing Law and the Special Provisions. Participation J0 1. Enter DBE prime and subcontractors certification number. Prime contractors shall indicate all work to be performed by DBEs including work performed by its own forces. If 100% of item is no[ to be performed or famished by DBE, describe exact portion of item to be performed or famished by DBE. ign u o ID R ?\ \?\' i? '? 3. See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts); [o determine how to count [he participation of DBE firms. Dale (Area Code) Tel. No. ?QNS ?? ??_\ ?? Local Agency BIDLJY.K - ll13t lntormattion (Rev 5/01/06) Distribution: (1) Copy -Fax immediately to [he Ca][rans Dis[ric[ Local Assistance Engineer (DLAE) upon award. (2) Copy -Include in awazd package [o Cal[rans Dis[ric[ Local Assistance (3) Original -Local agency files BP 25 of 37 Local Agency BIDDER-DBE (Construction Contracts)-Information he successful BIDDER must execute and return the LOCAL AGENCY BIDDER -DBE INFORMATION form, even if no DBE articipa[ion will be reported- ?rC?L-]l.[? ????yC?? LOCATION: ?? AGENCY:- PROJECT DESCRIPTION: El Salvador Pazk CONTRACT NUMBER:- i\-7S3S FEDERAL-AID PROJECT NUMBER: ? l-! S? TOTAL CONTRACT AMOUNT: $ FEDERAL SHARE (For local agencyy to ?om?? pplete) : $ BID DATE: ?? - LC7 ? LC7\ \ BIDDER'S NAME: `P??i._? ?. r?A T?T A-.c^ Trcar?riaa rr?nrro er-r evon can i'rv er?vrc?ov ae...P..?? ONTRACT ITEM NO. TEM OF WORK AND DESCRIPTION R SERVICES TO BE SUBCONTRACTED OR MATERIALS O BE PROVIDED ? BE Cert. No. D EXPB2ATION ATE AME OF DBEs t (Must be certified on [he date bids aze opened -include DBE address and hone number) OLLAR AMOUNT BE' PORTANT: Identify all DBE firms being participating in the project, regazdless of Names of [he Firs[ Tier DBE Subcontractors and [heir respective item(s) of work ier Total Claimed . is[ed above should be consistent, where applicable, with [he names and items of work in he "Lis[ of Subcontractors" submitted with your bid. Provide copies of [he DBEs' notes, and if applicable, a copy of join[ venture agreements. pursuant [o [he ubcon[rac[ors Listing Law and the Special Provisions. participation I. Enter DBE prime and subcontractors certification number. Prime contractors shall indicate all work [o be performed by DBEs including work performed by its own - forces. If 100% of item is no[ to be performed or famished by DBE, describe exact portion of erformed or famished by DBE item [o be Signa o ID R , ?\ . p . See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (cons[mction contracts); [o determine how to count [he participation of DBE firms Da[ (Area Code) Tel. No. ??;? \. Y ?, "`? r ,sr??y ar,?,.L,? - ?.nt. ,?,?a.,,...?.. r.«? ?,?,,.,?? Distribution: (1) Copy -Fax immediately [o [he Cal[rans Dis [ric[ Local Assistance Engineer (DEAF) upon award. (2) Copy -Include in awazd package [o Cal[rans District Local Assistance (3) Original -Local agency files BP 26 of 37 Local Agency BIDDER-DBE (Construction Contracts)-Information e successful BIDDER must execute and return the LOCAL AGENCY BIDDER -DBE INFORMATION form, even if no DBE articipation will be reported. AGENCY:- ?.13t4?.l? ti?C7'1?.'] LOCATION: S ?? PROJECT DESCRIPTION: Southwest Senior Center CONTRACT NUMBER:- \ O _ O FEDERAL-AID PROJECT NUMBER: ?OlS(o?? TOTAL CONTRACT AMOUNT: $ FEDERAL SHARE (For 1 cal a$ency,to complete) : $ BID DATE: ?-/(? -L?t? BIDDER'S NAME: ? S-?1trhC AD VERTISRD DRE CONTRACT AV AiLAR7iJTY ADVISORY Perr .nta net ONTRACT ITEM NO. ITEM OF WORK AND DESCRIPTION R SERVICES TO BE SUBCONTRACTED OR MATERIALS O BE PROVIDED ? BE Cert. No. D EXPIRATION ATE AME OF DBEs ` (Must be certified on the date bids aze opened -include DBE address nd hone number) OLLAR AMOUNT IIE 3 PORTANT: Identify all DBE firms being participating in [he project, regazdless of ier. Names of the First Tier DHE Subcontractors and their respective item(s) of work Total Claimed is[ed above should be consistent, where applicable, with the names and items of work in he "List of Subcontractors" submitted with your bid. Provide copies of the DBEs' uo[es, and if applicable, a copy of join[ venture agreements. pursuant to the ubcontrac[ors Listing Law and [he Special Provisions. Participation ,? 1. Enter DBE prime and subcontractors certification number. Prime contractors shall indicate all work [o be performed by DBEs including work performed by its own - forces. If 100% of item is no[ to be performed or furnished by DBE, describe exact portion of item [o be performed or furnished by DBE. gnatu DE ?t - is-?-?? t L L?, 3. See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (cons[mction contracts); [o determine how [o count [he participation of DBE firms. Date (Area Code) Tel. No. p ?QNS m?Ct'?l?C Local Agency t31UUtK - U13C tntormanon (Kev ?/Ul/U6) Distribution: (1) Copy -Fax immediately to [he Cal[rans Dis[ric[ Local Assistance Engineer (DEAF) upon award. (2) Copy -Include in award pacKage [o Caltrans District Local Assistance (3) Original -Local agency files BP 27 of 37 Local Agency BIDDER-DBE (Construction Contracts)-Information e successful BIDDER must execute and return the LOCAL AGENCY BIDDER -DBE INFORMATION form, even if no DBE azticipation will be reported- AGENCY: Y?KrA! =YW ? ?i?? ?+?"'S LOCATION: PROJECT DESCRIPTION: Madison Park CONTRACT NUMBER:- IOISSg FEDERAL-AID PROJECT NUMBER: tc-iZSS? TOTAL CONTRACT AMOUNT: $ FEDERAL SHARE (For local agen?yy??to complete) : $ BID DATE: y?Zi7'GY-??? BIDDER'S NAME: '??7uG Kk-?-'e-?>c< ?u-C ADVERTISED DBE CONTRACT AVAILABILITY ADVISORY Percentaee: ONTRACT ITEM NO. EM OF WORK AND DESCRIPTION R SERVICES TO BE UBCONTRACTED OR MATERIALS O BE PROVIDED ? BE Cert. No. D EXPIRATION ATE AME OF DBEs ? Mus[ be certified on the dale bids ? re opened -include DBE address and hone number) OLLAR AMOUNT BE' PORTANT: Identify all DBE firms being paz[icipating in [he project, regazdless of ier. Names of [he First Tier DBE Subcontractors and [heir respective item(s) of worK Total Claimed fisted above should be consistent, where applicable, with the names and items of work in he "Lis[ of Subcontractors" submitted with your bid. Provide copies of [he DBEs' uotes, and if applicable, a copy of joint venture agreements. pursuant to [he Subcontractors Listing Law and [he Special Provisions. Participation f0 I. Enter DBE prime and subcontractors certification number. Prime contractors shall indicate all work to be performed by DBEs including work performed by its own ? forces. If 100% of item is not to be performed or furnished by DBE, describe exact portion of item to be performed or furnished by DBE. g ur D ? ?? ~ Li ? '?+ 3. See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts); [o determine how [o count [he participation of DBE firms. Da[ (Area Code) Tel. No. ?- . __A ?? \?C C.ocal Agency BIDDER -DBE Information (Rev 5/01/06) Distribution: (1) Copy -Fax immediately [o [he Caltrans District Local Assistance Engineer (DEAF) upon awazd. (2) Copy -Include in award package to Caltrans Dis[ric[ Local Assistance (3) Original -Local agency £les BP 28 of 37 Local Agency BIDDER-DBE (Construction Contracts)-Information e successful BIDDER must execute and return the LOCAL AGENCY BIDDER -DBE INFORMATION form, even if no DBE articipa[ion will be reported. AGENCY:- -lt--?.t????-??yx?5 LOCATION:??'V PROJECT DESCRIPTION: Memorial Pazk CONTRACT NUMBER:- ? ?7 Z FEDERAL-AID PROJECT NUMBER: \ \l S2? TOTAL CONTRACT AMOUNT: $ FEDERAL SHARE (For local agency to\; mple[e) : $ BID DATE: ???-? BIDDER'S NAME: ? a?S ???r`n\T s'C A rlv GTl TiCPTI TIRF !'(1NTR A(?T AVAII ARri TTY GTIV [C(1RY PerrPr,fa vrr ONTRACT ITEM NO. EM OF WORK AND DESCRIPTION OR SERVICES TO BE SUBCONTRACTED OR MATERIALS O BE PROVIDED ? BE Cert. No. ND EXPIRATION ATE AME OF DBEs [ (Must be certified on the date bids re opened -include DBE address nd hone number) OLLAR AMOUNT BE' PORTANT: Identify all DBE Firms being participating in [he project, regazdless of Names of the Fitst Tier DBE Subcontractors and [heir respective item(s) of work iet Total Claimed . fisted above should be consistent, where applicable, wish the names and items of work in he "Lis[ of Subcontractors" submitted with your bid. Provide copies of [he DBEs' uo[es, and if applicable, a copy of joint venture agreements. pursuant to [he Subcontractors Listing Law and [he Special Provisions. pazicipa[ion 1. Enter DBE prime and subcontractors certification number. Prime contractors shall indicate all work [o be performed by DBEs including work performed by its own ? forces. If 100% of item is not [o be performed or furnished by DBE, describe exact portion of erformed or furnished by DBE item [o be S? na[u fBI Zd.? ? _yO . p . See Section "Disadvantaged Business Enterprise (DBE)," of [he Special Provisions (construction contracts); [o determine how [o count [he participation of DBE firms. Date (Area Code) Tel. No. ^ ` . r, Y?i?Sa M?_ Locat Agency nwUtx - IJnC tntormauon tKev J/U VUb) Distribution: (1) Copy -Fax immediately to [he Caltrans District Local Assistance Engineer (DEAF) upon award. (2) Copy -Include in awazd package [o Caltrans District Local Assistance (3) Original -Local agency files BP 29 of 37 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530: 117534; 117535: 118014; 107560 PARK IMPROVEMENTS: 107559; 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT NONLOBBYING CERTIFICATION FOR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influence or attempting to influence an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriate funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standazd Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub-recipients shall certify and disclose accordingly. BI S t e T ?? Firm '`{ / A/.. Date ?? ? Standard Form LLL may be obtained from Cal[rans and FHWA offices BP 30 of 37 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530: 117534; 117535: 118014: 107560 PARK IMPROVEMENTS: 107559: 112607: 117529 PROPOSAL AND CONTRACT AGREEMENT DISCLOSURE OF LOBBYING ACTIVITIES Can nlP.iP rl.ic fnrrn rn Aicrln r lr?},L.v, rr: viNoc .. .,r rr, R1 T T C f` 1169 1. Type of Federal Action 2. Status of Federal Action 3. Report Type: Q a. Contract Q a. Bid/offer/application 0 a. initial b. Grant b. initial award b. material change c. Corporate Agreement c, post-awazd d. Ban For Material Change only: e. Loan Guarantee Yeaz quarter f. Loan Insurance date of last re ort 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawazdee, Enter Name and Address of Prime: Prime Q Subwazdee Tier , Iflozown Con sional District, iflaeown Con ssional District, i lozown 6. Federal DepartrnenVAgency: 7. Federal Program Name/Description CFDA Number, If a licable 8. Federal Action Number, f Imowtx 9. Awazd Amount, if la?inwn ]O. a. Name and Address of Lobbying Entity b. Individual Performing Services (b??Ledbeg addmss¢'differ?TlfianxNo. (¢rdn?adnj Ic?rrvre?.fo?Ml) IQz) QasitTCnn?fisttimn? MI) (attach Continuation Sheet(s) if necess ) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply) $ Q Actual Q Planned ? a. retainer Q b. one-time fee 12. Form of Payment (check all that apply): Q c. commission a. cash ? d. contingent fee b. in-kind; specify: nature ? e. deferred value Q f. other, s ec? 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment indicated in item 11: (attach Continuation Sheet(s) i necessary) 15. Continuation Sheet(s) attached: ? Yes o lfz Ir>ft>arrati?rarnTestedflaaagjithis fumis ??1-?aedbyTale 31 USC Section 1352. Thisdi?lnslaeoflobbyingactivitiesisaTrla??lrefaesa-?onoffacYUpcat Signatu - whirhre]iarxEwas plaoedbythe fiaabove when the trarls?ctionwas made oren[aed '?T."? ? S?? into. T]tisclisclosiueisTagiucedg>ro,?r*to31 U.S.C.1352. Thisinfr>nn?onwillbe ? Print N e eMr-- reported mtheCongress senri-atmually and will be avat?ablefcspublic u>,?actiorL Ti l ? ? AnypersatwhofailstofiletherequueddisclosrueshaIlbesubjecth?acivtlpenaltyof t e . not less tl>irzt$10,000 and notntotethan $100000 forearli such failrue. -X ` ? \?'? Tele honeNo?1`\-S ? Dateki-\43 ?? I'E*da-dl jJee QnlSr Aurhori?xd for Local ReproducROn Standard Form-LLL BP 31 of 37 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530: 117534; 117535; 118014: 107560 PARK IMPROVEMENTS: 107559; 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING REQUIRED FEDERAL CONTRACT PROVISIONS (Form FHWA-1273) The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the required Federal Contract Provision (Form FHWA-1273) as shown in the appendix of the special provisions of this project. Signed Title Firm Date BP 32 of 37 y ??-? ? CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534; 117535: 118014; 107560 PARK IMPROVEMENTS: 107559: 112607: 117529 PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION FOR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief; that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for 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 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 an Federal contract, grant, loan, or cooperative agreement. (2) If any funds other 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 Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL*, "Disclosure of Lobbying Activities" in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub- cipients shall certify and disclose accordingly. BID n t e Ct 1?-?r? Firm --?la/, Date ,*?S,tanda?d Form LLL' may bepbtairied`.`.,from'?al trans or:FHWA of£ces , ;,"'. t?.s„,... ,?, ?,?„ ,.? ;'„ ,f? y _??, _ _ _?'+, ?„ _ ?'r s? ?,,, ?,„, ,,,.? ,„ ,; BP 33 of 37 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS. 117530: 117534: 117535; 118014; 107560 PARK IMPROVEMENTS: 107559: 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT BIDDER'S CERTIFICATE OF COMPLIANCE REGARDING "BUY AMERICA" REQUIREMENTS FOR STEEL OR MANUFACTURED PRODUCTS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the "Buy America" requirements of Section 165 of the Surface Transportation Assistance Act of 1982 and as shown in the special provisions of this project. Signed Title Firm Date y ?? ?? BP 34 of 37 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534; 117535; 118014: 107560 PARK IMPROVEMENTS: 107559; 112607: 117529 PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the BIDDER hereby declares under penalty of perjury under the laws of the State of California that the BIDDER has ,has not?been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "BIDDER" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: Signec Title Firm Date BP 35 of 37 The BIDDER must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530; 117534; 117535: 118014; 107560 PARK IMPROVEMENTS: 107559: 112607: 117529 PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10162 OUESTIONAIRE 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 ?/C If the answer is yes, explain the circumstances in the following space. BP 36 of 37 CITY OF SANTA ANA PARKING LOT IMPROVEMENTS: 117530: 117534: 117535: 118014: 107560 PARK IMPROVEMENTS: 107559: 112607; 117529 PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10232 STATEMENT In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor to comply with an order of the National Labor Relations Board. Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. BIDDERS are cautioned that malting a false certification may subject the certifier to criminal prosecution. Signet Title Firm Date BP 37 of 37 08739254 Bond No-- ---------------------------- Fidelity and Deposit Company Posy o?F?cE aox ?aa? OF MARYLAND a,?GnMOxE, nrD zi2o3 ?ID BOND , I KNOW ALL MEN BY T?iESE PRESENTS: Thai we, Ben's Asphalt, Inc . __--__----------------____-_- ___ -_ -__, as Principal, (hereinafter called the "Principal"), and 'the FCUEL[ll' AND DEt+?SIT CbMPANY OF MARYIANU, P.O. Boz 1227, Baltimore, Maryland 2 L203, a corporation duly .organized under the laws of t3ac State of Maryland, as Surety, (hereinafter called the "Surety"), are held and firrnlg? bound unto__-C i t Y- o f S an c a Ana ------- -------------------- -------------------------_-- - ---____-aS Obligee, (hereinafter called the "Obligee"). ---- - in the sum of__ten percent of amount-bid_---------------------------liars ($__ 10°s__-____ _ _ __). for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. `; ' WHEREAS. the Principal has submitted a bid for------------_--------------_----------_-----_-------------------- /.`' Parking Lot Smprovements 117530,117534,117535,118014,107560, - - - - ------------------------------------------------------------------------------------- 107559,112607,117529 I)iOW, THEREFORE, if the Obligec shall accept the bid' of the Principal and the Principal shall enter into a contract wig the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or contract documents with good and sufficient surety for the faithful performance of such contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter into such contract and give such bond or bonds, if the Principal shall pay.to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for wtuctt the Obligee may in good faith contract with another party to perform the work covered by said bid, then [his obligation shall be null and. void,, .otherwise to retrain in full force and effect. Signed and sealed this------------------ 14tH day of_-------------April --------------A-D'•2Q'???Z ' Ben's Asp alt, Inc. _(SEwc) - - Principal Witness /' {. ?.. BY _- -- - -- ----- ---------------------? ----- ------------ - Tide - -. FIDEL.I-CY AND DE S[T A Y OF MARYLAND - I Surety . ' ' ` ---- v-- ----------------------- - - - By- ??-?- ------_(SEwL) - ------- -- - --------- Witness ATTORNEY-IN-FACT Title c?zsr-so?r.?-vz Richard A. Coon - - - ? Cu,afo,ma a Amuican Iaiti,uk or Arddecas ppcya?e ., A-310, FW,Varr ,9]O FA i.iw.. - _ I ' i CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA County of Orange } On 4-14-11 before me, Lexie Sherwood Notary Public Date Here Insert Name and Title of the Officer ' personally appeared Richard A. Coon Name(s) of Signer(s) .::... LEXIE SHERWOOD COMM. #7856389 ? C:J t-- NOTARY PUBLIC ? CALIFORNIA 'n ? - ?? ? owvNCe couNrY Comm. Exp. JULY 27, 2073 Place Notary Seal Above 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. certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Wigtness my hand an o 'cia? a.?J?Q???d?J? Si nature S?gnatur¢ of ota utNic ? OPT/ONAL Though the information be/ow is not required by law, it may prove va/uab/e to persons relying on the document and cou/d prevent fraudulent remove/ and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: O Individual D Corporate Officer - Title(s):_ ? Partner - ? Limited D General ? Attorney in Fact ? Trustee D Guardian or Conservator ? Other: Signer Is Representing: Number of Pages: Signer's Name: O Individual O Corporate Officer -Title(s) ? Partner ? Limited O General ? Attorney in Fact ? Trustee ? Guardian or Conservator ? Other: Signer Is Representing: ® 2007 National Notary Assoria[lon - 9350 De Soto Ava., P.O. Box 2402 -Chatsworth, CA 91313-2402 - www_NalionalNOlary.org Item 1s5907 Reordac Call Tdl-Free 1-600-876-6827 Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation of the State of Maryland, by WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary, in pursuance of authority granted by Article Vl, Section 2, of [he By-Laws of said Company, are set forth on the reverse side hereof and are hereby certified to he in full force and effect on the date h e des by nominate, constitute and appoint Richard A_ COON, Charles L. FLAKE, David L. CULB n ? e OOD, all of Anaheim, California, EACH its true and lawful agent and a ? u ° d deliver, for, and on its behalf as surety, and as its act and deed: any an ° n ° xecution of such bonds or undertakings in pursuance of these prose ?`9r?c? 1 in ? as fully and amply, [o all intents and purposes, as if [hey had been d ? t ? Ht3H'a?n h ularly elected officers of the Company at its office in Baltimore, Md., i p per ? ? attorney revokes that issued on behalf of Richard A. COON, Charles L. FLAKE, C a ew P. FLAKE, Lexie SHERWOOD, dated November 7, 2005. The said Assistant ° s by certify that the extract set forth on the reverse side hereof is a true copy of? Article V Section 2, of the By- s said Company, and is now in force. IN WITNESS WHEREOF, the said V ice-iresident and Assistant Secretary fiaic .::;rau^ :^ s?bscr?'_?tJ J_hr;.r ??*.nes atx? affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 15th day o November, A.D. 2006. FIDELITY AND DEPOSIT COMPANY OF MARYLAND I, f ATTEST. 'gyp DEPOg?i ???4 (? _ p O J ?.? Z O tD? ? 4.V., I.?I? State of Maryland ss: City of Baltimore (///y ? f // ? y/?? /l/=„-„ //-?J By. L r Eric D. Barnes Assistant Secretary William J. Mills Vice President On this 15th day of November, A.D. 2006, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, came WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged [he execution of the same, and being by me duly sworn, severally and each for himself deposeth and with, that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. 1N TESTIMONY WHEREOF, I have hereunto set my hand and afi'ized my Official Seal the day and year first above written. ?i .:ri ? ? ' /? C,? / _ Constance A. Dunn Notary Puhlic My Commission Expires: July 14, 201 1 POA-F 012-4150H EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND "Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice-President, or any of the Senior Vice-Presidents or Vice-Presidents specially authorized so to do by the Board of Directors or by the Executive Committee, shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident Vice-Presidents, Assistant Vice-Presidents and Attorneys-in-Fact as the business of the Company may require, or to authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations, policies, contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages,... and to affix the seal of the Company thereto." CERTIFICATE I, the undersigned, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that ?.-;.. `:*??2:-i':es::?..i -:a :c, ?necutea trie saia Yower oY :vuorney was one- oI Lhe addiCional V ca-Presidents specially authorized by the Board of Directors to appoint any Attorney-in-Fact as provided in Artic?e VI, Section 2, of fhe By-Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether. made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall. be valid and binding upon the Company with the same force and effect as though manually affixed." IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said Company, this 14TH day of APRIL 2011 0 Assistant Secretary CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT crv?? coloe g ? ? sa State of California County of_? P? On ? /S?- // before me, ?/? G. `ice ? ?j ? ??Irt? ?•?WiG , Dale -? Here Insert Name and T[le of the fficer personally appeared \/U`!/1 ?? - f/??? Na s) of bigner(s) 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. A L. F it D I certify under PENALTY OF PERJURY under the CowMwissitoo ? 119 laws of the State of California that the foregoing frodry Pv61fe - ICaMAmu paragraph is true and correct. ? Cellwyr Comm. Flab 2t, 2015 WITNESS my hand and official seal. Signature ?r?? Place Notary Seal Above ? Signature of Notary Public OPT/ONAL Though the information below is not required by law, it may prove va/uab/e to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: D Corporate Officer -Title(s): C ] Individual - 0 Partner - C7 Limited 1. ]General Top of thumb here I-] Attorney in Fact U Trustee C_I Guardian or Conservator D other: Signer Is Representing: Signer's Name: C] Corporate Officer -Title(s): CJ Individual - O Partner - O Limited L.J General Top of thumb here LI Attorney in Fact O Trustee Cl Guardian or Conservator C? Other: Signer Is Representing: I _J Number of Pages: 2010 National Notary Association NationalNO[ary.org l-BOO-US NOTARY (1-BOO-B76-6B2]) Item #5907 MEMORANDUM To: From: Subject: Paul Walters City Manager Raul Godinez 11, Executive Director Public Works Agency Project No. 1 1-7530 Parking Lot and Parks Improvements Chansae Order No. 1 Contractor. Ben's Asphalt 2200 S. Yale Street Santa Ana, CA 90704 Date: March 12. 2012 Project Description: Parks Improvements Change Order Number: 1 Amount: $22,350 027188602300 13518783-66220-11752901028 $879,621 .50 Of Original $ 22,350 2.5% Accounting Unit, Account, and Activity Number: Original Contract Cost: Amount of This Change Order: $ -0- O.O% $ 22,350 2.5% Previously Approved Change Orders: Total Change Orders: REASON FOR CHANGES 1. During construction it was discovered that 13 existing bollards were in the landscaped area. The Community Development Agency requested the removal and disposal of ten (10) bollards, the relocation of three (3) bollards and the relocation of parking signage in Fiesta Marketplace parking lot. PCO #2 was issued on July, 13, 2011 AGREED PRICE _ $4,800.00 Project #11-7530 Request for Approval of Change Order No. 1 March 12, 2012 Page 2 of 2 2. The contract documents showed to resurface the playing surfaces of the basketball and volleyball courts at Memorial Park. At the request of Parks and Recreation, an additional 6,414 square feet of court surfacing was added to the areas surrounding the basketball and volleyball courts. (PCO 3). A prior approval was issued November 7, 2011. AGREED PRICE _ $7,955.00 3. A photocell, related wiring, and modification to the cabinet for the lighting at the Fiesta Marketplace parking lot was not included in the contract documents. The photocell is needed for the lights in the parking lot to come on at dusk and off at dawn. (PCO 4) A prior approval was issued November 7, 201 1 . AGREED PRICE _ $850.00 4. The existing chain link fence adjacent to the basketball courts and baseball dugouts at Memorial Park was old and had become deteriorated from years of use. At the request of Parks and Recreation, 240 LF of chain link fence was replaced (PCO 6). A prior approval was issued November 7, 2011 . AGREED PRICE _ $1,595.00 5. As part of this project the parking lot at Memorial Park was resurfaced. The striping plans were inadvertently omitted from the contract documents. At the request of Parks and Recreation the parking lots will be restriped. AGREED PRICE _ $7,150.00 Raul Godinez II, x cutive Director Public Works Age cy erardo Mouet Executive Director Parks, Recreation, and Community Services Agency APPROVED AS TO FUNDS AND ACCOUNTS: C?R?c? c? ? do ?? ? ? ? n Francisco Gutierrez, Executive Director Finance and Management Services Agency K:\construdion\projects\1'1-7530\MEM RFA 01 KW CITY OF SANTA ANA - PUBLIC WORKS AGENCY p., i ' CONTRACT CHANGE ORDER Project Number 1 1-7530; PARKING LOT AND PARKS IMPROVEMENTS Change Order Number 1 To Ben's Asphalt, Inc. Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated, rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by PUBLIC WORKS AGENCY EXTRA WORK AT AGREED PRICE 1. Remove and dispose of bollards as directed per PCO #2 issued on 7/13/2011 . AGREED PRICE _ $4,800.00 2. Install additional court surfacing on the basketball and volleyball courts at Memorial Park as directed per PCO #3. Prior approval was issued November 7, 201 1 . AGREED PRICE _ $ 7,955.00 3. Modify electrical cabinet at Fiesta Marketplace parking lot lighting as directed per PCO #4. Prior approval was issued November 7, 2011 . AGREED PRICE _ $850.00 4. Replace existing chain link fence at Memorial Park as directed per PCO #6. Prior approval was issued November 7, 2011 . AGREED PRICE _ $ 1 ,595.00 5. Restripe Parking Lot at Memorial Park per revised plan. AGREED PRICE _ $ 7,150.00 Page 1 of 2 CITY OF SANTA ANA PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number 11-7530; PARKING LOT AND PARKS IMPROVEMENTS Change Order Number To Ben's Asphalt contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specffications on this contract. NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated, rates for rental of equipment cover only such time as equipment is actually used and no allowance wi II be made for idle time. Change requested by PUBLIC WORKS AGENCY The compensation both time and cost set forth in this final change order comprises the total compensation due the Contractor, all Subcontractors, and all Suppliers for all work performed per this change order, including impact on unchanged work. By signing this final change order, the Contractor acknowledges and agrees on behalf of himself, all Subcontractors, and all Suppliers, that the stipulated compensation includes payment for all work contained in this final change order, plus all payment for interruption of schedules, extended field overhead, home office overhead, profit, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract. The signing of this final change order constitutes full mutual accord and satisfaction for all changes and work performed on this project, and that the time and cost paid per this final change order constitutes the total equitable adjustments owed the Contractor, all Subcontractors, and all Suppliers for all work performed on this project. The Contractor on behalf of himself, all Subcontractors, and all Suppliers agrees to waive all rights, without exception or reservation of any whatsoever to file any further claim related to this project. TOTAL COST THIS CHANGE ORDER: DECREASE ? _ _ _ _ _ INCREASE $ ZZ,35O.00 By reason of this order the CONTRACT TIME completion will be adjusted as follows: One Hundred Eight (108) Working Days We the undersigned contractor have given careful consideration to the change proposed and hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials, except as may otherwise be noted above, and perform all service necessary for the work above specified, and will accept as full payment therefor the prices. ho n above. Accepted, to y ?V I ? Contractor Ben'S AS halt By Title x/,10. ?L ?- 6 Approval recommended by ? Date ?' ?` ? ?/? PUBLIC WORKS AGENCY EXE UTl E DIRECTOR Approved by ?i ? Date ?? ?i ? L ?i CITY MAN R Page 2 of 2