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Home My WebLink AboutCALIFORNIA PROFESSIONAL ENGINEERING, INC. (4)a w ?o U ? ? U Hz oy A? ?w o? ?o w? c7 x U Wa a Recording Requested By, And When Recorded Mail To: Clerk of the Council, City of Santa Ana 20 Civic Center Plaza, P.O. Box 1988 Santa Ana, CA 92702 c.^ 0 Recorded in Official Records, Orange County Hugh Nguyen, Clerk-Recorder I111I IIIIIII111JJJII111111111111I11111111111111111911111111111111IIII]l NO FEE 6 2 * 201300041437310:30 am 07110113 217414N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 NOTICE OF COMPLETION NOTICE IS HEREBY GIVEN that the undersigned City of Santa Ana, California, a t._ municipal corporation, with the address of City Hall, 20 Civic Center Plaza, Santa Ana, California, 92701, is the owner of the property hereinafter described, that said owner has caused construction of Traffic Signal Installation On Civic Center Dr. & Pacific Ave. and 17a' St. & King St.; Bristol Bike Lane Extension From Edinger Ave. to McFadden Ave. under contract entered into on June 18, 2012 with California Professional Engineering, on which contract The Hanover Insurance Company is surety. The property on which such work improvement was placed is in the City of Santa Ana, County of Orange, State of California, and described as Project Nos. 10-6704, 10-6705, and 12-6763 located at VARIOUS LOCATIONS. The work improvement on said property was accepted as completed on June 14, 2013. A AN2. A MUNICIPAL CORPORATION by?rc r Dated: City Engineer TITLE VERIFICATION I, the undersigned, say: I am the City Engineer 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 7y u l at Santa Ana, California (signature of individual swearing that the contents of Notice of Completion are tine.) 11(1 THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN (10) DAYS AFTER COMPLETION REQUEST FOR _???? .t COUNCIL ACTION ??? r ??'?? CITY COUNCIL MEETING DATE: JUNE 18, 2012 TITLE: CONTRACT AWARD WITH CALIFORNIA PROFESSIONAL ENGINEERING, INC. FOR TRAFFIC SIGNAL INSTALLATIONS (PROJECT NOS. 106704, 106705 AND 126763) ?? r, . CITY MANA ER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED G'?8'?? L7 As Recommended oP.3'4 ? As Amended ? Ordinance on ??` Reading ? Ordinance on 2ntl Reading ? Implementing Resolution ? Set Public Hearing For CONTINUED TO FILE NUMBER Award a contract to California Professional Engineering, Inc_, the lowest responsible bidder, in accordance with unit bid quantity prices in the amount of $443,499 for the installation of traffic signals at two intersections: Seventeenth/King Streets and Civic Center Drive/Pacific/Bristol Street Bike Lane Extension. 2. Approve a Funding Analysis with a total estimated construction cost of $554,300_ DISCUSSION This project provides for the installation of new traffic signals at two intersections: Seventeenth/King Streets and Civic Center Drive/Pacific Street and the on-street bike lane on Bristol Street between McFadden and Edinger Avenues (Exhibit 1 )_ Once completed, these improvement projects will increase safety of motorists, pedestrians, and bicyclists at these locations. The Notice Inviting Bids was advertised on May 2 and 4, 2012 and bids were opened on May 23, 2012. A summary of the bid invitations mailed, the bids received, and the bid results follows. Santa Ana Contractors receiving notices: 1 Contractors requesting bidding documents: 13 Bids received: 5 Bids received from Santa Ana Contractors: O Contract Award With California Professional Engineering, Inc. June 18, 2012 Page 2 NAME OF RESPONSIVE BIDDER CITY BID AMOUNT 1. California Professional Engineering, Inc. La Puente $443,499 2. Sully-Miller Contracting Company Brea $460,997 3. JFL Electric, Inc. Los Angeles $1,558,940 4. VT Electric, Inc. Upland $1 ,801 ,800 5. Steiny & Company, Inc. Baldwin Park $1 ,874,054 The Engineer's estimate was $587,425. A total of five bids were received and all were responsive. The lowest bid was submitted by California Professional Engineering, Inc_ for $443,499. ENVIRONMENTAL IMPACT Environmental Review Nos. 2009-28, 2009-29, and 2012-13 were completed. Categorical Exceptions were filed for these projects pursuant to the California Environmental Quality Act_ FISCAL IMPACT The Funding Analysis shows a total estimated construction cost of $554,300 for the project (Exhibit 2). Funds are available in the Measure M Street Construction Fund (accounting unit 03217660-66220), Measure M2 Street Construction Fund (accounting unit 03217662-66220), Public Service -Street Safety Projects Fund (accounting unit 1 471 761 1-66220), and the Select Street Construction Fund (accounting unit 05917660-66220)_ ??= Rau odinez II Executive Director Public Works Agency APPROVED AS TO FUNDS AND ACCOUNTS: Francisco Gutierrez Executive Director Finance & Management Services Agency /? RG/ET Exhibit 1 : Project Location Map 2: Funding Analysis 17?^/King New Traffic Signal Civic Center/Pacific New Traffic Signal ? ? I _ H ? 17thl,Street h ?'? ?? .? i C A ?c I Ic Cent 'Dr ?' 5th St ? N I _.. w m > N y Santa Ana Blvd h d m _ ? t ? y ? Q ? 3 a ? ? ? r j ? ?i 1st Street w Z = ? a' ? I G ; Iuns st •- c McFadd n A e H ?` LL i Kent v-fie ? ?'. m ',,. .Z ? Edinger A e. wood PI Bristol Bike Lane Q W?rner "o c A e. i 'i C7 Segerstrom Ave. / MacArthur] Blvd. ../??% SANTA ANA ?? City Council Project Nos. 10-6704 8. 10-6705 -Traffic Signals at ? JpWA? Agenda Date Civic Center/Pacific and 17t^/King ? June 18. 2012 Project No. 12-6763: Bristol Street Bike Lane PUBLIC WGgKS AGENCY 55 ai Q ' c N 7 ~ I NORTH ?. Exhibit 1 FUNDING ANALYSIS PROJECT NOS. 106704, 106705 AND 126763 CONTRACT AWARD FOR TRAFFIC SIGNAL INSTALLATIONS AT SEVENTEENTH & KING AND CIVIC CENTER & PACIFIC AND BRISTOL STREET BIKE LANE EXTENSION Construction Contract $443,499 Contract Administration $33,200 Inspection and Testing $24,400 Survey Staking $8 852 Contingencies $44„349 TOTAL ESTIMATED CONSTRUCTION COSTS $554.300 Exhibit 2 THE REGISTER 625 N GRANp AVE, SANTA ANA, CA 92701 Telephone (714) 796-7000 /Fax (714) 796-6059 space ror nw^p cramp or+iy [rrrw my o W PROOF OF PUBLICATION (2015.5 C.C.P.) State o! California ) County of ORANGE ) ss Notice Type: gip _ NOTICE INVITING BIDS Ad Description: Tres fFc Signal Installation 8 Bike Lana Ex[ 1 am a cltiz en o! the United Stales and a resident of fhe States of California; I am over the age of eighteen years, and not a party to or interested in the above entitled matter. I am the principal clerk of the printer and publisher of the THE REGISTER, a newspaper published in the English language in [ha 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, Stale of California, under dale 11/19/1905, Case No. A21046. That the notice, of which the annexed Is a printed copy, has bean published in each regular and entire issue of said newspaper and not in any supplement thereof on the foNowing dates, to-wit: 05/02/2012, 05/04/2012 Executed on: 05/04/2012 At SANTA ANA. California I certify (or declare) under penalty o?g¢r)ury gnat the f ragoing true and correct ? ? ? to of on ?«?iiii viii iiiii iiii? ??tii iii ii?i? iiiii i?iiiii ?iii? i?i? ii?? C N S #: 2305958 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV PROPOSAL 8c CONTRACT AGREEMENT BID PROPOSAL TO: CITY COrU'NCIL OF THE CITY OF SANTA ANA FROM: ?itfOrnla f?esSiOnal Engineering 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 prov isions, for the unit price(s) or lump sum(s) set forth in the following schedule: Item # Bid Item Unit Quantity Unit Price Amount Proiect # 10-6704 1. Traffic Signal Installation at Civic LS 1 $gIP142? $ ??OII-} ?-u! Center Drive and Pacific Avenue 2. Install 2" PVC Conduit LF 25 $ 2-C7 S 5?? 3. Install 3" PVC Conduit LF 2500 $ ?? $ ?'IS.ba7 4. Install 4" PVC Conduit LF 100 $ 2? $ 2? S-C?f] 5. Install No. 6 Pull Box EA 20 $ S?? $ `? 6. 12PR#22 Signal Interconnect LF 2300 S ?° ? ? 5 ? ?.??' Cable (Including Splicing) 7. 12 Strands SMFO Cable LF 2300 $ I a 2s $ 21?i-1S 8. Fusion Splice 1 Strand of Fiber EA 48 $ ?(7 $ I i? Z? Optic 9. 3M Emergency Vehicle LS 1 S O? S ? 1 ?? Preemption System 10. Install IP Communication LS 1 $ (? ? ?? 5 «? S?? Equipment TO BE INCLUDED IN BID PACKAGE BP 1 of 32 11. Install Traffic Signal Loop EA 20 $ Igo $ 3? wC? Detector 12. Install Bicycle Loop Detector EA 8 $ L Z ? $ f ? ?P ?? (Diagonal Quadra Circle) 13. Signing c4L Striping LS 1 $ S? ? $ ?? ?? 14. Pothole for Utilities Not Shown on EA 10 $ ? $ ?? Plans Project No.: 10-6704, subtotal .............. TO BE INCLUDED IN BID PACKAGE BP 2 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. ]0-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8r KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV PROPOSAL 8c CONTRACT AGREEMENT BID PROPOSAL, continued Item # Bid Item Unit Quantity Unit Price Amount Project # 10-6705 15. Traffic Signal Installation at 17"' St LS 1 $ ilU? ?i S ???0? and King St 16. Install 2" PVC Conduit LF 120 S 2 O S 2 ? i-}CO 17. Install 3" PVC Conduit LF 950 S L`t3 $ f?? lC7O 18. Install 4" PVC Conduit LF 220 S 2S S ?? Sao 19. Install No. 6 Pull Box EA 1 1 S ?O S 'S ??7 20. 6PR#22 Signal Interconnect Cable LF 200 $ `?? ?? O $ `?,?7 (Including Splicing) 21. 3M Emergency Vehicle Preemption LS 1 $ ?, uCJ? S System 22. Install IP Communication Equipmen t LS 1 $ -?S1C?J S ?S1L7C? 23. Install IP Based CCTV System EA 1 $ '??? ? $ 2-5 24. Install Traffic Signal Loop Detector EA 25 S ig? 5 ??? 25. Install Bicycle Loop Detector EA 8 S l ? S ?? (Diagonal Quadra Circle) 26. Signing 8c Striping LS 1 $ ? U S? 27. Pothole for Utilities Not Shown on EA 1 O S -? S ? O Plans 28. Construct PCC Curb Ramp SF +Jjc ZC?U $ w $ ?? ?7U ??? A-? ? 1 Project No.: 10-6705, subtotal ....... ....... $ 2 4? ,?S 3 TO BE INCLUDED IN BID PACKAGE BP 3 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST Rc KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV PROPOSAL 8c CONTRACT AGREEMENT BID PROPOSAL, continued Item # Bid Item Unit Quantity Unit Price Amount Proiect # 12-6763 29. Cabinet modifications and LS 1 $ ? 1 ?a7 $ ? 1 ?DC? appurtenances 13 uoo 30. Signing 8r Striping LS 1 $ I $ ?`-3. 31. Install Traffic Signal Loop EA 27 $ ZU? $ ?? ??? Detector 32. Install Bicycle Loop Detector EA 26 $ ZZ y $ ? I, Z? (Diagonal Quadra Circle) 33. Install Bicycle Loop Detector EA 2 $ Z?? $ (Type Q Modified) Project No.: 12-6763, subtotal .............. Projects 10-6704, 10-6705 and 12-6763 Grand Total Bid $ Z(o, ? ? $ ? ? ? I `--t"? 1 1 The lowest responsible bidder shall be selected based on the low Grand Total Bid. The City reserves the right to award the Base Bid, and any, all or none of the alternate Bid Items. * The quantity for this bid item is shown for bid comparison only. This bid item shall not be subject to the "25%" limit as stated in Section 3-2 of the Standard Specifications. The actual amount for this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. -?- This bid item is considered a Specialty Item per Section 2-3.2 of the Standard Specifications. TO BE INCLUDED IN BID PACKAGE BP 4 of 32 PROJECT NO. ]0-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8t KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV PROPOSAL 8t CONTRACT AGREEMENT BID PROPOSAL, continued PROJECT NO. 10-6704: BIDDER TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACI FIC ST Firm Ca 1 ;'?CUYh? Q ?r??5?? Ova G PROJECT NO. 10-6705: Ehg\vl2E'_r\? `J TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c Address KING ST ? 2°t c?t??e r b? n -f?v P _ V rat E PROJECT NO. 12-6763: L a p`3C?? ? ? ?? 4 $ BRISTOL ST BIKE LANE EXTENSION FROM Phone EDINGER AV TO MCFADDEN AV C?°ZCV7 8\? -\ ?' 3 8 Fax ?(02?0? 8\0-1322 Email ?Q\,? L' ,Q 1 ???'lY?d`\?C. CCU BIDDER ) Signature TO BE INCLUDED IN BID PACKAGE BP 5 of 32 CITY OF SANTA ANA PROJECT NO. ]0-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17T'' ST 8c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV 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 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 (10) 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 Ca?? r ? Gl, ?yl ?r--I Signature of \ ?? BIDDER \ !! Title ??eS??PXt? (if an individual, so state) TO BE INCLUDED IN BID PACKAGE BP 7 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT continued (If a firm or co-partnership, state the firm name and give the names of al] individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) California Processional Engineering ,?? nA?? ? ??- ?r??,?,?, , six- ??, -rr.??c-r, rrw,??u,o??R Awarded to ? ? a? ?:. ? l`h?i?.n? ??rir?_in?,t// ? ?'< - on the basis of to t responsible ar?d nssponsive U ACTYON OF COUNCIL: bidder in the amount of $ ?!3 -y 9'9 Date ?o -- ae '7' -- 20 /?' ATTEST: Li??, CLERK OF THE COUNCIL Mar i G A. Hu i za r APPROVED AS TO FORM: ??o? Y ATTO EY ACCEPTED FOR THE CITY OF SANTA ANA: w EX UTIVE DIR OR PUBLIC WORKS AGENCY BP 8 of 32 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8r KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICHARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The BIDDER Cq?1?YY\\G ?PCOf?SS\OY?Q? ??\heerlhC/1 , proposed subcontractor - ,hereby certifies that he has ?, has not ,participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 1 11 14, 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 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV 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 are treated during employment without, regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to, the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause. 2. The Contractor shall, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. 3. The Contractor shall send to each labor union or representative of workers with which he/she has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 4. The Contractor shall comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5. The Contractor shall furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with such rules, regulations, and orders. 6. In the event of the Contractor's non-compliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole or in part and the Contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Execution Order 1 1246 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 1 O of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON C IVIC CENTER DR 8t PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV 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 subject to all the penalties imposed for aviolation of the Chapter. Signed Title PreS? d er,-t Firm CCi ? l ?l?' h\ q ?'? (}?C SS \ O v?cl ? E?^G1 \ ??QC- Y \ col Date S' 23? 1 2 TO BE INCLUDED IN BID PACKAGE BP 1 1 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST Rc KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV 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 aware 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 insura? and that the policy shall not be canceled nor the coverage reduced excep upon thirty (30) days pri written notice to the City of Santa Ana. ? ?? ? Signed Title Firm C?GI ? I?r x"1101 ?Y-(?-?SS \OV?G1 ? E?1 h-QQ r 1n Q Date?2 3?\ ? TO BE INCLUDED IN BID PACKAGE BP 12 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8r KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV 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. ? P??a?S-? S?? Name and Address of Owner. Name and Telephone Number of person familiar with project. Date Completed Contract Amount 2. Type of Work Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work 3. Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. s?v?eQ.' -?h e ?vtd ??ha,?nye ?+?e? . ? t??rpx 1?ranc? G rc? Zy?U? ?YiYi?Vt?d? ?'f - Sv%?P Itou 2 ?tucf"c?'E?vr 1Y1\ss? cm yie??. CA g2td9 ? ?av??-? ?a , c?k - ?yq- ???-'1C)U2 TO BE INCLUDED IN BID PACKAGE BP 13 of 32 929 Otterbein Ave., Unit E La Puente, CA 91748 : Ph: (626) 810-1338 : Fax: (626) 810-1322 www.cpengineeringinc.com California Professional Engineering, Inc. Job References PROJECTS: Traffic Sienal System Uaerade Phase I-IV Amount: $226,965 Owner: City of Santa Ano Project Manager: Ed Torres Contact Phone #: (714) 647-5018 Status: Completed Traffic Signal System Uaerade Phase V-VIII Amount: $292,175.99 Owner: City of Santa Ana Project Manager: Wil/iom A/bright Contact Phone #: (714) 647-5029 Status: Completed Traffic Sienal Installation at Main Street and Citron Street Amount: $273,994 Owner: City of Corona Project Manager: C/int Herrero Contact Phone #: (951J 739-4888 Status: Completed Installation of Traffic Sienal at 19`h Street and Jasper Street Amount: $161,526 Owner: City of Rancho Cucamonga Project Manager: John Gi/lespie Contact Phone #: (909) 477-2740 ext. 4051 Status: Completed Additional references available upon request CITY OF SANTA ANA PROJECT NO. ]0-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. ]0-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING APPRENTICESHIP REQUIREMENTS The undersigned BIDDER is familiar with the requirements of Section 1777.5 of the State Labor Code regarding employment of apprentices, and understands that contractors on contracts exceeding $30,000 or 20 working days shall: 1. Apply to the joint apprenticeship committee administering the apprenticeship standards of the craft or trade in the area of the site of the public work for a certificate approving the contractor under the apprenticeship standards for the employment and training of apprentices in the area or industry affected. 2. Employ the number of apprentices or the ratio of apprentices to journeymen stipulated in the apprenticeship standards. 3. Contribute to the fund or funds in each craft or ade in which he/she employs journeymen or apprentices on the public work, in the same amount or on the same basis and in the same manner as the other contractors, except contractors not signatory t - the trust agreement shall pay a like amount to the California ApprenticeshipgC uc?FrCr'r.-7 ,? / Signed Title ? Y'2S \ C??v`c? Firm CG ?rFO r n?\ 01 C??0?2 SS \U hG1 ? ?GV\G\\ y`?Q r ? ?1 c? Date ? ? 2 ?, ? \ Z TO BE INCLUDED IN BID PACKAGE BP 14 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17T'i ST 8c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV PROPOSAL AND CONTRACT AGREEMENT NON-COLLUSION AFFIDAVIT (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 declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any 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 Pro sal. Signing this Proposal on the signature portion thereof shall also constitute signature of thi on-collusion Affidavit. BIDDERS are cautioned that making ?fal?-certification mays subject t e certifier to criminal prosecution. Signed State of California V County of Subscribed and sworn to appeared before me. Notary Public Signature (or affirmed) before me on this ?Jday of proved to me on the basis of satisfactory evidence to Notary Public Seal IJ L.'tJ ?1- by be the person(s) who TO BE INCLUDED IN BID PACKAGE BP 15 of 32 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Los Angeles On ? I+?u.t Z?12CliZ before me, Olivia Cf,ea, Notary Public T (Here insert name and title of [he ofFcer) personally appeared Van Nguyen who proved to me on the basis of satisfactory evidence to be the person(s? whose name Is subscribed to the within instrument and acknowledged to me that'??t---'`t-?-- executed the same in is authorized capacityEiesj; and that bye signature(s? on the instrument the person?sj, or the entity upon behalf of which the persons acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. _ OLIVIA CHEA COMM.# 1931793 WITNESS my hand an official seal. N "O ?os AMGELIEa COUNTY"? N MY COM4. ExP. APR. 8, 2075 r Signature of oEary Public (Notary Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER D Individual (s) O Corporate Officer O Partner(s) O Attorney-in-Fact O Trustee(s) O Other INSTRUCTIONS FOR COMPLETING THIS FORM Arry acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached [o that document. The only exception is if a document is fo be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as [he verbiage does no[ require the notary to do something that is illegal for a notary in California (i. e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). Print the name(s) of document signer(s) who personally appear at the time of notarization. Indicate the correct singular or plurnl forms by crossing off incorrect forms (i. e. ke/she/t#tey- is /ara) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-seal if a sufficient area permits, otherwise complete a different acknowledgment form. Signature of the notary public must match the signature on File with the office of the county clerk. Additional information is not required but could help to ensure [his acknowledgment is no[ misused or attached to a different document. - Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). Securely attach this document to the signed document 2008 Version CAPA v12.10.07 800-873-9865 www.NOtaryClasses.com CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8r PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV 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" ct (18 USC 74) as supplemented in the Department of Labor regulations (29 CFR, Part 3). Thi act provides that each contractor or subcontractor shall be prohibited from inducing, by any means any person employed in the construction or repair of public work, to give up a y rt of the com?pensa 'on to which he/she is otherwise entitled. Signed ??-=s----? \\ Title ?r Firm Cctl?f?rY,?a? ?rp-?ssic??1 C ol?r??rr??n? Date 5 12 TO BE INCLUDED IN BID PACKAGE BP 16 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8r PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST Rc KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV 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: ?I?-T?7?'??Gl 'PYO??Q,SS?b??? E?q\???`?1?? Business Address: ? 2q CC?j"?"eT'?Q 1Y1 ?V? . lJ Y?\? ? L?71 \?? ?r??e ` C Pc C( \? ??b Telephone: ??p2?p? ? ?y- \ ???? State Contractor's License No. and Class: ? C( ?? (? ? ? pc- ? C - ? Q Expiration ?' Date: S Signed: Title: Pr e s?deln-? TO BE INCLUDED IN BID PACKAGE BP 17 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8r PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST PROPOSAL AND CONTRACT AGREEMENT FEDERAL REQUIREMENTS FOR FEDERAL-AID CONSTRUCTION PROJECTS GE]VFR Ai .-The wait herein pn.?pcsed will be fir'rarioed yr while or rtc pat with Fedaal fiacd? and therefiae all oftlte , rtrles and tegcrlatiorts pcanulga?d by the Feda-al Go?s7nrcart acrd applicable >n wixk firraice?d in whole or in pat with Feda-al finds wHl apply m atilt work The `Ytagrmecl Contract Pcwi4or? Feda-al- Aid C'.cxi4ttrctiar Cor?-ac?, "Earn FE-IWA 1273, are included in this Sacti? 14. Wltacever in said rearmed oQmact piwisiais refaarcc5 ace made 10 "SI-IA CortmacYUCg offioa;" "BHA resident eng¢cea," a `?iroti?d repcesavaive of the BHA," sud?r referr3>?s shall be oaishved m ttteac ` Fscgfi?" as defircedvr Sectim 1-1.18 oftlte Stacdad Spaif>caticrs. PERFORMANCE OF PREVIOUS CONTRACT - In addition m the pcwi4ats 'um Sec?ac II, "Norclisairninafiar," ad Battier VII, "S?rbletmtg or Assigru?rg the Corttiaci," of the rearmed oa>tr-xt Rovsias, the Camacua shall oorc?ly with the fi?llowuig The BIDDER shall exeaEe the CERTIFICATION Wl"II-I REGARD Tn THE PERFORMANCE OF PREVIOUS QDN7RACT"5 OR SL7BC'ONIRAC:IS SUBJECT TO THE EQUAL OPPORTUNI'T'Y CLAUSE AND THE FILING OF REQUIRED REPORTS lacaued in the picposaL No request fw subletmtg a assigning arty porOOn of the artmact Qr excess of$10,000 will be coruicJaed urrdathe prwisicrts ofSectiac VII ofthe tequved oa?IDact Iawisia?ts carless such regr? is aooarTaiied by tl?e CERTIFICATION rtfared m above, exea?cl by Uiepcoposed srbrorm-ac4?r. NON{'OLLUSION PROVISIONS -The pmvi9orts Qr 1}cis section ere applicable mall cot,h-acls except mIDac15 fa Feda-al Aid Serorcdary pmjac>s Title 23, United ShAcs Code, Section 112, regrrrtes as a cQditiac precedes to approval by the Fedaal Highway Achnutistr-atcx of the mrm-ad far this wait tl>at eadt BIDDER file a swan slaianart eacea9nd by, a arc behatfo? the pasa>, firrr>, associama>, a ompaabon m when such oormaR is m be awarded, oatifyQCg that suds pssort, firm, associaotion, a oocpocaoticrr has rnt, either' dtiectly orvr?tiy, ended into any ageanaV, patic?d in arty mlhsicrr a altawise taker arty xtiminrc?-aurtoffraeoorryxtitivebidd'vrgmcorvractionwidciliesrilanil?dbid A fixrrr &? make ttce noncolhrsiat atfidm?it statanart reclrmed by Sectiar 112 as a oatificdtiorr ra>d? penalty ofpajcay nVl? than as a swan sh?nart as pamit?d by 28, USC, Sec. 1746, is included in me proposal PARTICIPATION BY DISADVANTAGED BUSiniF'? ENTERPRi.SFC IN SUBCONTRACTING - Pact 26, Tdie 49, Code ofFeda-al Regril?ats supplies m this Fedaa?aid project Patiiart seOiars of said Code are vmtpa-a?cl in pat a irr its errtuety wiHtin cAlca secYias ofthese spacial prwi?zs. Sdier? dP B - Infcmrration far Detanivcing Joint Venhae Etigibr7ity. ("Phis form need not be filled in if all joint venture firms are minority owned.) 1. Name of joint venture y/1?? 2. Address ofjoin ventwe ? ? s 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-MBE joint venture: 5. Nature ofthejointventwe'sbusiness 6. Provide a copy of the joint venture agreement. 7. What is the claimed percentage of DBE ownership? 8. Ownership ofjoint venture: (This need not be filled in if described in the joint venture agreement, provided by question (6). a Profit and loss sharing b. Capital contributions, including equipment c. Other applicable ownership interests Attadrn?rt F,ich.'hirt A - FRl 8-07A7 TO BE INCLUDED IN BID PACKAGE BP 18 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR Rc PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV PROPOSAL AND CONTRACT AGREE 9. Cormol of and peuticipFmorr in this corm-act Identify by r?rr? race, sec, and "fant" those individuals (and their titles) who are responsible for day-today rtrazragerrrerri and policy decision malting, inchrlu?g, but not lvnited to, t?ho?s/e? with prime a FrtraQrcralbil?decisions yQ? ?????JY ? b. Mav?ganerrt decisions, such as: 1. R?Yin?atin? ??, ` ?? ?,1??/Y 2. Maaicetatg and sales ?An ' \Q? -Q111 ` 3. Hn?g of ?t??yy jAU, 4. ?? V lJ??« 1 V IJ??U-LJ? c. Supevision ?ffield operations r??r? w rn?. Note: Ii; after filing ttris cA,? de B and before the oomplction of the jovrt vathme's wait on the oontr-act Doused by this rcgrrlation, there is arty sigrrific?tt draige in the infarrr>abon v?I?,,;rrxl, the jovrt va?mae mist inforrrr the grmt?e, either dicecdy a- through the prune earhactor ifthejoint verrhae is a subcorMaLbor. A?icfndt `°lbe undersigned swear drat the foregoing shaoer?navs are corxecf. and 'include all nralsial infom?on *Y m idermfy and explain the tents and operation of our jourt verhne ard Uie intended particip?orr by each jovrt venRner irr the rra>rdataalm?g Furflie, the urrclersigned cwa?ri and agree to provide 1a gr-mrtee crnra>t oa?rrplete and aiocrnate inforrrration r?rlutg acaral joint venhrte wait and the payrcrerit therefore and arty prolxised cliarrges in any ofthe joQrt ver,bne a¢rarrgerterm and to permit the audit and examination ofthe boo16, records. and files ofthe joint verIlLrte, by ardhori?d rr?esarhatives of the gr-?nt?e or the Federal finidurg agency. Arty material ntiriamon will be granids far terrnin?-tmig arty carhact which may be awarded and for mitiarturg action uncle Federal a Spate laws oortcaniog false „ Amt F..xh?rt A- FR2 8-07-97 Califomi? Professional ?Fngir?ering Name ofFurn Name ofFinn Signatiue ? "C.lf ? Signamne N\ ? ?,^? Name TN? ` ,?^' C//?? `2 Title Date `` / ` Date Dain Shams of c«nurof -vim\.I?(7 ? ?? CTS, - On this day of ZOO before me appe?ad (ttane) >n me persarally Imown, who, beurg drily swam, did exea>? the foregoing affidavit and did staff that he or she was properly autlxxisd by (Narrre of firm) to eceerfie the affidavit arcrd did so as his or he free acx and dead. Notary Public Commission expres ??? Shane of Canny of Orr this _ day of 20? before rrre appe?ed (Name) to me personally laiowr?, who being swam did exeoiIIe the foregoing aJixlavit and did staff than he or she was properly audroti?d by (Marne of firm) Ln exear? the aft'davi[ arxi did so as his or ha free act and dead Notary Public Cormnission expires [?] TO BE INCLUDED IN BID PACKAGE BP 19 of 32 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Los Angeles On '(Y10a? ?? r 2Gi'Z before me, Olivia CFIea, Notary Public (Here insert name and title of the otTicer) personally appeared Van Nguyen who proved to me on the basis of satisfactory evidence to be the person{s? whose name Is subscribed to the within instrument and acknowledged to me that [?? executed the same in is authorized capacity(?es-? and that b ?'?°-'???=- si nature on the instrument the erson yam.=err g (s? p (?, or the entity upon behalf of which the personEsj acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. OLIVIA CHEA N COMM. # 1937783 /tL NOTARY PUBLIC-CALIFORNIA N LOB ANOELEE COUNTT ? <Notary Seal) MY COMM. ExP. APR. B, 2016 Signature of Norary?if ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER (] Individual (s) O Corporate Officer (Title) ? Partner(s) O Attorney-in-Fact O Trustee(s) ? Other Arty acknowledgment completed in California must contain verbiage ezac[ly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is ij a document it to be recorded outside of California. Jn such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require Lhe notary to do something [hat is illegal for a notary in California (i. e. certifying the authorized capacity of the signer). Please check the document carefully jor proper notarial wording and attach this form if required. • State and County information must be the State and County where the document signets) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. Indicate the corect singular or plural forms by crossing off incorrect forms (i.e. Aa/she/Fhay- is /et•e) or circling [he correct forms. Failure to correc [ly indicate [his information may lead to [ejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. IF seal impression smudges, re-seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match [he signature on £le with the office of [he county cleric. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. . Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by [he signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.10.07 800-873-9865 www.No[aryClasses.com CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17T'?' ST 8c KING ST PROPOSAL AND CONTRACT AGREEMENT 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 award, but will be considered in determining 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. Califo is Processional Engineering Name of BIDDER Signature of BIDDER Date +?23[ I i- FED.8-22-88 TO BE INCLUDED IN BID PA KAGE BP 20 of 32 Exhibit 15-G1 Local Agency Bidder UDBE Commitment (Construction Contracts) NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX F AGENCY: LOCATION: PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR Rc PACIFIC ST ?-p? PROJECT DESCRIPTION: PROJECT NO. Z (0.{'7!(?G St?N,0.? ?11e:r?-p,??yt?CS?/1 ? '?-LOTFi?D?I? I D-670Si "???L-(?Zb OTAL CONTRACT AMOUNT: $_ BID DATE ??Z?'???wlsw.w:w ?.w?wwwiwww? Cwwiwe ? ?i BIDDER'S NAME: ONTRACT UDBE GOAL: CONTRACT ITEM OF WORK AND DESCRIPTION ert. No. of UDBE AME OF UDBEs OLLAR AMOUNT ITEM NO. R SERVICES TO BE ND EXPIRATION Must be certi£ed on the date bids DBE SUBCONTRACTED OR MATERIALS DATE re opened -include UDBE address O BE PROVIDED nd hone number 'L - ??? - U V t?C 3 ?' For Local Agency to CUm plete: Total Claimed $ l-?? l Local Agency Contract Number: Participation ' Federal Aid Project Number: Federal Share: $22.120 ?? on[rnct Award Date: Local Agency certiF es that all information is complete and accurate. Print Name Signature Date Signature of Bidder Local Agency Representative ???? 12 ? ???? -\??? Area Code Tele hone Number: For Caltrans Review: Date (Area Code) Tel. No. Print Name Signature Date Calvans District Local Assistance Engineer Locnl Agency Bidder -UDBE Commitment (Rev 3/09) UlStrlbat100: (1) Copy -tax or scan a copy to me Caltrans UIStrICt Local ASSISIBnce tng meet (LLAr.) WI[nm 1 ? ?ay5 Of award. tau LLre [O send a copy to the DLAE within 15 days of award may result in de-obligation of Funds for this project. (2) Copy -- Include in award package to Caltrans District Local Assistance (3) Original -Local agency files TO BE INCLUDED IN BID PACKAGE BP 21 of 32 Exhibit 15-G2 Local Agency Bidder DBE Information (Construction Contracts) (Inclusive of all DBEs including the UDBEs listed at bid proposal) NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX F AGENCY: LOCATION: PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CI`VICICENTER DR 8r. PACIFIC ST PROJECT DESCRIPTIONS PROJECT NO. ?(_ S?G\ ?? T???.16 ?'t? ?LCJ-?L?/ Ga-??IU? / IZ -6763 OTAL CONTRACT AM?((???nUNT: $ BID DATE. ?`?? l{, w ¦.e . w e. -1 r_ BIDDER'S NAME: ONTRACT ITEM NO. ITEM OF WORK AND DESCRIPTION R SERVICES TO BE SUBCONTRACTED OR MATERIALS O BE PROVIDED ert. No. of DBE ND EXPIRATION ATE AME OF DBEs Must be certi£ed on the date bids re opened -include DBE address nd hone number DOLLAR AMOUNT BE Y \q\ _ 11? I - For Local Agency to Complete: L l C N b Total Claimed i i $ (?? ?(? oca Agency ontract um er: Federal Aid Project Number: Federal Share: $18.040 Partic pat on ? % ontrnc[ Award Dale: Local Agency certifies that all information is complete and acc urate. Print Name Signature Local Agency Representative Date Signature of Bidder 2 t``,, ?,s? J 12 ??- ?ly _` 333 Area Code Tele hone Number- FOC Caltrans Review: Print Name Signature Caltrans DlStrlc[ Local Assistance Engineer Date Date (Area Code) Tel. No. Local Agency Bidder -DBE Information (Rev 3/09) Distribution: (1) Copy -Fax or scan a copy [o the Caltrans District Local Assistance Engineer (DLAE) within 15 days of award. Failure to send a copy to the DLAE within 1 5 days of award may result in de-obligation of funds for [his project (2) Copy -- Include in award package to Caltrans Disvict Local Assistance (3) Original -Local agency £Ies TO BE INCLUDED IN BID PACKAGE BP 22 of 32 Exhibit 15-G1 Local Agency Bidder UDBE Commitment (Construction Contracts) NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX F AGENCY: LOCATION: PROJECT NO 10-6705 TRAFFIC S[GNAL INSTALLATION ON 1 7 r " ST 8e KING ST ??pp ??? PROJECT DESCRIPTION: PROJECT NO. TK?'n(_ S? -\ l 1 - ?ONA, ?K?A,I a-Y16N , '? j v-6? 04 ? (0-.67oS-?? C Z---6`? b 3 ONT : $ O ? ? ^ ? ? ? BI D DAT y??/??? ??qqyp??? ?? . BIDDER'S NAME: ONTRACT UDBE GOAL: ONTRACT ITEM OF WORK AND DESCRIPTION ert. No. of UDBE AME OF UDBEs OLLAR AMOUNT ITEM NO. R SERVICES TO BE ND EXPIRATION Must be certified on the date bids DBE SUBCONTRACTED OR MATERIALS ATE re opened -include UDBE address O BE PROVIDED nd hone number L For Local Agency to Complete: Total Claimed $+ 1?O Local Agency Contract Number: Participation ?l-?? Federal Aid Project Number: Federal Share: $22.120 ?? ontract Award Date: Local Agency certifies that all information is complete and acc urate. Print Name Signature Dale Signature of Bidder Local Agency Representative ?1 /` ?j ??? ' ` ??? ?V `? J Area Code Tele hone Number: For Caltrans Review: Date (Area Code) Tel. No. Pnnt Name Signature Dale Caltrans District Local Assistance Engineer Local Agency Bidder-UDBE Commitment (Rev 3/09) Distribution: (1) Copy -Fax or scan a copy [o the Caltrans District Local Assl stance Engineer (DEAF) within 15 days of award. Failure to send a copy to the DLAE within 1 5 days of award may result in de-obligaLOn of funds for [his project (2) Copy -- Include in award package to Caltrans District Local Assistance (3) Original -Local agency files TO BE INCLUDED IN BID PACKAGE BP 23 of 32 Exhibit 15-G2 Local Agency Bidder DBE Information (Construction Contracts) (Inclusive of all DBEs including the UDBEs listed at bid proposal) NOTE: PLEASE REFER TO INSTRUCTIONS O N APPENDIX F AGENCY: e ? LOCATION: PROJECT NO 10-6703 TRAFFIC SIGNAL INSTALLATION ON 17r?? ST Fc KING ST PROJECT DESCRIPTION: PROJECT NO. OTAL CONTR A T AMOUNT: $ C [ ? 2 ` BID DATE: ? \V/I???I:s? ? ?.?i ? :wwwl C wwiwp BIDDER'S NAME: ?r CONTRACT ITEM OF WORK AND DESCRIPTION ert_ No. of DBE AME OF DBEs DOLLAR AMOUNT ITEM NO. R SERVICES TO BE AND EXPIRATION Must be certified on the date bids BE SUBCONTRACTED OR MATERIALS ATE re opened -include DBE address O BE PROVIDED nd hone number G l U For Local Agency to Complete: ? ??--77 Total Claimed $ `??? Local A enc Contract Number: P iu i ? g y art pat on Federal Aid Project Number: Federal Share: $18.040 ontrnct Award Dale: __ Local Agency ce rtifles that all information is complete and acc urate. Print Name Signature Date Signature of Bidder Local Agency Representative A C d T l h N b ^ 1 r? ?11'\ ?\ L??` 2 ??- `-' "y- ??? rea o e e e one um er: For Caltrans Review: Dale (Area Code) Tel_ No_ Print Name Signature Date Caltrans District Local Assistance Engineer Local Agency Bidder -DBE Inform e[ion (Rev 3/09) Distribution: (1) Copy -Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within l 5 days of award. Failure to send a copy to the DLAE within 15 days oFaward may result in de-obligation of funds for this project. (2) Copy -- Include in award package to Caltrans District Local Assistance (3) Original -Local agency £les TO BE INCLUDED IN BID PACKAGE BP 24 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR &c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8r KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV 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 Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certifications be included in all lower tier subcontracts, which exceed $100,000 and that all su sub-recipients shall ,certify and disclose accordingly. BIDDER's Signature Ca 1 i-?r n ?c? Prof-?ss? ar, ca ? C-r.o??.?? r ? Firm S 23'12 Date ? ? Standard Form LLL may be obtained from Cal trans and FHWA offices- TO BE INCLUDED IN BID PACKAGE BP 25 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17Tt' ST 8c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV PROPOSAL AND CONTRACT AGREEMENT DISCLOSURE OF LOBBYING ACTIVITIES Complete this form [o disclose lobbvine activities pursuant to 3l U.S.C. 1352 1. Type of Federal Action a Contr t 2. Status of Federal Action ?) Q Bid/ tF / li i n ? 3. Report Type: / ? i i i l ` _ . ? /? ac / ?? er a. o app cat o a. n t a b. Grant / b. initial award b. material change a Corporate Agreement c, post-award d. Ban For Material Change only: e. Loan Guarantee Year quarter f. Loan Insurance date of last re ort 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Q Prime ? Subwardee ? /? Address of Prime: '?} /? Tier lfknowr Con essional District, i known Con ssional District, i known 6. Federal Departrnent/Agency: 7. Federal Program Name/Description N / CFDA Number, If a livable 8. Federal Action Number, fFoxowr ? 9. Award Amount,tfknowr ? T \ $ 10. a. Name and Address of Lobbying Entity (rrcLr.¢Gng nrfbncc rfcd?SrrBjrnrrr No. b. Individual Performing Servic e s (?izfviir>{kRrrrrgrv?N? ? /? // f ? ? ' (lcaTr?reefostn.?re, Mn ] \' l /? / r \ ` attach Continuation Sh s if recess ` 11. Amount of Payment (check all that apply): / $ ? Ach?al ? Planned ? / /1. 13. Type of Payment (check all that apply) 0 a. retainer / 7?? 0 b. one-time fee 12. Form of Payment (check all that apply): Q c. commission a. cash Q d. contingent fee b. in-kind; specify: nature ? e. deferred value ? f. other, s ci 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or memb r(s) contacted, for Payment indicated in item 11: ? ` attaci: Continuation Sheets 'recess 15. Continuation Shee s attached: Yes No -? 16. Ittfcarrt?on tegt?d ilncx>gltthis farm is ?rtlwri?d by Title 31 USC Section 1352.'IltisdisclosiaeofloblryQ?gxtivitiesisamate?ialrepesa?atiortoffactupon Signature which reli?re was placed by the tia above when thehaisacdut was made a erred 'vVO.7lvsdisclosuleistegtmedputsuarrtto3lUS.C.1352."Ihisinforrrr?mwillbe Print Name VQ \ teQntadht the Congers sari-?nelly ?dwill be avaik?ble fiapublic it?xctiai 1? ?'C e S ? ? e 1?-\ i l Arrypasonwhof?lsh?filetheregtmeddiscJostaeshallbesulJjecxtoacivlpataltyof T t e rot less drat $10,000 and trkmote than $100,000 for each such faltae. Tele honeN -p2lo - Date S 23 (2 Feda-al Use Only: Authorized for Local Rep uction Standard Forrn - LLL TO BE INCLUDED IN BID PACKAGE BP 26 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8z PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17T'-` ST c4c KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV 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 w k required by these bid documents, agrees to comply with the required Fede al Contract Provision (Form HWA-1273) as shown in the appendix of the special provisions of this project.` /?- -? n Signed Title Firm C'G{ ?\`?1??C1 \ 7Gl t? FC3???10Y)Q? Ey1G1?e? C \v?-? Date?J?2??/ 1'L \ TO BE INCLUDED IN BID PACKAGE BP 27 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8r KING ST 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 be half 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 f ct upon which reliance was placed when this transaction was made or entered into. Submission of this certificatio is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 3 1, U.S. Code. Any p rson who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not mor than $100,000 for each such failure. The prospective participant also agrees y submitting his or her proposal that he or she shall require that the language of this certifi tion be included in all ower tier subcontracts, which exceed $100,000 and that all such sub- recipients shall certify a?idl?dissncP ascordingl BIDDER Signature `? Ca It?r???ct ?'ro-F?-s?c?v.c:? E??t?er?rc? Firm 5/?3/.-z Date TO BE INCLUDED IN BID PACKAGE BP 28 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8r PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17T'?' ST 8c KING ST 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 t e work required by these bid documents, certify to comply with the Buy America" requirements f Section 165 of the Surface Transportation Assistance Act of 1982 and as?shy?wn in the special provisi ns of this project. Signed Title ??es? d Firm CGS 1 ? -C? r r ? c?, P c c?-Fc-?ss? c? r,c? t c-?c? ? v,? ? ? ?-, c?? Date S I ??? ? 12 TO BE INCLUDED IN BID PACKAGE BP 29 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST 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 1 101, with any public entity, as defined in Public Contract Code Section 1 100, including the Regents of the University of California or the Trustees of the California State University. The term "BIDDER" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The BIDDER must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on t e signature portion thereof shall also constitute signature of this Statement. BIDDERS are cautio d that making a false certification may subject the certifid? t rcrc? i3p,inal prosecution. ? Signed Title ?FJr Firm Date S?Z??1Z TO BE INCLUDED IN BID PACKAGE BP 30 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST &z KING ST 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 o/f a violation of law or a safety regulation? Yes No V If the answer is yes, explain the circumstances in the following space. TO BE INCLUDED IN BID PACKAGE BP 3 1 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8c KING ST 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 making a false certification may subject the certifier to criminal prosecution. Signed Title ?'reS ?G12 Y?- Firm C?.l?1fC7rY1\C? Date S ??31 ?2 - ? - - TO BE INCLUDED IN BID PACKAGE BP 32 of 32 CITY OF SANTA ANA PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8z KING ST PROJECT NO. 12-6763: BRISTOL ST BIKE LANE EXTENSION FROM EDINGER AV TO MCFADDEN AV 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 C C-?????? ?' LOCATION 1'?ZW lY?d.UIQ , G {? PHONE ?Q?n- ?[3- (d6? ? TYPE OF WORK Fi?02,2 OPCIG $ --?0,?8? NAME C ???. 11'? LOCATION `? Gl G PHONE - TYPE OF WO ?,???`n(,-? $ 2 NAME G ? L LOCATION PHONE TYPE OF WORK $??? NAME LOCATION PHONE TYPE OF WORK $ NAME LOCATION PHONE TYPE OE WORK $ Nam of Su itti Bid ?? 1? Signatur o DE NAME LOCATION PHONE TYPE OF WORK $ NAME LOCATION PHONE TYPE OF WORK $ NAME LOCATION PHON E TYPE OF WORK $ NAME LOCATION PHONE TYPE OF WORK $ NAME LOCATION PHONE TYPE OF WORK $ TO BE INCLUDED IN BID PACKAGE BP 6 of 32 Company Profile Company Profile Company Search Comps ny Search Results Company Information Old Company Names Agent for Service Reference Information N AIC Group List Lines of Business Workers' Compensation Complaint and Request for Action/Appeals Contact Information Financial Statements PDF'S Annual Statements Quarterly Statements Company Complaint Company Performance >3? Comparison Data Company Enforcement Action Composite Complaints Studies Additional Info Find A Company Representative In Your Area View Financial Disclaimer COMPANY PROFILE Company Information HANOVER INSURANCE COMPANY (THE) 440 LINCOLN STREET W ORCHESTE R, MA 01653 800-955-8850 Old Company Names Agent For S¢rV ice NANCY FLORES C/O CT CORPORATION SYSTEM S18 WEST SEVENTH STREET LOS ANGELES CA 90017 Refe r¢nc¢ Information Effective Date NAIC #: 22292 California Company ID #: 2097-4 Date Authorized in California: 01/01/1973 License Status: UNLIMITED-NORMAL Company Type: Property & Casualty State of Domicile: NEW HAMPSHIRE bacK to top NAIC Group List NAIC Group #: 0088 The Hanover Ins Grp Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. AIRCRAFT AUTOMOBILE BOILER AND MACHINERY BURGLARY COMMON CARRIER LIABILITY CREDIT DISABILITY FIRE LIABILITY MARINE MISCELLANEOUS PLATE GLASS SPRINKLER Page 1 of 2 http://interactive.web. insurance. ca. gov/companyprofile/companyprofile?event=companyPro... 6/6/2012 Company Profile SURETY TEAM AND VEHICLE WORKERS' COMPENSATION back to top W orKers' Compensation Complaint and Requests for Action Contact Information Part 1: Complaints and Requests for Action (CRA) Page 2 of 2 If you are seeking information about your workers' compensation insurance policy, you must first submit a Complaint and Request for Action (CRA) to the workers' compensation insurance company using the address below. Phone Number: 415-955-2758 Ext: FAX: 508-926-5689 E-Mail: ca wcplhreq@hanoven com WEB Address: www.ha nover.com Mailing Address: 425 Market Street San Francisco CA 94105 Department Name: Contact Notes: Part 2: Appeals to the Uepa rtm ent of Insurance You may contact the department if you disagree with your workers' compensation insurance company's written decision on your CRA. You also must mail a copy of what you send us to your workers' compensation insurance company using the address below. Phone Number: 415-955-2758 Ext: FAX: 508-926-5689 E-Mail: ca wcpihreq@ha Hove r.com WEB Address: www.ha nover.com Mailing Address: 425 Market Street San Francisco CA 94105 Department Name: Appeals Notes: bacK to top © 2008 California Department of Insurance http://interactive.web. insurance. ca. gov/companyprofile/companyprofile?event=companyPro... 6/6/2012 THE AMERICAN INSTITUTE OF ARCHITECTS ??[jtij`li/ _- ?"-= AlA Document A3?0 Bid Bond BOND # N/A KNOW ALL MEN BY THESE PRESENTS, that we CALIFORNIA PROFESSIONAL ENGINEERING, INC. DBA CALIFORNIA PROFESSIONAL ELECTRICAL ENGINEERING 929 Ottarbeln Avenue, Suite E Rowland Heights, CA 9'1748 (Here insert full name ,and address or legal title of Contractor) as Principal, hereinafter called the Principal, and The Hanover Insurance Company 333 City Boul®vard West, '17th FI. Orange, CA 92868 (Hare insert full name ,and address or legal titl¢ of Surety) a corporation duly organized under the laws of the State of NH as Surety, hereinafter called the Surety, are held and firmly bound unto City Of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92707 (Here insert full nam¢ ,and address or legal title of Owner) as Obligee, hereinafter called the Obligee, in the sum of Ten Percent of Amount Bid------------------------------------------ Dollars ($ 10.00% % ), 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 TRAFFIC SIGNAL INSTALLATION (Here insert full name, address and description oT project) NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with 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 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 which the Obligee may in good faith contract with another party to perform the Work covered by said bid then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this 18TH day of May 2012 (Witness) (witness) Yung T. (Seal) INSTITUTE OF ARCHITECTS, '1735 N.Y. AVE., N.W. WASHINGTON, D.C. 20006 ?v.N ACKNOWLEDGMENT State of California County of Orange ) On May 18, 2012 before me, Christine T_ HoanQ, Notary Public (insert name and title of the officer) personally appeared Yune T. Mullick who proved to me on the basis of satisfactory evidence to be the person() whose name() is/?t?c subscribed to the within instrument and acknowledged to me that he/t#ri?}p executed the same in hisdbec/a;ia?ir authorized capacity, and that by his/iaaLe?uc signature(s) on the instrument the person(), or the entity upon behalf of which the person() acted, executed the instrument. - I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS han d offi ial seal. .d..' ' --;? NOTARY PusLiC-CALIFORNIA ORANGE COUNTY u My Comm. Expires DEC 23. 2012 Signature (Seal) CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Los Angeles On ?? Z3t Zy\? before me, Olivia CFtea, Notary Public personally appeared van Nguyen name and title of the oFFicer) who proved to me on the basis of satisfactory evidence to be the person(s? whose name Is subscribed to the within instrument and acknowledged to me that ?'r? executed the same in is authorized capacityFiesj; and that by ..???°? ,.°-'?r??-'-r signature(-sj on the instrument the person(, or the entity upon behalf of which the person(-s? acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my d official seal. OLIVIA CHEA ? COMM. # 1931793 '?tttt NOTARY PUBLIC-CALIFORNIA Nt L08 ANGELES COUNTY .+ MY Coxes. E%P. APR. 8, 2075 (Notary Seal) Signature of Notary Pu tc ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description o£attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER O Individual (s) ? Corporate Officer O Partner(s) O Attorney-in-Fact O Trustee(s) O Other INSTRUCTIONS FOR COMPLETING THIS FORM Arty acknowledgment completed in California must contain verbiage exactly ar appears above in the notary section or q separate acknow/edgmenl form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of Calfornia. In such instances, any alternative acknow/edgment verbiage qs may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal jor q notary in California (i. e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form ijrequlred. • State and County information must be the State and County where the document signet(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i. e. iae/she/t-hey- is /era) or circling [he correct forms. Failure to correctly indicate this information may lead to [ejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover [ex[ or lines. IF seal impression smudges, re-seal iE a sufficient area permits, otherwise complete a different acknowledgment Form. • Signature of the notary public must match the signature on file with the ofFce of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached [o a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by [he signer. If [he claimed capacity is a corporate ofFicer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWERS OF ATTORNEY CERT/PIED COPY KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a corporation organized and existing under the laws of the State of Michigan, do hereby constitute and appoint James W. Moilanen, Yung T. Mullick, and/or Jennifer C. Anaya of Mission Viejo, CA and each is a true and lawful Attorney(s)-in-fact to sign, execute, seal, acknowledge and deliverfor, and on its behalf, and as its act and deed any place within the United States, or, if the following line be filled in, only within the area therein designated any and all bonds, recognizances, undertakings, contracts of indemnity or other writings obligatory in the nature thereof, as follows: Any such obligations in the United States, not to exceed Ten Million and No/'100 (510,000,000) in any single instance and said companies hereby ratify and confirm all and whatsoever said Attorney(s)-in-fact may lawfully do in the premises by virtue of these presents. These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions are still in effect: "RESOLVED, That the Presider[[ or any Vice President, in conjunction with any Vice President, be and they are hereby authorized and empowered to appoint Attorneys-in-(act of the Company, in its name and as its acts, to execute and acknowledge for and on its behalf as Surety any and all bonds, recognizances, contracts of indemnity, waivers of citation and all other writings obligatory in the nature thereof, with power to attach thereto the seal of the Company. Any such writings so executed by such Attorneys-in-fact shall be as binding upon the Company as it they had been duly executed antl acknowledged by the regularly elected officers of the Company in their own proper persons." (Adopted October 7, 7987 - Tha Hanover Insurance Company; Adopted Apnl 74, 7982 -Massachusetts Bay Insurance Company; Adopted September 7, 2007 -Citizens Insurance Company of America) IN WITNESS WHEREOF. THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by two Vice Presidents, this 3rd day of January 202. THE HANOVER INSURANCE COiAPANY ???_?`? t iplyk} MA$SACHUSE7'TS BAY INSVRANCE COMPANY q, CITIZENS SURANCE COMPANY OF AMERICA 164"'1 ? ?°?0 t?/y4aL` ? ??.??tL?,?J'I7'yl,ta/1,r,. R.abert Thomas. Vice Presjdent THE COMMONWEALTH OF MASSACHUSETTS ) ??-?-?? ? ? ? ? `? ._ COUNTY OF WORCESTER ) ss. toe, rl4 enstrom, is Preside-nt On this 3rd day of January 20'12 before me came the above named Vice Presidents of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and officers described herein, and acknowletlged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. BARBARA A. GARLICK Notary Public / ?? ,/? ?y +? "y eammonreaM?ar Macoaor+sMS '74?"/ /Jj??.C? f<? ?'?Y/??J uy comm=u?on Esa? seµ. zr. ttte ` Barbara A. Garlick, Notary Public My Commission Expires September 21.2018 I, the undersigned Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company ofAmerica, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Companies, and do hereby further certify that the said Powers of Attorney are still in force and effect. This Certificate may be signed by facsimile under antl by authority of the following resolution of the Board of Directors of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America. "RESOLVED, That any and all Powers of Attorney and Carti£etl Copies of such Powers of Attorney and certilcetion in respect thereto, granted and executed by the President or any Vice President in conjunction with any Vice President of the Company, shall be binding on the Company to the same extant as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may ba facsimile." (Adopted October 7, 7987 -The Hanover Insurance Company; Atlopted April 74, 7982-Massachusetts Bay Insurance Company; Adopted September 7, 2007 -Citizens Insurance Company of America) 18th May 12 GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts, this day of 20 THE HANOVER INSURANCE COMPANY MASSACHUSETTS HAY INSURANCE COMPANY CIT/iZ/.ENS INSURANjC///?JE COMPANY OF AMERICA n Margosian, Vice President T'H E ..BOND EXCHANGE Principal: CPE BOND CHECKLIST Delivery Info: 0 Bond Forms glp 0 Bond Number? 0 Premium? 0 Premium Disclaimer? 0 Bid Amount/Final Bond Amount Correct? 0 Principal Name Correct? 0 Correct Surety? - 0 mated? O Sealed? O Signed by Attorney-In-Fact? L] Any Misc. Errors? 0 Notary Acknowledgement O Dated to match bond? 0 Attorney-In-Fact same as bond? D Notary Seal? 0 Attach Powers 0 Correct Surety? 0 Dated to match bond? 0 Named Attorney-In-Fact same as bond? O Sealed? PERFORMANCE PAYMENT Prepared By: Christine Proofed By: y.ts?, x cr- !rJ OL C-') f M C-4 i -rs X it> U U U Q) C? ?.. - ^^c? U - bJp ?. Cp ' ?? S a> CV Cr\ Q '? W U N U O ? C/D a + cr) H C? CV C!?. w W W O O .4 '- 4 7 00 , ? W . -? - c ;-4 ? V = p , bA bA w 4- CA _ ? ? ? ? U U O > CM c? ? .-cs oN F? F? a GLl Z_ irk 'L7 Cy U C C CD -? C> C? MEMORANDUM Kevin O'Rourke ,.ro: Interim City Manager Raul Godinez II, Executive Director From: Public Works Agency 30 Date: June 14, 2013 Project Nos. 10-6704, 10-6705 and 12-6763 Traffic Signal Installation on Civic Center Dr. & Pacific St.; Traffic Signal Installation on 17th/King St. and Bristol St. Bike Lane Extension from Edinger to McFadden Avenues -[Federal Project HSIPL-5063(130) and HSIPL-5063(129)] Subject: Change Order No. 1 Contractor: California Professional Engineering 929 Otterbein Avenue, Unit E La Puente, CA 91748 Project Description: Traffic Signal Installations and Bike Lane Extension Change Order Number: 1 Total This Change Order $ 12,487.50 Accounting Unit-Activity Number: 05917660-10670503028 JUSTIFICATION The project includes the installation of two new traffic signals at the intersections of Seventeenth/King Streets and Civic Center Drive/Pacific Street and to stripe a bike lane along Bristol Street between McFadden and Edinger Avenues. A contract was awarded to California Professional Engineering, Inc. on June 18, 2012 for the improvements which include: new traffic signal poles, conduit, street lights, traffic loops, and striping. To enhance pedestrian and motorist safety, a new traffic signal was installed at the intersection of 17th and King Streets. However, due to the close proximity of the existing traffic signal on 17th and English Streets with the new traffic signal on 17th and King Streets, motorists approaching one intersection could confuse the signal light with the adjacent intersection. Therefore, the Traffic Engineering section recommended replacing the heads with programmable vehicle light emitting diodes heads which appear off until motorists approach the next intersection in order avoid this potential hazard per PCO No 2 dated 03/21/2013. AGREED COSTS 12,487.50 Project Nos. 10-6704, 10-6705 & 12-6763 Request for Approval of Change Order No. 1 June 14, 2013 Page 2 of 3 CONTRACT COST SUMMARY Original Contract Total $443,499 Amount % of Contract Previously Approved Change Order $-0- 0.0% This Chanae Order 12.487.50 Increase 2..82°/0 to date 2,487.50 Increase 2.82% Adjusted Contract Total $455,986.50 SCHEDULEIMPACT The programmable vehicle light emitting diodes heads have a three to four week lead time. The contract time will be extended by 27 days to allow the contractor time to procure the materials and perform the work included in this change order. The revised completion date will be June 14, 2013. APP ED AS TO FUNDS AND ACCOUNTS: ?.c 1 ?? 1 J ^F n?`s? 1 a?) ASRau odinez II, Executive Director Francisco Gutierrez, Executive irector Publi Works Agency Finance and Management Services Agency KAconstruction\projects\10-6704\CO #01\MEM RFA CCO #01 Project Nos. 10-6704, 10-6705 & 12-6763 Request for Approval of Change Order No. 1 June 14, 2013 Page 3 of 3 CHANGE ANALYSIS DETAILED JUSTIFICATION Seventeenth/King Streets and Civic Center Drive/Pacific Street traffic signal improvements included: new traffic signals, conduit, interconnect cable, pull boxes, emergency preemption system, communication equipment, both signal and bicycle traffic loops and signing and striping. Due to the close proximity of the new traffic signal on 17th Street/King Street with the existing traffic signal on 17th Street/English Street motorists approaching one intersection that has a red light may confuse the green light from the other intersection. To avoid this potential red light running issue Programmable vehicular heads are needed. PV heads can be programmed to appear blank as you approach until you are in close proximity to the intersection. Therefore, Traffic Engineering requested replacing the traffic signal heads with programmable traffic signal heads. A prior approval was granted for this work on March 21, 2013. REVISED DETAILS: N/A COST ANALYSIS This Change Order accounts for only the agreed work not covered by contract line items. Item No Description Agreed Costs 1 Furnish and install programmable vehicular heads $12,487.50 K:\construction\projects\10-6704\CO #01\MEM RFA CCO #01 CITY OF SANTA ANA PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project Nos.10-6704, 10-6705 & 12-6763; Traffic Signal Change Order Number 1 Installation on Civic Center Drive/Pacific St. & 17th/King Streets, & Bristol St.Bike Lane Extension from Edinger Ave. to McFadden [Federal Project HSIP-5063(130),(129)] To California Professional Enqineerinq, 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 PRICES 1. Furnish and install 3 each traffic signal programmable vehicle light emitting diodes heads per PCO No. 2 dated 03/21/2013. AGREED COST = $ 12,487.50 Page 1 of 2 CITY OF SANTA ANA PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project Nos.10-6704, 10-6705 & 12-6763; Traffic Signal Change Order Number Installation on Civic Center Drive/Pacific Street & 17th/King Streets, & Bristol St.Bike Lane Extension from Edinger Ave. to McFadden [Federal Project HSIP-5063(130),(129)] To California Professional Engineering, 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 The compensation both time and cost set forth in this change order comprises the total compensation due the Contractor, all Subcontractors, and all Suppliers for all work performed per this change order, including impact on unchanged work. By signing this change order, the Contractor acknowledges and agrees on behalf of himself, all Subcontractors, and all Suppliers, that the stipulated compensation includes payment for all work contained in this change order, plus all payment for interruption of schedules, extended field overhead, home office overhead, profit, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract. The signing of this change order constitutes full mutual accord and satisfaction for all changes and work performed on this project, and that the time and cost paid per this change order constitutes the total equitable adjustments owed the Contractor, all Subcontractors, and all Suppliers for all work performed on this project. The Contractor on behalf of himself, all Subcontractors, and all Suppliers agrees to waive all rights, without exception or reservation of any whatsoever to file any further claim related to this project. TOTAL COST THIS CHANGE ORDER: DECREASE. $ _ _ _ _ _ INCREASE $ 12,487.50 By reason of this order the CONTRACT TIME completion will be adjusted as follows: Twenty Seven (27) Working Days We the undersigned contractor have given careful consideration to the change proposed and hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials, except as may otherwise be noted above, and perform all service necessary for the work above specified, and will accept as full payment therefor the prices shown above. Acce ed, ate / Contractor California Professional Engineering, Inc. By Title A Pv. Approva recommended by PUBLIC WORKS AGENCY WORKS AGENCY &4ECUTIGE DIRECTOR Approved by CITYMANAGER Date Date 17-/?--/3 Page 2 of 2