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PACIFIC CONSTRUCTION COMPANY, INC.
Recording Requested By, And When Recorded Mail To: Cleric of the Council, City of Santa Ana 20 Civic Center Plaza, P.O. Box 1988 Santa Ana, CA 92702 r Recorded In Official Records, Orange County Hu hN n Clerk-Recorder VIII I� NO FEE IIIV �II �II6 �� VIIII I�6 illy �II II III III 2014000159767 8:25 am 04128114 66 414 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NOTICE OF COMPLETION NOTICE IS HEREBY GIVEN that the undersigned City of Santa Ana, California, a municipal corporation, with the address of City Hall, 20 Civic Center Plaza, Santa Ana, California, 92701, is the owner of the property hereinafter described, that said owner has caused a construction of; EL SALVADOR & WINDSOR PARKS WALKWAY RECONSTRUCTION q o under contract entered into on FEBRUARY 19, 2013, with PACIFIC CONSTRUCTION w COMPANY, INC., on which contract NORTH AMERICAN SPECIALTY INSURANCE cCOMPANY is surety. The property on which such work improvement was placed is in the City 04 of Santa Ana, County of Orange, State of California, and described as Project No. 13 -7513 & 13- q 7514 located at: EL SALVADOR & WINDSOR PARKS. The work improvement on said oproperty was accepted as completed on November 22, 2013. CITY OF SANTA A IvdUNICIP AL CORPORATION w by 7 u z /( �q ¢ Dated: � �--1' Acting City Engineer g TITLE U--- ___ -_ -_- - ___ - -_ ai VERIFICATION I, the undersigned, say: I am the Acting 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 dec l /are under penalty of perjury that the facts therein stated are true. Executed on 14 at Santa Ana, Califo is ' i'/ 7aro, Kr2rmn� (Signature of individual swearing that the contents of Notioe of Completion are nue.) THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN (10) DAYS AFTER COMPLETION REQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: FEBRUARY 19, 2013 TITLE: CONTRACT AWARD TO PACIFIC CONSTRUCTION COMPANY, INC., FOR EL SALVADOR AND WINDSOR PARKS WALKWAY RECONSTRUCTION (PROJECT NOS. 137513 & 137514) CITY MANAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED C�'-/ 91-1-� [3- A's Recommended�O J,f - El As Amended ❑ Ordinance on 151 Reading ❑ Ordinance on 2nd Reading ❑ Implementing Resolution ❑ Set Public Hearing For CONTINUED TO FILE NUMBER 1. Award a contract to the lowest responsible bidder, Pacific Construction Company, Inc., in accordance with the Base Bid totaling $186,255 for the reconstruction of El Salvador and Windsor Parks walkways. 2. Approve the Cost Analysis, as shown in Exhibit 1, for a total estimated project delivery cost of $274,860. DISCUSSION The concrete walkways at El Salvador and Windsor Parks have deteriorated due to weather, age, and usage, and are in need of replacement. Once completed, these improvements will improve access by visitors and enhance surface drainage issues which have become a problem. Exhibit 2 shows the park locations in the city where improvements will be made. These projects are funded with Community Development Block Grant (CDBG) funds. To be eligible for CDBG funding the majority of the project area must be within a low- moderate - income neighborhood. The City reviewed the census tract information to confirm that this recommended service area meets the requirements. A Notice Inviting Bids was advertised on January 7 and 8, 2013, and bids were opened on January 29, 2013. The following is a summary of the bid invitations mailed, bids received, and bid results: Contract Award to Pacific Construction Company, Inc., for El Salvador and Windsor Park Walkway Reconstruction February 19, 2013 Page 2 Contractor Participation Data: Santa Ana contractors receiving notices: 14 Contractors requesting bidding documents: 15 Bids received: 12 Bids received from Santa Ana contractors: 1 Bid Results Summary RANK BIDDERS NAME LOCATION BASE BID 1 Pacific Construction Co., Inc. Granada Hills $186,255.00 2 ACE CD, Inc. Glendora $189,869.50 3 KASA Construction, Inc. Ontario $208,800.00 4 C.S. Legacy Construction, Inc. Chino $231,418.00 5 ATL Landscape, Inc. Los Angeles $240,000.00 6 AMTEK Construction Whittier $245,492.20 7 Gama Builder, Inc. Irvine $246,259.00 8 Micon Construction, Inc. Placentia $252,923.40 9 PALP Inc. DBA Excel Paving Co. Long Beach $256,933.00 10 Hondo Company, Inc. Santa Ana $259,150.00 11 Sunrise Landscape Company, Inc. Santa Fe Springs $285,260.59 12 Atom Engineering Construction, Inc. Hemet $376,998.00 A total of 12 bids were received and all were deemed responsive. The bid results and the lowest responsive bid by Pacific Construction Company, Inc., in the amount of $186,255, compares favorably with the Engineer's Estimate of $217,600. ENVIRONMENTAL IMPACT In accordance with the California Environmental Quality Act, the recommended actions are exempt from further review. Categorical Exemptions Environmental Review Nos. 2013 -02 (El Salvador Park) and 2013 -03 (Windsor Park) were filed for these projects. In addition, a Certification of Categorical Exemption and a Statutory Worksheet have been prepared in accordance with the National Environment Policy Act. Contract Award to Pacific Construction Company, Inc., for El Salvador and Windsor Park Walkway Reconstruction February 19, 2013 Page 3 FISCAL IMPACT A project cost analysis (Exhibit 1) determined that $274,860 is needed to deliver the project, which includes construction administration, inspection, testing, and contingencies. Funding is available to cover costs in the Community Development Block Grant Fund (Account 13518783 - 66220). Raul Godinez II Executive Director Public Works Agency c-- Gerardo ouet E ecu ' e Dire' to, P s, Recreation, and Community Services Agency RG /ET Exhibit 1: Cost Analysis 2: Project Location Map APPROVED AS TO FUNDS AND ACCOUNTS: rancisco Guti ez Executive Director " Finance & Management Services Agency r l aln N w Nancy T. E ards Executive Director Community Development Agency COST ANALYSIS PROJECT NOS. 137513 AND 137514 EL SALVADOR AND WINDSOR PARKS WALKWAY RECONSTRUCTION Construction Contract Contract Administration Inspection and Testing Survey Staking Contingencies TOTAL ESTIMATED CONSTRUCTION COSTS Exhibit 1 $186,255 $5,000 $9,000 $4,625 $69,980 274 860 i PROJECT LOCATION EXHIBIT 2 SANTA ANA TITLE: CITY COUNCIL CONTRACT AWARD FOR P W A AGENDA DATE: EL SALVADOR AND WINDSOR PARKS FEB. 19, 2013 WALKWAY RECONSTRUCTION PUBLIC WORKS AGENCY (PROJECT NOS. 137513 & 137514) = oil - ..- "IUCC AVE CNIC CENTER DR PROJECT NO. PROJECT LOCATION EXHIBIT 2 SANTA ANA TITLE: CITY COUNCIL CONTRACT AWARD FOR P W A AGENDA DATE: EL SALVADOR AND WINDSOR PARKS FEB. 19, 2013 WALKWAY RECONSTRUCTION PUBLIC WORKS AGENCY (PROJECT NOS. 137513 & 137514) THE REGISTER 625 N GRAND AVE, SANTA ANA, CA 92701 Telephone (714) 796 -7000 / Fax (714) 796 -6059 (2015.5 C,C.i State of California . ) County of ORANGE ) SS Notice Type: BID - NOTICE INVITING BIDS Ad Description: El Salvador Park Walkway Reconstruction & Windsor Park Walkway Reconstruction I am a citizen of the United States and a resident of the State 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 the city of SANTA ANA, county of ORANGE, and adjudged a newspaper of general circulation as defined by the laws of the State of California by the Superior Court of the County of ORANGE„ State of California, under date 11/15/1805, Case No. A21046. That the notice, of which the annexed is a printed copy, has been published in each regular and entire issue of said newspaper and not in any supplement thereof on the following dates, to -wit: 01/07/2013, 01/08/2013 Executed on: 01/0812013 At SANTA ANA, 'California I certify (or declare) under penalty of perjury that the foregoing is true and correct. CNS #: 2428808 NOTICE I VITING BID,F NOT IC HEREBY WE that the City of Santa Ana, California will receive at City Hall - Ross. Annex, (M -22), 20 Civic Center Plaza., Santa Ana, California 92701, the Public Works Agency Third oar�ReFI ce t�dnts ,ton or Bore the he hour of 2:00 p.m. on Tuesday, January 29, 2013 sealed bids and/or proposals for PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO., 13 -7514: WINDSOR PARK. WALKWAY RECONSTRUCTION Notice is hereby given BIDDERS that this project is funded with Community Development Block Grant (CDBG) man ey, and that the rate at wages for each craft or type of work or mechanic employed under this contract shall he as specified under the current determinations of the De artmenit of Labor as regulrQd uncle Bacon Act. Where a pscred' panty artists between Federal and State prevailing wage rate, the higher of the two prevailing wage rates shall apply. Each bid shall be accompanied by cash, a Cashier's or certified check payable to the City of Santa Ana, or bid bond issued by a corporate surety, for an amount not less than ten percent (10%) of the aggregate of the bid, as a guarantee that the BIDDER Will enter into the proposed . contract if the same is awarded to him. The signature of the BIDDER on the bid bond MUST be notarized.. The City Council reserves the right to reject any or all bids. The successful BIDDER must possess or obtain a. valid Caiifornia Class JA) Contractor's license prior to the scheduled award date of this contract. The work to be pattormed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701 u (Section 3). The City of Santa Ana has established an Annual Anticipated DBE: Participation Level (AADPL) of 9.65%.. (3.27% Race Neutral and 6.38% Race Conscious) for projects constructed during the Federal Fiscal Year 2012/2013. This percentage Shall apply to the cost of the This space for Piling stamp only entire project. The DBE Commitment form Exhibit 15- 02 may be submitted with the bid proposal. If the DBE form is not submitted with the bid, the apparent Vow bidder, the second low bidder, and the third low bidder must Complete and submit the form to the City. The Form must be recotved by the City no later than the time specified in the Federal Requirement of Appendix H of the Special Provisions. Substitution of secudfies for any monies withheld' by the City of Santa Ana to ensure performance is allowed in accordance with the Public Contract Code. Complete electronic sets of the Plans and Specificatlons will be furnished upon application at the Public Works Agency counter, First Floor, 20 Civic Center Plaza, Ross Annex, . Santa Ana, California 92701. Plans and Specifications are available In portable document format (PDF) on a compact disk (CD) only. There is no charge for the Plans and Specifications on CD.. PWA Counter Business Hours are 9:00am to 4:00pm, Monday into Thursday. Call the PWA Projects Information Line Fit 714 -647 -5660 for availability of CDs. To request a CD by mail, the Contractor must submit an email request to sarmourosania- ana.arg and provide the following inform8liom Company name, mailing address, phone number, FedEx account, and email Subject heading: CD Request for <project no.> < project name >. Checks are no longer accepted. Addenda will be issued by email to those who received CDs directly from the Public Works Agency, . DO NOT CALL PURCHASING DIVISION REGARDING PUBLIC WORKS AGENCY PROJECTS. 117, 116/13 CNS- 2428608# THE REGISTER 1111119VntlI�IIVII0 VII'0 YI2 �I�IdVIIIII 7 VI'IYVII'1IC91111 cc —j tn U-1 LL C:L c M C) LLJ LLJ C-) LLJ am) CD O Cl) LIJ Q = a z W N Q Lu Q d N .m PM V=- ft co O N LIEI— m OJ 01 V- N - -� I ❑ Ell ❑ ❑ � N c0 r O V" fedex.com i.soo.coFedEx iA N 8 a H gg� g8 i u .- I in Ll�)p I I_;I -J- n VE m �--' Q ru ._ CO z } m ru C C3 ff EJ S Q .,co i L e Lo IN C 4 a Eg ' � . i tL n E $m v +3 } Harz° c �# -R: �. _ — _ r.. s.. s...+.... �... �.-. �... �.._®..=..., r�raea•- ome.+. w.. �.. �..,-. �,.... a�.._..-... a-.. ..�- :.•.��n,.e....t.�...��,.,.e - 6E£E'£9b'008'1 X POJ09-0081 W03'X8pej I o s +� chi 7Z � N OL � Q 41C OL :?w OL 43 All tA Li) I o � N CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL & CONTRACT AGREEMENT BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: -FA C—) F( L C0i\J1;T"GTI6✓J • , /�L REQUIREMENT: The undersigned declares that he /she has carefully examined the location of the proposed work, that he /she has examined the Plans and Specifications and read the accompanying instruction to BIDDERS, and hereby proposes to furnish all material and do all the work required to complete the said work in accordance with said plans, specifications and special provisions, for the unit price(s) or lump sum(s) set forth in the following schedule: Item # Bid Item Unit Quantity Unit Price Amount 1. Unclassified Excavation CY 270 $ $20., ZSo 2. Cold Milling (2 ") SF 23,000 $ i%• 50 $ 11, sd0 3. PCC Walkway (4 ") SF 34,000 $ 3-5-0 $ D b0 4. Decomposed Granite with Stabilizer SF 8,750 $ (3 „) 5. Redwood Header LF 300 $� 2 $ O 6. Root Shave EA 6 $ 41b $ 00 7. Adjust Water Valve Box Frame and EA 1 $ 200 $ ZOO Cover to Finished Grade 8. Adjust Pull Box to Finished Grade EA 2 $ 2 L,,) L9 $ od 9. Temporary Construction Sign EA 4 $ 15-0 $ 6 CO 10. Irrigation Sleeve LS 1 $ 700 $ 00 oa TOTALBID--------------------------------------------------------------------------- - - - - -- $2 SS TO BE INCLUDED IN BID PACKAGE BP 1 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL & CONTRACT AGREEMENT BID PROPOSAL, continued The lowest responsible bidder shall be selected based on the low Total Bid. The City reserves the right to award the Base Bid, and any, all or none of the alternate Bid Items. PROJECT NO. 13 -7513: BIDDER EL SALVADOR PARK WALKWAY Firm RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY Address RECONSTRUCTION D'11 () V E rJ S 1-11) 12- E A V16 G "^/A DA t. LS, Ch . °113 L i Phone 8 8— 931— 3 7 7 8 Fax b18— 9.3(_3811 Email (1-11 r�j Sn BIDDER I 1 M �� Signature •� C--- TO BE INCLUDED IN BID PACKAGE BP 2 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION 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; %% of the bid or $10,000, whichever is greater - Buildings, parks, or other projects: %2% of the bid BIDDER proposes to subcontract certain portions of the work to the firms listed below: NAME N D 1 r LOCATION PHONE TYPE OF WORK NAME LOCATION PHONE TYPE OF WORK NAME LOCATION _ PHONE TYPE OF WORK NAME LOCATION _ PHONE TYPE OF WORK NAME LOCATION PHONE TYPE OF WORK $ G ( V-- I L cc' n C' I "J C- Na# of Fr 1 Submitting Bid M Sigddture bf BIDDER NAME LOCATION PHONE TYPE OF WORK NAME LOCATION PHONE TYPE OF WORK NAME LOCATION PHONE TYPE OF WORK NAME LOCATION PHONE TYPE OF WORK NAME LOCATION PHONE TYPE OF WORK S TO BE INCLUDED IN BID PACKAGE BP 3 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL & 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 L F( l / '') 5 v�'Tl Signature of BIDDER k V Title T1 51 D C_ r,� -T— (if an individual, so state) TO BE INCLUDED IN BID PACKAGE BP 4 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT continued (If a firm or co- partnership, state the firm name and give the names of all individual co- partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) Awarded td,i��-/, /-)�r f on the basis of low st responsible and responsive bidder in the amount of _ $ ATTEST: = 1 —1 u CLERK OF THE COUNCIL APPROVED AS TO FORM: ACTION OF COUNCIL: Date 7 %� 20 l S' ACCEPTED FOR THE CITY OF SANTA ANA: CITY ATTORNEY ECUTIVE DIRECTOR PUBLIC WORKS AGENCY TO BE INCLUDED IN BID PACKAGE BP 5 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The BIDDER IA(-, I h(--- 6I\J S T - Co . I PJ G- 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, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60- 1.7(b) (1)), and must be submitted by BIDDERS and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60 -1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO -1) is the only report required by the Executive Orders or their implementing regulations. Proposed Prime Contractors and Subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60- 1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. TO BE INCLUDED IN BID PACKAGE BP 6 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION 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 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law. TO BE INCLUDED IN BID PACKAGE BP 7 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION 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 subj e to all the penalties imposed for a violation of the Chapter. Signed C/— Title 'F'P— C S► -D L k-d 1 Firm T"k—C i FL 6-, ('0 /�j s�fL Date j 1qr J— 2 pj — 2 O I-� TO BE INCLUDED IN BID PACKAGE BP 8 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION 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 1, as the Contractor, now or at any time during the course of this agreement, qualify as an employer under California Labor Code Section 3300, unless the hired employee(s) is (are) persons excluded by said Labor Code, I shall furnish the City of Santa Ana with an insurance certificate from my workers' compensation insurance carrier certifying that I carry such insurance and that the policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior written notice to the City of Santa Ana. 1 1 I _ Signed - 0 V V\,Wb1 L--- Title F,-05 I p r' Firm 71kG l F� C-- Date j R rJ — 2-5 — Zb 3 TO BE INCLUDED IN BID PACKAGE BP 9 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION 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. P.99AWt: ta-r Eup.►✓fio�✓ 1. L o P,5 - V,41 -ux - 6W s-r k-e'Pnd W ATir p-- A 4 C�N �% Name d Address o VIP-G /L 6Li4g-> Owner. Name and Telephone Number of erson familiar with project. I // �, b bo rcz-1 7-1" t 14 SPM+6r Contract Amount Type of Work 2. l t)G,l ni d i` g ert e VA -o1'e7 ( CiAll N M-19006 e and Address of owner. e 'T,�F"R-r 760- 2-Yo- -70 00 Name and Telephone Number of person familiar with project. / yr, 000 �o, ✓ c,� ��- ����w�, y Contract Amount Type of Work 3. c'f/p4 "'E 1itrJC A Add f 20 /Z Date Completed Lx X 71// 2pa%. Date Completed c_G ,46k41 n/,0 /U,-- / C H,( o /2- fia 00 l/"L/',00 ✓ &-k- ct✓) Name an ress o oW11.11. 3P/ 4 /TrF- 2 /4oAlS- Z6) - 723 - b03y Name and Telephone Number of person familiar with project. M/-5-. D o o '0q,09-so Contract Amount Type of Work Zv/D - 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. 0 TO BE INCLUDED IN BID PACKAGE BP 10 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION 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 trade in which he /she employs journeymen or apprentices on the public work, in the same amount or upon the same basis and in the same manner as the other contractors except contractors not signatory to the trust agreement shall pay a like amount to the California AvAlticeshin„Council. Title T (Z ES i D u�fj -F— Firm " P C- i F i C_ Co JC,T P-0 GTj C) • ( AEG Date � Ak-i— Z S— 'z— 0 1 3 TO BE INCLUDED IN BID PACKAGE BP 11 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT NON - COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 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 abovq Non collusion Affidavit is part of the Proposal. Signing this Proposal on the signature porti ereof shall also constitute signature of this Non - collusion Affidavit. BIDDERS are cautioned th t aki alsecerttification may subject the certifier to criminal prosecution. Signed State of California County of U Subscribed and sworn to (or affirmed) before me on this 2 L-L""' day of ackAA 20j-� by } aWv Mi yNgss. jet/-, proved to me on the basis of satisfactory evidence to be the person(s) who appe •ed before me. KANWAL JEET SINGH � Commission # 1950286 Not Public - California z z n� Los Angeles County D �—' My Comm. Expires Aug 29, 2015 Notary Public Signature Notary Public Seal TO BE INCLUDED IN BID PACKAGE BP 12 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING "ANTI- KICKBACK" REQUIREMENTS The undersigned is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the Copeland "Anti- Kickback" Act (18 USC 74) as supplemented in the Department of Labor regulations (29 CFR, Part 3). This act provides that each contractor or subcontractor shall be prohibited from inducing, by any means, any person employed in the construction or repair of publ+work,, to„give up any part of the compensation to which he /she is otherwise entitled. Signed Title I b L —rJT Firm LA-( i r/ c- C0✓JSTfLVC- 1-101 (nlL . Date JArJ- ZS — 2-0 1-� TO BE INCLUDED IN BID PACKAGE BP 13 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION 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 r X Business Address: _� ��'� (� D nl S m p Ave , 61�A NdbA H ILI S A . Telephone: S— 8 3 (, 3-77e State Contractor's License No. and Class: `b2 31S-7 I�,}3,C _�j x'_27. Expiration Date: 2 p 3 Signed: 4- c Title: Mfg 5 I TO BE INCLUDED IN BID PACKAGE BP 14 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT CLAUSES SECTION 3 - CONTRACT CLAUSES A. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD- assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low- and very low- income persons, particularly persons who are recipients of HUD assistance for housing. B. The parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the part 135 regulations. C. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the contractor's commitments under this Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. D. The contractor agrees to include the Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this Section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR Part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge of that the subcontractor has been found in violation of the regulations in 24 CFR Part 135. TO BE INCLUDED IN BID PACKAGE BP 15 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT SECTION 3 - CONTRACT CLAUSE continued E. The Contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected, but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR Part 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CFR Part 135. F. Noncompliance with HUD's regulations in 24 CFR part 35 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. G. With respect to work performed in connection with Section 3 covered Indian housing assistance, Section (7) b of the Indian Self - Determination and Education Assistance Act (25 U.S.C. 450e) also applies to the work to be performed under this contract. Section 7(b) requires that to the greatest extent feasible (I) preference and opportunities for training and employment subcontracts shall be given to Indians, and (ii) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises. Parties to this contract that are subject to the provisions of Section 3 and Section 7 (b) agree to comply with Section 3 to the maximum extent feasible, but not in derogation of compliance with Section 7(b). For the purpose of training and employment the rip mart' Section 3 covered project area is the area in closest proximity to the actual construction work site within the U.S. Census Tract in which the project is located. It is understood that priority for employment opportunity is to be given to residents residing within the primary Section 3 area as defined. A Section 3 area resident is any lower income individual residing within the Section 3 area, whose total family income does not exceed 80% of the median income of the metropolitan statistical area in which the project is located (Orange County). A public housing resident is defined by regulations as Section 3 resident, regardless of income. The contractor and each subcontractor certifies that they will provide, to the greatest extent feasible, opportunities for employment to lower income residents (local residents) and job opportunities in connection with projects in their neighborhoods. For fiscal year 1996 -97, minimum goal for each project is 30 %. TO BE INCLUDED IN BID PACKAGE BP 16 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT SECTION 3 - CONTRACT CLAUSE continued The Contractor /Sub - contractor /Service Provider by the signature affixed hereto declares under penalty of perjury: Contractor /Sub - contractor /Service Provider has read Section 3 requirements and accepts all its requirements contained therein for all of his/her operations within the City of Santa Ana. VVA G— Signature Signature IfAPrZ- -Y _ PR US►v err Print Name and Title Print Name and Title Signature Print Name and Title JA/l_ 2 0- 7-01 Date TO BE INCLUDED IN BID PACKAGE BP 17 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT FEDERAL REQUIREMENTS FOR FEDERAL -AID CONSTRUCTION PROJECTS GENERAL —The wo& herd proposed will be financed mwholeor in patwith Federal fiords, ad therefore all ofibe stahn6es, rules and regulations p mulgated by the Federal Cvvan nierrt and applicable b wak financed in whole or in pat with Federalfimdswillapplytbaxhwoils. The" Requin�dCor�adProvisia�s,Federal- Aid Ccr shuction Ca bads, "Fam FHWA 1273, are included in this Section 14. Whenever m said required catad previsions iefaaoes are made to "SHA Ccritracring offioa;' "SHA residerrt engineer;' or "authorised represertafhe of the S[W' sudi refaaxes shall be coi>shued to rmean ` Enguied' as defined in Section 1 -1.18 ofthe Slandad Specifications. PERFORMANCE OF PREVIOUS CONTRACT - In additun to the povisions in Section Il; and Section VI1, "Subletting or Assign the Cxkact ' of the required contract pnivisictA the Caractor shall damply with the kilowung The BIDDER shall o=* the CIRTIFICATION WITH REGARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTU sM CLAUSE AND THE FILM OF RE.QUIIZEA REPORTS located in the proposal. No request for subletting or assigning any portion of the co trad in excess of$10,000wrllbeoaE deW under'the p uvmmofSecbm VI[ofthe required oontrad pnn'isior>s unless suds request is a000rrrpaded by the CINTIFIt ATIONreferodtoabomo =ulodbytheproposedsuboantiactor. NON4C0 .USION PROVISIONS - The povwns m this sec ran ae appbcablebaUm *actso=ptcamactsforFedwJAidSeoa day Mnjeds. Tide 23, United States Code, Section 112, requires as a oondition promde t to approval by the Federal I rig may Admnnistr" of the cantrad for this work that ach BIDDER file am= staternart o mded by, or on behaffot the person, firm, association, or corporation to wham such cadrad is L be awarded, certifying that such person, firm, assockbon, or corporation has nX either din * or indiro*, entered mb any agoeni , participated m ary collusion or otherwise taken ary actioninieshair> taffreeoar bidduiginoornnediaiwiththeatxnittedbid. A far to make the non-collusion afizclM staternernt requrtad by Section 112 as a certification iuderparaltyofperjuryradnerthanasasvx mstatanartaspamiftedby 28, USC, Sec.1746, is included in the proposal. PARTICIPATION BY DISADVANTAGED BUSINESS ENIERPRISFS IN SUBCONIRACTING- Pat26,T1de49, CodeofFederal Regulations supplies to this Federal aid project. Pertinent sectias of said Code are moopor Winpatorinitsentirelywithinothersectionsofthesespecialpovmis. Rhoi&B -k&m-f mforD&nnmmgka tVertL=Higbrlily. Atta hmert Exhi A -FRI 8.07 -97 (This form need not be filled in if all joint venture firms are minority owned.) 1. Name of joint venture 2. Address of join venture 3. Phone number of joint venture 4. Identify the firms which comprise the joint venture. (The DBE partner must complete Schedule A) a. Describe the role of the DBE firm in this joint venture. b. Describe very briefly the experience and business qualifications of each non -MBE joint venture: 5. Nature ofthe jointventure's business 6. Provide a copy of the joint venture agreement. 7. What is the claimed pmerrtage ofDBE ownership? 8. Ownership of joint 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 TO BE INCLUDED IN BID PACKAGE BP 18 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT 9. Catolofandpaticpadonm iscmkd Ideotifybyrmir ace, sex, and `find'those individuals (axl thmbtles) who ae resporsble far days rrra>aganant and Policy decision makM including but not limited to, those with prune rvspo tnbrk for a Financial decisicm H ,4 rL Kj f"" 1 1 IV4 S! /Al - l b.Mahagarnatdacsior such as: LEstimaling H,4PPY M (IVA fS IAIJ AG t fi L ( -VJST: Co. I /J Naneof�'ijm a Na►neofFmn S� ��SSIAJ Sim Name I P— �StDENr Tide Tide JYIft't- 2B _ Z013 Eon- 2.Maicelirgaidsales f-tA" Date 3.Huing" ofnrxr�arnart Alta^( f•1r A/A ff 1,a •./ 4.1[3wchasingof itemsoraffhes A" `"t 1,✓,4fftA -✓ o Supm ision offdd operatims 14Ap -p-y ►+� 1,A --J NTa(e: g after filing this Miedule B and before the completion ofthe jointvait re' swodconthecwhadcoveredbyfisregr atior,&=is any sigpificart daW in the irdarrim submitted, the joint verrhae must inform the garive, either directly or through the prune cw hactor ifthe jourt vernLae is a subcontractor. ` Ibe undersigned swear that the foregoing sttrternabs are correct aid mclude all material mfomrbm necessary to identify and explain the tars and gxrabon of our joint venture and the intended participation by each joint verturcr m the mdalaldrg. Ruth r, the undersigned ooverrnt ad agree lo provide to gratift c rrelht, cornpletc and accurate infomnatim regarding actual jourt verrtrre wrik and the paymert dwrelb a and arty proposed changes in any of the joint win ahmMnen s and to permit the audit and examination of the books, records, and files of the jourt venture, by aphorized represetilatives of the game or the Federal funding agency . Any material misvepteuilation will be gourds for tern tiding any cortact which may be awarded and for initiating action underFederal or State laws commin Use sdznahts" Aitadrmart Exhi*A -FIU 8-07-97 Slateof Countyof M S"d Wary Certificate On this _ day of 20_, before me appeared (none) to me personally lmown, who, being drily swot, did a=ute the foregoing affidavit and did staff that he or she was prapaiy au tlaized by (Nave of f m) NotayPublic Canunissiona#res [SeA Date Stateof Courdyof to owcute the affidavit and did so as his or her free act and dead. On this _ day of 20� b&m me appeared oq me) to me pasorrally kuwrh, who beirg wxm, did omite the foregoirg affidavit and did slate that he or she was propaiy a llmimd by (Name of fun) Not ryPublic BP 19 of 30 iD exearte the affidavit and did so as his or her five act and deed. TO BE INCLUDED IN BID PACKAGE CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Los Angeles On Z i3 before me, Kanwal Jeet Singh Notary Public Date Here Insert Name and Title of the Officer personally appeared qA,,\V-1 S�4 fqj 0 !�j I Civil I Narne(s) of Signer(s) 7- Z 4 t Commission # 1950286 public S G 0j ' 1) N "tart I-0s Angele 2q 201S MV who proved to me n the basis of satisfactory evidence to be the person ;j " whose name(g) islam-subscribed to the within instrument and acknowledged to me that helsho4hey-executed the same in histherAheir authorized capacity(ws)-,and that by histhei1'Me-ir signature(q)-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 my hand and r <�al seal,.,/ Signature Place Notary Seal Above signature Of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another documenL Description of Attached Document Title or Type of Document: Document Date: Number ef"Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ignees Name: r ❑ Individual ❑ Individual ❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General 0 Partner — ❑ Limited ❑ General D ❑ Attorney ❑ Attorney in Fact • 0 Attorney in Fact • T. 'thumb h4.e ❑ Trustee TO IhUrnb here 0 Trustee El Trustee ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: 02007 National Notary Association • 9350 De Soto Am, P.O. Bm 2402 • Ctm%mm1h, CA 91313-2402- wwwNabonaiNaLM.org ftem#59(Y7 ReordmCdToll-Freel-800-876-68V CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION 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. FED.8 -22 -88 Name of BIDDER Signature of BIDDER Date IV _ Z _ Z10 13 TO BE INCLUDED IN BID PACKAGE BP 20 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION 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 certification be included in all lower tier subcontracts, which exceed 100,000 and that all such sub - recipients shall certify and disclose accordingly. BIDDER's ignature P� L I C�- �0 �i S 12,U L-n 0 rJ (�O , 1,ic Firm .1ArJ_ ZO- 2013 Date • Standard Form LLL may be obtained from Caltrans and FHWA offices TO BE INCLUDED IN BID PACKAGE BP 23 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 1. Type of Federal Action 2. Status of Federal Action 3. Report Type: ❑ a. Contract ❑ a. Bid/offer /application ❑ a. initial b. Grant b. initial award b. material change c. Corporate Agreement c, post -award d. Ban For Material Change only: e. Loan Guarantee Year quarter f. Loan Insurance date of last report 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: ❑ Prime ❑ Subwardee Tier , If known Congressional District, i known Congressional District, i known 6. Federal Department/Agency: 7. Federal Program Name/Description CFDA Number, If applicable 8. Federal Action Number, jAnown 9. Award Amount, if known 10. a. Name and Address of Lobbying Entity b. Individual Performing Services (#rht ag aatimss fa fr=Na 10q) 0LWnwr,#gAV (lastnfy9 AV attach Continuation Sheet(s) if necessary) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply) $ ❑ Actual ❑ Planned ❑ a. retainer ❑ b. one -time fee ❑ a commission 12. Form of Payment (check all that apply): ❑ a. cash ❑ d. contingent fee ❑ b. in -kind; specify: nature ❑ e. deferred value I ❑ f other, specify 14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment indicated in item 11: attach Continuation Sheets i recess 15. Continuation Sheet(s) attached: D No 16.Inmra6mmWestoddmtoltris fam ismkri2edbyT#ie31 USC Sec im 1352 Thisdisdoaaeoflobbyingacar�isanx4n l moffactupm Signature whichmhanoewaspWMb) d ticr*mwtendbetmsac imwmnm&cra*ed \ n Print Name -� {z� �( I" \ (��} SS / inb. Thiis&domisregiWpL t1o31US.C.1352 Thisinibnr�onw�lbe repottadbtbeCcngtesssm i arxnrallyandwMbemailableforpti) icinspection. E S I %j J Any pesonv& fatlsbfiledremoeddscimnshall bewbjec #bacivi1penaltyof Title (=f mtlessdran$ 10, 000ardmtrmtedmn $100,000foreachsxhfiuliae S 7 7 8 Telephone No. i 8 $ 3 — Date Iq n1 _ 2 _ z 0 13 Federal Use Autlronzed for Local Reproduction Standard Form —LLL TO BE INCLUDED IN BID PACKAGE BP 24 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING REQUIRED FEDERAL CONTRACT PROVISIONS (Form FHWA -1273) The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the required Federal Contract Provision (Form FHWA -1273) as shown in the appendix the s al provisions of this project. I / I Signed V �.a Title r S l b e W 1 Firm EA ejri (,oi � IAJ C Date 4I � Vii - 2 - ZD 13 TO BE INCLUDED IN BID PACKAGE BP 25 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION FOR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief; that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal Agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, grant, loan, or cooperative agreement. (2) If any funds other Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL *, "Disclosure of Lobbying Activities" in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her proposal that he or she shall require that the Lang ag of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub - a 'pien s all certify and disclose accordingly. BIDDER Signature Firm J A z�- -Z Date *Standard Form LLL may be obtained from Caltrans or FHWA offices. TO BE INCLUDED IN BID PACKAGE BP 26 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT BIDDER'S CERTIFICATE OF COMPLIANCE REGARDING "BUY AMERICA" REQUIREMENTS FOR STEEL OR MANUFACTURED PRODUCTS The undersigned, is submitting this proposal for performing by contract the work required by these bid documents, certify to comply with the " Buy America" requirements of Section 165 of the Surface Transportation Assistagc� Act of 1982 and as shown in the special provisions of this project. n Signed Title P (2 e S 1 D 6N Firm PAC_IPrC- CD1JSTR -uC- Io� 60- Date J /4rn/ _ -2-0— Z 0] 3 TO BE INCLUDED IN BID PACKAGE BP 27 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the BIDDER hereby declares under penalty of perjury under the laws of the State of California that the BIDDER has _ , has not been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 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 the signature portion thereof shall also constitute signature of this Statement. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed Title FF-G I T) e rJ 1- Firm 'F& C � r- l L� CO AJ (-TI QA) Date )A-tJ— 2(�— Z0�3 TO BE INCLUDED IN BID PACKAGE BP 28 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION PROPOSAL AND CONTRACT AGREEMENT PUBLIC CONTRACT CODE SECTION 10162 QUESTIONAIRE In conformance with Public Contract Code Section 10162, the BIDDER shall complete, under penalty of perjury, the following questionnaire: Has the BIDDER, any officer of the BIDDER, or any employee of the BIDDER who has a proprietary interest in the BIDDER, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation? Yes No If the answer is yes, explain the circumstances in the following space. TO BE INCLUDED IN BID PACKAGE BP 29 of 30 CITY OF SANTA ANA PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION 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 y t D eri T— - Firm _ PA -1 f 1 L ��U f��� 0. �- Date C 1 Aki - 2( - TO BE INCLUDED IN BID PACKAGE BP 30 of 30 THE AMERICAN INSTITUTE OF ARCHITECTS A!A Document A310 • : • • KNOW ALL MEN BY THESE PRESENTS. that we Harry Minassian, Inc. dba Pacific Construction Co., Inc. 10910 Densmore Avenue Granada Hills , CA 91344 as Principal, hereinafter called the Principal, and North American Specialty Insurance Company 6 Hutton Center Drive, Suite 850 Santa Ana , CA 92707 a corporation duly organized under the laws of the State of New Hampshire as Surety, hereinafter called the Surety, are held and firmly bound unto City of Santa Ana 20 Civic Center Plaza, Santa Ana, CA 92707 as Obligee, hereinafter called the Obligee, in the sum of Bond Number: HARMI -194 Ten Percent of Amount Bid Dollars ($ 10% of Amount Bid 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: Project No. 13 -7513 & 13 -7514 - El Salvador Park Walkway Reconstruction & Windsor Park Walkway Reconstruction 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 15th day of January, 2013 (Witness) (IMtness) Harry ssi n d a Pac c �ction . n (Seal) iD0rJ (Title) North A S ecialty Insurance Company r (sue (Seat) Attorney -in -Fact AIA DOCUMENT A310 • BID BOND • AIA 0 • FEBRUARY 1970 ED • THE AMERICAN INSTITUTE OF ARCHFFECTS, 1735 N.Y. AVE., N.W., WASHINGTON, D.C. 201306 1 CALIFORNIA ALL- PURPOSE ACKNOWLEDGMENT State of California ❑ Individual County of Los Angeles ❑ Corporate Officer — Title(s): On ' Z 6 _ 7-0 before me, Kanwal Jeet Singh Notary Public Date Here Insert Name and Title of the Officer personally appeared l Q M 1 i'l S Names) of s) O Trustee who proved to me on the basis of satisfactory evidence to ❑ Trustee be the person(eywhose name(s) is/are'subscribed to the within instrument and acknowledged to me that he/sbett ay- executed the same in his/ttrftheir authorized capacity(ie5),and that by his/her&eir signature(s)-on the Kr1NWAL JEET SINGH instrument the person( the entity upon behalf of 'tea Commission # 1950286 which the person(okcted, executed the instrument. Z : Fk Notary Public- California z Z 'rte Los Angeles D Signer Is Representing: County I certify under PENALTY OF PERJURY under the laws My Comm. Expires Aug 29, 2015 of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and officia seal. Signature Place Notary Seal Above Signattme of Notary Pubrrc OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signers Name: Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ General _ ❑ Attorney in Fact ❑ Attorney in Fact O Trustee Top of thumb hem ❑ Trustee Twp'+of ihtxnb:t ere ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: 02007 National Notary Association • 9350 De Soto Ave., P.O. Banc 2402 • Chatsworth, CA 91313- 2402 • www.NabonalNotary org Item #5907 Reorder Call 1blif a 1 -800- 876 -6827 CALIFORNIA ALL- PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA County of Orange On 1/15/13 before me, Karen L. Ritto, Notary Public Date Here Insert Name and Title of the Officer personally appeared Arturo Ayala OPTIONAL Though the information below is not required by law it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Bid Bond Document Date: 1/1 Signer(s) Other Than Named Above: None Capacity(ies) Claimed by Signer(s) Signer's Name: Arturo Ayala ❑ Individual ❑ Corporate Officer Title(s): ❑ Partner — ` Limited" General S6 Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: One Signer's Name: ❑ Individual ❑ Corporate Officer — Title(s)— ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Top of thumb here V 2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313 -2402 • www.NationalNotary.org Item #5907 Reorder: Call Toll -Free 1- 800- 876 -68227 Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(g) whose name(g) is /tee subscribed to the within instrument and acknowledged to me that he /stream executed the same in his /hachibelc authorized capacity( ), and that by his/faarttoir signature(x) on the instrument the person(x), or the entity upon behalf of which the person() acted, executed the instrument. COMM. #1965188 M Notary Public California @my KAREN L. RITTO 1 certify under PENALTY OF PERJURY under the laws of the State California that the f is true of graph ORANGE COUNTY Comm. Expires Dec 2015 and correct. Lregoing Witness my ha and cal se Signature Pla ce Notary Seal Above Signature f Noiary Public Karen L. Ritto OPTIONAL Though the information below is not required by law it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Bid Bond Document Date: 1/1 Signer(s) Other Than Named Above: None Capacity(ies) Claimed by Signer(s) Signer's Name: Arturo Ayala ❑ Individual ❑ Corporate Officer Title(s): ❑ Partner — ` Limited" General S6 Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: One Signer's Name: ❑ Individual ❑ Corporate Officer — Title(s)— ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Top of thumb here V 2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313 -2402 • www.NationalNotary.org Item #5907 Reorder: Call Toll -Free 1- 800- 876 -68227 NAS SURETY GROUP Bond No. HARMI -194 NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under laws of the State of New Hampshire, and having its principal office in the City of Manchester, New Hampshire, and Washington International Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg, Illinois, each does hereby make, constitute and appoint: DANIEL HUCKABAY, ARTURO AYALA, and DWIGHT REILLY JOINTLY OR SEVERALLY Its true and lawful Attomey(s) -in -Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION ($50.000.000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 91h of May, 2012: "RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." Stl� \IIUNInNrq r� � won a �VV�SG1ALiY/ / /rir -r�'` en;tuiw n opPiiq,�•�,`.s(� a rF _� ; By SEAL. n' Steven P. Anderson, Senior Vice President of Washington International Insurance Company '• $� •�1y 'a �u1 ;Z 1973 PY,,::n m � o &S enior V ice P resi d en t ofNorth A merican Special ty Insurance Company O: IM111% By_ David M. Layman, Vice President of Washington International Insurance Company & Vice President of North American Specialty Insurance Company IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this20th day of June , 2012 North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Cook SS: On this 20th day of June , 2012 , before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M. Layman , Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. E�OFFRCIAL AL•• LENS tat e of Illinois Expires 10/0612015 Donna D. Sklens, Notary Public 1, Jeffrey Goldberg , the duly elected Assistant Secretary ol'North American Specialty Insurance Company and Washington International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company, which is still in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 15th day of January 20 13 Jeffrey Goldberg. Vice President & Assistant Secrete of Washington International Insurance Company & North Amencan Specialty Insurance Company Company Profile Company Profile Company Search Company Search Results Company Information Old Company Names Agent for Service Reference Information NAIC 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 & Comparison Data Company Enforcement Action Composite Complaints Studies Additional Info Find A Company Representative In Your Area View Financial Disclaimer COMPANY PROFILE Company Information NORTH AMERICAN SPECIALTY INSURANCE COMPANY 650 ELM STREET, 6TH FLOOR MANCHESTER, NH 03101 -2524 Old Company Names Effective Date Agent For Service NANCY FLORES C/O CT CORPORATION SYSTEM 818 WEST SEVENTH STREET LOS ANGELES CA 90017 Reference Information NAIC #: 29874 California Company ID #: 3208 -6 Date Authorized in California: 06/30/1989 License Status: UNLIMITED - NORMAL Company Type: Property & Casualty State of Domicile: NEW HAMPSHIRE back to top NAIC Group List NAIC Group #: 0181 SWISS RE 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 DISABILITY FIRE LIABILITY MARINE PLATE GLASS SPRINKLER SURETY WORKERS' COMPENSATION back to top © 2008 California Department of Insurance Page 1 of 1 http: // interactive. web. insurance. ca. gov /companyprofile /companyprofile ?event= companyPr... 2/11/2013 Exhibit 15-G2 Local Agency Bidder DBE Information (Construction Contracts) (Inclusive of all DBEs at bid proposal) NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX H AGENCY City of Santa Ana.---- LOCATION,. Windsor Park ROJEC'I'DESCRIPTION. ProiectNo 13-7514 TOTAL FLULRAL, CONTRACT AMOUNT. $100,000 BIDDATEi 01/29!2013 —7 L;G77 BIDDER'S NAME ITEM M 0 -WO co' -of DBE ,ONTRACT ITEM OF WORK AND DESCRIPTION 'crt. No of PI TI( ND EXPIRATION NDL EXPIRATION NAME OF DBEs DOLLAR AMOUNT NAME DBEs 1, date bids B Must be certified on the date bids H certified Must I� JR SERVICES ITEM NO R SERVICES TO BE Sr VIC �c Al 1,113CONTRAc-i-ED OR MATERIALS )ATE B;N RV d address reopened - include DBE address n- c FO BE PROVIDED OCK 1 dphonenumber) d It n nor IN C4 For Local Agency to Complete: "total Claimed 1,ocal Agency Contract Number Participation Federal Aid Project Nunitx.-r Federal Share ontractAwardDate Local Agency cerlifics that all information is complete and accurate Signature of Bidder Print Name n .1c Daw Local Agency Representative L Area 3 7 7e, For Caltrans Review' Date (Area Code) Tcl No Print Name Signature Date Caltrans District Local Assistance Engineer Local Agency Bidder DBE 1nfon-!,— 3,09) I Distribution. (1) Copy - Fax or scan a copy to the Caltrans District Local Assistance Engineer (bLAE-:) within 15 days of award Failure to send a copy to the DI.AF. within 15 days of award may result in de-obligation of funds for this project (2) Cory - Include an award package to Caltrans District Local Assistance (3) Original - Local agency flies TO BE INCLUDED IN BID PACKAGE BP 22 of 30 Exhibit 15 -G2 Local Agency Bidder DBE Information (Construction Contracts) (Inclusive of all DBEs at bid proposal) NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX H AGENCY, City of Santa Ana LOCATION F,I Salvador Park PROJECT DESCRIPTION. soiect No. 13 -7513 TOTAL FF.DERAL CONTRACT AMOUNT. $120.000 BIDDAIF 01 /29/2013 BIDDER'S NAME. / \ -- I C = -'U Jfi CU . N1L 'ONTRACT 1'I-EM NO 1-I PM OF WORK AND DESCRIPTION OR SERVICES TO BE SUBCONTRACTED OR MA -1 F RIALS 'ert . No. of DBE, AND EXPIRATION DATE NAME OF DBEs Must be certified on the date bids are opened - include DBE= address DOLLAR AMOUN "I DBE' 1 O BE PROVIDED and phone number)_ - - - G - C HP Moe For Local Agency to Complete: r, -total Claimed 00V Local Agency Contract Number- - -__ -- --- -- - -._ —_- Participation - - — — Federal Aid Project Number Federal Share o; o - ontract Award Dale. Local Agency certifies that all information Is complete and accurate �- Signature of Bidder Pnnt Name Signature - -- pate - Locai Agency Representative �J Area Code) Tcic hone Number: Date (Area Code, Tel No For Caltrans Review: Print Name - -- Signature — Caltrans District Local Assistance Engmeer pate I.ocjJ Agency B,d& -r - DBE Information (Rey ::09) Distribution (1) Copy - Fax or scan a copy to the Caltrans District Local Assistance Lngmeer (ULAG) wttnm t f) days of award vauure to send a copy to the DI, AE within 15 days of award may result In de- obfigaUon of funds for this project (2) Copy -- Include in award package to Caltrans District Local Assistance (3) Original - Local agency files "I70 BE INCLUDED IN BID PACKAGE BP 21 of 30 FPCr1 : CHAt•16ER= PHONE NO. : 909 394 0645 JAN. 30 2013 10:59Ar1 P3 Metropolitan Trsnsportation Authority One Gateway PI472 213.922.2000 TO Los Angetet, CA 90012-2952 metro -net Metj"0 CALI1•UNNIA UNIFIED CERTIFICATION PR ®CRAM January 30, 2009 CUCP 11329 Metro File # 1 f4 Jonnio Chambers Jennie Chambers ]rucking 916-C W. Foothill, Room 145 Claremont, CA 91711 RE: Disadvantaged Business Enterprise Certification Dear Ms. Chambers: We are pleased to advise you that after careful review of your application and supporting documentation, the Los Angeles County Metropolitan Transportation Authority (Metro) has determined that your firm meets the eligibility standards to be certified as a Disadvantaged Business Enterprise (DSE) 3s required under the U.S. Dopartmont of TranvpM,2tinn (I I.<; nnT) RROtllfllinn 49 CFR Part 26, a$ amended. Your DBE certification status will be honored by all of the U.S_ DOT recipients in California. Your firm will be listed in the California Unified Certification Program ((_:UGk,) oataoase or certitieu uoas mium ih= NJ1lvvrlfq,1 oV.in- expertise: NAICS (2002) Description Size Standard 484110 General Freight Trucking, Local $20.41 million 484220 Specialized Freight (except Used Goods) Trucking, Local $20.41 million Your DBE certification is good for five years from the date of this letter and applies only for the above NAICS 2002 codes. Requests for additional or revised NAICS 2002 codes must be made in writing to Metro. Attar the five -year certification period, your entire file will be reviewed in order to ascertain continued DBE certification status. Prior to your firm's DBE certification expiration date, Metro will send a letter to you requesting information necessary to complete this review. The Regulations also require annual updates during this five -year period. In order to assure continuing DBE status, you must submit annually a DBE Declaration with supporting documentation, In the format that will be sent to you. Based on your annual submission that no change in ownership and control has occurred, or if changes have occurred, they do not affect your firm's OBE standing, the DBE certification of your firm will continue until the five -year certification has expired. Also, should any changes occur that could affect your certification status prior to receipt of the DBE Declaration, such as changes in your firm's name, businessimailing address, ownership, management or control, or Failure to meet the applicable business size standards or personal net worth standard, please notify Metro immediately. Your DBE certification is subject to review at any time. Failure to submit forms and /or change of information will be deemed as failure to cooperate under §26.109 of the Regulations. Gongratulatlons, and thank you for your interest in the CUCP- Sincerely, Shirley Wong Certification Representative S_j A.Sinrw cerdtlratloe Unit one Gate" PWA. Mall glop 903.W$, Loa Ange4e$, CA PW2.2952 6w 71L 77 -70%40 MEMORANDUM David Cavazos, To: City Manager Edwin "William" Galvez, P.E. Interim Executive Director, From: Public Works Agency Date: October 21, 2013 Project Nos.:137513 & 137514; El Salvador/Windsor Park Walkway Reconstruction Subject: Change Order No. 1 Contractor: Pacific Construction Company, Inc. o 10910 Densmore Avenue Granada Hills, CA 91344 z> °` Project Description: El Salvador/Windsor Park Walkway Reconstruction = co Change Order Number: 1 Total This Change Order $ 43,006.00 Accounting Unit - Activity Number: 13518783 - 13751301028 JUSTIFICATION The concrete walkways at El Salvador and Windsor Parks project are funded by the Community Development Block Grant Fund Program which was established in 1974 by the United States Department of Housing and Urban Development and provides grant funds for to address community development needs. However, due to funding constraints and the engineer's estimate, certain improvements that encompassed these requirements were deleted from the final design. Consequently with the bids coming in lower than expected, Parks, Recreation and Community Services (PRCS) staff recognized this opportunity to utilize grant funds to add enhancements and requested the to rehabilitate the parking lot at south end of El Salvador Park. This compensates the contractor for all costs related to the re- construction of the pavement, an ADA curb ramp and restriping per City of Santa Ana PCO #2 dated 5/7/2013. AGREED COST = $43,006 Request for Approval of Change Order No. 1 October 21, 2013 Project Nos.: 137513 & 137514 Page 2 of 3 CONTRACT COST SUMMARY Original Contract Total $186,255 Amount % of Contract Previously Approved Change Order $ -0- 0% This Change Order $43,006 Increase 23.09% Total Change Order to date $43,006 Increase 23.09% Adjusted Contract Total $229,261 SCHEDULEIMPACT The contract time was extended 88 days to allow the contractor time to procure an asphalt contractor to perform the work included in this change order. The revised completion date will be September 24, 2013. APPROVED AS TO FUNDS AND ACCOUNTS: Edwin "William" Galve , P.E. Interim Francisco Gutierrez, Executive Director Executive Director Finance & Management Services Agency i Public Works Agency Gerardo Mouet, Executive [ Parks, Recreation and Com Services Agency -41 - AN, 6 unity Co K:\ construction \projects \137513 \CO #01 \MEM RFA CCO #01 ncy Agency Director Request for Approval of Change Order No. 1 October 21, 2013 Project Nos.: 137513 & 137514 Page 3 of 3 CHANGE ANALYSIS DETAILED JUSTIFICATION The concrete walkways at El Salvador and Windsor Parks have deteriorated due to weather, age and usage; which have become a concern at the parks. The replacement of these walkways will restore the walkways for the park visitors. The improvements include removal of existing asphalt and placement of portland cement walkways and decomposed granite areas. Due to the limited funding compared to the original engineer's estimate certain improvements were deleted from the final design. Consequently with the bids coming in lower than expected, Parks, Recreation and Community Services staff recognized this opportunity to utilize the grant funds and add the parking lot enhancement: A prior approval was granted for this work on May 7, 2013. The work included pulverizing the asphalt, grading, paving, restriping and an ADA curb ramp. Also, a temporary portable restroom for public use was during these renovations. REVISED DETAILS Rehabilitate Parking lot including restriping and ADA curb ramp at El Salvador Park: cmc cep oR EL SALVADOR PARK PARKING LOT eB j Rl.LL'N - POfRg3fFLL 311iRYi CITY OF SANTA ANA PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project Nos. 137513 & 137514; El Salvador/Windsor Park Change Order Number 1 Walkway Reconstruction To Pacific Construction Company, 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. Rehabilitate the parking lot at south end of El Salvador Park to include the American Disability Act ramp and re- striping as directed per City of Santa Ana PCO No. 2 dated 4/17/2013. Page 1 of 2 AGREED COST = $43,006 CITY OF SANTA ANA PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project Nos. 137513 & 137514; El Salvador/Windsor Park Change Order Number 1 Walkway Reconstruction To Pacific Construction Company, 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 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 $ 43,006 By reason of this order the CONTRACT TIME completion will be adjusted as follows: Eighty -eight (88) 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 pd s sh wn above. Accepted, Date (0. j� 20 3 Contractor Pacific Construction Company, Inc. By k Title SIZES t 0 Cwt- Approval recommended by Date �� 7_o/.3 PUBLIC WORKS AGENCY EXECUTIVE DIRECTOR Approved by Date CITYMANAGER Page 2 of 2