City of Barstow
Community Development Department
Engineering Division
Contract Documents
and
Specifications
THAT HUB OF THE WEST
BARSTOW
Waste Water Treatment Plant Pond Pumping
System
Received:
APR 2 8 2025
Initial: MC
Project#: WWTP-25-001
Bid Open: Friday, March 28, 2025
Close Date: Monday, April 28, 2025
For use in connection with
Standard Specification for Public Works Construction
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City of Barstow
Community Development Department
Engineering Division
NOTICE TO BIDDERS, PROPOSAL, CONTRACT
AND SPECIFICATIONS
FOR THE CONSTRUCTION OF
Project #: WWTP-25-001
Waste Water Treatment Plant
Pond Pumping System
MAYOR
Tim Silva
MAYOR PRO TEM
Barbara M. Rose
COUNCIL MEMBERS
Carmen Hernandez James Noble
John "Tex" Williams
Consultant City Engineer:
Brad Merrell
Merrell Johnson Companies
22221 Highway 18
Apple Valley, CA 92307
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TABLE OF CONTENTS
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
SECTION
NOTICE INVITING SEALED BIDS.... A
INSTRUCTIONS TO BIDDERS ...... .B
PROPOSAL INFORMATION AND DOCUMENTS.. C
CONTRACT INFORMATION AND DOCUMENTS D
STANDARD SPECIFICATIONS.. .E
SPECIAL PROVISIONS - 700 SERIES ...F
PLANS. APPENDIX 2
24" VALVE SPECIFICATION APPENDIX 3
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SECTION A
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
NOTICE INVITING SEALED BIDS
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INVITING SEALED BIDS
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
PUBLIC NOTICE IS HEREBY GIVEN that the City of Barstow (City, invites sealed bids for the above- stated project and will receive such bids in the office of the City Clerk, 220E. Mountain View St, Suite A, Barstow, CA 92311 up to the hour of 12:00 p.m., on the 28th day of April 2025. The bids will be publicly opened and read at 12:00 p.m. on the 28" day of April 2025, in the Council Chambers of the City of Barstow, 220 E. Mountain View St., Suite A, Barstow, California 92311.
The Engineer's Estimate for this project is $368,736.00.
This project consists of the construction of piping, valves, and fittings, for the Waste Water Treatment Plant (WWTP) Pond Pumping System.
A Mandatory Job Walk will be held on Wednesday, April 9, 2025, at 10:00 am at 2200 Riverside Dr., in the City of Barstow, California, 92311. We will meet at the entrance gate and drive to the project location at the Waste Water Treatment Plant.
Copies of the plans, specifications, and contract documents are available at the City of Barstow contact Wes Garrison at [email protected]. In accordance with the provisions of California Public Contract Code $ 3300, and Business and Professions Code § 7028.15(e), the City has determined that the contractor shall possess a valid Class A, or C-34 Contractors License at the time that the contract is awarded. Failure to possess the specified license shall render the bid as non-responsive and shall act as a bar to award of the contract to any bidder not possessing said license at the time of the award.
CONTRACTORS ARE REQUIRED BY LAW TO BE LICENSED AND REGULATED BY THE CONTRACTORS' STATE LICENSE BOARD. ANY QUESTIONS CONCERNING A
CONTRACTOR MAY BE REFERRED TO THE REGISTRAR, CONTRACTORS' STATE LICENSE BOARD, P.O. BOX 26000 SACRAMENTO, CA 95826. At the time the contract is awarded, the contractor shall be properly licensed in accordance with the laws of this state. The first payment for work or material shall not be made unless and until the Registrar of Contractors verifies to the City that the records of the Contractors' State License Board indicate that the contractor was properly licensed at the time the contract was awarded. Any bidder or contractor not so licensed shall be subject to all legal penalties imposed by law including, but not limited to, any appropriate disciplinary action by the Contractors' State Board. Failure of the bidder to obtain proper and adequate licensing for an award of a contract shall constitute a failure to execute the contract and shall result in the forfeiture of the security of the bidder. (Public Contract Code § 20103.5)
CONTRACTORS AND SUBCONTRACTORS ARE ALSO REQUIRED TO BE REGISTERED WITH Bids must be prepared on the approved bid forms in conformance with INSTRUCTION TO BIDDERS and submitted in the envelopes provided, sealed, and plainly marked on the outside:
"WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM "
PROJECT NO. WWTP-25-001
DO NOT OPEN WITH REGULAR MAIL"
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The bid must be accompanied by a bid guarantee in the amount of 10% of the total bid by 2:00 p.m. on April 28, 2025. More specifically, pursuant to Public Contract Code §§ 20170 and 20171, all bids for the project shall be presented under sealed cover and shall be accompanied by one of the following forms of bidder's security in the amount of ten percent (10%) of the bid: (a) cash; (b) a cashier's check made payable to the City of Barstow; (c) a certified check made payable to the City of Barstow; or (d) a bidder's bond executed by an admitted surety insurer, made payable to the City of Barstow. Such security shall be forfeited should the successful bidder to whom the contract is awarded fail to timely execute the contract and deliver the necessary bonds and insurance certificates as specified in the contract documents.
To the extent applicable, at any time during the term of the Agreement for the proposed project, the successful bidder may, at its own expense, substitute securities equivalent to the amount withheld as retention (or the retained percentage) in accordance with Public Contract Code § 22300.
Pursuant to California Civil Code § 9550, a payment bond is required to be submitted for all projects estimated more than $25,000.00.
The City has determined that the proposed project is a public works subject to the provisions of Labor Code § 1720 thereby requiring the Contractor to pay the prevailing wage rates for all work performed under the Contract. Accordingly, the proposed project is subject to compliance monitoring and enforcement by the California Department of Industrial Relations.
A weekly certified payroll is required during the term of construction of the project. Payments) of invoice(s) for this project may be delayed when certified payrolls are not submitted weekly. The CITY/COUNTY shall make progress payments on any properly completed payment request submitted by the Prime Contractor. The payment request shall not be deemed properly completed unless all certified payroll(s) for the project is submitted every week for each week worked during the period covered by said payment request.
The City reserves the right to reject any and all bids.
If you have any questions, please contact Wes Garrison, at wgarrison(@barstowca.org.
By order of the City Council of the City of Barstow, California.
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SECTION B
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
INSTRUCTION TO BIDDERS
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INSTRUCTIONS TO BIDDERS
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
B1.01 INSPECTION OF SITE OF WORK
All bidders shall carefully and completely examine the site of the work contemplated, the plans and specifications, and the proposal and Contract forms therefor, and perform all tests and inspections necessary to inform the bidder of all conditions that may be encountered, the character, quality, and scope of work to be performed, and the quantities of materials to be furnished. The submission of a bid shall be conclusive evidence that the bidder has investigated and is satisfied as to the conditions to be encountered, as to the character, quality, and scope of work to be performed, the quantities of materials to be furnished and as to the requirements of the proposal, Plans, Specifications, and the Contract.
Where the City has made investigations of site conditions, including subsurface conditions in areas where work is to be performed under the Contract, or in other areas, some of which may constitute possible local material sources, bidders and Contractor may, upon written request, inspect the records of the City as to those investigations subject to and upon the conditions hereinafter set forth. The investigations are made only for the purpose of study and design.
The records of investigations, project records, log of test borings, record of geotechnical data, investigation of subsurface conditions, cross-sections, contour maps, and any other investigations provided by the City, are not a part of the Contract and are available solely for the convenience of the bidder or Contractor. It is expressly understood and agreed that the City assumes no responsibility whatsoever in respect to the sufficiency or accuracy of the above described documents or of the interpretations set forth therein or made by the City in its use thereof and there is no warranty or guaranty, either express or implied, as to the completeness or accuracy of the documents, that the conditions indicated by the documents are representative of those existing in or throughout those areas, or any part thereof, or that unlooked-for developments may not occur, or that materials other than, or in proportions different from those indicated, may not be encountered. The availability or use of information described in this section is not to be construed in any way as a waiver of the provisions of the first paragraph in this section and a bidder or Contractor shall make their own investigation and examination to be satisfied as to conditions to be encountered in the performance of the work
No information derived from the inspection of investigations or compilation thereof made by the City or from the Engineer, or their consultants, will in any way relieve the bidder or Contractor from any risk or from properly fulfilling the terms of the Contract.
If, during the course of his/her examination, a bidder finds facts or conditions which appear to him/her to conflict with the letter or spirit of the contract documents, or with any other data furnished him/her, he/she may apply to the City in writing in accordance with B1.04 INTERPRETATION OF CONTRACT DOCUMENTS for additional information and explanation before submitting his/her bid.
The submission of a proposal by the bidder shall constitute the acknowledgment that, if awarded the contract, he/she has relied and is relying on his/her own examination of (a) the site of the work, (b) the B-2
access to the site, and (c) all other data, matters, and things requisite to the fulfillment of the work and on his/her own knowledge of existing services and utilities on and in the vicinity of the site of the work to be constructed under the contract, and not on any representation or warranty of the City. No claim for additional compensation will be allowed which is based upon a lack of knowledge of the above items.
B1.02 EXAMINATION OF CONTRACT DOCUMENTS
Each bidder shall thoroughly examine and be familiar with legal and procedural documents, general conditions, specifications, drawings, and addenda (if any). The submission of a proposal shall constitute an acknowledgment upon which the City may rely that the bidder has thoroughly examined and is familiar with the contract documents. The bidder's attention is directed to the need, if any, for special invoicing for this project. The failure or neglect of a bidder to receive or examine any of the contract documents shall in no way relieve him/her from any obligations with respect to his/her proposal or to the contract. No claim for additional compensation will be allowed which is based upon a lack of knowledge of any contract document.
B1.03 CONTRACT PERIOD/CONSTRUCTION COMPLETION DATE
Bidder's attention is called to the provisions set forth in SECTION E, STANDARD SPECIFICATIONS, particularly those pertaining to the contract period and liquidated damages for avoidable delays.
The Contractor shall begin work within fifteen (15) calendar days after the date of the Notice to Proceed and shall diligently prosecute said work to completion before the expiration of 30 WORKING DAYS. The Contractor shall pay to the City the sum of $1.000.00 per day, for each and every calendar day's delay in finishing the work in excess of the number of working days prescribed above.
B1.04 INTERPRETATION OF CONTRACT DOCUMENTS
No oral interpretations will be made to any bidder as to the meaning of the contract documents. Requests for an interpretation shall be made in writing and delivered to the City at least ten (10) days before the time announced for opening the proposals. Interpretations by the City will be in the form of an addendum to the contract documents and, when issued, will be sent as promptly as is practical to all parties to whom the contract documents have been issued. The City makes no guarantee that all bidders will receive all addenda.
Copies of addenda will be made available for inspection at the office where contract documents are on file for inspection as indicated on the Invitation for Bids. All such addenda shall become part of the contract.
All questions shall be addressed to Wes Garrison at warrison@ barstowca.org.
B1.05 REPORTS AND OTHER INFORMATION TO BE OBTAINED PRIOR TO BIDDING Soil reports have not been prepared for this project.
A pre-bid conference has been scheduled at the site of the work, all bidders, subcontractors, material suppliers and others who may be working on the work of improvement are strongly encouraged to attend this pre-bid conference. Due to the facts and circumstances of this particular project, the pre-bid conference may be the only opportunity to conduct the pre-bid investigation of the site and satisfy the pre-bid obligations set forth in these Contract Documents. If a bidder (or others) attends the entirety of a scheduled pre-bid conference and needs additional time to complete its investigation of the site or other pre-bid obligations set forth in these Contract Documents, bidder must notify the City in writing, via certified or registered mail, no less than two workdays after the scheduled pre-bid conference, to request additional time. The written request must include an estimate of the amount of additional time required by bidder.
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B1.06 PROPOSAL
Proposals shall be made on the forms enclosed in SECTION C of these specifications with or without removal from the bound contract documents. All proposals shall give the prices proposed, both in writing and in figures, shall give all other information requested herein, and shall be signed by the bidder or his/her authorized representative, with his/her address. If the proposal is made by an individual, his/her name, signature and post office address must be shown; if made by firm or partnership, the name and post office address of the firm or partnership and the signature of at least one of the general partners must be shown; if made by a corporation, the proposal shall show the name of the state under the laws of which the corporation is chartered, the name and post office address of the corporation, and the name and title of the person who signs on behalf of the corporation. If the proposal is made by a corporation, a certified copy of the bylaws or resolution of the board of directors of the corporation shall be furnished showing the authority of the officer signing the proposal to execute contracts on behalf of the corporation.
Each proposal shall be enclosed in a sealed envelope, labeled as specified in SECTION A - NOTICE INVITING SEALED BIDS. Bidders are warned against making erasures or alterations of any kind, and proposals which contain omissions, erasures, or irregularities of any kind may be rejected. No oral, telegraphic, or telephonic proposals or modifications will be considered In conformance with the Business and Profession Code, § 7028.15, the Contractor must state clearly his/her license number and expiration date. In addition, he/she shall sign a statement that these representations were made under the penalty of perjury. This statement shall be made on the EXPERIENCE STATEMENT in SECTION C.
The Contractor will be required to pay prevailing wage pursuant to California Law, including California Labor Code §§ 1770 et seq. and the federal prevailing wage, commonly referred to the Davis-Bacon Act.
Where there are differences, the higher of the two wage rates will be enforced. Copies of the prevailing rate of per diem wages are on file at the offices of the City.
B1.07 ADDENDA
Each proposal shall include specific acknowledgment in the space provided on SECTION C - BID PROPOSAL of receipt of all addenda issued during the bidding period. Failure to so acknowledge may result in the proposal being rejected as not responsive.
B1.08 BID PRICES
Bid prices shall include everything necessary for the completion of construction and fulfillment of the contract including, but not limited to, furnishing all materials, equipment, tools, plant and other facilities and all management, superintendence, labor, and services, except as may be provided otherwise in the Contract Documents. In the event of a difference between a price quoted in words and a price quoted in figures for the same quotation, the words shall be the amount bid.
In preparing bid prices bidder represents that he/she has carefully examined the Contract Documents and the site where the work is to be performed and that he/she has familiarized himself with all local conditions and federal, state, and local laws, ordinances, rules, and regulations that may affect, in any manner, the performance of the work. The bidder further represents that he/she has studied all surveys and investigation reports about subsurface and physical conditions pertaining to the job site, that he/she has performed such additional surveys and investigations as he/she deems necessary to complete the work at his/her bid price, and that he/she has correlated the results of all such data with the requirements of the Contract Documents.
The submittal of a bid shall be conclusive evidence that the bidder has investigated B-4
and is satisfied as to the conditions to be encountered, including locality, uncertainty of weather and all other contingencies, and as to the character, quality, quantities, and scope of the work.
The plans and specifications for the work show subsurface conditions or otherwise hidden conditions as they are supposed or believed by the Design Engineer to exist, but it is not intended or to be inferred that the conditions as shown thereon constitute a representation that such conditions are actually extant. Except as otherwise specifically provided in the Contract Documents, the City, the Design Engineer and their consultants or agents shall not be liable for any loss sustained by the Contractor as a result of any variance of such conditions as shown on the plans and the actual conditions revealed during the progress of the work or otherwise.
The Contractor shall perform an independent quantity take-off of the plans and bid accordingly. Quantities listed in the BID SCHEDULE in SECTION C are intended only as a guide for the Contractor as to the anticipated order of magnitude of work. The Contractor shall be responsible for verifying all estimated quantities. The Contractor will be reimbursed for the quantity of items actually installed as required by the Contract Documents and shown on the plans to neat line and grade.
The Contractor will not be reimbursed for unauthorized work performed outside of that required by the Contract Documents.
B1.09 TAXES
No mention shall be made in the proposal of sales tax, use tax, or any other tax, as all amounts bid will be deemed and held to include any such taxes which may be applicable.
B1.10 RECOGNITION OF BONDING COMPANIES
All bonding companies used by the Contractor in this contract must be recognized by the Federal Government within Circular 570. All proposals or contracts received that include bonds posted by bonding companies not recognized in Circular 570 will result in the disqualification of the bid proposal and forfeiture of the bid bond.
B1.11 QUALIFICATION OF BIDDERS
Each bidder shall be skilled and regularly engaged in the general class or type of work called for under the contract. A statement setting forth his/her experience shall be submitted by each bidder on the EXPERIENCE STATEMENT form provided in SECTION C.
Each bidder shall possess a valid, active and in good standing, State of California Department of Consumer Affairs, Contractor's License Board A or C-34 contractor license, for a minimum of five (5) continuous years prior to the date of bid opening. The class of license shall be applicable to the work specified in the contract. Each bidder shall also have no less than three (2) years' experience in the magnitude and character of the work bid and have completed to the public owner's satisfaction, no less than 5 public works projects in the State of California, each with an original contract price of no less than $50,000, within the past three years prior to the date of bid opening.
All Sub-Contractor's shall possess a valid Contractor's License issued by the Contractor's State License Board at the time his/her bid is submitted. The class of license shall be applicable to the work specified in the contract. The sub-contractor must have at least (5) years of continuous public works experience for the respective portion of work and the scope and complexity similar to the project contemplated herein B-5
and must have successfully completed such projects under the same-sub-Contractor's license number specified in the Sub-Contractor's list.
The Contractor performing the work must have at least (5) years of continuous public works experience for the scope and complexity similar to the project contemplated herein and must have successfully complete such projects under the same Contractor's license number as declared in this proposal Bidders shall not have any pending disciplinary proceedings or investigations by the Contractor's State License Board. As of the date of bid opening, or within the past five years, bidders shall not have any suspensions, disbarments, or similar proceedings (including stipulated agreements), restricting, limiting, or prohibiting bidder from bidding or performing other public works for any other public City.
The City intends to award a contract to a bidder who has furnished satisfactory evidence that he/she has the requisite experience and ability and that he/she has sufficient capital, facilities, and plants to enable him/her to prosecute the work successfully and properly, and to complete it within the time specified in the contract.
To determine the degree of responsibility to be credited to the bidder, the City will weigh any evidence that the bidder has performed satisfactorily other contracts of like nature, magnitude, comparable difficulty, and comparable rates of progress. If in the opinion of the City, a bidder is determined to be insufficiently qualified, then that bid will not be considered for award of the contract.
B1.12 DESIGNATION OF SUPPLIERS AND SUBCONTRACTORS
Each proposal shall have listed on the DESIGNATION OF SUPPLIERS AND SUBCONTRACTORS form provided in SECTION C the name, address, and license number of each subcontractor to whom the bidder proposes to sublet portions of the work over one-half percent of the total amount of his/her bid. For this paragraph, a subcontractor is defined as one who contracts with the Contractor to furnish materials and labor, or labor only for the performance of work at the site of the work or who will specially fabricate a portion of the work off the site pursuant to detailed drawings in the contract documents.
Public Contract Code § 4104 requires that all bidders list subcontractors who will perform work over 2% of the total bid, or the case of streets and highways, ½% or $10,000, whichever is greater.
Public Contract Code § 6109 prohibits a contractor from performing work with a subcontractor who is debarred pursuant to Labor Code §§ 1777.1 or 1777.7. Furthermore, no contractor shall work on this job who has been debarred from doing work on federally funded projects since this project is funded in whole or in part with federal funds.
B1.13 PROPOSAL GUARANTEE
The proposal shall be accompanied by a proposal guarantee bond duly completed on the form provided herewith by a guarantee company authorized to carry on business in the State of California for payments to the City in the sum of at least 10% of the total amount of the bid proposal, or alternatively by a certified or cashier's check payable to the City, or cash, in the sum of at least 10% of the total amount of the bid proposal.
The amount payable to the City under the proposal guarantee shall be forfeited to the City in case of failure or neglect of the bidder to furnish, execute and deliver to the City the required bonds, evidence of insurance and to enter into, execute and deliver to the City the agreement on the form B-6
provided herewith, within ten (10) days after being notified in writing by the City that the award has been made and the agreement is ready for execution.
B1.14 MODIFICATION OF PROPOSAL
A modification of a bid proposal already received will be considered only if the modification is received prior to the time announced for the opening of bids. All modifications shall be made in writing, executed and submitted in the same form and manner as the original bid proposal.
B1.15 WITHDRAWAL OF PROPOSAL
A proposal may be withdrawn by a written request signed by the bidder. Such requests must be delivered to the City's designated official prior to the bid opening hour stipulated in SECTION A - NOTICE INVITING SEALED BIDS. Proposals may not be withdrawn after said hour without forfeiture of the proposal guarantee. The withdrawal of a proposal will not prejudice the right of the bidder to submit a new proposal, providing there is time to do so.
B1.16 POSTPONEMENT OF BID OPENING
The City reserves the right to postpone the date and time for opening of bids at any time prior to the date and time announced in SECTION A-NOTICE INVITING SEALED BIDS.
B1.17 DISQUALIFICATION OF BIDDERS
If there is reason to believe that collusion exists among the bidders, none of the bids of the participants in such collusion will be considered. In the event that any bidder acting as a prime Contractor has an interest in more than one proposal, all such proposals will be rejected, and the bidder will be disqualified. This restriction does not apply to subcontractors or suppliers who may submit quotations to more than one bidder, and while doing so, may also submit a formal proposal as a prime Contractor.
B1.18 REJECTION OF PROPOSALS
The City reserves the right to reject any and all proposals, to waive any irregularity, and to reject any proposals which are incomplete, obscure or irregular; any proposals which omit a bid on any one or more items on which bids are required; which omit unit prices if unit prices are required in which unit prices are unbalanced in the opinion of the City; which are accompanied by insufficient or irregular bid security; and which are from bidders who have previously failed to perform properly or to complete on time contracts of any nature.
B1.19 AWARD OF CONTRACT
The Award of Contract, if it is awarded, will be made to the lowest responsible and responsive bidder, whose bid proposal is not rejected for cause by the City. However, until an award is made, the right will be reserved to reject any or all bids, and to waive technical errors or discrepancies, if to do so is deemed to best serve the interests of the City. In no event will an award be made until all necessary investigations are made as to the responsibility and qualifications of the bidder to whom it is proposed to make such an award.
Each bidder's attention is directed to the possibility that the award of the project may be delayed for various reasons. The City reserves the right to delay the award of the project for 45 calendar days. After 45 calendar days, the low bidder may at any time request release from its bid without penalty.
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The acceptance of a proposal will be evidenced by a Notice of Award of Contract in writing, delivered by mail to the bidder whose proposal is accepted. No other act of the City shall constitute acceptance of a proposal. The award of contract shall obligate the bidder whose proposal is accepted to furnish a performance bond, payment bond and maintenance bond, as well as evidence of insurance and to execute the contract set forth herein.
B1.20 RETURN OF PROPOSAL GUARANTEES
Within ten (10) calendar days after the bids are opened, the City will release the proposal guarantees ccompanying the proposals which are not to be considered in making the award. Proposal guarantees to he two lowest bidders will be held until the contract has been fully executed after which they will b returned to the respective bidders whose proposals they accompanied.
B2.21 EXECUTION OF CONTRACT
The contract agreement shall be executed in duplicate by the successful bidder and returned, together with the contract bonds and evidence of insurance, within ten (10) calendar days after the notification of the contract award by the City in writing. In case of failure of the successful bidder to execute the contract agreement within ten (10) calendar days after such notice, or any subsequent extension approved by City, the City at its option may consider the bidder in default, in which case the bid bond or proposal guarantee accompanying the bid shall become the property of the City. After execution by the City, one original contract shall be returned to the Contractor.
B1.22 FLEXIBILITY OF BID SCHEDULE
It is the intent of the City to award a contract to the lowest responsible and responsive bidder and the flexibility shown in the bid schedule is necessary to ensure a project within the City's budget limits and constraints.
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SECTION C
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
PROPOSAL INFORMATION AND DOCUMENTS
BID PROPOSAL
BID SCHEDULE
BID BOND
BID GUARANTEE
BIDDER INFORMATION
EXPERIENCE STATEMENT
DESIGNATION OF SUPPLIERS AND SUBCONTRACTORS
NONCOLLUSION AFFIDAVIT
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BID PROPOSAL
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
The undersigned, as bidder, declares that he/she has examined all of the contract documents and specifications contained in this project manual for the above-referenced project, and that he/she will contract with the City on the form of contract provided herewith to do everything necessary for the fulfillment of this contract at the price, and on the terms and conditions therein contained.
The following are included and are to be considered as forming a part of this proposal: BID PROPOSAL,
BID SCHEDULE, BID BOND, NONCOLLUSION AFFIDAVIT, BID GUARANTEE (if submitted in lieu of Bid Bond), BIDDER INFORMATION, EXPERIENCE STATEMENT,
DESIGNATION OF SUPPLIERS & SUBCONTRACTORS, BIDDER'S STATEMENT REGARDING INSURANCE COVERAGE, and STATEMENT REGARDING CONTRACTOR'S LICENSING LAWS.
Contractor acknowledges receipt and inclusion of addenda_NA_to_NA into this bid proposal and the contract documents.
Attached is a Bid Bond duly completed by a guarantee company authorized to carry on business in the State of California in the amount of at least 10% of the total amount of our proposal, or alternatively, there is attached a certified or cashier's check payable to the City, in the amount of at least 10% of the total amount of our proposal.
If our proposal is accepted, we agree to sign the contract form and to furnish the Performance Bond and the Payment Bond (each to be 100% of the bid amount), the Maintenance Bond (to be 50% of the bid amount), and the required evidences of insurance within ten (10) calendar days after receiving written Notice of Award of Contract.
We further agree if our proposal is accepted and a contract for the performance of the work is entered into with the City, to so plan the work and to prosecute it with such diligence that all of the work shall be completed within the time stipulated in SECTION E - TIME OF COMPLETION.
NAME OF BIDDER: KELLEY'S UNDERGROUDN CONSTRUCTION INC.
MAILING ADDRESS: 22411 HIGHWAY 18, APPLE VALLEY, CA 92307 STATE OF INCORPORATION: CA
AUTHORIZED SIGNATURE: + KULY
TITLE: PRESIDENT
DATE: 4/25/2025
(If Company is a Corporation, provide corporate resolution per B2.06 PROPOSAL) C-2
BID SCHEDULE
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
The cost of all labor, services, material, equipment, and installation necessary for the completion of the work itemized under this schedule, even though not shown, or specified, shall be included in the unit price for the various items shown herein. For a description of the work associated with each bid item, see SECTION E-STANDARD SPECIFICATIONS AND SECTION F - SPECIAL PROVISIONS - 700 SERIES The City reserves the right to increase or decrease the quantity of any item or omit items as may be necessary, and the same shall in no way affect or make void the contract, except that appropriate additions or deductions from the contract total price will be made at the stipulated unit price in accordance with these Contract Documents.
The City reserves the right to reject any and all bids, to waive any informality in a bid, and to make awards in the interest of the City.
The Contractor shall perform an independent take-off of the plans and bid accordingly. Quantities listed in addenda, and shown on the plans to neat line and grade.
The Contractor will not be reimbursed for work performed for his convenience, or as required to adapt to field conditions, or for unauthorized work performed outside of that required by the Contract Documents.
The Contractor shall be responsible for calculating and providing totals for the schedule. The proposal schedule shall include all costs for labor, services, material, equipment, and installation associated with completing the work in place per the plans, specifications, and details.
NAME OF BIDDER: - KELLEY'S UNDERGROUDN CONSTRUCTION INC.
CONTRACTOR'S LICENSE NO.: _ 930886
AUTHORIZED SIGNATURE: rous
TITLE: - PRESIDENT
DATE: - 4/25/2025
C-3
BID SCHEDULE (Continued)
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM (WEST)
Spec Description Unit Unit Price Total Price
Item Section
Qty.
8-01 C-900 PVC PIPE 24" LF 740 00
256.0º 189,440.
2. 8-02 DUCTILE IRON TEE 24" MJ EA 2
22,060.°º 44,120.°º
OFCI - DUCTILE IRON 24"
3. 8-03 EA 4
VALVE MJ 5,490.° 21,960.00
+ 8-04 DUCTILE IRON 45° BEND 24" MJ EA 4
7,880.°° 31,520.
MOBILIZATION/ DEMOBILIZATION/
5. 8-06 LS 00
INSURANCE & BOND 23,1700° 23,170.
Construction Staging & Traffic Control
6 LS
10,08000 10,080.ºº
SMPP Implementation LS
9,1500° 9,150.ºº
8-08 CASH ALLOWANCE LS 1 $12,500.00 $12,500.00
oi 8-10 Rip-Rap Dso = 12" QY 6
1,120.00 10,720,0°
10. Staking and Monumentation LS 1
(City of Barstow)
00 Base Bid Total: $348,660.
Three HUnDRED FORTY-EIGHT ThOUSAND SIX HUNDRED SiXTY
Bid Schedule Total (in words):
The City reserves the right to award based upon Base Bid only The Contractor shall be responsible for calculating and providing unit prices for the schedule. The proposal schedule shall include all costs for services, labor, materials, equipment, and installation associated in completing the work in place per the Specifications and details.
KELLEY'S UNDERGROUDN CONSTRUCTION INC. 4/25/2025
(Company Name of Bidder) (Date)
C-4
BID BOND
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
KNOW ALL. MEN BY THESE PRESENTS that Bidder Kelley's Underground Construction, InCas PRINCIPAL, and The Ohio Casualty Insurance Company, as SURETY, are held and firmly bound unto the City of Barstow as CITY, penal sum
Ten Percent of Total Amount Bid
($10% of bid amount L, fortine as ten percent (10%) of the total amount bid by PRINCIPAL to class for the above stated project, for the payment of which sum, PRINCIPAL and SURETY agree to be bound, jointly and severally, firmly by these presents.
The SURETY, for value received, hereby stipulates, and agrees that the obligations of said SURETY and its BOND shall be in no way impaired or affected by any extension of the time within which the CITY may accept such Bid; and said SURETY does hereby waive notice of any such extension.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas PRINCIPAL is about to submit a bid to CITY for the above stated project, if said bid is rejected, or if said bid is accepted and a contract is awarded and entered into by PRINCIPAL in the manner and time specified, and provides the required payment and performance bonds and insurance coverages to CITY, then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor of CITY.
IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seals this day of ... April 15 .... 2025.
PRINCIPAL* Kelley's Underground Construction, Inc.
runs
Jennifer Kelley, President
22411 Outer Highway 18, Apple Valley, CA 92307 760-247-6537 SURETY* The Ohio Casualty Insurance Company
L Oconum
Janelle L. Tuominen, attorney-in-fact
*Provide BIDDER and SO STY name, address and elephone 2nd the marc. title, address and telephone number for the respective authorized representatives. Power of Attornev must be attached.
Subscribed and swor to this 22. day of ARe! ... 2025
SEE ATTACHED AFFIDAVIT
NOTARY PUBLIC (SEAL)
C-5
Liberty POWER OF ATTORNEY
Mutuál. Certificate No: 8213355-984221
Liberty Mutual Insurance Company
SURETY The Ohio Casualty Insurance Company
West American Insurance Company
Monteon; Janelle L. Tuominen
all of the city of Riverside state of CA each individually if there be more than one named, its true and lawful attorney-in-fact to make, ecute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuar these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own pro persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 13th day of March 2025
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
CORPORATE West American Insurance Company
1912 1919 1991 Math L
A4439 MASSACHUS, ANVAN LSaM INDIANA
By:
guarantees. Nathan J. Zangerle, Assistant Secretary
State of PENNSYLVANIA
County of MONTGOMERY SS
letter of credit, On this 13th day of before me personally appeared Nathan J. Zangerle, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance (POA) verification inquiries, IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written. loan. PASTELLA
TERESA Commonwealth of Pennsylvania - Notary Seal
Teresa Pastolla, Notary Public
Montgomery County Pastella please call 610-832-8240 or email [email protected] My commission expires March 28, 2029 By:
SPASY LA Commission number 1126044
currency rate, interest rate or residual value Member, Pennsytvania Association of Notaries Teresa Pastella, Notary Public
NOTARY PUBLIC
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
Not valid for mortgage, no For bond and/or Power of Attorney ARTICLE IV - OFFICERS: Section 12. Power of Attorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shali appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attoreys-in-fact subject to the limitations set forth in their respective powers of attomey, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary.
Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Nathan J. Zangerle, Assistant Secretary to appoint such attorneys-in-fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations.
Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attomey issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insuranca Company do hereby certify that the original power of attomey of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 15th day of April 2025:
CORPORATE INSURANCE CASUALTY INSURANCE
MUT CORPORATE MERICAN CORPORATE
1912 1919 1991 Pen enter.
ANTINOD By:
Nadi INDIANA Renee C. Llewellyn, Assistant Secreiary
<83M*
LMS-12873 LMIC OCIC WAIC Multi Co 02/24
CALIFORNIA NOTARIAL CERTIFICATE
(JURAT)
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Riverside
Subscribed and sworn to (or affirmed) before me on this 15th _ day of April 2025 - by Janelle L. Tuominen _ proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
SUSAN C. MONTEON
COMM. #2365920
Signature Susan C. Montion
(Seal) Notariverside Calloria
My Comm. Expires July 16, 2025
Copyright © 2018 NotaryAcknowledgement.com. All Rights Reserved.
CALIFORNIA JURAT
A notary public or other officer completing this certificate verifies only the identity of he individual who signed the document to which this certificate is attached, and no the truthfulness, accuracy, or validity of that document.
State of California )
County of SAM BERNARDINO )
Subscribed and sworn to (or affirmed) before me on this 22Ad day , 202°5 - , by. JENNIFER
• KELLEY
proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
TONY SCAFIDI
COMM. #2446452
VRO Notary Public - California NR01
San Bernardino County
My Comm. Expires May 9, 2027(
Signature
(Seal)
Optional Information
Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this jurat to an unauthorized document and may prove useful to persons relying on the attached document.
Description of Attached Document Additional Information Method of Affiant Identification
This certificate is attached to a document titled/for the purpose of Proved to me on the basis of satisfactory evidence:
• form(s) of identification O credible witnesses)
BIO BOrD
Notarial event is detailed in notary journal on:
Page # Entry #
Notary contact:
Other
Affant(s) Thumbprints) • Describe:
containing pages, and dated 04/15/2025
© Copyright 2007-2018 Notary Rotary, PO Box 41400, Des Moines, IA 50311-0507. All Rights Reserved. Item Number 101884. Please contact your Authorized Reseller to purchase copies of this form.
BIDDER INFORMATION
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
BIDDER certifies that the following information is true and correct:
Name of Bidder: KELLEY'S UNDERGROUDN CONSTRUCTION INC.
Business Address: 22411 HIGHWAY 18, APPLE VALLEY, CA 92307 Telephone: 760-247-6537 ...FAX: 760-810-7320
E-mail: [email protected]
930886 Date License Issued: 4/1/2010
Contractor's License No.
License Expiration Date:.... 6/30/2026
The following are the names, titles, addresses, and phone numbers of all individuals, firm members, partners, joint venturers, and/or corporate officers having a principal interest in this proposal: (Name / Title / Address / Telephone #)
NA
Any voluntary or involuntary bankruptcy judgments against any principal having an interest in this proposal are as follows: (Type of Judgment / Date)
NA
All current and prior DBA's, alias, and/or fictitious business names for any principal having an interest in this proposal are as follows: (Principal / DBA's / Applicable Dates) NA
Prior Disqualification
C-7
Has your firm ever been disqualified from performing work for any City, County, Public, or Private Contracting entity? Yes / No_NO _. If yes, provide the following information. (If more than once, use separate sheets):
Date:. Entity:..
Location:
Reason:.
Provide Status and any Supplemental Statement:..
Has your firm been reinstated by this entity? Yes / No.
Violations of Federal or State Law
A. Has your firm or its officers been assessed any penalties by any CITY for noncompliance, violations of Federal or State labor laws and/or business or licensing regulations within thepast five (5) years relating to your construction projects?
Yes / No: NO Federal / State:
If "yes", identify and describe, (including status):
Have the penalties been paid? Yes / No:
C-8
B. Does your firm or its officers have any ongoing investigations by any CITY regarding violations of the State Labor Code, California Business, and Professions Code or State Licensing laws?
Yes / No: NO Codes / Laws:. Section / Article:
If "yes", identify and describe (including status):.
I declare under penalty of perjury under the laws of the State of California that all of the representations made in this BIDDER INFORMATION are true and correct. Executed this day of__ APRIL _ 2025, at APPLE VALLLEY
California.
Authorized Representative Signature and Tito_ fuy ,PRESIDENT C-9
EXPERIENCE STATEMENT
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
Pursuant to this BID PROPOSAL and QUALIFICATION OF BIDDERS, the following is a record of the Bidder's experience in construction of a type similar in magnitude and character to that contemplated under this contract. Included in this section should be a complete list of references for similar projects in terms of scope of work, value of work, and time constraints. The Contractor must demonstrate that he/she has experience with this type of project and can manage this project effectively. If necessary, additional numbered pages can be attached to this page. The Contractor must be properly licensed to perform the work in this project as determined by the State Contractor's License Board.
Project Title: ASHLEY PARKING LOT _Client:_ HMC CONSTRUCTION Date: 2024 Project Value: 1,800,000.00 _ Contact:DAN WALLERTel # Description: Installation of 8" dip water main, fire hydrant and services, gate valve installation of 96" CMP underground retention system 875'ft long by 34'ft wide.
Subject to Federal Labor Standards: (Yes) No
Project Title: _Emergency Connection @ HDPP_Client: _ City Of Victoville Date: 3/2024 Project Value: 100,000.00 _Contact: DENNIS LEE Tel #_ Description: INSTALLATION OF 8" DIP AND RELATED APPURTENANCES
VALVES AND METER INSTALLION FOR CRITICAL FUNCTIONALITY
OF THE HIGH DESERT POWER PLANT
Subject to Federal Labor Standards: Yes No
C-10
EXPERIENCE STATEMENT (Continued)
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
Project Title: STANDING BOCK LIFT STATION _Client:_LGI HOMES Date: 2024 Project Value: 860,000.00_Contact:_DENNIS G. _Tel#_323-302-2847 Description: INSTALLATION OF SEWER LIFT STATION 25' DEEP
WITH WET WELLS & MUFFINMOSTER
Subject to Federal Labor Standards: Yes (No
Project Title: SBC - MAINTENCE BUILDING Client: SAN BENARDINO COUNTY Date: 1/2019 Project Value: 450K Contact:_HAMEL _Tel #_ 951-600-2783 Description: INSTALLATION OF SEWER LIFT STATION 15'FT DEEP AND RELATED APPURTENANCES.
Subject to Federal Labor Standards: (Yes No
I declare under penalty of perjury under the laws of the State of California that all of the representations made in this EXPERIENCE STATEMENT are true and correct. Executed this day of APRIL _, 2025, at_
PRESIDENT
Authorized Representative Sighature and Title
C-11
DESIGNATION OF SUPPLIERS AND SUBCONTRACTORS
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
The following is a list of subcontractors and suppliers, as defined in 2-3 SUBCONTRACTS of the Standard Specifications, who will perform work or provide materials of value in excess of one-half percent of the total bid price or $10,000, whichever is greater.
No subcontractor shall perform work in excess of the amount specified in 2-3 SUBCONTRACTS of the Standard Specifications, without the written approval of the City.
The Contractor is responsible to ensure that appropriate provisions are to be inserted in all subcontracts to bind subcontractors to the contract requirements as contained herein.
Each subcontractor must agree to comply with all applicable Federal, State, and local requirements.
Name, Address, and License Employer MBE/ Work Subcontracted Portion of Work (% of # of Subcontractor Tax Id # WBE Contract Price)
(Y/N)
Western Water Works
5671 Gates St, Chino, Ca N 46%
95-1459073 Materials
91710
C-12
Name and Address of Employer MBE/ Work Subcontracted Portion of Work (% of Subcontractor Tax Id # WBE Contract Price)
(Y/N)
These representations are being made under the penalty of perjury. The undersigned hereby certifies that each subcontractor has been notified in writing of its equal opportunity obligations.
NAME OF BIDDER: KELLEY'S UNDERGROUND CONSTRUCTION INC
AUTHORIZED SIGNATURE: _ runy
Date:_4/25/2025
D-1
NONCOLLUSION AFFIDAVIT
WASTE WATER TREATMENT PLANT POND PUMPING SYSTEM
PROJECT NO. WWTP-25-001
IN THE CITY OF BARSTOW, CALIFORNIA
NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY
BIDDER AND SUBMITTED WITH BID
The undersigned declares:
underground construction.
lam theresidentof helles, the party making the foregoing bid The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham.
The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. 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, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.
Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on 4 | 22(25 [date), arapple vallity, D-2
CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT
notary public or other officer completing this certificate verifies only the identity o the truthfulness, accuracy, or validity of that document.
State of California )
County of SAN BRRMARDINO )
On AlRi 22,2025 beforeme, SCAFIDI NOTARY PUBLIC'
(here insert name and title of the officer
personally appeared JENNIFER J. KELLEY
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in -his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the personts), 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.
TONY SCAFIDI
COMM. #2446452
Notary Public - California NR01
WITNESS my hand and official seal. San Bernardino County My Comm. Expires May 9, 2027 (
Signature (Seal)
Optional Information
Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document.
Description of Attached Document Additional Information The preceding Certificate of Acknowledgment is attached to a document Method of Signer Identification Proved to me on the basis of satisfactory evidence:
titled/for the purpose of Moncomesion O forms) of identification O credible witnesses) AFFIDAVIT Notarial event is detailed in notary journal on:
41/22/2025 Page # Entry #
containing pages, and dated
The signer(s) capacity or authority is/are as: Notary contact:
• Individual(s) Other
• Attorney-in-Fact • Additional Signer(s) ] Signer(s) Thumbprint(s) X Corporate Officers) PRESIDENT
Title(s)
• Guardian/Conservator
• Partner - Limited/General
• Trustee(s)
• Other:
representing:
Name(s) of Person(s) or Entity(ies) Signer is Representing © Copyright 2007-2018 Notary Rotary, PO Box 41400, Des Moines, IA 50311-0507. Ail Rights Reserved. Item Number 101772. Please contact your Authorized Reseller to purchase copies of this form.