SECTION 4: BID DOCUMENTS
All documents provided in this Section 4, including this page, must be completed. Unless otherwise specified, all bid documents must be submitted online (via PlanetBids) to be considered for award for this bid solicitation.
4.1 BID SCHEDULE
4.2 ADDENDA ACKNOWLEDGEMENT/SIGNATURE
4.3 LIST OF SUBCONTRACTORS
4.4 BID BOND (SEE SECTION 3.2 FOR INSTRUCTIONS)
4.5 NONCOLLUSION DECLARATION
4.6 CERTIFICATION OF NON-DISCRIMINATION BY CONTRACTORS
4.7 WORKERS' COMPENSATION INSURANCE CERTIFICATE
4.8 CERTIFICATION OF SITE EXAMINATION
4.9 INFORMATION TO COMPLY WITH LABOR CODE SEC. 2810
4.10 IRAN CONTRACTING ACT OF 2010 COMPLIANCE AFFIDAVIT
4.11 STATEMENT BY BIDDER: QUALIFICATION AND EXPERIENCE STATEMENT (REFERENCES)
4.12 CONFLICT OF INTEREST DISCLOSURE FORM
I (Bidder), _R&R Roofing & Waterproofing, INC, certify that all of the above required documents have been completed. I also understand that failure to submit a completed bid package (fully completed and executed) will result in rejection of bid.
Dated 10/04/23 R&R Roofing & Waterproofing, INC
(Bidder)
(Signature)
Raul Jasso
(Printed Name)
President
(Title)
4.1 BID SCHEDULE
BIDDER'S NAME: - R&R Roofing & Waterproofing, INC
By submitting this bid, we offer to furnish all necessary labor, tools, materials, and equipment to complete all Work mentioned in the Notice Inviting Bids, in full compliance with all documents, including plans, specifications, attachments and exhibits pertaining to IFB#20238007 - City Hall South and 7 Street Theater Roof Restoration Project, at the prices listed below.
The basis of comparison to determine the low bid is the Total Bid Price.
BID SCHEDULE
Description Location Unit of Total Bid Total Bid Amount Measure Amount in in Words
Figures
Contractor shall provide all labor, City Hall LS $ 77,540.00 Seventy Seven Thousand -ive Hundred Forty Dollars
additional materials, and equipment for South
the roof restoration work of City Hall
Line Item - Contractor shall provide all City Hall Sq.Ft. $ 6.25 Dollars & enty Five Ce
labor, additional materials, and South
equipment for unforeseen Deck
Replacement (City Hall South Roof)
Contractor shall provide all labor, 7in Street LS $ 72,050.00 Seventy Two Thousand Fifty Dollars
additional materials, and equipment for Theater
the roof replacement work of 7t Street
Total: A + B = Base Bid LS $ 149,590.00 ne Hundred Forty Nin housand, Five Hundred Ninet
Dollars
TOTAL BID PRICE IN FIGURES: $149,590,00
TOTAL BID PRICE IN WORDS: One Hundred Forty Nine Thousand, Five Hundred Ninety Dollars We understand that these quantities are estimates only and are given solely for the purpose of facilitating the comparison of Bids, and that the Contractor's compensation will be computed on the basis of the actual quantities in the completed Work.
The following information will be used for statistical analysis only:
Is the Bidder a Disadvantaged Business (DBE)? No. If yes, Certification No.
Is the Bidder a Minority-Owned Business? No. Which racial minority? Is the Bidder a Women-Owned Business? No.
Is the Bidder a certified Small Business? Yes._ If yes, Certification No. 2026283
4.2 ADDENDA ACKNOWLEDGEMENT / SIGNATURE
This Bid is submitted with respect to the changes to the Plans & Specifications included in the following addenda numbers:
2 3 6 7
(Initial above all appropriate numbers)
Bidder certifies that the Bid is complete and Bidder has examined the site. By signing below, Bidder also certifies that the Contractor will not submit a claim based on failure to examine the site thoroughly.
Respectfully submitted,
10/4/23
Bidder Signature Date
Raul Jasso, President
Print Name / Title
R&R Roofing & Waterproofing, INC 17995 Collier Ave, Lake Elsinore, CA 92530 Legal Name of Company Business Address (Actual Address - Post Office Box) 951.245.0200 [email protected]
Telephone Number Email Address
934782 1000048273
Contractor's License Number DIR Registration Number
4.3 LIST OF SUBCONTRACTORS
In accordance with the requirements provided in the "Subletting and Subcontracting Fair Practices Act" Division 2 Part 1, Chapter 4 of the California Public Contract Code, the Bidder shall set forth hereon the name, the location of the place of business, Department of Industrial Relations registration number, and the California contractor license number of each subcontractor who will perform work or labor or render service to the prime contractor in or about the construction of the work or improvement, or a subcontractor licensed by the State of California who, under subcontract to the prime contractor, specially fabricates and installs a portion of the work or improvement according to plans and specifications, in an amount in excess of one-half of 1 percent of the prime contractor's total bid or, in the case of bids or offers for the construction of streets or highways, including bridges, in excess of one- half of 1 percent of the prime contractor's total bid or ten thousand dollars ($10,000), whichever is greater.
The prime contractor shall also set forth hereon the portion of the work (type and dollar value) that will be done by each subcontractor. The prime contractor shall list only one subcontractor for each portion as defined by the prime contractor in his or her bid. Information requested, other than the subcontractor's name, location of business, Department of Industrial Relations registration number, contractor license number, and the portion of work that will be done by each subcontractor, may be submitted by the prime contractor within 24 hours after the deadline for submission of bids.
Name: N/A Type of Work:
Address Email Address:
Phone No.: Dollar Value of Subcontract: $
License No. DIR Registration No.
Name: Type of Work:
Address: Email Address:
Phone No.: Dollar Value of Subcontract: $
License No. DIR Registration No.
Name: Type of Work:
Address: Email Address:
Phone No.: Dollar Value of Subcontract: $
License No. DIR Registration No.
Name: Type of Work:
Address: Email Address:
Phone No.: Dollar Value of Subcontract: $
License No. DIR Registration No.
Name: Type of Work:
Address: Email Address:
Phone No.: Dollar Value of Subcontract: $
License No. DIR Registration No.
Name: Type of Work:
Address: Email Address
Phone No.: Dollar Value of Subcontract: S
License No. IR Registration No
Name: Type of Work:
Address: Email Address
Phone No.: Dollar Value of Subcontract: $
License No. DIR Registration No.
Name: Type of Work:
Address: Email Address
Phone No.: Dollar Value of Subcontract: $
License No. DIR Registration No.
BOND NO. N/A
4.4 BID BOND
KNOW ALL MEN BY THESE PRESENTS that we R&R Roofing & Waterproofing, Inc.
Principal, hereinafter referred to as "Contractor" and Philadelphia Indemnity Insurance Company Surety, are held and firmly bound unto the City of Chino, hereinafter called the "City," in the sum of TEN PERCENT (10%) of the Total Amount Bid--.
→, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. conditions of this obligation are such that whereas the Contractor submitted to the City a certain Bid, attached hereto and hereby made a part hereof, to enter into a contract in writing for the THEATER ROOF RESTORATION PROJECT _ and will furnish all required certificates of insurance and bonds as required by the Contract.
NOW, THEREFORE, if said Bid shall be rejected; or in the alternate, if said Bid is accepted, and the Contractor (i) executes and delivers a contract in the prescribed form of the Agreement, (i) delivers certificates evidencing that the required insurance is in effect, (iii) executes and delivers bonds in the forms prescribed, and (iv) in all other respects performs the agreement created by the acceptance of said Bid, then this obligation shall be void; otherwise this obligation shall remain in full force and effect, it being expressly understood and agreed that the liability of the Surety for any and all default of the Contractor hereunder shall be the amount of this obligation as herein stated. In the event suit is brought upon this bond by City and judgment is recovered, Surety shall pay all costs incurred by City in said suit, including a reasonable attorney's fee to be fixed by the court.
The Surety, for the value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall in no way be impaired or affected by an extension of the time within which the City may accept such a bid; and said Surety does hereby waive notice of any such extension.
SIGNED AND SEALED, this 4th _day of October _ 20_23
R&R Roofing & Waterproofing, Inc. _(Seal) Philadelphia Indemnity Insurance Company(Seal) (Principal) (Surety)
OCT 0 4 2023
By: By
(Signature) (Signature)
Edward N. Hackett, Attorney-in-Fact
(SEAL AND NOTARIAL ACKNOWLEDGMENT OF SURETY)
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
STATE OF CALIFORNIA
County of Orange
On OCT 0 4 2023 before me, C. Maestas , Notary Public,
Date Insert Name of Notary exactly as it appears on the official seal personally appeared Edward N. Hackett
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies). and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
C. MAESTAS I certify under PENALTY OF PERJURY under the laws of Notary Public • California the State of California that the foregoing paragraph is true Orange County and correct.
Commission # 2456669
My Comm. Expires Aug 1, 2027 Witness my hand and official seal.
Signature
Place Notary Seal Above Signature of Notar 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 the form to another document.
Description of Attached Document
Title or Type of Document: R&R Roofing Bid Bond
OCT 0 4 2023 _ Number of Pages:
Document Date:
Signers) Other Than Named Above: None
Capacity(ies) Claimed by Signers)
Signer's Name: _Edward N. Hackett Signer's Name: None
• Individual • Individual
• Corporate Officer — Title(s): • Corporate Officer — Title(s):
• Limited • General • Partner • Limited • General
• Partner
RIGHT THUMBPRINT • Attorney in Fact RIGHT THUMBPRINT
M Attorney in Fact
OF SIGNER • Trustee OF SIGNER
1 Trustee
Guardian or Conservator Top of thumb here • Guardian or Conservator Top of thumb here Other: • Other:
Signer is Representing:
Signer is Representing
PHILADELPHIA INDEMNITY INSURANCE COMPANY
One Bala Plaza, Suite 100
Bala Cynwyd, PA 19004-0950
Power of Attorney
KNOW ALL PERSONS BY THESE PRESENTS: That PHILADELPHIA INDEMNITY INSURANCE COMPANY (the Company), a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint Edward N. Hackett and Christine Maestas of Hackett Bonds & Insurance Services L.L.C, its true and lawful Attorney-in-fact with full authority to execute on its behalf bonds, undertakings, recognizances and other contracts of indemnity and writings obligatory in the nature thereof, issued in the course of its business and to bind the Company thereby, in an amount not to exceed $25.000.000.
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 14* of November, 2016.
RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the Company: (1) Appoint Attorney(s) in Fact and authorize the Attorney(s) in Fact to execute on behalf of the Company bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof and to attach the seal of the Company thereto, and (2) to remove, at any time, any such Attorney-in-Fact and revoke the authority given. And, be it
FURTHER
RESOLVED: That the signatures of such officers and the seal of the Company may be affixed to any such Power of Attorney or certificate relating thereto by facsimile, and any such Power of Attorney so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the Company in the future with respeet to any bond or undertaking to which it is attached.
IN TESTIMONY WHEREOF. PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND ITS CORPORATE SEALTO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 5TH DAY OF MARCH, 2021. 1927
Lal Witten
(Seal)
John Glomb, President & CEO
Philadelphia Indemnity Insurance Company
On this 5® day of March, 2021 before me came the individual who executed the preceding instrument, to me personally known, and being by me duly sworn said that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY; that the seal affixed to said instrument is the Corporate seal of said Company, that the said Corporate Seal and his signature were duly affixed Notary Public:
Vanessa mcKenzie
monwealth of Pennsylvania - Notary Sea
Vanessa Mckenzie, Notary Public
Montgomery County
My commission expires November 3, 2024
Commission number 1366394
Member. Pannsylvan a Association of Notaries residing at: Bala Cynwyd, PA My commission expires: November 3, 2024
1, Edward Sayago, Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do hereby certify that the foregoing resolution of the Board of Directors and the Power of Attorney issued pursuant thereto on the 5° day March, 2021 are true and correct and are still in full force and effect. I do further certify that John Glomb, who executed the Power of Attorney as President, was on the date of execution of the attached Power of Attorney the duly elected President of
PHILADELPHIA INDEMNITY INSURANCE COMPANY
October 2023
In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this 4th day of Edward Sayago, Corporate Secretary
PHILADELPHIA INDEMNITY INSURANCE COMPANY
1927
No. 3576-6
STATE OF CALIFORNIA
DEPARTMENT OF INSURANCE
SAN FRANCISCO
Amended
Certificate of Authority
THIS IS TO CERTIFY that, pursuant to the Insurance Code of the State of California, Philadelphia Indemnity Insurance Company
of Pennsylvania, organized under the laws of Pennsylvania, subject to its Articles of Incorporation or other fundamental organizational documents, is hereby authorized to transact within this State, subject to all provisions of this Certificate, the following classes of insurance:
Fire, Marine, Surety, Disability, Plate Glass, Liability, Boiler and Machinery, Burglary, Sprinkler, Automobile, and Miscellaneous
as such classes are now or may hereafter be defined in the Insurance Laws of the State of California.
THIS CERTIFICATE is expressly conditioned upon the holder hereof now and hereafter being in full compliance with all, and not in violation of any, of the applicable laws and lawful requirements made under authority of the laws of the State of California as long as such laws or requirements are in effect and applicable, and as such laws and requirements now are, or may hereafter be changed or amended.
IN WITNESS WHEREOF, effective as of the 11'h day of September, 2015, I have hereunto set my hand and caused my official seal to be affixed this 11' day of September, 2015.
Dave Jones
Insurance Commissioner
Valu Sast
By Valerie Sarfaty
for Nettie Hoge
Chief Deputy
NOTICE:
Qualification with the Secretary of State must be accomplished as required by the California Corporations Code promptly after issuance of this Certificate of Authority. Failure to do so will be a violation of Insurance Code section 701 and will be grounds for revoking this Certificate of Authority pursuant to the covenants made in the application therefor and the conditions contained herein.
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
County of _ State of califor ursi de.
on 10/5/23 before me, Stedranie OHt), Notary Public
(insert name and title of the officer)
Raul Jasso
personally appeared
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 capacityies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
STEPHANIE A. OTTO
COMM. #2355474
WITNESS my hand and official seal. NRO Notary Public - California Riverside County
My Comm. Expires Apr. 24, 2025{
Signature stepte 0000 (Seal)
4.5 NONCOLLUSION DECLARATION
(TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID)
The undersigned declares:
I am the _ President of RaR Rooting & Waterprooing, INC, 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 [Date], at Lake Elsinore _[City], California
CONTRACTOR
(signature)
Raul Jasso
(printed name)
President
(Title)
Subscribed and sworn to before me this _ 5 _ day of October _ 2023 Stephanie Otto (Seal) STEPHANIE A. OTTO
(Principal)
NRO1
My Comm. Expires Apr. 24, 20251
Sionature
Notary Public in and for the County of Riverside
State of California.
My Commission Expires_ April 24 _ 2025
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Riverside
on 10/5/23 before me, Stephanic Otto, Notary public
(insert name and title of the officer)
Raul Jasso
personally appeared
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
STEPHANIE A. OTTO
WITNESS my hand and official seal. COMM. #2355474
Notary Public - California
Riverside County
My Comm. Expires Apr. 24, 2025 l
signature apher Ollo (Seal)
4.6 CERTIFICATION OF NON-DISCRIMINATION BY CONTRACTORS
As suppliers of goods or services to the City of Chino, the company listed below certifies that it does not discriminate in its employment with regard to race, color, religion, sex or national origin; that it is in compliance with all federal, state and local directives and executive orders regarding non-discrimination in employment; and that it agrees to demonstrate positively and aggressively the principle of equal opportunity in employment.
We agree specifically:
To establish or observe employment policies which affirmatively promote opportunities for minority persons at all job levels.
2. To communicate this policy to all persons concerned, including all company employees, outside recruiting services, especially those serving minority communities, and to the minority communities at large.
3. To take affirmative steps to hire minority employees within the company.
COMPANY NAME R&R Roofing & Waterproofing, INC
NAME & TITLE OF PERSON SIGNING Raul Jasso, President
SIGNATURE
DATE 10/4/23
Please include any additional information available regarding equal opportunity employment programs now in effect within your company.
4.7 WORKERS' COMPENSATION INSURANCE CERTIFICATE
The Contractor shall execute the following form as required by the California Labor Code, Section 1860 and 1861:
I am aware of the provisions of Section 3700 of the State Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of this contract.
DATE: 10/4/23
R&R Roofing & Waterproofing, INC
CONTRACTOR
Raul Jasso
(Printed Name)
President
(Title)
4.8 CERTIFICATION OF SITE EXAMINATION
Each bidder shall be fully informed of the conditions relating to the construction of the work and the employment of labor thereon. Failure to do so will not relieve Contractor of the obligation to furnish all material and labor necessary to carry out the provisions of the Contract Documents. Each bidder shall examine the site for the work described herein. A mandatory pre-bid meeting to walk the site is scheduled for Thursday, September 21, 2023 at 10:00 a.m. at the City Hall South building located at 13250 Central Ave, Chino, CA 91710 near the center of the City Hall courtyard. All bidders will be required to conclude the pre-bid meeting at the 7t Street Theater located at 13123 7* Street, Chino, CA 91710. Bidders must attend this meeting at both sites for their bids to be This is to certify that I have examined the site and the bid is complete and there will be no additional payment for failure to examine the site thoroughly.
10/21/23 R&R Roofing & Waterproofing, INC
Date of Site Examination Bidder
Tristin Jasso
Printed Name of Bidder Representative
AsTo
Signature of Representative
10/4/23
Date
4.9 INFORMATION TO COMPLY WITH LABOR CODE SEC. 2810
To comply with Labor Code Sec. 2810, Contractor shall complete and submit this Information Sheet which shall be incorporated into and be a part of the Contract:
1) Workers' Compensation Insurance:
a. Policy Number: RRWC431059
b. Name of Insurer (NOT Broker): Redwood Fire & Casualty Ins Co c. Address of Insurer: 1314 DOUGLAS ST SUITE 1300. OMAHA, NE 68102-1944 d. Telephone Number of Insurer: (916) 492-3657.
2) For vehicles owned by Contractor and used in performing work under this Contract:
a. VIN (Vehicle Identification Number): IGCRABEK9PZ282264 b. Automobile Liability Insurance Policy Number: 504-59285-8913-001 c. Name of Insurer (NOT Broker): Infinity Select Insurance Company d. Address of Insurer: 200 East Randolph Street, Suite 3300, Chicago, IL 60601 e. Telephone Number of Insurer: 1-800-INFINITYype text here 3) Address of Property used to house workers on this Contract, if any: N/A 4) Estimated total number of workers to be employed on this Contract: 6 5) Estimated total wages to be paid those workers: 60,000.00 6) Dates (or schedule) when those wages will be paid (Describe schedule: For example, weekly or every other week or monthly): 6 Employees - Duration of 14 days - Paid Weekly. 7) Estimated total number of independent contractors to be used on this Contract: N/A 8) Contractor's Taxpayer's Identification Number: 81-4352602
4.10 IRAN CONTRACTING ACT of 2010 COMPLIANCE AFFIDAVIT
(Public Contract Code sections 2202-2208)
The California Legislature adopted the Iran Contracting Act of 2010 to respond to policies of Iran in a uniform fashion (PCC §2201(q)). The Iran Contracting Act prohibits bidders engaged in investment activities in Iran from bidding on, submitting proposals for, or entering into or renewing contracts with public entities for goods and services of one million dollars ($1,000,000) or more (PCC § 2203(a)). A bidder who "engages in investment activities in Iran" is defined as either:
1. A bidder providing goods or services of twenty million dollars ($20,000,000) or more in the energy sector of Iran, including provision of oil or liquefied natural gas tankers, or products used to construct or maintain pipelines used to transport oil or liquefied natural gas, for the energy sector of Iran; or
2. A bidder that is a financial institution (as that term is defined in 50 U.S.C. § 1701) that extends twenty million dollars ($20,000,000) or more in credit to another person, for 45 days or more, if that person will use the credit to provide goods or services in the energy sector in Iran and is identified on a list created by the California Department of General Services (DGS) pursuant to PCC § 2203(b) as a person engaging in the investment activities in Iran.
The bidder shall certify that at the time of submitting a bid for new contract or renewal of an existing contract, the bidder is not identified on the DGS list of ineligible businesses or persons and that the bidder is not engaged in investment activities in Iran in violation of the Iran Contracting Act of 2010.
California law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made; contract termination; and three-year ineligibility to bid on contracts (PCC § 2205).
To comply with the Iran Contracting Act of 2010, the bidder shall provide its vendor or financial institution informatino below:
OPTION #1 - CERTIFICATION
I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person/vendor, for 45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS.
Vendor Name/Financial Institution (Printed) Federal ID Number (or n/a) R&R Roofing & Waterproofing, INC 81-4352602
By (Authorized Signature)
Printed Name and Title of rson Signing
Raul Jasso, President
Date Executed Executed in
10/5/23 Lake Elsinore, CA
OPTION #2 - EXEMPTION
Pursuant to Public Contract Code sections 2203(c) and (d), a public entity may permit a vendor/financial institution engaged in investment activities in Iran, on a case-by-case basis, to be eligible for, or to bid on, submit a proposal for, or enters into or renews, a contract for goods and services.
If you have obtained an exemption from the certification requirement under the Iran Contracting Act, please fill out the information below, and attach documentation demonstrating the exemption approval.
Vendor Name/Financial Institution (Printed) Federal ID Number (or n/a) By (Authorized Signature)
Printed Name and Title of Person Signing Date Executed
4.11 STATEMENT BY BIDDER: QUALIFICATION AND EXPERIENCE STATEMENT (REFERENCES)
4.11 General Statement.
The following outline is a record of the undersigned Bidder's experience as specified in Section 1.5 above of this bid document. Include the location of each project as well as the name, address, and phone number of the owner, and name of individual to contact.
Subcontractors performing in excess of one half of one percent of the prime Contractor's total bid shall provide a similar outline. Additional pages outlining this portion of the Bid may be attached. Failure to provide this statement may result in rejection of the bid by the City of Chino.
1. Owner's Name: Colton Joint USD
Dennis Aceves Phone: (909) 580-5008 x 5342
Contact Person:
Address of Owner: 1313 W. Valley Blvd. Colton, CA 92324 Project Description: Re-Roof
Amount of Contract: 480,581.00 Completion Date: 2022
2. Owner's Name: San Bernardino Community College District Contact Person: Hassan Mirza Phone: (909) 388-6958
Address of Owner: 701 South Mount Vernon Avenue, San Bernardino Project Description: Re-Roof
Amount of Contract: 249,240.00 Completion Date: 2022
3. Owner's Name: Riverside Community College District
Contact Person: Robert Beebe Phone: (951) 222-8813
Address of Owner: 4800 Magnolia Ave, Riverside, CA 92506 Project Description: Re-Roof
Amount of Contract: 107,840.00 Completion Date: 2023
Owner's Name: Manhattan Beach Unified School Distict
4. Contact Person: Paul Rutta Phone: (310)318-7345
Address of Owner: 325 S Peck Ave, Manhattan Beach, CA 90266 Project Description: Re-Roof
Amount of Contract: 770259.00 Completion Date: 2020
5. Owner's Name: Long Beach Unified School District
Contact Person: Arash Mir Phone: 213-804-4617
2425 Webster Ave., Long Beach, CA 90810
Address of Owner:
Project Description: Re-Roof
Amount of Contract: 111,321.00 Completion Date: 2022
4.12 CONFLICT OF INTEREST STATEMENT
Provide a statement disclosing any past, ongoing or potential conflicts of interest that your firm, proposed staff, or any subcontractors may have as a result of performing this work.
If there is no conflict of interest then provide such statement in this section.
If there is a real or perceived conflict of interest that exists with the submission of a bid proposal, or would exist if the Bidder entered into an Agreement with the City of Chino in this bid, full details should be provided in this section. Detail a plan to manage the conflict of interest.
R&R Roofing & Waterproofing, INC has no conflicts of interest. Thank you. **End of Section 4**