1363002.1 1
PUBLIC WORKS AGREEMENT
(Uniform Cost Accounting Contract-DBMC Chapter 3.25)
The following agreement ("Agreement") is made and entered into, in duplicate, as of the date executed by the City Manager and attested to by the City Clerk, by and between Siterep Construction Services, Inc. hereinafter referred to as the "Contractor" and the City of Diamond Bar, California, hereinafter referred to as "City." WHEREAS, City received Contractor’s bid on February 12, 2025 WHEREAS, City accepted the bid of Contractor under its Uniform Public Construction Cost Accounting Ordinance, Diamond Bar Municipal Code Chapter 3.25 (“UPCCA Ordinance”); and
WHEREAS, the UPCCA Ordinance authorizes the Public Works Director to execute written contracts with the Contractor for the Pantera Park Hardcourt Improvements. CITY PROJECT NO. FP23503.
NOW, THEREFORE, in consideration of the mutual covenants herein contained, it is agreed:
1. GENERAL SCOPE OF WORK: Contractor shall furnish all necessary labor, tools, materials, appliances, and equipment for and do the work for the Pantera Park Hardcourt Improvements (CITY PROJECT NO. FP23503) in the City (the “Work”).
The Work to be performed in accordance with the proposal dated February 12, 2025 (the “Proposal”) on file with the City and in accordance with bid prices hereinafter mentioned and in accordance with the instructions of the City’s Project Manager, who is Jason Williams, Supervisor.
2. INCORPORATED DOCUMENTS TO BE CONSIDERED
COMPLEMENTARY/PRIORITY OF DOCUMENTS: The Proposal is incorporated herein by reference and made a part hereof with like force and effect as if set forth in full herein. The Proposal, February 12, 2025 (“Contractor’s Bid”) together with this Agreement shall constitute the entire agreement between the parties. This Agreement is intended to require a complete and finished piece of work and anything necessary to complete the work properly and in accordance with the law and lawful governmental regulations shall be performed by the Contractor whether set out specifically in this Agreement or not. Should it be ascertained that any inconsistency exists between the aforesaid documents and this Agreement, the following order of precedence shall apply:
(1) this Agreement; and (2) the Proposal (collectively, the “Contract Documents”).
3. COMPENSATION: Contractor agrees to receive and accept the prices set forth in its Contractor’s Bid as full compensation for furnishing all materials, performing all Work, and fulfilling all obligations hereunder. Said compensation in the amount of three hundred seven thousand six hundred eighty four dollars and 00/100 ($307,684) shall cover all expenses, losses, damages, and consequences arising out of the nature of the Work during its progress or prior to its acceptance, including those for well and faithfully completing the Work and the whole thereof in the manner and time specified in the Contract Documents; and also including those arising from actions of the elements, unforeseen difficulties or obstructions encountered in the prosecution of the Work, suspension or discontinuance of the Work, and all other unknowns or risks of any description connected with the Work. Final payment to Contractor shall be withheld for Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 1363002.1 2
at least 30 days after the time in which Contractor has verified, to the City's satisfaction, that it has submitted all information to the Department of Industrial Relations required by Labor Code §1773.3.
4. TERM OF AGREEMENT/LIQUIDATED DAMAGES: Contractor agrees to complete the work within fifty (50) working days from the date of the notice to proceed (the “Completion Date”).
5. INSURANCE: Contractor shall not commence work under this Agreement until it has obtained all insurance required hereunder in a company or companies acceptable to City nor shall the Contractor allow any sub-contractor to commence work on his sub-contract until all insurance required of the sub-contractor has been obtained.
The Contractor shall take out and maintain at all times during the life of this contract the following policies of insurance:
a. Workers' Compensation Insurance: Before beginning work, the Contractor shall furnish to the City a certificate of insurance as proof that he has taken out full workers' compensation insurance for all persons whom he may employ directly or through sub-contractors in carrying out the work specified herein, in accordance with the laws of the State of California. Such insurance shall be maintained in full force and effect during the period covered by this contract.
In accordance with the provisions of Section 3700 of the California Labor Code, every Contractor shall secure the payment of compensation to his employees. The Contractor, prior to commencing work, shall sign and file with the City a certification 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 workers' 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 work of this contract."
b. For all operations of the Contractor or any sub-contractor in performing the work provided for herein, insurance with the following minimum limits and coverage:
1) General Liability - $2,000,000 per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this Agreement or the general aggregate limit shall be twice the required occurrence limit. 2) Automobile - $2,000,000 per accident for bodily injury and property damage.
3) Employer's Liability - $1,000,000 per accident for bodily injury or disease.
c. Each such policy of insurance provided for in paragraph b. shall:
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1) Be issued by an insurance company approved in writing by City, which is authorized to do business in the State of California.
2) Name as additional insured the City of Diamond Bar, its officers, agents and employees, and any other parties
specified in the bid documents to be so included;
3) Specify it acts as primary insurance and that no insurance held or owned by the designated additional insured shall be called upon to cover a loss under the policy;
4) Contain a clause substantially in the following words:
"It is hereby understood and agreed that this policy may not be canceled nor the amount of the coverage thereof reduced until thirty (30) days after receipt by City of a written notice of such cancellation or reduction of coverage."
5) Waives all right of subrogation against all persons and entities specified in subparagraph 4.c.(2) hereof to be listed as additional insured in the policy of insurance provided for in paragraph b. by reason of any claim arising out of or connected with the operations of Contractor or any subcontractor in performing the work provided for herein; 6) Otherwise be in form satisfactory to the City.
d. The Contractor shall, prior to performing any work under this Agreement, deliver to the City Manager or his designee the original policies of insurance required in paragraphs a. and b. hereof, or deliver to the City Manager or his designee a certificate of the insurance company, showing the issuance of such insurance, and the additional insured and other provisions required herein.
6. PREVAILING WAGE: Notice is hereby given that in accordance with the provisions of California Labor Code, Division 2, Part 7, Chapter 1, Articles 1 and 2, the Contractor is required to pay not less than the general prevailing rate of per diem wages for work of a similar character in the locality in which the public works is performed, and not less than the general prevailing rate of per diem wages for holiday and overtime work. In that regard, the Director of the Department of Industrial Relations of the State of California is required to and has determined such general prevailing rates of per diem wages. Copies of such prevailing rates of per diem wages are on file in the Office of the City Clerk of the City of Diamond Bar, 21810 Copley Drive, Diamond Bar, California, and are available to any interested party on request. Contractor shall cause a copy of such determinations to be posted at the job site.
Contractor shall forfeit, as penalty to City, not more than two hundred dollars ($200.00) for each laborer, workman or mechanic employed for each calendar day or portion thereof, if such laborer, workman or mechanic is paid less than the general prevailing rate of wages hereinbefore stipulated for any work done under this Agreement, by him or by any sub-contractor under him.
Contractor and any of its sub-contractors must be registered with the Department of Industrial Relations pursuant to Labor Code section 1725.5, which precludes the Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 1363002.1 4
award of a contract for a public work on any public works project awarded after April 1, 2015 to a person not registered. This Agreement is subject to compliance monitoring and enforcement by the Department of Industrial Relations.
7. APPRENTICESHIP EMPLOYMENT: In accordance with the provisions of Section 1777.5 of the Labor Code, and in accordance with the regulations of the California Apprenticeship Council, properly indentured apprentices may be employed in the performance of the work.
Contractor is required to make contribution to funds established for the administrative of apprenticeship programs if he employs registered apprentices or journeymen in any apprenticeship trade on such contracts and if other Contractors on the public works site are making such contributions.
Contractor and any sub-contractor under him shall comply with the requirements of Sections 1777.5 and 1777.6 in the employment of apprentices.
Information relative to apprenticeship standards, wage schedules and other requirements may be obtained from the Director of Industrial Relations, ex-officio the Administrator of Apprenticeship, San Francisco, California, or from the Division of Apprenticeship Standards and its branch offices.
8. LEGAL HOURS OF WORK: Eight (8) hours of labor shall constitute a legal day's work for all workmen employed in the execution of this Agreement, and the Contractor and any sub-contractor under him shall comply with and be governed by the laws of the State of California having to do with working hours set forth in Division 2, Part 7, Chapter 1, Article 3 of the Labor Code of the State of California as amended.
Contractor shall forfeit, as a penalty to City, twenty-five dollars ($25.00) for each laborer, workman or mechanic employed in the execution of the contract, by him or any sub-contractor under him, upon any of the work hereinbefore mentioned, for each calendar day during which the laborer, workman or mechanic is required or permitted to labor more than eight (8) hours in violation of the Labor Code.
9. TRAVEL AND SUBSISTENCE PAY: Contractor agrees to pay travel and subsistence pay to each workman needed to execute the work required by this contract as such travel and subsistence payments are defined in the applicable collective bargaining agreements filed in accordance with Labor Code Section 1773.8.
10. CONTRACTOR'S LIABILITY: The City and its officers, agents and employees ("Indemnitees") shall not be answerable or accountable in any manner for any loss or damage that may happen to the work or any part thereof, or for any of the materials or other things used or employed in performing the work; or for injury or damage to any person or persons, either workers or employees of Contractor, of its sub-contractors or the public, or for damage to adjoining or other property from any cause whatsoever arising out of or in connection with the performance of the work.
Contractor shall be responsible for any damage or injury to any person or property resulting from defects or obstructions or from any cause whatsoever.
Contractor will indemnify Indemnities against and will hold and save Indemnitees harmless from any and all actions, claims, damages to persons or property, penalties, obligations or liabilities that may be asserted or claimed by any person, firm, entity, corporation, political subdivision, or other organization arising out of or in connection with the work, operation, or activities of Contractor, its agents, employees, subDocusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 1363002.1 5
contractors or invitees provided for herein, whether or not there is concurrent passive negligence on the part of City. In connection therewith:
a. Contractor will defend any action or actions filed in connection with any such claims, damages, penalties, obligations or liabilities and will pay all costs and expenses, including attorneys' fees, expert fees and costs incurred in connection therewith.
b. Contractor will promptly pay any judgment rendered against Contractor or Indemnitees covering such claims, damages, penalties, obligations and liabilities arising out of or in connection with such work, operations or activities of Contractor hereunder, and Contractor agrees to save and hold the Indemnitees harmless therefrom.
Contractor's obligations under this section apply regardless of whether or not such claim, charge, damage, demand, action, proceeding, loss, stop notice, cost, expense, judgment, civil fine or penalty, or liability was caused in part or contributed to by an Indemnitee. However, without affecting the rights of City under any provision of this Agreement, Contractor shall not be required to indemnify and hold harmless City for liability attributable to the active negligence of City provided such active negligence is determined by agreement between the parties or by the findings of a court of competent jurisdiction. In instances where City is shown to have been actively negligent and where City active negligence accounts for only a percentage of the liability involved, the obligation of Contractor will be for that entire portion or percentage of liability not attributable to the active negligence of City.
So much of the money due to Contractor under and by virtue of the contract as shall be considered necessary by City may be retained by City until disposition has been made of such actions or claims for damages as aforesaid.
It is expressly understood and agreed that the foregoing provisions are intended to be as broad and inclusive as is permitted by the law of the State of California. This indemnity provision shall survive the termination of the Agreement and is in addition to any other rights or remedies which Indemnitees may have under the law.
This indemnity is effective without reference to the existence or applicability of any insurance coverage which may have been required under this Agreement or any additional insured endorsements which may extend to Indemnitees.
Contractor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation and contribution against the Indemnitees, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to activities or operations performed by or on behalf of the Contractor regardless of any prior, concurrent, or subsequent passive negligence by the Indemnitees.
11. NON-DISCRIMINATION: Pursuant to Labor Code Section 1735, no discrimination shall be made in the employment of persons in the work contemplated by this Agreement because of the race, color, sex, mental disability, physical disability, religion or other reason set forth in Government Code § 12940 of such person.
Contractor agrees to post in conspicuous places available to employees and applications, a notice setting forth provisions of this non-discrimination clause. A violation of this section exposes the Contractor to the penalties provided for in Labor Code Section 1735.
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12. RESERVED:
13. PRESENTATION OF CLAIMS: Any claim, as that term is defined in Public Contract Code §9204, shall be submitted in accordance with Section 9204 and shall contain a sufficient description of the claim, the basis therefore and documentation in support of the claim. The claim shall be processed as more fully set forth in the Plans and Specifications.
14. TERMINATION: This Agreement may be terminated by the City for any reason upon the giving of a written "Notice of Termination" to Contractor at least thirty (30) days prior to the date of termination specified in the notice. Upon receipt of such notice, Contractor shall immediately cease work, unless otherwise directed by the Notice of Termination. In the event of such termination, Contractor shall be paid for services satisfactorily rendered and expenses reasonably and necessarily incurred prior to the effective date of termination, unless the Notice of Termination is issued for cause, in which event the City may withhold any disputed compensation. Contractor shall not be entitled to any claim for lost profits.
State of California
Contractor’s License No. 1094220
Contractor’s Business Phone:909-418-8690
Contractor’s emergency phone which can be reached at any time: 909-418-8690 IN WITNESS WHEREOF, the parties hereto have executed this Agreement with all the formalities required by law on the respective dates set forth opposite their signatures.
Siterep Construction Services Inc.
By:
Title:
Date:
By:
Title:
Date:
Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 Andre Ortiz, Vice-President
4/9/2025
1363002.1 7
CITY OF DIAMOND BAR, CALIFORNIA
By: _____________________________________
Dan Fox, City Manager
ATTEST:
By: _____________________________________
Kristina Santana, City Clerk
APPROVED AS TO FORM:
_____________________________________
Omar Sandoval, City Attorney
*NOTE: If Contractor is a corporation, the City requires the following signature(s):
-- The Chairman of the Board, the President or a Vice-President, AND (2) the Secretary, the Chief Financial Officer, the Treasurer, an Assistant Secretary or an Assistant Treasurer. If only one corporate officer exists or one corporate officer holds more than one corporate office, please so indicate. OR
-- The corporate officer named in a corporate resolution as authorized to enter into this Agreement. A copy of the corporate resolution, certified by the Secretary close in time to the execution of the Agreement, must be provided to the City.
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BIDDER'S PROPOSAL
CITY OF DIAMOND BAR
PANTERA PARK IMPROVEMENTS PROJECT
CITY PROJECT NO. FP23503
Date , 20
To the City Council of the City of Diamond Bar:
The Undersigned hereby declares:
(a) That the only persons or parties interested in this proposal as principals are the following:
(If the bidder is a corporation, give the name of the corporation and the name of its president, secretary, treasurer, and manager. If a co-partnership, give the name, under which the co-partnership does business, and the names and addresses of all co-partners.
If an individual, state the name under which the contract is to be drawn.) (b) That this proposal is made without collusion with any person, firm or corporation. (c) That he has carefully examined the location of the proposed work and has familiarized himself with all of the physical and climatic conditions, and makes this bid solely upon his own knowledge.
(d) That by submitting this Bidder's Proposal, he acknowledges receipt and knowledge of the contents of those communications sent by the City of Diamond Bar to him at the address furnished by him to the City of Diamond Bar when this proposal form was obtained. (e) That he has carefully examined the specifications, both general and detail, and the drawings attached hereto, and communications sent to him as aforesaid, and makes this proposal in accordance therewith.
(f) That, if this bid is accepted he will enter into a written contract for the performance of the proposed work with the City of Diamond Bar.
(g) That he proposes to enter into such Contract and to accept in full payment for the work actually done thereunder the prices shown in the attached schedule. It is understood and agreed that the quantities set forth are estimates and that the unit prices will apply to the actual quantities whatever they may be.
Accompanying this proposal is a certified or cashier's check or bidder's bond, payable to the order of the City of Diamond Bar in the sum of
2/12/2025 25 Siterep Construction Services Inc.
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DOLLARS ($ ).
Said bidder's bond has been duly executed by the undersigned bidder and by a financially sound surety company authorized to transact business in this state.
It is understood and agreed that should the bidder fail within ten (10) days after award of contract to enter into the contract and furnish acceptable surety bonds, then the proceeds of said check, or bidder's bond, shall become the property of the City of Diamond Bar; but if this Contract is entered into and said bonds are furnished, or if the bid is not accepted then said check shall be returned to the undersigned, or the bidder will be released from the bidder's bond.
Address of Bidder Telephone of Bidder
City Zip Code Signature of Bidder
10% OF BID 301 E Arrow Hwy Ste #105 (909)418-8690 San Dimas 91773 Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 14 1293492.1
BID SCHEDULE
CITY OF DIAMOND BAR
CONTRACT DOCUMENTS AND SPECIFICATIONS
PANTERA PARK IMPROVEMENTS PROJECT
CITY PROJECT NO. FP23503
BASE BID
ITEM
NO.
ESTIMATED
QUANTITY UNIT
DESCRIPTION
WRITTEN IN WORDS
UNIT
PRICE AMOUNT
1 LS 1 MOBILIZATION
2 LS 1 SPORT COURT IMPROVEMENTS
3 LS 1 DRINKING FOUNTAIN
4 LS 1 LIGHTING IMPROVEMENTS
ALTERNATE BID
ITEM
NO.
ESTIMATED
QUANTITY UNIT
DESCRIPTION
WRITTEN IN WORDS
UNIT
PRICE AMOUNT
A1 LS 1 FLAG POLE
The BASIS OF AWARD shall be the sum of the BASE BID and the ALTERNATE BID. The City reserves the right to delete the ALTERNATE BID from the Award of Contract.
TOTAL AMOUNT BID (IN FIGURES)
TOTAL AMOUNT BID, (WRITTEN IN WORDS):
Bid Schedule Note: Bid Price indicated refers to all items illustrated on the plans and details, and delineated within the specifications installed and completely in place with all applicable portions of the construction documents and include all costs connected with such items including, but to necessarily limited to, materials, transportation, taxes, insurance, labor, overhead, and profit, for General Contractor and Subcontractors.
All work called for on the construction documents are to provide a completed project with all systems operating properly and ready for use.
$46,350.00 $46,350.00 $105,005.00 $105,005.00 $12,653.00 $12,653.00 $129,228.00 $129,228.00 $14,448.00 $14,448.00 $307,684.00
THREE HUNDRED AND SEVEN THOUSAND, SIX HUNDRED EIGHTY-FOUR DOLLARS Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 15 1293492.1
Award will be based on the items of Bid Schedule. Therefore, Contractor shall completely fill out Bid Schedule.
Accompanying this proposal is
(Insert "$ cash", "cashier's check", "certified check", or "bidder's bond" as the case may be) in the amount equal to at least ten percent (10%) of the total bid.
The undersigned further agrees that in case of default in executing the required contract, with necessary bond, within ten (10) days, not including Sundays and legal holidays, after having received notice that the Contract has been awarded and ready for signature, the proceeds of the security accompanying his bid shall become the property of the City of Diamond Bar, and this proposal and the acceptance thereof may be considered null and void.
NAME OF BIDDER (PRINT) SIGNATURE DATE
ADDRESS
CITY ZIP CODE TELEPHONE
STATE CONTRACTOR LICENSE NO. AND CLASSIFICATION
I declare under penalty of Perjury of the laws of the State of California that the representations made herein are true and correct in accordance with the requirements of California Business and Professional Code Section 7028.15.
CONTRACTOR SIGNATURE OR AUTHORIZED OFFICER
10% Siterep Construction Services Inc. 2/12/2025 301 E Arrow Hwy Ste #105 San Dimas 91773 (909)-418-8690 #1094220 ( Class A,B,C-34) Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 16 1293492.1
LIST OF SUBCONTRACTORS *
BID OPENING DATE
PROJECT PROJECT NO.
LOCATION
CLIENT
CONTRACTOR
Name Under Which
Subcontractor is
Licensed
License
No.
&
DIR No.
Address
of
Place of Business
Percent
of
Total
Contract
Specific Description
of
Subcontract
* In compliance with the provisions of the Public Contract Code Section 4104, the undersigned bidder herewith sets forth the name, location of the place of business, and California contractor license of each Subcontractor – who will perform work or labor or 2/27/2025 Pantera Park Improvements FP 23503 738 Pantera Dr Diamond Bar, CA 91765 City of Diamond Bar Siterep Construction Services Inc. 1340 W. Princeton St. Electrical/Lighting Ontario, CA 91762 Ryan Electric Inc. 790924
1000000794
34%
4457 Oak Lane Court Surfacing/Nets Claremont, CA 91711
California Surfacing 404352
1000002250
24%
599 S. Barranca Ave. Windscreen Covina, CA 91732
IE Fence 1001488
1000790239
3%
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render service to the Prime Contractor, specially fabricates and installs a portion of the work or improvement necessary to complete construction contained in the plans and specifications, in an amount in excess of one-half (1/2) of one percent (1%) of the General Contractor’s total base bid amount 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 (0.5%)of the Prime Contractor’s total base bid or ten thousand ($10,000.00), whichever is greater, and the portion of the work which will be done by each Subcontractor.
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DECLARATION OF ELIGIBILITY TO CONTRACT
[Labor Code Section 1777.1; Public Contract Code Section 6109] The undersigned, a duly authorized representative of the contractor, certifies and declares that:
1. The contractor is aware of Sections 1777.1 and 1777.7 of the California Labor Code, which prohibit a contractor or subcontractor who has been found by the Labor Commissioner or the Director of Industrial Relations to be in violation of certain provisions of the Labor Code, from bidding on, being awarded, or performing work as a subcontractor on a public works project for specified periods of time.
2. The contractor is not ineligible to bid on, be awarded or perform work as a subcontractor on a public works project by virtue of the foregoing provisions of Sections 1777.1 or 1777.7 of the California Labor Code or another provision of law.
3. The contractor is aware of California Public Contract Code Section 6109, which states:
(a) A public entity, as defined in Section 1100 [of the Public Contract Code], may not permit a contractor or subcontractor who is ineligible to bid or work on, or be awarded, a public works project pursuant to Section 1777.1 or 1777.7 of the Labor Code to bid on, be awarded, or perform work as a subcontractor on, a public works project. Every public works project shall contain a provision prohibiting a contractor from performing work on a public works project with a subcontractor who is ineligible to perform work on the public works project pursuant to Section 1777.1 or 1777.7 of the Labor Code.
(b) Any contract on a public works project entered into between a contractor and a debarred subcontractor is void as a matter of law. A debarred subcontractor may not receive any public money for performing work as a subcontractor on a public works contract, and any public money that may have been paid to a debarred subcontractor by a contractor on the project shall be returned to the awarding body.
The contractor shall be responsible for the payment of wages to workers of a debarred subcontractor who has been allowed to work on the project.
4. The contractor has investigated the eligibility of each and every subcontractor the contractor intends to use on this public works project, and determined that none of them is ineligible to perform work as a subcontractor on a public works project by virtue of the foregoing provisions of the Public Contract Code Sections 1777.1 or 1777.7 of the Labor Code, or any other provision of law.
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I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed this day of ________________, 2024, at ___________________ (place of execution).
Signature
Name:
Title:
Name of Contractor:
_____________________________
2/12/2025 301 E Arrow Hwy Ste#105, San Dimas Siterep Construction Services Inc. CA,91773 Andre Ortiz President Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 20 1293492.1
BIDDER'S VIOLATION OF LAW/SAFETY QUESTIONNAIRE
In accordance with Government Code Section 14310.5 and in conformance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire:
QUESTIONNAIRE
Has the Bidder, any officer, principal or employee of the Bidder who has a proprietary interest in the business of the Bidder, ever been disqualified, removed, or otherwise prevented from bidding on or completing a federal, state or local government project because of violation of law or a safety regulation?
YES NO
If the answer is yes, explain the circumstances in the following space:
STATEMENT
In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than on 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.
X
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CONTRACTOR'S INDUSTRIAL SAFETY RECORD
Project Identification
Bid Date
This information must include all construction work undertaken in the State of California by the bidder and any partnership, joint venture or corporation that any principal of the bidder participated in as a principal or owner for the last five calendar years and the current calendar year prior to the date of bid submittal. Separate information shall be submitted for each particular partnership, joint venture, corporation or individual bidder. The bidder may attach any additional information or explanation of data, which he would like, taken into consideration in evaluating the safety record. An explanation must be attached of the circumstances surrounding any and all fatalities.
ITEM 5 CALENDAR YEARS
PRIOR TO CURRENT YEAR
CURRENT
YEAR
2020 2021 2022 2023 2024 TOTAL
No. of Contracts
Total dollar amount
of
contracts (in 1,000’s)
No. of lost workday
cases
No. of lost work day
cases
involving permanent
transfer to
another job or
termination of
employment
No. of lost workdays
*The information required for this item is the same as required for columns 3 to 6, Code 10, Occupational Injuries, Summary - Occupational Injuries and Illnesses, OSHA No. 102.
The above information was compiled from the records that are available to me at this time and I declare under penalty of perjury that the information is true and accurate within the limitations of these records.
______________________________ ________________________________ Name of Bidder (Print Signature
______________________________ ________________________________ Address State Contractor’s Lic. No. & Class
______________________________ ________________________________ City Zip Code Telephone
2/27/2025 2025 0 0 1 3 6 10 2
0 0 100 300 2000 24000 1000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Siterep Construction Services Inc. 301 E Arrow Hwy Ste #105 #1094220 (class A, B, C-34) San Dimas 91773 (909) 418-8690 Pantera Park Improvements, Project NO FP 23503 Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823
CERTIFICATION OF NON-DISCRIMINATION AND AFFIRMATIVE ACTION As suppliers of goods or services to the City of Diamond Bar, the firm listed below certifies that it does not discriminate in its employment with regards to race, 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 will pursue an affirmative course of action as required by the affirmative action guidelines.
We agree specifically:
1. 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.
FIRM
TITLE OF OFFICER SIGNING
SIGNATURE DATE
Please include any additional information available regarding equal opportunity employment programs now in effect within your company:
Siterep Construction Services Inc. 2/12/2025 President
Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 33 1293492.1
CERTIFICATION WITH REGARD TO THE PERFORMANCE OF
PREVIOUS CONTRACTS OR SUBCONTRACTS SUBJECT TO THE
EQUAL OPPORTUNITY CLAUSE AND THE FILING OF REQUIRED REPORTS The bidder , proposed subcontractor , hereby certifies that he has , has not , participated in a previous contract or subcontract subject to the Equal Opportunity Clause, as required by Executive Orders 10925, 11114, or 11246, and that he has , has not , 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 filing requirements. (COMPANY)
BY:
(TITLE)
DATE: , 20 .
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 of such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S.
Department of Labor.
February 12 25 X X
X
Siterep Construction Services Inc. President
Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 Docusign Envelope ID: 4ACD421C-62AC-4584-951F-A7AC27DAC823 Certificate Of Completion
Envelope Id: 4ACD421C-62AC-4584-951F-A7AC27DAC823 Status: Completed Subject: Docusign: SITEREP - Contract (Pantera hardcourt Improvements/042025) Source Envelope:
Document Pages: 26 Signatures: 1 Envelope Originator:
Certificate Pages: 4 Initials: 0 Angie Hernandez
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
21825 Copley Dr
Diamond Bar, CA 91765-4178
[email protected]
IP Address: 47.176.65.100
Record Tracking
Status: Original
4/7/2025 5:16:08 PM
Holder: Angie Hernandez
[email protected]
Location: DocuSign
Signer Events Signature Timestamp
Andre Ortiz
[email protected]
Andre Ortiz, Vice-President
Security Level: Email, Account Authentication
(None) Signature Adoption: Pre-selected Style
Using IP Address: 47.156.188.148
Sent: 4/7/2025 5:22:32 PM
Viewed: 4/9/2025 11:30:18 AM
Signed: 4/9/2025 11:30:27 AM
Electronic Record and Signature Disclosure:
Accepted: 3/5/2024 5:47:10 PM
ID: f95744ba-7144-4a1d-8627-7f24c42fa737
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 4/7/2025 5:22:32 PM
Certified Delivered Security Checked 4/9/2025 11:30:18 AM Signing Complete Security Checked 4/9/2025 11:30:27 AM
Completed Security Checked 4/9/2025 11:30:27 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, City of Diamond Bar (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system.
Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents for a limited period of time (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per-page fee. You may request delivery of such paper copies from us by following the procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us.
All notices and disclosures will be sent to you electronically Electronic Record and Signature Disclosure created on: 8/30/2023 9:00:10 AM Parties agreed to: Andre Ortiz
Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us.
How to contact City of Diamond Bar:
You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows:
To contact us by email send messages to: [email protected] To advise City of Diamond Bar of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at [email protected] and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address.
If you created a DocuSign account, you may update it with your new email address through your account preferences.
To request paper copies from City of Diamond Bar
To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an email to [email protected] and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with City of Diamond Bar
To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:
i. decline to sign a document from within your signing session, and on the subsequent page, select the check-box indicating you wish to withdraw your consent, or you may; ii. send us an email to [email protected] and in the body of such request you must state your email, full name, mailing address, and telephone number. We do not need any other information from you to withdraw consent.. The consequences of your withdrawing consent for online documents will be that transactions may take a longer time to process..
Required hardware and software
The minimum system requirements for using the DocuSign system may change over time. The current system requirements are found here: https://support.docusign.com/guides/signer-guidesigning-system-requirements.
Acknowledging your access and consent to receive and sign documents electronically To confirm to us that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please confirm that you have read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for your future reference and access; or (ii) that you are able to email this ERSD to an email address where you will be able to print on paper or save it for your future reference and access. Further, if you consent to receiving notices and disclosures exclusively in electronic format as described herein, then select the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system.
By selecting the check-box next to ‘I agree to use electronic records and signatures’, you confirm that:
You can access and read this Electronic Record and Signature Disclosure; and You can print on paper this Electronic Record and Signature Disclosure, or save or send this Electronic Record and Disclosure to a location where you can print it, for future reference and access; and
Until or unless you notify City of Diamond Bar as described above, you consent to receive exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you by City of Diamond Bar during the course of your relationship with City of Diamond Bar.