FAIRFAX TOWN COUNCIL MEETING
STAFF REPORT
AGENDA ITEM #4
MEETING DATE: September 4, 2024
PREPARED FOR: Mayor and Town Council
PREPARED BY: Loren Umbertis, Public Works Director
SUBJECT: Adopt a Resolution awarding a contract with RWR Construction, Inc. for 103 Rocca Drive Roadway Stabilization and Retaining Wall project and Authorize Town Manager to Execute the contract and Pay an amount not to exceed $234,643, with an Additional Contingency of 10%, for a Project Total of $258,107.
RECOMMENDATION
Staff recommends that the Town Council adopt the resolution to award the contract to RWR Construction Inc. and authorize the Town Manager to execute the contract and pay the total project amount not to exceed $258,107.
BACKGROUND
A section of roadway near 103 Rocca Drive has shown signs of movement over time, raising concerns about the potential slope failure that could impact nearby private properties. A similar incident occurred in the adjacent area several decades ago, prompting repairs by the Town. The current location is adjacent to that previously failed area. Currently, Miller Pacific Engineering Group has been monitoring the site using an inclinometer confirming ongoing slope movement. They have prepared the plans and specifications for this stabilization project, which were issued as part of the recent invitation to bid.
DISCUSSION
The Town issued a call for bids with a deadline of August 13, 2024. Six bids were received, ranging from $234,643 to $438,800. RWR Construction Inc. submitted the lowest bid at $234,643, which was reviewed and deemed responsive and responsible. No bid protests were received, and their proposal aligns closely with the Engineer's Estimate of $250,000. Staff recommends RWR Construction Inc. due to their competitive pricing and timely completion plan, crucial for addressing the slope movement before the winter season.
Bid Results
RWR Construction Inc $234,643
Acustruct $238,662
Advanced Geotechniques $259,625
Farallon Co. $278,640
Maggiora & Ghilotti $294,700
Ground Control Inc $438,800
COMMUNITY OUTREACH
Staff have engaged with the adjacent property owner to ensure the project proceeds safely, including a pre-construction inspection of the property and the residence to prevent any adverse effects. 2 FISCAL IMPACT
The contract with RWR Construction, Inc is set to not exceed $234,643. Staff recommends including a 10% contingency ($23,464) to address any unforeseen conditions for a total estimated cost of $258,107. This project will be funded through the Capital Improvement Program, specifically from fund 51-845.
ATTACHMENTS
A. Resolution
B. Bid Proposal from RWR Construction, Inc.
1 ATTACHMENT A
RESOLUTION 24-__
A RESOLUTION OF THE TOWN COUNCIL OF THE TOWN OF FAIRFAX AWARDING A CONTRACT TO RWR CONSTRUCTION INC; AUTHORIZING THE TOWN MANAGER TO EXECUTE THE CONTRACT FOR THE 103 ROCCA DRIVE ROADWAY STABILIZATION AND RETAINING WALL PROJECT AND PAY AN AMOUNT NOT TO EXCEED $234,643, WITH AN ADDITIONAL CONTINGENCY OF 10%, FOR A PROJECT TOTAL OF UP TO $258,107 WHEREAS, staff has been monitoring a section of roadway located near the address of 103 Rocca that has experienced movement over time leading to concerns that the slope could fail and damage a private structure and property below; and
WHEREAS, decades past, an adjacent section of the slope had failed, and the Town made repairs at that time to stabilize the slope and that this new location is adjacent to the previously failed area; and WHEREAS, Miller Pacific Engineering Group have prepared plans and specifications for the project which were recently issued as part of an invitation to bid and estimated construction costs of approximately $250,000; and
WHEREAS, the Bid Proposal from RWR Construction, Inc for an amount not to exceed $234,643, was the lowest and was deemed responsive and responsible.
WHEREAS, a contingency of 10% or $23,464 will be included in the budget to address any unforeseen conditions for a total estimated cost of $258,107; and
WHEREAS, Funds are currently available in the Capital Improvement Program under fund 51-845; and NOW, THEREFORE, BE IT RESOLVED that the Town Council of the Town of Fairfax, California hereby authorizes the Town Manager to execute and pay for a construction contract with RWR Construction, Inc for the 103 Rocca Drive Roadway Stabilization and Retaining Wall project in the amount of $234,643 and include a 10% Contingency for a total project cost of up to $258,107.
The foregoing resolution was duly passed and adopted by the Town Council of the Town of Fairfax at a duly noticed meeting held in said Town on the 4th day of September, 2024 by the following vote:
AYES:
NOES:
ABSENT:
ATTEST
______________________________ _________________________________
BARBARA COLER CHRISTINE FOSTER
MAYOR DEPUTY TOWN CLERK
ATTACHMENT B
00 41 43- BID FORMS
1.1 Bid.
Bids will be received at the Town of Fairfax, 142 Solinas Rd., Fairfax, California 94930, until 2:00 p.m. pst, August 13, 2024
NAMEOFBIDDER: f<v\lt< lonShg\luhvn InvThe undersigned hereby declare that we have carefully examined the location of the proposed Work, and have read and examined the Contract Documents, including all plans, specifications, and all addenda, if any for the following Project:
103 Rocca Road Stabilization and Retaining Wall Project We hereby propose to furnish all labor, materials, equipment, tools, transportation, and services, and to discharge all duties and obligations necessary and required to perform and complete the Project, as described and in strict conformity with the Drawings, and these Specifications for TOTAL BID PRICE indicated herein.
The undersigned acknowledges receipt, understanding, and full consideration of the following addenda to the Contract Documents:
Addenda No. tJ 1- date t.l '6 / ·1 / ,:74
1. Attached is the required Bid Guarantee in the amount of not less than 10% of the Total Bid Price.
2. Attached is the completed Designation of Subcontractors form.
3. Attached is the fully executed Noncollusion Declaration form.
4. Attached is the completed Iran Contracting Act Certification form.
5. Attached is the completed Public Works Contractor Registration Certification form.
6. Attached is the completed Contractor's Certificate Regarding Workers' Compensation form.
7. Attached is the completed Bidder Information and Experience form. -17- 00 41 43 - BID FORMS
38072.00001\34443465.1
A. BID SCHEDULE
Item Descri tion Quanti
1 Mobilization 1
2 Clearing and Grubbing 1 LS
3 Demolition and Removal 1 LS
4 18-lnch Drilled Hole 165 LF
5 Steel Soldier Pile 253 LF
6 Timber Lagging 420 SF
7 Tieback Anchors 5 EA
8 Steel Waler 25 LF
9 Backfill 125 CY
10 Rock Slope Protection 8 TON
11 Midwest Guardrail System (Steel Post) 50 LF
12 Retaining Wall Safety Rail 50 LF
13 Hydroseeding and Planting 1 LS
Total
The costs for any Work shown or required in the Contract Documents, but not specifically identified as a line item are to be included in the related line items and no additional compensation shall be due to Contractor for the performance of the Work.
In case of discrepancy between the Unit Price and the Item Cost set forth for a unit basis item, the unit price shall prevail and shall be utilized as the basis for determining the lowest responsive, responsible Bidder. However, if the amount set forth as a unit price is ambiguous, unintelligible or uncertain for any cause, or is omitted, or is the same amount as the entry in the "Item Cost" column, then the amount set forth in the "Item Cost" column for the item shall prevail and shall be divided by the estimated quantity for the item and the price thus obtained shall be the Unit Price.
For purposes of evaluating Bids, the Town will correct any apparent errors in the extension of unit prices and any apparent errors in the addition of lump sum and extended prices.
The estimated quantities for Unit Price items are for purposes of comparing Bids only and the Town makes no representation that the actual quantities of work performed will not vary from the estimates. Final payment shall be determined by the Engineer from measured quantities of work performed based upon the Unit Price.
-18- OD 41 43 - BID FORMS
38072.0000! \34443465.1
B. TOTAL BID PRICE:
TOTAL BID PRICE BASED ON BID SCHEDULE TOTAL OF UNIT PRICES FOR 103 ROCCA ROAD STABILIZATION AND RETAINING WALL PROJECT In case of discrepancy between the written price and the numerical price, the written price shall prevail.
The undersigned agrees that this Bid Form constitutes a firm offer to the Town which cannot be withdrawn for the number of calendar days indicated in the Notice Inviting Bids from and after the Bid opening, or until a Contract for the Work is fully executed by the Town and a third party, whichever is earlier.
The successful bidder hereby agrees to sign the contract and furnish the necessary bonds and certificates of insurance within ten (10) working days after the Town provides the successful bidder with the Notice of Award.
Upon receipt of the signed contract and other required documents, the contract will be executed by the Town, after which the Town will prepare a letter giving Contractor Notice to Proceed. The official starting date shall be the date of the Notice to Proceed, unless otherwise specified. The undersigned agrees to begin the Work within ten (10) working days of the date of the Notice to Proceed, unless otherwise specified.
The undersigned has examined the location of the proposed work and is familiar with the Drawings and Specifications and the local conditions at the place where work is to be done.
If awarded the contract, the undersigned agrees that there shall be paid by the undersigned and by all subcontractors to all laborers. workers and mechanics employed in the execution of such contract no less than the prevailing wage rate within Marin County for each craft, classification, or type of worker needed to complete the Work contemplated by this contract as established by the Director of the Department of Industrial Relations. A copy of the prevailing rate of per diem -19- 00 41 43 - BID FORMS
3 8072.0000 l \34443465. l
wages are on file at the Town's Administration Office and shall be made available to interested parties upon request.
Enclosed find cash, bidder's bond, or cashier's or certified check No. _____ from the _______ Bank in the amount of _______________ , which is not less than ten percent (10%) of this bid, payable to Town of Fairfax as bid security and which is given as a guarantee that the undersigned will enter into a contract and provide the necessary bonds and certificates of insurance if awarded the Work.
The bidder furthermore agrees that in case of bidder's default in executing said contract and furnishing required bonds and certificates of insurance, the cash, bidder's bond, or cashier's or certified check accompanying this proposal and the money payable thereon shall become and shall remain the property of the Town of Fairfax.
___ , or partnership ___ , organized under
Bidder confirms license( s) required by California State Contractor's License Law for the performance of the subject project are in full effect and proper order. The following are the Bidder's applicable license number(s), with their expiration date(s) and class of ficense(s):
If the Bidder is a joint venture, each member of the joint venture must include the required licensing information.
Sureties that will furnish the Faithful Performance Bond and the Labor and Material Payment Bond, in the form specified herein, in an amount equal to one hundred percent (100%) of the contract price within ten (10) working days from the date the Town provides the successful bidder the Notice of Award. Sureties must meet all of the State of California bonding requirements, as defined in California Code of Civil Procedure Section 995.120 and must be authorized by the State of California.
The insurance company or companies to provide the insurance required in the contract documents must have a Financial Strength Rating of not less than "A-" and a Financial Size Category of not less than "Class VII" according to the latest Best Key Rating Guide. At the sole discretion of the Town, the Town may waive the Financial Strength Rating and the Financial Size Category classifications for Workers' Compensation insurance. (signatures continued on next page)
-20- 00 41 43-8ID FORMS
38072.0000 l \34443465.1
I hereby certify under penalty of perjury under the laws of the State of California that all of the information submitted in connection with this Bid and all of the representations made herein are true and correct.
(Bidders Name - Print or Type)
( Corporate Seal)
Names of individual members of firm or names and titles o a I officers of corporation and their addresses are listed below:
Name Title
------------ ------------------
Complete Address __________________________ _
Phone _______________ FAX _______________ _
Name ____________ Title _________________ _
Complete Address ___________________________ _
Phone FAX
--------------- ----------------
-21- 00 41 43 - BID FORMS
38072.00001\34443465. l
1.2 Bid Bond
[Note: Not required when other form of Bidder's Security, e.g. cash, certified check or cashier's check, accompanies bid.]
The makers of this bond are, RWR Construction, Inc. , as Principal, and Developers Surety and Indemnity Company , as Surety and are held and finnly bound unto the Town of Fairfax, hereinafter called the Town, in the penal sum of TEN PERCENT (10%) OF THE TOTAL BID PRICE of the Principal submitted to Town for the work described below, for the payment of which sum in lawful money of the United States, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH that whereas the Principal has submitted the accompanying bid dated August 13 20 for 103 ROCCA ROADWAY STABILIZATION ANO RETAINING WALL PROJECT If the Principal does not withdraw its Bid within the time specified in the Contract Documents; and if the Principal is awarded the Contract and provides all documents to the Town as required by the Contract Documents; then this obligation shall be null and void. Otherwise, this bond will remain in full force and effect.
Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract Documents shall in affect its obligation under this bond, and Surety does hereby waive notice of any such changes.
In the event a lawsuit is brought upon this bond by the Town and judgment is recovered, the Surety shall pay all litigation expenses incurred by the Town in such suit, including reasonable attorneys' fees, court costs, expert witness fees and expenses.
By their signatures hereunder, Surety and Principal hereby confirm under penalty of perjury that surety is an admitted surety insurer authorized to do business in the State of California.
IN WITNESS WHEREOF, the above-bound parties have executed this instrument under their several seals this~ day of August , 201.!._, the name and corporate seal of each corporation. (Corporate Seal)
By
Developers Surety and Indemnity Company
(Corporate Seal)
::~ ~c,
(Attach Attorney-in-Fact Certificate) Title Rose Vittiglio, Attorney-In-Fact -22- CO 41 43- BID FORMS
3K072(XJOOl\3..i443-l65. I
Acknowledgement Form
State of FLORIDA )
)ss.:
County of SEMINOLE
On the
_
8 _
th
__ day of _Ju_ly ____ in the 2024 before me, the undersigned notary public, personally appeared _R_os_'e_V_it_tig_l_io _______ , personally known to me or proved to me on the basis of satisfactory evidence to be the individual(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 capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.
AUDAIANNA L MARTINEZ
NOTARY PUBUC
STATE Of FLORIDA
NO. HH 529811
MY COMMISSION EXPIRES JUN. 17, 2028
otary Public
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF 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, aJ]d not the truthfulness, accuracy, or validity of that document.
State of California }
}
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 th.e person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
1/
WITNESS my hand and offif ~1._ ~-···········~ J. C. LOPEZ URIOSTEGUI • - Notary Public • Caiiforni~ ! Marin County f Commission# 2475909 -
-~- My Comm. Expires Jan 7, 2028
Notary Public Signature l, ( (Notary Public Seal)
INS1RUCTIONS FOR COMPLETING THIS FORM
ADDITIONAL OPTIONAL INFORMATION This form complieswith cun-en.t California statules regarding nota,y wording and, DESCRIPTION OF, THE A TT AC D DOCUMENT if needed, should be completed and attached to the document. Acknowledgments (TiUe or description of attached document continued)
Number of Pages __ Document Date ___ _
CAPACITY CLAIMED BY THE SIGNER
Individual (s)
Corporate Officer
(Title)
Partner(s)
Attorney-in-Fact
Trustee(s)
Other _________ _
2015 Version www.NotaryClasses.com .800~873~9865 .
from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California nota,y Jaw.
• State and County infonnation must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/ttley;- is /are) or circling the correct forms. Failure to correctly indicate this infonnation may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. hnpression must not cover text or lines.· If seal impression smudges, re-seal if a sufficient area pennits, otherwise complete a different acknowledgment fonn. • Signature of the notary public must match the signature on file with the office of the county clerk. •
Additional infonnation is not required but could help to ensure this acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document_ with a staple.
POWER OF A TTORNF:Y FOR
COREPOINTE INSllRANCE COMPANY
DEVELOPERS SURETY AND 11\'DEMi\Tf\' C0:\•1PA,"W
59 Maiden Lane, 43rd Ftoor. New York. NY 10038
(212) 220-7120
KNOW ALL BY THESE PRESENTS thut, except as expressly lnmtcd herein, C'OREPOINTE INSURANCE COMPANY and DEVEIJWr:RS SURETY AND INDEMNITY COMPANY, <lo hereby make, constitute and appoint R
__ os_e_V_i_tti.cc.g_lio_,_B_a_rr~y_P_a_ge_,_B_o_n_ni_e_R_o_b_b_in_s._M_ar_s_ha_W_e_n_dt_, _C_ha_r_le_s_B_o_m_a_z_ia_n_, J_e_a_n_E_._L_iu_a_n_d_B_r_en_n_a_T_u_c_ce_l_li __ , of Longwood, FL as its true and lawful Attorney-in-Fact, to make, execute, <lelivcr and acknowledge, for and on behalfof said companies, as sureties, bonds, tmdcrtakmgs and contracts of surctyship giving an<l granting unto said Attomey-m-fact lull power and authority to do and to perform every act nL'Cessary. requisite or proper to be done in conn;:ction therewith as each of said company could <lo, but reserving to each of said company fi.111 power of substitution and revocation, and all of the acts of said Attorney-in-Fact pursuant to thl!'se presents, are hereby rat1fie<l and confirmed. 'Tl1is Power of Attorney 1s etlcctive April 3, 2023 ... -···•········-·-·· and shall expin.> on December 3 I. 2025
111is Power of Attorney is granted and is signed under and by authority of the following resolutions adopted by the Board of Directors ofCOREPO!NTE INSURANCE COMPANY and DEVELOPERS SURETY ANO INDEMNITY COMPANY tco!lectivcly, ··company''! on February 10, 2023 RESOLVED. that .fut~l':rwntio.a. James Bell Vice President Surety Underwriting, and ~utive Underwriter.
Surro. each an employee of AmTrust North America Inc .. an affiliate of the Company {the "Authorized Signors"}. are hereby authorized to execute a Power of Attorney. qualifymg attorney(s}-in-fact named 111 the Power of Altorm.")' to execute. on behalf of the Company. bon<ls. undertakings and contract~ or surelyship. or other suretyship obligations: and that the Secretary or any Assistant Secretary oftlic Company be, a11d each of them hereby is. authorized to attest the execution of any such Po,ver of Attorney
RESOLVED. that the signature of any one of the Authorized Signors and the St'Crctary or any Assistant Secretary of the Company. and the seal of the Company must be affixed to any such Power of Attorney, and any such signature or seal may be affixed by facsimile, and such Power of Attorney shall be valid and bmding upon the Company \\ii1en so affixed and in the future with rcspt'l:t to any bond, undertaking or comracl of surelyship to which It 1s attached IN WITNESS WHEREOF, COREPOJNTE INSURANCE COMPANY and DEVELOPERS SURETY ,AND lNDEMNffY COMPANY have caused thcSe presents to be Title-: President. Surety Unden.-vT1ting
ACKNOWLEDGEMENT:
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.
STA"IT OF _C_.a_li_fo_n_,_ia _________ _ COUNTY OF _O_r_an~g~c ________ _ On this 27 day or March , 20 23 . before me, _Hoang-Quven Phu Pham . personally appeared _Sa_· m_Z_,az_·-_a ________ _ who proved to me on the basis or satisfactory evidence to be the person whose name is subscribed to within the instrument and acknmvlcdgcd to me that they executed the same in their authorized capacity. and that by the signature 011 the instmment the entities upon behalf which the person acted. executed this instnuncnL l ccrtily, under penalty ofperjurv. under the laws of the State of_(=~a'-'-'l""1t ___ o""'n-'11-"-a _________ that the foregoing paragraph is true and correct WITNESS my hand and official seal.
CORPORATE CERTIFICATION
•••••••• f
HOANG-QUYEN P. PHAM
Notary Public • Clltforn~ z
Orange County J
Commission I tMy Comm. Expires Dec 11, 2026
-
·111c undersigned, the Secretary or Assistant S1.-crctary of COREPOINTE INSURANCE COMPANY and DEVELOPERS SURETY AND INDEMNITY COMPANY, does hereby certify that the provisions of U1c rcsol utions of the respective Boards of Oircdors of said corporations ~et forth in this Power of Attorney are in force as ofthc date of this Certification
llm Certification is ex~-cutcd in the City of Cleveland, Ohio, this March 19, 2023 r:ocuSigned by:
sy -e;__.,.a ...... m ..... 1 ....... W=----&"-'"!1>-St.,.,,.,. ------- os641serAOe54sc."' Barry W. Moses. Assistant Secretary OocuSignEnvelopelD:3352BFO6-5E9O-4 796-837E-C i E455E6530F Signed and sealed this 8th day of August, 2024.
POA No. N/A
-------
Ed. 0323
1.3 List of Subcontractors
In compliance with the Subletting and Subcontracting Fair Practices Act Chapter 4 ( commencing at Section 4100 ), Part 1, Division 2 of the Public Contract Code of the State of California and any amendments thereof, Bidder shall set forth below: (a) the name and the location of the place of business, (b) the California contractor license number, ( c) the DIR public works contractor registration number unless exempt pursuant to Labor Code Sections 1725.5 and 1771.1, and(d) the portion of the work which will be done by each subcontractor who will perform work or labor or render service to the Bidder in or about the construction of the work or improvement to be performed under this Contract in an amount in excess of one-half of one percent (0.5%) of the Bidder's Total Bid Price. Notwithstanding the foregoing, if the work involves the construction of streets and highways, then the Bidder shall fist each subcontractor who will perform work or labor or render service to the Bidder in or about the work in an amount in excess of one-half of one percent (0.5%) of the Bidder's Total Bid Price or $10,000, whichever is greater. No additional time shall be granted to provide the below requested information.
If a Bidder fails to specify a subcontractor or if a contractor specifies more than one subcontractor for the same portion of work, then the Bidder shall be deemed to have agreed that it is fully qualified to perform that portion of work and that it shall perform that portion itself.
Work to be
done by
Subcontractor
38072.0000 I \34443465. l
Name of
Subcontractor
Location of
Business
-25-
CSLB
Contractor
License No.
DIR
Registration
Number
%of
Work
00 41 43-BID FORMS
CSLB DIR Work to be Name of Location of Contractor Registration % of done by Subcontractor Business License No. Number Work Subcontractor (Attach additional sheets if necessary)
Name of Bidder____.. ___ _
Name and Title
Dated
-26- 00 41 43- BID FORMS
3 8072.0000 l \34443465. I
1.4 Bidder Information and Experience Form
ARTICLE 1. INFORMATION ABOUT BIDDER
(Indicate not applicable ("N/A") where appropriate.)
NOTE: Where Bidder is a joint venture, pages shall be duplicated and information provided for all parties to the joint venture.
1.0 Name of Bidder:
3.0 Bidder Address:
4.0 5.0
6.0 Facsimile Number Telephone Number
Ho~ ~ny years has Bidder's organization been in business as a Contractor? c,:, y,l(;r5;
How man~ears has Bidder's organization been in business under its present name? __.._N__n ...... --------
5.1 Under what o or former names has Bidder's organization operated? __ 1...::&....f--11:..,_----------------
If Bidder's organization is a corporation, answer the following: 6.1 Date of Incorporation: 1'1112
6.2 State of Incorporation: ()A 6.3 President's Name:
6.4 Vice-President's Name(s):
6.5 Secretary's Name: NI rt
6.6 Treasurer's Name: tJ/B
-27- 00 41 43 BID FORMS
38072.0000 I \34443465.1
7 .0 If an individual or a partnership, answer the following:
8.0 9.0
7.1 Date of Organization: _N.___,,_/_A ____________ _
I
7.2 Name and address of all partners (state whether general or limited partnership):
NIA
I
If other than a corporation or partnership, describe organization and name principals:
NIA
I
List other states in which Bidder's organization is legally qualified to do business. t4 /A10.0 What type of work does the Bidder normally perform with its own forces?
11.0 Has Bidder ever failed to complete any work awarded to it? If so, note when, where, and why:
No
12.0 Within the last five years, has any officer or partner of Bidder's organization ever been an officer or partner of another organization when it failed to complete a contract? If so, attach a separate sheet of explanation:
ND
-28- 00 41 43- BID FORMS
38072.00001\34443465.l
13.0 List Trade References:
14.0 List Bank References (Bank and Branch Address):
15.0 Name of Bonding Company and Name and Address of Agent:
[REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK]
-29- 00 41 43- BID FORMS
38072.0000 l \34443465. I
ARTICLE 2. LIST OF CURRENT PROJECTS (BACKLOG)
[**Duplicate Page if needed for listing additional current projects.**] Project
3 8072. 0000 I \34443465 .1
Description of
Bidder's Work
Completion Date
-30-
Cost of Bidder's
Work
00 41 43 - BID FORMS
ARTICLE 3. LIST OF COMPLETED PROJECTS - LAST THREE YEARS [**Duplicate Page if needed for listing additional completed projects.**] Please include only those projects which are similar enough to demonstrate Bidder's ability to perform the required Work.
Project
38072.0000 l \34443465.1
Description of
Bidder's Work
-31-
Completion Date Cost of Bidder's
Work
00 41 43-8ID FORMS
ARTICLE 4. EXPERIENCE AND TECHNICAL QUALIFICATIONS QUESTIONNAIRE Personnel:
The Bidder shall identify the key personnel to be assigned to this project in a management, construction supervision or engineering capacity.
1. List each person's job title, name and percent of time to be allocated to this project:
2. Summarize each person's specialized education:
3. List each person's years of construction experience relevant to the project:
4. Summarize such e;cperience:
- Ltj...t10V
Bidder agrees that personnel named in this Bid will remain on this Project until completion of all relevant Work, unless substituted by personnel of equivalent experience and qualifications approved in advance by the Town.
Changes Occuring Since Prequa/ification
If any substantive changes have occurred since Bidder submitted its prequalification package for this Project, Bidder shall list them below. If none are listed, Bidder certifies that no substantive changes have occurred.
-32- 00 41 43-BID FORMS
38072.00001 \34443465.1
Additional Bidder's Statements:
If the Bidder feels that there is additional information which has not been included in the questionnaire above, and which would contribute to the qualification review, it may add that information in a statement here or on an attached sheet, appropriately marked:
ARTICLE 5. VERIFICATION AND EXECUTION
These Bid Forms shall be executed only by a duly authorized official of the Bidder:
I declare under penalty of perjury under the laws of the State of California that the foregoing information is true and correct:
Name oni C tA. ft\ A ()\ o
r.
Title v1!V\·l,( MAVla:jtf
Date i"/12/ Vj
-33- 00 41 43- BID FORMS
38072.00001 \34443465. l
1.5 Non-Collusion Declaration
The undersigned declares:
The Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization1 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 company1 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 and c rect and that '\this, declar~tion is executed on IO: [date], at ..:;..Ji..- [city], Ca \t fo ( V'\ l tt,, rstateJ.
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38072.0000 l \34443465. l
1.6 Iran Contracting Act Certification.
(Public Contract Code section 2200 et seq.)
As required by California Public Contract Code Section 2204, the Contractor certifies subject to penalty for perjury that the option checked below relating to the Contractor's status in regard to the Iran Contracting Act of 2010 (Public Contract Code Section 2200 et seq.) is true and correct:
The Contractor is not:
(1) identified on the current list of person and entities engaged in investment activities in Iran prepared by the California Department of General Services in accordance with subdivision (b) of Public Contract Code Section 2203; or (2) a financial instruction that extends, for 45 days or more, credit in the amount of $20,000,000 or more to any other person or entity identified on the current list of persons and entities engaging in investment activities in Iran prepared by the California Department of General Services in accordance with subdivision (b) of Public Contract Code Section 2203, if that person or entity uses or will use the credit to provide goods or services in the energy sector in Iran. 0 The Town has exempted the Contractor from the requirements of the Iran Contracting Act of 2010 after making a public finding that, absent the exemption, the Town will be unable to obtain the goods and/or services to be provided pursuant to the Contract. 0 The amount of the Contract payable to the Contractor for the Project does not exceed $1,000,000.
Printed Name:
Note: In accordance with Public Contract Code Section 2205, false certification of this form shall be reported to the California Attorney General and may result in civil penalties equal to the greater of $250,000 or twice the Contract amount, termination of the Contract and/or ineligibility to bid on contracts for three years.
<Month> <Year>
Pipeline Project XX.XX
38072.00001 \3444346S. I
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1.7 Public Works Contractor Registration Certification
Pursuant to Labor Code sections 1725.5 and 1771.1, all contractors and subcontractors that wish to bid on, be listed in a bid proposal, or enter into a contract to perform public work must be registered with the Department of Industrial Relations. See http://www.dir.ca.gov/PublicWorks/PublicWorks.html for additional information.
No bid will be accepted nor any contract entered into without proof of the contractor's and subcontractors' current registration with the Department of Industrial Relations to perform public work.
Bidder hereby certifies that it is aware of the registration requirements set forth in Labor Code sections 1725.5 and 1771.1 and is currently registered as a contractor with the Department of Industrial Relations. 1
Name of Bidder: R
----------------
DIR Registration Number: I O OD tf O Lf '+ d 8, DIR Registration Expiration:
Small Project Exemption: ___ Yes or ___ No
Unless Bidder is exempt pursuant to the small project exemption, Bidder further acknowledges:
1. Bidder shall maintain a current DIR registration for the duration of the project.
2. Bidder shall include the requirements of Labor Code sections 1725.5 and 1771.1 in its contract with subcontractors and ensure that all subcontractors are registered at the time of bid opening and maintain registration status for the duration of the project.
3. Failure to submit this form or comply with any of the above requirements may result in a finding that the bid is non-responsive.
Signature __ ..,,..
Name and Tit
Dated
1 If the Project is exempt from the contractor registration requirements pursuant to the small project exemption under Labor Code Sections 1725.5 and 1771.1, please mark "Yes" in response to "Small Project Exemption." <Month> <Year> -36- 00 41 43- BID FORMS
Pipeline Project XXXX
38072.00001 \34443465. I
1.8 Contractor}s Certificate Regarding Workers' Compensation.
I am aware of the provisions of section 3700 of the Labor Code which require 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 the work of this Contract.
Name of Bidder
Signature
Name
Title
Dated
<Month> <Year>
Pipeline Project XX.XX
3 8072.0000 I \34443465 .1
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