CITY OF LAKE ELSINORE
CIP Project No. Z10004
SECTION C
BID DOCUMENTS
B-6
CITY OF LAKE ELSINORE
CIP Project No. Z10004
BIDDER'S PROPOSAL
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM
CIP PROJECT NO. Z10004
Company:. Interstate striping INC.
Honorable Mayor, Members of the Council:
In accordance with the Notice Inviting Bids pertaining to the receiving of bid proposals by the City of Lake Elsinore for the above titled improvement, the undersigned hereby proposes to furnish all Work to be performed in accordance with the Specifications, Standard Drawings, and the Contract Documents, for the unit price or lump sum set forth in the following schedule:
COST PROPOSAL SHEET - ANNUAL STREET STRIPING SERVICES
ITEM DESCRIPTION OF ITEMS UNIT PRICE QUANTITY TOTAL
No.
1 4" Broken lane line paint 0.09 15000 $1,350.00
2 4" Solid lane line White or Yellow paint 0.17 9000 $1,200.00 3 Double Yellow paint 0.20
10,000 $2,000.c0
4 Detail 22 paint LF 0.09 20000
,800.10
5 6" Solid White line D39/39A Paint LF 0.10 25,000 52,500.00 6 8" Solid DET 38A Paint LF 0.20 5, ice
7 551,020.00
8" Solid DET 38 Paint LF 0.10 5,00 500.00
8 12" White or Yellow Thermo LF 3.00 32,000
$ 912, 020.00
9 4" Detail 15 Paint LF 0.10 24, 00
ДА § 7, 400.c
10 4" Detail 16 Paint LF 0.20
15,000 i3,00. с
11 Words Thermo SF 3.00 15, ско
12 $45,000.00
Symbols & Numbers Thermo SF 3,00 $45,000.c0
13 Arrows Thermo SF 3,00 15,8,000 $ 24,000.00
14 Layout PER HR 300.00 $300.00
15 Curb Paint LF 1.50 1,000
$1,500.00
16 Remove Paint Striping LF 0.50 $10,000.00
17 20,00
Remove Thermo Striping LF 0.50 30,00
18 $15,000.c0
Remove Paint Markings SF 1.00
19 20, cu 520, 000.00
Remove Thermo Markings SF 1. W
20 20,000 $ 20, 00.00
4" Broken Lane Line Thermo LF 0.25 10, 000 #2,500.c0
21 4" Double Yellow Thermo Detail 21 LF 0.35 20,00 21, 0000. c 22 4" Solid Detail 27B Thermo LF 0,30 30,00 $ 9,000. cl 23 6" Broken Lane Line Thermo LF 0.30
24 $ 6,000.00
6" Double Yellow Thermo Detail 21 LF 0,85 $ 12,750.00
25 Two Way Left Detail 31 Thermo LF 0,80 10,00 88,000.00 26 8" Skip Detail 37B Thermo LF 0,70 10,000 $ 7, 000.00 27 8" Solid Detail 38A Thermo LF 0.75 15,000 $ 11,250.00 28 6" Solid Detail 39 & Detail 39A Thermo LF 0.00 20,00 $ 12, 000. 00 29 4" Skip Detail 40 Thermo LF 0,40 10,000 14,000.00
30 Install Reflective Markers EA 10.00 510.00
31 Install Blue Markers EA 12,00 $ 12.00
32 Install Sign on Existing Post EA 250.00 $250.10
33 Install Sign and Post EA 350.00 $350,00
34 Remove Markers EA 2.C0 9 21C0
35 Traffic Control EA 1,000.c0 $ 1,00,0
TOTAL $373, 6074.00
C-7
CITY OF LAKE ELSINORE
CIP Project No. Z10004
Material Markup: .% (percent)
*Normal Business Hours: 7:30 a.m. to 5:30 p.m. (Monday - Friday) **Emergency and After-Hours Service: 5:30 p.m. to 7:30 a.m. (Weekends and Holidays) TOTAL BID PRICE:
$_ 373, яти. с
Total Bid Price in Numbers
Three hundred seventy three thousand six hundred
Total Bid Price in Written Form and seventy four dollars d zero cents
In case of discrepancy between the written price and the numerical price, the written price shall prevail.
Note:
Estimated quantities are for the purpose of Bid comparison only; payments will be made on the basis of actual measurement of Work completed, except for lump sum (LS) and final pay (F) quantities. (S) denotes a specialty item. The Bid Price shall include, but not be limited to, sales tax and all other applicable taxes and fees.
All work described on the plans and in the specifications and other incidentals necessary to complete the project shall be paid under items above. No additional payments will be allowed. *BID MAY BE REJECTED IF TOTAL IS NOT SHOWN FOR BOTH FIGURES AND WORDS.
CITY OF LAKE ELSINORE
CIP Project No. Z10004
The undersigned agrees to enter into and execute a contract, with necessary bonds, at the unit prices set forth herein and in case of default in executing such contract, with necessary bonds, the check or bond accompanying this bid and the money payable thereon shall be forfeited thereby to and remain the property of the City of Lake Elsinore.
The above unit prices include all work appurtenant to the various items as outlined in the Specifications and all work or expense required for the satisfactory completion of said items. Ir case of discrepancies between unit prices and totals, the unit prices shall govern.
The undersigned declares that it has carefully examined the Plans, Specifications, and Contract Documents, and has investigated the site of the work and is familiar with the conditions thereon.
Contractor
Interstate Striping, Ina
Date: 11/21/2023 By No stephante Acosta
Contractor's State License No: 10 87|40
Class:_ C32
Department of Industrial Relations Registration No: 1000800044 Registration Date: 60/30/2022 Expiration Date: L/30 2026 Address: 9784 poplar Ave
Fontana, Ca 92335
Phone: 909.774-9803
FAX: vone
C-9
CITY OF LAKE ELSINORE
CIP Project No. Z10004
ACKNOWLEDGMENT OF ADDENDA RECEIVED
ANNUAL TRAFFIC STRIPING AND 21GE PROGRAM PROJECT
The Bidder shall acknowledge the receipt of addenda by placing an "X" by each addendum received.
Addendum No. 1
Addendum No. 2.
Addendum No. 3_
Addendum No. 4
If an addendum or addenda have been issued by the City and not noted above as being received by the Bidder, the Bid Proposal may be rejected.
Bidder's Signature " 21 2023.
Stephante Acosta president
Print Name Title
C-10
CITY OF LAKE ELSINORE
CIP Project No. Z10004
NON-COLLUSION AFFIDAVIT
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
STATE OF CALIFORNIA
SS
COUNTY OF San Bernardino)
(NAME). Stephanie Acosta
affiant being first duly sworn, deposes and says:
That he or she is President _ of
(sole owner, partner or other proper title)
interstati striping InC the party making the foregoing Bid, that the Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the Bid is genuine and not collusive or sham; that the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a false or sham Bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any Bidder or anyone else to put in a sham Bid, or that anyone shall refrain from bidding; that the Bidder has not in any manner, directly or indirectly sought by agreement, communication, or conference with anyone to fix the bid price of the Bidder or any other Bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other Bidder, or to secure any advantage against the public body awarding the Contract of anyone interested in the proposed Contract; that all statements contained in the Bid are true; and, further, that the Bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company associations, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham Bid. (Public Contract Code Section 7106) Address: 9784 poplar Al, fontana, ca 92335
Telephone No.: 909-774-9803
Print Name: shante Alosta
Signature:_
Title:_ president Date: 11/21/2023
SIGNING INSTRUCTIONS TO THE CONTRACTOR
C-11
ACKNOWLEDGMENT
A notary public or other officer completing this
State of California SAN BERNARDINO County of
On NOVEMBER 21, 2023 before me,_ STEVEN SANCHEZ, NOTARY PUBLIC (insert name and title of the officer)
personally appeared STEPHANIE ACOSTA
who proved to me on the basis of satisfactory evidence to be the person(g) whose name(s)is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/be?/their authorized capacitylies), and that by hisked/their signature(&) on the instrument the person(s), or the entity upon behalf of which the person(8) 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.
STEVEN SANCHEZ
WITNESS my hand and official seal. Notary Public • California San Bernardino County
Commission # 2341591|
My Comm. Expires Jan 16, 2025
Signature (Seal)
CITY OF LAKE ELSINORE
CIP Project No. Z10004
BOND NO. N/A
BIDDER'S BOND
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
KNOW ALL MEN OR WOMEN BY THESE PRESENTS:
That we _ Interstate Striping, Inc. _ as PRINCIPAL,
hereinafter referred to as "Contractor", and U.S. Specialty Insurance Company a duly authorized corporate as "Surety," are held and firmly bound unto the City of Lake Elsinore ir he penal sum of TEN PERCENT (10%) OF THE TOTAL AMOUNT OF THE BID of the Contracto above named, submitted by said Contractor to the City of Lake Elsinore for the work for said project entitled above, for the payment of which sum in lawful money of the United States, well and truly to be made, to the City of Lake Elsinore to which said bid was submitted, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. In no case shall the liability of the surety hereunder exceed the amount of ten percent of the amount bid.
THE CONDITION OF THIS OBLIGATION IS SUCH:
That whereas the Contractor has submitted the above-mentioned Bid to the City of Lake Elsinore as aforesaid for the work for said project entitled above.
NOW, THEREFORE, if the aforesaid Contractor is awarded the Contract and, within the time and manner required under the Contract documents, after the prescribed forms are presented to him or her for signature, enters into a written Agreement in the prescribed form and in accordance with the Contract documents, and files two bonds with the City of Lake Elsinore, one to guarantee faithful performance and the other to guarantee payment for labor and materials, in accordance with said Contract documents, and as required by law, and files the required insurance certificate(s) in accordance with said Contract documents, then this obligation shall be null and void; otherwise, it shall be and remain in full force and effect until execution of the Agreement or forfeiture pursuant to the Provisions of Sections 20172 and 20174 of the Public Contract Code.
In the event suit is brought upon this bond by the City and judgment is recovered, the Surety shall pay all costs incurred by the City in such suit, including a reasonable attorney fee to be fixed by the court.
(SIGNATURE PAGE FOLLOWS)
C-12
CITY OF LAKE ELSINORE
CIP Project No. Z10004
BIDDER'S BOND SIGNATURE PAGI
INNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJEC
CIP PROJECT NO. Z10004
IN WITNESS WHEREOF, we have hereunto set our hands and seals on this i4thday of_November _ 20 23
BIDDER: CORPORATE SURETY:
Contractor Name: Interstate Striping, Inc. Company Name: U.S. Specialty Insurance Company Address: 9784 Poplar Ave. Address: 1 MacArthur Place, Suite 550 Fontana, CA 92335 Santa Ana, CA 92707
Telephone No.: 909-774-9803 Telephone No.: 714-740-7000 Print Name: Stephante Acosta Print Name: James Scott Salandi Title: president Title: Attorney-in-fact
Signature: Signature:
Date: 1121/2023 Date:
SIGNING INSTRUCTIONS TO THE CONTRACTOR
Bidder's Bond must be accompanied by notary certificates for EACH signature. Note the description of the document on the notary certificate. Attach BOTH notary certificates Corporate Seal may be affixed hereto.
The attorney-in-fact for corporate surety must be registered, as such, in at least one county in the State of California. Attach one original Power of Attorney immediately following the notary certificates.
none esponse to mi by sign of omits the required signatures, the bid will be considered C-13
ACKNOWLEDGMENT
A notary public or other officer completing this
State of California SAN BERNARDINO County of
On NOVEMBER 21, 2023 before me, STEVEN SANCHEZ, NOTARY PUBLIC (insert name and title of the officer)
personally appeared STEPHANIE ACOSTA
who proved to me on the basis of satisfactory evidence to be the person(8) whose name(s) islare subscribed to the within instrument and acknowledged to me that he/she they executed the same in his/Ker/their authorized capacity(jes), and that by his/ked/their signature(s) on the instrument the personts), or the entity upon behalf of which the person(6) 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.
STEVEN SANCHEZ
WITNESS my hand and official seat. Notary Public - California San Bernardino Countyl
Commission # 2341591
My Comm. Expires Jan 16, 2025
Signature (Seal)
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, and not the truthfulness, accuracy, or validity of that document State of California }
County of San Bernardino - }
On Novembu 14, 223_ before me, Tina Downey, Notary Public (Here insert name and title of the officer)
personally appeared James Scott Salandi
who proved to me on the basis of satisfactory evidence to be the person(s) whose names) islare subscribed to the within instrument and acknowledged to me that he she/they executed the same in(his/her/their authorized capacity(les), and that by his her/their signature(s) on the instrument the persons, or the entity upon behalt 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.
TINA DOWNEY
WITNESS my hand and official seal. Notary Public - Caiifornia San Bernaraino County
Commission # 2383319
My Comm. Expires Yov 21. 2025
Downey
Notary Public Signature (Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed, should be completed and attached to the document. Acknolwedgents 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 notary law. (Title or description of attached document) • State and County information 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 signers) personally appeared which (Title or description of attached document continued) 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 Number of Pages Document Date 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.
CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/shc/they, is /are) or circling the correct forms. Failure to correctly indicate this • Individual (s) information may lead to rejection of document recording. • Corporate Officer • The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re-seal if a sufficient area permits, otherwise complete a different acknowledgment form. (Title) • Signature of the notary public must match the signature on file with the office of Partners) the county clerk.
Attorney-in-Fact Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document.
Trustee(s) Indicate title or type of attached document, number of pages and date.
Other Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). 2015 Version www.NotaryClasses.com 800-873-9865 • Securely attach this document to the signed document with a staple.
TOKIO MARINE
HC C
POWER OF ATTORNEY
AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company, a California corporation, Texas Bonding Company, an assumed name of American Contractors Indemnity Company, United States Surety Company, a Maryland corporation and U.S. Specialty Insurance Company, a Texas corporation (collectively, the "Companies"), do by these presents make, constitute and appoint:
David S. Jacobson or James Scott Salandi of Irvine California its true and lawful Attorney(s)-in-fact, each in their separate capacity if more than one is named above, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include riders, amendments, and consents of surety, providing the bond penalty does not exceed *****Ten Million***** (****$10,000,000.00****). This Power of Attorney shall expire without further action on April 23rd, 2026. This Power of Attorney is granted under and by authority of the following resolutions adopted by the Boards of Directors of the Companies:
Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions:
Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached IN WITNESS WHEREOF, The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 18"h day of April 2022.
AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING OMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY State of California
County of Los Angeles By:
Daniel P. Aguilar, Vice President
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 On this 18'h day of April 2022, before me, Sonia O. Carrejo, a notary public, personally appeared Daniel P. Aguilar, Vice President of American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S. Specialty Insurance Company who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
SONIA O. CARREJO
WITNESS my hand and official seal. Notary Public - California Clan Cuto
Signature —
1, Kio Lo, Assistant Secretary American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S. Specialty Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies, which is still in full force and effect; furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect.
In Witnessay oreof, I have hereunto set my hand and affixed the seals of said Companies at Los Angeles, California this November Corporate Seals ПОДРАСТОРОВІ PONDING COL
Bond No. BID BOND
SEPT 21, 1H0
Agency No. 17514 STE OFTENE Kio Lo, Assistant Secretary HCCSMANPOA02/2023
visit tmhcc.com/surety for more information
CITY OF LAKE ELSINORE
CIP Project No. Z10004
LIST OF SUBCONTRACTORS
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
Name Under Which Subcontractor is Licensed: None
License Number:
Address of Office, Mill or Shop:
Specific Description of Sub-Contract: and Bid Items of Work:
Name Under Which Subcontractor is Licensed:
License Number:
Address of Office, Mill or Shop:
Specific Description of Sub-Contract: and Bid Items of Work Name Under Which Subcontractor is Licensed:
License Number:
Address of Office, Mill or Shop:
Specific Description of Sub-Contract: and Bid Items of Work:
Name Under Which Subcontractor is Licensed:
License Number:
Address of Office, Mill or Shop: _
Specific Description of Sub-Contract: and Bid Items of Work:
Subcontractors listed in accordance with the provisions of Section 2-3 must be properly licensed under the laws of the State of California for the type of work that they are to perform. Do not list alternate subcontractors for the same work.
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CITY OF LAKE ELSINORE
CIP Project No. Z10004
REFERENCES
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
Failure to demonstrate adequate experience may result in rejection of the bid.
For all public agency projects with a similar scope of work which you have worked on (or are currently working on) in the past two (2) years, provide the following required information:
Name (Firm/Agency) City of Highland
Address _ 27215 Base line Road, Highland, 0992346
Project Title Cry-wide Traffic striping i pavement markings Project Location citywade in Highland
Type of Work paant/ Thermo striping, Markings, Removals t Markers Project Manager Contact Jim Richardson Phone 909-863-0284ex101 Dated Completed 2021/2022 & Contract Amount $$200, cuD.co 2023-ongong
2. Name (Firm/Agency)_ City of upland
Address 4600 1. Evalid Are, uplana, ca 91786
Project THe 2020/2021 t2021/2022 stywide Striping Replacement Project Location CStywide in upland
Type of work poent stripe, thema Mankng, Mankers & signage Project Manager Contact Kirk Swanner_Phone 909-291-2938 Dated Completed 09/2023 Contract Amount $179,527.90
Name (Firm/Agency) City of Diamand Bar
Address_ 2181D Copley onle, Diamand bar, Ca 91765
Project Title Hawkwood drive striping
Project Location Hawkwood drive, diamond bar, ca
Type of Work Thermo striping, Mankers & signs
Project Manager Contact Christian Malping Phone 909-839-7042 Dated Completed 01/2023 Contract Amount $15,500.c0
C-15
CITY OF LAKE ELSINORE
CIP Project No. Z10004
List any other projects (private, older than three (3) years, etc.) that may represent qualifying or similar experience:
4. Name (Firm/Agency) City OF Highland
Address 27215 Baseline Rd, highland, c9 92346
Project Tie City-wade in highland
Project Location_ Striping, s estywide in highland
Type of Work Striping, Markings, Markers, Signs, Removals Project Manager Contact Jim Richardson_ Phone _909-843-0284 ex101 Dated Completed _2020-Decemb Contract Amount $ 50, 000
Name (Firm/Agency)
Address
Project Title
Project Location
Type of Work
Project Manager Contact Phone
Dated Completed Contract Amount
Name (Firm/Agency)
Address
Project Title
Project Location NIA
Type of Work
Project Manager Contact Phone
Dated Completed Contract Amount
C-16
CITY OF LAKE ELSINORE
CIP Project No. Z10004
CONTRACTOR INFORMATION
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
Contractor's License No: 1087140 Class: C32
a. Date first obtained: 02/10/2022 _ Expiration 02/29/2024 b. Has Bidder's License ever been suspended or revoked? NO If yes, describe when and why: sone
c. Any current claims against License or Bond? _ND
If yes, describe claims: sone
Principals in Company (List all - attach additional sheets if necessary):
NAME IITLE LICENSE NO.
(If Applicable)
Stephante Acosta president None
Mans Loshelder RMO 1087140-032
C-17
CITY OF LAKE ELSINORE
CIP Project No. Z10004
VIOLATIONS OF FEDERAL, STATE OR LOCAL LAWS
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
Has your firm or its officers been assessed any penalties by an agency for noncompliance or violations of Federal, State or Local labor laws and/or business or licensing regulations within the past five (5) years relating to your construction projects? YES /NO (circle one)
Federal / State / Local (circle one) NIA
If "YES," identify and describe, (including agency and status): None Nore
Have the penalties been paid? YES / NO (circle one) None Does your firm or its officers have any ongoing investigations by any public agency regarding violations of the State Labor Code, California Business and Professions Code or State Licensing Laws?
YES /NO (circle one)
Code/Laws: Nore
Section/Article: Nore
(r"yes, identify and describe, (including agency and status: Nore Nore
Has Bidder been "default terminated" by an owner (other than for convenience), or has a Surety completed a contract for Bidder within the last five (5) years? YES /NO (circle one)
If "yes," please explain: None
None
4. Has Bidder been cited more than twice for failure to pay prevailing wages in the last five (5) years?
YES /NO> (circle one)
If "yes," please explain: None
None
C-18
CITY OF LAKE ELSINORE
CIP Project No. Z10004
Notes: Providing false information may result in criminal prosecution or administrative sanctions.
The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. 11-21-2023
Signature Date
Stephante Acosta aresident
Print Name
Interstate Striping, Ine.
Contractor Name
C-19
CITY OF LAKE ELSINORE
CIP Project No. Z10004
DISQUALIFICATION OR DEBARMENT
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
YES I( NO (circle one)
If yes, provide the following information (if more than once, use separate sheets):
Date: Entity:
Location:
Reason: _ sone
Provide Status and any Supplemental Statement: None
sore
Nore
Has your firm been reinstated by this entity?
YES/NO (circle one) Nore
Notes: Providing false information may result in criminal prosecution or administrative sanctions.
The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. 112/2023
Signature Date
sterhande Alosta president
Print Name' Title
Interstate stripins, Fre.
Contractor Name
C-20
CITY OF LAKE ELSINORE
CIP Project No. Z10004
If the Bipor fal to properly sigt of omits the required signature, the bid will be considered
UTILITY AGREEMENT
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
The undersigned hereby promises and agrees that in the performance of the work specified in this contract for Project No. Z10004, ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT, (!) (we) (it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary, primary or transmission facilities. The term "Qualified person" is defined in Title 8, California Administrative code, Section 2700, as follows:
Qualified Person: A person who by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved." The undersigned also promises and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal-OSHA requirements.
The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained Signature
By: Stephanie Alasta
Name
THe resident
Interstate stripins, EDe.
Contractor Name
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CITY OF LAKE ELSINORE
CIP Project No. Z10004
PUBLIC CONTRACT CODE
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
Public Contract Code Section 10285.1 Statement
In accordance with Public Contract Code Section 10285.1 (Chapter 376, State. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as detined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1.
Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the Signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution.
Public Contract Code Section 10162 Questionnaire
In accordance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire:
Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation:
Yes_ No
If the answer is yes, explain the circumstances in the following space.
Public Contract Code 10232 Statement
In accordance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federa court has been issued against the Contractor within the immediate preceding two-year perioc because of the Contractor's failure to comply with an order of 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. 11/21/2023
Signature Date
Stephanie Aposta president
Print Name Title
Interstate Striping, Pne.
Contractor Name
C-22
CITY OF LAKE ELSINORE
CIP Project No. Z10004
BOND NO. N/A
BIDDER'S BOND
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
KNOW ALL MEN OR WOMEN BY THESE PRESENTS:
That we _ Interstate Striping, Inc. _ as PRINCIPAL,
hereinafter referred to as "Contractor", and U.S. Specialty Insurance Company a duly authorized corporate as "Surety," are held and firmly bound unto the City of Lake Elsinore in the penal sum of TEN PERCENT (10%) OF THE TOTAL AMOUNT OF THE BID of the Contractor above named, submitted by said Contractor to the City of Lake Elsinore for the work for said project entitled above, for the payment of which sum in lawful money of the United States, well and truly to be made, to the City of Lake Elsinore to which said bid was submitted, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. In no case shall the liability of the surety hereunder exceed the amount often percent of the amount bid.
THE CONDITION OF THIS OBLIGATION IS SUCH:
That whereas the Contractor has submitted the above-mentioned Bid to the City of Lake Elsinore as aforesaid for the work for said project entitled above.
NOW, THEREFORE, if the aforesaid Contractor is awarded the Contract and, within the time and manner required under the Contract documents, after the prescribed forms are presented to him or her for signature, enters into a written Agreement in the prescribed form and in accordance with the Contract documents, and files two bonds with the City of Lake Elsinore, one to guarantee faithful performance and the other to guarantee payment for labor and materials, in accordance with said Contract documents, and as required by law, and files the required insurance certificate(s) in accordance with said Contract documents, then this obligation shall be null and void; otherwise, it shall be and remain in full force and effect until execution of the Agreement or forfeiture pursuant to the Provisions of Sections 20172 and 20174 of the Public Contract Code.
In the event suit is brought upon this bond by the City and judgment is recovered, the Surety shall pay all costs incurred by the City in such suit, including a reasonable attorney fee to be fixed by the court.
(SIGNATURE PAGE FOLLOWS)
C-12
CITY OF LAKE ELSINORE
CIP Project No. Z10004
BIDDER'S BOND SIGNATURE PAGE
ANNUAL TRAFFIC STRIPING MAINTENANCE PROGRAM PROJECT
CIP PROJECT NO. Z10004
IN WITNESS WHEREOF, we have hereunto set our hands and seals on this iLithday of November 2023
BIDDER: CORPORATE SURETY:
Contractor Name: Interstate Striping, Inc. Company Name: U. S. Specialty Insurance Company Address: 9784 Poplar Ave. Address: 1 MacArthur Place, Suite 550 Fontana, CA 92335 Santa Ana, CA 92707
Telephone No.: 909-774-9803 Telephone No.: 714-740-7000 Print Name: Stephante Alosta Print Name: James Scott Salandi Title: president Title: Attorney-in-fact
Signature: Signature:
Date: 1121/2023 Date:
SIGNING INSTRUCTIONS TO THE CONTRACTOR
Bidder's Bond must be accompanied by notary certificates for EACH signature. Note the description of the document on the notary certificate. Attach BOTH notary certificates Corporate Seal may be affixed hereto.
The attorney-in-fact for corporate surety must be registered, as such, in at least one county in the State of California. Attach one original Power of Attorney immediately following the notary certificates.
If the Bidder fails to properly sign or omits the required signatures, the bid will be considered non-responsive and will be rejected.
C-13
ACKNOWLEDGMENT
A notary public or other officer completing this
State of California SAN BERNARDINO County of
On NOVEMBER 21, 2023 before me, STEVEN SANCHEZ, NOTARY PUBLIC (insert name and title of the officer)
personally appeared STEPHANIE ACOSTA
who proved to me on the basis of satisfactory evidence to be the person(8) whose name(s) islare subscribed to the within instrument and acknowledged to me that he/she they executed the same in his/Ker/their authorized capacity(jes), and that by his/ker/their signature(s) on the instrument the personts), or the entity upon behalf of which the person(8) 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.
STEVEN SANCHEZ
WITNESS my hand and official seat. Notary Public - California San Bernardino County
Commission # 2341591
My Comm. Expires Jan 16. 2025
Signature (Seal)
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, and not the truthfulness, accuracy, or validity of that document State of California
County of San Bernardino }
On Novembe 14, 2023 _ before me, Tina Downey, Notary Public (Here insert name and title of the officer)
personally appeared James Scott Salandi
who proved to me on the basis of satisfactory evidence to be the person(s whose names) is/are subscribed to the within instrument and acknowledged to me that (ne)she/they executed the same in(his/her/their authorized capacity(les), and that by (his her/their signature(s) on the instrument the personts), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
TINA DOWNEY
WITNESS my hand and official seal. Notary Public - Caiifornia San Bernardino County
Commission # 2383319
My Comm. Expires Nov 21. 2025
Notary Mule Signature (Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed, should be completed and attached to the document. Acknolwedgents 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 notary law. (Title or description of attached document) • State and County information 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 signers) personally appeared which (Title or description of attached document continued) 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 Number of Pages _ _ Document Date 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.
CAPACITY CLAIMED BY THE SIGNER he/she/they. is /are) or circling the correct forms. Failure to correctly indicate this • Individual (s) information may lead to rejection of document recording.
Corporate Officer • The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re-seal if a sufficient area permits, otherwise complete a different acknowledgment form. (Title) • Signature of the notary public must match the signature on file with the office of Partners) the county clerk
Attorney-in-Fact Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document.
Trustee(s) Indicate title or type of attached document, number of pages and date.
Other _ 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. 2015 Version www.NotaryClasses.com 800-873-9865
TOKIO MARINE
HCC
POWER OF ATTORNEY
AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company, a California corporation, Texas Bonding Company, an assumed name of American Contractors Indemnity Company, United States Surety Company, a Maryland corporation and U.S. Specialty Insurance Company, a Texas corporation (collectively, the "Companies"), do by these presents make, constitute David S. Jacobson or James Scott Salandi of Irvine California its true and lawful Attorneys)-in-fact, each in their separate capacity if more than one is named above, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include riders, amendments, and consents of surety, providing the bond penalty does not exceed *****Ten Million***** (**.*$10,000,000.00****). This Power of Attorney shall expire without further action on April 23rd, 2026. This Power of Attorney is granted under and by authority of the following resolutions adopted by the Boards of Directors of the Companies:
Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions:
Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary.
Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.
IN WITNESS WHEREOF, The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 18'h day of April 2022
AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING OMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY State of California
County of Los Angeles By:
Daniel P. Aguilar, Vice President
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 On this 18" day of April 2022, before me, Sonia O. Carrejo, a notary public, personally appeared Daniel P. Aguilar, Vice President of American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S. Specialty Insurance Company who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
SONIA O. CARRESO
WITNESS my hand and official seal. Notary Public - California Los Ancies Count
Commission / 2398710
ChanCe My Corm. Expires Apr 23, 2026
Signature — (seal)
I, Kio Lo, Assistant Secretary American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S. Specialty Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies, which is still in full force and effect; furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect.
In Witness Whereof, I have here el ket my hand and affixed the seals of said Companies at Los Angeles, California this 141 day of_ Corporate Seals ОДРАСТОРІ OHDING C
Bond No. BID BOND
SEPT. 21, 1H0 stors
Agency No. 17514 SATE CETE Kio Lo, Assistant Secretary
HCCSMANPOA02/2023
visit tmhcc.com/surety for more information