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CITY OF LAKE ELSINORE
CIP Project No. Z10032
SECTION C
BID DOCUMENTS
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
BIDDER’S PROPOSAL
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT CIP PROJECT NO. Z10032
Company: _________________________________________________ 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:
Time of Completion: One Hundred Twenty (120) Working Days from Issuance of Notice to Proceed (NTP) by City to Contractor.
1. BID SCHEDULE A
ITEM
NO. ITEM DESCRIPTION UNIT QUANTITY UNIT COST TOTAL COST
GENERAL ITEMS
1. Mobilization & Demobilization (Not to Exceed 5% of Bid). LS 1
2. Site Maintenance and Best Management Practice LS 1
3. Traffic Control and Public Convenience. LS 1
4. Construction Survey and Re-Establishing Centerline Ties and Monuments. LS 1
SITE DEMOLITION
5. Sawcut, Remove and Dispose of Existing AC Pavement SF 28,460
6. Remove And Dispose of Existing AC Berm LF 505
7. Remove And Dispose of Existing Concrete Headwall w/ Precautionary Measures Taken to Protect the Two
Existing 36" Fiberglass Pipes In-Place for Reuse
LS 1
8. Sawcut, Remove and Dispose of Existing Concrete Curb & Gutter LF 355
9. Sawcut, Remove and Dispose of Existing Concrete Curb Only LF 75
10. Sawcut, Remove and Dispose of Existing Concrete
Sidewalk SF 440
11. Sawcut, Remove and Dispose of Existing Concrete
Cross-Gutter & Curb at T-Intersection SF 1,085
12. Remove Existing Gabion Wall for Reuse (59 LF).
Dispose of Existing Filter Fabric Material. LS 1
13. Remove And Dispose of Existing 7’ Wide Curb Opening Catch Basin w/ Precautionary Measures Taken to
Protect the Existing 15" And 24" Storm Drain Pipes In - Place for Reuse
EA 1
UNCLASSIFIED EXCAVATION, SOIL EXPORT AND GRADING
14. Earthwork Trenching & Stockpiling, Cut-Volume CY 4850
15. Earthwork Backfill and Roadway Grading, Fill-Volume CY 2,700
16. Off-site Hauling and Disposal of Surplus Soil Material (As-Needed) CY 2,150
STREET IMPROVEMENTS
17. Construct 8" Hot Mix Asphalt Dike Per City of Lake Elsinore Std. No. 207 LF 616
18. Construct 4" AC Paving Over 95% Compacted Native
Soils Per Soil Engineer's Recommendations TON 387
19. Construct 6" Thick PCC Residential Driveway Approach Per City of Lake Elsinore Std. No. 207, Width Per Plan SF 340
20. Construct 8" Curb Only, Type 8A Per City of Lake
Elsinore Std. No. 203 LF 56
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
21. Construct 6' Wide Concrete Cross Gutter Only Per
Section A-A Of City of Lake Elsinore Std. No. 209A and
Detail 26 On Sheet 2. Construct Weakened Plane Joints
for Gutter Every 10'
SF 1,425
22. Construct 4' Wide Concrete Ribbon Gutter Per Detail 27 on Sheet 2 SF 2,580
23. Construct 8" Concrete Integral Curb & Gutter Type 8 Per City of Lake Elsinore Std No. 201 LF 80
24. Cold Mill 2" Min. Of Existing AC Pavement, Crack Seal 1/4" Or Larger, And Construct 2" Min. AC Overlay Per
Detail on Sheet 2
SF 1800
25. Construct 3' Long 0" Curb to Full Height Curb Transition LF 6
26. Construct Full Depth AC Paving. Paving To Match
Existing Pavement Section. (4” Min.) SF 415
27. Construct 4" Thick Concrete Sidewalk Per City of Lake Elsinore Std No. 210 SF 575
28. Reinstall Gabion Wall Using Salvaged Materials with New Mirafi 140N Filter Fabric (or Approved Equal) Per
Plan (59 LF)
LS 1
29. Traffic Striping & Markers, and Pavement Legends (4" Double Yellow Striping per Caltrans STD. A20A, Detail
22; 4" White Edge of Traveled Way Line per Caltrans
STD. 27B; Stop Pavement Marking and 12" Limit Line
Striping)
LS 1
30. Re-install Salvaged Traffic Signs with Mounting per City STD. No. 406A. EA 1
31. Install MUTCD Warning Sign W3-1 (CA) With Mounting
Per City of Lake Elsinore Stop Sign Installation Detail Std. Dwg. 406A
EA 1
32. Construct 2” AC (4” AC at Storm Drain Trench) Paving Per Detail on Sheet 2 TON 565
STORM DRAINAGE IMPROVEMENTS
33. Install 15" RCP (D-LOAD Per Profile). Trench And Pipe Bedding Per RCFC&WCD Std. Dwg. No. M815 LF 88
34. Install 18" RCP (d-load per profile). Trench and pipe Bedding Per RCFC&WCD Std. Dwg. No. M815 LF 570
35. Install 24" RCP (D-Load Per Profile). Trench And Pipe Bedding Per RCFC&WCD Std. Dwg. No. M815 LF 72
36. Install 36" RCP (D-Load Per Profile). Trench And Pipe Bedding Per RCFC&WCD Std. Dwg. No. M815 LF 896
37. Install 48" RCP (D-Load Per Profile). Trench And Pipe Bedding Per RCFC&WCD Std. Dwg. No. M815 LF 723
38. Construct Concrete Collar Per RCFC&WCD Std. Dwg.
No. M803 EA 1
39. Construct Catch Basin No. 1 Per RCFC&WCD Std. Dwg.
No. CB100 – 10’ C.B. EA 3
40. Construct Catch Basin No. 1 Per RCFC&WCD Std. Dwg.
No. CB100 – 14’ C.B. EA 3
41. Construct Catch Basin No. 1 Per RCFC&WCD Std. Dwg.
No. CB100 – 21’ C.B. EA 4
42. Construct Catch Basin with Grate Inlets Per SPPWC Std.
Plan No. 301-4 – 14’ C.B. EA 1
43. Construct Catch Basin with Grate Inlets Per SPPWC Std.
Plan No. 301-4 – 21’ C.B. EA 1
44. Construct Manhole No. 2 Per RCFC&WCD Std. Dwg.
M.H. 252 EA 11
45. Construct Junction Structure No. 2 Per RCFC&WCD Std.
Dwg. JS227 EA 1
46. Construct Junction Structure - Pipe to Pipe Per SPPWC Std. Plan No. 332-2 EA 4
47. Install Precast Jensen 24"X36" Catch Basin Model No.
DI243660 With Bolted Down Traffic -Rated Trax Plate
Steel Cover, Slip Resistant and Painted Black Per Detail No. 15 On Sheet 13
EA 1
48. Install Trash Rack (Inclined) Per SPPWC Std. Dwg. 361- 2 EA 1
49. Install 18" CMP Pipe by Cutting Existing 18" CMP and Welding 18" CMP Tee Per Detail 18 on Sheet 13 EA 1
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
50. Install 24" CMP Riser Per Detail 13 On Sheet 15 (CMP Shall Be Polymer Lined Per ASTM Std. A762, AASHTO
Std. M245, Inside and Out)
EA 1
51. Construct Concrete Headwall and Wingwalls Per
Caltrans Std. Plan D90 With Concrete Cutoff Wall - 4.0' Deep, 12" Wide w/ #4 @ 12" E.W.
EA 1
52. Construct Grouted 1/4 Ton Rip-Rap, 2.7 Deep w/ Mirafi 1100N Filter Fabric Per Detail No. 16 on Sheet 13 (3,100 SF)
LS 1
53. Construct Local Depression No. 2 Per RCFC&WCD Std.
Dwg. No. LD201 and Per Detail on Sheet 3 EA 11
54. Connect RCP Pipe to Catch Basin or Manhole Structure Per Plan. Apply Non-Shrink Grout to Form a Water Tight
Seal
EA 56
55. Install 36"x72" Precast Reinforced Concrete Box Per CALTRANS Std. No. D83A D83B LF 554
56. Construct Transition Structure for RCB to Pipe per SPPWC Std. Plan No. 342-2 EA 1
57. Construct Junction Structure to Connect Pipe to RCB per SPPWC Std. Plan No. 333-2 EA 4
58. Construct manhole Structure per SPPWC Std. Plan No. 323-4 EA 2
59. Install (Modified) Cast-in-Place Reinforced Concrete Junction Structure per CALTRANS Std. Plan No. D91A EA 1
60. Install 24" Flap Gate (Hydrogate or Approved Equal) EA 1
61. Remove interfering Portion of Exist. 30" Water Line and Cap Ends. Install 48" Steel Casing per EVMWD Std. Plan
W-6 (Casing Only for Future Use). Cap Ends.
LF 20
62. Install Bio-Clean Full Capture Filter with 21' Trough System Curb Opening Catch Basin Model No. CIF -Full-
24. EA 4
63. Install Bio-Clean Full Capture Filter with 14' Trough System Curb Opening Catch Basin Model No. CIF -Full-
24. EA 2
64. Install Bio-Clean Full Capture Filter with 10' Trough System Curb Opening Catch Basin Model No. CIF -Full-
24. EA 3
65. Install Bio-Clean's Connector Pipe Screen (CPS) Model No. U 4.7 x 24. EA 2
TOTAL BID PRICE:
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.
TOTAL BID PRICE BASED ON BID SCHEDULE TOTAL OF UNIT PRICES FOR
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
$
Total Bid Price in Numbers
$
Total Bid Price in Written Form
In case of discrepancy between the written price and the numerical price, the written price shall prevail.
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
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. In 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
Date: _______________________________ By: ___________________________________
Contractor’s State License No.: _______________________________
Class: ___________________________________________________
Department of Industrial Relations Registration No: ___________________________________
Registration Date: _________________________ Expiration Date: ______________________
Address: ____________________________________________________________________
Phone:
FAX:
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
ACKNOWLEDGMENT OF ADDENDA RECEIVED
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT CIP PROJECT NO. Z10032
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 Date
____________________________________ ____________________ Print Name Title
CIry OF LAKE ELSINORE
CIP Project No.210032
NON.COLLUSION AFFIDAVIT
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJEGT clP PROJECT NO.210032
STATE OF CALIFORNIA )
)SS
)
Tamer Khalil
couNrY oF &\JlwhtD6
(NAME)
affiant being first duly sworn, deposes and says:
That he or she is
(sole owner, partner or other proper title)
Aneen Construction the party making the foregoing Bid,
that the Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, comgany, 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) AddfeSS: ss38 Masnolia, Riversido cAs25o3
Telephone No.:
Prlp[ Jrt2;ps; r"m
Signature:
Date: +nzc
SIGN!NG INSTRUCTIONS TO THE CONTRACTOR
Non-Collusion Affidavit must be accompanied by notary certificates for signature. Note the description of the document on the notary certificate. Attach notarv certificate immediatelv followinq this oaqe. If the Bidder fails to properly sign or omits the required signature, the bid will be considered non-responsive and will be rejected. of
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President
JURAT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of RIVERSIDE
Subscribed and sworn to (or affirmed) before me on
this aTH day of APRIL .,20 24 ,
by rnrurn xHnlll
proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
Signature
(Seal)
K. DUNN
coMM. # 2451484
NOTARY PUBLIC . CALIFORNIA
RIVERSIDE COUNTY
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
LIST OF SUBCONTRACTORS
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO. Z10032
The bidder is required to fill in the following blanks in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Chapter 2 of Division 5, Title 1 of the Government Code of the State of California) and should familiarize itself with Sections 2-3 of the Standard Specifications.
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:____________________________ ____________________________________________________________________________
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. Z10032
REFERENCES
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO. Z10032
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:
1. Name (Firm/Agency) ________________________________________________
Address __________________________________________________________
Project Title ________________________________________________________
Project Location_____________________________________________________
Type of Work ______________________________________________________
Project Manager Contact ____________________ Phone____________________
Dated Completed _______________ Contract Amount ____________________
2. Name (Firm/Agency) ________________________________________________
Address __________________________________________________________
Project Title ________________________________________________________
Project Location_____________________________________________________
Type of Work ______________________________________________________
Project Manager Contact ____________________ Phone____________________
Dated Completed _______________ Contract Amount ____________________
3. Name (Firm/Agency) ________________________________________________
Address __________________________________________________________
Project Title ________________________________________________________
Project Location_____________________________________________________
Type of Work ______________________________________________________
Project Manager Contact ____________________ Phone____________________
Dated Completed _______________ Contract Amount ____________________ C-17
CITY OF LAKE ELSINORE
CIP Project No. Z10032
List any other projects (private, older than three (3) years, etc.) that may represent qualifying or similar experience:
4. Name (Firm/Agency) ________________________________________________
Address __________________________________________________________
Project Title ________________________________________________________
Project Location_____________________________________________________
Type of Work ______________________________________________________
Project Manager Contact ____________________ Phone____________________
Dated Completed _______________ Contract Amount _____________________
5. Name (Firm/Agency) ________________________________________________
Address __________________________________________________________
Project Title ________________________________________________________
Project Location_____________________________________________________
Type of Work ______________________________________________________
Project Manager Contact ____________________ Phone____________________
Dated Completed _______________ Contract Amount ____________________
6. Name (Firm/Agency) ________________________________________________
Address __________________________________________________________
Project Title ________________________________________________________
Project Location_____________________________________________________
Type of Work ______________________________________________________
Project Manager Contact ____________________ Phone____________________
Dated Completed _______________ Contract Amount ____________________ C-18
CITY OF LAKE ELSINORE
CIP Project No. Z10032
CONTRACTOR INFORMATION
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO. Z10032
Contractor’s License No.: ______________________ Class: _____________________
a. Date first obtained: __________________________ Expiration _____________
b. Has Bidder’s License ever been suspended or revoked? ________________ If yes, describe when and why: _____________________________________________
c. Any current claims against License or Bond? _________________ If yes, describe claims: ___________________________________________________
Principals in Company (List all – attach additional sheets if necessary):
NAME TITLE LICENSE NO.
(If Applicable)
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
VIOLATIONS OF FEDERAL, STATE OR LOCAL LAWS
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO. Z10032
1. 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)
If “YES,” identify and describe, (including agency and status):
Have the penalties been paid? YES / NO (circle one)
2. 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:
Section/Article:
If “yes,” identify and describe, (including agency and status):
3. 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: _____________________________
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: _____________________________
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
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.
Signature Date
Print Name Title
__________________________________________________________ Contractor Name
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
DISQUALIFICATION OR DEBARMENT
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO. Z10032
Has your firm, any officer of your firm, or any employee who has a proprietary interest in your firm ever been disqualified, removed, or otherwise prevented from bidding on, performing work on, or completing a federal, state or local project because of a violation of law or a safety regulation?
YES / NO (circle one)
If yes, provide the following information (if more than once, use separate sheets):
Date: _______________ Entity:
Location:
Reason:
Provide Status and any Supplemental Statement: _____
Has your firm been reinstated by this entity?
YES / NO (circle one)
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.
Signature Date
Print Name Title
Contractor Name
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
If the Bidder fails to properly sign or omits the required signature, the bid will be considered non-responsive and will be rejected.
UTILITY AGREEMENT
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT
CIP PROJECT NO. Z10032
HONORABLE MAYOR AND CITY COUNCIL
CITY OF LAKE ELSINORE, CALIFORNIA
The undersigned hereby promises and agrees that in the performance of the work specified in this contract for Project No. Z10032, THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT, (I) (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 re quirements, 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 herein.
Signature
By:
Name
Title
Contractor Name
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CITY OF LAKE ELSINORE
CIP Project No. Z10032
PUBLIC CONTRACT CODE
THE AVENUES MASTER PLAN STORM DRAIN IMPROVEMENT PROJECT CIP PROJECT NO. Z10032
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 __ , has not ________ 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 wor ks contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term “bidd er” 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 federal court has been issued against the Contractor within the immediate preceding two -year period because of the Contractor’s failure to comply with an order of federal court whi ch 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.
Signature Date
Print Name Title
Contractor Name