staff or City Council should be contacted about this procurement during the bidding process. All inquiries and comments regarding this Bid must be communicated in writing, unless otherwise instructed by the City. The City may, in its sole discretion, disqualify any Bidder who engages in any prohibited communications.
BID FORMS
1.1 BID.
Bids will be received at 2525 " Street, Merced, California 95340, until 2 PM on March 921. 2023.
NAME OF BIDDER: T&S Intermodal Maintenance, Inc. dba T&S West City of Merced
2525 "0" Street
Merced, California 95340
The undersigned hereby declare that we have carefully examined the location of the proposed Work. and have read and examined the Contract, including all plans, specifications, and all addenda, if any for the following Project:
REGIONAL PARK RESTROOMS 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 BASE BID PRICE AND ANY SELECTED ALTERNATE indicated herein.
The undersigned acknowledges receipt, understanding, and full consideration of the following addenda to the Contract:
Addenda No. 1. 2.3.4, 5, 6
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.
XII
BASE BID SCHEDULE - REGIONAL PARK RESTROOMS - RAHILLY &
MCNAMARA
ITEM ITEM UNIT OF ESTIMATED UNIT PRICE ITEM TOTAL
NO. MEASURE QUANTITY (IN FIGURES) (IN FIGURES)
1 Permits, Bonds, Licenses & Insurance LS 1 $100,000. 00 $1D0,000"0 2 Public Convenience and Safety LS 1 IS 15,00.00 $_15,000.00 3 Water Pollution Control EA 2 $ 3,000 0s $6,000.00
4 Interior Demolition of Rahilly LS 1 S1S,000.0o $15,000.40 5 Restrooms Fixtures, Rahilly LS 1 $25000.00/825,000.00 6 Exterior Doors EA 2 $5, 001 vo $10,000.00
7 Paint-Rahilly LS 1 $15, .0s 00 $15,000.00
8 Rahilly SS Plumbing Replacement LS 1 $10,004 • 00 $10,000 .00 9 Interior Demolition of McNamara LS $20, 000.00 $ 20,000.00 10 Clearing and Grubbing EA 1 $10, 050.00 $10,078:00
11 4" SDR35 Piping Install LF 85 $ 200 00 $17,080.00
12 1.5" Water Line Install/water service and box EA $12,500.00 812, 600.00 13 Remove Concrete SF 25 30 _0 $ 750.00
14 Install Concrete SF 440 35 $15,400.00
15 CTX Precast Cortez CR-1390 EA 1 $/ 35,008 @ $135,002.00 16 Prepare Subbase/base for Restroom Slab EA 1 $ 20,002.2 $20,001.00 17 Electrical System LS 1 $20,000.00 $20.030.00
18 Relocate Bench and Install New Pad LS 1 53,000. 00 $3,000.20 19 Native Fill Material for Slopes CY 37 $ 100.00 $3,700.00 20 Restoration of Site LS 1 $5000.00|55,000.00
458,350.0
TOTAL BASE BID SCHEDULE ITEMS 1 THROUGH 20 $
XIII
ALTERNATE #1 BID SCHEDULE - REGIONAL PARK RESTROOMS -
APPLEGATE
ITEM ITEM UNIT OF ESTIMATED UNIT PRICE ITEM TOTAL
NO. MEASURE QUANTITY (IN FIGURES) (IN FIGURES)
1 Permits, Bonds, Licenses & Insurance LS $35,091.05 $35,000.10 2 Public Conveyance and Safety LS $3,0tA = $3,000.50
3 Water Pollution Control LS 1 $1,000 00$1,001.03
4 Demolition of Restrooms EA 2
5 Remove Existing Drain and Piping EA 1 $3,000.00 $3,010:60 6 Abandon Lateral Utilities LS $5,050. 00 $5,000 00
7 Prepare Subbase/base for Restroom Slab EA 1 S 1. 00 S 1. 00 8 New Connection to Existing Utilities LS 1 $5,000.00 $ 5,000.40 9 Prepare Subbase/base for Restroom Slab EA 1 $ 20,000.00 $ 20,000.50 10 CT Precast Santiago (Dakota) S-349 EA $220,000.2 $220.000.00 11 Remove Existing Concrete SF 1100 $
18: 01$11, 000:00
12 Install Concrete SF 1291 30.00 $ 38/30.01
13 Electrical System EA $10,050.03 $10,000:03
14 Landscaping 1100 5 0s $5,500.00
15 Native Fill Material for Slopes CY 150 50.00 $ 7,500.00 16 Restoration of Site LS 1 $3,002.00 $3,000.00
TOTAL ALTERNATE #1 BID SCHEDULE ITEMS 1 THROUGH 16 $ 379,731, us XIV
ALTERNATE #2 BID SCHEDULE - REGIONAL PARK RESTROOMS -
FAHRENS
ITEM ITEM UNIT OF ESTIMATED UNIT PRICE ITEM TOTAL
NO. MEASURE QUANTITY (IN FIGURES) (IN FIGURES)
1 Permits, Bonds, Licenses & Insurance LS 1 $35,000.00 $35,000.00 2 Public Convenience and Safety LS 1 $3,000. co $3,00.00 3 Water Pollution Control LS $1, 000.00 S1,000 DA
4 Clearing and Grubbing EA 1 $5,000.00 $5,008.00
5 Demolition of Restrooms LS 1 $10,001. ": 510, 000.00
6 Remove Existing Concrete LF 900 $ 10.50 59, 000.00
7 Remove Trees EA 4 $6,000.00 $24,000.00
8 Abandon Lateral Utilities LS $5,000. 00 $5,000.00
9 4" SDR35 Piping Install LF 70 $ 200.00 $14,000. c0
10 1.5" Water Service and Box LS $12,500 00 812,500.00
11 Prepare Sub base/base for Restrooms EA 1 1$20,010.00 $ 20,000.00 12 CTX Precast Cortez LS 1 $140, 000.00 $/40,000.00
13 Install Concrete SF 434 $ 30 00 $13020.00
14 Native Fill Material for Slopes LS $10, 000.00 S10, 093 to 15 Concrete Bike Path Install SF 1934 30. 00$53,0000
16 Electrical System LS 1 $ 10,010. 00$10,007.00
17 Core into Existing SSMH EA 1 $7,000.00 $7,000.00
18 Landscaping SF 1000 500 $ 5,000.00
19 Restoration of Site LS 1 $ 3000.00 $3,000 I0
TOTAL ALTERNATE #2 BID SCHEDULE ITEMS 1 THROUGH 19 $ 384,540 The costs for any Work shown or required in the Contract, 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.
XV
24 Water • Pollution Contro LS
TOTAL ALTERNATE #2 BID SCHEDULE ITEMS/ THROUGH 24
$
The costs for any Work shown or required in the Contract, 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 City 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 City 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.
TOTAL BASE BID PRICE:
TOTAL BID PRICE BASED ON BASE BID SCHEDULE TOTAL OF UNIT PRICES
FOR REGIONAL PARK RESTROOMS
458,350,00
Total Base Bid Price in Numbers
$ FOUR HUNDRED FIFTY EIGHT THOUSAND, THREE HUNDRED FIFTY-NO CENTS Total Base Bid Price in Written Form
In case of discrepancy between the written price and the numerical price, the written price shall prevail.
TOTAL ALTERNATE #1 BID PRICE:
XVII
TOTAL BID PRICE BASED ON ALTERNATE #1 BID SCHEDULE TOTAL OF UNIT PRICES
FOR REGIONAL PARK RESTROOMS
$- 377, 731
Total Base Bid Price in Numbers
$ THREE HUNDRED SEVENTY SEVEN THOUSAND, SEVEN HUNDRED THIRTY ONE - Total Base Bid Price in Written Form NO CENTS
In case of discrepancy between the written price and the numerical price, the written price shall prevail.
TOTAL ALTERNATE 2 BID PRICE:
TOTAL BID PRICE BASED ON ALTERNATE #2 BID SCHEDULE TOTAL OF UNIT PRICES
FOR REGIONAL PARK RESTROOMS
3244, 540. • Total Base Bid Price in Numbers
" Three hundred eighty four thousand, five hundred forty Total Base Bid Price in Written Form no cents.
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 City 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 City 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 City 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 City, after which the City 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 XVIII
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 Merced 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 wages are on file at the City'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 City of Merced 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 City of Merced.
Bidder is an individual — or corporation _ or partnership _, organized under the laws of the State of_California
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 numbers), with their expiration date(s) and class of license(s):
939001 - A. B - 10.31.2023
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 City 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 must have a Financial Strength Rating of not less than "A-" and a Financial Size Category of not less than "Class VIl" according to the latest Best Key Rating Guide. At the sole discretion of the City, the City may waive the Financial Strength Rating and the Financial Size Category classifications for Workers' Compensation insurance.
XIX
information submitted in connection with this Bid and all of the representations made herein are true and correct.
Executed at LOCkeford, CA on this 31 day or January 2023 (Bidders Name - Print or Type)
Sammy Cox, President
(Name and Title)
(Corporate Seal)
(Signature)
Names of individual members of firm or names and titles of all officers of corporation and their addresses are listed below:
Name Sammy Cox Title President
Complete Address_6540 Austin Rd., Stockton, CA 95215
Phone_209.942.1360 _ FAX_209.942.1368
Name_Larry Cox Title Vice President
Complete Address_6540 Austin Rd., Stockton, CA 95215
Phone_209.942.1360 FAX_209.942.1368
Name_George Faist Title_Secretary / Treasurer
Complete Address_6540 Austin Rd., Stockton, CA 95215
Phone 209.942.1360 _ FAX _209.942.1368
Name N/A Title
Complete Address
Phone FAX_
XX
1.2 BID BOND
[Note: Not required when other form of Bidder's Security, eg. cash, certified check or cashier's check, accompanies bid.]
The makers of this bond are, T&S S INTERMODAL INC. DBA T & S WEST , as Principal, and THE OHIO CASUALTY INSURANCE COMPANY , as Surety and are held and firmly bound unto the City of Merced, hereinafter called the City, in the penal sum of TEN PERCENT (10% OF THE TOTAL BASE BID PRICE of the Principal submitted to City 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 March 16 - 2023, for Project Number 122013 Regional Park Restrooms:
If the Principal does not withdraw its Bid within the time specified in the Contract; and if the Principal is awarded the Contract and provides all documents to the City as required by the Contract; 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 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 City and judgment is recovered, the Surety shall pay all litigation expenses incurred by the City in such suit, including reasonable attorneys' fees, court costs, expert witness fees and expenses.
IN WITNESS WHEREOF, the above-bound parties have executed this instrument under their several seals this 16th _day of March , 2023, the name and corporate seal of each corporation.
(Corporate Scal) T & S INTERMODAL MAINTENANCE INC. DBA T & S WEST Contractor/ Principal
By.
SAmmy Cox
Title_ PRESIDENT
(Corporate Seal) Surety_THE OHIO CASUALTY INSURANCE COMPANY Atomay inFact
(Attach Attorney-in-Fact Certificate) Title_ Karen Amin, Attorney-in-Fact XXI
** Please See Attached**
Notary Acknowledgment
STATE OF CALIFORNIA
COUNTY OF
On - 20 , before me,. _ Notary Public, personally
appeared , who proved to me on the basis of satisfactory I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature of Notary Public
OPTIONAL
Though the infoud prevent a nated red by and relay pront of this ote perant re dog mthe document.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT • Individual
• Corporate Officer
Title(s) Title or Type of Document
• Partners) Limited
General Number of Pages
• Attorney-In-Fact
• Trustee(s)
• Guardian/Conservator Date of Document
Name of Persorts Or Ehilyles)
Signer(s) Other Than Named Above
NOTE: This acknowledgment is to be completed for Contractor/Principal.
XXII
** Please See Attached**
Notary Acknowledgment
STATE OF CALIFORNIA
COUNTY OF
On - 20 , before me, . Notary Public, personally
appeared who proved to me on the basis of satisfactory
evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacityies), and that by his/her/their sie instrume on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature of Notary Public
OPTIONAL
Though the informatior erow a nute red by and lema prent of list to persons re ing on the document
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT • Individual
Corporate Officer
Title(s) Title or Type of Document
• Partners) Limited
General Number of Pages
1 Attorney-In-Fact
Date of Document
Signers) Other Than Named Above
NOTE: This acknowledgment is to be completed for the Attorney-in-Fact. The Power-of-Attorney to local representatives of the bonding company must also be attached.
END OF BID BOND
XXIII
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individua State of California
County of San Joaquin
On March 16, 2023 before me, _ Jennifer Loper, Notary Public (insert name and title of the officer)
personally appeared
who proved to me on the basis of satisfactory evidence to be the person(s) whose names) is/axe subscribed to the within instrument and acknowledged to me that Ke/she/xey executed the same in łs/her/Wei authorized capacity(fes), and that by *i/her/Kef signature(5) on the instrument the person(8), 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.
WITNESS my hand and official seal. JENNIFER LOPER
COMM. #2344049
) NOTARY PUBLIC - CALIFORNUA R
SAN JOAQUIN COUNTY
My Corn. Expires JAN 27, 2025)
(Seal)
This Power of Attorney limits the acts of those named herein, and they have no authority to Liberty bind the Company except in the manner and to the extent herein stated.
Mutual. Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company Certificate No 8207631-969440 SURETY West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the Companies"). pursuant to and by authority herein set forth, does hereby name, constitute and appoint.
Daniel M. Connolly, David Schnapp, Jennifer Loper, Karen Amin all of the city of Lodi, state of CA each individually if there be more than one named, its true and lawful attorney-in- fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 13m day of April 2022
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
West American Insurance Company
INSURANCE CORPORATE RICAN CORPORATEL INSURANCE
MUT «CORPORATY
1912 1919 1991 or land an
ANTINOD
INDIANA
SHI 1S3M David M. Carey. Assistant Secretary
STATE OF PENNSYLVANIA sS
COUNTY OF MONTGOMERY
On this 13th day of April 2022, before me personally appeared David M Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company. The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authonzed so to do. execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written Commonwealth of Pennsy/vana - Notary Seal
Teresa Pastella. Notary Public
Montgomery County less stella
My commission expires March 28. 2025 By:
currency rate, interest rate or residual value guarantees Commission number 1126044 Teresa Pastella. Notary Public Member. Pennsylvania Association of Notanes For bond and/or Power of Attorney (POA) verification inquiries please call 610-832-8240 or email [email protected].
Not valid for mortgage, note, loan, letter of credit, This Power of Attomey is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Chio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV - OFFICERS: Section 12. Power of Attomey
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President. and subject to such limitation as the Chairman or the President may prescribe. shall appoint such attorneys-in-fact. as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact, subject to the limitations set forth in their respective powers of attorney shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe. shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make. execute, seal. acknowledge and deliver as surety any and all undertakings. bonds, recognizances and other surety obligations. Such attoreys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authonzes David M. Carey, Assistant Secretary to appoint such attomeys infact as may be necessary to act on behalf of the Company to make, execute seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations.
Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed I. Renee C. Llewellyn, the undersigned, Assistant Secretary, of Liberty Mutual Insurance Company, The Ohio Casualty Insurance Company, and West American Insurance Company do hereby certify that this power of attorney executed by said Companies is in full force and effect and has not been revoked IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 16th day of March 2023
INSURANCE CASUALTY INSURAN RICAN INSURANCE
CORPORATE CORPORATE CORPORATE
1912 1919 1991 Ram culler
HE HAMPERE By:
ANVARO LS3M INDIANA Renee C. Llewellyn, Assistant Secretary POA - LMIC OCIC WAIC Multi Co_022021
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
Civil Code § 1189
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 Joaquin
On March 16, 2023 before me, Angela R. Hawkins,
Notary Public
personally appeared Sammy Cox who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
ANGELA R. HAWKINS
Notary Public - California
Calaveras County
Commission # 2415639
ConglaR Hawkens My Comm. Expires Sep 14, 2026
(Seal)
Signature of Notary Public
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 list 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 CSLB DIR
Location of Contractor Registration % of
done by Name of Work
Business License No. Number
Subcontractor
Subcontractor
GRADING
DEMO STOCKTON, 10094/73 1000035884 50%
Diet Dynasty
CONCRETE CA
XXIV
Work to be CSLB DIR
Location of Contractor Registration % of
done by Name of Business Work
Subcontractor License No. Number
Subcontractor
Attach additional sheets if necessary)
Name of Bidder T&S Intermodal Maintenance, Inc. dba T&S West Signature
Name and Title_ Sammy Cox, President
Dated January 31,2023
XXV
1.4 BIDDER INFORMATION AND EXPERIENCE FORM
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: I&S Intermodal Maintenance, Inc. dba T&S West
2.0 Type of Entity: Corporation
3.0 Bidder Address: Physical Address: 6540 Austin Rd., Stockton, CA 95215 Mailing Address: P.O. Box 1592, Linden, CA 95236
Facsimile Number Telephone Number
209.942.1368 209.942.1360
Email Address
4.0 How many years has Bidder's organization been in business as a Contractor? 14 years
name? 21 years
5.1 Under what other or former names has Bidder's organization operated? N/A
6.0 If Bidder's organization is a corporation, answer the following:
6.1 Date of Incorporation: 07.24.2001
6.2 State of Incorporation: California
6.3 President's Name: Sammy Cox
6.4 Vice-President's Name(s): Larry Cox
XXVI
6.5 Secretary's Name: George Faist
6.6 Treasurer's Name: George Faist
7.0 If an individual or a partnership, answer the following:
7.1 Date of Organization: _N/A
7.2 Name and address of all partners (state whether general or limited partnership):
N/A
8.0 If other than a corporation or partnership, describe organization and name principals:
N/A
9.0 List other states in which Bidder's organization is legally qualified to do business.
N/A
10.0 What type of work does the Bidder normally perform with its own forces? New Construction. Tenant Improvements.
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:
No
XXVII
13.0 List Trade References:
SEE ATTACHED
14.0 List Bank References (Bank and Branch Address):
F&M Bank
18836 E. Main St.
Linden, CA 95236
15.0 Name of Bonding Company and Name and Address of Agent:
Alliant Insurance Services, Inc. - 641 Ham Lane, Ste. B, 95242 Agent - Karen Amin
[REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK]
XXVIII
T & S Intermodal Maintenance, Inc. DBA T & S West
PO Box 1592 Corporation, in business since 2001
Linden, CA 95236 Incorporated 07-24-2001
Office: (209) 942-1360 Federal Tax ID #68-0479675
Fax: (209) 942-1368 D-U-N-S #16-767-1697
Contractor's License #939001 A & B
Physical Address: CA ID #471-44878
6540 S. Austin Road Sales Tax Exempt: No
Stockton, CA 95215 Type of Business: General Contractor/Maintenance No. of Employees: 44
A/P Contact: Tricia Mitchell Purchase Orders Required: No [email protected]
Principal:
Sammy Cox, President
PO Box 1112
Linden, CA 95236
Bank References:
Checking: 04-184092-01
F & M Bank Money Market: 04-184092-02
18836 E. Main Street - Linden, CA 95236 Contact: Nathan Dellinger Phone: (209) 887-2835 Fax: (209) 887-2299
Trade Credit References: Equipment Rental References:
George Reed, Inc. (Customer #882995) Holt of California (Customer #1000211) Attn: Naiome Grissom Attn: Francesca Taylor
[email protected] [email protected]
P.O. Box 4760 1234 West Charter Way
Modesto, CA 95352 Stockton, CA 95206
(209) 532-0734 (209) 462-3660
Fax (209) 521-1346 Fax (209) 467-4658
Paul E. Vaz Trucking Inc. (Customer #02485) United Rentals, Inc. (Customer #713137) Attn: Julie Vaz Attn: Josh Browning
[email protected] [email protected]
4740 E. Peltier Road Credit Office #586 File 51122
Acampo, CA 95220 Los Angeles, CA 90074-1122
(209) 334-9001 (209) 948-9500
Fax (209) 367-7930 Fax (209) 948-8157
Platt Electric Supply / Rexel USA, Inc. Ahern Rentals (Customer #227599) Attn: Cody Hoffman Attn: Accounts
[email protected] [email protected]
PO Box 418759 P.O. Box 271390
Boston, MA 02241-8759 Las Vegas, NV 89127
(916) 690-3414 (702) 966-4864
Fax (702) 966-4864
T&S Intermodal Maintenance, Inc. DBA T & S West
PO Box 1592 Linden, CA 95236 Office: (209) 942-1360 Fax: (209) 942-1368
LIST OF CURRENT PROJECTS (BACKLOG)
[**Duplicate Page if needed for listing additional current projects.**] Project Description of Completion Date Cost of Bidder's Bidder's Work Work
nden Unife
is Charging Station Charging stations for electric bus 01.27.2023 $285,600 tenor & exterior demo, abatement, ad
grades to restrooms, shoers, doorway 02.06.2023 $2,133,000 thresholds, remodeled spaces, finishes
PCC-ADA Push Button on Doors Instal push uton operal panel. 04.15.2023 $107,000 Re metic Water Boilers Replace Water Boilers 05.20.2023 $194,000 JC Sheriffs Offic Painting and repairs 03.01.2023 $65,267 letro Bidg. Paintin
JC Sheriffs Office
letro Bida. Floorin Flooring Repairs 04.20.2023 $98,600 Stanislaus County Replace tire carousel 03.31.2023 $90,000 Tire Carousel at Fleet shop
SJC Clover Larch Playgrond Playground removal 05.25.2023 $57,000 Merced Airport Transient Pilot RR Renovate basement restrooms TBD $138,000 XXIX
EXPERIENCE AND TECHNICAL QUALIFICATIONS QUESTIONNAIRE
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:
George Raley - Project Manager - 100%
Randy Bese - Superintendent - 100%
2. Summarize each person's specialized education:
SEE ATTACHED
3. List each person's years of construction experience relevant to the project:
SEE ATTACHED
4. Summarize such experience:
SEE ATTACHED
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 City.
Changes Occurring Since Prequalification
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.
N/A
XXXI
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:
N/A
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 of Bidder_T&S Intermodal Maintenance, Inc. dba T&S West Signature June
Name_Sammy Cox
Title President
Dare January 31.2023
Contractor License No. 939001
DIR Contractor Registration No. 1000011948
XXXII
1.5 NON-COLLUSION DECLARATION
The undersigned declares:
I am the President of I&S Intermodal Maintenance, Inc dba T&S West _ the party making the Toregoing Bid.
The Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The Bid is genuine and not collusive or sham.
The Bidder has not directly or indirectly induced or solicited any other Bidder to put in a false or sham bid. The Bidder has not directly or indirectly colluded, conspired, connived, or agreed with any Bidder or anyone else to put in a sham bid, or to refrain from bidding. The Bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the Bid Price of the Bidder or any other Bidder, or to fix any overhead, profit, or cost element of the Bid Price, or of that of any other Bidder. All statements contained in the Bid are true. The Bidder has not, directly or indirectly, submitted his or her Bid Price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.
Any person executing this declaration on behalf of a Bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the Bidder.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on 5 St _ [date], at LOCketoro [city] culitornia [state]. anuary 2023
Name of Bidder T&S Intermodal Maintenance, Inc. dba T&S West Signature
Name Sammy Cox
Title President
XXXIII
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 Joaquin
Subscribed and sworn to (or affirmed) before me on this 31 day of January _ 2023, by_Sammy Cox
proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
TYLER RAE HAWKINS
Notary Public - Californla
Calaveras County
Commission # 2359165
My Comm. Expires Jun 8, 2025
(Seal) Signature_
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:
M 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. • The City has exempted the Contractor from the requirements of the Iran Contracting Act of 2010 after making a public finding that, absent the exemption, the City will be unable to obtain the goods and/or services to be provided pursuant to the Contract. • The amount of the Contract payable to the Contractor for the Project does not exceed $1,000,000.
Signature:
Printed Name:_Sammy Cox
Title: President
Firm Name: T&S Intermodal Maintenance, Inc. dba T&S West Date: unvang 31,2023
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.
XXXIV
1.7 LOCAL BUSINESS ENTERPRISE (LE) PARTICIPATION
REGIONAL PARK RESTROOMS
PROJECT NUMBER 122013
A. GENERAL
This project is subject to the policies and requirements established by the City of Merced. The City is committed to ensuring full and equitable participation by Local Business Enterprises (LBES) In the provision of all goods and services to the City or Agency on a contractual basis. This outreach program is set forth in these Special Provisions. Bidders shall be fully informed concerning the requirements of this program. Failure to comply with the Good Faith Effort Outreach Program will render the bid non-responsive.
Please note that in accordance with the State Labor Law, the bidder is required to fill out the list of subcontractors (Page 16) at time of bid for any branch of work that is to be accomplished by persons or companies other than the general Contractor. This requirement is considered a totally separate issue from meeting the LBE requirements.
B. POLICY
The subcontracting outreach policy requires the bidder of this project to make a "Good Faith Effort" to obtain sub-bid participation by LEs which is anticipated by the City to produce the level of LBE participation as shown in the "Notice Inviting Bids"
C. DEFINITIONS
1. Local Business Enterprise (LBE): An LBE is defined as a business firm with a valid non- delinquent City of Merced business license and with fixed offices or distribution points within the County of Merced.
2. Certification as an LBE: A business is automatically considered a certified LBE with the City of Merced if the business has a permanent physical location within Merced County and has an active City business license.
3. Good Faith Effort: The bidder must take affirmative steps prior to bid opening to ensure that a maximum effort is made to recruit LBE sub-bidder/subcontractors. LBEs must be considered along with other business enterprises whenever possible as sources of supplies. construction and other services. The required affirmative steps for Good Faith Effort Certification and Documentation are outlined in Paragraph D herein.
4. Subcontractor: For the purpose of this program, the term "Subcontractor" denotes an agreement between the prime Contractor and an individual, firm or corporation for the performance of a particular portions) of the work for which the prime Contractor has XXXV
obligated itself. Subcontractors must have a valid California Contractor's License or Professional License. For purposes of meeting the LBE requirement, other work including but not limited to trucking, equipment rentals, or any service rendered by local firms for the project shall also be included.
5. LBE Participation Credit: This applies to recognition as an LBE. a. Work performed by a prime Contractor who is an LBE is credited 100% b. Work performed by a prime Contractor who is not an LBE will not be considered for credit in computing any expected levels of LBE participation established for this project.
The prime Contractor will be required to make good faith efforts to obtain reasonably expected participation levels through subcontracting or materials and supplies acquisition.
c. Credit for materials and/or supplies purchased locally shall be considered at 100% of the amount to be paid to the local vendor for such materials/supplies in computing the expected levels of LBE participation.
D. GOOD FAITH EFFORT CERTIFICATION AND DOCUMENTATION
It is the policy of the City of Merced to provide LEs an equal opportunity to participate in the performance of all City contracts. Bidders shall assist the City in implementing this policy by taking all reasonable steps to ensure that any qualified available business enterprise including LBEs, have an equal opportunity to compete for and participate in City contracts. A bidder's good faith efforts to reach out to LBEs shall be determined from documentation of the level of effort put into achieving the following factors. Certification of Good Faith Effort must be returned with the bid. The low bidder shall submit detailed Good Faith Effort Documentation by 5:00 PM within two working days after the bid opening to the Engineering Department, 678 West 18th Street, Merced, California. 95340. Failure to submit the required Good Faith Effort Documentation by 5:00 PM within two working days after the day of the bid opening will render the bid non-responsive. Any other bidders who may be considered for award in the event that the low bidder is considered non-responsive shall submit the detailed Good Faith Effort Documentation by 5:00 PM within two working days after receipt of a request from the Engineering Department.
Good faith shall be determined by the following:
1. The bidder has made a good faith effort to obtain sub-bid participation by LBEs that could reasonably be expected to produce a level of participation by LBEs, as called for in the Notice Inviting Bids.
2. The bidder has identified and selected specific work items in the project to be performed by sub-bidders/subcontractors in order to provide an opportunity for participation by LBEs.
Upon making this determination, the bidder subdivided the total contract work requirements into smaller portions or quantities to permit maximum active participation of LBEs. If the XXXVI
bidder has identified an amount of subcontracting work less than the proposed LBE goal or intends to do all of the project with his own forces, this shall not disqualify his bid. However. the bidder should make a good faith effort to maximize use of local services.
3. The City will provide a plan holder's list for this project upon request to the Engineering Department, phone (209) 385-6846 and provide outreach to local businesses regarding subcontracting opportunities through the Building Exchanges. However, the bidder should also provide written notice of its interest in receiving sub-bids on the contract to those business enterprises, including LBEs having an interest in participation in the selected work items, through builder's exchanges and the trade press.
4. The bidder has documented efforts to follow-up initial solicitations of sub-bid interest by contacting the affected business enterprises to determine with certainty whether said enterprises were interested in performing specific portions of the project work.
5. The bidder has negotiated in good faith with interested LBEs and did not unjustifiably reject as unsatisfactory bids or proposals prepared by any enterprise, as determined by the Engineering Department. As documentation the bidder must submit a list of all sub-bidders for each item of work solicited, including dollar amounts of potential work for LBEs.
The anticipated levels of LBE participation shall not by itself become the basis for any bidder's disqualification or determination of lack of Good Faith Effort. Adequacy of a bidder's good faith effort will be determined by the City Engineer after consideration of the factors of good faith as set forth above. Attached hereto is a copy of the Certification of Good Faith Effort due with the bid and the detailed evaluation sheet (Good Faith Effort Documentation) used by the City to assist in determining the adequacy of a bidders good faith effort.
All Bidders shall submit a completed Certification of Good Faith Effort with their bid. Detailed Good Faith Effort Documentation may be submitted with the bid or shall be submitted by the low bidder by 5:00 PM within two working days after the day of the bid opening. Failure to do so will render the bid non-responsive. The Engineering Department, in its review of the Good Faith Effort Documentation may request additional information to validate and/or clarify that a good faith effort was adequately made. Such information shall be submitted promptly upon request. If the low bid Documentation by stop vi idio day after he dily of receip of eques form de Frainering.
Department.
XXXVII
E. AWARD OF CONTRACT
The City reserves the right to reject any and all bids. The award of a contract will be to the lowest responsible bidder whose proposal complies with all requirements prescribed herein. This includes compliance with the required good faith effort outreach program. A positive and adequate demonstration to the satisfaction of the City of a good faith effort is a condition for being eligible for award of the contract.
In the event that the City considers awarding away from the apparent low bidder because of the bidder's failure to satisfy the City with its good faith efforts, the City shall, if requested, and prior to the award of the contract, afford the bidder an opportunity to present further evidence to the City of the bidder's good faith effort.
XXXVIII
(This form must be returned with bid)
CITY OF MERCED
PROJECT NUMBER 122013
REGIONAL PARK RESTROOMS
CERTIFICATION OF GOOD FAITH EFFORT
Bidders are required to initial the underlined space provided to the left of each applicable provisior the Purchasing higent, a 325 - stet, ered, Citamia 546. Fair to sido the regiod checklist with the bid will render the bid non-responsive.
The bidder is a certified Local Business Enterprise and is therefore automatically qualified for 100% credit. No other portions of this Certification of Good Faith Effort form (except date, signature and contractor name) are required to be filled out and detailed documentation is not required.
(If item 1 above is not checked, please proceed)
2. The bidder is not a Local Business Enterprise. The bidder hereby certifies that his actual LBE participation, estimated at %, exceeds the goal listed in the Notice Inviting Bids.
No other portions of this Certification of Good Faith Effort form (except date, signature and contractor name) are required to be filled out. Within two days after bid opening, only item 7 of the detailed Good Faith Effort Documentation, listing LBEs who will be subcontractors on this project, is required if bidder is the low bidder. (If the bidder has checked this item and after the bids are opened, it is determined that the bidder has not actually met the goal, the bidder must submit a new certification form completely documenting the bidder has made a good faith effort as required below.) (If item 1 or 2 is not checked, you must complete the remainder of this form) The bidder has made a good faith effort to obtain sub-bid participation by LBEs which could reasonably be expected to produce a level of participation by LBEs as called for in the Notice Inviting Bids.
The bidder has identified and selected specific work items in the project to be performed by subbidder/subcontractors in order to provide an opportunity for participation by LBEs.
Upon making this determination, the bidder subdivided the total contract work requirements into smaller portions or quantities to permit maximum active participation XXXIX
of LBEs. If the bidder's total identified opportunities for subcontracting are less than the requested participation, this shall not disqualify the bid. However, bidder must make a good faith effort on all identified subcontracting.
5. The bidder has documented efforts to follow-up initial solicitations of sub-bid interest by contacting the affected business enterprises to determine with certainty whether said enterprises were interested in performing specific portions of the project work
6. The bidder has negotiated in good faith with interested BEs and did not unjustifiably reject as unsatisfactory bids or proposals prepared by any enterprise, as determined by the City. As documentation due after the bid, the bidder must submit a list of all sub- bidders for each item of work solicited, including dollar amounts of potential work for LBEs.
The bidder estimates that his total LBE participation will be %. (Actual amount to be provided with detailed documentation due after bid).
CERTIFICATION
I have used this checklist and certify that positive steps were taken and documented to ensure that all available LBEs have had an equal opportunity to compete for and participate in this project. 1 am submitting this Certification of Good Faith Effort checklist herewith as evidence of the "Good Faith Effort" made. I understand that if 1 am the low bidder I am required to submit detailed documentation (unless I am a certified LBE or only the list of BE's if I have met the goal) by 5:00 P.M. within two working days after the day of the bid opening or if my bid is to be considered for award, I am required to submit detailed documentation by 5:00 P.M. within two working days after receiving the request from the Engineering Department. I understand that if my documentation does not demonstrate that I have complied with the requirements of the "Good Faith Effort Outreach Program" as required by these bid specifications or if I do not submit adequate documentation, that my bid will be deemed non-responsive by the City.
January 31,2023
Date Officer's Signature
T&S Intermodal Maintenance, Inc. dba T&S West Sammy Cox, President Firm Name: Officer's Name and Title (Type or Print)
XL
EXHIBIT "D" - CERTIFICATION LABOR CODE SECTION 1861
1, the undersigned Contractor, am aware of the provisions of Section 3700, et seq., of the California Labor Code which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions of the Code, and 1, the undersigned Contractor, agree to and will comply with such provisions before commencing the performance of the Work on this Contract.
T&S Intermodal Maintenance, Inc. dba T&S West
[INSERT CONTRACTOR NAMEJ
By:
Sammy Cox
Name (Print)
President
Title (Print)
62 EXHIBIT "F" - 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/Public- Works/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.
Contractor 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 Contractor: T&S Intermodal Maintenance, Inc. dba T&S West DIR Registration Number: 1000011948
DIR Registration Expiration: 06.30.2025
Small Project Exemption: _ _ Yes or X _ No
Unless Contractor is exempt pursuant to the small project exemption, Contractor further acknowledges:
• Contractor shall maintain a current DIR registration for the duration of the project. • Contractor 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.
Failure to submit this form or comply with any of the above requirements may result in a finding that the bid is non-responsive.
Name of Contractor T&S Intermodal Maintenance, Inc. dba T&S West Signature
Name and Title Sammy Cox, President
Dated January 31,2023
' 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." 63 ane
January 12, 2023
CITY OF MERCED
DEPARTMENT OF PUBLIC WORKS (ENGINEERING)
678 W. 18th Street, Merced, CA 95340
ADDENDUM NO. 1
To ALL PROSPECTIVE BIDDERS
Under Specifications for the Construction of the
REGIONAL PARK RESTROOMS
PROJECT NUMBER 122013
For which bids are to be received by the City of Merced Purchasing Agent, at the Purchasing Conference Room, at 2525 "O" St., Merced, CA 95340, until 2:00 PM on Thursday 16, 2023.
The following revision to the specifications shall be made:
Item 1: SPECIFICATIONS: - PAGE 1, NOTICE INVITING BIDS - N-1, replace "2:00 PM on January 31, 2023" with "2:00 PM on Feb 7, 2023"
Item 2: SPECIFICATIONS: - PAGE 2, NOTICE INVITING BIDS - N-8, replace "January 17, 2023" with "January 24, 2023"
Item 3: SPECIFICATIONS: - PAGE 2, NOTICE INVITING BIDS - N-9, replace "January 31, 2023, at 2:00PM" with "February 7, 2023. At 2:00 PM" Item 4: SPECIFICATIONS: - PAGE 2, NOTICE INVITING BIDS - N-11, replace "2:00 'M on January 31, 2023" with "2:00 PM on February 7, 2023" and replace "Januar 1, 2023, at 2:00PM", with "February 7, 2023, at 2:00pm' Item 5: SPECIFICATIONS: - PAGE III, PRE-BID CONFERENCE, replace "January 17, at 10:00 am", with "January 24, at 10:00 am"
Item 6: SPECIFICATIONS: - PAGE XII, BID FORMS - 1.1 BID, replace "2 PM on January 31, 2023" with "2:00 PM on February 7", 2023"
1 Michael R. Beltran I PE
lily Engineer
Name of Bidder or Firm: T&S Intermodal Maintenance, Inc. dba T&S West THIS ADDENDUM MUST BE SIGNED AND RETURNED WITH BID PROPOSAL.
ADDENDUM NO. I has been received and incorporated into the bid proposal.
Received By:
Sammy Cox. President
Date: | 312023 Planholder : T&S Intermodal Maintenance, Inc. dba T& West NOTE: RECEIPT OF THIS ADDENDUM MUST ALSO BE ACKNOWLEDGED IN THE CONTRACTOR'S BID PROPOSAL.
e
January 26. 2023
CITY OF MERCED
DEPARTMENT OF PUBLIC WORKS (ENGINEERING)
678 W. 18th Street. Merced, CA 95340
ADDENDUM NO. 2
To ALL PROSPECTIVE BIDDERS
Under Specifications for the Construction of the
REGIONAL PARK RESTROOMS
PROJECT NUMBER 122013
For which bids are to be received by the City of Merced Purchasing Agent, at the Purchasing Conference Room, at 2525 "O*St.. Merced, CA 95340. until 2:00 PM on Tuesday. February 7. 2023.
The following revision to the specifications shall be made:
Item 1: SPECIFICATIONS: - PAGE III, NOTICE INVITING BIDS - N-6, after paragraph 1. add The Local Business Enterprise (BE) goal is 5 percent.
Michael R. Beltran II. P.E.
City Engineer
Name of Bidder or Firm: T&S Intermodal Maintenance, Inc. dba T&S West THIS ADDENDUM MUST BE SIGNED AND RETURNED WITH BID PROPOSAL.
ADDENDUM NO. 2 has been received and incorporated into the bid proposal.
Received By:
Date: 131\2023 Plan holder: T&S Intermodal Maintenance, Inc. dba T&S West NOTE: RECEIPT OF THIS ADDENDUM MUST ALSO BE ACKNOWLEDGED IN THE CONTRACTOR'S BID PROPOSAL.
2 February 6, 2023
CITY OF MERCED
DEPARTMENT OF PUBLIC WORKS (ENGINEERING)
678 W. 18th Street, Merced, CA 95340
ADDENDUM NO. 3
To ALL PROSPECTIVE BIDDERS
Under Specifications for the Construction of the
REGIONAL PARK RESTROOMS
PROJECT NUMBER 122013
For which bids are to be received by the City of Merced Purchasing Agent, at the Purchasing Conference Room, at 2525 "O" St., Merced, CA 95340, until 2:00 pm on Thursday, February 23, 2023.
The following revision to the specifications shall be made:
Item 1: SPECIFICATIONS: - PAGE 1, NOTICE INVITING BIDS - N-1, replace "2:00 pm on January 31, 2023" with "2:00 pm on February 23'd, 2023" Item 2: SPECIFICATIONS: - PAGE 2, NOTICE INVITING BIDS - N-9, replace "January 31,2023, at 2:00 pm" with "February 23, 2023, at 2:00 pm" Item 3: SPECIFICATIONS: - PAGE 2, NOTICE INVITING BIDS - N-11, replace "2:00 pm on January 31, 2023" with "2:00 pm on February 23, 2023" and replace "January 31, 2023, at 2:00 pm", with "February 23, 2023, at 2:00 pm" Item 4: SPECIFICATIONS: - PAGE XII, BID FORMS - 1.1 BID, replace "2:00 pm on January 31, 2023" with "2:00 pm on February 23, 2023"
SPECIFICATIONS: - PAGE III, ADDENDA, add: The last day to submit questions for the project will be Feb 10, 2023, at 5:00 pm. Any questions submitted after the deadline will not be answered.
1 Michael R. Beltran II, P.E.
City Engineer
Name of Bidder or Firm: T&S Intermodal Maintenance, Inc. dba T&S West THIS ADDENDUM MUST BE SIGNED AND RETURNED WITH BID PROPOSAL.
ADDENDUM NO. 3 has been received and incorporated into the bid proposal.
Received By: sam can point,
Date : 02.07.2023 Planholder : T&S Intermodal Maintenance, Inc. dba T&S West NOTE: RECEIPT OF THIS ADDENDUM MUST ALSO BE ACKNOWLEDGED IN THE CONTRACTOR'S BID PROPOSAL.
February 15, 2023
CITY OF MERCED
DEPARTMENT OF ENGINEERING
678 W. 18th Street, Merced, CA 95340
ADDENDUM NO. 4
To ALL PROSPECTIVE BIDDERS
Under Specifications for the Construction of the
REGIONAL PARK RESTROOMS
PROJECT NUMBER 122013
For which bids are to be received by the City of Merced Purchasing Agent, at the Purchasing Conference Room, at 2525 "O" St., Merced, CA 95340, until 2:00 pm on Thursday, March 9, 2023.
The following revision to the specifications shall be made:
Item 1: SPECIFICATIONS: - PAGE 1, NOTICE INVITING BIDS - N-1, replace "2:00 pm on January 31, 2023" with "2:00 pm on March 9th, 2023" Item 2: SPECIFICATIONS: - PAGE 2, NOTICE INVITING BIDS - N-9, replace "January 31, 2023, at 2:00 pm" with "March 9t, 2023, at 2:00 pm" SPECIFICATIONS: - PAGE 2, NOTICE INVITING BIDS - N-11, replace "2:00 pm on January 31, 2023" with "2:00 pm on March 9*, 2023" and replace "January 31, 2023, at 2:00 pm", with "March 9th, 2023 at 2:00 pm" Item 4: 42.00 pm ol
January 31,2023 with 2:00 pm on March 0,2023 - 11 BID, replace SPECIFICATIONS: - PAGE III, ADDENDA, add: The last day to submit questions for the project will be Feb 24, 2023, at 5:00 pm. Any questions submitted after the deadline will not be answered.
1 tello
Michael R. Beltran II. P.E.
City Engineer
Name of Bidder or Firm: T&S Intermodal Maintenance, Inc. dba T&S West THIS ADDENDUM MUST BE SIGNED AND RETURNED WITH BID PROPOSAL.
ADDENDUM NO. 4 has been received and incorporated into the bid proposal.
Received By: Sammy core Poul
Date: 2/21/23 Planholder: T&S Intermodal Maintenance, Inc. dba T&S West NOTE: RECEIPT OF THIS ADDENDUM MUST ALSO BE ACKNOWLEDGED IN THE CONTRACTOR'S BID PROPOSAL.
2 March 3, 2023
CITY OF MERCED
DEPARTMENT OF ENGINEERING
678 W. 18th Street, Merced, CA 95340
ADDENDUM NO. 5
To ALL PROSPECTIVE BIDDERS
Under Specifications for the Construction of the
REGIONAL PARK RESTROOMS
PROJECT NUMBER 122013
For which bids are to be received by the City of Merced Purchasing Agent, at the Purchasing Conference Room, at 2525 "O" St., Merced, CA 95340, until 2:00 pm on Thursday, March 16, 2023.
The following revisions to the Plans shall be made:
Item 1: PLANS - Sheets 4, 6, 8, 11, 12, 13 and 15 have been revised and attached to this Addendum.
The following revision to the specifications shall be made:
Item 1: SPECIFICATIONS: - PAGE 1, NOTICE INVITING BIDS - N-1, replace "2:00 pm on January 31, 2023" with "2:00 pm on March 16th, 2023" Item 2: SPECIFICATIONS: - PAGE 2, NOTICE INVITING BIDS - N-9, replace "January 31, 2023, at 2:00 pm" with "March 16, 2023, at 2:00 pm" Item 3: SPECIFICATIONS: - PAGE 2, NOTICE INVITING BIDS - N-11, replace "2:00 pm on January 31, 2023" with "2:00 pm on February 23, 2023" and replace "January 31, 2023, at 2:00 pm", with "March 16, 2023, at 2:00 pm" Item 4: SPECIFICATIONS: - PAGE XII, BID FORMS - 1.1 BID, replace "2:00 pm on January 31, 2023" with "2:00 pm on March 16, 2023"
Item 5: SPECIFICATIONS: - PAGE III, ADDENDA, add: The last day to submit questions for the project will be March 8, 2023, at 5:00 pm. Any questions submitted after the deadline will not be answered.
Item 6: SPECIFICATIONS: - BASE BID SCHEDULE -REGIONAL PARK RESTROOMS - RAHILLY & MCNAMARA page XIII - Bid schedule modified.
New bid schedule is attached to this Addendum.
Item 7: SPECIFICATIONS: - ALTERNATE #1 BID SCHEDULE - REGIONAL PARK RESTROOMS - APPLEGATE page XIV - Bid schedule modified. New bid schedule is attached to this Addendum.
Item 8: SPECIFICATIONS: - ALTERNATE #2 BID SCHEDULE - REGIONAL PARK RESTROOMS - FAHRENS page XV - Bid schedule modified. New bid schedule is attached to this Addendum.
Item 9: SPECIFICATIONS: - Item "CONSTRUCTION CONTRACT" 3. Terms, 3.3 Period of Performance and Liquidated Damages was revised to read as follows:
3.3 Period of Performance and Liquidated Damages. Contractor shall perform anc complete all Work under this Contract within 60 working days, beginning the effective date of the Notice to Proceed ("Contract Time"). Contractor shall perform its Work in strict accordance with any completion schedule, construction schedule or project milestones developed by the City. Such schedules or milestones may be included as part of Exhibits "A" or "B" attached hereto, or may be provided separately in writing to Contractor. Contractor agrees that if such Work is not completed within the aforementioned Contract Time and/or pursuant to any such completion schedule, construction schedule or project milestones developed pursuant to provisions of the Contract, it is understood, acknowledged and agreed that the City will suffer damage.
Pursuant to Government Code Section 53069.85, Contractor shall pay to the City as fixed and liquidated damages the sum of $3500 per day for each and every calendar day of delay beyond the Contract Time or beyond any completion schedule, construction schedule or Project milestones established pursuant to the Contract.
Item 10: SPECIFICATIONS: - EXHIBIT "B" PLANS AND SPECIFICATION was updated and replaced in its entirety pages 27 - 64. New Exhibit B is attached to this Addendum. Items added are in italic and underlined. Items removed are strikethrough.
leto
Michael R. Beltran II, P.E.
City Engineer
Name of Bidder or Firm: T35 INtErmona MAINTENANCE, lue. DOn TAS wesT THIS ADDENDUM MUST BE SIGNED AND RETURNED WITH BID PROPOSAL.
ADDENDUM NO. 5 has been received and incorporated into the bid proposal.
Received By:
Date: 3/16/23 Planholder cr FILeSInENT
TOS INTERmENtL MiNNiENANCE, INK. DRA TES WEST
NOTE: RECEIPT OF THIS ADDENDUM MUST ALSO BE ACKNOWLEDGED IN THE CONTRACTOR'S BID PROPOSAL.
March 8, 2023
CITY OF MERCED
DEPARTMENT OF ENGINEERING
678 W. 18th Street, Merced, CA 95340
ADDENDUM NO. 6
To ALL PROSPECTIVE BIDDERS
Under Specifications for the Construction of the
REGIONAL PARK RESTROOMS
PROJECT NUMBER 122013
For which bids are to be received by the City of Merced Purchasing Agent, at the Purchasing Conference Room, at 2525 "O" St., Merced, CA 95340, until 2:00 PM on Thursday, March 16, 2023.
The following revision to the Project shall be made:
Item 1: Wrong Bid opening date change from Tuesday March 16, 2023 at 2:00 pm to Thursday March 16, 2023 at 2:00 pm
pero
Michael R. Beltran II, P.E.
City Engineer
Name of Bidder or Firm: I35 Intermoise MaiNTeNANCE, INe, DBA T*S LESIT THIS ADDENDUM MUST BE SIGNED AND RETURNED WITH BID PROPOSAL.
ADDENDUM NO. 6 as been received and incorporated into the bid proposal.
Received By: Anton, mennert
Date: 3/16/23 Planholder : TOS INTERNOR MANTENANCE, INi DEA TIS LEST NOTE: RECEIPT OF THIS ADDENDUM MUST ALSO BE ACKNOWLEDGED IN THE CONTRACTOR'S BID PROPOSAL.
WRITTEN CONSENT OF ACTION WITHOUT MEETING
OF THE DIRECTORS OF
T & S INTERMODAL MAINTENANCE, INC. DBA T & S WEST
a California Corporation
The undersigned, being a majority of the Directors of T & S Intermodal Maintenance, Inc. DBA T & S West (hereinafter referred to as the "Corporation") approve the following actions by written consent in lieu of meeting.
WHEREAS, Binding Agreements, Bidding Documents and Contracts will need to be executed. It is in the best interest of the company to require Officers to execute these documents on behalf of the company.
IT IS THEREFOR
RESOLVED, that
BE IT FURTHER RESOLVED, that the President, Manager and Secretary/Treasurer of the Company be, and hereby is/are, authorized, empowered and directed in the name and on behalf of the Company, to execute such other agreements, instruments and other documents, and to take such other actions, as any of them may approve as necessary, appropriate or desirable in order to perform and otherwise carry out the intents and purposes of the foregoing resolutions, the execution of any such document or the taking of any such action, as applicable, to be conclusive evidence of that approval.
IN WITNESS WHEREOF, the undersigned have executed this Action by Written Consent as of July 1, 2001.
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Director
Da suis
Director
2:\Shareholder Information\Corporate Resolutions\WRITTEN CONSENT OF ACTION WITHOUT MEETING - Binding Agreements.docy Teneral kagineermes Hutding Contractor S WEST
Contract Admin- Please Contact for any questions.
E-Mail: [email protected]
T & S Intermodal Maintenance, Inc. DBA T & S West has been in business since 2001 and carries A, B, and C-10 California State Contractors Licenses (No. 939001), allowing us to offer the following services:
Grading - Paving - Concrete - Underground - Asphalt Maintenance - New Construction - Tenant Improvements - Building Maintenance - Electrical Supervisors are CPR, First Aid Certified, and Confined Space Certified. The company participates and complies with multiple Specialty Safety Programs as required by our customers.
2020-PRESENT MAJOR CONTRACTS
General Engineering Contractor - "A" License
JOC Maintenance Contracts- Multiple Projects San Joaquin County Public Works $ 3,000,000.00 Richmond Auto Improvements (2021) BNSF Railway $ 7,000,000.00 Pavement Maintenance Project BNSF Railway $ 5,000,000.00 : $ 1,067,379.00
Whiskey Slide-Ponderosa Calaveras County
• Tracy Sidewalks (incl. Storm, Water Services) City of Tracy $ 1,300,000.00 • Merced Amtrak Platform BNSF Railway $ 1,846,000.00
MacArthur Dr Widening (incl. Storm, Sewer, Water) City of Tracy $5,497,000.00 Mormon CARB Electric BNSF Railway $ 375,700.00
• Jennings WQC Plant City of Modesto $ 3,896,827.00
• Bridge Scour Mitigations San Joaquin County Public Works $ 1,600,000.00 General Building Contractor - "B" License
JOC Maintenance Contracts- Multiple Projects Merced County Public Works $ 8,700,000.00 • JOC Maintenance Contracts- Multiple Projects San Joaquin County General Services $ 1,500,000.00 • JOC Maintenance Contracts- Multiple Projects Calaveras County General Services $ 180,000.00 • Facility Maintenance Contract-Remodel/Tl's BNSF Railway - Northern California $ 2,500,000.00 Facility Maintenance Contract-Remodel/Tl's Union Pacific Railroad - Northern California $ 1,000,000.00 • WJHS HVAC Replacement Waterford Unified School District $ 543,000.00 Richmond Crew Shanty BNSF Railway $ 397,566.00
• Main Admin 3rd Floor Remodel Merced County Public Works $1,152,900.00 • Sheriffs Office Exterior ADA Tile & Ramp Repairs San Joaquin County Capital Projects $ 407,984.00 PERSONNEL:
Sammy Cox, President - In the construction industry for over 30 years. Involved in heavy civil work for public, private, commercial, and Industrial work with a current market value in excess of $400 million. (Previous...Granite Construction, Sierra Nevada Construction) Travis Collins, Construction Manager - In the construction industry for over 20 years. Involved in heavy civil work for public, private, commercial, and Industrial work with a current market value in excess of $200 million. (Previous...Granite Construction) Randy Bese, General Superintendent, B Scope - In the construction/maintenance industry for over 20 years. Involved in Public, Private, Commercial, and Industrial work with a current market value in excess of $100 million. c, private, commercial, an
heorge work previ us. GerB Seed. - Intre Constructiomies, stry for Communiters. Ivolved in heavy civil work for public REFERENCES:
Krt Manes Leisser Mazariegos Spenser Ivancich
Senior Project Manager Associate Civil Engineer Assistant Public Works Director Persinger Architects and Associates City of Tracy County of Merced [email protected] leisser.mazariegos @cityoftracy.org Spenser.Ivancich(acountyofimerced.com Phone: (707) 592-5626 Phone: (209) 831-6467 Phone: (209) 385-7602 T & S Intermodal Maintenance, Inc. DBA T & S West
P.O. Box 1592 Linden, CA 95236 - Office: (209) 942-1360 - Fax: (209) 942-1368 License A, B 939001 - DIR 1000011948 - EIN 68-0479675 - DUNS 16-767-1697 dca STATE LIRASE BOARD
MATIENT: NAMERAP ACTIVE LICENSE
Учала . 939001 Emey CORP
Businera Hame T & S INTERMODAL MAINTENANCE
INC DBA T & S WEST
CSLB
sanctions) A B XX
Espiraion o 10/31/2023 www csib ca gov
Industrial Relations
STATE OF CALIFORNIA
APPLICATION FOR
PUBLIC WORKS CONTRACTOR REGISTRATION
Registration Information
Type: Public Works
Period: 07/01/2022 06/30/2025
Contractor Information
Contractor Name: T & S INTERMODAL MAINTENANCE, INC.
Trade Name: T & S West
License Type Number: 1000011948
Contractor Physical Address
Physical Business Country: United States of America Physical Business City/ STOCKTON Province:
Physical Business Address: 6540 S. AUSTIN ROAD Physical Business State: CA Physical Business Postal 95215
Code:
Contractor Mailing Address
Mailing Country: United States of America Mailing City /Province: LINDEN Mailing Address: PO BOX 1592 Mailing State: CA
Mailing Postal Code: 95236
Contact Info
Davtime Phone: Daytime Phone Ext.:
Mobile Phone: Business Email: [email protected] Applicant's Email: [email protected]
Registration Services:: Page 1 of 2 6/9/2022 11:51:24 AM Workers' Compensation
Professional Employer Organization (PEO)
Do you lease employees through Professional Employer Organization? No Workers' Compensation Overview
Carrier: State Fund Inception Date: 05/01/2022
Policyholder Name: T & S INTERMODAL Expiration Date: May 1, 2023 MAINTENANCE, INC.
Policy Number: 9275430-22
Certification
Yes I certify that I do not have any delinquent liability to an employee or the state for any assessment of back wages or related damages, interest, fines, or penalties pursuant to any final judgment, order, or determination by a court or any federal, state, or local administrative agency, including a confirmed arbitration award I certify that the contractor is not currently debarred under Section 1777.1 or under any other federal or state law providing for the debarment of contractors from public works.
Yes I certify that one of the following is true: (1) 1 am licensed by the Contractors State License Board (CSLB) in accordance with Chapter 9 (commencing with Section 7000) of the Business and Professions Code; or (2) my business or trade is not subject to licensing by the CSLB.
I understand refunds are not authorized
1, Angela Hawkins, the undersigned, am, T & S INTERMODAL MAINTENANCE, INC. with the authority to act for and on behalf of the above named contractor. I certify under penalty of perjury that all of the above information provided is true and correct. I further acknowledge that any untruthful information provided in this application could result in the certification being canceled.
I certify this on: 11:49 AM
Legal Entity Information
Legal Entity Type: Corporation
Name: T & S INTERMODAL MAINTENANCE, INC.
Registration Services:: Page 2 of 2
W-9 Request for Taxpayer Give Form to the
Form
Identification Number and Certification requester. Do not (Rev. October 2018)
Department of the Treasury send to the IRS.
Internal Revenue Service • Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line: do not leave this line blank.
T & S Intermodal Maintenance, Inc.
2 Business name/disregarded entity name, if different from above DBA T & S West
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals, see instructions on page 3):
Individual/sole proprietor or C Corporation • S Corporation Partnership • Trust/estate single-member LLC Exempt payee code (if any)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) • Print or type. See Specific Instructions on page 3. Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any) another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that s disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructions) • (Appies to accouns maintained cus de the D5 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) PO Box 1592
6 City, state, and ZIP code
Linden, CA 95236
7 List account numbers) here (optional)
Part l Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSN), However, for a resident alien, sole proprietor, or disregarded entity. see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. 6 8 4 7 9
Part II Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATA code(s) entered on this form (if any) indicating that I am exempt from FATA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part ll, later.
Sign Signature of
Here U.S. person • Date • 01.10.2023
General Instructions • Form 1099-DIV (dividends, including those from stocks or mutual funds)
Section references are to the Internal Revenue Code unless otherwise • Form 1099-MISC (various types of income, prizes, awards, or gross noted.
proceeds)
Future developments. For the latest information about developments • Form 1099-B (stock or mutual fund sales and certain other related to Form W-9 and its instructions, such as legislation enacted transactions by brokers) after they were published, go to www.irs.gov/FormW9.
• Form 1099-S (proceeds from real estate transactions)
Purpose of Form • Form 1099-K (merchant card and third party network transactionsi An individual or entity (Form W-9 requester) who is required to file an • Form 1098 (home mortgage interest), 1098-E (student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T (tuition) identification number (TIN) which may be your social security number • Form 1099-C (canceled debt) SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number • Form 1099-A (acquisition or abandonment of secured property) (EIN), to report on an information return the amount paid to you, or other Use Form W-9 only if you are a U.S. person (including a resident amount reportable on an information return. Examples of information alien), to provide your correct TIN. returns include, but are not limited to, the following. If you do not return Form W-9 to the requester with a TIN, you might • Form 1099-INT (interest earned or paid be subject to backup withholding. See What is backup withholding Cat. No. 10231X Form W-9 Rev. 10-2018