/RFDO$VVLVWDQFH3URFHGXUHV0DQXDO (;+%,74
'LVFORVXUHRI/REE\LQJ$FWLYLWLHV
(;+,%,74 ',6&/2685(2)/2%%<,1*$&7,9,7,(6
COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
a. contract a. bid/offer/application a. initial
b. grant b. initial award b. material change
c. cooperative agreement c. post-award
d. loan For Material Change Only:
e. loan guarantee year ____ quarter _________
f. loan insurance date of last report __________
4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:
Prime Subawardee
Tier _______ , if known
Congressional District, if known Congressional District, if known
6. Federal Department/Agency: 7. Federal Program Name/Description:
CFDA Number, if applicable ____________________
8. Federal Action Number, if known: 9. Award Amount, if known:
10. Name and Address of Lobby Entity 11. Individuals Performing Services (If individual, last name, first name, MI) (including address if different from No. 10) (last name, first name, MI)
(attach Continuation Sheet(s) if necessary)
12. Amount of Payment (check all that apply) 14. Type of Payment (check all that apply) $ _____________ actual planned a. retainer
b. one -time fee
13. Form of Payment (check all that apply): c. commission a. cash d. contingent fee
b. in-kind; specify: nature _______________ e deferred
Value _____________ f. other, specify _________________________
15. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 12:
(attach Continuation Sheet(s) if necessary)
16. Continuation Sheet(s) attached: Yes No
17. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352
. This information will be reported to Congress
semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Signature: ________________________________ ________
Print Name: ________________________________ _______
Title: ________________________________ ____________
Telephone No.: ____________________ Date:___________
Authorized for Local Reproduction
Federal Use Only: Standard Form - LLL
Standard Form LLL Rev. 04-28-06
Distribution: Orig- Local Agency Project Files
/33 0D\
✔ ✔ ✔
Jay Zhong
CFO
925-339-8607 11/3/24
✔
/RFDO$VVLVWDQFH3URFHGXUHV0DQXDO (;+%,74
'LVFORVXUHRI/REE\LQJ$FWLYLWLHV
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
,GHQWLI\WKHW\SHRIFRYHUHGIHGHUDODFWLRQIRUZKLFKOREE\LQJDFWLYLW\LVRUKDVEHHQVHFXUHGWRLQIOXHQFHWKHRXWFRPHRID FRYHUHGIHGHUDODFWLRQ
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
VXEFRQWUDFWVVXEJUDQWVDQGFRQWUDFWDZDUGVXQGHUJUDQWV ,IWKHRUJDQL]DWLRQILOLQJWKHUHSRUWLQ,WHPFKHFNV6XEDZDUGHHWKHQHQWHUWKHIXOOQDPHDGGUHVVFLW\VWDWHDQG]LSFRGHRI WKHSULPHIHGHUDOUHFLSLHQW ,QFOXGH&RQJUHVVLRQDO'LVWULFWLINQRZQ (QWHUWKHQDPHRIWKHIHGHUDODJHQF\PDNLQJWKHDZDUGRUORDQFRPPLWPHQW ,QFOXGHDWOHDVWRQHRUJDQL]DWLRQOHYHOEHORZ DJHQF\QDPHLINQRZQ )RUH[DPSOH'HSDUWPHQWRI7UDQVSRUWDWLRQ8QLWHG6WDWHV&RDVW*XDUG (QWHUWKHIHGHUDOSURJUDPQDPHRUGHVFULSWLRQIRUWKHFRYHUHGIHGHUDODFWLRQ LWHP
,INQRZQHQWHUWKHIXOO&DWDORJRI)HG HUDO
'RPHVWLF$VVLVWDQFH
&)'$
QXPEHUIRUJUDQWVFRRSHUDWLYHDJUHHPHQWVORDQVDQGORDQFRPPLWPHQWV (QWHUWKHPRVWDSSURSULDWHIHGHUDOLGHQWLI\LQJQXPEHUDYDLODEOHIRUWKHIHGHUDODFWLRQLGHQWLILFDWLRQLQLWHP HJ5HTXHVWIRU
3URSRVDO
5)3
QXPEHU,QYLWDWLRQIRU%LG
,)%
QXPEHUJUDQWDQQRXQFHPHQWQXPEHUWKHFRQWUDFWJUDQWRUORDQDZDUGQXPEHU WKHDSSOLFDWLRQSURSRVDOFRQWUROQXPEHUDVVLJQHGE\WKHIHGHUDODJHQF\ ,QFOXGHSUHIL[HVHJ5)3'(
)RUDFRYHUHGIHGHUDODFWLRQZKHUHWKHUHKDVEHHQDQDZDUGRUORDQFRPPLWPHQWE\WKH)HGHUDODJHQF\HQWHUWKHIHGHUDODPRXQW RIWKHDZDUGORDQFRPPLWPHQWVIRUWKHSULPHHQWLW\LGHQWLILHGLQLWHPRU (QWHUWKHIXOOQDPHDGGUHVVFLW\VWDWHDQG]LSFRGHRIWKHOREE\LQJHQWLW\HQJDJHGE\WKHUHSRUWLQJHQWLW\LGHQWLILHGLQ,WHPWR LQIOXHQFHWKHFRYHUHGIHGHUDODFWLRQ
(QWHUWKHIXOOQDPHVRIWKHLQGLYLGXDO
V
SHUIRUPLQJVHUYLFHVDQGLQFOXGHIXOODGGUHVVLIGLIIHUHQWIURP D
(QWHU/DVW1DPH
)LUVW1DPHDQG0LGGOH,QLWLDO
0O
(QWHUWKHDPRXQWRIFRPSHQVDWLRQSDLGRUUHDVRQDEO\H[SHFWHGWREHSDLGE\WKHUHSRUWLQJHQWLW\ ,WHP
WRWKHOREE\LQJHQWLW\
,WHP
,QGLFDWHZKHWKHUWKHSD\PHQWKDVEHHQPDGH
DFWXDO
RUZLOOEHPDGH
SODQQHG
&KHFNDOOER[HVWKDWDSSO\ ,IWKLV LV
DPDWHULDOFKDQJHUHSRUWHQWHUWKHFXPXODWLYHDPRXQWRISD\PHQWPDGHRUSODQQHGWREHPDGH &KHFNDOOER[HVWKDWDSSO\ ,ISD\PHQWLVPDGHWKURXJKDQLQNLQGFRQWULEXWLRQVSHFLI\WKHQDWXUHDQGYDOXHRIWKHLQNLQG SD\PHQW
&KHFNDOOER[HVWKDWDSSO\ ,IRWKHUVSHFLI\QDWXUH 3URYLGHDVSHFLILFDQGGHWDLOHGGHVFULSWLRQRIWKHVHUYLFHVWKDWWKHOREE\LVWKDVSHUIRUPHGRUZLOOEHH[SHFWHGWRSHUIRUPDQGWKH GDWH
V
RIDQ\VHUYLFHVUHQGHUHG ,QFOXGHDOOSUHSDUDWRU\DQGUHODWHGDFWLYLW\QRWMXVWWLPHVSHQWLQDFWXDOFRQWDFWZLWKIHGHUDO RIILFLDOV ,GHQWLI\WKHIHGHUDORIILFHU
V
RUHPSOR\HH
V
FRQWDFWHGRUWKHRIILFHU
V
HPSOR\HH
V
RU0HPEHU
V
RI&RQJUHVVWKDW
ZHUHFRQWDFWHG
&KHFNZKHWKHURUQRWDFRQWLQXDWLRQVKHHW
V
LVDWWDFKHG
7KHFHUWLI\LQJRIILFLDOVKDOOVLJQDQGGDWHWKHIRUPDQGSULQWKLVKHUQDPHWLWOHDQGWHOHSKRQHQXPEHU Public reporting burden for this collection of information is estimated to average 30-minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any ot her aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. SF- LLL-Instructions Rev. 06-04
/33 0D\
Local Assistance Procedures Manual Exhibit 15-G
Construction Contract DBE Commitment
Exhibit 15-G: Construction Contract DBE Commitment
1. Local Agency: 2. Contract DBE Goal:
3. Project Description:
4. Project Location:
6. Prime Certified DBE: 7. Bid Amount:5. Bidder's Name:
8. Total Dollar Amount for ALL Subcontractors: 9. Total Number of ALL Subcontractors:
10. Bid
Item
Number
11. Description of Work, Service, or
Materials Supplied
12. NAICS or
Work
Category
Codes
13. DBE
Certification
Number
14. DBE Contact Information
(Must be certified on the date bids are
opened)
15. DBE
Dollar
Amount
Local Agency to Complete this Section upon Execution of Award 16. TOTAL CLAIMED DBE PARTICIPATION
22. Local Agency Contract Number:
23. Federal-Aid Project Number:
%24. Bid Opening Date:
25. Contract Award Date:
IMPORTANT: Identify all DBE firms being claimed for credit, regardless of tier. Names of the First Tier DBE Subcontractors and their respective item(s) of work listed above must be consistent, where applicable with the names and items of the work in the "Subcontractor List" submitted with your bid. Written confirmation of each listed DBE is required.
26. Award Amount:
Local Agency certifies that all DBE certifications are valid and information on this form is complete and accurate.
27. Local Agency Representative’s Signature 28. Date
29. Local Agency Representative’s Name 30. Phone
31. Local Agency Representative’s Title
17. Preparer’s Signature 18. Date
19. Preparer’s Name 20. Phone
21. Preparer’s Title
DISTRIBUTION: 1. Original – Local Agency
2. Copy – Caltrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract execution may result in de-obligation of federal funds on contract.
3. Include additional copy with award package.
January 2023
City of Richmond
Lincoln Safe Route to School CML- 05137(055 )
29 6th St, Richmond, CA 94801
BuildCorp Inc
1$ 27,360.00
$ 456,000.00
2 Traffic Control 561990 50891 MZB Engineering 192 Athlone Lane Corona, $ 27,360.00 $ 27,360.00
6.00 11/03/2024
Jay Zhong 925-339-8607
CFO
Local Assistance Procedures Manual Exhibit 15-G
Construction Contract DBE Commitment
INSTRUCTIONS – CONSTRUCTION CONTRACT DBE COMMITMENT
CONTRACTOR SECTION
1. Local Agency - Enter the name of the local agency that is administering the contract.
2. Contract DBE Goal - Enter the contract DBE goal percentage as it appears on the project advertisement.
3. Project Description - Enter the project description as it appears on the project advertisement (Bridge Rehab, Seismic Rehab, Overlay, Widening, etc).
4. Project Location - Enter the project location(s) as it appears on the project advertisement.
5. Bidder’s Name - Enter the contractor’s firm name.
6. Prime Certified DBE - Check box if prime contractor is a certified DBE.
7. Bid Amount - Enter the total contract bid dollar amount for the prime contractor.
8. Total Dollar Amount for ALL Subcontractors – Enter the total dollar amount for all subcontracted contractors.
SUM = (DBEs + all Non-DBEs). Do not include the prime contractor information in this count.
9. Total number of ALL subcontractors – Enter the total number of all subcontracted contractors. SUM = (DBEs + all Non-DBEs). Do not include the prime contractor information in this count.
10. Bid Item Number - Enter bid item number for work, services, or materials supplied to be provided.
11. Description of Work, Services, or Materials Supplied - Enter description of work, services, or materials to be provided. Indicate all work to be performed by DBEs including work performed by the prime contractor’s own forces, if the prime is a DBE. If 100% of the item is not to be performed or furnished by the DBE, describe the exact portion to be performed or furnished by the DBE. See LAPM Chapter 9 to determine how to count the participation of DBE firms.
12. NAICS or Work Category Codes - Enter NAICS or Work Category Codes from the California Unified Certification Program database.
13. DBE Certification Number - Enter the DBE’s Certification Identification Number. All DBEs must be certified on the date bids are opened.
14. DBE Contact Information - Enter the name, address, and phone number of all DBE subcontracted contractors.
Also, enter the prime contractor’s name and phone number, if the prime is a DBE.
15. DBE Dollar Amount - Enter the subcontracted dollar amount of the work to be performed or service to be provided.
Include the prime contractor if the prime is a DBE. See LAPM Chapter 9 for how to count full/partial participation.
16. Total Claimed DBE Participation - $: Enter the total dollar amounts entered in the “DBE Dollar Amount” column. %: Enter the total DBE participation claimed (“Total Claimed DBE Participation Dollars” divided by item “Bid Amount”). If the total % claimed is less than item “Contract DBE Goal,” an adequately documented Good Faith Effort (GFE) is required (see Exhibit 15-H DBE Information - Good Faith Efforts of the LAPM).
17. Preparer’s Signature - The person completing the DBE commitment form on behalf of the contractor’s firm must sign their name.
18. Date - Enter the date the DBE commitment form is signed by the contractor’s preparer.
19. Preparer’s Name - Enter the name of the person preparing and signing the contractor’s DBE commitment form.
20. Phone - Enter the area code and phone number of the person signing the contractor’s DBE commitment form.
21. Preparer’s Title - Enter the position/title of the person signing the contractor’s DBE commitment form.
LOCAL AGENCY SECTION
22. Local Agency Contract Number - Enter the Local Agency contract number or identifier.
23. Federal-Aid Project Number - Enter the Federal-Aid Project Number(s).
24. Bid Opening Date -Enter the date contract bids were opened.
25. Contract Award Date - Enter the date the contract was executed.
26. Award Amount – Enter the contract award amount as stated in the executed contract.
27. Local Agency Representative’s Signature - The person completing this section of the form for the Local Agency must sign their name to certify that the information in this and the Contractor Section of this form is complete and accurate.
28. Date - Enter the date the DBE commitment form is signed by the Local Agency Representative.
29. Local Agency Representative’s Name - Enter the name of the Local Agency Representative certifying the contractor’s DBE commitment form.
30. Phone - Enter the area code and phone number of the person signing the contractor’s DBE commitment form.
31. Local Agency Representative Title - Enter the position/title of the Local Agency Representative certifying the contractor’s DBE commitment form.
January 2023
Local Assistance Procedures Manual Exhibit 15-H
Proposer/Contractor Good Faith Effort
EXHIBIT 15-H: PROPOSER/CONTRACTOR GOOD FAITH EFFORTS
Cost Proposal Due Date ___________________ PE/CE
Federal-aid Project No(s). _____________________ Bid Opening Date ___________________ CON The established a Disadvantaged Business Enterprise (DBE) goal of for this contract. The information provided herein shows the required good faith efforts to meet or exceed the DBE contract goal.
Proposers or bidders submit the following information to document their good faith efforts within five (5) calendar days from cost proposal due date or bid opening. Proposers and bidders are recommended to submit the following information even if the Exhibit 10-O1: Consultant Proposal DBE Commitments or Exhibit 15-G:
Construction Contract DBE Commitment indicate that the proposer or bidder has met the DBE goal. This form protects the proposer’s or bidder’s eligibility for award of the contract if the administering agency determines that the bidder failed to meet the goal for various reasons, e.g., a DBE firm was not certified at bid opening, or the bidder made a mathematical error.
The following items are listed in the Section entitled “Submission of DBE Commitment” of the Special Provisions, please attach additional sheets as needed:
A. The names and dates of each publication in which a request for DBE participation for this project was placed by the bidder (please attach copies of advertisements or proofs of publication):
Publications Dates of Advertisement
B. The names and dates of written notices sent to certified DBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the DBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.):
Names of DBEs Solicited Date of Initial Solicitation Follow Up Methods and Dates
10/23/2024
CML-5137(055) 10/23/2024
BuildCorp Inc
6 Proterra Builders, Inc10/21/2024
10/21/2024
10/21/2024
10/21/2024MZB Engineering Inc.
Local Assistance Procedures Manual Exhibit 15-H
Proposer/Contractor Good Faith Effort
C. The items of work made available to DBE firms including those unbundled contract work items into economically feasible units to facilitate DBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate DBE participation in order to meet or exceed the DBE contract goal.
Items of Proposer or Bidder Breakdown of Amount Percentage Work Normally Performs Item Items ($) Of (Y/N) Contract D. The names, addresses and phone numbers of rejected DBE firms, the reasons for the bidder's rejection of the DBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each DBE if the selected firm is not a DBE:
Names, addresses and phone numbers of rejected DBEs and the reasons for the bidder's rejection of the DBEs:
Names, addresses and phone numbers of firms selected for the work above:
E. Efforts (e.g. in advertisements and solicitations) made to assist interested DBEs in obtaining information related to the plans, specifications and requirements for the work which was provided to DBEs:
Traffic control $ 27,360.00 62
Countervail Engineering 512-799-6983, no answer
Local Assistance Procedures Manual Exhibit 15-H
Proposer/Contractor Good Faith Effort
F. Efforts (e.g. in advertisements and solicitations) made to assist interested DBEs in obtaining bonding, lines of credit or insurance, necessary equipment, supplies, materials, or related assistance or services, excluding supplies and equipment the DBE subcontractor purchases or leases from the prime contractor or its affiliate:
G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using DBE firms (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.):
Name of Agency/Organization Method/Date of Contact Results H. Any additional data to support a demonstration of good faith efforts: