San Jacinto Parks Bid Package_Western State Builders_Rev Docs — San Jacinto City Council, September 16, 2025

00 41 43 - BID FORMS
BID
Bids will be received on www.planetbids.com, until 5:00 PM on SEPTEMBER 8, 2025.

PLAYGROUND DEMOLITION AND CONSTRUCTION PROJECT
NAME OF BIDDER: Western State Builders, Inc.

To the City of San Jacinto, with its principal place of business at: 595 S. San Jacinto Ave, San Jacinto, CA 92583
A. In response to the Notice Inviting Bids and in accordance with the accompanying Instructions to Bidders, the undersigned hereby proposes to the City to furnish all labor, technical and professional services, supervision, materials and equipment, other than materials and equipment specified as furnished by the City, and to perform all operations necessary and required to construct the Project in accordance with the provisions of the Contract Documents and any addenda thereto, and at the prices stated opposite the respective items set forth in the Bid Schedule.

B. This Bid constitutes a firm offer to the City which cannot be withdrawn for 90 calendar days after the date set for opening of bids, or until a Contract is executed by the City and a third party, whichever is earlier.

C. The undersigned certifies that it has examined and is fully familiar with all of the provisions of the Contract Documents and any addenda thereto; that it has carefully checked all of the words and figures shown in its Bid Schedule; that it has carefully reviewed the accuracy of all statements in this Bid and attachments hereto; and that it understands and agrees that the City will not be responsible for any errors or omissions on the part of the undersigned in preparing this Bid.

D. If awarded a Contract, the undersigned agrees to execute and deliver to the City within ten (10) calendar days after date of receipt of Notice of Award, a signed Contract and the necessary performance bond, payment bond, and certificates of insurance and endorsements.

E. The following Bid Forms, which have been completed and executed by the undersigned Bidder, are incorporated by this reference and made a part of this Bid:

1. Bid Schedule

2. Bid security and Notary Acknowledgement from.

3. Completed Designation of Subcontractors form.

4. Completed Bidder Information and Experience form.

5. Public Contract Code form.

6. Fully executed Non-collusion Declaration form.

1. Completed Iran Contracting Act Certification form.

8. Completed Public Works Contractor DIR Registration Certification form.

9. Completed Contractor's Certificate Regarding Workers' Compensation form

10. Anti-trust Claim form.

PLAYGROUND DEMOLITION AND CONSTRUCTION C-1 00 41 43 - BID FORMS

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11. Completed Executive Order N-22 Certification form.

12. Completed Fleet Compliance Certification form.

F. Bidder is an O individual, or © corporation, or O partnership, organized under the laws of the State of Cal: tornia
G. The undersigned is hereby representing that it is and will be properly licensed both at the time that it submits a Bid as well as at the time the Contract is awarded, if the Contract is awarded to the undersigned.

1. Individual Contractor. Undersigned certifies that it is now licensed in accordance with the provisions of the Contractor's License Law of the State of California.

License number 1069617
Expiration date 10/3112026
License classification_ A. B. DIL. 034

1. Joint Venture. Undersigned certifies that the individual members of the joint venture are now licensed in accordance with the provisions of the Contractor's License Law of the State of California.

Member No. 1
Name
License number
Expiration date
License classification_
Member No. 2
Name
License number
Expiration date_
License classification_
(If there are more than two members of the joint venture, attach a page for the additional members) with the above information.)
The undersigned acknowledges receipt, understanding, and full consideration of the following addenda to the Contract Documents:

PLAYGROUND DEMOLITION AND CONSTRUCTION C-2 00 41 43 - BID FORMS

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Addenda No.
[SIGNATURE ON NEXT PAGE]
BLOND DEMOLITION AND CONSTRUCTION| C-3 00 41 43 - BID FORMS

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I hereby certify under penalty of perjury under the laws of the State of California that all of the information submitted in connection with this Bid and all of the representations made herein are true and correct.

BIDDER: Bidder's Business Address:
western State Builders. Inr. 2141 Orange Ave.
(Company Name) Escondido. CA 92029
760-540-2405
(Type or print name) (Phone Number)
Vice President [email protected]
(Title) (Email Address)
Escandido. A
(Where signed) (City, State)
(corporate seal)
Dated: 98 = 2025
State of Incorporation: (alifornia
Names and addresses of all partners or joint venturers:

James Jared Muen 2363 has Ardillas Escondivo. (A 9202G
Julian Moen Isda Via Paldma Escandido. (A 92020
Statement of the authority of signatory to bind Bidder:

PLAYGROUND DEMOLITION AND CONSTRUCTION C-4 00 41 43 - BID FORMS

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CALIFORNIA ALL-PURPOSE

CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
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() on the instrument the persons), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal. HEATHER ANNE GARCIA
Notary Public • California
San Diego County
Heather Garcia Commission # 2497273
(Notary Seal) My Comm. Expires Aug 11. 2028
Signature of Notary Public

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (ie. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signers) who personally appear at the time of notarization.

Corporate Officer • The notary scal impression must be clear and photographically reproducible.

Jalian P. Dillaw-Mon. Vice President Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of Partners) the county clerk.

Attorney-in-Fact Additional information is not required but could help to ensure this • Trustee(s) acknowledgment is not misused or attached to a different document.

Indicate title or type of attached document, number of pages and date.

Other Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com

PROPOSAL

TO THE CITY COUNCIL

CITY OF SAN JACINTO

SAN JACINTO, CALIFORNIA
The undersigned bidder hereby proposes to furnish all labor, material, equipment, tools and services necessary to perform all work required under the City of San Jacinto Specifications

CONTRACT DOCUMENTS

AND SPECIFICATIONS
FOR

PLAYGROUND DEMOLITION AND CONSTRUCTION PROJECT
In accordance with the intent of said Specifications, Plans, and all addenda issued by said City prior to opening of the proposals. Said bidder agrees that, within ten (10) calendar days after date of written Notice of Award of the Contract by said City, he will execute a contract in the required form of which the Notice Inviting Bids, Instructions to Bidders, Proposal, Specifications, Plans, and all addenda issued by said City prior to the opening of proposals, are a part, and will secure the required insurance and bonds; and that upon failure to do so within said time, then the Proposal Guarantee furnished by said bidder shall be forfeited to said City as liquidated damages for such failure; provided, that if said bidder shall execute the Contract and secure the required insurance and bonds within said time, his check, if furnished shall be returned to him within five (5) days thereafter, and the Bid Bond, if furnished, shall become void.

Said bidder further agrees to complete all work required under the Contract within the time stipulated in said Specifications, and to accept in full payment therefor the prices named in the Bid Schedule.
9|8/2025
Date western Stale Builders, Inr.

Bidden
gnature
Julian Muen
Name (PrintType)
Vice President
Title
PLAYGROUND DEMOLITION AND CONSTRUCTION C-5 00 41 43 - BID FORMS

PROJECT

CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
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(g) on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal. HEATHER ANNE GARCIA
Notary Public • California
San Diego County
Weather Garcia Commission # 2497273
(Notary Seal) My Comm. Expires Aug 11, 2028
Signature of Notary Public

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section of a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signers) who personally appear at the time of notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.

CAPACITY CLAIMED BY THE SIGNER He/she/they, is /are) or circling the correct forms. Failure to correctly indicate this • Individual (s) information may lead to rejection of document recording • Corporate Officer • The notary seal impression must be clear and photographically reproducible.

Setian P. Dillarou-Moca, Vice Presidcar Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) • sufficient area permits, otherwise complete a different acknowledgment form.

Partner(s) • Signature of the notary public must match the signature on file with the office of Attorney-in-Fact Additional information is not required but could help to ensure this Trustee(s) acknowledgment is not misused or attached to a different document.

Indicate title or type of attached document, number of pages and date. • Other ** Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com

BID SCHEDULE

BASE BID SCHEDULE
UNIT OF EST. UNIT PRICE ITEM COST
NO. ITEM DESCRIPTION QTY.

MEASURE

1. Mobilization LS 1 24,000.00 24,000.00

2. istall Playground Equipmer LS 1
t Colonel Lewis Pat 186,759.00 186, 759.00
Install Playground Equipment LS 1

3. at Stallions Crossing Park 40,292.00 40,292.°
Install Playground Equipment LS 1

4. 111,211.00 111,211.a0
at Tamarisk Park
BASE BID (BID ITEMS # 1-4) TOTAL $362, 2620°
BASE BID TOTAL 00
$362,262

TOTAL BID PRICE BASED ON BID SCHEDULE
Three hundred sixty two thousand two hundred
$_ sixty to dollars and zero cents
Total Base Bid in Numbers
$362, 262.00
The costs for any work shown or required in the Contract Documents, but not specifically identified as a bid. line item are to be included in the related bid line items and no additional compensation shall be due to Contractor for the performance of the work.

All blank spaces appearing above must be filled in. Failure to fill in any blank spaces may render the Bid non-responsive. In case of discrepancy between the Unit Price and Item Cost set forth for a unit basis item, the Unit Price shall prevail and 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.

PLAYGROUND DEMOLITION AND CONSTRUCTION 00 41 43 - BID FORMS C-6

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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 City from measured quantities of work performed based upon the Unit Price.

The undersigned agrees that this Bid Schedule 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.

If the Contract Documents specify alternate bid items, the City can choose to include any, all, or none of the alternate bid items in the Work. If the City selects any of the alternate bid items, the corresponding alternate bid prices shall be added to or deducted from Base Bid Price for the work.

The City can award/select alternate bid items at any times).

TOTAL AMOUNT BASE BID IN DOLLARS: $ 362, 262.a0
TOTAL AMOUNT BASE BID IN WORDS: Three hundred sixty two Thousand two hundred sixty two dollars and
zero cents.

List of Addenda Received:

Name of Bioder? western State Builders.lni.
signature: sure
Name and Title: Julian Muen. Vire President
Dated:_ 9|82025
PLAYGROUND DEMOLITION AND CONSTRUCTION C-7 00 41 43 - BID FORMS

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CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
who proved to me on the basis of satisfactory evidence to be the persong) 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() on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

HEATHER ANNE GARCIA
WITNESS my hand and official seal.

Notary Public - California
San Diego County
Weather Sarcia Commission # 2497273
(Notary Seal) My Comm. Expires Aug 11, 2028
Signature of Notary Public

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signers) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signers) who personally appear at the time of CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.

He/she/they, is /ere) or circling the correct forms. Failure to correctly indicate this • Individual (s) information may lead to rejection of document recording.

Corporate Officer • The notary seal impression must be clear and photographically reproducible.

Julian P. Dalvou-Moca Vice President Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of Partners)
Attorney-in-Fact Additional information is not required but could help to ensure this • Trustee(s) acknowledgment is not misused or attached to a different document. * Indicate title or type of attached document, number of pages and date.

Other * Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com

BID SECURITY

BID BOND
[Note: Not required when other form of Bidder's security, e.g. cash, certified check or cashier's check, accompanies Bid.]
The makers of this bond are, WESTERN STATE BUILDERS, INC. _ as Principal, and NATIONWIDE MUTUAL INSURANCE COMPANY ., as Surety and are held and firmly bound unto the City of San Jacinto, with its principal place of business at 595 S. San Jacinto Ave, San Jacinto, CA 92583, hereinafter called the City, in the penal sum o TEN PERCENT (10%) OF THE TOTAL BID PRICE of the Principal submitted to the 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 datedSEPTEMBER 8, 2025, for PLAYGROUND DEMOLITION AND CONSTRUCTION PROJECT.

If the Principal does not withdraw its Bid within the time specified in the Contract Documents; and if the Principal is awarded the Contract and provides all documents to the City as required by the Contract Documents; then this obligation shall be null and void. Otherwise, this bond will remain in full force and effect.

Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract Documents shall 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. Surety signatures on this bond must be acknowledged before notary publics, and a legally sufficient power of attorney must be attached to the bond to verify the authority of any party signing on behalf of a surety.

IN WITNESS WHEREOF, the above-bound parties have executed this instrument under their several seals this 4TH day of SEPTEMBER 2025 the name and corporate seal of each corporation.
(Corporate Seal) WESTERN STATE BUILDERS, INC.

Contractor/ Principal
Brule
Title JULIAN P. DILAVOU-MOEN, VICE PRESIDENT

NATIONWIDE MUTUAL INSURANCE COMPANY
(Corporate Seal) Surety
serg
By
Attorney-in-Fact
(Attach Attorney-in-Fact Certificate) Title SANDRA FIGUEROA, ATTORNEY-IN-FACT PLAYGROUND DEMOLITION AND CONSTRUCTION C-8 00 41 43 - BID FORMS

PROJECT
Notary Acknowledgment
entes orible idently of heroice the e

STATE OF CALIFORNIA

COUNTY OF
On _ 20 , before me, _ Notary Public, personally
appeared who proved to me on the basis of satisfactory
Name(s) of Signer(s)
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 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 inf out prevent aucten red by an eatly prove of tale to po ans nor ng on the document.

CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT Individual
• Corporate Officer
Title(s) Title or Type of Document
D Partners) Limited
General Number of Pages
• Attorney-In-Fact
• Trustee(s) |
• Guardian/Conservator Date of Document
• Other:

Signer is representing:

Name Of Person(s) Or Entity(ies)
Signers) Other Than Named Above
NOTE: This acknowledgment is to be completed for Contractor/Principal.

PLAYGROUND DEMOLITION AND CONSTRUCTION C-9 00 41 43 - BID FORMS

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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 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 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
hough the information below is not required by law, it may prove valuable to persons relying on the documen and could prevent fraudulent removal and reattachment of this form to another documen

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
" Other:

Signer is representing:

Name Of Person(s) Or Entity(ies)
Signer(s) 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
PLAYGROUND DEMOLITION AND CONSTRUCTION C-10 00 41 43 - BID FORMS

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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 3830808088808880388:888:88898080848884808830883080838080808080808080888480808088080808880:08080898080893:8080808088388030803#80888080838380838083888884895088808 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 DIEGO
On _SEPTEMBER 4. 2025 before me,. MICHELE KIRSTEN GIESING, NOTARY PUBLIC Date Here Insert Name and Title of the Officer
personally appeared JULIAN P. DILLAVOU-MOEN
Name(s) of Signers)
ho proved to me on the basis of satisfactory evidence to be the person(s) whose name(g) is/are subscribe › the within instrument and acknowledged to me that he/she/they executed the same in his/her/the authorized capacityfies), 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

MICHELE KIRSTEN GIESING
Notary Public • California laws of the State of California that the foregoing San Diego County paragraph is true and correct.

Commission # 2434345
My Comm. Expires dan 15, 2027
WITNESS my hand and official seal.

Signature
Place Notary Seal and/or Stamp Above Signature of Notary Public

OPTIONAL
Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document.

Description of Attached Document
Title or Type of Document:

Document Date: Number of Pages:

Signer(s) Other Than Named Above:

Capacity(les) Claimed by Signer(s)
Signer's Name: Signer's Name:
• Corporate Officer - Title(s): • Corporate Officer - Title(s):
• Partner - • Limited • General • Partner - D Limited • General • Individual • Attorney in Fact • Individual • Attorney in Fact • Trustee • Guardian of Conservator • Trustee • Guardian of Conservator • Other: • Other:

Signer is Representing: Signer is Representing: _
8880888888883888308888898080808888030838888880888088888030898080808880898980880808388808088888884808888888808388888888388888838383838988898583803083809 ©2017 National Notary Association
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 888888838888888888888888888888888888888888888888888838883888888883888388888833838888888 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 DIEGO
On _ SEPTEMBER 4, 2025 _ before me, MICHELE KIRSTEN GIESING, NOTARY PUBLIC Date Here Insert Name and Title of the Officer
personally appeared SANDRA FIGUEROA
Name(s) of Signers)
authorized capacity(tes), 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
MICHELE KIRSTEN GIESING laws of the State of California that the foregoing Notary Public • California paragraph is true and correct.

San Diego County
Commission # 2434345
My Coom. Expires Jan 15,2027 WITNESS my hand and official seal.

Signature
Place Notary Seal and/or Stamp Above Signature of Notary Public - OPTIONAL
Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document.

Description of Attached Document
Title or Type of Document:

Document Date: Number of Pages:

Signers) Other Than Named Above:.

Capacity(ies) Claimed by Signer(s)
Signer's Name: SANDRA FIGUEROA Signer's Name:
• Corporate Officer - Title(s): • Corporate Officer - Title(s):
• Partner - • Limited • General • Partner - • Limited • General • Individual • Attorney in Fact • Individual • Attorney in Fact • Trustee • Guardian of Conservator • Trustee • Guardian of Conservator • Other: • Other:

Signer is Representing: Signer is Representing: _
88888888888838388888888888888888888888888883838838988
©2017 National Notary Association
Power of Attorney
KNOW ALL MEN BY THESE PRESENTS THAT:

Nationwide Mutual Insurance Company, an Ohio corporation hereinafter referred to severally as the "Company" and collectively as "the Companies" does hereby make, constitute and appoint:

HELEN MALONEY; JOHN G MALONEY; MARK DIATAROLA; MICHELE KIRSTEN GIESING; SANDRA FIGUEROA;
each in their individual capacity, its true and lawful attorney-in-fact, with full power and authority to sign, seal, and execute on its behalf any and all bonds and undertakings, and other obligatory instruments of similar nature, in penalties not exceeding the sum of

UNLIMITED
and to bind the Company thereby, as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company; and all acts of said Attorney pursuant to the authority given are hereby ratified and confirmed.

This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company:
"RESOLVED, that the president, or any vice president be, and each hereby is, authorized and empowered to appoint attorneys-in-fact of the Company and to authorize them to execute and deliver on behalf of the Company any and all bonds, forms, applications, memorandums, undertakings, of said documents on behalf of the Company."
"RESOLVED FURTHER, that such attorneys-in-fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company subject to the terms and limitations of the power of attorney issued to them, and to affix the seal of the Company thereto; provided, however, that said seal shall not be necessary for the validity of any such documents." This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company.

Execution of Instruments. Any vice president, any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved documents, instruments, contracts, or other papers in connection with the operation of the business of the company in addition to the chairman of the board, the chief executive officer, president, treasurer or secretary; provided, however, the signature of any of them may be printed, engraved, or stamped on any approved document, contract, instrument, or other papers of the Company.

IN WITNESS WHEREOF, the Company has caused this instrument to be sealed and duly attested by the signature of its officer the 1st day of April, 2024. 400
Antonio C. Albanese, Vice President of Nationwide Mutual Insurance Company

ACKNOWLEDGMENT
STATE OF NEW YORK COUNTY OF KINGS: ss
On this 1st day of April, 2024, before me came the above-named officer for the Company (SEAL aforesaid, to me personally known to be the officer described in and who executed the preceding instrument, and he acknowledged the execution of the same, and being by me duly sworn, deposes and says, that he is the officer of the Company aforesaid, that the seal affixed COLABUS, ON hereto is the corporate seal of said Company, and the said corporate seal and his signature were duly affixed and subscribed to said instrument by the authority and direction of said Sharon Laburda
Notary Public, State of New York
No. 01LA6427697
Qualified in Kings County Notary Public
Commission Expires January 3, 2026 My Commission Expires January 3, 2026

CERTIFICATE
1, Lezlie F. Chimienti, Assistant Secretary of the Company, do hereby certify that the foregoing is a full, true and correct copy of the original power of attorney issued by the Company; that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked or amended in any manner; that said Antonio C. Albanese was on the date of the execulion of the foregoing power of attorney the duly elected officer of the Company, and the corporate seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors; and the foregoing power of attorney is still in full force and effect.

IN WITNESS WHEREOF, I have hereunto subscribed my name as Assistant Secretary, and affixed the corporate seal of said Company this 4TH day of

SEPTEMBER
Cost. Cl
Assistant Secretary
BDJ 1(04-24)00

DESIGNATION OF SUBCONTRACTORS
The subcontractor listed below will perform work or labor or render service to the successful Bidder in or about the construction of the work or improvement, or are subcontractors licensed by the State of California who will, under subcontract to the successful Bidder, specially fabricate and install a portion of the work or improvement according to detailed drawings contained in the Contract Documents, in an amount in excess of one-half of one percent (1/2 of 1%) of the Bidder's total bid. 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.

In compliance with the Subletting and Subcontracting Fair Practices Act Chapter 4 (commencing at Section 4100), Part 1, Division 2 of the California Public Contract Code, the Bidder shall set forth below:
(a) The portion of the work to be done by the subcontractor; (b) The name and the location of the place of business; (0) The California contractor license number; and
(d) The DIR public works contractor registration number.

If a Bidder fails to specify a subcontractor or if a Bidder 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.

Portion of CSLB DIR
Work to be Name of Location of Contractor Registration
done by Subcontractor Business License No. Number
Subcontractor
Robertsons 2140 E Cedien
Pared in St. Tempe Az. 667261 1000002700
Indusines
Place
Rubber
PLAYGROUND DEMOLITION AND CONSTRUCTION C-11 00 41 43 - BID FORMS

PROJECT
Portion of CSLB DIR
Work to be Name of Location of Contractor Registration
done by Subcontractor Business License No. Number
Subcontractor
(Attach additional sheets if necessary)
Name of Bidder_ western State Builders.Inc.

Signature le
Name and Title Julian Muen. Wire President
Dated 9/8/2025
C-12 00 41 43 - BID FORMS

PLAYGROUND DEMOLITION AND CONSTRUCTION

PROJECT

CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(g) 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(8) on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal. HEATHER ANNE GARCIA
Notary Public - California
San Diego County
Weather Garcia Commission # 2497273
(Notary Seal) My Comm. Expires Aug 11, 2028
Signature of Notary Publi

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signers) who personally appear at the time of notarization.

CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.

He/she/they, is /are) or circling the correct forms. Failure to correctly indicate this • Individual (s) information may lead to rejection of document recording. • Corporate Officer • The notary seal impression must be clear and photographically reproducible.

Malian P. Dall ros: Moer. Vice Presiden Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form.

I Partners) • Signature of the notary public must match the signature on file with the office of • Attorney-in-Fact Additional information is not required but could help to ensure this Trustee(s) acknowledgment is not misused or attached to a different document. * Indicate title or type of attached document, number of pages and date. • Other Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com

BIDDER INFORMATION AND EXPERIENCE FORM
A. 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: western Stute Builders, Inc.

2.0 Type, if Entity: Corporation

3.0 Bidder Address: 2841 Orange Aur.

Escondido. (A 92029
740-546-2405
Telephone Number
[email protected]
Email Address

4.0 How many years has Bidder's organization been in business as a Contractor?

5.0 How many years has Bidder's organization been in business under its present name?

5.1 Under what other former names has Bidder's organization operated?_ western State Builders

6.0 If Bidder's organization is a corporation, answer the following:

6.1 Date of Incorporation: 12/16/2019

6.2 State of Incorporation: California

6.3 President's Name: James Jared Moen

6.4 Vice-President's Name(s): Julian Moen

6.5 Secretary's Name: James Jared Morn

6.6 Treasurer's Name: Julian Moen
PLAYGROUND DEMOLITION AND CONSTRUCTION C-13

PROJECT

7.0 If an individual or a partnership, answer the following:

7.1 Date of Organization: NIA

7.2 Name and address of all partners (state whether general or limited partnership):

NIA

8.0 If other than a corporation or partnership, describe organization and name principals: a I A

9.0 List other states in which Bidder's organization is legally qualified to do business.

None

10.0 What type of work does the Bidder normally perform with its own forces? Installation at playgrounds, shade structures.
fitness equipment, site furnishings, and site
work

11.0 Has Bidder ever failed to complete any work awarded to it? If so, note when, where, and why:

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
PLAYGROUND DEMOLITION AND CONSTRUCTION C-14 00 41 43 - BID FORMS

PROJECT

13.0 List Trade References:

Superior Ready Mix, Carlos Amador 740-745-0556
Robertson's, Della Rumsey, 951-493-4525
RR Leonard, Janet Waley, 542. 941-2289

14.0 List Bank References (Bank and Branch Address):

Chris Greenhouse a Chase Bank
2500 El Camino Real Ste 200 Carlsbad, CA 9L008
619-948-3225

15.0 Name of Bonding Company and Name and Address of Agent:

Mark latardla- Maloney and Associates
435 w. Grand Aur. Escondida, CA 92025
760-734-2610
[REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK]
PLAYGROUND DEMOLITION AND CONSTRUCTION C-15 00 41 43 - BID FORMS

PROJECT
B. LIST OF CURRENT PROJECTS (BACKLOG)
[Duplicate page if needed for listing additional current projects.] Project Client Reference Description of Completion Date Cost of Bidder's (agency Bidder's Work Work
name/contact
info)
San Diegousn sun Orego UsO Purchase /Insteril Morch 2024 $1.018,898
GroUp HA Snado, 019-260-5406 SHORES
San Dreçi SSD San Dieso vsD Purchased Instell March 2024 $ 947.212 Group tB Shades 619. 260-5406 snadas
PLAYGROUND DEMOLITION AND CONSTRUCTION C-16 00 41 43 - BID FORMS

PROJECT
C. LIST OF COMPLETED PROJECTS - LAST THREE YEARS
[Duplicate page if needed for listing additional completed projects.] Please include only those projects which are similar enough to demonstrate Bidder's ability to perform the required work on the Project.

Project Client Reference Description of Completion Date Cost of Bidder's (agency Bidder's Work Work
name/contact
info)
Sterns Ports Cite out los Alamitos (ity Parts Febzozs $1,143,346 542-451-3838 Renovation
scott valley city at Encinitas Icity Pork $ 554.545
Renovation Rey 2025
Pork 140 - 943-2230
towngate (ity ot Horend Valley city post
Renovation Jan 2025 $ 331,514
Pork 951-415-3704
PLAYGROUND DEMOLITION AND CONSTRUCTION C-17 00 41 43 - BID FORMS

PROJECT
D. EXPERIENCE AND TECHNICAL QUALIFICATIONS QUESTIONNAIRE Personnel:

The Bidder shall identify the key personnel to be assigned to this project in a management, construction supervision or engineering capacity.

1. List each person's job title, name and percent of time to be allocated to this project:

James Jared Moch. Superintendent 100%
Doug Lewis- Project Manager 50%

2. Summarize each person's specialized education:
tame, Jared Men- Backder Degree
Doug Lewis - Bornelor Degree

3. List each person's years of construction experience relevant to the project:

James Jared Moen - 1s Years
Doug kur. So years

4. Summarize such experience:

James and Doves have decades of experience in
park plurground installation experience. Both are
also UPs certited installers
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.

PLAYGROUND DEMOLITION AND CONSTRUCTION C-18 00 41 43 - BID FORMS

PROJECT
E. 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:

Name of Bidder_ wastern State Builders, Inr.

Signature_ fale
Name and Title Julian Muen. Wire President
Dated_ 98/2025
00 41 43 - BID FORMS
PLAYGROUND DEMOLITION AND CONSTRUCTION C-19

PROJECT

CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
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(g) on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal. HEATHER ANNE GARCIA
Notary Public • California
San Diego County
Weather Sarcia Commission # 2497273
(Notary Scal) My Comm. Expires Aug 11, 2028
Signature of Notary Public

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the names) of document signers) who personally appear at the time of notarization.

CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/they, is /ere) or circling the correct forms. Failure to correctly indicate this • Individual (s) information mav lead to rejection of document recording Corporate Officer • The notary seal impression must be clear and photographically reproducible Julian P. Dalamou-16ven. Vice Precisiar Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of Partners)
Attorney-in-Fact Additional information is not required but could help to ensure this • Trustee(s) acknowledgment is not misused or attached to a different document.

Indicate title or type of attached document, number of pages and date • Other. * Indicate the capacity claimed by the signer, If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com

PUBLIC CONTRACT CODE
PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT
In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder , has not* been convicted within the preceding three years of any offenses referred to I that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1.

Note: The bidder must place a checkmark after "has" or "has not" in one of the blank spaces provided. he above Statement is part of the Proposal. Signing this proposal on the signature portion thereot shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may be subject to certifier to criminal prosecution.

PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE
In conformance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire:

Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation?
YES NO
If the answer is yes, explain the circumstances in the following space.

PLAYGROUND DEMOLITION AND CONSTRUCTION C-20 00 41 43 - BID FORMS

PROJECT
PUBLIC CONTRACT CODE SECTION 10232 STATEMENT
In conformance with Public Contract Code Section 10232, the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two-year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor to comply with an order of the national Labor Relations Board.

Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire.

Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution.

DEBARMENT AND SUSPENSION CERTIFICATION
TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29
The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager:

Is not currently under suspension, debarment, voluntary exclusion or determination of indelibility by any Federal agency;
- Has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federal agency within the past 3 years;
- Does not have a proposed debarment pending; and
- Has not been indicted, convicted, or had a civil judgement rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years.

If there are any exceptions to this certification, insert the exceptions in the following space.

Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action.

Notes: Providing false information may result in criminal prosecution or administrative sanctions.

The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification.

Me, то 9/8/025
PLAYGROUND DEMOLITION AND CONSTRUCTION C-21 00 41 43 - BID FORMS

PROJECT

CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
who proved to me on the basis of satisfactory evidence to be the persong) whose name(g) 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(g) on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal. HEATHER ANNE GARCIA
Notary Public • California
INA
San Diego County
weather sarca Commission # 2497273
(Notary Seal) My Comm. Expires Aug 11, 2028
Signature of Notary Public

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signers) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signers) who personally appear at the time of CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/they, is /are) or circling the correct forms. Failure to correctly indicate this • Individual (s) information may lead to rejection of document recording. • Corporate Officer • The notary seal impression must be clear and photographically reproducible.

Julian P. Dillane-Men. Vice Presidens Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of Partners) the county clerk.

Attorney-in-Fact Additional information is not required but could help to ensure this Trustee(s) acknowledgment is not misused or attached to a different document.

NON-COLLUSION DECLARATION
The undersigned declares:
lam the Vire President western State Bulderslni., the party making the foregoing 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 9/8/2025 [date], at Escondido _[city], CA
Name of Bidder Western State Builders. Inr.

Signature fe
Name and Title Julian Main, Vice Diesident
Dated 9/8/2025
PLAYGROUND DEMOLITION AND CONSTRUCTION C-22 00 41 43 - BID FORMS

PROJECT

CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer
personally appeared Julian P Dillavou-Moen
who proved to me on the basis of satisfactory evidence to be the person(g) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature() on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal. HEATHER ANNE GARCIA
Notary Public • California
San Diego County
Meather Jarcia Commission # 2497273
(Notary Seal) My Comm, Expires Aug 11, 2028
Signature of Notary Public

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signers) who personally appear at the time of • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.

CAPACITY CLAIMED BY THE SIGNER he/she/they, is /are) or circling the correct forms. Failure to correctly indicate this • Individual (s) information mav lead to reiection of document recording. • Corporate Officer • The notary seal impression must be clear and photographically reproducible.

Julien P. Dillavoa Moen. Vice Presides Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of • Partners)
• Attorney-in-Fact Additional information is not required but could help to ensure this • Trustee(s) acknowledgment is not misused or attached to a different document.

Indicate title or type of attached document, number of pages and date. • Other * Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com IRAN CONTRACTING ACT CERTIFICATION.
(Public Contract Code section 2200 et seq.)
As required by California Public Contract Code Section 2204, the Contractor certifies subject to penalty for perjury that the option checked below relating to the Contractor's status in regard to the Iran Contracting Act of 2010 (Public Contract Code Section 2200 et seq.) is true and correct:
• The Contractor is not:
(1) identified on the current list of person and entities engaged in investment activities in Iran prepared by the California Department of General Services in accordance with subdivision (b) of Public Contract Code Section 2203; or (2) a financial instruction that extends, for 45 days or more, credit in the amount of $20,000,000 or more to any other person or entity identified on the current list of persons and entities engaging in investment activities in Iran prepared by the California Department of General Services in accordance with subdivision (b) of Public Contract Code Section 2203, if that person or entity uses or will use the credit to provide goods or services in the energy sector in Iran.

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: Julian Moen
Title:_ urce president
-
Firm Name: Western State Builders, Inr. -
Date: 98/2025
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.

PLAYGROUND DEMOLITION AND CONSTRUCTION C-23 00 41 43 - BID FORMS

PROJECT

CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
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(ios), and that by his/her/their signature(p) on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal. HEATHER ANNE GARCIA
Notary Public • California
San Diego County
Weather Sarcia Commission # 2497273
(Notary Seal) My Comm. Expires Aug 11, 2028
Signature of Notary Public

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (ie. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the names) of document signers) who personally appear at the time of notarization.

CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/they, is /are) or circling the correct forms. Failure to correctly indicate this • Individual (s) information may lead to rejection of document recording. • Corporate Officer • The notary seal impression must be clear and photographically reproducible.

Sula P. Dalo: on. Vice Preited Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of D Partners) the county clerk.

Attorney-in-Fact Additional information is not required but could help to ensure this • Trustee(s) acknowledgment is not misused or attached to a different document.

Indicate title or type of attached document, number of pages and date. • Other _ * Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com

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.

Bidder hereby certifies that it is aware of the registration requirements set forth in Labor Code sections 1725.5 and 1771.1 and is currently registered as a contractor with the Department of Industrial Relations.'
Name of Bidder:_ western Sitate Builders, Ine.

DIR Registration Number:_ 1000106410
DIR Registration Expiration: 4/30/2027
Small Project Exemption: _ Yes or _ No
Unless Bidder is exempt pursuant to the small project exemption, Bidder further acknowledges:

1. Bidder shall maintain a current DIR registration for the duration of the project.

2. Bidder shall include the requirements of Labor Code sections 1725.5 and 1771.1 in its contract with subcontractors and ensure that all subcontractors are registered at the time of bid opening and maintain registration status for the duration of the project.

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 Bidder_ western State Builders, Iar.

Name and title Julian Muen, Wire President
Dated 98/2025
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." C-24 00 41 43 - BID FORMS

PLAYGROUND DEMOLITION AND CONSTRUCTION

PROJECT

CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
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(8) on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal. HEATHER ANNE GARCIA
Notary Public • California
San Diego County
Heather Garcia Commission # 2497273
(Notary Seal) My Comm. Expires Aug 11, 2028
Signature of Notary Public

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not reguire the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the names) of document signers) who personally appear at the time of CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.

He/she/they, is /ere ) or circling the correct forms. Failure to correctly indicate this • Individuals) information may lead to rejection of document recording Corporate Officer • The notary seal impression must be clear and photographically reproducible.

Him P. Dilawo-Moet, Vice President Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form.

Partners) • Signature of the notary public must match the signature on file with the office of • Attorney-in-Fact Additional information is not required but could help to ensure this • Trustee(s) acknowledgment is not misused or attached to a different document. * Indicate title or type of attached document, number of pages and date ] Other * Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com CONTRACTOR'S CERTIFICATE REGARDING WORKERS' COMPENSATION.

I am aware of the provisions of section 3700 of the Labor Code which require every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this Contract.

Name of Bidder, Western State Builders. Inr.
signature farle
Name and Title. Julian Moen, vire Praident
Dated 9/8/2025
PLAYGROUND DEMOLITION AND CONSTRUCTION 00 41 43 - BID FORMS C-25

PROJECT

CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
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() on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and otticial seal. HEATHER ANNE GARCIA
Notary Public - California
San Diego County
Meather Marcia Commission # 2497273
(Notary Seal) My Comm. Expires Aug 11, 2028
Signature of Notary Public

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization.

CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e He/she/they, is /are) or circling the correct forms. Failure to correctly indicate this • Individual (s) information may lead to rejection of document recording. • Corporate Officer • The notary seal impression must be clear and photographically reproducible Julian P. Dillatou-Mon. Vice Fresident Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form.

Partners) • Signature of the notary public must match the signature on file with the office of the county clerk
Attorney-in-Fact Additional information is not required but could help to ensure this Trustee(s) acknowledgment is not misused or attached to a different document.

Indicate title or type of attached document, number of pages and date.

ANTI-TRUST CLAIM
In entering into a public works contract or a subcontract to supply goods, services, or materials pursuant to a public works contract, the contractor or Subcontractor offers and agrees to assigr o the City all rights, title, and interest in and to all causes of action it may have under Section of the Clayton act (15 U.S.C. Sec. 15) or under the Cartwright Act (Chapter [commencing with Section 16700] of Part 2 of Division 7 of the Business and Professions Code), arising from purchases of goods, services, or materials pursuant to the Public Works Contract or the Contract or the Subcontract. This assignment shall be made and become effective at the time the Agency tenders final payment to the Contractor, without further acknowledgement by the parties.

RESPECTFULLY SUBMITTED:
feve Julian Moen
Signature Printed Name
Vice President 2141 orange Ave. Escandida. dA 42029
Title Address
D9l/8/2025
1069077 A,B, DIL. D3"1
Contractor's California License Number Type of License
western State Builders.Inr. 10131 / 2026
Name of License Holder Expiration Date
THE REPRESENTATIONS MADE HEREIN ARE MADE UNDER PENALTY OF PURJURY. 85-2764904
Federal I.D. Number
(Seal O if Bid is by a Corporation)
ares heather Saree
00 41 43 - BID FORMS
PLAYGROUND DEMOLITION AND CONSTRUCTION C-26

PROJECT

CALIFORNIA ALL-PURPOSE

CERTIFICATE OF ACKNOWLEDGMENT
1 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 Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(g) 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() on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal. HEATHER ANNE GARCIA
Notary Public • California
San Diego County
heather Marcis Commission # 2497273
(Notary Seal) My Comm. Expires Aug 11, 2028
Signature of Notary Public

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Pleuse check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signers) personally appeared before the notary public for acknowledgment. •Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the names) of document signer(s) who personally appear at the time of • Indicate tile correct singular or plural forms by crossing off incorrect forms (i.e.

CAPACITY CLAIMED BY THE SIGNER he/she/they, is /are) or circling the correct forms. Failure to correctly indicate this • Individual (s) information may lead to rejection of document recording.

Corporate Officer • The notary seal impression must be clear and photographically reproducible.

Helen P. Dares Moca. We Preelent Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of • Partners) the county clerk.
• Attorney-in-Fact Additional information is not required but could help to ensure this • Trustee(s) acknowledgment is not misused or attached to a different document. * Indicate title or type of attached document, number of pages and date. • Other * Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com EXECUTIVE ORDER N-6-22 CERTIFICATION.

Executive Order N-6-22 issued by Governor Gavin Newsom on March 4, 2022, directs all agencies and departments that are subject to the Governor's authority to (a) terminate any contracts with any individuals or entities that are determined to be a target of economic sanctions against Russia and Russian entities and individuals; and (b) refrain from entering into any new contracts with such individuals or entities while the aforementioned sanctions are in effect.

Executive Order N-6-22 also requires that any contractor that: (1) currently has a contract with District funded through grant funds provided by the State of California; and/or (2) submits a bid or proposal or otherwise proposes to or enter into or renew a contract with the District funded by State of California grant funds, certify that the person is not the target of any economic sanctions against Russia and Russian entities and individuals.

The contractor hereby certifies, SUBJECT TO PENALTY FOR PERJURY, that a) the contractor is not a target of any economic sanctions against Russian and Russian entities and individuals as discussed in Executive Order N-6-22 and b) the person signing below is duly authorized to legally bind the Contractor. This certification is made under the laws of the State of California. sons ale
Printed Name:_ Julian Moen
Title: Ute President
Firm Name: Western State Builders, Inr.

Date:_ 9/8/2025
PLAYGROUND DEMOLITION AND CONSTRUCTION ( C-27 00 41 43 - BID FORMS

PROJECT

CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
who proved to me on the basis of satisfactory evidence to be the person(g) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature() on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signers) who personally appear at the time of notarization.

Talian P. Dillow: Moen. Vice President Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of • Partner(s)
Attorney-in-Fact Additional information is not required but could help to ensure this ] Trustee(s) acknowledgment is not misused or attached to a different document.

Indicate title or type of attached document, number of pages and date. • Other Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com

FLEET COMPLIANCE CERTIFICATION
Bidder hereby acknowledges that they have reviewed the California Air Resources Board's policies, rules and regulations and are familiar with the requirements of Title 13, California Code of Regulations, Division 3, Chapter 9, effective on January 1, 2024 (the "Regulation"). Bidder hereby certifies, subject to penalty for perjury, that the option checked below relating to the Bidder's fleet, and/or that of their subcontractors) ("Fleet") is true and correct:
& The Fleet is subject to the requirements of the Regulation, and the appropriate Certificate(s) of Reported Compliance have been attached hereto. • The Fleet is exempt from the Regulation under section 2449.1(f)(2), and a signed description of the subject vehicles, and reasoning for exemption has been attached hereto. • Bidder and/or their subcontractor is unable to procure R99 or R100 renewable diesel fuel as defined in the Regulation pursuant to section 2449.1(f)(3). Bidder shall keep detailed records describing the normal refueling methods, their attempts to procure renewable diesel fuel and proof that shows they were not able to procure renewable diesel (i.e. third party correspondence or vendor bids).

The Fleet is exempt from the requirements of the Regulation pursuant to section 2449(i)(4) because this Project has been deemed an Emergency, as defined under section 2449(c)(18). Bidder shall only operate the exempted vehicles in the emergency situation and records of the exempted vehicles must be maintained, pursuant to section 2449(i)(4).

The Fleet does not fall under the Regulation or are otherwise exempted and a detailed reasoning is attached hereto.

Printed Name: Dulian Macn
Title: Vice President
-
Firm Name: Western Stade Bulders Ine.
-
Date: 9/8/2025
. END OF BID FORMS
PLAYGROUND DEMOLITION AND CONSTRUCTION C-28 00 41 43 - BID FORMS

PROJECT

CALIFORNIA ALL-PURPOSE

State of California
County of San Diego
On September 8, 2025 before me, Heather Anne Garcia, Notary Public (Here insert name and title of the officer)
personally appeared Julian P Dillavou-Moen
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(8) on the instrument the person(s), or the entity upon behalf of which the person(8) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal. HEATHER ANNE GARCIA
Notary Public • California
San Diego County
Meather Sarcia Commission # 2497273
(Notary Seal) My Comm. Expires Aug 11, 2028
Signature of Notary Publio

ADDITIONAL OPTIONAL INFORMATION

INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attached document continued)
• State and County information must be the State and County where the document Number of Pages Document Date signers) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers) personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.

CAPACITY CLAIMED BY THE SIGNER he/she/they, is /are) or circling the correct forms. Failure to correctly indicate this • Individual (s) information may lead to rejection of document recording. • Corporate Officer • The notary seal impression must be clear and photographically reproducible.

Jolies P. Dillo-Mon. Vice Presse Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form. • Partners) • Signature of the notary public must match the signature on file with the office of • Attorney-in-Fact Additional information is not required but could help to ensure this • Trustee(s) acknowledgment is not misused or attached to a different document.

Indicate title or type of attached document, number of pages and date. • Other _ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com California Environmental Protection Agency
Air Resources Board
January 1, 2025

CERTIFICATE OF REPORTED COMPLIANCE

OFF-ROAD DIESEL VEHICLE REGULATION
is issued to

WESTERN STATE BUILDERS INC
This certificate indicates that the fleet isted above has reported off-road diesel vehicles to the California Air Resourdes Board and has certified they are in compliance with title 13 CCR section 2449. All applicable vehicles owned by the individual, company, or agency must be reported and labeled as specited in Section 2449, with all possible completeness, else this certificate is null and void. Certificate expires 2/28/2026 Off-road Diesel Fleet Identification
174367
lack Kitcursk
Chief, Mobile Sourte Conttol Divisi Tip verify the authenticity of this certificale enter this number at Callomia Air Restarces Board http://www.arb.cagov/doors/campliance_cert1 htnil ACORD® DATE (MM/DDYYYY)
CERTIFICATE OF LIABILITY INSURANCE 7/1/2025
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

MPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed IF SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement o this certificate does not confer rights to the certificate holder in lieu of such endorsements).

Acrisure Southwest Partners Insurance Services, LLC TFAC, NO): 949-201-4515 4000 Westerly Place
ADDRESS: [email protected]
Newport Beach CA 92660 INSURERS) AFFORDING COVERAGE
License#: BR-1801370 INSURER A: LIO Specialty Insurance Company. 17346 WESTSTA-02 INSURER B: Security National Insurance Company 19879

INSURED
Western State Builders Inc INSURER C: Endurance American Specialty Insurance Company. 41718 2141 Orange Ave. 27847
Escondido CA 92029 INSURER D: Insurance Company of the West INSURER E:

INSURER F:

COVERAGES CERTIFICATE NUMBER: 1795610334

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INSR

TYPE OF INSURANCE
A X COMMERCIAL GENERAL LIABILITY LSIC110000968600 8/12/2024 11/10/2025 $1,000,000 CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) _ $ 300,000 MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY [X] PECT LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: COMBINED SINGLE LIMIT $1,000,000
B AUTOMOBILE LIABILITY SPP1818543 01 12/21/2024 11/10/2025 (Ea accident X ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

AUTOS ONLY AUTOS PROPERTY DAMAGE

HIRED NON-OWNED
AUTOS ONLY AUTOS ONLY (Per accident)
] UMBRELLA LIAB ELD30066161800 8/12/2024 11/10/2025 EACH OCCURRENCE $ 4,000,000 OCCUR
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000

RETENTIONS
TWORKERS COMPENSATION WSD505782004 11/10/2024 11/10/2025 X STATUTE I AND EMPLOYERS' LIABILITY $ 1,000,000
E.L. EACH ACCIDENT
N/ A
(Mandatory in NH) ELL. DISEASE - EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 For business auto, cericate holder is aded as agional insured, coverage is primary and non-contractory, and a waiver of subrogation is in place a equired by written agreement between certificate holder and named insured, per attached business auto policy form # CA990187071:

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

Proof of Insurance

ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: SPP1818543 01 COMMERCIAL AUTO
CA990187 0715
This Endorsement Changes The Policy. Please Read It Carefully

BUSINESS AUTO COVERAGE EXPANSION

ENDORSEMENT
This endorsement modifies insurance provided by the following:

BUSINESS AUTO COVERAGE FORM
Withs met to by trage posed by this endorsement, the provisions of the COVERAGE FORM apply A. Newly Acquired or Formed e. An "employee" of yours is an "insured" Organizations, Employee Hired Car while operating an "auto" hired or rented Liability and Blanket Additional Insured under a contract or agreement in that Status for Certain Entities. "employee's" name, with your permission, while performing duties
Item 1. Who is an Insured of Paragraph A. related to the conduct of your business.

Coverage under SECTION I| - COVERED
AUTOS LIABILITY COVERAGE is f. Any person or organization you are amended to add: required by written contractor
agreement to name as an additional
d. Any organization you newly acquire or
form, other than a partnership, joint "insured", but only with respect to liability created in whole or in part by
venture or limited liability company, and
such agreement.
over which you maintain ownership of a
majority interest (greater than 50%), will B. Increase Of Loss Earnings Payment qualify as a Named Insured; however, Subpart (4) of a. Supplementary Payments (1) coverage under this provision is of Item 2. Coverage Extensions of afforded only until the 180t day Paragraph A. Coverage under SECTION I after you acquire or form the - COVERED AUTOS LIABILITY organization or the end of the policy COVERAGE is amended to read:
period, whichever is earlier; (4) We will pay reasonable expenses (2) coverage does not apply to "bodily incurred by the "insured" at our injury", "property damage" or request, including actual loss of "covered pollution cost or expense earnings up to $1,000 per day that results from an "accident" which because of time off from work. occurred before you acquired or C. Fellow Employee Injured By Covered formed the organization; and Auto You Own Or Hire
(3) coverage does not apply if there is Item 5. Fellow Employee of Paragraph B. other similar insurance available to Exclusions under SECTION II - COVERED that organization, or if similar AUTOS LIABILITY COVERAGE is insurance would have been amended to add:
available but for its termination or
the exhaustion of its limits of This exclusion does not apply if the "bodily insurance. auro your or hire, Such average as
This insurance does not apply if is afforded by this provision is excess over coverage for the newly acquired or any other collectible insurance. formed organization is excluded either
by the provisions of this coverage form
or by endorsement.

CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5 Used with permission
G. "Personal Effects" Coverage
D. Limited Automatic Towing Coverage
Item 4. Coverage Extensions of Paragraph
Item 2. Towing, of Paragraph A. Coverage,
under SECTION III - PHYSICAL DAMAGE A. Coverage, under SECTION III - COVERAGE is amended to read: PHYSICAL DAMAGE COVERAGE, is amended to add:

2. Towing «Personal Effects" Coverage
We will pay for towing and labor costs
each time that a covered "auto" is We will pay actual cash value for "loss" to "personal effects" of the "insured" while in
disabled. All labor must be performed at
a covered "auto" subject to a maximum
the place of disablement of the covered
"auto". limit of $2,500 per "loss", for that covered
"auto" caused by the same "accident". No
a. The limit for towing and labor for deductible will apply to this coverage. each disablement is $500;
H. "Downtime Loss" Coverage
b. No deductible applies to this cover- Item 4. Coverage Extensions, of age.

Paragraph A. Coverage, under SECTION
E. Item 3. Glass Breakage - Hitting A Bird III. PHYSICAL DAMAGE COVERAGE, is Or Animal - Falling Objects or Missiles of amended to add:

Paragraph A. Coverage under SECTION III "Downtime Loss" Coverage - PHYSICAL DAMAGE COVERAGE, is
amended to add: We will pay any resulting "downtime loss" expenses you sustain as a result of a
Glass Repair Coverage covered physical damage "loss" to a We will waive the Comprehensive covered "auto" up to a maximum of $100 deductible for Glass, if one is indicated on per day, for a maximum of 30 days for the your covered "auto", for glass repairs. We same physical damage "loss", subject to will repair at no cost to you, any glass that the following conditions:
can be repaired without replacement,
provided the "loss" arises from a covered a. We will provide "downtime loss" beginning on the 5' day after we have given you
Comprehensive "loss" to your "auto".
our agreement to pay for repairs to a
F. Increase Of Transportation Expense covered "auto" and you have given the Coverage repair facility your authorization to make
Subpart a. Transportation Expenses of repairs;
Item 4. Coverage Extensions of Paragraph b. Coverage for "downtime loss" expenses A. Coverage under SECTION III - will end when any of the following occur:

PHYSICAL DAMAGE COVERAGE is
(1) You have a spare or reserve "auto"
amended to read:
available to you to continue your
a. Transportation Expenses operations.

We will pay up to $50 per day to a (2) You purchase a replacement "auto". maximum of $1,000 for temporary (3) Repairs to your covered "auto" have transportation expense incurred by you been completed by the repair facility because of the total theft of a covered
and they determine the covered
"auto" of the private passenger type.
"auto" is road-worthy.

We will pay only for those covered
"autos" for which you carry either (4) You reach the 30 day maximum Comprehensive or Specified Causes of coverage.

Loss Coverage or Theft Coverage. We
will pay for temporary transportation
expenses incurred during the period
beginning 48 hours after the theft and
ending, regardless of the policy's
expiration, when the covered "auto" is
returned to use or we pay for its "loss".

CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission
I. Item 4. Coverage Extensions, of d. Contraband or property in the course Paragraph A. Coverage, under SECTION of illegal transportation or trade.

III. PHYSICAL DAMAGE COVERAGE, is e. "Loss" caused by theft, unless there is amended to add: evidence of forced entry into the
We will pay any resulting rental covered "auto" and a police report is reimbursement expenses incurred by you for filed.
a rental of an "auto" because of "loss" to a K. Accidental Airbag Discharge Coverage covered "auto" up to a maximum of $100 per
day, for a maximum of 30 days for the same Item 3.a. of Paragraph B. Exclusions under physical damage "loss", subject to the SECTION III - PHYSICAL DAMAGE COVERAGE is amended to read:
following conditions:
a. We will provide rental reimbursement a. Wear and tear, freezing, mechanical incurred during the policy period or electrical breakdown. The beginning 24 hours after the "loss" and exclusion relating to mechanical ending, regardless of the policy break-down does not apply to the expiration, with the number of days питера геріас accidental discharge of an air bag. reasonably required to repair or replace L. Loan or Lease Gap Coverage the covered "auto". If the "loss" is Paragraph C. Limit Of Insurance under caused by theft, this number of days is SECTION III - PHYSICAL DAMAGE the number of days it takes to locate the COVERAGE is amended to add:
covered "auto" and return it to you or the
If a covered "auto" is owned or leased and
number of days it takes for the claim to
be settled, whichever comes first. if we provide Physical Damage Coverage on it, we will pay, in the event of a covered
b. Our payment is limited to necessary and total "loss", , any unpaid amount due on the actual expenses incurred. lease or loan for a covered "auto", less:
c. This coverage does not apply while a. The amount paid under the Physical there are spare or reserve "autos" Damage Coverage Section of the available to you for your operations. policy; and
d. If a "loss" results from the total theft of a
b. Any:
covered "auto" of the private passenger
type, we will pay under this coverage (1) Overdue lease or loan only that amount of your rental payments including penalties, reimbursement expenses which is not interest or other charges already provided for under the Physical resulting from overdue payments at the time of the
Damage Coverage Extension.
"loss";
J. "Personal Effects" Exclusion
(2) Financial penalties imposed
Paragraph B. Exclusions under SECTION under a lease for excessive use, III - PHYSICAL DAMAGE COVERAGE, is abnormal wear and tear or high amended to add: mileage;
"Personal Effects" Exclusion (3) Costs for extended warranties, We will not pay for "loss" to "personal Credit Life Insurance, Health, effects" of any of the following: Accident or Disability Insurance purchased with the loan or
a. Accounts, bills, currency, deeds,
lease;
evidence of debt, money, notes,
securities or commercial paper or (4) Security deposits not refunded other documents of value. by the lessor; and
Bullion, gold, silver, platinum, or other (5) Carry-over balances from precious alloys or metals; furs or fur previous loans or leases garments; jewelry; watches; precious
or semi-precious stones.

C. Paintings, statuary and other works of
art.

CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission
M. Aggregate Deductible (3) An "executive officer" or director, if Paragraph D. Deductible under SECTION you are a corporation; III - PHYSICAL DAMAGE COVERAGE is (4) A manager or member, if you are a amended to add: limited liability company;
Regardless of the number of covered (5) Your insurance manager; or "autos" involved in the same "loss", only (6) Your legal representative. one deductible will apply to that "loss". If
the deductible amounts vary by "autos", P. Waiver Of Subrogation For Auto Liability Losses Assumed Under Insured Contract
then only the highest applicable deductible
will apply to that "loss". Item 5. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A.

N. Diminishing Deductible
Loss Conditions under SECTION IV -
Paragraph D. Deductible under SECTION BUSINESS AUTO CONDITIONS is III - PHYSICAL DAMAGE COVERAGE is
amended to read:
amended to add:

5. Transfer of Rights of Recovery
Any deductible will be reduced by the Against Others To Us percentage indicated below on the first
"loss" reported during the corresponding If any person or organization to or for whom we make payments under this
policy period:

Coverage Form has rights to recover
damages from another, those rights are
Loss Free Policy Periods Deductible transferred to us. That person or With the Expansion Reduction on the organization must do everything Endorsement first "loss" necessary to secure our rights and must 0% do nothing after an "accident" or "loss"
to impair them. However, if the insured
25%
has waived those rights to recover
3 50% through a written contract, we will waive
4 75% any right to recovery we may have
100% under this Coverage Form.

If we pay a Physical Damage "loss" during Q. Insurance is Primary and the policy period under any BUSINESS Noncontributory
AUTO COVERAGE FORM you have with Subpart a. of Item 5. Other Insurance of us, your deductible stated in the Paragraph B. General Conditions under Declarations page of each such SECTION IV - BUSINESS AUTO COVERAGE FORM will not be reduced on CONDITIONS is amended to read:
any subsequent claims during the remainder a. This insurance is primary and of your policy period and your deductible noncontributorv, as respects any other reduction will revert back to 0% for each insurance, if required in a written such COVERAGE FORM if coverage is contract with you.
renewed.

R. Other Insurance - Hired Auto Physical

0. Knowledge of Loss and Notice To Us Damage
Subsection a. of Item 2. Duties In the Event Subpart b. of Item 5.. Other Insurance of of Accident, Claim, Suit or Loss of Paragraph B. General Conditions under Paragraph A. Loss Conditions under SECTION IV - BUSINESS AUTO SECTION IV -- BUSINESS AUTO CONDITIONS is amended to read:

CONDITIONS is amended to add:
b. For Hired Auto Physical Damage
However, prompt notice of the "accident", Coverage, the following are deemed claim, "suit" or "loss" to us or our to be covered "autos" you own:
authorized representative only applies
after the "accident", claim, "suit" or "loss" is (1) Any covered "auto" you lease, known to: hire, rent or borrow; and
(1) You, if you are an individual;
(2) A partner, if you are a partnership;
CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission
(2) Any covered "auto" hired or rented
by your "employee" under a
contract in that individual
"employee's" name, with your
permission, while performing
duties related to the conduct of
your business.

However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto".

S. Unintentional Failure To Disclose
Hazards
Paragraph B. General Conditions under

SECTION IV - BUSINESS AUTO CONDI-
TIONS is amended to add:

9. Your failure to disclose all hazards
existing as of the inception date of this
policy shall not prejudice the coverage
afforded by this policy, provided that
such failure to disclose all hazards is not
intentional. However, you must report
such previously undisclosed hazards to
us as soon as practicable after its
discovery.

T. Additional Definition
SECTION V - DEFINITIONS is amended to
add:
"Personal effects" means personal
property owned by the "insured".
"Downtime loss" means actual loss of
"business income" for the period of time
that a covered "auto":

1. Is out of service for repair or
replacement as a result of a covered
physical damage "loss" and

2. Is in the custody of a repair facility if
not a total "loss".
"Business Income" means:

1. Net Income (Net Profit or Loss
before income taxes) that would
have been earned or incurred; and

2. Continuing normal operating
expenses incurred, including payroll.

In this endorsement, Headings and Titles
are inserted solely for the convenience and
ease of reference. They do not affect the
coverage provided by this endorsement,
nor do they constitute any part of the terms
and conditions of this endorsement. All
other policy wording not specifically
changed, modified, or replaced by this
endorsement wording remains in effect.

CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission
POLICY NUMBER: LSIC1100009686-00 COMMERCIAL GENERAL LIABILIT G 20 10 10 0°
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - OWNERS, LESSEES OR

CONTRACTORS - SCHEDULED PERSON OR

ORGANIZATION
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE
Name of Person or Organization:

When required under written contract and fully executed prior to an "occurrence". (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
A. Section II - Who Is An Insured is amended to (1) All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations service, maintenance or repairs) to be performed for that insured. performed by or on behalf of the addi- tional insured(s) at the site of the cov-
B. With respect to the insurance afforded to these ered operations has been completed; additional insureds, the following exclusion is
or
added:
(2) That portion of "your work" out of which

2. Exclusions the injury or damage arises has been
This insurance does not apply to "bodily in- put to its intended use by any person or jury" or "property damage" occurring after: organization other than another con- tractor or subcontractor engaged in
performing operations for a principal as
a part of the same project.

CG 20 10 10 01 © ISO Properties, Inc., 2000 Page 1 of 1 POLICY NUMBER: LSIC1100009686-00 COMMERCIAL GENERAL LIABILITY CG 20 37 10 01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - OWNERS, LESSEES OR

CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE
Name of Person or Organization:

When required under written contract and fully
executed prior to an "occurrence".

Location And Description of Completed Operations:

Additional Premium:
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products-completed operations haz- CG 20 37 10 01 © ISO Properties, Inc., 2000 Page 1 of 1

COMMERCIAL GENERAL LIABILITY
CG 20 01 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

PRIMARY AND NONCONTRIBUTORY -

OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
ne followina is added to the other insuranc
ondition and supersedes anv orovision
contrary:

Primary And Noncontributory Insurance additional insured.

This insurance is primary to and will not seek
contribution from any other insurance available
to an additional insured under your policy
provided that:
(1) The additional insured is a Named Insured
under such other insurance; and
CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00)

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce ur right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us).

The additional premium for this endorsement shall be 2% of the total California Workers' Compensation premium otherwise due.

Schedule
Person or Organization Job Description

ANY PERSON OR

ORGANIZATION FOR

WHOM THE NAMED

INSURED IS REQUIRED

UNDER WRITTEN

CONTRACT TO FURNISH
THIS WAIVER.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 11/10/2024 Policy No. WSD 5057820 04 Endorsement No.

Insured WESTERN STATE BUILDERS INC. Premium $ INCL.

Insurance Company INSURANCE COMPANY OF THE WEST
Countersigned By
WC 99 06 34
(Ed. 8-00)

INSURED
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY

EXCLUSION - OPERATIONS COVERED BY A DEDICATED

INSURANCE (WRAP-UP) PROGRAM
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART The following exclusion is added to this Policy:

This insurance does not apply to:
"Bodily injury" or "property damage" arising out of your ongoing operations or your operations included within the "products-completed operations hazard" at any location where a consolidated (wrap-up) insurance program has been provided by the prime contractor, project manager, or owner of the construction project and you are enrolled in such consolidated (wrap-up) insurance program.

This exclusion applies whether or not the consolidated (wrap-up) insurance program:

1. Provides coverage to one or more contractors;

2. Provides multiple lines of coverage;

3. Provides coverage identical to that provided by this Policy;

4. Has limits adequate to cover all claims or "suits", or

5. Remains in effect.

For the purposes of this endorsement, consolidated (wrap-up) insurance program includes an owner- controlled insurance program, contractor-controlled insurance program, rolling wrap-up, and any other iob or project specific insurance program.

All other terms and conditions of the Policy remain unchanged LSIC-IL-1008 11 23 Includes copyrighted material of Insurance Services Page 1 of 1 Office, Inc., with its permission.

Home CONTRACTORS STATE LICENSE BOARD
•Contractor's License Detail for License # 1069677
DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this information, you should be aware of the following limitations. • CSLB complaint disclosure is restricted by law ( B&P 7124.6 ) If this entity is subject to public complaint disclosure click on link that will appear below for more information. Click here for a definition of disclosable actions. • Only construction related civil judgments reported to CSLB are disclosed (B&P 7071.17). • Arbitrations are not listed unless the contractor fails to comply with the terms. » Due to workload, there may be relevant information that has not yet been entered into the board's license database.

Data current as of 9/8/2025 11:53:28 AM
Business Information

WESTERN STATE BUILDERS INC
2141 ORANGE AVE
ESCONDIDO, CA 92029
Business Phone Number:(760) 546-2405
Entity Corporation
Issue Date 10/09/2020
Expire Date 10/31/2026
License Stalus
This license is current and active.

All information below should be reviewed.

Classifications

B-GENERAL BUILDING
• A-GENERAL ENGINEERING
• C-61 / D34 - PREFABRICATED EQUIPMENT
• C-61 / D12 - SYNTHETIC PRODUCTS
Bonding Information
Contractor's Bond
This license filed a Contractor's Bond with NORTH RIVER INSURANCE COMPANY (THE).

Bond Number: 04CF618849
Bond Amount: $25,000
Effective Date: 05/09/2023
Contractor's Bond History.

Bond of Qualifying Individual
The qualifying individual JULIAN PATRICK DILLAVOU-MOEN certified that he/she owns 10 percent or more of the voting stock/membership interest of this company; therefore, the Bond of Qualifying Individual is not required Effective Date: 04/21/2025
Bol's Bond History
Workers' Compensation
This license has workers compensation insurance with the INSURANCE COMPANY OF THE WEST Policy Number:WSD505782004
Effective Date: 11/10/2023
Expire Date: 11/10/2025
Workers' Compensation History
Workers' compensation classification code(s):
5102 - Iron/Steel Erection-non-structural
For a description of the workers' compensation classification code(s) listed for this licensee, contact the licensee's insurance carrier.

Contact information for the licensee's insurer is available by clicking the insurer link above. Classification codes are also available on the Workers' Compensation Insurance Rating Bureau's classification search page.

The board does not verify or investigate the accuracy of classification codes displayed.

Other
• Personnel listed on this license (current or disassociated) are listed on other licenses.

THIS CERTIFIES THAT

WESTERN STATE BUILDERS

HAS SUCCESSFULLY DEMONSTRATED THE TECHNICAL

PROFICIENCY AND INSTALLATION EXPERIENCE TO

MEET THE CRITERIA ESTABLISHED BY PLAYCRAFT

SYSTEMS TO BECOME A FACTORY AUTHORIZED
PLAYGROUND INSTALLER.

ISSUE DATE: 1/1/2022
EXPIRATION DATE: 12/31/2026
CS.SA

VICE PRESIDENT/GENERAL MANAGER
Task Task Name Duration Start Finish Predecessors Resource Names Det 13, 24 Dec8, 24 Feb 2,25 | Mar 30, 25 |Jul 20, 25 T i S w | s 30.3 1773.25
Mode.

San Jacinto Parks Playground Renovation 58 days Fri 8/22/25 Tue 11/11/25 Wed 9/17/25 Wed 9/24/25 L
Preconstruction 6 days
Received Notice of Award 1 day Wed 9/17/25 Wed 9/17/25 City of San Jacinto - City of San Ja N
Submit bond and insurance documents Thu 9/18/25 Thu 9/18/25 Western State Builder Western Stati 1 day
Prepare and submit project schedule 3 days Thu 9/18/25 Mon 9/22/25 Western State Builder • Western Stat Prepare and submit schedule of values 1 day Thu 9/18/25 Thu 9/18/25 N Western State Builder i Western Stati 5 days Wed 9/24/25 N Western State Builder 1 Western Sta Prepare and Submit project submittals Thu 9/18/25 1 City of Sand Project Preconstruction Meeting 1 day Mon 9/22/25 Mon 9/22/25 City of San Jacinto Tamarisk Park 58 days Fri 8/22/25 Tue 11/11/25
Mobilize at Site O days Fri 8/22/25 Fri 8/22/25 Western State Builder • 8/22 Demo Existing playground and surfacing 3 days Mon 9/29/25 Wed 10/1/25 WSB Demo • WSB Deme Install Play Equipment 6 days Thu 10/2/25 Thu 10/9/25 10 WSB Install Team 1 Te. WSB Inst Install PIP Safety Surfacing 4 days Fri 10/10/25 Wed 10/15/25 SpectraTurf I Spectra Install Loose Fill Rubber Thu 10/16/25 Thu 10/16/25 Western State Builder *Wester 1 day
Surfacing Cure Period 5 days Thu 10/16/25 Wed 10/22/25 SpectraTurf Punch Walk 1 day Thu 10/23/25 Thu 10/23/25 14 WSB / City Punch Corrections 2 days Fri 10/24/25 Mon 10/27/25 15 Western State Builder Remove Temp Fence 1 day Tue 10/28/25 Tue 10/28/25 16 Rent a Fence Site Complete 1 day Wed 10/29/25 Wed 10/29/25 17
Colonel Lewis Park 29 days Wed 10/1/25 Tue 11/11/25
Mobilize at Site O days Wed 10/1/25 Wed 10/1/25 10 Western State Builder Demo Existing playground and surfacing 5 days Thu 10/2/25 Wed 10/8/25 20 Western State Builder Install Play Equipment 8 days Fri 10/10/25 Tue 10/21/25 WSB Install Install Safety Surfacing 5 days Wed 10/22/25 Tue 10/28/25 22 SpectraTurf Surfacing Cure Period 5 days Wed 10/29/25 Tue 11/4/25 Spectraturf Punch Walk 1 day Wed 11/5/25 Wed 11/5/25 24 WSB / City
Punch Corrections 2 days Thu 11/6/25 Fri 11/7/25 Western State Builder Remove Temp Fence 1 day Mon 11/10/25 Mon 11/10/25 26 Rent a Fence TR Site Complete 1 day Tue 11/11/25 Tue 11/11/25 27
Stallions Park 10 days Wed 10/8/25 Wed 10/22/25
30 E Mobilize at Site O days Wed 10/8/25 Wed 10/8/25 Western State Builder • 10/8 2 days Thu 10/9/25 Fri 10/10/25 WSB Demo TWSB Der
Demo Existing playground and
surfacing
Install Play Equipment 4 days Thu 10/9/25 Tue 10/14/25 WSB Install Team 1 * WSB In:

Install Safety Surfacing 1 day Wed 10/15/25 Wed 10/15/25 WSB "WSB 1 day WSB / City *WSB/
Punch Walk Thu 10/16/25 Thu 10/16/25
Task 2 Project Summary Manual Task Start-only Deadline
Project: San Jacinto Parks Playg ... Inactive Task Duration-only Finish-only Progress Date: Mon 9/8/25 Milestone Inactive Milestone Manual Summary Rollup External Tasks Manual Progress Summary Inactive Summary Manual Summary External Milestone

Page 1 ends

Task Task Name Duration Start Finish Predecessors Resource Names 2a3 2M 8, 24 | Feb 2, '25 SM 30:25 1 My 2325 15125 M T| S w | s
Mode Western State Builder Weste
Punch Corrections 2 days Fri 10/17/25 Mon 10/20/25
Remove Temp Fence 1 day Tue 10/21/25 Tue 10/21/25 Rent a Fence PRent a Project Complete 1 day Wed 10/22/25 Wed 10/22/25 36
Task AND Project Summary Manual Task HEN Start-only
Project: San Jacinto Parks Playg Inactive Task Duration-only Finish-only Date: Mon 9/8/25 Milestone Inactive Milestone Manual Summary Rollup = External Tasks Summary Inactive Summary • Manual Summary External Milestone

Page 2 ends

San Jacinto City CouncilSeptember 16, 2025

San Jacinto City Council
September 16, 2025