PROPOSAL FORM
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
TO THE CITY OF SANTA CLARITA, AS CITY:
in accordance with CITY's NOTICE INVITING BIDS, the undersigned BIDDER hereby proposes to furnish all materials, equipment, tools, labor, and incidentals required for the above-stated project as set forth in the plans, specifications and contract documents therefore, and to perform all work in the manner and time prescribed therein.
BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, INSTRUCTIONS TO BIDDERS, and ail other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with CITY at the unit and/or lump sum prices set forth in the following BID SCHEDULE. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to CITY of the proposal guarantee accompanying this proposal.
BIDDER understands that a bid is required for the entire work that the estimated quantities set forth in BID SCHEDULE are solely for the purpose of comparing bids, and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE CITY RESERVES THE RIGHT TO INCREASE OR DECREASE THE AMOUNT OF ANY QUANTITY SHOWN AND TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum price(s) bid include all appurtenant expenses, taxes, royalties, and fees for the project's duration. In case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures.
If awarded the contract, the undersigned further agrees that in the event of the Bidder's default in executing the required contract and filing the necessary bonds and insurance certificates within ten working days after the date of the CITY's notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the CITY and this bid and the acceptance hereof may, at the CITY's option, be considered null and void.
Company Name: Backflow prevention Device Tester
Company Address: 27899 Smuthbr
valencia, cA91355
Phone: 1001-294-0901
Email: [email protected]
By: megan ravica
rint Nam
Title: office manager
Signature: negan Paulica
Date: 112/2024
NOTICE TO BIDDERS REGARDING CONTRACTUAL REQUIREMENTS
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
SUMMARY OF INDEMNITY AND INSURANCE REQUIREMENTS
1. These are the Indemnity and Insurance Requirements for Contractors providing services or supplies to City of Santa Clarita (City). By agreeing to perform the work or submitting a proposal, you verify that you comply with and agree to be bound by these requirements. If any additional Contract documents are executed, the actual Indemnity language and Insurance Requirements may include additional provisions Questions and requests for modification of these terms must be negotiated and approved prior to bid submission and are at the full discretion of the City.
2. You should check with your Insurance advisors to verify compliance and determine if additional coverage or limits may be needed to adequately insure your obligations under this agreement. These are the minimum required and do not in any way represent or imply that such coverage is sufficient to adequately cover the Contractor's liability under this agreement. The full coverage and limits afforded under Contractor's policies of Insurance shall be available to Buyer and these Insurance Requirements shall not in any way act to reduce coverage that is broader or includes higher limits than those required.
The Insurance obligations under this agreement shall be: 1—all the Insurance coverage and limits carried by or available to the Contractor; or 2-the minimum Insurance requirements shown in this agreement, whichever is greater. Any insurance proceeds in excess of the specified minimum limits and coverage required, which are applicable to a given loss, shall be available to City.
3. Contractor shall furnish the City with original Certificates of Insurance including all required amendatory endorsements and a copy of the Declarations and Endorsement Page of the CL policy listing all policy endorsements to City before work begins. City reserves the right to require full-certified copies of all Insurance coverage and endorsements.
I. INDEMNIFICATION:
City and its respective elected and appointed boards, officials, officers, agents, employees, and volunteers (individually and collectively, "Indemnitees") shall have no liability to CONTRACTOR or any other person for, and CONTRACTOR shall indemnify, defend, protect, and hold harmless Indemnitees from and against, any and all liabilities, claims, actions, causes of action, proceedings, suits, damages, judgments, liens, levies, costs, and expenses of whatever nature, including reasonable attorney's fees and disbursements (collectively, "Claims), which Indemnitees may suffer or incur or to which Indemnitees may become subject by reason of or arising out of any injury to or death of any person(s), damage to property, loss of use of property, economic loss, or otherwise occurring as a result of or allegedly caused by the CONTRACTOR'S performance of or failure to perform any services under this Agreement, or by the negligent or willful acts or omissions of CONTRACTOR, its agents, officers, directors, or employees, committed in performing any of the services under this Agreement.
If any action or proceeding is brought against Indemnitees by reason of any of the matters against which CONTRACTOR has agreed to indemnify Indemnitees as provided above, CONTRACTOR, upon notice from City, shall defend Indemnitees at its expense by counsel acceptable to City, such acceptance not to be unreasonably withheld. Indemnitees need not have first paid for any of the matters to which Indemnitees are entitled to indemnification in order to be so indemnified. The limits of the insurance required to be maintained by CONTRACTOR in this Agreement shall not limit the liability of CONTRACTOR hereunder. The provisions of this section shall survive the expiration or earlier termination of this agreement.
The provisions of this section do not apply to Claims occurring as a result of the City's active negligence or acts of omission.
II. INSURANCE
CONTRACTOR shall maintain and submit certificates of all applicable insurance including, but not limited to, the following and as otherwise required by law. The terms of the insurance policy or policies issued to provide the above insurance coverage shall provide that said insurance may not be amended or canceled by the carrier, for non-payment of premiums or otherwise, without thirty (30) days prior written notice of amendment or cancellation to the CITY. In the event the said insurance is canceled, the CONTRACTOR shall, prior to the cancellation date, submit to the City Clerk new evidence of insurance in the amounts established.
Liability Insurance
During the entire term of this Agreement, the CONTRACTOR agrees to procure and maintain General Liability insurance at its sole expense to protect against loss from liability imposed by law for damages on account of bodily injury, including death therefrom, suffered or alleged to be suffered by any person or persons whomsoever, resulting directly or indirectly from any act or activities, errors or omissions, of the CITY, or CONTRACTOR or any person acting for the CITY, or under its control or direction, and also to protect against loss from liability imposed by law for damages to any property of any person caused directly or indirectly by or from acts or activities of the CITY, or CONTRACTOR or any person acting for the CITY, or under its control or direction. Such public liability and property damage insurance shall also provide for and protect the CITY against incurring any legal cost in defending claims for alleged loss. Such General, Public and Professional liability and property damage insurance shall be maintained in full force and effect throughout the term of the Agreement and any extension thereof in the amount indicated above or the following minimum limits:
Commercial General Liability Insurance, including coverage for Premises and Operations, Contractual Liability, Personal Injury Liability, Products/Completed Operations Liability, and Independent Contractors' Liability (if applicable), in an amount of not less than two million dollars ($2,000,000.00) per occurrence, four million dollars ($4,000,000.00) annual aggregate, written on an occurrence form.
Products/Completed Operations coverage shall extend a minimum of three (3) years after project completion. Coverage shall be included on behalf of the CONTRACTOR for covered claims arising out of the actions of independent contractors. If the CONTRACTOR is using subcontractors, the policy must include work performed "by or on behalf" of the CONTRACTOR. Policy shall contain no language that would invalidate or remove the CONTRACTOR'S duty to defend or indemnify for claims or suits expressly excluded from coverage. Policy shall specifically provide for a duty to defend on the part of the CONTRACTOR.
Worker's Compensation Insurance
The CONTRACTOR shall procure and maintain, at its sole expense, Worker's Compensation Insurance in the amount of $1,000,000 per occurrence or in such amount as will fully comply with the laws of the State of California and which shall indemnify, insure and provide legal defense for both the CONTRACTOR and the CITY against any loss, claim or damage arising from any injuries or occupational diseases happening to any worker employed by the CONTRACTOR in the course of carrying out the work within the Agreement. Such insurance shall also contain a waiver of subrogation naming the City of Santa Clarita.
Automotive Insurance
The CONTRACTOR shall procure and maintain, at its sole expense, throughout the term of this Agreement, and any extension thereof, public liability and property damage insurance coverage for automotive equipment with coverage limits of not less than $1,000,000 combined single limit for each accident. All such insurance shall be primary insurance and shall name the City of Santa Clarita as an additional insured.
Builder's Risk
Upon commencement of construction and with approval of CITY, CONTRACTOR shall obtain and maintain Builder's Risk Insurance for the entire duration of the Project until only the CITY has an insurable interest.
The Builder's Risk coverage shall include the coverages as specified below:
The named insureds shall be CONTRACTOR and CITY, including its officers, officials, employees, and agents. All subcontractors (excluding those solely responsible for design work) of any tier and suppliers shall be included as additional insureds as their interests may appear. CONTRACTOR shall not be required to maintain property insurance for any portion of the Project following transfer of control thereof to CITY.
The policy shall contain a provision that all proceeds from the Builder's Risk Policy shall be made payable to the CITY. The CITY will act as a fiduciary for all other interests in the Project.
Policy shall be provided for replacement value on an "all risk" basis for the completed value of the project.
There shall be no coinsurance penalty or provisional limit provision in any such policy. Policy must include:
(1) coverage for any ensuing loss from faulty workmanship, nonconforming work, omission or deficiency in design or specifications; (2) coverage against machinery accidents and operational testing; (3) coverage for removal of debris, and insuring the buildings, structures, machinery, equipment, materials, facilities, fixtures and all other properties constituting a part of the Project; (4) Ordinance or law coverage for contingent rebuilding, demolition, and increased costs of construction; (5) transit coverage (unless insured by the supplier or receiving contractor), with sub-limits sufficient to insure the full replacement value of any key equipment item; (6) ocean marine cargo coverage insuring any Project materials or supplies, if applicable; (7) coverage with sub-limits sufficient to insure the full replacement value of any property or equipment stored either on or off the site or any staging area. Such insurance shall be on a form acceptable to CITY to ensure adequacy of terms and sub-limits and shall be submitted to the CITY prior to commencement of construction.
Fire and Extended Coverage Insurance (Services involving real property only) CONTRACTOR agrees to procure and maintain, at its sole expense, during the term of this Agreement, and any extension thereof, a policy of fire, extended coverage and vandalism insurance.
Pollution Liability and/or Asbestos Pollution Liability and/or Errors & Omissions Contractors Pollution Liability and/or Asbestos Pollution Liability and/or Errors & Omissions with limit no less than $2,000,000 per claim or occurrence and $2,000,000 aggregate per policy period of one year.
Coverage must be included for bodily injury and property damage, including coverage for loss of use and/or diminution in property value, and for clean-up costs arising out of, pertaining to, or in any way related to the actual or alleged discharge, dispersal, seepage, migration, release or escape of contaminants or pollutants, arising out of or pertaining to the services provided by CONTRACTOR under this Agreement, including the transportation of hazardous materials or contaminants.
Professional Liability (if Design-Build)
Professional Liability Insurance, insuring against professional errors and omissions arising from CONTRACTOR'S work on the Project, in an amount not less than [$2,000,000] combined single limit for each occurrence. If CONTRACTOR cannot provide an occurrence policy, CONTRACTOR shall provide insurance covering claims made as a result of performance of work on this Project and shall maintain such insurance in effect for not less than three years following final completion of the Project.
Waiver of Subrogation
All insurance coverage maintained or procured pursuant to this Agreement shall be endorsed to waive subrogation against the CITY, its elected or appointed officers, agents, officials, employees and volunteers or shall specifically allow CONTRACTOR or others providing insurance evidence in compliance with these specifications to waive their right of recovery prior to a loss. CONTRACTOR hereby waives its own right of recovery against the CITY, and shall require similar written express waivers and insurance clauses from each of its subconsultants.
Separation of Insureds
A severability of interests provision must apply for all additional insureds ensuring that CONTRACTOR'S insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the insurer's limits of liability. The policy(ies) shall not contain any cross-liability exclusions.
Pass Through Clause
CONTRACTOR agrees to ensure that its subconsultants, subcontractors, and any other party involved with the project who is brought onto or involved in the project by CONTRACTOR, provide the same minimum insurance coverage and endorsements required of CONTRACTOR. CONTRACTOR agrees to monitor and review all such coverage and assumes all responsibility for ensuring that such coverage is provided in conformity with the requirements of this section. CONTRACTOR agrees that upon request, all Agreements with consultants, subcontractors, and others engaged in the project will be submitted to the CITY for review.
Self-Insured Retentions
Any self-insured retentions must be declared to and approved by the CITY. The CITY reserves the right to require that self-insured retentions be eliminated, lowered, or replaced by a deductible. Self-insurance will not be considered to comply with these specifications unless approved by the CITY.
Primary and Additional Insured
All of such insurance shall be primary and shall name the City of Santa Clarita as additional insured. A Certificate of Insurance and an additional insured endorsement (for general and automobile liability), evidencing the above insurance coverage with a company acceptable to the City's Purchasing Agent shall be submitted to the CITY prior to execution of this Agreement on behalf of the CITY.
Requirements
Should CONTRACTOR, for any reason, fail to obtain and maintain the insurance required by this Agreement, CITY may obtain coverage at CONTRACTOR'S expense and deduct the cost of such insurance from payments due to CONTRACTOR under this Agreement or terminate. In the alternative, should CONTRACTOR fail to meet any of the insurance requirements under this Agreement, CITY may cancel the Agreement immediately with no penalty.
Should CONTRACTOR'S insurance required by this Agreement be canceled at any point prior to expiration of the policy, CONTRACTOR must notify CITY within 24 hours of receipt of notice of cancelation.
Furthermore, CONTRACTOR must obtain replacement coverage that meets all contractual requirements within 10 days of the prior insurer's issuance of notice of cancelation. CONTRACTOR must ensure that there is no lapse in coverage.
If the operation under this Agreement results in an increased or decreased risk in the opinion of the City's Purchasing Agent, then the CONTRACTOR agrees that the minimum limits herein above designated shall be changed accordingly upon request by the City's Purchasing Agent.
The CONTRACTOR agrees that provisions of this paragraph as to maintenance of insurance shall not be construed as limiting in any way the extent to which the CONTRACTOR may be held responsible for the payment of damages to persons or property resulting from the CONTRACTOR'S activities or the activities of any person or persons for which the CONTRACTOR is otherwise responsible.
I have read and understand the above requirements and agree to be bound by them for any work performed for the City.
utones saur. Megan Paulica a 10/12/2024
pontes ame. Megan Pavlica
BIDDER'S INFORMATION AND CERTIFICATION
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, CA
Bidder certifies that the representations of the bid are true and correct and made under penalty of perjury.
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE
Bidder certifies that in all previous contracts or subcontracts, all reports which may have been due under the requirements of any CITY, State, or Federal equal employment opportunity orders have been satisfactorily filed, and that no such reports are currently outstanding.
AFFIRMATIVE ACTION CERTIFICATION
Bidder certifies that affirmative action has been taken to seek out and consider minority business enterprises for those portions of the work to be subcontracted, and that such affirmative actions have been fully documented, that said documentation is open to inspection, and that said affirmative action will remain in effect for the life of any contract awarded hereunder. Furthermore, Bidder certifies that affirmative action will be taken to meet all equal employment opportunity requirements of the contract documents.
CERTIFICATION REGARDING DIR CONTRACTOR/SUBCONTRACTOR REGISTRATION By my signature hereunder, as the Contractor, I certify that Contractor, and all Subcontractors listed on the Subcontractor Designations form are the subject of current and active contractor registrations pursuant to Division 2, Part 7, Chapter 1 (commencing with section 1720) of the California Labor Code. Contractor's registration number is indicated below. Subcontractors' registration numbers are indicated on the Subcontractor Designations form.
Bidde's Name: Backflow Prevention Device Tester
Business Adress: 21899 Smyth Dr, Valencia, CIA 91355
Telephone No: (dld-294-0901
State CONTRACTOR'S License No. & Class: A1 - 1058504
DIRNO: 1000000932
Original Date: | 24/2015 Expiration Date: 6/302025
The following are the names, titles, addresses, and phone numbers of all individuals, firm members, partners, joint ventures, and/or corporate officers having a principal interest in this proposal:
Bernard Clarke-awner -100%
The dates of any voluntary or involuntary bankruptcy judgments against any principal having an interest in this proposal, or any firm, corporation, partnership or joint venture of which any principal having an interest in this proposal was an owner, corporate officer, partner or joint venture are as follows:
All current and prior DBAs, alias, and/or fictitious business names for any principal having an interest in this proposal are as follows:
IN WITNESS WHEREOF, BIDDER executes and submits this proposal with the names, title, hands, and seals of all aforementioned principals this day of
Bernael) Clabe
BIDDER:
signatur
BERNARd D CLANKE OWNER
Name and Title of Signatory
Backflow Prevention Device. Tester
Legal Name of Bidder
27899 Smyth Dr, valencia, CA 9355
(00l-294-0901 95. 40100013
Telephone Number Federal Tax I.D. No.
CALIFORNIA JURAT GOVERNMENT CODE § 8202
80888888888888888884888808088588880803385808303086x083948880358380838 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
countyor Los Angeles
Subscribed and sworn to (or affirmed) before me on
13 _ day of June _ 2024 by
Date Month Year
11) - Bernard D Clarke
CARY SCOTT FRIEDMAN
сОмМ. #2344524
(and (2)
Name(s) of Signers)
proved to me on the basis of satisfactory evidence/to
be the person(s) who appeared before-me.
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
Tale or Type of Documen: Bidder's Information and Certification Document Date: _ Number of Pages:
Signer(s) Other Than Named Above:
80488888898888888938384243538378530898833983348989083008883231888045888 ©2019 National Notary Association
BIDDER'S QUESTIONNAIRE
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
Backflow Prevention
1. submitted by: Device Tester Telephone: 10201-294-0901 Principal ofice Address: 27899 Smyth Dr, Valencia, CAGI355
2. Type of Firm:
C Corporation
S Corporation
Individual/Sole Proprietor or Single -Member LLC
Partnership
• Limited Liability Company "C" C-Corp
• Limited Liability Company "S" S-Corp
Limited Liability Company "p" Partnership
• Other
3a. If a corporation, answer these questions:
Date of Incorporation: State of Incorporation:
President's Name:
Vice-President's Name:
Secretary or Clerk's Name:
Treasurer's Name:
3b. If a partnership, answer these questions:
Date of organization: _State Organized in: _
Name of all partners holding more than a 10% interest: _ Designate which are General or Managing Partners.
BIDDER'S QUESTIONNAIRE (cont'd)
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
Bernard Clarke
Name of person holding CONTRACTOR's license: Backflow Prevention Device Tester License number 058504 class: Al Expiration Date: 11/30/2024 D..R. Registration # 10000060932
5. CONTRACTOR'S Representative: megan Pavlica
Title: Office manaser
Alternate: Bernard Curte
Title: owner
List the major construction projects your organization has in progress as of this date:
A.
owner: City of moorpark
Project Location: moorpark, cA
Type of Project: Annual Back fow Testing and repairs
Owner: Henry nayo memara Nospital
Project Location: 23845 mebean Prux, valencia.
Type of Project: Annual Backfow Testna and repairs
Owner: LA Countu Sanitation District
Project Location: Valenua, Saugus, Lancaster and Palmoale Type of Project: Annual Backflow resting and repaurs
CERTIFICATION OF NON-SEGREGATED FACILITIES
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
The BIDDER certifies that it does not maintain or provide for its employees any segregated facilities at any of its establishments, and that it does not permit its employees to perform their services at any location, under its control, where segregated facilities are maintained. The BIDDER certifies further that it will not maintain or provide for its employees any segregated facilities at any of its establishments, and that it will not permit its employees to perform their services at any location, under its control, where segregated facilities are maintained. The BIDDER agrees that a breach of this certification is a violation of the Equal Opportunity clause in this Contract. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, rest rooms, and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because of habit, local custom, or otherwise. The BIDDER agrees that (except where it has obtained identical certifications from proposed subcontractors for specific time periods) it will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause, and that it will retain such certifications in its files. negan Paulica-Back flew Prevention Davre Tester
Required by the May 19, 1967 order on Elimination of Segregated Facilities, by the Secretary of Labor - 32 F.R. 7439, May 19, 1967 (F.R. Vol. 33, No. 33 - Friday, February 16, 1968 - p. 3065).
DESIGNATION OF SUBCONTRACTORS
Bid # LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
vith NA. Add addt. sheets if needed
Subcontractor DIR Registration No.* Dollar Value of Work NA
Location and Place of Business
Bid Schedule Item No's: Description of Work
License No. Exp. Date: 7 7 Phone ()
Subcontractor DIR Registration No.* Dollar Value of Work Location and Place of Business
Bid Schedule Item No's: Description of Work
License No. Exp. Date: / / Phone ()
Subcontractor DIR Registration No.* Dollar Value of Work NIA
Locatioh and Place of Business
Bid Schedule Item No's: Description of Work
License No. Exp. Date: / / Phone ( )
NOTE: A BIDDER or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, as defined in this chapter, unless currently registered and qualified to perform public work pursuant to Section 1725.5 of the Labor Code. It is not a violation of this section for an unregistered BIDDER to submit a bid that is authorized by Section 7029.1 of the Business and Professions Code or by Section 10164 or 20103.5 of the Public Contract Code, provided the BIDDER is registered to perform public work pursuant to Section 1725.5 of the Labor Code at the time the contract is awarded. *Pursuant to Division 2, Part 7, Chapter 1 (commencing with section 1720) of the California Labor Code.
NON-COLLUSION AFFIDAVIT
(Title 23 United States Code Section 112 and Public Contract Code Section 7106) Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
To the CITY OF SANTA CLARITA:
In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106, the Bidder declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and no ollusive or sham; that the Bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the Bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the Bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the Bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THE "BIDDER'S CERTIFICATION" SHALL
ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH FORM A PART OF THE PROPOSAL. BIDDERS ARE CAUTIONED THAT MAKING A FALSE CERTIFICATION MAY SUBJECT THE CERTIFIER TO CRIMINAL PROSECUTION.
NON-COLLUSION AFFIDAVIT
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
TO BE EXECUTED BY EACH BIDDER OF A PRINCIPAL CONTRACT
STATE OF CALIFORNIA
COUNTY OF LOS ANGELES
Bernard Clarke being first duly sworn deposes and says that he/she is Faceuprevention sevicetester" (sole owner, a partner, president, etc.) of _ the party making the foregoing bid; that such
bid is not made in the interest of or behalf of any undisclosed person, partnership, company, association, organization or corporation, that such bid is genuine and not collusive or sham, that said BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, or that anyone shall refrain from bidding, that said BIDDER has not in any manner, directly or indirectly sought by agreements, communication or conference with anyone to fix the bid price of said BIDDER or of any other BIDDER, or to fix the overhead, profit, or cost element of such bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the Contract or anyone interested in the proposed Contract; that all statements contained in such bid are true, and further, that said BIDDER has not, directly or indirectly, submitted its bid price, or any breakdown thereof, or the contents thereof, or divulged information or date relative thereto, or paid and will not pay any fee in connection, therewith to any corporation, partnership, company, association, organization, bid depository, or to any member or CITY thereof, or to any other individual information or date relative thereto, or paid and will not pay any fee in connection, therewith to any corporation, partnership, company association, organization, bid depository, or to any member or CITY thereof, or to any other individual, except to such person or persons as have a partnership or other financial interest with said BIDDER in his general business.
Bernard O Carpe
Bidder:
Signature
Title Owner
CALIFORNIA JURAT GOVERNMENT CODE § 8202
868:8888888888888:888888888888888888888888888888888888888888889 888888888 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 Los Angeles
Subscribed and sworn to (or affirmed) before me on
13 - day of June _. 2024 by
Date Month Year
11). Bernard O Clarke
CARY SCOTT FRIEDMAN
Nolary Public - California S COMM. #2344524
(and (2) - -).
Los Angeles County Name(s) of Signer(s)
My Comm. Expires Jan. 31, 2026l
proved to me on the basis of satisfactory evidence to
be the person(s) who appeared before me.
Signature eve
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
Tile or Type of Document: on Collusion Giffidavit
Document Date: _ Number of Pages:
Signer(s) Other Than Named Above:
003881884845853988858830208080888838810898889803883128880/20388388398808089958889880888088 C)2019 National Notary Association
ACKNOWLEDGEMENT & ACCEPTANCE OF SCOPE OF WORK
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
By providing the three (3) required signatures below, the Contractor acknowledges full nderstanding, complete agreement to, and accepts in its entirety, all Bid Specifications for th ity-Wide Backflow Prevention Devices Maintenance. The Contractor will be expected t perform maintenance practices and uphold the standards herein to the established specifications throughout the length of the contract.
Dare: 0/12/24
*Estimator's signature: Megan Paulica _Date: 0-13-2024
comes some Bernar Carde Date: 4-13-2024
*All three signatures required
EXHIBIT 1
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
REFERENCES
CERTIFICATION, SERVICE AND REPAIR OF BACKFLOW PREVENTION DEVICES LMD
he tollowing are the names, addresses, and telephone numbers of three public agencies fo vhich BIDDER has performed work of a similar scope and size within the past 3 years
1. Cityof moorpark- 199 moorpark Ave, Moorpark, Cr
Vame and Address of Owner / Agency
93021
beland Baxter - 805-517-4344
Name and Telephone Number of Person Familiar with Project Testongdrepairong backflows annually.
+ - $10,000 Maintain over 120 Backfbust regulators.
Contract Amount Type of Work
2018 and ongang eate compied
Date Started
2. William S. Hart School Dist - 21380 Centre Painte PEwy Name and Address of Owner / Agency Santa clanta
Carte mole 8181-259-0033:322
Name and
Backflowtestingt
+-#14,000 repairs to the entire school Dist.
Contract Amount Date Completed
2001 and on gang year pited
Date Started
ame and Address o
valencia
sarymiller - 100-200-1174
Vame and Telephone Number of Person Familiar with Projec H-$8,000 Annual Backflow testings repairs throughout the Contract Amount
hospital
2000 and on gara yearly
Date Started Jate Completed
EXHIBIT 1 (con't.)
1. Litterock Creek Irrigation Dist- 35141 8Ths East, littlerock.
Name and Address of Owner / Agency
tana Bunch ordiz onta 944-2015
+-$8,000
Contract Amount Date Completed
2003 and on going yearl
Date Started Date Complete
s. Westside union School Dist- 41914 soth st West, QuartzHil Name and Address of Owner / Agency
let Sense da to 71310
Name and Telephone Number of Person Familiar with
+ - $15,000
Contract Amount Jate Completed
20s2 and angang year ud
Date Started
The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance bonds:
N/A-not required onthis contract
EXHIBIT 2
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
Scenarios
(Please include responses in Bid Schedule where indicated:) A. 2" Febco 825Y backflow assembly had a relief valve opening of 1.2lbs. Provide pricing for a relief valve rubber repair kit (Part # 905-054) to repair the backflow and complete a final certification.
Labor: $ 120,00
Materials: $ 99,91
Total: $_219,91
B. 6" Ames 3000SS backflow assembly has a #1 check leak at the time of testing; provide pricing to repair the backflow's #1 check (Part # 7010098), #2 check (Part # 7010101), and complete a final certification.
Labor: $ 400.00
Materials: $864,76
Total: $ 1, 264.710
C. 1.5" Watts 009M2PCQT backflow assembly has been stolen and only the brass inlet/outlet riser and concrete pad remain. Provide price to install a new 1.5" Watts 009M2PCQT backflow assembly (Part # 0436043) and StrongBox, Part # SBBC-45CR enclosure.
Labor: $ 500,00
Materials: $4,044,85 Backflow -#1,1409,10
Total: $4,544,85 endusure -#2,875,75
EXHIBIT 2
D. 1" Watts 009M2PCQT backflow assembly has a #1 ball valve that has freeze damage and needs to be replaced with a new Watts ball valve (Part # LFFBV-0125028).
Labor: $ 225,00
Material: $ 156,20
Total: $ 381,20
E. 10" Watts 774 backflow assembly has a #2 gate valve leaking, provide pricing to repair the gate valve packing.
Labor: $ 250.00
Materials: $100,00
Total: $ 350,00
F. You receive a call at 3:30pm on a Friday that a 2" Watts 009M2PCQT backflow assembly is leaking and needs a complete rubber repair kit (Part # 0887547) to be repaired by 6:30pm.
Labor: $120,00
Materials: $ 155,93
Total: $ 275,93
G. A 2" Watts 115 regulator is not regulating properly and needs a new main body rubber kit (Part # 5346-01) and pilot rubber kit (Part # 5138-06).
Labor: $ 300,00
Materials: $ 370,00
Total: $ 670,00
EXHIBIT 2
H. 1.5" BIC-1000 station is turning off because the ACV orifice (Part# 2691-27) is inoperable. Cost to repair and re-certify.
Labor: $ 285.00
Materials: $ 115,00
Total: $ 400,00
I. A 1.5" Watts 223 regulator located on the inlet riser is not working and needs to be replaced with a Watts LF-223B (Part# 0298569).
Labor: $ 385,00
Materials: $ 1,214.14
Total: $1,601,74
J. A 2" backflow was stolen and they only left the unions to adapt to at the ground. A dig- up is not needed, but new risers, fittings and a backflow are needed. Please provide a cost to install a new backflow assembly and the backflow being used should be a 2" ARI 501 backflow assembly.
Labor: $ 500,00
Materials: $1,17/47 Backflow-# 816.69
62)2024-#139,12
Total: $1,671,47 (4)2x40-841042
K There san inalion ostr pump that is not tuming on inos or the iND hE ou pare (2) 90-54642 ins nich - #82.44 There is need for a certified electrician to inspect the pumps electrical to assist your team on determining if the issue is the pump itself or is the issue an electrical problem to the pump. You will need an electrician for 2 hours, so please calculate that into your total cost, and you will also need a new flow switch to get the pump back up and running again.
Labor: $|200,00
Materials: $ 385:00
Total: $1585,00
EXHIBIT 3
BID SCHEDULE
Bid #LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
Fill out this form completely and submit with the bid response. Line item pricing must be entered on BidNet. In the event any mathematical discrepancies are found, please refer to Section B, Bid Instructions.
The award of contract, if made, will be to the lowest responsive BIDDER determined solely by the AGENCY.
The AGENCY also reserves the right to add/delete the quantities to the existing bid items, or delete the entire bid item if they are found not required by the Agency during the course of the construction, or add new bid items or scope of work by Contract Change Order at any time during the project up to the last contract working day.
The BIDDER agrees to hold all unit prices in this Bid Schedule constant throughout the duration of the project up to the last contract working day.
ALL LINE ITEMS TO BE PROVIDED AND INSTALLED COMPLETE
(INCLUDES LABOR USING PREVAILING WAGE REQUIREMENTS, MOBILIZATION, MATERIALS, EQUIPMENT, ETC.)
Item Unit
Item Description Units Qty. Cost Bid Price
No
General Testing and Response (approximate Quantities)
1 Backflow Testing Fee for initial annual test and EA 850 #L00 $51,000
certification
Backflow re-testing fee for
2 additional testing (if needed due EA 375 #0
to initial test failure)
3 Automatic Control Valve (ACV)
inspection and pressure calibration EA 25 #150 #3,750
4 Backflow Irrigation Control (BIC) EA 30
station commissioning $125 #3,750
5 Direct acting regulator inspection EA 300
and pressure calibration #125 $37,500
6 After hours response (2 hours) EA 40 #125 $5,000
Potential Scenarios (Actual # of instances will vary)
7 See Scenario A. EA 350 219,91 51696850
8 See Scenario B. EA 6 11264,76 #7,588,56
9 See Scenario C. EA 3
4,544,85 #13,634,55
10 See Scenario D. EA 50 381,20
$19,040.00
11 See Scenario E. EA 5 #350,00
# 1,150,00
12 See Scenario F. EA 20
8215.93 #5, 518,60
13 See Scenario G. EA 8
1670,00 # 5, 360,00
14 See Scenario H. EA 30 $400,00
#12,000,00
15 See Scenario I. EA 10
1, 00174 516, 017,40
16 See Scenario J. EA 10 1,67141"16, 714,70
17 See Scenario K. EA 30
M1,585,00 #47,550,00
Total all #323,10231
BASE BID TOTAL AMOUNT IN FIGURES:
$323,162,31
BASE BID TOTAL AMOUNT IN WORos: Three Hundred Twenty-Three Thousand One Hunched Sixty-Two and 31100
ALL SUBMISSIONS SHALL BE BASED ON PREVAILING WAGE REQUIREMENTS Company: Back flow Prevention Device Tester
Contract Name: Megan tavica
Address: 27899 Smyth Dr, Valencia, 01791355
Date: 10|12/2024
License No. (Class A): 6058504
SANTA
CITY OR
Addendum No. 1
June 10, 2024
Addendum No. 1
BID # LMD-23-24-36
City-Wide Backflow Prevention Devices Maintenance
City of Santa Clarita, California
This addendum must be acknowledged via BidNet and should be included with the bid response.
The purpose of this addendum is to address the following for this bid:
I. LIABILITY INSURANCE
In the NOTICE TO BIDDERS REGARDING CONTRACTUAL REQUIREMENTS document in the bid packet, Section Il states:
Commercial General Liability Insurance, including coverage for Premises and Operations, Contractual Liability, Personal Injury Liability, Products/Completed Operations Liability, and Independent Contractors' Liability (if applicable), in an amount of not less than two million dollars ($2,000,000.00) per occurrence, four million dollars ($4,000,000.00) annual aggregate, written on an occurrence form.
Please defer to the Sample Agreement language instead, which states:
Commercial general liability insurance will meet or exceed the requirements of ISO-CGL Form No. CG 00 01 11 85 or 88. The amount of insurance set forth above will be a combined single limit of $1,000,000 per occurrence, $2,000,000 general aggregate, for bodily injury, personal injury, and property damage for the policy coverage. Liability policies will be endorsed to name City, its officials, and employees as "additional insureds" under said insurance coverage and to state that such insurance will be deemed "primary" such that any other insurance that may be carried by City will be excess thereto. Such insurance will be on an "occurrence," not a "claims made," basis and will not be cancelable or subject to reduction except upon thirty (30) days prior written notice to City.
BID # LMD-23-24-36
Addendum No. 1
June 10, 2024
END OF ADDENDUM
This addendum must be acknowledged via BidNet and should be included with the response. megan Paulica 6|13/2024
Contractor's Representative Date
Backflow Prevention Device Tester
Company Name
BID # LMD-23-24-36
CONTRACTORS STATE LICENSE BOAR
•Contractor's License Detail for License #
658504
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.
• CSIB complaint disclosure is restricted by lav (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 relalen cil judements reported to CSLB are disclosed (BP 7071,171 * Arbitrations are not listed unless the contractor fails to comply with the terms. • Due to worklond, there may be relevant information that has not yet been entered into the board's license database.
Data current as of 6/12/2024 1:03:44 PM
Business Infonnation
BACKFLOW PREVENTION DEVICE TESTER
POBOX 220114
NEWHALL, CA 91322-0114
Business Phone Number:(661) 294-0901
Entity Sole Ownership
Issue Date 11/16/1992
Expire Date 11/30/2024
License Status
This license is current and active.
All information below should be reviewed.
Classifications
A - GENERAL ENGINEERING
Bonding Information
Contractor's Bond
Bond erns er 3 Contractor's Bond with HUDSON INSURANCE COMPANY.
Bond Amount: $25,000
Effective Date: 11/09/2023
Contractor's Bond History
Workers' Compensation
This license has workers compensation insurance with the EMPLOYERS PREFERRED INSURANCE
COMPANY
Policy Number:EIG548484700
Effective Date: 05/01/2024
Expire Date: 05/01/2025
Workers' Compensation History
Back to Top Conditions of Use
Privacy Policy Accessibility
Accessibility Certification
Copyright @ 2024 State of California
Industrial Relations
STATE OF CALIFORNIA
APPLICATION FOR
PUBLIC WORKS CONTRACTOR REGISTRATION
Registration Information
Type: Public Works
Period: 07/01/2024 06/30/2025
Contractor Information
Contractor Name: BACKFLOW PREVENTION DEVICE TESTER
Trade Name: BACKFLOW PREVENTION DEVICE TESTER
License Type Number: 1000006932
Contractor Physical Address
Physical Business Country: United States of America Physical Business City/ VALENCIA Province:
Physical Business Address: 27899 SMYTH DR. Physical Business State: CA Physical Business Postal 91355
Code:
Contractor Mailing Address
Mailing Country: United States of America Mailing City /Province: NEWHALL Mailing Address: PO BOX 220114 Mailing State: CA
Mailing Postal Code: 91322
Contact Info
Daytime Phone: Daytime Phone Ext.:
Mobile Phone: Business Email: [email protected] Applicant's Email: [email protected]
Registration Services:: Page 1 of 2 6/11/20245:15:05 PM Workers' Compensation
Professional Employer Organization (PEO)
Do you lease employees through Professional Employer Organization? No Workers Compensation Overview
Carrier: EMPLOYERS PREFERRED Inception Date: 05/01/2024
INSURANCE COMPANY
Policyholder Name: BERNARD CLARKE Expiration Date: May 1, 2025 Policy Number: EIG548484700
Certification
Yes I certify that I do not have any delinquent liability to an employee or the state for any assessment of back wages or related damages, interest, fines, or penalties pursuant to any final judgment, order, or determination by a court or any federal, state, or local administrative agency, including a confirmed arbitration award Yes I certify that the contractor is not currently debarred under Section 1777.1 or under any other federal or state law providing for the debarment of contractors from public works.
Yes I certify that one of the following is true: (1) I am licensed by the Contractors State License Board (CSLB) in accordance with Chapter 9 (commencing with Section 7000) of the Business and Professions Code; or (2) my business or trade is not subject to licensing by the CSLB.
I understand refunds are not authorized
I, BERNARD CLARKE, the undersigned, am, BACKFLOW PREVENTION DEVICE TESTER with the authority to act for and on behalf of the above named contractor. I certify under penalty of perjury that all of the above information provided is true and correct. I further acknowledge that any untruthful information provided in this application could result in the certification being canceled.
I certify this on: 5:12 PM
Legal Entity Information
Legal Entity Type: Sole Proprietorship
Name: BACKFLOW PREVENTION DEVICE TESTER
Registration Services:: Page 2 of 2
6/11/24,5:16 PM Registrations
Contractor Information Registration History_
Effective Date Expiration Date
Legal Entity Name
BACKFLOW PREVENTION DEVICE TESTER 06/15/18 06/30/19
Legal Entity Type
Sole Proprietorship 06/14/17 06/30/18
Status 06/07/16
Active 06/30/17
Registration Number 06/15/15 06/30/16
1000006932
Registration effective date 01/26/15 06/30/15
07/01/24
Registration expiration date 07/01/19 06/30/20
06/30/25 07/01/22 06/30/23
Mailing Address
PO BOX 220114 NEWHALL 91322 CA United States ... 03/04/21 06/30/22 Physical Address
27899 SMYTH DR. VALENCIA 91355 CA United Stat... 07/01/23 06/30/24 Email Address 07/01/24 06/30/25
[email protected]
Trade Name/DBA
BACKFLOW PREVENTION DEVICE TESTER
License Number (s)
CSLB:658504
Legal Entity Information
Sole Proprietor Name: BERNARD CLARKE
Worker's Compensation
Do you lease employees through Professional Employer Organization (PEO)?: No Please provide your current worker's compensation insurance information below:
PEO PEO PEO
PEO InformationName Phone Email
Insured by Carrier
Policy Holder Name: BERNARD
Insurance Carrier: EMPLOYEI
Policy Number: EIG54848
Inception date: 05/01/24
Expiration Date: 05/01/25
https://cadir.my.salesforce-sites.com/ContractorSearch/registrationSearchDetails?id=a1R8y000001zqMFEAI 1/1 CALIFORNIA-NEVADA SECTION File with your certificate
American Water Works Association
Attach the upper portion of this card to your
Backflow Prevention Assembly Tester certificate.
Cert. No.: 09274 Exp. Date
For grade information, exam location and dates,
ih.l! 04/30/2026 address changes or payment information, contact:
Certification Director Effective Date:
03/18/2023 CA-NV Section, AWWA
10435 Ashford St.
CALIFORNIA-NEVADA SECTION Rancho Cucamonga, CA 91730
American Water Works Association
Backflow Prevention Assembly Tester Off.: 909-481-7200
Fax: 909-481-4688 9910
Effective Date:
Douglas Tigert 03/18/2023
P.O. Box 220114
Newhall, CA 91322 Cert. No.
USA PLEnt 09274
Certification Director Exp. Date Form 1002(5-96)
04/30/2026
CERTIFIED BACKFLOW TESTER
DOUG TIGERT / GENERAL
TESTER#: P10000651
EXPIRES: 08/16/2025
EMPLOYER:
BACKFLOW PREVENTION
Certified by:
Los Angeles County Dept of Public Health
Cross Connection &
Water Pollution Control Program
(626)-430-5290