N. If Contractor hires, employs, or uses one or more Subcontractor(s) to perform work, services, operations, or activities on Contractor’s behalf, Contractor shall ensure that the Subcontractor complies with the following.
1. Meets, and fully complies with, this Agreement’s insurance requirements; and
2. Furnishes City at any time upon its request, with a complete copy of the Subcontractor’s insurance policy or policies for City’s review, or approval, or both. Failure of City to request copies of such documents shall not impose any liability on City, or its employees.
O. Contractor’s failure to comply with an insurance provision in this Agreement constitutes a material breach upon which City may immediately terminate or suspend Contractor’s performance of this Agreement, or invoke another remedy that this Agreement or the law allows. At its discretion and without waiving any other rights it may have pursuant to law, City has the right but not a duty to obtain or renew the insurance and pay all or part of the premiums. Upon demand, Contractor shall repay City for all sums or monies that City paid to obtain, renew, or reinstate the insurance, or City may offset the cost of the premium against any sums or monies that City may owe Contractor.
3.0 CONTRACTOR’S SUBMITTAL OF CERTIFICATES AND ENDORSEMENTS A. Contractor shall have its insurance carrier(s) or self-insurance administrator(s) complete and execute the following insurance documents and shall deliver said documents at the same time Contractor delivers this Agreement to City. City will neither sign this Agreement nor issue a “Notice to Proceed” until the City Attorney or City’s Risk Manager has reviewed and approved all insurance documents. City's decision as to the acceptability of all insurance documents is final. Sample insurance documents in the City’s approved format are set forth in Exhibit 4.
B. Required Submittals for Commercial General Liability and Business Automobile Insurance and Contractor’s Pollution Liability Insurance. The following submittals must be on forms satisfactory to the City Attorney or City’s Risk Manager, and signed by the insurance carrier or its authorized representative – which fully meet the requirements of, and contain provisions entirely consistent with, all of the insurance requirements set forth herein.
1. “Certificate of Insurance”
2. “Additional Insured Endorsement”
3. Waiver of Subrogation Endorsement: “Waiver of Transfer to Rights of Recover Against Others” Both Certificates of Insurance and Additional Insured Endorsements must read as follows: “The City of Vernon, and its officers, agents, employees and representatives are included as additional insureds under the policy(s). This insurance is primary to all other insurance of the City. The City’s insurance and self-insurance will apply in excess of, and will not contribute with this insurance. This insurance applies separately to each insured or additional insured who is seeking coverage, or against whom a claim is made or a suit is brought. The issuing company shall mail thirty (30) days advance notice to the City for any policy cancellation, termination, non-renewal, or reduction in coverage.” C. Required Submittals for Workers’ Compensation Insurance. Contractor shall provide City with a certificate of insurance and a subrogation endorsement on forms satisfactory to the City Attorney or City’s Risk Manager, and signed by the insurance carrier or its authorized representative – which fully meet the requirements of, and contain provisions entirely consistent with, this Contract’s workers compensation insurance requirements. If Contractor is self-insured for workers’ compensation, a copy of the “Certificate of Consent to Self-insure” from the State of California is required; or if Contractor is lawfully exempt from workers’ compensation laws, an “Affirmation of Exemption from Labor Code §3700” form is required.
D. Required Evidence of Builder’s Risk Coverage. Contractor will provide a certificate of insurance and a declarations page on a form satisfactory to the City Attorney or City’s Risk Manager, and signed by the insurance
carrier or its authorized representative. The policy terms must fully meet the requirements of, and contain provisions entirely consistent with, all of the insurance requirements set forth herein. The City shall be named as a loss payee on the insurance policy for the full replacement value of all buildings, structures, fixtures and materials to be constructed, maintained, repaired or supplied pursuant to this Contract.
E. Contractor agrees to monitor and review all such coverage and assumes all responsibility for ensuring that all required coverage is provided. Contractor agrees to obtain certificates evidencing such coverage.
F. Contractor agrees to provide immediate notice to City of any claim or loss against Contractor that includes City or any other indemnitee as a defendant. City assumes no obligation or liability by such notice, but has the right (but not the duty) to monitor the handling of any such claim or claims if they are likely to involve City.
G. No liability policy shall contain any provision or definition that would serve to eliminate so-called “third party action over” claims, including any exclusion for bodily injury to an employee of the insured or of any contractor or subcontractor.
H. Any “self-insured retention” must be declared and approved by City. City reserves the right to require the self-insured retention to be eliminated or replaced by a deductible as approved by the City. Self-funding, policy fronting or other mechanisms to avoid risk transfer are not acceptable. If Contractor has such a program, Contractor must fully disclose such program to City.
EXHIBIT 5
Statement of Intent to Comply with Minimum Requirements of the Stormwater Permit Permit Number:
CITY OF VERNON
PUBLIC WORKS DEPARTMENT
Construction Stormwater Program
------------ Date: _______ _
Applicant: Pavement Coatings Co. Phone: 714-826-3011
Project Address: ___,,;,C.;.;.ity'-o;.;;.f....;.V..;;.;em;.;.;;.o.;;.;;.n;;...._ _________________ _ Property Owner: City of Vernon
Contractor: Pavement Coatings Co.
Contractor's Address: 10240 San Sevaine Way, Jurupa Valley, CA 91752 The National Pollutant Discharge Elimination System (NPDES) is a portion of the Clean Water Act that applies to the protection of receiving waters. Under permits from the Los Angeles Regional Water Quality Control Board (RWQCB), certain activities are subject to RWQCB enforcement. To meet the standards of the Waste Discharge Requirements for Municipal Separate Storm Sewer System (MS4) Discharges within the Coastal Watershed of Los Angeles County, Except those Discharges Originating from the City of Long Beach MS4 (CAS004001 ), the City of Vernon has adopted minimum standards for stormwater runoff from development construction activities.
These minimum standards require the implementation of an effective combination of erosion and sediment control Best Management Practices (BMPs) to prevent erosion and sediment loss, and the discharge of construction waste at each site. At a minimum, the construction activity associated with the construction project identified above shall be conducted in such a manner that:
► Prevents illicit construction-related discharges of pollutants into the MS4 and receiving waters. ► Implements and maintains structural and non-structural BMPs to reduce pollutants in stormwater runoff from construction sites.
► Reduces construction site discharges of pollutants to the MS4 to the maximum extent practicable. ► Prevents construction site discharges to the MS4 from causing or contributing to a violation of water quality standards.
Note: The Stormwater BMP Construction Handbook sheets developed by the California Stormwater Quality Association shall be used as guidance in determining and implementing required BMPs. The BMP sheets may be reviewed at the Public Works Department counter during regular business hours. A General Construction Permit shall be obtained and maintained for all construction sites one (1) acre or greater. Additional conditions may be required for these sites.
I have read and understand the re uirements listed above and certify that I will comply with the minimum requirements above.
EXHIBITS
Statement of Intent to Comply with Minimum Requirements of the California Covid-19 Industry Guidance: Construction
CITY OF VERNON
PUBLIC WORKS DEPARTMENT
Project Address: City of Vernon
Property Owner: City of Vernon
Contractor: Pavement Coatings Co.
Contractor's Address: 10240 San Sevaine Way. Jurupa Valley. CA 91752 The latest COVID-19 industry guidelines can be accessed at the following web address:
https://www.dir.ca.gov/dosh/coronavirus/Guidance-by-lndustry.html This document provides guidance for the construction industry to support a safe, clean environment for workers. The guidance is not intended to revoke or repeal any worker rights, either statutory, regulatory or collectively bargained, and is not exhaustive, as it does not include county health orders, nor is It a substitute for any existing safety and health-related regulatory requirements such as those of Cal/OSHA.1 Stay current on changes to public health guidance and state/local orders, as the COVID-19 situation continues. Cal/OSHA has more safety and health guidance on their Cal/OSHA COVID-19 Infection Prevention for Construction 2 Employers and Workers webpage.
CDC has additional guidance for businesses and employers.
I have read and understa,1.1.Mt~:1..1 d above and certify that I will comply with the minimum requirements above.
Date: __ 4_{ f W_{t __ S_
EXHIBIT B
SPECIAL PROVISIONS
SPECIFIC FOR THIS PROJECT
EXHIBIT B – SPECIAL PROVISIONS
1 EXHIBIT B – SPECIAL PROVISIONS
SPECIFIC FOR THIS PROJECT
CITYWIDE SLURRY SEAL PROJECT
EXHIBIT B – SPECIAL PROVISIONS
2 Table of Contents
A. General .................................................................................................................................................. 4
1. Scope of Work .................................................................................................................................. 4
2. Contract Specifications .................................................................................................................... 4
3. Specifications ................................................................................................................................... 4
4. Length of Contract ........................................................................................................................... 4
5. Liquidated Damages......................................................................................................................... 4
6. Delays and Extensions of time ......................................................................................................... 5
7. Quality of Work ................................................................................................................................ 5
8. Unit Prices ........................................................................................................................................ 5
9. Extra Work ....................................................................................................................................... 5
10. Compliance with Laws, Regulations, and Safe Practices ................................................................. 6 B. Construction Phase Specifications ........................................................................................................ 6
1. Scheduling of Work .......................................................................................................................... 6
2. Material Submittals .......................................................................................................................... 6
3. Weather Limitations ........................................................................................................................ 6
4. Construction Hours .......................................................................................................................... 6
5. Traffic Requirements ....................................................................................................................... 7
6. Maintaining Existing Traffic Signal System ...................................................................................... 8
7. Notification of Affected Residents/Businesses ................................................................................ 8
8. Notification of Utilities ..................................................................................................................... 9
9. Protection of the Public ................................................................................................................... 9
10. Noise Restrictions ............................................................................................................................ 9
11. Construction Order of Work .......................................................................................................... 10
12. Character of Workers ..................................................................................................................... 10
13. Examination of Site ........................................................................................................................ 10
14. Mobilization ................................................................................................................................... 10
15. Dust Control ................................................................................................................................... 11
16. Best Management Practices (BMP’s) ............................................................................................. 11
17. Temporary Water Meter................................................................................................................ 11
18. Cleaning of Site During Construction ............................................................................................. 11
19. Sanitary Facilities ........................................................................................................................... 11
20. Parkway Restoration ...................................................................................................................... 12
EXHIBIT B – SPECIAL PROVISIONS
3 21. Root Shaving/Pruning .................................................................................................................... 12
22. Final Cleaning of Site and Restoration ........................................................................................... 12
23. Contractor Responsibility ............................................................................................................... 12 C. Material Specifications ........................................................................................................................ 13
1. Slurry Seal ...................................................................................................................................... 13
2. Adjust Manhole Frame and Cover Utility Valves ........................................................................... 13
3. Replacement of Manhole Frame and Cover .................................................................................. 14
4. Benchmark Replacement ............................................................................................................... 14
5. Traffic Detector Loops.................................................................................................................... 14
6. Striping Improvements .................................................................................................................. 14 a. General ........................................................................................................................................ 14 b. Temporary Striping ..................................................................................................................... 15 c. Paint Materials ............................................................................................................................ 15 d. Testing ......................................................................................................................................... 16
EXHIBIT B – SPECIAL PROVISIONS
4 A. General
1. Scope of Work
This project consists of citywide slurry seal including traffic control, protection and restoration of existing improvements, removal and restoration of existing improvements. All labor, material, equipment, and transportation necessary for the project shall be included for all construction bid items listed for this project.
2. Contract Specifications
The details and the exact limits for the asphalt and concrete work in this project are shown on the City of Vernon sheet drawings, incorporated into this Agreement by this reference:
Sheet No. Plan
No.
Description
- 1 City Plan for PCI Treatment
1~14 -
Striping and Pavement Markings
Improvement Plans
3. Specifications
Installation and payment for all the work shall conform to the Standard Specifications for Public Works Construction (2024 Edition), State of California Department of Transportation “Caltrans” Standard Plans (2023 Edition) and State of California Department of Transportation Standard Specifications (2023 Edition), latest edition of the California Manual on Uniform Traffic Control Devices, and the City of Vernon Standard Plans.
The Standard Specifications for Public Works Construction (2024 Edition) shall be referred to hereafter as the “Standard Specifications”. The Caltrans Standard Plans (2023 Edition) shall be referred to hereafter as the “Caltrans Standard Plans”.
4. Length of Contract
All work in this project shall be completed within sixty (60) calendar days as specified in the Bidder's Proposal.
5. Liquidated Damages
In accordance with Section 6-9 of the Standard Specifications, for each consecutive calendar day in excess of the time specified for completion of the work, as adjusted in accordance with Section 6-9 of the Standards Specifications, the Contractor shall pay to the agency, or have withheld from monies due it, the sum of two hundred and fifty ($250) per calendar day.
EXHIBIT B – SPECIAL PROVISIONS
5 6. Delays and Extensions of time
The provisions of Section 6-4 entitled "Delays and Extensions of Time" of the Standard Specifications shall apply except as modified and supplemented below.
The second paragraph of subsection 6-4.1 is hereby deleted and the following paragraph shall be inserted in its place:
No extension of time will be granted for a delay caused by the inability of the Contractor to obtain materials, equipment and labor, except as authorized by the City's Project Manager. The length of contract time stipulated includes any time which may be required to obtain materials, equipment and labor, and the Contractor in submitting a bid shall be deemed to have ascertained the availability of materials, equipment and labor and considered same in his/her proposed construction schedule.
7. Quality of Work
The provisions of Section 3 entitled "Control of the Work" of the Standard Specifications shall apply. In addition, any work deemed unacceptable by the City's Project Manager, whether a cause is determined or not shall be repaired or replaced by the Contractor at his/her expense.
8. Unit Prices
All costs not covered by specific unit prices but required for a complete job in place, shall be included in the items most related to the work.
9. Extra Work
In the event the City and the Contractor are unable to negotiate an agreed price for extra work, which is acceptable to both parties, payment shall be made based on time and materials as follows:
• Work by the Contractor: The following percentages shall be added to the Contractor's cost and shall constitute the markup for all overhead and profits:
1. Labor 33%
2. Materials 15%
3. Equipment Rental 15%
4. Other Items and Expenditures 15%
• Work by the Subcontractor: When all or any part of the extra work is performed by a subcontractor, the markup provided by the Contractor as mentioned above shall apply to the subcontractor’s actual costs. A markup of 5% of the subcontracted portion of each extra work may be added for the Contractor.
EXHIBIT B – SPECIAL PROVISIONS
6 10. Compliance with Laws, Regulations, and Safe Practices The Contractor shall perform all work in a safe, competent manner and in accordance with all federal, state, and local statues, regulations, ordinances, rules, and governmental orders. The Contractor will be solely and completely responsible for the conditions of the job site, including safety of all persons and property during performance of the work. This requirement will apply continuously and not be limited to normal working hours. Inspection of the Contractor's performance by the City, its agents, or employees is not intended to include review of the adequacy of the Contractor's safety measures in or near the job site.
B. Construction Phase Specifications
1. Scheduling of Work
The Contractor shall submit his/her work schedule to the City's Project Manager prior to the preconstruction meeting. The construction schedule shall show the sequence of work, critical path and estimated time for completion of each segment of work. This schedule must be reviewed and accepted by the City's Project Manager before the Contractor will be permitted to begin work. In addition, the Contractor shall submit a detailed schedule forecasting two weeks of work describing each day’s work. This schedule shall be updated and submitted to the City every other Monday during the construction period. The Contractor shall give 48 hours’ notice to the City's Project Manager prior to the start of the work.
2. Material Submittals
The Contractor shall provide all required submittals including, but not limited to the following:
• Shop drawings
• Materials and mix designs (submitted upon reward of the contract for review and approval before the construction); and
The “Notice to Proceed” will not be issued to the Contractor until all the submittals have been reviewed and approved by the City.
3. Weather Limitations
Placement operations shall not be performed during wet conditions or if rain or cold conditions (less than 45°F) are imminent or predicted to exist at any time. “Imminent or predicted” is defined as being forecasted within a 48-hour period on the National Weather Service Web Site http://www.wrh.noaa.gov for the most representative and nearest location listed where placement is to begin and end.
4. Construction Hours
Work shall occur Monday-Thursday between the hours of 7:00 am to 4:00 pm unless otherwise restricted by the type of work shown below:
• Asphalt work that requires a half or full street closure shall occur on Saturday and Sunday between the hours of 6:00 am to 5:00 pm.
EXHIBIT B – SPECIAL PROVISIONS
7 • All re-striping work shall occur at night between the hours of 9:00 pm to 5:00 am. Layout “Cat Track” shall be approved by the City before the final striping improvements are installed.
• Traffic signal loop installation shall occur Monday-Friday between the hours of 7:00 am to 4:00 pm.
5. Traffic Requirements
Before any partial or total closure of any street, the Contractor shall be required to obtain the approval of the City's Project Manager.
The Contractor shall comply with Section 600 and 601 of the Standard Specifications and provide safe and continuous passage for pedestrian and vehicular traffic at all times. The Contractor shall provide and maintain all necessary flagmen, barricades, delineators, signs, flashers and any other safety equipment as set forth in the latest publication of the State of California, Division of Highways, Traffic Manual or as required by the City's Project Manager to ensure safe passage of traffic.
The following provisions shall apply unless otherwise directed by the City's Project Manager. • The traffic control shall be in accordance with the California Manual of Temporary Traffic Controls (CA MUTCD, latest edition) handbook.
• The Contractor shall submit traffic channelization and detour plans to the City's Project Manager for approval at least fourteen (14) fourteen working days prior to commencement of work. Traffic control plans (previously approved by the City's Project Manager) shall be maintained within the construction zone for the duration of the construction.
• Traffic Control Work shall include all labor, materials, tools, equipment, transportation and incidentals necessary to maintain and control all vehicular and pedestrian traffic through the construction site. The cost of furnishing and maintaining traffic control during the construction including flagmen as necessary must be included in the various bid items, and no extra compensation will be paid to the Contractor. • In addition to the requirements of the MUTCD handbook, the City's Project Manager may require fifteen (15) foot wide travel lanes, flatter traffic tapers, additional traffic control devices, barricading, and other signing in order to ensure driver awareness and safety in the construction area. Further, the Contractor shall provide Type II or Type III barricades with flashers and delineators at locations as determined by the City's Project Manager. • Construction hours shall be per pursuant to Section B4. Monday-Thursday; Contractor
EXHIBIT B – SPECIAL PROVISIONS
8 shall maintain at least one (1) through lane of traffic in each direction during the hours of 6:00 am – 8:00 am and 4:00 pm – 6:00pm each day.
• The Contractor shall provide access to local businesses at all times unless otherwise approved by the City's Project Manager. This may include providing steel plates at some driveway approaches. Message boards shall be used for pre-construction warnings, lane closure/detour areas, and placed 14 calendar days in advance of the closure/detour. • The posting of "NO PARKING" signs within the construction limits is permitted with the approval of the City Engineer. "NO PARKING" signs shall contain a "TOW AWAY" warning.
These signs shall be furnished and maintained by the Contractor and shall be of the type approved by the City's Project Manager. Each sign posted shall have the date and time indicating the duration of the "NO PARKING" prohibition printed clearly in a manner acceptable to the City's Project Manager. New signs shall be posted when changes occur in the parking prohibitions indicated on the previously posted signs. Signs must be posted at least seventy-two (72) hours in advance of construction or they are invalid. Signs shall not be attached to trees or taped to street light or traffic signal poles. Contractor shall only post "NO PARKING SIGNS" on one side of the street at a time unless otherwise approved by the City's Project Manager. The signs shall be effective for no more than five (5) working days and shall be removed within twenty-four (24) hours after the work is complete. If signs are not removed in a timely manner, the City's Project Manager may suspend all work until the signage requirement is corrected. All signs, lights and other warning devices used shall be in accordance with State of California Business and Transportation City Department of Public Works Manual of Warning Signs, Lights and Devices for Use in Performance of Work upon Highways.
6. Maintaining Existing Traffic Signal System
In accordance with Sections 701-4 and 701-5.3 of the Standard Specifications, the existing traffic signals shall be in operation at all times.
7. Notification of Affected Residents/Businesses
The Contractor shall be responsible for distribution of the general information letter of the project to all affected residents and businesses. A project general information letter and sufficient copies thereof will be prepared by City staff for Contractor distribution to all residents, business establishments, and institutions fronting on or directly affected by the project.
The Contractor shall be responsible for distribution of said letter in handout form to all the appropriate residences and buildings in the subject area. Distribution shall be accomplished in a manner acceptable to the City's Project Manager and shall be five (5) working days prior to the beginning of construction operations in the immediate vicinity.
EXHIBIT B – SPECIAL PROVISIONS
9 In addition to the above, the Contractor shall be fully responsible for such other notifications as may be required related to necessary closures of streets, alleys, driveways, etc., or to unavoidable access or parking restrictions. These notifications shall apply where the closures and access or parking restrictions required in the performance of any work under this contract preclude any resident, tenant, or property owner from utilizing the premises or conducting business thereon in a reasonable and customary manner.
Additional notification to the affected businesses and residents shall be prepared by the City and distributed by the Contractor for roadway and driveway closures five (5) working days in advance of any construction work. No removal or excavation work is allowed until the additional notification has been distributed to the affected residents and businesses. If a Contractor is unable to adhere to his/hers schedule as indicated on his/hers written notification, then all the affected residents and places of business shall be re-notified of the revised schedule, in writing, as indicated above. Contractor costs for all of the above notifications shall be considered as included in the appropriate items of the Bid Proposal.
8. Notification of Utilities
The provisions of Section 402 entitled "Utilities" of the Standard Specifications shall apply. The Contractor shall contact the Underground Service Alert of Southern California (U.S.A.) at least three (3) working days in advance of the construction work.
9. Protection of the Public
The Contractor shall take such steps and precautions as his/her operations warrant to protect the public from danger, loss of life, loss of property or interruption of public services. Unforeseen conditions may arise which will require that immediate provisions be made to protect the public from danger or loss, or damage to life and property, due directly or indirectly to prosecution of work under the contract. Whenever, in the opinion of the City's Project Manager, a condition exists in which the Contractor has not taken sufficient precaution of public safety, protection of utilities, and/or protection of adjacent structures or property, the City's Project Manager will order the Contractor to provide a remedy for the condition. If the Contractor fails to act on the situation within a reasonable time period as determined by the City's Project Manager, or in the event of an emergency situation, the City's Project Manager may provide suitable protection by causing such work to be done and material to be furnished as, in the opinion of the City's Project Manager, may seem reasonable and necessary. The cost and expense of all repairs (including labor and materials) as are deemed necessary, shall be borne by the Contractor. All expenses incurred by the City for emergency repairs will be deducted from the final payment due to the Contractor.
10. Noise Restrictions
The Contractor may not operate certain power equipment, within a residential area or within a radius of five-hundred (500) feet from a residential area, except during the following times:
• From 7:00 am to 4:00 pm, Monday through Thursday
EXHIBIT B – SPECIAL PROVISIONS
10 • From 6:00 am to 5:00 pm on Saturday and Sunday
In addition, the noise level from the Contractor's operations shall not exceed eighty-five (85) dBA when measured within a one hundred (100) foot radius at any time.
11. Construction Order of Work
Work shall be scheduled so as to lessen the impact upon businesses. All construction shall conform to the latest edition of the Standard Specifications and shall proceed in a smooth, efficient, timely and continuous manner. As such, once construction is started in a work area, the Contractor will be required to work continuously in that work area until construction has been completed and the work area is open and accessible to both vehicular and pedestrian traffic in a manner approved by the City's Project Manager before the next stage of work will be allowed to begin.
Once construction is started in a work area, the Contractor shall not withdraw manpower or equipment from that work area in order to start construction in another work area if doing so, in the opinion of the City's Project Manager, delays the completion of the work presently under construction.
The Contractor shall maintain continuous access to all residents and businesses within the project limits, including drive approaches, unless the Contractor has obtained the approval of the City's Project Manager to close either such access or drive approach.
No stockpiling of material and construction equipment on public streets or sidewalks will be permitted on this project unless approved by the City's Project Manager. Material and equipment placed on public streets, sidewalks and on the construction areas shall be used the same day.
12. Character of Workers
If any subcontractor or person employed by the Contractor shall fail or refuse to carry out directions of the City's Project Manager or shall appear to the City's Project Manager to be incompetent or act in a disorderly or otherwise improper manner, he/she shall be immediately discharged from the project on the request of the City's Project Manager, and such person shall not be reemployed on the work. If said individual has an ownership interest in the contracting entity, the City's Project Manager will serve written notice upon the Contractor and the Surety providing the faithful performance bond, in accordance with Section 6-8, "Termination of the Contractor by Default" of the Standard Specifications, demanding complete and satisfactory compliance with the Contract.
13. Examination of Site
The Contractor is required to examine the site and judge for themselves the location. Physical conditions, substructures and surroundings of the proposed work.
14. Mobilization
The cost of all preparatory work and operations for the multiple movements of personnel,
EXHIBIT B – SPECIAL PROVISIONS
11 equipment, supplies, and incidentals to the project site must be included in the various bid items, and no extra compensation will be paid to the Contractor.
15. Dust Control
Throughout all phases of construction, including suspension of work, and until final acceptance of the project, the Contractor shall abate dust nuisance by cleaning, sweeping and sprinkling water, or other means as necessary when requested by the City. Failure of the Contractor to comply with the City's Project Manager cleanup orders may result in an order to suspend work until the condition is corrected. No additional compensation or extension of contract completion time will be allowed as a result of such suspension. The cost of furnishing and operating dust control during the construction project shall be included in the various bid items, and no extra compensation will be paid to the Contractor.
16. Best Management Practices (BMP’s)
The Contractor shall submit a copy of their Best Management Practices (BMPs) to the City Engineer for review ten (10) days prior to the beginning of any work.
The Contractor is hereby notified that specific construction practices in the Standard Specifications, Section 3-12.6.2, “Best Management Practices (BMPs)” are considered to be Best Management Practices. The Contractor shall implement and maintain such BMP’s as are relevant to the work, and as are specifically required by the Plans or Special Provisions. The Contractor shall not commence activity until the BMP submittal has been reviewed and approved.
17. Temporary Water Meter
If necessary, the Contractor shall obtain a temporary water meter from the City of Vernon Water Department by placing a deposit of $1,000. Contractor shall pay for all water used.
Contractor shall not relocate the service. The Contractor shall call the City of Vernon Water Department to relocate the service and will be charged fifty dollars ($50.00) for each relocation.
18. Cleaning of Site During Construction
During construction, all existing improvements, including pavement, sidewalk, curb and gutter, adjacent to the work area shall be swept free from soils, gravel, dirt or debris on a daily basis.
The Contractor is responsible for maintaining all sidewalk, curb and gutter areas within the construction zone free from loose materials at all times.
19. Sanitary Facilities
The Contractor shall furnish and maintain sufficient sanitary facilities by the worksites for the entire duration of construction activities. The cost of furnishing and maintaining sufficient sanitary facilities shall be included in the various bid items, and no extra compensation will be paid to the Contractor.
EXHIBIT B – SPECIAL PROVISIONS
12 20. Parkway Restoration
Parkway and lawn areas disturbed by construction and/or root removal operations shall be backfilled with material approved by the City's Project Manager, mechanically compacted to 90% of optimum density, and graded to join the adjacent improvements and parkway lawn areas. The parkway and lawn area shall be restored by sodding in accordance with Section 801-4.8 of the Standard Specifications, and the irrigation system to match the adjacent parkway area. The payment for this work shall be included in the most appropriately related bid item.
21. Root Shaving/Pruning
Where the sidewalk has been raised by an existing tree, interfering roots shall be shaved per the City's Project Manager direction. The shaving of the roots will be paid under the appropriate bid item. The cost of shaving the tree roots and backfilling with clean soil shall be included in the Prune/Root Shave bid unit price and no additional compensation shall be made to the Contractor therefor.
22. Final Cleaning of Site and Restoration
The Contractor shall be responsible for cleaning and restoration of all damaged existing improvements such as sidewalk, driveway, curb and gutter, and private property at no cost to the City. The Contractor shall remove all loose aggregates by sweeping all the sidewalks and gutters. The cost of furnishing and operating such sweeping after the construction of the project must be included in the various bid items, and no extra compensation will be paid to the Contractor.
23. Contractor Responsibility
The Contractor shall be responsible for the final product and shall make any quality control, adjustments and corrections necessary to obtain the final product accepted by the City's Project Manager. The Contractor shall perform process and quality control sampling and testing and exercise management control the work of his/her subcontractors, technicians and workers to ensure that the milling, transporting, spreading, compaction, and finishing processes conform to these Specifications. The City's Project Manager shall have unrestricted access to the laboratory, sampling, testing sites, and all information resulting from mix design and quality control activities.
All Quality Control testing results shall be submitted to the City's Project Manager on a daily basis.
EXHIBIT B – SPECIAL PROVISIONS
13 C. Material Specifications
1. Slurry Seal
a. General
Slurry seal surfacing shall consist of the mixing spreading and application of Rubberized Emulsion – Aggregate Slurry (REAS) which consist of Rubberized Polymer Modified Emulsion (PRME), aggregate, water, and Portland cement. The REAS shall meet all requirements stated in section 203-5 related to Rubberized Emulsion – Aggregate Slurry and sections 302-4.1, 302-4.2, 302-4.4 to 302-4.7, 302-4.8.1, and 302-4.8.3 to 302-4.11 of the Standard Specifications.
b. Materials
Materials for REAS shall conform to 203-5.2 of the Standard Specifications and Brown Book latest edition.
c. Mix Design and Calibration
Mix Design and Calibration shall be per 203-5.3 and 302-4.5.4 of the Standard Specifications and Brown Book latest edition. Mix Design results shall include any proposed additives. The Mix Design shall include the weight per liter (gallon) of REAS.
The City will require samples of REAS to be taken from the central mixing plant for verification of REAS conformance to the approved Mix Design. If the tests do not meet specification requirements, the plant's formula shall be adjusted, and additional tests shall be performed at the Contractor's expense until is acceptable mix is obtained. REAS shall be delivered by vehicles equipped with a calibrated agitator capable of maintaining a homogeneous slurry mix. The contractor shall maintain the Calibration records for each vehicle used, and to provide a copy to the City of Vernon representative upon request. d. Application and Field Sampling
The application rate and field sampling testing shall conform to 302-4.8.3.1, 302-4.8.3.2 and 302-4.9 of the Standard Specifications.
The completed slurry shall have a minimum skid resistance number of 35 (coefficient of friction 0.35) when tested per California Test Method No.342. The Standard Wet Track Abrasion Test (WTAT) ASTM D3910 template shall be modified to a thickness of 3.18mm (0.125in.) for Type I REAS, and 3/8 in. (9.5 mm) for Type III REAS. For Type II REAS as prescribed in ASTM D3910, Y-i in. (6 mm) shall be used. Use of ASTM D3910 shall be modified to include the aggregate retained on No. 4 (4.75mm) for Type II and Type III REAS.
e. Quality Control Program
The contractor shall have established quality control program to ensure compliance with the required specifications of the contract. A copy of the quality control program and the test results shall be available to the City of Vernon upon request.
EXHIBIT B – SPECIAL PROVISIONS
14 2. Adjust Manhole Frame and Cover Utility Valves
The Contractor, as part of the paving operations, shall adjust to finish grade all the utility (gas, water etc.) manholes, valves and survey monuments as necessary at no cost to the City. The City will furnish new extension sleeves when necessary and the Contractor shall install as directed by the City. The Contractor shall free all the valve covers 300 feet ahead of the paving machine.
Immediately after rolling, the valve covers must be raised or lowered to new grade to insure proper access. Existing valves must be exposed and accessible at all times. The valve covers that are unable to be freed and raised during paving operations shall be marked on the new pavement or tied to the existing sidewalk and the Contractor shall raise or adjust the valve covers to the new finished grade within a week with no cost to the City.
3. Replacement of Manhole Frame and Cover
The contractor must provide a cut sheet of the manhole frame and cover to the City for approval prior to the purchase of these materials. The manhole frame and cover name must match with the utility. Additionally, the manhole frame and cover must meet all the specifications of the Standard Plans for Public Works Construction (2021 Edition) Standard Plan No. 630-5.
The cost for the materials and disposal of the manhole frame and cover must be included in the manhole frame and cover bid item.
4. Benchmark Replacement
If benchmarks and/or centerline ties are displaced or damaged during construction, the Contractor shall replace them per City of Vernon Standards at no cost to the City. Contractor shall notify the City within 24 hours of displacing a benchmark and/or centerline ties.
5. Traffic Detector Loops
The traffic detector loops shall be installed per the Caltrans Standard Plan ES-5B. Loops and “home runs” shall be cut 4 inches deep with the stub out cut to match. Home run loops shall be spliced in series and twisted at a rate of 3 turns per foot. Cut out, deburr, and place new 4 inches deep threaded ring for stub out.
The cost of furnishing and installation of new traffic detector loops and “home runs” complete in place and in working order must be included in the loop bid item.
6. Striping Improvements
a. General
Furnishing and installing traffic striping, pavement markers, and pavement markings (legends) shall conform to Section 214 of the Standard Specifications and/or the provision in Section 84 “Traffic Stripes and Pavement Markings”, and in Section 85, “Pavement Markers” of the Caltrans Standard Specifications. The Contractor shall layout (cat track) all striping within one week after the placement of the final paved surface. Once approved by the City, the striping of all the streets shall be installed with Thin-mil thermoplastic traffic stripes and pavement markings. The Contractor shall furnish the necessary control points for all existing striping and legend marking
EXHIBIT B – SPECIAL PROVISIONS
15 prior to removing them. Traffic striping shall be placed upon the finished asphalt concrete or PCC pavement surface according to the plans. Crosswalk markings at adjacent approaches to the improvements shall be restriped as noted on traffic striping plans. The Contractor shall be responsible for the completeness and accuracy of the layout and re-striping to the satisfaction of the City. A blue retro reflective raised pavement marker per Caltrans Traffic Manual Section 6-
03.4, Figure 6-44 shall be placed on new asphalt pavement at all fire hydrant locations. The contractor shall place temporary striping tabs before the street is opened up to traffic. The Contractor shall also install pavement markers according to the striping plans.
Prior to the installation of the traffic signal loops, the contractor shall layout the proposed crosswalks. The cost of preparing layout and furnishing control points must be included in the respective lump sum bid item, and no extra compensation will be paid to the Contractor. b. Temporary Striping
The Contractor shall install temporary traffic striping tabs on the same day(s) of the cold planning and overlay before the lanes are opened to traffic. The cost of all the temporary striping and incidentals to the various project sites must be included in the various bid items, and no extra compensation will be paid to the contractor. All temporary striping shall be removed prior to the final striping.
c. Paint Materials
Furnishing and installing traffic striping, pavement markers, and pavement markings (legends) shall conform to Section 214 of the Standard Specifications and/or the provision in Section 84 “Traffic Stripes and Pavement Markings”, and in Section 85, “Pavement Markers” of the Caltrans Standard Specifications.
Thin-mil thermoplastic traffic stripes and pavement markings, and thermoplastic crosswalks and limit lines shall conform to the provisions in Sections 84-1, “General,” and 84-2, “Thermoplastic Traffic Stripes and Pavement Markings,” of the Caltrans Standard Specifications and these special provisions.
Specifications for glass beads shall be “8010-004 (Type II).” Glass beads shall be premixed within the thermoplastic material prior to application and also applied to the thermoplastic striping material immediately following the application of the striping.
Thin-mil thermoplastic material shall conform to the requirements of Caltrans Specification No. PTH-02SPRAY, for Thermoplastic Traffic Striping Material, Sprayable, White and Yellow.
The binder material shall be Alkyd. Copies of the Caltrans Specification No. PTH- 02SPRAY are available at the Caltrans Transportation Laboratory, Sacramento, California.
Thermoplastic material shall conform to the requirements of Caltrans Specification No.
PTH-02ALKYD.
Thin-mil thermoplastic material for traffic stripes shall be applied by spray method in single uniform layer at the minimum thickness of 30 mils and not to exceed 45 mils.
EXHIBIT B – SPECIAL PROVISIONS
16 Thin-mil thermoplastic material shall be applied to the pavement at a temperature between 350º F. and 400º F., unless the manufacturer recommends a different temperature.
The Contractor shall adjust the thermoplastic application rate as necessary to achieve the thermoplastic application rate stated above prior to striping. Thermoplastic application rate tests (up to and including 5 thermoplastic application rate tests per day, including the thermoplastic application rate test at the start of each workday) may be conducted at random times and locations throughout each workday at the discretion of the City's Project Manager.
Beads Materials:
• Beads shall be colorless and free from milkiness.
• No. 2 beads shall be used.
• Beads shall be kept in a dry storage to prevent moisture absorption. • Beads shall be applied uniformly at the rate of five (5) pounds to seven (7) pounds of beads per gallon of paint.
• Beads shall be uniformly heated to not less than eighty (80) degrees Fahrenheit when applied.
The cost of all paints, beads, other material and equipment required to complete the job must be included in the respective lump sum bid item, and no extra compensation will be paid to the contractor.
d. Testing
The paint application rate shall be determined by passing the striper over a metal plate while the paint application system is operating. The flow of glass beads shall be stopped while passing over the metal plate. The Engineer or representative shall measure thickness of the applied thermoplastic immediately after application of thermoplastic on the metal plate.
Striping shall not continue if the proper thickness of thermoplastic is not being applied.
Adjustments and corrective measures shall be applied to ensure that the correct thickness of thermoplastic will be applied. Testing of the thermoplastic application rate, as described above, will be required following any adjustment to the thermoplastic application rate, thermoplastic applicator nozzles, or any other thermoplastic application equipment prior to commencement or re-commencement of striping. The initial testing and re-testing of thermoplastic application rates at any location shall be considered as a single thermoplastic application rate test.
EXHIBIT C
EQUAL EMPLOYMENT OPPORTUNITY
PRACTICES PROVISIONS
A. Contractor certifies and represents that, during the performance of this Agreement, the contractor and each subcontractor shall adhere to equal opportunity employment practices to assure that applicants and employees are treated equally and are not discriminated against because of their race, religious creed, color, national origin, ancestry, handicap, sex, or age. Contractor further certifies that it will not maintain any segregated facilities.
B. Contractor agrees that it shall, in all solicitations or advertisements for applicants for employment placed by or on behalf of Contractor, state that it is an "Equal Opportunity Employer" or that all qualified applicants will receive consideration for employment without regard to their race, religious creed, color, national origin, ancestry, handicap, sex or age.
C. Contractor agrees that it shall, if requested to do so by the City, certify that it has not, in the performance of this Agreement, discriminated against applicants or employees because of their membership in a protected class.
D. Contractor agrees to provide the City with access to, and, if requested to do so by City, through its awarding authority, provide copies of all of its records pertaining or relating to its employment practices, except to the extent such records or portions of such records are confidential or privileged under state or federal law.
E. Nothing contained in this Agreement shall be construed in any manner as to require or permit any act which is prohibited by law.
EXHIBIT D
CITY STANDARD PLANS
SPECIFIC FOR THIS PROJECT
PLAN NO. 1 UPDATED SLURRY SEAL
PROJECT SITE CITY OF VERNON PUBLIC WORKS DEPARTMENT STRIPING & PAVEMENT MARKINGS IMPROVEMENT PLAN FOR CITYWIDE CHIP SEAL PROJECT 1 14
2 14
3 14
4 14
5 14
6 14
7 14
8 14
9 14
10 14
11 14
13 14 12
14 14 13
14 14
~y E
"' •P'i'p
~~ ~ ~~~
~~ "~C ~. < A L I F O R N I A
March 10, 2025
Via Planetbids
NOTICE TO BIDDERS -ADDENDUM No.l
to the REQUEST FOR BIDS
CITYWIDE CHIP SEAL PROJECT
This notice shall be considered as Addendum No. 1 to the Request for Bids for the abovementioned project and modifies the original Specifications and Contract Documents as noted below. Portions of the Request for Bids, not specifically mentioned in the Addendum, remain in force.
Contract Specifications
1. Project name is hereby amended to Citywide Slurry Seal Project.
2. Request for Bids deadline has been extended to 2:00 p.m., April 1, 2025.
3. Plan No. 1 -City Plan for PCI Treatment Map is hereby amended as attached to this Addendum as Attachment No. 1.
4. Bid Item(sl have been ubdated r~er below table:
Item Description Units Qty. Unit Cost Amount
No.
1. Slurry Seal-Rubberized Emulsion SY 105,773 ~,~~ ~~~~gyp,53 - A re ate Slur REAS
2. Striping, Legends, Markings, LS 1 2$(~~(~ ~~ 2g(~~4CQ `" reflectors, traffic loops, etc on
various streets as noted on tans.
Bid $
Total ~' ~ ~ r ~y~• 5~
written $S~x~~t S~~~y 5a~e~T~~a~c~, E~,~h~k~un~1 ~o~y ~ollacs Amount ~1nc1 F;-~' -Chc~ cep
5. Exhibit B -Special Provisions Section C.1 is hereby amended to read as follows:
1. Slurry Seal
a. General
Slurry seal surfacing shall consist of the mixing spreading and application of Rubberized Emulsion - Aggregate Slurry (REAS) which consist of Rubberized Polymer Modified Emulsion (PRME), Public Works Department
4305 Santa Fe Avenue, Vernon, CA, 90058
CityofVernon.org
~ ~ VERNafVCALIFORNIA
aggregate, water, and Portland cement. The REAS shall meet all requirements stated in section 203-5 related to Rubberized Emulsion -Aggregate Slurry and sections 302-4.1, 302-4.2, 302-4.4 to 302-4.7, 302-4.8.1, and 302-4.8.3 to 302-4.11 of the Standard Specifications. b. Materials
Materials for REAS shall conform to 203-5.2 of the Standard Specifications and Brown Book latest edition.
c. Mix Design and Calibration
Mix Design and Calibration shall be per 203-5.3 and 302-4.5.4 of the Standard Specifications and Brown Book latest edition. Mix Design results shall include any proposed additives. The Mix Design shall include the weight per liter (gallon) of REAS.
The City will require samples of REAS to be taken from the central mixing plant for verification of REAS conformance to the approved Mix Design. If the tests do not meet specification requirements, the plant's formula shall be adjusted, and additional tests shall be performed at the Contractor's expense until is acceptable mix is obtained. REAS shall be delivered by vehicles equipped with a calibrated agitator capable of maintaining a homogeneous slurry mix. The contractor shall maintain the Calibration records for each vehicle used, and to provide a copy to the City's representative upon request.
d. Application and Field Sampling
The application rate and field sampling testing shall conform to 302-4.8.3.1, 302-4.8.3.2 and 302-
4.9 of the Standard Specifications.
The completed slurry shall have a minimum skid resistance number of 35 (coefficient of friction
0.35) when tested per California Test Method No.342. The Standard Wet Track. Abrasion Test ~WTAT) ASTM D3910 template shall be modified to a thickness of 3.18mm (0.125in.) for Type REAS, and 3/8 in. (9.5 mm) for Type III REAS. For Type II REAS as prescribed in ASTM D3910, Y-i in. (6 mm) shall be used. Use of ASTM D3910 shall be modified to include the aggregate retained on No. 4 (4.75mm) for Type II and Type III REAS.
e. Quality Control Program
The Contractor shall have established quality control program to ensure compliance with the required specifications of the contract. A copy of the quality control program and the test results shall be available to the City upon request.
If you have any questions, please contact Gerard Garcia, Assistant Engineer, at (323) 583-8811 ext. 294 or at [email protected].
i /
r~
~~ ~da~' ~~`
•
~;~L~% I,1,ai ~i xj~•w1y~.
.~~t ~%
March 20, 2025
Via Planetoids
NOTICE TO BIDDERS
QUESTIONS AND ANSWERS
to the REQUEST FOR BIDS
CITYWIDE SLURRY SEAL PROJECT
1. Please clarify if the City is looking to utilize REAS I, II, or III for this project.
The City will utilize REAS Type I.
2. Will the City be revising the bid forms to reflect the project name going from chip seal or slurry seal? Or should we proceed with using the previous forms? Please use the forms provided in the notice inviting bids.
3. It looks like the bid schedule has been changed but I don't see the bid proposal sheet corrected just the new updated schedule on the addendum itself. Can someone please let me know what we are to do with the updated schedule?
Please complete and submit both proposal sheets provided in the notice inviting bids and in Addendum No. 1.
If you have any questions, please contact Gerard Garcia, Assistant Engineer, at (323) 583-8811 ext. 294 or at [email protected].
Public Works Department
4305 Santa Fe Avenue, Vernon, CA, 90058
CityofVernon.org
BIDDIfVG FORMS
BIDDER'S PROPOSAL
The undersigned submits this Bid in response to the Notice Inviting Bids issued by the City to construct the Work of the following Project in accordance with the Contract Documents:
PROJECT: Citywide Chip Seal Project
A. Enclosed herewith and by this reference incorporated herein and made a part of this Bidder's Bid are the following completed forms:
1. Bidder's Proposal
2. Schedule of Bid Prices
3. Incumbency Certificate
4. Bid Security in the following form (check one):
❑ Cashier's Check ❑Certified Check Q Bid Bond ❑Cash
5. Bidder's Statement of Qualifications
6. Experience Form
7. Statement of Violations of Federal, State or Local Law, if applicable N ~ A
8. Specialty Contractor Statement of Qualifications
9. Contractor Safety Questionnaire
10. Designation of Subcontractors
11. Contractor's A~davit of Non-Collusion
12. Insurance Requirements Affidavit
13. Pre-Bid Site Inspection Certification
B. Acknowledgment of Addenda. The Bidder shall acknowledge the receipt of all Addenda by attaching a signed copy of all Addenda, and by listing all Addenda received and attached in the space below. ~,~
If an Addendum or Addenda have been issued by the City and not attached and noted above as being received by the Bidder, the Bid may be rejected.
C. Inspection of the Work and Contract Documents. Bidder certifies that it has carefully examined and is fully familiar with all of the provisions of the Bidding Documents and said Bidding Documents contain su~cient detail regarding the Work to be performed; that it has notified City of any errors or omissions in the Bidding Documents andlor any unusual site conditions; and that it has carefully checked all words, prices, and statements in this Bidding Document. Bidder hereby certifies that helshe and hislher Subcontractors have inspected the site and related Drawings antl Specifications of Work and fully acquainted themselves with all conditions and matters which may in any way affect the Work, time of completion or the costs thereof.
Bidder also certifies helshe has observed the designated Contractor Work areas and access routes, if disclosed or shown, as part of the Work in this Contract.
PRE-BID SITE INSPECTION —CERTIFICATION:
Persan(s) who inspected site of the proposed Wark for your firm:
Name: James Wu
Title: Vice President
Name:
Title;
Date of Inspection 3/ 4/ 2 0 2 5
Date of Inspection
D. Bidder agrees that all costs of Work shown in the Bidding Documents, including work reasonably inferable therefrom and necessary thereto, are included in hislher Bid. All Work shown in the Contract Documents for which a specific line item is not provided in the Bidding Form is included in the Bidder's Total Base Bid Price.
Contractor shall be reimbursed for the actual direct cost of all Permit Fees, if any, as defined in Paragraph 1.01 and addressed in Paragraph 1.03 of the General Conditions. Bidder shall exclude the cost of Permit Fees from Bidder's Base Bid sum; Base Bid sum shall include the cost of administration and coordination of Governmental Approvals and Utility Fees. Bidder agrees that City will not be responsible far any errors or omissions on the part of the undersigned in making this Bid.
E. Forfeiture of Bid Security. Bidder further agrees that, in case of hislher default in executing the required Contract and the required bonds, or furnishing the required insurance, the money payable under the Bid Security accompanying this Bid shall be applied by the City towards payment of the damage to the City on account of such default, as provided in the Bidding Documents.
F. Period of Irrevocability, Bidder agrees that this Bid shall remain open and shall not be withdrawn for a period of not less than ninety (90) calendar days from the date of award of Contract, or until rejected by the City, whichever period is shorter.
G. Bid Dispute Indemnification. In the event of a Bid dispute based upon the Bidder's submission of this Bid and the City acceptance of same, the Bidder shall indemnify, defend (with counsel acceptable to City), and hold harmless the City, its City Council members, employees, and agents from liability, claims, demands, damages, and costs arising therefrom if such dispute or action arises solely upon the award of a Contract in compliance with federal, state, and local laws.
The Bidder declares that neither he/she nor any member of hisJher firm or corporation is an officer or employee of the City of Vernon.
hereby certify under penalty of perjury under the laws of the State of California that the representations made herein are true and correct.
Executedthis_~dayof~,2o25,at Jurupa valley California
City State
Bidder's Proposal
Respectfully Submitted
NAME OF BIDDER
COMPANY NAME:
ADDRESS
CONTACT PERSON
Pavement Coatings Co.
10240 San Sevaine Wav
Jurupa Valley, CA 91752
James Wu - Vice President
TELEPHONE NUMBER: ( 714) 8 2 6 — 3 011
E-MAIL: [email protected]
CALIFORNIA STATE CONTRACTOR'S LICENSE NUMBER: 3 0 3 6 0 9 EXPIRATION DATE: 0 9/ 3 0/ 2 0 2 6
TAX IDENTIFICATION NO.: 95-2916670
SURETY COMPANY: The Ohio Casualty insurance company
All Bid forms must be signed where so indicated by the person or persons duly authorized to sign on behalf of the Bidder. By signing the Bid, the person signing is deemed to represent that he or she has authority to bind the Bidder.
Failure to sign the Bidder's Proposal may invalidate the Bid.
BIDDER'S PROPOSAL — SIGNATURE(S):
Form of Entity of Bidder:
Please check the appropriate signature block below and fill in all related information. ❑ Sole Proprietorship:
Name: N/A
Title:
Signature:
List all dlbla's:
❑ Partnership: ❑General Partner ❑Limited Partner
Name: N/A
Title;
Signature:
Corporation:
iip
Name: N/A
Title:
Signature:
Name of all Joint Venturers:
Corporate0fficerTitle: dice President
Corporate Seal
[If the Bidder is a corporation or a limited liability company, enter state or county of incorporation in addition to the business address and include an incumbency certificate executed by a Secretary thereof in the farm set forth herein listing each officer with signing authority and hislher corresponding office. If the Bidder is a partnership orjoint venturer stating that the respective partner or joint venturer agrees to be held jointly and severally liable for any and all of the duties and obligations of the Bidtler under the Bid and under any contract arising therefrom. Attach evidence to the Bid Proposal Form that the individual signing has authority to do so.]
SCHEDULE OF BID PRICES
PROJECT: Citywide Chip Seal Project
BIDDER'S NAME: Pavement Coatings Co .
BASE BID
Pursuant to and in compliance with your Notice Inviting Bids and Contract Documents relating to the Project including all Addenda (attach signed copies), Bidder, having become thoroughly familiar with the terms and conditions of the Contract Documents and with local conditions affecting the performance and the costs of the Work at the place where the Work is to be done, hereby proposes and agrees to fully perform the Work within the time stated in strict accordance with the Contract Documents (including the furnishing of any and all labor, materials, tools, expendable equipment, and utility and transportation services necessary to fully perform the Work and complete it in a workmanlike manner) for the total Base Bid sum of:
N ~ ~ Dollars ($ ~ (A
Item No. Description Units Quantity Unit Cost Amount
1. Chip Seal -Polymer Modified SY 105,773
Emulsified Asphalt (including ~1~ ~~ n
screenings and flush coatlfog ~
seal
2. Striping, Legends, Markings, LS 1
reflectors, etc. on various streets ~ (~ N l A
as noted on lans
BID TOTAL
$ ~~
WRITTEN AMQUNT n
$ 1-\
All other work items, labor, materials, tools and incidentals which are not specifically listed in the above bid items, but are necessary to complete the project per specifications, and all other applicable standards and codes are considered to be included in the above bid items.
If there is a discrepancy between (1) the "Grand Total" shown immediately above, (2) any of the "total costs" shown in the far right column above, or (3) the individual Unit Price, then the Unit price shall control over the total cost, and the total cost shall control over the total, If, however, the unit price is ambiguous, unintelligible, or uncertain for any cause, or is omitted, or is the same amount as the entry for the item total, then the item total shall prevail and shall be divided by the estimated quantity for the item and the price thus obtained shall be the unit price.
Bidder shall exclude the cost of Permit Fees from Bidder's Base Bid sum; Base Bid sum shall include the cost of administration and coordination of Governmental Approvals and Utility Fees. ~TAL BID AMOUNT (Base Bid Sum)
I A Dollars ($ N f .A
(written dollar amount) (dollar amount)
Ily submi d:
J~~_ ~:~/~~1 - Vice President
~t
3 6~9
ic~nse ~furr~~er
(SEAL - if Bid is by a corporation)
10240 San Sevaine Way, Jurupa Valley CA 91752
Address
2'2'1 ~ 2~ 2.'S
Date
09/30/2026
Date of Expiration
Attest: ~ ~ ~ ~' ~'~
Amount of Certified or Cashier's Check or Bid Bond $ 10 0 Name of Bonding Company: The Ohio Casualty Insurance Company
0 V
INCUMBENCY CERTIFICATE
Print legibly the names and title of the president and all officers of the Company who are authorized to sign the Bid Forms:
PRESIDENT'S &OFFICERS' NAME:
Tim Schmid
James Wu
Tom Mucenski
TITLE:
President
Vice President
Secretary
The undersigned hereby certifies to the City of Vernon that he/she is the duly elected and acting Secretary of Pavement Coatings Co . (the "Company"), and that, as such, he/she is authorized to execute this Incumbency Certificate on behalf of the Company, and further certifies that the persons named above are the duly elected, qualified and acting officers of the Company, holding on the date hereof, the titles and positions set forth opposite their names and are authorized to sign the Bid Forms.
IN WITNESS WHEREOF, the undersigned has executed this Incumbency Certificate this 2~" day of Febry a r~ , 205"
~or~t M~c~ry s~<z
Secretary's Name-Printed
._~
Secretary's Signature
Bond No.: c•tlpr
Premium Amount: $ N/~
Bond's Effective Date: rJ/Pr
t • • t ~ ~ •
Ct!.~.!sC<!sC:!.C.!cG!s~..~.C.!.~.!cC:.cC:!cCt!cC<!.~C!s~.!:~~Y~Ct!~.C:!oCC! ~C!.~.!.C<! ~~!.~C!cCC!sC.!sC...C.!.C.!cC2..C.!.~C!cC.!sC.!:~.{-~.! ~t4.~C!{mac! ~.{:~.!:~.{.~.{s~.•{•~.{iC:!:~.! A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Riverside )
On March 6th, 2025 before me, Trisha Vander Sluis, Notary Public , Date Here Insert Name and Title of the Officer
personally appeared Tom Mucenski
Name() of Signer()
who proved to me on the basis of satisfactory evidence to be the person() whose name() is/~lre subscribed to the within instrument and acknowledged to me that he/sY~e/tKey executed the same in his/hbr/tt~ir authorized capacity(i~s), and that by his/her/their signature() on the instrument the person(), or the entity upon behalf of which the person() acted, executed the instrument. 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.
,~5~~ °t ryf TRISHA PANDER SLUIS ,,~ n r
w'• ~ ~• ~ Notary Public -California Signature ~ CX~~
~ ~ Riverside County i .- ~ Signature of Notary Public
Y ~ Commission # 2390925
`"~~~. ~"~' My Comm. Expires Jan 16, 2026
Place Notary Seal Above
OPTIONAL
Though this section is 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:
Number of Pages:
Document Date:
Signers) Other Than Named Above:
Capacity(ies) Claimed by Signers)
Signer's Name:
L~ Corporate Officer — Title(s):
❑ Partner — ~ Limited ~l General
O Individual i_~l Attorney m ~F
CJ Trustee f J Guardi ~r Conservator
D Other:
Signer Is Repres ng:
~~ is Name:
U Corporate Officer — Title(s):
O Partner — ( ~ Limited _~ General
(J Individual i--' Attorney in Fact
Trustee ~_~ Guardian or Conservator
C~ Other:
Signer Is Representing:
GS'ri:~rit~~!«t!.'ti:~✓:'✓:~ri<',i4'e7,%6~P/i~J,4'C/L\~'~G\'LG~r~:\✓,G~t/4~d6~!/<':/:\'.~ri~•ri~•ri~ei~~ei~~ei,Cei~ • ei,~~iG~. ~r!4'~:~~i~~:it•.i4'e/ti:i.'✓t~ei6~✓4~~i4~rit~ri.~
RECITALS:
1. The City of Vernon, California ("City"), has issued a Notice Inviting Bids for the Work described as follows:
Citywide Chip Seal Protect in Vernon, CA. ("Project").
2. In response to the Notice Inviting Bids, Pavement Coatings Co . (Name, address, and telephone of Contractor)
10240 San Sevaine Way, Jurupa Valley CA 91752 -(714)826-3011 submitted the accompanying Bid for the Project.
("Principal"), has
3. Principal is required under the terms of the Specification and all Bidding Documents referenced in it to furnish a bond with the Bid.
The Specification, including all its amendments and supplements, and Principal's Bid are incorporated into this Bond and made a part of it by this reference.
OBLIGATION:
THEREFORE, for value received, We, Principal and
The Ohio Casualty Insurance Company
(Name, address, and telephone of Surety)
790 The City Drive South, Ste 200, Orange CA 92868 ("Surety"),aduly admitted surety insurer under California's laws, agree as follows:
By this Bond, We jointly and severally obligate and bind ourselves, and our respective heirs, executors, administrators, successors, and assigns to pay City the penal sum of Ten Percent of Bid Amount Dollars ($ 10 0 ) ("the Bonded Sum"), this amount comprising not less than TEN PERCENT (10%) of Principal's Base Bid, in lawful money of the United States of America.
The Licensed Agent for Surety is: Alera -Adamson McGoldrick Insurance Agency, LLC 1150 East Orangethorpe Avenue Suite 100, Placentia, CA 92870 (Name, address, and telephone)
Registered Agent's California Department of Insurance License No. 6005102 THE CONDITION OF THIS BOND'S OBLIGATION IS THAT, if: (1) Principal does not (a) withdraw its Bid for the period specified in the Bidding Documents, or if no period is specified for ninety (90) calendar days after City awards the Contract for the Project, or (b) attempt to withdraw its Bid when the requirements of California Public Contract Code §5101 et seq., or any successor legislation, are not met; or (2) City awards Principal the Contract in response to Principal's Bid, and within the time and manner specified by the Specification or Contract Documents or if no period is specified within fourteen (14) calendar days after the Contract's award, Principal (a) signs and delivers to City the Contract, in accordance with the Bid as accepted, (b) furnishes the required bonds for not only Principal's faithful performance and proper fulfillment of the Contract, but also Principal's payment for labor and materials used in the Project, and (c) furnishes the required insurance, then this obligation becomes null and void.
Otherwise, this Bond remains in full force and effect, and the following terms and conditions apply to this Bond:
1. Surety's obligations under this Bond are separate, independent from, and not contingent upon any other surety's guaranteeing that upon City's awarding the Contract to Principal, the Principal will enter into the Contract with City.
2. No right of action accrues on this Bond to any entity other than City or its successors and assigns.
3. If an action at law or in equity is necessary to enforce or interpret this Bond's terms, Surety must pay in addition to the Bonded Sum City's reasonable attorneys' fees and litigation costs, in an amount the court fixes.
4. Surety shall mail City written notice at least 30 days before: (a) the effective date on which the Surety will cancel, terminate, or withdraw from this Bond; or (b) this Bond becomes void or unenforceable for any reason.
On the date set forth below, Principal and Surety duly executed this Bond, with the name of each party appearing below and signed by its representatives) under the authority of its governing body.
Date: February 25, 2025
PRINCIPAL:
Pave Co tin
(C mp~ny
~r (Signature)
J es Wu
(Name)
Vice President
(Title)
Address for Serving Notices or Other Documents
CORr OFt{',TE SEAL
SURETY:
The Ohio Casualty Insurance Company
(Co p ny Name)
l
(Signature
By: Brigid Lopez
(Name)
tS; Attorney-in-Fact
(Title)
Address for Serving Notices or Other Documents:
175 Berkeley SUeet, Boston, Massachusetts 02116
CORPORATE SEAL ~ S
`r~~c;
• '
~'~ ~
,' ,; •s
~'
~~
~, , i,
' ~ c` }
.~ ~ > / '~ ~~ ~, >
■ EVI DENCE MUST BE ATI-ACHED OF THE AUTHORI TY OF ANY PERSON SIGNING ASATTORNEY IN-FACT. ■ THE ATTORNEY-IN-FACT'S SIGNATURE MUST BE NOTARIZED.
■ A CORPORATE SEAL MUST BE IMPRESSED ON THIS FORM WHEN THE PRINCIPAL, OR THE SURETY, OR 80TH, ARE A CORPORA TION.
See attached
BOND ACKNOWLEDGMENT
FOR
SURETY'S ATTORNEY-IN-FACT
STATE OF CALIFORNIA )
ss
COUNTY OF )
On this day of , 20 ,
before me. e), a Notary Public for said County, personally appeared (name), who proved to me on the basis of s
instrument as the attorney in fact of
subscribed the name of
as attorney in fact.
evidence to be the person whose name is subscribed to this and acknowledged to me that he/she
thereto as principal, and his/he own name
certify under P LTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correc
Notary Public
SEAL
1 1 • t ~ 1 ~ •
C:~• :..~~C/s~~!c~C!~...~: ~Q!.~C.~~C.~.~C..~C~~r•~i. v N.•.~~.c~.~:~:.~< ~ c!~.!~~.!~c!~..cc!~c!~.!~...~,!cc.!~~.~.:• :,.~...~c.~:.!s~C c < c Q.c~:!c~C~~N.~~t!c~~.
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California )
County of Riverside )
On February 27th, 2025 before me, Trisha Vander Sluis, Notary Public , Date Here Insert Name and Title of the Officer
personally appeared James Wu
Name() of Signer()
who proved to me on the basis of satisfactory evidence to be the person() whose name() is/ire subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/tf~y~ir authorized capacity(i~s), and that by his/her/their signature() on the instrument the person(), or the entity upon behalf of which the person) acted, executed the instrument. certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is true and correct.
S ~~ ,.t,~~y o° T TRISHA PANDER SIUIS
~ ~~ ~_ ~F~ Notary Public -California
Z W T Riverside County ~
Y L ~~ ~~ Commission ~ 2390925
`"~iip0."~' My Comm. Expires Jan 16, 2026
WITNESS my hand and official seal.
` V~.,v~~
Signature
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though Phis section is 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:
Number of Pages:
Document Date:
Signers) Other Than Named Above:
Capacity(ies) Claimed by Signers)
Signer's Name:
C:1 Corporate Officer — Title(s):
C-~ Partner — ~~ Limited Ci General
C~ Individual i ;Attorney in Fa
Trustee : ~ Guardia Cc
Other:
Signer Is Representi
rvator
~i~'ier's Name:
Ci Corporate Officer — Title(s):
Partner — [ ~ Limited _ 1 General
Cl Individual ~ ;Attorney in Fact
~~ Trustee ~ ~ Guardian or Conservator
rl Other:
Signer Is Representing:
02014 Na~onal Notary Association • www,NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907
• • • t 0 1 i ~
.v,. .ca .aN.c~<.c~~,a~~C~C~~~•~C~ _.~C_c~ .sue ..~..at,.~ ..~..a~C~•~.~:i..:~...~~/:~:.:CJ.s~C..~C!:~J.~•,s~~!:~:!~:!~:~.i~!.~C!:~.!:~C/..~..~ .:~:.aC..~C..~~.:~..
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 Orange
On February 25, 2025 before me, Evett Lam, Notary Public , Date Here Insert Name and Title of the Officer
personally appeared Brigid Lopez
Names) of Signers)
who proved to me on the basis of satisfactory evidence to be the person( whose name(s~ is/~ subscribed to the within instrument and acknowledged to me that b+~lshe/ executed the same in /her/ authorized capacity(, and that by /her/fir signature( on the instrument the person(, or the entity upon behalf of which the person( acted, executed the instrument. certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is true and correct
=~~ ~`~~ ~~ t" ~~ ~ WITNESS my h nd an fficial seal. Q ~ ~ ~ _ Notary Public •California Z, Z =, Orange County ~
~' Commission ~ 2380930
`'- ~`"~* My Comm. Expires Oct 31, 2025 Signature
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deer alteration of the do fraudulent reattachment of this form to an unintended documer~~ Description of Attached Document
Title or Type of Document:
Number of Pages: Signers) Other Than N
Capacity(ies) Claimed by Signers)
Signer's Name: , /
❑ Corporate Officer — Title(s):
❑ Partner — ~_~ Limited ~ General
~J Individual ~J A rr5ey in Fact
O Trustee ~ uardian or Conservator
L~l Other:
Signer Is R esenting:
nt Date:
ove:
Signer's Name:
C~ Corporate Officer — Title(s):
❑ Partner — J Limited O General
Individual L Attorney in Fact
Trustee C~ Guardian or Conservator
C' Other:
Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907
c
'v ~
~~
U ~
o~
a`>
~~ _~
~ 'v~
O ~
aj O
O ~
C~
~ ~
~ ~
L
~~
E~
o~
>~
o ~ ~.
ZU
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. ~'~ Libe~ Liberty Mutual Insurance Company
Mutual. The Ohio Casualty Insurance Company Certificate No: 8208193-971991 West American Insurance Company
SURETY
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Brian A.
McGoldrick, Brigid Lopez, Evett Lam, Marisella Rivera
all of the city of Placentia state of CA each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 21st day of June 2022
Liberty Mutual Insurance Company
P~ 1NSV~ P~~Y INS a 1NSU~pq The Ohio Casualty Insurance Company ,~J ~oaPO~a, ~~, y~ ~oRPORa,.~y ~P ~o~PORa,. y~ West American Insurance Company J 3 '~o R~ Q 3 `moo C~ ~ 3 Fo tt~
~ 1912 ~ " 1919 ~ ~ 1991 ~
>' 'l chai ~ ~ Z ~u O Q ~
i~ ~
to
~dJl ~sACHUs" ,da y~ ~hAMPS~`,da~ ~s ~NOIANP ,da3 ~ i! ~ U David M. Carey, Assistant Secretary ~' ~
State of PENNSYLVANIA ~ ~
County of MONTGOMERY SS _o ~
On this 21st day of June 2022 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes L therein contained by signing on behalf of the corporations by himself as a duly authorized officer. ~ ~ IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. O P PAS 0-~
Q~GS~oNw ~F~ Commonwealth of Pennsylvania -Notary Seal
t~ p~ ~~, ~ Teresa Pastella, Nolary Public ~ ~'~
~ ~ OF 2 ~
Montgomery County ~~~~~ ~ ~
My commission expires March 28, 2025 B ~,~2~1:1:.(.(~CJ O ~ ~~~ Commission number 1126044 y. ~ ~
~j.~q~ ~~~G Member, Pennsylvania Association of Notaries eresa Pastella, Notary Public o O "— O
L
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual ~ Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: a M ARTICLE IV —OFFICERS: Section 12. Power of Attorney. o 0 Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the ~ President may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety ~ ~ any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall -o ~ have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such o a~ instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under the ~ provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ~ Q ARTICLE XIII —Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instniments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary.
Certificate of Designation —The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys-infact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify ti~at'~h2 original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked.
IN TESTIMONY 1NNERE~~, I have hereunto set my hand and affixed the seals of said Companies this 25 day of February 2025 JQ' oR oaq~'L Jp~oRvo~U'Q9 VQao No2qq'L
~ v r ~+ ~ v r ti ~ c o J3 `~oc~ vQ3 `~o m ~3 Fot~
~ 1912 ~ o y 1919 ~ o a 1991 0 ! ~,,~
d~ ~BACHUS~.aa y~ ~HAMPS~`~ ~ ~ ~NOIANp' a~
B~/:
~~~ * *~ ,~yl * *aa s~M * *~d Renee C. Llewellyn, Assistant Secretary LMS-12873 LMIC OCIC WAIC Multi Co 02121
BIDDER'S STATEMENT OF QUALIFICATIONS
1. ORGANIZATION
1.1 How many years has your organization been in business as a Contractor? 4 8 years
1.2 How many years has yourorganization been in business under its present name? 48 years
1.2.1 Under what other names has your organization operated? N/A
1.3 If your organization is a corporation, answer the following:
1.3.1 Date of i ncorporationlorganization: 0 3/ 0 3/ 19 7 5
1.3.2 State of incorporationlorganization: California
1.3.3 Corporate ID number: 0 0 7 2 4 9 4 8
1.3.4 Name of President: Tim Schmid
1.3.5 Agent for Service of Process: Nikki Re y e s
1.4 If your organization is a partnership, answer the following:
1.4.1 Date of organizationlformation: N/A
1.4.2 Type of partnership (if applicable): N/A
1.4.3 Names) of general partner(s); N/A
1.4.4 List all states in which you are registered and state ID numbers for each:
N/A
1.5 If your organization is individually owned, answer the following:
1.5.1 Date of organization: N/A
1.5.2 Name of owner: N/A
1.6 If the form of your organization is other than those listed above, describe it and name the principals:
N/A
2. LICENSING
2.1 List jurisdictions in which your organization is legally qualified to do business, indicate registration or license numbers, and category of license, if applicable.
California — 303609, A, C-32
Nevada — 0079452, A-11, A-12, A-8
2.2 List jurisdictions in which your organization's partnership or trade name is filed.
None
2.3 List any licensing suspensions and/or violations assessed against your organization within the past five years.
3. EXPERIENCE
3.1 List the categories of Work that your organization normally performs with its own personnel.
Slurry Seal, Chip Seal, Cape Seal, REAS, Microsurfacing, Scrub Seal
3.2 On the Experience Form, list the project information that establishes that Bidder meets the essential requirements for qualification set forth in the Mandatory Qualifications paragraph of the Notice Inviting Bids for this Project.
3.3 Have Subcontractors for street striping and traffic markings work complete the Specialty Contractors' Statements of Qualifications (or Bidder to complete if self-performing).
3.4 On a separate sheet, list projects to which your firm or business has been awarded a government contract since your firm or business has been in existence (giving the name and address of the project, the government agency, contact name and phone number, the contract amount, and contract's starting date and ending date).
3.5 On a separate sheet, list the experience and present commitments of the key individuals of your organization.
CLAIMS; LAWSUITS; CRIMINAL ACTS
For the following questions, the term "owner" does not include owners of stock in your firm if your firm is a publicly traded corporation.
4.1 In the past five (5) years, have, you, your firm or any of its owners, partners, officers, or employees been a defendant in court, or participated in an arbitration or mediation, on a matter related to:
PAVEMENT COATINGS CO.
10240 San Sevaine Way, Jurupa Valley, CA 91752
Office (714) 826-3011 /Fax (714) 826-3129
Contractors License Number 303609; DIR #1000003382
PROJECT REFERENCES
City/County Protect Name Contaet Person Desc~Iption of Work OrlglnaUflnal Start/End Dates Reason for Contract Contract Amount Amount Being Different
Los Angeles County Public Works RMD JOC 6681-401 Michigan Avenue Joseph Min, Project Manager RAP Micro-Surfacing, Slurry Seal, Chip Seal, Scrub Seal $1,172,790 / $1.139.378 6/1/2021.7/13/2021 QuantityUnderruns 900 South Fremont Ave. (562) 869-1176
Alhambra, CA 91803-1331
City of Victorville 2021 Liberty Village Pavement Ryan Schultz, Project Engineer Slurry Seal and Micro-Surtacing $1.802,205 / $1,591,397 6/1/2021- 8/21/2021 Quantity Underruns 14343 Civic Drive Rehabilitation Project (760) 243-6358 Victorville, CA 92393-5001 Project CC21-103 Rschuttz@victorillesa. ov Los Angeles County Public Works RMD lOC 6681-300139th St. Phase 1 Ossama Ghanim RAP, Micro-Surfacing, Slurry Seal, Chip Seal, Scrub Seal $675,093 / $641,794 7/6/2021- 8/6/2021 Quantity Underruns 900 South Fremon[ Ave. W. Rancho Dominguez (310)348-6448 Alhambra, CA 91803-1331
City of Malibu 2021 Annuat Street Maintenance Project lenna Sobrieray, Project Manager Slurty Seal $660,485 / $630,003 8/30/2021-11/2/2021 Quantity Underruns 23825 Stuart Ranch Rd (310)456-2489
Malibu. CA 90265-4681 [email protected]
City of Redondo Beach Citywide Slurry Seal Project (Phase 2) Javier Urista Type II Slurry Seal 5720,725 / $774,712 8/21/2021- i/8/2022 Quantity overruns /contract 415 Diamond Street Job No. 41140 (310) 318-0661 change orders Redondo Beach, CA 90277
City of Lynwood Citywide Slurry Seal (Phase 2) Khrisrynne Aramouni Type II Slurry Seal $299,931.00 12/5/2022 -12/23/2022 11330 Bullis Road, Lynwood (909) 816-5216
CA 90262 Karamouni@lynwoodCa. ov
City of San Diego Slurry Seal Group 2121 Edgar Puente, Sr. Civil Engineer Slurry Seal 53,798,322.00 10/21/2021- 4/1/2022 Quantity overruns /contract 2781 Saminito Choltas. MS 44 (610) 527-7527 change orders San Die o, CA 92105 Epuente@sandie o. ov
City of Ontario 2022 Street Maintenance Yessenia Lopez Type II Slurry Seal, Crack Seal, $1,821,885 / $1,810,139 9/12!2022 -1/27/2023 Quantity Underruns 303 E. B St., Ontario, CA 91764 Slurry Seat, Cape Seal 8 CDBG 909-395-2103 Asphalt &Concrete, ARAM, Traffic Loops, ylopez@ontar~oca. ov Strfpin , Utili Ad ustment
Los Angeles County Pavement Preservation lOC Clarence Su RAP Slurry Seal, Micro-mill, RAP Scrub Seal, $1,951,761.26 / $1,898,060.76 5/1/2023 - 6/23/2023 Reduced Contract Quantities 900 S. Fremont Ave, Alhambra, RMD JOC 6711 626-458-7927 Cape Seal CA 91803.1331 [email protected]. ov
City of San Diego Slurry Seal Group 2124 Edgar Puente Slurry Seal Type II, III, AC Repairs, Crack Seal, Striping, $5,453,874.87 / $5,252,204.31 8/4/2022 - 8/31/2023 ($135,000) Oil Index Credit and 2781 Caminito Chollas. MS 44, 619-527-7527 Signage, Trattfc Loops, Utility Adjustments Reduced Contract Quantities San Die o, CA 92105 epuente@sandie o.gov
County of Ventura Pavement Resurfacing -Ojai Area Sohil Bhakta Type III Slurry Seal, ARAM, Tree Trimming, Crack Treatment, $1,785,907 / $1,661,537.70 8/8/2023 -10/10/2023 Contract Bid Items Resulting in 800 S. Victoria Ave.. Ventura. 805-6543987 Cold Milling, AC Taper, Tack Coat, Seal Coat, Asphalt Paving, Underruns CA 93009 [email protected] Stripin ,Surve Monument FramesAd'ustment City of Santee Citywide Sturry Seal and Roadway Toby Espinola AC Repairs, Concrete Pedestrian Ramps, Curb &Gutter, $3,691,633.87 / $3,944,145.82 7/17/2023 -11/17/2023 Change Orders for Additional 10601 Magnolia Ave, Santee, Program 2023, CIP 2023-06 619-322-2970 ARAM, Sturry Seal, Striping & Signage, Utility Adjustments Asphalt, Slurry Seal, ARAM CA 92071 [email protected]
City of Garden Grove Arterial Streets Slurry Seal Project 2023 Nick Hsieh Asphalt Paving, Type III Slurry Seal, Type II RAP Slurry Seal, 54,643,865 /54,561,240.14 6/19/2023 - 8/31/2024 Deletion of bid items, underrun 11222 Acacia Parkway, 714-741.5190 ARAM, Replacement of PCC Curb &Gutter, Splash Pad, Striping, in contract quantities Garden Grove, CA 92842 nhsieh@ city,org CCN Cameras &Cables. Traffic Loops
PAV~M ~I~I7" COA7"I I~ICS GO.
10240 San Sevaine Way, Jurupa Valley, Ca 91752, Phone 714-826-3011 Fax 714-826-3129 Contractor's License Number 303609
DIR Number 1000003382
Superintendent
Resume
Bryan Boudreaux: Slurry Seal, 34 years
• 11 years with various Southern California Slurry Seal companies o Journeyman laborer performing work in the four groups associated with application of slurry Seal: Operator, Linedriver/Shuttleman, Squeegee man, &Traffic Control person
• Superintendent at Pavement Coatings Co. for 23 years
o In charge of actual fieldwork, oversees multiple crews and is responsible for managing maintenance on equipment in the field as required o Interacts daily with engineers &inspectors of the owners/agencies/customers and public as needed.
o Reports directly to the Project Manager daily to ensure performance and flow of projects is satisfactory.
*Note: Superintendent position is subject to change as other persons may be used to perform this project.
Slurry Seal Resurfacing ... It Makes a Difference
Member of:
AGC, Associated General Contractors, ISSA, International Slurry Surfacing Association, Strcet Superintendents and Maintenance Association of California
4.1.1 The performance, non-performance, default, violation, or breach of a contract or agreement?
❑ YES D NO
4.1.2 A vehicle collision or accident involving your firm's employees? ❑ YES ❑D NO
4.1.3 Damage to real property arising out of your services or operations? ❑ YES ❑D NO
4.1.4 Employment-related litigation brought by an employee of your firm? ❑ YES ❑D NO
4.1.5 Payment to a subcontractor or supplier?
❑ YES ❑D NO
4.1.6 Defective, deficient, or substandard work?
❑ YES ❑D NO
If the answer to any questions in 4.1.1 to 4.1.6 is YES, identify the name of the person or entity that sued (i.e., "the plaintiff') or was involved in the mediation or arbitration; list the date, curt, court address, and case number; describe the facts and circumstances giving rise to the lawsuit, mediation, or arbitration; and set forth the outcome or disposition. Attach additional sheets as necessary.
4.2 4.3
4.4 Have you or your firm ever filed a claim for damages or a lawsuit, or requested arbitration or mediation, against a government entity or a Client?
❑ YES ❑D NO
If YES, identify the government entity or client; list the date, court and case number; describe the facts and circumstances about the claim for damages, or the lawsuit, or both; and set forth the outcome or disposition. Attach additional sheets as necessary.
Are there any pending or outstanding judgments or liens against you, your firm, or any of its owners, partners, officers, or employees?
❑ YES ❑D NO
If YES, identify the name of the person or entity entitled to payment; list the date court and case number; describe the facts antl circumstances giving rise to the judgment or lien; and set forth the amount of the judgment or lien. Attach additional sheets if necessary.
In the past five (5) years, has any government entity ever: (a) investigated, cited, disciplined,
or assessed any penalties against you, your firm, or any of its owners, partners, officers, or employees, or (b) determined or concluded that your firm or any of its owners, partners, officers, or employees violated any laws, rules, or regulations? ❑ YES ❑D NO
if YES, identify the government entity; list the date, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.
4.5 In the past five (5) years, have you, your firm or any of its owners, partners, officers or employees been convicted of a crime related to the bidding of a government contract, the awarding of a government contract, or the performance of a government contract? ("Convicted" includes a verdict of guilty by a judge orjury, a plea of guilty, a plea of nolo contendere, or a forfeiture of bail.)
❑ YES ❑D NO
If YES, identify the government entity; list the date, court and case number; describe the facts and circumstances about each instance; and set forth the penalty or punishment imposed. Attach additional sheets as necessary.
4.6 In the past five (5) years, have you, your firm, or any of its owners, partners, officers or employees been convicted of a crime involving embezzlement, theft, fraud, forgery, bribery, deceptive or unlawful business practices, perjury, falsifying or destroying records or evidence, or receiving stolen property, or making or submitting a false claim? ❑ YES ❑D NO
If YES, identify the crime or offense; list the date, court and case number; describe the facts and circumstances about each instance; and set forth the penalty or punishment imposed. Attach additional sheets as necessary.
4.7 Have you or, if Bidder is a corporation, any principal of the corporation ever been convicted of a felony?
❑ YES ❑D NO
If YES, please explain the details of that conviction and, if so, whether you or said officer have served his or her sentence.
4.8 In the past five (5) years, has a government entity determined or concluded that you, your firm, or any of its owners, partners, officers or employees made or submitted a false claim (including a false claim for payment), or made a material misrepresentation? ❑ YES D NO
If YES, identify the government entity, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.
4.9 Have you or your company ever been charged by any governmental agency for failure to follow safety procedures? If YES, please explain.
❑ YES D NO
~~
4.10 Has any governmental agency ever submitted a complaint against you or your firm to the California State Labor Commission far failure to submit certified payrolls? If your answer is "Yes", please provide the details of such complaint. ❑ YES ❑D NO
N~~
5. FIRM'S OPERATIONAL STATUS
5.1. In the past seven (7) years, has your firm, or anyone else acting on behalf of your firm, filed for bankruptcy, insolvency, receivership, or reorganization? ❑ YES D NO
If YES, list the filing date, identify the court and case number; describe the facts and circumstances giving rise to each instance; and set forth the disposition or current status.
Attach additional sheets as necessary.
5.2. In the past five (5) years, has your firm had an consolidations, mergers, acquisitions, closings, layoffs or staff reductions?
❑ YES D NO
If YES, list the filing date, and describe the facts and circumstances about each instance.
Attach atlditi~nal sheets as necessary.
5.3. Is your firm in the process of, or in negotiations toward: (a) consolidating, merging, selling, or closing its business, or (b) laying off employees or reducing staff? ❑ YES ❑X NO
If YES, describe the transaction; list the anticipated date for completing the transaction, laying off employees, or reducing staff; and describe the facts, circumstances, and reason for taking the action. Attach additional sheets as necessary.
BIDDING; DEBARMENT; CONTRACT PERFORMANCE
6.1. Has a government entity ever debarred, disqualified, removed, suspended, or otherwise prevented you or your firm from bidding on, contracting, or completing a construction project?
❑ YES ❑X NO
If YES, identify the name of the government entity, list the date, and describe the facts and circumstances about each instance, and state the reason for the government entity's action against your firm. Attach additional sheets as necessary.
6.2. Has a government entity ever rejected your firm's Bid or Proposal on the ground that you or your firm is a "non-responsible" bidder or proposer? ❑ YES D NO
If YES, identify the name of the government entity, list the date, describe the facts and circumstances about each instance, and state the reason or basis far the government entity's determining that your firm was a "non-responsible" bidder. Attach additional sheets as necessary.
6.3. Have you or your firm ever failed to fulfill or perform —either partially or completely — a contract or an agreement with a government entity or a client? ❑ YES ❑X NO
If YES, identify the name of the government entity or client, list the date, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.
6.4. In the past five (5) years, have you or any officer or principal of your firm been an officer of another firm which failed to perform a contract or agreement? ❑ YES ❑X NO
If YES, list the date, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.
6.5. Has your firm ever advised a government entity or a client, while your firm was under contract with the government entity or client, that your firm could not (or would not) fulfill or perform —either partially orcompletely —the contract or the agreement based on the prices that your firm had originally submitted in a Bid or a Proposal? ❑ YES D NO
If YES, list the date, identify the name of the government entity or client, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.
6.6. Has your firm ever requested a government entity or a client, while your firm was under contract with the government entity or client, to renegotiate one or more terms of the existing contract or agreement?
❑ YES D NO
If YES, identify the name of the government entity or client, list the date, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.
6.7. Has your firm ever requested a government entity or a client, while your firm was under contract with the government entity or client, to: (a) cancel the contract or agreement, or (b) release or discharge your firm form the contract or agreement? ❑ YES ❑X NO
If YES, identify the name of the government entity or client, list the date, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.
6.8. Has a government entity or a client ever terminated, suspended, ornon-renewed your firm's contract or agreement before its completion?
❑ YES ❑D NO
If YES, identify the name of the government entity, list the date, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.
6.9. Has a government entity or a client ever notified or advised your firm that your firm's performance under a contract or agreement was poor, sub-standard, deficient, or noncompliant? ❑ YES ❑D NO
If YES, identify the name of the government entity or client, list the date, and describe the facts and circumstances about each instance. Attach additional sheets as necessary.
6.10. In the past five (5) years, has your firm paid, or has your firm been assessed, liquidated damages on a contract or agreement?
❑ YES ❑D NO
If YES, identify all such contracts/projects by owner, owner's address, the date of completion of the project, amount of liquidated damages assessed, and all other information necessary to fully explain the assessment or payment of liquidated damages. Attach additional sheets as necessary.
INSURANCE AND BONDS
7.1. In the past ten years, has an insurance company or a surety company:
7.1.1, Refused to insure your firm for liability coverage? ❑ YES D NO
7.1.2. Canceled ornon-renewed your firm's insurance coverage? ❑ YES D NO
7.1.3. Refused to issue your firm a bond?
❑ YES D NO
7.1.4. Canceled or revoked a bond obtained by your firm? ❑ YES D NO
If the answer to any questions in 7.1.1 to 7.1.4 is YES, identify the name of the insurance company or surety company, list the date, and describe the facts and circumstances about each instance. Attach addition sheets as necessary.
7.2 In the past ten (10) years, has an insurance company or surety company made any payments on your firm's behalf as a result of a default, to satisfy any claims against a performance bond, payment bond, or maintenance bond issued on your firm's behalf? ❑ YES ❑D NO
If YES, identify each contract completed or amount of each claim, the name and telephone number of the claimant, the date, grounds and current status of the claim, and if resolved, the method, nature, and amount of the resolution. Attach addition sheets as necessary.
8. SURETY
8.1 If a performance and/or payment bond is required by this bid, identify the bonding company if arrangements for the bond have been made; if not, identify the bonding company for the Contractor's most recent project:
The Ohio Casualty Insurance Company
8.2 Name and address of agent:
Brigid LOp2Z - 790 The City Drive South, Ste 200, orange CA 92868 (714)257-9644
All of the above statements as to experience, financial qualifications, and available plant and equipment are submitted in conjunction with the proposal, as a part thereof, and the truthfulness and accuracy of the information is guaranteed by the Bidder.
hereby certify under penalty of perjury under the laws of the state of California that the representation made herein are true and correct.
BIDDER'S EXPERIENCE FORM
PROJECT NAME: _Citywide Chip Seal Project
COMPANY NAME; Pavement Coatings Co.
***Please use additional sheets if necessary
List below the project information that establishes that Bidder meets the essential requirements for qualification set forth in the Mandatory Qualifications paragraph of the Notice Inviting Bids for this Project.
CONTRACT CONTRACT CONTRACT PROJECT NAME AND CONTACT PHONE START DATE END DATE $AMOUNT AGENCY ADDRESS CONTACT NAME NUMBER See Attached
2 3
All of the ahove statements as to experience are submitted in conjunction with the proposal, as a part thereof, and the truthfulness and accuracy of the information is guaranteed by the Bidd ere y rtify under penalty of perjury under the laws of the state of California that the representation made herein are true and correct. ~~ ~~
Signature n.
Prim I~;a Ja $~ Vice President
ractor's License No. 3 0 3 6 0 9
expiration date 0 9/ 3 0/ 2 0 2 6
PAVEMENT COATINGS CO.
10240 San Sevaine Way, lurupa Valley, CA 91752
Office(714)826-3011/Fax (714)826-3129
Contractors License Number 303609; DIR #1000003382
PROJECT REFERENCES
City/County ProJeci Name Contact Person Description of Work OriglnaUFlnal Start/End Dates Reason for Contract Contract Amount Amount Being Different
Ciryof Ontario 2022 Street Maintenance Yessenia Lopez Type II SlurrySeal, CrackSeal, 31,821,885/$1,810,139 9/12/2022-1/27/2023 QuantityUnderruns 303 E. B St., Ontario, CA 91764 Slurry Seal, Cape Seal & CDBG 909.395.2103 Asphalt &Concrete, ARAM, Traffic Loops, [email protected].~ox Stripin , UtiliryAdjustment
City of San Diego
2781 Caminito Chollas, MS 44,
San Diego. CA 92105
Slurry Seal Group 2124 Edgar Puente
619-527-7527
[email protected]
Slurry SealType II,111, AC Repairs, Crack Seal, Striping, Signage, Traffic Loops, UtiliryAdjustments
$5.453,874.87 / $5.252.204.31 8/4/2022 - 8/31/2023 ($135,000) Oil Index Credit and Reduced Contract Quantities
County of Ventura
800 S. Victoria Ave., Ventura,
CA 93009
Pavement Resurfacing •Ojai Area Sohil Bhakta
805-654-3987
sohil.bhakta@veoN[ao~
Type III Slurry Seal. ARAM, Tree Trimming, CrackTreatment, Cold Milling, AC Taper, Tack Coat, Seal Coat, Asphalt Paving, Striping, Survey Monument Frames Adjustment
51,785,907 / $1,661,537.70 8/8/2023. 10/10/2023 Contract Bid Items Resulting in Underruns
City of Santee
10601 Magnolia Ave, Santee,
CA 92071
Citywide Slurry Seal and Roadway
Program 2023, CIP 2023-06
Toby Espinola
619-322-2970
[email protected]!ov
AC Repairs, Concrete Pedestrian Ramps. Curb &Gutter,
ARAM, Slurry Seal, Striping & Signage, Utility Adjustments $3,691,633.87 / $3,944,145.82 7/17/2023 -11/17/2023 Change Orders for Additional Asphalt, Slurry Seat, ARAM
ity of Garden Grove Arterial Streets Slurry Seal Project 2023 Nick Hsieh Asphalt Paving, Type III Slurry Seal, Type II RAP SlurrySeal, $4,643,865 / $4,561,240.14 6/19/2023.8/31/2024 Deletion of bid items, underrun 1222 Acacia Parkway, 714-741-5190 ARAM, Replacement of PCC Curb &Gutter, Splash Pad. Striping, in contract quantities arden Grove, CA 92842 nhsieh@~city_o~E CCN Cameras &Cables, Traffic Loops
CONTRACTOR SAFETY QUESTIONNAIRE
Company Name: Pavement Coatings Co.
Primary Type of Work: Slurry Seal, Chip Seal, REAS, Cape Seal, Scrub Seal Person Completing Form. Terry Villegas
Title: Safety Manager
Date: 2/27/2025
Phone Number: (9 51) 2 3 2- 8 8 3 8
SAFETY PERFORMANCE
1. List your company's Interstate Experience Rating Modifier (ERM)1 for the three most recent years. 2024_ 0.81
2023_ 0.66
2022_ 0.73
2. List your company's number ofinjuries/illnesses from your OSHA 300 logs for the three most recent years. 2024 2023 2022
a. Fatalities 0 0 0
b. OSHA recordable incidents 0 2 0
c. Lost work day incidents 0 1 0
d. Total lost work days 0 6 0
e. Total hours worked 134,274_124,005 114,707
3. Upon request from the City, the contractors) shall provide copies of the following items (a-g); and Items (dg)for each listed Subcontractor a). OSHA 300 logs for the most recent three years
and current year-to-date
b). Verification of ERM from your insurance carrier
c). Injury/Illness Report
d). Complete written Safety Program
4. Company Safety Contact:
a. Narpe Terry Villegas
b. Ph0112 951-232-8838
e). Training Plans
fl. Training Certificates for Employees
g). Emergency Response Training
1 ERM = applies to workers' compensation policies. It compares the experience of this contractor to others of similar size, type and ratio. Used against annual premium. It has a direct correlation to how much the contractor pays in workers' comp premium.
CONTRACTOR SAFETY QUESTIONNAIRE (continued)
SAFETY PROGRAM
1. SAFETY PROGRAM DOCUMENTATION Circle One
a. Do you have a written safety program manual? es No
1) Last revision date o~~~2~2025
b. Do you have a written safety field manual? ~e No
c. Are all workers given a booklet that contains work rules, responsibilities, and other appropriate information? ~e No
2. POLICY AND MANAGEMENTSUPPORT
a. Do you have a safety policy statement from an officer of es No the company?
b. Do you have a disciplinary process for enforcement es No of your safety program?
c. Does management set corporate safety goals? es No
d. Does executive management review:
❑X Accident reports? es No
Q Safety statistics? es No
~ Inspection reports? es No
e. Do you safety pre-qualify subcontractors? es No
f. Do you have a written policy on accident reporting 'f~e~ No and investigation?
g. Do you have alight-duty, return-to-work policy? es No h. Is safety part of your supervisor's performance evaluation? ~e No i. Do you have a personal protective equipment (PPE) policy? es No j. Do you have a written substance abuse program? es o
If yes, does it include (check all applicable boxes):
Q Pre-employment testing ❑Return-to-duty testing
Q Random testing Q Disciplinary process
Q Reasonable cause testing Q Alcohol testing
Q Post accident testing ❑National Institute on Drug Abuse 0 Panel Screen
k. Does each level of management have assigned safety Ye No duties and responsibilities?
3. TRAINING AND ORIENTATION
a. Do you conduct safety orientation training for each
employee? Yes No
b. Do you conduct site safety orientation for every `~e~ No person new to the job site?
Does your safety program require safety training meetings? es o for each supervisor (foreman and above)?
How often?
❑ Weekly 0 Monthly Q Quarterly ❑Annually ❑Other
d. Do you hold tool boxltailgate safety meetings
focused on your specific work operations/exposures? ~e No How often?
~ Weekly ❑Daily ❑Other
e. Do you require equipment operation/certification training? Ye No
4. ADMINISTRATION AND PROCEDURES
a. Does your written safety program address
administrative procedures? ~Ye No
If yes, check which apply:
" Pre projectltask planning
x Record keeping
x Safety committees
x HAZCOM
Substance abuse prevention
X Return-to-work
b. Do you have project safety committees?
x Emergency procedures
x Audits/inspections
x Accident investigationslreporting
x Training documentation
~ Hazardous work permits
Subcontractor prequalification
c. Do you conduct job site safety inspections?
How often?
❑ Daily ~ Weekly ❑Monthly ❑Other
Yes No
es No
Do these inspections includes a routine safety
inspection of equipment (e.g., scaffold, ladders, fire
extinguishers, etc.)? ~e No
d. Do you investigate accidents? Yes No
How are they reported?
Q Total company ❑ By superintendent
❑ By project ❑ By project manager
❑ By foreman ❑ In accordance with OSHA
e. Do you discuss safety at all preconstruction and progress meetings? ~e No
Do you perform rigging and lifting checks prior to lifting? es No ~ For personnel ~ For equipment ❑Heavy lifts (more than 10,000 Ibs.)
5. WORK RULES
a. Do you periodically update work rules? es No
When was the last update? 01112!2025
b. What work practices are addressed by your work rules? Q CPR/first aid ~ Access--entranceslstairs
Q Barricades, signs, ~ Respiratory protection
and signals
❑ Blasting Q Material handlinglstorage
0 Communications ❑Temporary heat
❑ Compressed air and gases Q Vehicle safety
Q Concrete work ~ Tragic control
Q Confined-space entry ❑Site visitor escorting
❑ Craneslrigging and hoisting Q Public protection
❑Electrical grounding ~ Equipment guards and grounding
~ Environmental controls and Q Monitoring equipment
Occupational health
Q Emergency procedures Q Flammable material handlinglstorage ❑x Fire protection and prevention ❑Site sanitation
❑ Floor and wall openings Q Trenching and excavating
Q Fall protection ~ Lockout/Tagout
Q Housekeeping ~ Energizedlpressurized equipment
Q Ladders and scaffolds
Q Mechanical equipment! Q Personal protective equipment maintenancelpre-op checks! Q Tools, power and hand
operation Q Electrical power lines
❑ Welding and cutting (hot work) ❑Other
OSHA INSPECTIONS
a. Have you been inspected by OSHA in the last three years? Yes o0 b. Were these inspections in response to complaints? Ye No c. Have you been cited as a result of these inspections? Yes Vo If yes, describe the citations (add additional sheets if necessary):
OSHA's Form 300A (Rev. o~~aooa~ Year zo2a ~~"~
Summary of Work-Related Injuries and Illnesses ~w ~ ~o~P a~ento f habor . . .. . . .. Fom appro~! O!.'9 ro. 1216~Ct;C
All estaDlishmenfs covered by Part 1904 must complete this Summary pale, evcrn it no injurFes a illnesses occurred during the yoar RemamDer to review the Lod fo mrHy that fho QnMes aro ComplerA Using the Log, count the ind vidua! enhies you made fa each category. Tlxin write the fola/s below, making suro you've addt~d tho vnlrins from awry pago o/!he log. If you had no cases wrfly '10." Employees lamer employees. and their represenlatives have thv right to revlow lho OSHA Form 300 in its cnfrrory. Thoy a►so havr limr'led acaass to tho OSHA Form 30t or ifs oCuhalenL See 29 CFR 1904.35. in OSHA's Recordkeeping rub. /a lwther dBfarls on the access provisions for lheso tams.
Number of Cases
Total number of Total number of Total number of cases Totat number of deaths cases with days with job transfer or other recordable away from work restriction cases
0 0 0 0
(G) (H)
Number of Days
(I) (J)
Total number of Total number of days of
days away from job transfer or restriction
\~MrL/
0 0
(K) (L)
Injury and Illness Types
Total number of...
(M)
(1) Injury 0 (4) PoisoninG 0
(2) Skin Disorder 0 (5) Hearing Loss 0
(3) Respiratory
Condition 0 (6) All Other Illnesses 0
Post this Summary page from February 1 to Apn130 of the year following the year covered by the forth Public reporting burden tat tlus eo:loctian of infarm~tlon is ostanci2od to arorego 58 rrrrxAos Por ror~onx, indudu~9limo ro roviow tho kr..ituction. soarch and ga7+er the data necdod, and cacrphte and reviow the co4E~ion of intamation. Persais are not req~uod to respond b tho colloction o(Infartw~tion unless N d~ptays a arre~tly vafd OMB oontd rxmber. It you havo arty cartrrb~ts about Rasp osMnates or any aspocts of Qds data coAectlon, conbcY US DepartTont o(labor. OSHA Office of SiaGatics. Room NJ6d4. 200 Constitution Ave. NW, Wash»oton. OC 20210. Do mf serM tho cortioleled corms to tl~is ofico.
Your establishment name Pavement Coatlnos Co.
SUeet 10240 San Sevaine Way
City JuruDa Vatley State CA ZAP 9 752
Industry desuiptlon (e.g.. Manufacture of motor Wdc trailers) Highway Heavy Consavctlon
Standard IndusUial Classificatlon (SIC). ff known (e.g.. SIC 3715) ~ 6 t ~
OR North American Industrial CIa55~Catlon (NAILS}, if known (e.g.. 336212} 2 3 7 3 1 0
Employment information
Annual average number of employees 69
Total hours woAced by all employees last
year 134.274
Sign here ~•---
Knowingly falsHyl~g this docum t may result in a floe.
certify that I have examined this document and that to the best of my knowledge the enUies are We, accurate. and complete.
Scott Fraser Satety and Quality Director
Company executive Title
951 92-1091 f ~~~~L~
Phone Date
OSHA's Form 300A (Rev.01l2004)
Summary of Work-Related Injuries and Illnesses
Af! estabGshmenfs cove3ied by Par 7904 must complete this Summary page, even ~I rro ~n~unes or ;Jlnesses ocicurmd dunng the year Remember to rev~ev: the Log to vertly that the enrnes art3 compiefe Us+ng me Loq, count the ~nd~wdual onmes you made loreach caeegwy Then wnte N~o tWals below, making surt~ youtie added tho entnes Irom every page o7 the log. !J you had no cases wnre '0 " employees /ormor employees, and fhe~r rep~esentat~ves have the nght to rewow fhe OSHA Form 300 m ds entrrey. They also have !orated access fo the OSHA Form 301 or its equivalent See 29 CFR 1904.35, m OSHA's Recordkeepi~ note. !a lurthe~ derails on the access prov,sions for ri~ese /ems.
Numaer of Cases
Total number of Total number of Total number of cases Total number of deaths cases with days with job transfer or other recordable away from work restnct~on cases
0 1 1 0
(G) (H) (Ij (J)
Number of Days
Total number of Total number of days of
days away from fob transfer or restriction
work
6 57
(K) (L)
Injury and Illness Types
Total number of...
jM)
(1) Injury 2 (4) Poisornng 0
(2) Skin Disorder 0 (5) Hearing Loss 0
(3) Respiratory
Condition p (6) All Other Illnesses 0
Post this Summary page from February 1 to April 30 of the year following the year covered by the form ?ublic repaung buroen fa Crs col~oction of intomia4on is es~mated ~o a+erago 58 mirwtes per response, inducting lime to ren~iew tie w:strudion. sexcn and ga~hor the data roeded, and comp!cle and rov~ew the cdlec~on of inlamaum. Porsons ere not reQuued to respotb to ilia coNectwn of inlarmalan unloss A 6sptays a cu~renlly valid OMB canuol numDcr. It you hero arty comrt~en~s about these osbmales w eery aspects of this d2la oolleCtiOn. CantxC US Department of Labe. 0.SHA Otfioe of Slalis0a. Room PJ3644. X00 Constitution Ave, NW. Wa~i~pton. DC 20210. Do not sera the comdefed forms to tltis ofGoe.
Year 2023 ~j
U.S. Departrnent of Labor
Occupat~on~i S.Acry end Hc~~t~ ACminntration
=r~m ~;;~o.od GRAB nC 7218~077G
Establishment information
Your establishment name pavement Coatings Co
Street 1240 San Sevame way
City Juruoa Valley State C~ Zip 9?752
Industry tlescnpt~on (e g ,Manufacture of motor truck traders) Highway Heavy Construction
Standara industnal Class~t~cauon (SIC), if known (e.g.. SIC 3715) 7 6 1 1
~R North Amencan Intlustnal Class,ficaUon (NAILS), ~f known (e.g.. 336212) 2 3 7 3 1 0
Employment information
Annual average number of employees 62
Total hours worked by all employees IaSt
year 124,005
Sign here
Knowingly falsifying this document may wsutt in a Tine_ certify that I have exartyned this tloCument and that to the best of my knowledge the enures are true. accurate, antl complete. -'
Cathy Hansel Satety and Quai,ry Director
Company oxecuGve 7RIe
951-903-&277 / ~ / 7. ~
Phone Da e
OSHA's Form 300A (Rev. 01/2004)
Summary of Work-Related Injuries and Illnesses
A!! establishments covered by Para 1904 must complete 1Ms Summary page, even if no injuries a illnesses occurred during the yeas. Remember to review the LoG to verily that the enfnes are complete Using the Log, count the indrvduaJ entries }rou made !or each category. Then write the totals below, making sure you've added the entries from every page of the log. tl yrou had rro cases write "0. " Employees /ormer employees. and !heir representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 a its equivalent. See 29 CFR 1904.35, in OSHA's Recadkeeprng rule, fa further details on the access provisions for these forms.
Number of Cases
Total number of Total number of
deaths cases with days
away from work
0 0
(G) {H)
Number of Days
Total number of
days away from
,.....v
0 (K)
Injury and Illness Types
Total number of cases Total number of
with job transferor other recordable
restriction cases
0 0
(I) (J)
Total number of days of
job transferor restriction
0 (L)
Total number of...
(M)
(1) Injury 0 (4) Poisoning
{2) Skin Disorder 0 (5) Hearing Loss
(3) Respiratory
Condition 0 (6) All Other Illnesses
0 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Year 2022 C~
U.S. Department of Labor
Oeeupeilonal Safety and Health Adminishaoon
Fp:m approvetl OM8 rp. ?2' 8-07 76
(Establishment information
Your establishment name Pavement Coatings Co.
Street 102x0 San Sevaine Way
City Jurupa Vailey Stale CA Zip 91752
Industry description (e.g.. Manufacture of motor truck trailers) Highway Heavy Construction
Standard Industrial Classification {SIC), if known (e.g.. SIC 3715) 1 6 1 1
OR North American Industrial Classification (NAILS). if known (e.g., 336212) 2 3 7 3 1 0
Employment information
Annual average number of employees 65
Total hours worked by all employees Iast
year 114.707
Sign here
Knowingly falsifying this document may result in a fine. ~~ "~
1 certify that I h e xamined this document a hat to the best of my knowledge the entries are true, accurate. and complete.
Cathy Hansel) Satety and duality Director
Company executive Title
951-903-6277 ~ / ~ ~ -~
Phone Dat
Public reporting burden (or This cW~ection of infortnatan is estimated to average 58 minutes per 2sponse, including time l0 2view the instructbn, search and gather the data needed, and complete and review the cdlection of informatan. Persons are not required to respond to the cd~ection of iMortnatioa unless it diSGays a artently valid OM8 control number. Ii you have any tommenls about these estimates or any aspects of this data collection. contact US Department of Labor. OSHA pffice o1 Statistics. Room N•3644. 200 CgnSGlulion Ave. NW. WashiMton. OC 20210. Do not send the canoleted tomes to this office. "-- -~T~'~'s~~:.. . .. -... ---r'vt. ,s. ,. . a ^c~^,+-r>-~~.~^:~.n..r -.~,~+r,~,.~rr-- -,;r. .~^e ..aicr-:,+--.-.--,., r~ -' - - - --....,.t._:s...:......i......e....,__ _~ee'.• _.v....__<._.~.~..~,x...,.,.'.&'y~`<<S-_... ~':ca:~'......'u._... ~...:aza ~'.9eri'$".~ai.'a~,~~
~4/li at n
October 3, 2024
Re: Pavement Coatings Company —Experience Modification History (California) To Whom It May Concern:
Please accept this letter as verification that the workers compensation experience modification for the past three years is as follows:
• Effective: 10/01 /2024 - 0.81
• Effective: 10/01 /2023 - 0.66
• Effective: 10/01 /2022 - 0.73
• Effective: 10/01 /2021 - 0.69
• Effective: 10/01 /2020 - 0.71
If you should have any questions, please do not hesitate to give me a call at 213-402-0225.
Sincerely,
~Gt~i,e,
U
Julie Branstetter
Senior Vice President
Alliant Insurance Services, Inc.
333 S. Hope Street
Suite 3750
Los Angeles, CA 90017
Alliant Insurance Services, Inc.
601 South Figueroa St Ste 4480 Los Angeles, CA, 90017
CA License #OC36861 www.alliant.com
DESIGNATION OF SUBCONTRACTORS
NAME OF BIDDER: Pavement Coatings Co .
Each Bidder must list, on the form provided on the next page, each Subcontractor who will perform work or labor or render service to the Contractor in or about the construction of the Work or improvement, or a Subcontractor licensed in the State of California who, under subcontract to the Contractor, specially fabricates and installs a portion of the Work or improvement according to detailed drawings contained in the Drawings and Specifications, in an amount in excess of one-half of one percent of the Contractor's Base Bid Amount. Each Subcontractor must have an active antl current license, and all requisite specialty certifications, when listed.
Bitltler must provide the following information for EACH Subcontractor.
1. The name of the Subcontractor;
2. The trade and type of work that the Subcontractor will perform;
3. Location (address) of Subcontractor's place of business;
4. Subcontractor's license number; and any specialty licenses;
5. Subcontractor's public works contractor registration number; and
6. Dollar value of the Work that the Subcontractor will perform.
Subletting or subcontracting of any portion of the Work in excess of one-half of one percent of the Contractor's Base Bid to which no Subcontractor was designated in the original Bid shall only be permitted in cases of public emergency or necessity, and then only after a finding reduced to writing as a public record of the City setting forth the facts constituting the emergency or necessity.
If the Contractor violates any of the above provisions the Contractor may be in breach of this Contract and the City may exercise the option, in its own discretion, to (1) cancel this Contract, or (2} assess the Contractor a penalty in an amount not more than ten percent (10%) of the amount of the subcontract involved, and this penalty shall be deposited in the fund out of which the prime Contract is awarded.
If the Contractor fails to specify a Subcontractor, or if the Contractor specifies more than one Subcontractor for the same trade or type of Work to be performed under the Contract in excess ofone-half of one percent of the Contractor's Base Bid Amount, then the Contractor agrees that he/she is fully qualified to perform that Work himselflherself, and that helshe shall perform that Work himselflherself. If after award of Contract, the Contractor subcontracts any such Work, the Contractor will be subject to the statutory penalties,
DESIGNATION OF SUBCONTRACTORS FORM
IS ON THE FOLLOWING PAGE
Please type or legibly print (attach additional sheets as necessary).
Name of Subcontractor Email Contact
Information
Trade and Type
of Work to be
Performed
Business Location
~~J 5-~~C~~i~'1~GC. ,
Z. ~~, .
~Q:c~.~En~
S ~~G . b`, ~
Stc:~«~
Zn~~-- .11c~~~en
O~ca.~`:.D G.~
i~e~~~o
Cof1~Cc~C~oc's ,~,nG
lu~~-l~~,c~
t~nc.,:,l .CoM
~~-~~,c,
Loo~S
S~a~ch ~
~ ~,q
License
Number
Public Works
Contractor
Registration
Number
Dollar ($) Value
53g2~1 IOO~DO~atZ ~ IOCt~"~~
loq~$s~ 100~9~515? ~Zq, ~6g
The Contractor shall not:
A. Substitute any person as Subcontractor in place of the Subcontractor listed in the original Bid, except that the City may consent to the substitution of another person as Subcontractor in any of the following situations:
1. When the Subcontractor listed in the Bid, after having had a reasonable opportunity to do so, fails or refuses to execute a written contract for the scope of Work specified in the Subcontractor's bid and at the price specified in the Subcontractor's bid, when that written contract, based upon the general terms, conditions, Drawings antl Specifications for the Project or the terms of Contractor's written Bid, is presented to the Subcontractor by the Contractor;
2. When the listed Subcontractor becomes insolvent or the subject of an order for relief in bankruptcy;
3. When the listed Subcontractor fails or refuses to perform hislher subcontract;
4. When the listed Subcontractor fails or refuses to meet the bond requirements of the Contractor as set forth in Public Contract Code Section 4108;
5. When the Contractor demonstrates to the City that the name of the Subcontractor was listed as the result of an inadvertent clerical error;
6. When the listed Subcontractor is not licensed pursuant to the Contractors License Law;
7. When the City determines that the Work performed by the listed Subcontractor is substantially unsatisfactory and not in substantial accordance with the Drawings and Specifications, or that the Subcontractor is substantially delaying or disrupting the progress of the Work;
8. When the listed Subcontractor is ineligible to work on a public works project pursuant to Section 1777.1 or 1777.7 of the Labor Code; or
9. When the City determines that the listed Subcontractor is not a responsible contractor.
B. Permit any subcontract to be voluntarily assigned or transferred or allow it to be performed by anyone other than the original Subcontractor listed in the original Bid, without the consent of the City.
C. Other than in the performance of "change orders" causing changes or deviations from the original Contract, sublet or subcontract any portion of the Work in excess of one-half of one percent of the Contractor's Base Bid Amount as to which his/her original Bid did not designate a Subcontractor.
Prior to approval of the Contractor's request for a Subcontractor substitution, the Ciry shall give notice in writing to the listed Subcontractor of the Contractor's request to substitute and of the reason for the request. The notice will be served by certified or registered mail to the last known address of the Subcontractor. The listed Subcontractor who has been so notified shall have five (5} Working Days within which to transmit to the City written objections to the substitution. Failure to file these written objections shall constitute the listed Subcontractor's consent to the substitution.
If written objections are filed, the City shall give notice in writing of at least five (5) Working Days to the listed Subcontractor of a hearing by the City on the Contractor's request for substitution.
The Contractor, as a condition to asserting a claim of inadvertent clerical error in the listing of a Subcontractor, shall within two (2) Working Days after the time of the Bid Deadline, give written notice to the City and copies of such notice to both the Subcontractor helshe claims to have listed in error and the intended Subcontractor who had bid to the Contractor prior to the Bid Deadline.
QUESTIONNAIRE REGARDING SUBCONTRACTORS
Bidder shall answer the fallowing questions and submit with hislher Contract proposal.
Were bid depository or registry services used in obtaining subcontractors bid figures in order to compute your bid? Yes ❑ No Q
2. If the answer to No. 1 is "Yes", please forward a copy of the rules of each bid depository you used with this questionnaire.
3. Did you have any source of subcontractors' bids other than bid depositories?
4. Has any person or group threatened you with subcontractor boycotts, union boycotts, or other sanctions to attempt to convince you to use the services or abide by the rules of one or more bid depositories? Yes ❑ No Q
5. If the answer to No. 4 is "Yes", please explain the following details:
(a) Date:
(b) Name of person or group:
(c) Job involved (if applicable):
(d) Nature of the threats:
(e) Additional comments:
(Use additional paper if necessary)
6. Was a conscious effort made to recruit or provide equal opportunity for bids by minority or project area subcontractors? Yes Q No ❑
7. Was a conscious effort made to recruit and hire project area lower-income residents? Yes ❑ No Q
Please submit statement.
8. We declare under penalty of perjury that the foregoing is true and correct.
Dated this 3 day of March , 20 2 5 .
All of the above statements as to experience, financial qualifications, and available plant and equipment are submitted in conjunction with the proposal, as a part thereof, and the truthfulness and accuracy of the information is guaranteed by tFa bidJer.
Na any avement~oatings Co.
Wu - Vice President
SPECIALTY CONTRACTOR OR SUBCONTRACTOR STATEMENT OF QUALIFICATIONS Street Striping and Traffic Markings
As part of its Bid, Bidder shall submit this Statement of Qualifications for the Subcontractor that will perform the {Insert specialty sub-contractor work}, or for the Bidder itself, if Bidder will self-perform the street striping and traffic marking work. This information shall provide evidence to indicate successful experience in providing street striping and traffic marking work comparable to that specified in the Project Drawings and Specifications. Referenced qualifications shall demonstrate experience as a successful installer of street striping and traffic marking work.
A Bid may be rejected asnon-responsive if Bidder fails to provide this completed form with the Bid or submits this form with inaccurate information.
Mandatory qualifications: Specialty Contractor (or Bidder, ifself-performing) shall possess a valid C-32 Parking and Highway Improvement California Contractors License California Contractors License at the time of the Bid Deadline and at all times during performance of the Work and shall establish that it satisfactorily completed at least three (3) projects as the installer of a minimum of {Insert description of the work to be performed}; each comparable in scope and complexity to this Project, within three (3) years prior to the Bid Deadline.
Specialty Contractor Name: ~ & ~ ~~ ~ `~t n~ G C~ ZNG , Project Manager 1 Foreman: (~~~~~ ~~G~~'n
Phone No: ~ ~G . q~7 . g073
COMPARABLE PROJECTS
1. Project Name: C
E-mail: ~~~~1~~ ~/~cS~C, 3~Z
e three (3) projects)
Address. ~O~ CE~~.~~ t1 ~ 0.1 ~C~~/`. ~ t~5-~ ~ ,(1 ~~ 9 ~ ~ F~ C7 Date Completed: ~~ ~ o•~ ~
Reference /Contact Name: ~' ~
Reference /Contact Phone No: ~~ ~ • ~ 73 • ~ ~ ~
Description of work performed: 5~~~ ~7 i Yl~, — ~o.~` ~'C ~~~ S
2. Project Name: G ~'-~ y o-~ Cl~:~d ~ ~~nnUc,. ~ ~e~b s ; Q~ ~~~ Address: ~D~c7 ~~C~' ~ChO~~P~(~ ~~/E~ . ~~~ ►~1p C~ Q ~ 7 ~ Date Completed: ~ ~— C`l~ t ~°1
Reference /Contact Name: ~oP~ ~~f0.~C~
Reference /Contact Phone No: Q ~~ - 2 ~ ~ . j S~-{
Description of work performed: S~ ~ ~ 1~~ ~~ " ~Qr~ ''n`1 S ~ ~ ~~ ~ S ~ ~~vG~S r LG~~~V~~ ~ oC [~c~d'EC~~I~~ LD'~s
3. Project Name: ~ ~~~ Of- T~cbo, ~~~'~C~ / ~~5~~~~'i
Address: `i g y~ Co sh Lornc,~ AVM • YO t'b('~. L ~~lda ~ CA ~2 ~ ~ (p Date Completed: ~n ~~~~°~
Reference /Contact Name: '~`~'~'~'~~C~ ~L Q~'M~ °
Reference /Contact Phone No: ~ ~ y ~ g ~ y ' ~(~ $ ~
Description of work performed: S'~'~~~~+~~i ~ MG`~~~1/l~$ ~ ~(~~S ~ L~yo~~,.
Project Name: ~ ~~v ~ ~ 3~~~W~'~l Ca~~ ~~~~~~~ ~'
Address: ~ y~103 ~o.C~'~~~ ~~1~ ~G~~W~t1 ~G~~ C~ q~7~(o Date Completed: Z ' ~ ~ Z o2 S
Reference !Contact Name: ~~~~o~1~F
Reference /Contact Phone No: ~ ~~ • ~~~~ ~ ~0~
Description of work performed: 5~~1~"~~1 r ~~'~-CK`~.Q1~ ~ Ql ~~~5
CONTRACTOR'S AFFIDAVIT OF NON-COLLUSION
STATE OF CALIFORNIA
ss
COUNTY OF Qi~FRStpE )
James Wu being first duly sworn, deposes and says:
That helshe is the vice President (Title of office if a corporation, "sole owner," "Partner," orotherpropertitle)of Pavement Coatings Co. , (hereinaftercalled"Contractor") who has submitted to the City of Vernon a Bid for the construction of the Citywide Chip Seal Project;
2. That said Bid is genuine; that the same is not sham; that all statements of fact therein are true;
3. That said Bid is not made in the interest or behalf of any person, partnership, company, association, organization, or corporation not named or disclosed;
4. That Contractor did not, directly or indirectly induce, solicit, agree, collude, conspire or contrive with anyone else to submit a false or sham bid, to refrain from bidding, or withdraw hislher bitl, to raise or fix the Bid price of Contractor or of anyone else, or to raise or fix any overhead profit, or cost element of Contractor's price or the price of anyone else; and did not attempt to induce action prejudicial to the interests of the City of Vernon, or of any other Bidder, or anyone else interested in the proposed Contract;
5. That the Contractor has not in any manner sought by collusion to secure for himself an advantage over any other Bidders or induce action prejudicial to the interests of the City of Vernon or of any other Bidder, or anyone else interested in the proposed Contract;
6. That the Contractor has not accepted any bid from any Subcontractor or material supplier through any bid depository, the bylaws, rules or regulations of which prohibit or prevent the Contractor from considering any bid from any Subcontractor or material supplier, which is not processed through said bid depository, or which prevent any Subcontractor or material supplier from bidding to any Contractor who does not use the facilities of or accept bids from or through such bid depository;
7. That the Contractor did not, directly or indirectly, submit the Contractor's Bid price or any breakdown thereof, or the contents thereof, or divulge information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, or to any individual or group of individuals, except to the City of Vernon, or to any person or persons who have partnership or other financial interest with said Contractor in hislher business. declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Dated this2~" day of f' at Jurupa Valley ,California
Mont !Year City State
Pavement Coatings Co.
~ • • ~ •t ;•
.mot v c. ~ s~ .c~c.c~ .a~..c~c.c~e.c~<.~ .c~e.s~e~..c,. .c~ r .~crc~ .rc.~ .~~c.c..c~ .~c.c~ .c~c!:~N.c~ .cam .~e!~C .c~<.~ .cam. ~ ...~t.c~e.c~ .v~ .a .a .~..c~e.~~ .c~c.
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Riverside )
On February 27th, 2025 before me, Trisha Vander Sluis, Notary Public Date Here Insert Name and Title of the Officer
personally appeared ___ James Wu
Name() of Signer()
who proved to me on the basis of satisfactory evidence to be the person() whose name() is/~'re subscribed to the within instrument and acknowledged to me that he/she/t~'ey executed the same in his/her/their authorized capacity(i~s), and that by his/her/their signature() on the instrument the person(), or the entity upon behalf of which the person() acted, executed the instrument. certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph ~~..r~ is true and correct.
F,~,~OF TN TRISHA VANDER SLUIS ~ WITNESS my hand and official seal. ~~ ~~~~~~ ~`~ s Notary Public -California Z
a;
;~,~. Ri~~e~side Ccunty
Z y °~ Commission # 2390925 ~ ~ .
~a1~~~4"`' My Comm. Expires Jan 16, 2026 Signature ~ ~~~ ~ _ -~ "~~'~~ Signature of Notary Public
Place Notary Sea! Above
OPTIONAL
Ti~ougf~ this section is optional, completing this information can deter altera fraudulent reattachment of this form to an unintended
Description of Attached Document
Title or Type of Document: _____~.
Number of Pages: _ Signer(s) Other Th
Capacity(ies) Claimed by Signers)
Signer's Name:
U Corporate Officer — Title(s): _
[~ Partner — Limited '__~ General
❑ Individual [:~ orney in Fact
❑ Trustee ._~ Guardian or Conservator
Other:
Signer Is Representing: __
nt.
Document Date; ,___
amed Above:
tine document or
Signer's Name:
Corporate Officer — Title(s): _ ____ ___._____
Partner — ~-1 Limited :=J General
~:~ Individual C~ Attorney in Fact
CJ Trustee C7 Guardian or Conservator
r' Other:
Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org ~ 1-800-US NOTARY (1-800-876-6827} Item #5907
THE BIDDER'S INSURANCE COMPANY(S) OR INSURANCE AGENT MUST COMPLETE THIS FORM AND
THE BIDDER MUST SUBMIT THIS CERTIFICATION WITH THE BID FORMS.
I, the undersigned (Please check one box) ~ underwriter x agent, certify that I and the Contractor listed below have jointly reviewed the "Insurance Requirements" in these Bidding Documents and the Contract Documents. If the City of Vernon ("City") awards the Contractor the Contract for this project, I will be able—within fourteen (14) calendar days after the Contractor is notified of the Contract's award—to furnish the City with valid insurance forms (including one or more insurance certificates and additional insured endorsements) that fully meet all of the Insurance Requirements.
Travelers
Name of Insurance Company
Yvonne Galvan
Insurance Agent's Name (Printed)
(signature) ~o-n,ne, ~a.etca.n,
2/27/2025
Date
Alliant Insurance Services, Inc.
Insurance Agent's Name
333 S. Hope St, Ste 3750 Los Angeles, CA 90071
Address City State Zip Code
213-402-0220
Telephone Number
[email protected]
Email Address
Pavement Coatings Co. N/A-Citywide Chip Seal Project
Contractor's Name City Specification Number
Below State the Name of Insurance Company Providing Coverage; DO NOT write "Will Provide," "To Be Determined," "When Required," or similar phrases.
Travelers Property Casualty Co. of America Travelers Property Casualty Co. of America Commercial General Liability Automobile Liability
Travelers Property Casualty Co. of America
Workers' Compensation Liability
City Will Purchase Policy, if required St. Paul Surplus Lines Ins. Co.
Builders Risk Pollution Liability
[NOTE TO CONTRACTOR: See "Insurance Requirements" EXHIBIT 4 of the Contract forthe requirement of obtaining Pollution Liability Insurance.]
NOTE TO THE UNDERWRITER /AGENT: If the insurance forms that the Contractor submits to the City do not fully comply with the Insurance Requirements, and/or if the Contractor fails to submit the forms within the 14-day time limit, the City may: (1) declare the Contractor's Bid non-responsive, and (2) award the Contract to the next lowest responsible Bidder.
CERTIFICATE OF EQUAL OPPORTUNITY PRACTICES
City of Vernon
4305 Santa Fe Avenue
Vernon, CA 90058
(323) 583-8811
Website: www,cityofvernon.org
Article I. Affidavit of Equal Opportunity Employment &
Non-segregation (Form AA-1)
Article II. Vendor List Questionnaire (Forms AA-2 & 3)
In order to be placed to the City's vendor list and be eligible to receive City business, you must provide the following information except where indicated as "optional." By submitting this form you are declaring under penalty of perjury under the laws of the State of California and the laws of the United States that the information is true and correct. Furthermore, you are certifying that your firm will adhere to equal opportunity employment practices to assure that applicants and employees are not discriminated against because of their race, religion, color, national origin, ancestry, disability, sex or age. And, your firm does not and will not maintain or provide for its employees any segregated facilities at any of its establishments, and that it does not and will not permit its employees to perform their services at any location, under its control, where segregated facilities are maintained.
Name of Company: Pavement Coatings Co .
Business Telephone: (714) 8 2 6- 3 011
Address: 10240 San Sevaine Way
City: Jurupa Valley State: CA Zip 91752
Contact Person James wu E-mail Address JWu@pavementrecycling . com (optional)
Tax ID Number (or Social Security Number) 95-2916670
Remit Address (if different)
N/A
Please state clearly and concisely the types) of goods and services your company provides:
Slurry Seal, Chip Seal, REAS, Cape Seal, Scrub Seal
The following section is OPTIONAL and is for statistical reporting purposes only. Ownership (please check all that apply):
African-American Asian Armenian Hispanic Native American Disabled Female
Proiect Workforce Utilization (Form AA-2)
This form is to be included in all bid documents for projects involving labor or services valued at $25,000 or more.
Instructions: Please indicate the job titles/classifications to be used in the performance of this contract should it be awarded to your firm. Please indicate the number of employees in each job classification as well as the number of new hires, if any, as a result of this contract.
Name of Company: Pavement Coatings Co . Project: Citywide Chip Seal Project ]ob Titles/Classification Estimated number of existing staff to be employed in this classification if awarded the contract
Estimated number of new hires to be employed in
this classification if awarded the contract
Laborers 9 0
Are any current employees or potential
new hires Vernon residents? If so, how
many?
NO ~
Current Permanent Workforce Utilization (Form AA-3)
Name of Company: Pavement Coatings Co .
Project: Citywide Chip Seal Project
Completion of this form is OPTIONAL. Any information supplied by vendors is for reporting purposes only and will not be factored into the award of any contract.
Instructions: Please indicate the number of employees in each Job Classification belonging to the following groups.
White
(not of Hispanic
origin)
African-American
(not of Hispanic
origin)
Hispanic Asian/Pacific
Islander
Native
American
Armenian Male Female
CLASSIFICATION
Officials/
Managers
Professionals
Technicians
Office/Clerical
Skilled Craft Workers
Operators
(semi-skilled)
Laborers
Service Workers
TOTAL