HomeMy WebLinkAboutProject No. 245-58382 Traffic Operation Upgrade 1-23-2017 10C 4 Y�
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0-FF * This is a preliminary Summary of Bids.
GR City of Pomona Bids shown were announced at the bid
Bid Opening Summary opening. Final results are subject to review
and verification in order to determine the
lowest, responsive, and responsible bidder.
ew
Bid Title: NOTICE INVITING SEALED BIDS S&E)- TRAFFIC OPERATION
COMMUNICATION UPGRADE PROJECT - GAREY AVENUE ,
Project No.: 245-58882
Bid Deadline: Monday, January 28, 2017
Bids opened by: 11:00a.m.
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City Of Pomona 505 south Pomona,CA Pomona,CA 91766
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Upcoming Agenda Items
City Council
Presentation/Procl Present a Certificate of Recognition to Herbert and Cynthia Wilkins
17-176 Status: Agenda Ready Department: City Clerk
Presentation/Procl Receive a Presentation from Ciclavia and SGVCOG Regarding Planning
Efforts Associated with an Upcoming Open Streets Event to be Held in
Pomona and Three Surrounding Communities on April 2018
17-191 Status: Draft Department: Public Works
Presentation/Procl Approve and present a Proclamation of the City Council of the City of
Pomona proclaiming the week of February 17, 2017 - March 3, 2017 as
""Pomona Kindness project Week" in the City of Pomona
17-252 Status: Agenda Ready Department: City Clerk
Consent Calendar Appeal of Planning Commission Action on January 11, 2017 for CUP
5063-2016, 2085 S. Towne Avenue
17-186 Status: Draft Department: Development Services
Consent Calendar Adopt a Resolution to Enhance Pedestrian, Bicycle, and Vehicular Traffic
Flow along Garey Avenue between Mission Boulevard and County Road by
Amending the FY 201.6-17 Capital Improvement Program (CIP) Budget by
;.. A a Viable
Re-appropriating
$30,000 o�Proop C Funds and Appropriating $275,576 of
�� � p , and TDA Article 3 Funds to l ;lpo
Operations - Communication Upgrade," Project No. 245-25301-xxxxx-58382,
and Aviia:rding, a Construction Contract in W6 Amount of $853,670 to Elecnor
W
Belco Electric, Inc. for Funded Project
17-040 Status: Agenda Ready Department: Public Works
Consent Calendar Annual Audit Reports, Fiscal Year Ended June 30, 2016
17-115 Status: Draft Department: Finance
Consent Calendar Adopt the Electronic Reader Board Messaging Policy (Plaza Park)
Page 1 Printed on 2116/2017
Thumday, Janua!y ig, 2017
Consent Calendar Adoption of a Resolution Approving a Small: Cell License Agreement with
Los Angeles SMSA Limited Partnership, dba Verizon Wireless, for
Construction, Operation and Maintenance of its Telecommunications
Network in the City Right-of-Way on Eight City Streetlight Poles
117-039 Status: Draft Department: Public Works
Consent Calendar Award of Contract to XX for Traffic Operations - Communication Upgrade,
Project No. 245-58382
17-040 Status: Draft Department: Public Works
N, Dab;
'Consent Calendar Award an agreement for residential recyclables processing, transportation
and residual disposal
16-285 Status: Draft Department: Public Works
Discussion Art in Public Places Policy and Guidelines Manual (AIPP Manual) Adopt a
Resolution amending
16-270 Status: Draft Department: Development Services
Discussion Rental Housing Inspection Ordinance
16276 Status: Draft Department: Development Services
Public Hearing Conduct a Public Hearing to introduce, at first reading, an Ordinance
adopting Code Amendment (Code 4326-2016) for the establishment of land
use permits for newly established waste and recycling facilities in the "M-2"
zones and confer a deemed approved status citywide for all existing
permitted, conditionally permitted and legal non-conforming waste and
recycling businesses, provide standards for the continued operation of
waste and recycling facilities, and set grounds for the modification,
revocation and termination of Conditional Use Permits and deemed
approved status
16-265 Status: Draft Department: Development Services
Public Hearing Conduct a Public Hearing to introduce, at first reading, an Ordinance for
SB2
16-283 Status: Draft Department: Development Services
Public Hearing Landscape - Model Water Efficient Landscape Ordinance (MWELO) new
residential, commercial, industrial and institutional development projects
that include landscape areas of 500 sq. ft. or more
16-358 Status: Draft Department: Development Services
Page 7 Printed on 111912017
PROPOSAL FORM
FIRM NAME
ADDRESS
c�t Q�j- c-1q,,,
,� .. ,Gil
TELEPHONE
FAX NUMBER 5
FOR
TRAFFIC OPERATION COMMUNICATION UPGRADE PROJECT
GAREY AVENUE
Project No, 245-2590-XXXXX-58382
FOR
CITY OF POMONA
POMONA,CALIFORNIA
(One copy shall be filled in and submitted as the
bid; the other shall be the bidder's file copy.)
C-1
BIDDERS PROPOSAL
FOR
TRAFFIC OPERATION COMMUNICATION UPGRADE PROJECT —
GAREY AVENUE
PROJECT NO. 245-2590-XXXXX-58382
In compliance with the annexed "Notice Inviting Scaled Bids", the undersigned hereby proposes and
agrees to perform all the work and improvements therein described, and to furnish all labor and
materials, equipment and incident insurance necessary therefore in accordance with the specifications
therefore, known as"Traffic Operation Communication Upgrade Project—Garey, Project No. 245-
2590-XXXXX-58382" which are on file in the office of the City Engineer of the City of Pomona. The
undersigned agrees to perform the work and improvements therein mentioned to the satisfaction of and
under the supervision of the City Engineer of the City of Pomona, duly appointed for said work in the
matter of the construction and installation of"Traffic Operation Communication Upgrade Project —
Garey Avenue, Project No. 245-2590-XXXXX-58382", as designated on the specifications known as
"Traffic Operation Communication Upgrade Project — Garey Avenue, Project No. 245-2590-
XXXXX-58382"", on file in the office of the City Engineer of the City of Pomona, and further agrees to
enter into a contract therefore in the time, form and manner provided by law at the following prices.
Each line item bid shall contain all costs and expenses for the work described in the Technical
Provisions of the Contract Documents.
"Traffic Operation Communication Upgrade Project—Garcy Avenue,Project No. 245-2590-
XXXXX-58382"
ITEM DESCRIPTION QUANTITY UNIT TOTAL
PRICE PRICE
I MOBILIZATION 1 LS $(;.-,00a ISI 000
2 TRAFFIC CONTROL 1 LS Ilie 00 a $ 1 LJ1000
LABOR AND EXPENSES FOR DELIVERY ANDINSTALLATION
OF ALL ITEMS LISTED BELOW.FURNISH AND INSTALL
3 EQUIPMENT AND APPURTENANCES TO ACHIEVE THE 1 LS
DESIRED OPERATIONS FOR THE TRAFFIC OPERATION
COMMUNICATION UPGRADE PROJECT-GAREY AVENUE, 10" oo a o 0 a
COMPLETE AND READY FOR USE
4 VIDEO DETECTION SYSTEM 10 EA $z,000 $ :?Ao 00 0
i.............—
5 2"PVC CONDUIT 20 LF
6 3"PVC CONDUIT 515 LF
1-
7 4"PVC CONDUIT 1105 LF 3.
$ %1 $
a COUNTDOWN PEDESTRIAN HEAD AND MOUNTING 78 EA $ w7s $ 0
9 RE-WIRE INTERSECTION 8 EA 9JU a0a
.z .........
10 VDSL ETHERNET SWTICH(RS930L)WITH 107E ETHERNET 9 EA
CARD $ 31 stio $ 71IS-60
C-2
"Traffic Operation Communication Upgrade Project—Garey Avenue,Project No. 245-2590-
XXXXX-5838293
ITEM [DESCRIPTION QUANTITY UNIT TOTAL
PRICE PRICE
VDSL ETHERNET SWTICH(RS900L;)WITH 107E ETHERNET
1I CARD 1 EA 1,
12 PULL BOX#6 2 EA
13 PULL BOX#6 WITH EXTENSION 9 EA
14 REMOVE EXISTING VIDEO DETECTION SYSTEM 1 EA $ ti $ 11000
15 REMOVE EXISTING PEDESTRIAN HEADS COMPLETE 78 EA $ $ /
91*0
16 REMOVE DETECTOR LEAD-IN CABLES 9 EA
17 REMOVE EXISTING PULL BOX 32 EA
TOTAL BID AMOUNT: S I
TOTAL BID AMOUNTIN 'WORDS:
l
Each alternate bid item shall contain all costs and expenses for the work described in the
Technical Provisions of the Contract Documents.
"Traffic Operation Communication Upgrade Project—Garey Avenue,Project No. 245-2590-
XXXXX-58382"
ITEM (DESCRIPTION(ALTERNATE BID TIEMS) QUANTITY UNIT TOTAL
PRICE PRICE
LABOR AND EXPENSES FOR DELIVERY AND
INSTALLATIONOF ALL ITEMS LISTED BELOW,FURNISH
AND INSTALL EQUIPMENT AND APPURTENANCES TO
1 A ACHIEVE THE DESIRED OPERATIONS FOR THE TRAFFIC 1 LS $ $
OPERATION COMMUNICATION UPGRADE PROJECT--
GAREY AVENUE,COMPLETE AND READY FOR USE W DOdog
2A 73W LED BULB ON EXISTING LUMINAIRE 34 EA 1/000 000
TYPE,332L CABINET AND FOUNDATION WITH 2070 ATC
3A CONTROLLER AND OMNI EX SOFTWARE INCLUDING 5 EA
BATTERY BACKUP SYSTEM IN SIDE-MOUNTED CABINET. $ ' ,� 0 0a
PERFORM FIBER OPTIC CABLE TESTING AND POSSIBLE
4A REPAIR BETWEEN TMC,GAREYIMISSION TRAFFIC SIGNAL, 1 EA
AND OLD TMC $ �/ $ l Ido''6
5A TYPE 111-CF SERVICE ENCLOSURE ON NEW FOUNDATION 1 EA $ It
* $ 1000
^ 00
6A TYPE 15 WITH 73W LED LUMINAIRE ANDFOUNDATION 2 EA $ 1 061 $ r 0
REMOVE EXISTING MARBELITE LUMINAIRE AND
7A FOUNDATION COMPLETE 2 EA $ N s 19/00,0
8A REMOVE EXISTING TYPE 336 CABINET AND FOUNDATION 5 EA $ 11500 $ -7 0
C-3
"Traffic Operation Communication Upgrade Project—Garey Avenue,Project No. 245-2590-
XXXXX-58382"
ITEM DESCRIPTION (ALTERNATE BID TIEMS) QUANTITY UNIT TOTAL
PRICE PRICE
9A REMOVE EXISTING CONTROLLER 5 EA s 1400 s ri
TOTAL ALTERNATE BID AMOUNT:
TOTAL ALTERNATE BID AMOUNT IN WORDS:
TV'Q 14VrV!92 -re�j -Ct'V U SPfw-J2 e �i Ile t4vNo,ajw D 4 UA-A� ZCA-0 CL41
"Traffic Operation Communication Upgrade Project—Garey Avenue, Project No. 245-259'0-
XXXXX-58382"
ITEM DESCRIPTION (ADDITIONAL UPGRADE QUANTITY UNIT TOTAL
RECOMMENDATIONS) PRICE PRICE
LABOR AND EXPENSES FOR DELIVERY ANDINSTALLATION
OF ALL ITEMS LISTED BELOW.FURNISH AND INSTALL
I R EQUIPMENT AND APPURTENANCES TO ACHIEVE THE, 1 LS
DESIRED OPERATIONS FOR THE TRAFFIC OPERATION $ s
COMMUNICATION UPGRADE PROJECT-GAREY AVENUE,
COMPLETE AND READY FOR USE U/0 6(; 1: (J/ d alo
2R PULL BOX LID WITH CORRECT LABEL 6 EA '300 1'e too
3R 12"VEHICLE HEAD ON EXISTING POLE 28 EA IZ 001 M/1 0"
4R ADA PEDESTRIAN PUSH BUTTON 20 EA Sao (0, 00f)
5R REMOVE/REPLACE EXISTING I BROKEN MISLABELED 6 EA *300 s 11600
PULL BOX LID
6R REMOVE EXISTING 8"VEHICLE HEAD 28 EA
7R REMOVE EXISTING PEDESTRIAN PUSH BUTTON 20 EA
TOTAL ADDITIONAL UPGRADE RECOMMENDATIONS AMOUNT: 551
....................
TOTAL ADDITIONAL UPGRADE RECOMMENDATIONS AMOUNT IN WORDS:
Cl El� I olM CAOXr�
C-4
PROPOSAL BID SECURITY
BIDDER'S GUARANTY: Pd ih 's bond, certified check or Cashier's Check No.
N bidder's er
of the X)2 Bank, for ...payable to
the City Clerk of the City of Pomona, California, which is not less than ten percent (10%) of this bid,
and which is given as a guarantee that the undersigned will enter into the contract, if awarded to the
undersigned. The undersigned further agrees that in case of default in executing the required contract
with the necessary bonds and submittals, within the time limits specified, said bond or check and the
money payable therein shall be forfeited to and become the property of the City of Pomona, California.
The Council of the City of Pomona reserves the right to reject any and all bids.
The undersigned further agrees, in case of award, to execute the contract and provide all submittals
required for the within described work and improvements, within fifteen (15) calendar days after
written notice of the award of the contract. All work to be done under this contract shall be completed
within thirty (30) consecutive working days, beginning on the date stipulated in the written Notice to
Proceed issued by the City Engineer.
The bid is submitted in response to Notice Inviting Sealed Bids attached hereto, and pursuant to all of
the proceedings of the Council of the City of Pomona heretofore had and taken to date.
The undersigned hereby certifies that he/she has received addenda number(s)
and that this bid includes the cost of all additional work specified thereon.
The names of all persons, firms and corporations interested in the foregoing Proposal as principals are
as follows:
mk
The undersigned shall satisfy the Council of the City of Pomona of their ability, experience,
qualifications, and resources to perform the contract for the proposed work and improvements in
accordance with the requirements of the Contract Documents.
Dated UZ:-:�
Signature o ' der
C-5
DESIGNATION OF SUBCONTRACTORS
In compliance with the Subletting and Subcontracting Fair Practices Act of the Public Contract Code of the State
of California, each bidder shall provide: (a)the name and the location of the place of business and(b)the work to
be performed by each subcontractor who will perforin work or labor or render service to the Contractor in or
about the construction of the work in an amount in excess of one-half of one percent (1/2%) of the Contractor's
Total Bid Price, Notwithstanding the foregoing, if the work involves streets and highways, then the Contractor
shall list each subcontractor who will perform work or labor or render service to Contractor in or about the work
in an amount in excess of one-half of one percent (1/2%) of the Contractor's Total Bid Price or $10,000,
whichever is greater. No additional time shall be granted to provide the below requested information.
If no subcontractor is specified, for a portion of the work, or if more than one subcontractor is specified for the
same portion of Work, to be performed under the Contract in excess of one-half of one percent (1/2%) of the
Contractor's Total Bid Price or $,10,000, whichever is greater if the work involves streets or highways, then the
Contractor shall be deemed to have agreed that it is fully qualified to perform that Work, and that it shall perform
that portion itself.
Work To Be Subcontractor Location of Business %of the Work
Performed:
The total percentage of the work performed by all subcontractors shall not exceed fifty percent (50%) of
the total bid amount.
Name of Bidder
Signature
Name and Title
Date
C-6
BID BOND
KNOW ALL MEN BY THESE PRESENTS, THAT WE Fleenor Belco Electric,Inc. as
PRINCIPAL. and Fidelity and Deposit Company of Maryland as SURETY, are held and firmly bound unto the
CITY OF POMONA, CALIFORNIA, hereinafter referred to as the "City", in the Sum Of tell percent
(10%) of the total amount of the bid of the Principal above named, submitted by said Principal to said
City, for the work described below, for payment of which sum in lawful money of the United States of
America, well and truly to be made, we bind Ourselves, our heirs, executors, administrators and
successors,jointly and severally, firmly by these presents.
In no case shall the liability Of the Surety hereunder exceed the surn of $
. Ten Percent of the Amount Bid (10%)
THE CONDITIONS OF THIS OBLIGATION ARE SUCH, that whereas, said Principal has
submitted the same mentioned bid to said City, for construction of work under the City's specification
entitled "Traffic Operation Communication Upgrade Project, Project No. 245-2590-XXXXX-
58382", for which bids are to be opened in the City Engineer's office, City Hall of said City at 11:00
AM on January 23,2017 .
NOW, THEREFORE, if said Principal is awarded the contract, and within the time and manner
required under the heading "Instructions to Bidders", after the prescribed forms are presented to him
for signature, enters into a written contract, in the form of agreement bound herein, in accordance with
the bid, submits and obtains City approval of required submittals, and files the two (2) bonds with said
City, one to guarantee faithful performance and the other to guarantee payment for labor and materials,
then this obligation shall be null and void; otherwise, it shall be and remain in fall force and effect.
In the event Suit is brought upon this bond by the Obligee and judgment is recovered, said Surety shall
pay all costs incurred by the Obligee in such suit, including a reasonable attorney's fee to be fixed by the
Court.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this 23rd day Of January
,2017.
Elccnor Belco Electric, Inc. Fidelity and Deposit Company of America
Principal Surety
Kelly Nicole Bru n�
13 0� v t t�e c vi 99C jn,�ttorney-ln-Fact
(SEAI1)
D-I
ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate
is attached, and not the truthfulness, accuracy„ or validity of that document.
State of }
County of —
Cin before me,
(Here msen narrk and Cade of the o er)
personally appeared
who proved to me on the basis of satisfaefory evidence to be the person(s) whose
name(s) )are subscribed to the within instrument and acknowledged to me that
e he/they executed the same in rs erltheir authorized capacity(ies), and that by
Is erltheir signature(s) on the instrument the persons), or the entity upon behalf of
which the person(&) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
t LIVIA
WITNE Yhand"° nd official seal. Commission N#o.2107474
r y NOTARY PWLd(,`•r-Cllk.IFORNIA 2
SAN BERMC Y
Nlo ubli ,nature (Notary Public,Seal)
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLEA'ING-I'I IIS FORM
This form complies with current California statutes regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT ifneeded,should he completed and attached to the document.4cknotwedgentsfrom
other states may completed for documents being sent to that state so long as the
si ording does not require the California notary to violate California notary law.
(Title or description of attached document) • State and County information must be the State and County where the document
signers)personally appeared before the notary public for acknowledgment.
°°°°°---- • Bate of notarization must be the date that the signer(s)personally appeared which
(Title or description of attached document continued) must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
Number qt PagesDQCUment Date commission followed by a comma and then your title(notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e
he/sheAhey-is lafe)or circling the correct forms.Failure to correctly indicate this
® ndivldual(S) information may lead to rejection of document recording.
IV Corp ora C) lGe • The notary seat impression must be clear and photographically reproducible.
Impression must not cower text or lines. If seal impression smudges,re-seal if a
(Title) sufficient area permits,otherwise complete a different acknowledgment form.
[I Partner(s) • Signature of the notary public must match the signature on file with the office of
the county clerk.
❑ Attorney-In-Fact ti Additional information is not required but could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached to a different document,
Other 4 Indicate title or type of attached document,number of pages and date.
*.• Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer,indicate the title(i e.CEO,CFC),Secretary).
yiir+ rd k�:'ir 1 i,'r tri 311 3�;F, • Securely attach this document to the signed document with a staple_
BIDDERS BOND
ACKNOWLEDGMENT OF SURETY
STATE OF Minnesota
COUNTY OF Hennepin —)SS.
On this gird day of January _,20 17 ,A.D-Kelly Nicole BRIq enxan personally
appeared before me, a
(Notary Public, Judge or Other Officer)
in and for Hennepin County, State of Minnesota known to me to
be the Attorney-In-Fact of the corporation that executed the foregoing
instrument and, upon oath, did depose that he is the officer of said corporation as above designated; that
he is acquainted with the seal of said corporation and the seal affixed to said instrument is the corporate
seal of said corporation; that the signatures to said instrument were made by officers of said corporation
as indicated after said signatures; and that the said corporation executed the said instrument freely and
voluntarily and for the uses and purposes therein mentioned.
(Notary Public, Judge or Other Officer)
MEGAN NICOLE MONETTE
NOTARY PUBLICr-MINNESOTA Megan Nico Monette,Notary Public
my commission Expires
January 31,2021
D-2
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL.AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (heroin collectively called the "Companies"), by
GERALD F.HALEY,Vice President,in pursuance of authority granted by Article V, Section 8,of the By-Laws of said Companies,which
are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate,
constitute, and appoint Robin RUTLIN, Suzanne M. BRENNER, Kelly Nicole BRUGGEMAN, Blake S. BOHLIG, Logan Charles
LEHRKAMP, Tasha N. WILLIAMS, Julie Marie DECKER, Megan Nicole MONETTE and Michelle Anne MCMAHON, all of
Minneapolis,Minnesota, EACH its true and lawful agent and Attorney-in-Fact,to make,eXeCLI(O—Wal and deliver, for,and on its hehalfas
surety,and as its act and deed: any and all bonds and undertakings,and the eXCCLlti0n Ol'SUCh bonds or undertakings in Pursuance of these
presents, shall he as binding upon said Companies, as fully and amply, to all intents and Purposes, as if they had been duly CACCUled and
acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New
York- the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings
Mills,Maryland-and the regularly elected officers of the FIDELITY AND DEPOSrr COMPANY OF MARYLAND art its office in Owings
Mills, Maryland-in their own Proper persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy ol'Article V, Section It, of
file By-Laws of said.Companies,and is now in force.
IN WITNESS WHEREOF, (lie said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this Lith day of August,A.D. 2010.
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDE,LITY AND DEP()SIT COMPANY OF MARYLAND
110 PEPO"
Q,
aft
SEAL
0
96 . aip �
....Sec re Vice President
Michael i1,,'cKibbcji Gerald F. Halo
State of Maryland
County ol"Baltimore
Oil this 8th day of August,A.D.2016.before the subscriber,a Notary Public elf the State of Maryland,duly commissioned and qualified,GERALD F.
HALEY,Vice President,and MICHAEL MCKIBBEN,Secretary, of the Companies,to me personally known to be the indMdUals and officers described
in and who executed the preced4lg instrument.and acknowledged the execution of same ;and being by me duly sworn,deposeth and sailh,that he/she is the
said officer of the Company aforesaid, and that the seals affixed to the preceding, instrument are the Corporate Seals of said Companies. zinc] that the said
Corporate Seals and the sig,nature y
as such officer were (July affixed anti subscribed to the said instrument b the authority and direction ofthe said
Corporations.
IN TESTIMONY WHEREOF,I have hereunto set loy hand and affixed my Official Seal the(lay and year 1-u-st above written.
D
Maria 1).Adarnski,Notary Public
My Commission Expires:July 8,2019
POA-F 184-8370L
INFORMATION REQUIRED OF BIDDERS
CONTRACTOR LICENSE AFFIDAVIT
(To Be Executed By Bidder and Submitted With Bid)
STATE OF
COUNTY OF )SS.
being first duly sworn,deposes
NAMP
and says that he or she is V c v
TITLE
of the party
NAME OF FIRM
making the foregoing bid, is a licensed Contractor, or a duly authorized partner of a Joint Venture which holds a
license as a Partnership, or is a duly authorized principle and/or representative of a Corporation which holds a
license as a Corporation and that he or she understands that the information shown below shall be included with
the bid, and understands that any bid not containing this information, or if this information is subsequently proven
to be false,shall be considered non-responsive and shall be rejected by the City of Pomona.
Contractor's State License Number and Classification
License Expiration Date
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Subscribed at:
'4'm R2�WWtA(ab CCUA
City and County State
on `23 (A"I
Date
NOTARY TO AFFIX
SEAL, AND
CERTIFICATE OF Signature
ACKNOWLEDGMENT
tww �ee State License Number and Classification
Street Address
I o
City State Zip
Telephone Number:
E-I
FIdentity
A notary public or other officer completing this certificate verifies only the
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
County of V10
On before me, (Here insert narrne and tatEe of Ch,n icer)
--AMA OWM
personally appeared
who proved to me on the basis of sat]-sfdctory evidence to be the person(s) whose
name(&)(Nare subscribed to the within instrument and acknowledged to me that
(ERghe/they executed the same in fjigher/their authorized capacity(46), and that by
(itsher/their signature(s) on the instrument the person(s), or the entity upon behalf of
which the person() acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
OLIVIA CHEA
WIT m and Owl . m6a n d pa� official seal. Commission No.2107474 Z 1�
0
NOTARY PUBLIC-CALIFORMA 2
SAN BERNARDINO COUNTY I
MY Comm ERWOS APRI
Notary Public Signature (Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION INSTR(jC VIONS FOR COMPLETING THIS FORM
This form complies with current Califormastatutes regarding notary notawording and,
DESCRIPTION OF THE ATTACHED DOCUMENT if needed,should be completed and attached to the document, 4cknotivedgentsfrom
other states may be completed for documents being sent to that state so long as the
wording does not require the California notary to vtol te C
a alifornia notary law
(Title or description of attached document) State and County information must be the State and County where the document
signer(s)personally appeared before the notary public for acknowledgment
(Title or description of attached document continued) Date of notarization must be the date that the signer(s)personally appeared which
must also be the same date the acknowledgment is completed,
Number of Pages--,Document Date I'he notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title(notary public)
Print the name(s) of document signer(:) who personally appear at the time of
notarization
CAPACITY CLAIMED BY THE SIGNER m Indicate the correct singular or plural forms by crossing off incorrect forms(i e.
El
Individual (s) iwshc/Oiey-,-is/afe)or circling the correct forms Failure to correctly indicate this
t 0 1 r information may lead to rejection of document recording.
po The notary seal impression must be clear andphotographically reproducible
Impression must not cover text or lines. If seal impression smudges, re-seal if a
(Fitle) sufficient areapermits,otherwise complete a different acknowledgment form
1.1 Partner(sSignature of the notary public must match the signature on file with the office of
)
the county clerk,
E Attorney-in-Fact 4 Additional information is
riot required but could help to ensure this
Lj Trustee(s) acknowledgment is not misused or attached to a different document
Other fi Indicate title or type of attached document,number of pages and date,
0 Indicate the capacity claimed by the signer, If the claimed capacity is a
corporate officer,indicate the title(ic CFO,CFO,Secretary)
Securely attach this document to the signed document with a staple
.............
NONCOLLUSION AFFIDAVIT
(To Be Executed By Bidder and Submitted With Bid)
State of C'10i�VfblmcL,
County of""z"CIR VO' )(Ir ss.
be'n 1first duly sworn deposes and says that he or she
Yy'
is of If—"'C C the party making
the foregoing bid; that the bid is not made in the interest of or on behalf of any undisclosed person,
partnership, company, association, organization, or corporation; that the bid is genuine and not collusive
or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a
false or sham bid; has not directly or indirectly colluded, conspired, connived or agreed with any bidder
or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in
any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to
fix the bid price of the bidder or any other bidder, or to fix any overhead, profit or cost element of the
bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the
contract of anyone interested in the proposed contract; that all statements contained in the bid are true;
and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any
breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and
will not pay, any fee to any corporation, partnership, company association, organization, bid depository,
or to any member or agent thereof to effectuate a collusive or sham bid.
Signature of Bidder
Subscribed and sworn to before me this
—day of 20_.
NOTARY TO AFFIX
SEAL AND CERTIFICATE OF
ACKNOWLEDGMENT
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J lug RAT
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
Subscribed and sworn to (or affirmed) before me on this day of ...
20 by At N ft
proved to me on the basis of satisfactory evidence to be the person(s) who appeared
before me.
4',g LI I
„ -
Commission No.2107474
t�¢y" NOTARY PUBLIC-CALIFORNIA
R,`w},
SAN B£RiV�1FZ'IaC4rao COUNTY
Sig re (Seal) My Comm.E.xiresAIPRIL 18.2019
1
OPTIONAL INFORMATION INSTRUCTIONS
The wording of all Jurats completed in California alter January f, 2015 most be in the
form as set forth within this Jurat. There are no exceptions. If a Jurat to be completed
does not follow this form, the notary must correct the verbiage by using a Jurat stamp
containing the correct wording or allaching a separate jurat form such as this one with
does contain the proper wording. In addition, the notary must require an oath or
DESCRIPTION OF THEATTACHED DOCUMENT affirmation from the document signer regarding the truthfulness of the contents of the
document.The document must be signed AFTER the oath or affirmation.if the document
'I" was previously signed,it most be re-signed in front of the notary public during the jurat
(Title or description of attached document) process.
• State and county information must be the state and county where the i
- document signer(s)personally appeared before.the notary public.
(Title or description of attached document continued} . Date of notarization must be the date the signer(s) personally
appeared which must also be the same date the jurat process is
completed.
Number of Pages Document Date . Print the name(s) of the document signer(s)who personally appear at
the time of notarization.
• Signature of the notary public must match the signature on file with the
Additional information office of the county clerk.
. The notary seal impression must be clear and photographically
reproducible. Impression must not cover text or lines.If seal impression
smudges, re-seal if a sufficient area permits, otherwise complete a
different jurat form.
Additional information Is not required but could help
to ensure this jurat is not misused or attached to a
different document.
Indicate title or type of attached document,number of
pages and date.
2045 Version wmv.NotaryClasses.com 800-873-9865 Securely attach this document to the signed document with a staple.
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RESOLUTION OF CONSTRUCTION CLAIMS
(To Be Executed By Bidder and Submitted With Bid)
In all Public Works claims which may arise between the Contractor and the City of Pomona which do
not exceed the sum of three hundred seventy-five thousand dollars ($375,000), the requirements of
California Public Contract Code, Sections 20104 through 20104,8, inclusive, shall apply. Said Code
Sections shall apply for the purpose of filing claims and civil actions for claims as defined in Section
20104 of the Public Contract Code.
The bidder's signature is required to verify he/she has reviewed the Code Sections.
(rignature of Bidder)
Dated
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INFORMATION REQUIRED OF BIDDERS
The bidder is required to supply the following information.
(Additional sheets may be attached if necessary.)
(1) Address: C�
(2) Telephone: 10
(3) Type cuju of Firm:
Individual,PaAnership, or Corporation
(4) Corporation organized under the laws of the State of Ca r r 1.0"
(5) Is 5 1%or more of the business owned by: American Indian Asian Black
Hispanic (), Female (), Other(Specify)
(6) List the names and addresses of all members of the firm or names and titles of all officers of the
corporation.
(7) Number of years experience as a Contractor in construction work.
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(8) List of all projects completed within last three years:
If you do not have enough space in a box,keel!moving to the next lower box until all information in that column is completed. When
finished with all information fora project,skin a row of boxes and start the next project in the left column.
Original Bid Class('I'Ypc)of Date Describe any Claims,Mediation, Amount and Type of Name,Contact,
Contract Amount Completed Arbitration or lawsuits,amount Change Orders Address and
and results 'fele phone o,F.Owner
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Original[aid Class(Type)of Work [late Describe any Claims,Mediation. Amount and'rype of Name,Contact,
Contract Amount Completed Arbitration or lawsuits,amount Change Order„s, Address and
and results Telephone of Owner
(NIMI I A W� '
a
Dcl
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W. b
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L-6
Original Bid Class(Type of Work Date Describe any Claims,Mediation, Amount and Type of Name,Contact,
Contract Amount Completed Arbitration or lawsuits,amount Chan cg,,,,,Orders Address and
and results "Fete hone of Owner
Contractor's failure to providc a complete list will result in automatic disqualification.
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(9) I.Ast the name of the person(s)who inspected the site of the proposed work for your firm:
Name IMOvi I I,
�( �A(j-,1,q � — Date of Inspection:
J
(10) The Contractor shall furnish the following information concerning bid depository or registry
services used in obtaining Subcontractor bid figures for this Proposal. Additional sheets may be
attached if necessary.
1. Were bid depository or registry services used in obtaining Subcontractor bid figures in
order to compute your bid?
Yes ( ) No 011�)
2. If the answer to No. I is "yes", forward a copy of the rules of each bid depository you
used in the preparation of this Proposal.
3. Did you have any source of Subcontractors' bids other than bid depositories?
Yes( ) NoM
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 )
S. 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 threats:
(e) Additional comments:
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(TO ACCOMPANY PROPOSAL)
The bidder shall answer each of the questions below with full disclosure, under penalty of perjury. This
information will be used in the determination of whether the Bidder is a Responsible Bidder or a Non-
Responsible. One additional page per question may be attached to the Proposal as bidder deems
necessary to explain his or her circumstance..
QUESTIONNAIRE
Bankruptcy
Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in
the bidder, ever been adjudged bankrupt in any voluntary or involuntary bankruptcy proceeding?
Yes X No
If yes, when and where?
Debarment
Flas the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in
the bidder, ever been debarred, disqualified, removed, or otherwise prevented from bidding on, or
completing a Federal, State, or local government project? _Yes KNo
If yes, provide a description of the case, the court location, case number and the outcome for each
lawsuit a full explanation below.
Claims and Litigation
Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in
the bidder, ever had any claims filed against them by any "owner" (including a public agency owner),
bonding company, subcontractor or supplier? —Yes XNo
If yes, describe the nature of each claim and its resolution.
Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in
the bidder, ever been sued by any "owner" (including a public agency owner), or bonding company
insuring said "owner" for default on a contract? _Yes "o
If yes, provide a description of the case, the court location, case number and the outcome for each
lawsuit a full explanation below,
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Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in
the bidder, ever been sued by a subcontractor or material supplier for default on a contract? Yes
N0
If yes, provide a description of the case, the court location, case number and the outcome for each
lawsuit.
During the past 5 years, has the bidder, any officer of the bidder, or any employee of the bidder who has
a proprietary interest in the bidder, been a defendant in any professional related lawsuit besides those
described in the paragraphs above? _Yes No
If yes, provide a description of the case, the court location, case number and the outcome for each
lawsuit.
Contractor as Claimant or Plaintiff
Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in
the bidder, ever filed a claim against an "owner" (including any public agency o7wner) or a bonding
I
company insuring an "owner" for any claims arising under any contract? —Y No
If yes, provide details as to the nature, date and resolution of any such claim.
Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in
the bidder, ever filed a lawsuit against an "owner" (including any public agency owner) or a bonding
company insuring an "owner" for any disputes arising under any contract? ? _Yes XNo
If yes, provide a description of the case, the court location, case number and the outcome for each
lawsuit.
Binding Arbitration
Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in
the bidder, ever had to submit to binding arbitration to resolve a dispute arising from a contract?
—Yes No
If yes, what were the circumstances and outcome of such arbitration?
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Bonding
Has any bonding company ever refused to bond the bidder, any officer of the bidder, or any employee of
the bidder who has a proprietary interest in the bidder for a contract? —Yes No
If yes, what were the circumstances?
Has any bonding company ever been required to pay on a bond issued to the bidder, any officer of the
bidder, or arty employee of the bidder who has a proprietary interest in the bidder for a contract?
_Yes ..N0
If yes, what were the circumstances?
Prevailing Wages
Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in
the bidder, ever been a) sued for, or b) penalized by any court, regulatory agency, or similar entity, for
failure to pay prevailing wages to any persons performing work under a contract, including
subcontractors?
_Yes No
If yes, what were the circumstances?
I declare under penalty perjury of the laws of the State of California that the information contained in
this Questionnaire beginning on Page E-9 are true and correct to the best of my knowledge, and that this
declaration w executed on �.�"�C AM °_Ja ,`..''LW.) , at `. `"'� , California.
(signature)
(printed name)
(title)
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