contract summary sheetclkrep.lacity.org/onlinecontracts/2014/c-123891_c_03-28... · 2014-05-07 ·...

CONTRACT SUMMARY SHEETTO: THE OFFICE OF THE CITY CLERK,

COUNCIL/PUBLIC SERVICES DIVISIONROOM 395, CITY HALL

DATE: MAY 7,2014

FROM (DEPARTMENT): BOARD OF PUBLIC WORKS

CONTACT PERSON: MARY CARTER PHONE: 213-978-0262

CONTRACT NO.: C-123891 COUNCIL FILE NO.: _

m NEW CONTRACTADOPTED BY COUNCIL: DAMENDMENT NO.

DATE DADDENDUM NO. -APPROVED BY BPW: 03/28/2014 DSUPPLEMENTAL NO.

DATE D CHANGE ORDER NO.CONTRACTOR NAME: SULLY-MILLER CONTRACTING COMPANY

TERM OF CONTRACT: 420 CALENDAR DAYS THROUGH: ---------TOTAL AMOUNT: $767,724.00-----------------------PURPOSE OF CONTRACT:

BALBOA BOULEVARD AT KNOLLWOOD PLAZA DRIVEWAY FEDERAL PROJECT NO.HPLUL-5006 (534) AND BALBOA BOULEVARD AND SAN FERNANDO RAODINTERSECTIONIMPROVEMENT FEDERAL PROJECT NO. HPLUL-5006 (490)

NOTE: CONTRACTS ARE PUBLIC RECORDS - SCANNED AND UPLOADED TO THE INTERNET

ORIGINAL CONTRACTDOCUMENT

ORIGINALBID PROPOSAL

PART IOF II

Balboa Boulevard at Knollwood Plaza DrivewayCERTIFICATE OF LIABILITY INSURANCE . . .

APPROVEDAND'0N(f)M..l9:o.E1907276 ; Federal Project No.IIPLUL-5006(534)&

Balboa Boulevard and San Fernando RoadIntersection Improvement

Approved03- 2...-1 0 l '-'f

MICH LN.FEUER~ttomeyIn and for the

By ~ . City of Los AngelesV California

W.O. No. E1906350 ; Federal Project No. HPLUL-5006(490)

tIJ l3oJ7100 I 0 o~

'1J--f,ij;1b1,

TYPE OF CONTRACT CASH

PROPOSALATTACHMENTS Plan Drawings: Index No. D-34290 (10 sheets) & P-37671 (10 sheets)

SPECIFICATIONS General Conditions (2), General Requirements (2), TechnicalSpecifications (2), Geotechoical Report (1),Specifications for PublicWorks Construction (Greenbook) 2009 edition as amended by theCity's BroViTIBook, January 6, 2011 edition.

PROJECT LOCATION 2007 Thomas Guide Page No. 481-D2 & D7

COMPLETION TIMELIQUIDATED DAMAGES

Milestone 1: 120 Calendar Days= (Balboa Boulevard at Knollwood PlazaDriveway)Milestone 2: 300 Calendar Days* (Balboa Boulevard and San FernandoRoad Intersection Improvement)

- BID~ DATE~;

~~.

$1000 Per Calendar Day

-,Finn Name: Sully-Miller Contracting CompanyAddress; 135 S. State College Blvd., Ste. 400, Brea, Ca 92B21

Telephone Number (714 ) bf!H1600 Fa:>:Number ( 714 ) 578-9600Contractor's License Number:? 47612 Classification:A, C,1 0 E,-pil'OtiRJI.Pr'l!h:31, 201

Business tax Reaistratlcu Certlflcate (BrRe) No. 940439-01

Bids must be received no later thau 10:00 a.m. on November 13.2013 at Los AngelesCity Hall; 200 North Spring Street, Room 355; Los Angeles, California 90012. Call theBoard Office at (213) 978-0262 if you have difficulties gaining access to City Hall.

"Refer to CeueralRequirements, Section 01112 "Description of Work" for more information.

Rev. 04/09113F-1

SCHEDULE OF WORK AND PRICESCity of Los Angeles - Department of Public Works - Bureau of Engineering

Balboa Boulevard at Knollwood Plaza DrivewayW.o. No. E1907276; Federal Project No. HPLUL-5006(534)

Balboa Boulevard and San Fernando Road intersection Improvementw.o.No. E19D6350 ; Federal Project No. HPLUL-5006(490)

BALBOA BOULEVARD AT KNOLLWOOD PlAZADRIVEWAYY<GENERAL

MOBILIZATION per General Requirements, Sections 01292 and 01721 LS c>cD .--2 Modified Class 'B" field office with air condllioning and broadband internet LS I~=0. .~access

ALLOWANCE to protect unknown and/or relocate prior to construction3 substructures with approved materials (estimated 25 GY) per General LS 2,250.00

RequJrementsJ Sections 01212, 01253, and 01732

4ALLOWANCE to pothole unknown substructures (estimated 4 potholes)

LS 1,000.00per General Requlrernsnts, Sections 01212, 01253 and 01732

ALLOWANCE for preparing and implementing a Wet Weather Erosion5 Control Plan for unlimited storm occurrences per General LS 1,000.00

Requirements, Sections 01212 and 01571

6 ALLOWANCE for providing, installing and maintaining required project LS 1,000.00sIgns per GeneraJ Requirements, Sections 01212 and 01581

7ALLOWANCE for payment for permits per General Conditions Section LS 1,500.0000217 and General Requirements Section 01212

STREET REMOVAL

8 Clearing and grubbing LS 'I~COD. .----

9 Remove reinforced concrete pedestrian ramp East side Balboa BI South of LSdriveway; H::::::0 to 2,5 -feet, including haul away and 64 LF of handraiHng d 'Icc, r-10 Sawcut, 6 -lnch concrete pavement, including integra! curb and gutter LF 50 s:-- d.-S I), /'11 Sawcut asphalt concrete pavement, T::::::6 to 10 -in ell Varies LF 264 Lj~ I Cl5"(, --12 Cold-mill asphalt concrete pavement (2 -lnch minimum) SF 810 I.f .. ....-- J J. '10. --

STREET CONSTRUCTION

13 Type "A" concrete curb; variable curb height 0 to 8 -inch LF 43 -:back of East RIW Balboa 81 (City olLA Std. Plan S-410-2) iu. 130. ...--14 Type nAto concrete curb; variable curb height 0 10 6 -inch LF 76 ;).12 ,


Balboa Boulevard at Knollwood Plaza Drivewayw.o. No. E1907276 ; Federal project No. HPLUL-5006(534}Balboa Boulevard and San Fernando Road Intersection ImprovementW.o. No. E1906350 ; Federal Project No. HPLUL.5006(490}

, ,~-': - _.. ~"~ ,_ ~ (_3_~~;_'~_~"~::_;'-'- '-- - .. - u'NIi Pliic~ ... -ITEM oeSCRIPTION UNJT QTY. JTEMTOTA~ 'I,." ". 'BALBOA BOULEVARD ATKNOLI.,WOOD PLAZA DRIVEWAY" ... ........... '_ ...... , .. ", '. '

8 -lnch concrete driveway; modified Case 4 including integral concrete curb;18 two-stage pour with 650-C-4000 early strength concrete mix per DWG. No. C- SF 715 So ,/"""3 and Part 4 o!Technical Specifications; (City ofLA Std. Plan S-440-3) 7- ~3'X

North and south retaining waU, incfuding exoavtion, concrete 560wC-3250,19 reinforcing steel, formwork, and backfilr; per DWG. No. CA. Detail 1 and LF 54 »:

/'-/ [;g'o.->

Sections A, B" and C; (Atl work in Public RIW East side Balboa 81) ~70.Short retaining wall for private pedestrian ramp; including excavation.

20concrete, reinforcing steel, formwork and backfill; H =: 0 to 25 "feet, LF 33 /'per OWG. No. e-s, Details 2 and 48a and Sections G and H;

;;),28 4 -inch crushed miscellaneous base material (eMS) SF 2,885 • t..jo 1 / S'1. ..--,29 6 -inch crushed aggregate base material (CAB) for retaining wall base back of SF 190 -: ~East Rf\N Balboa B!; per DWG, No. C-4, Detail 1 and Sections A, B, and C S. 15'0.30 Unclassified excavation CY 52 ~ 8".

,.----S 53(.. "..-

31 Pedestrian pipe handrail, Type A1 with curb per DWG. No. C-4, Sections A LF 36 I,-(t). -: /'and C; (City of LA Std. Plan 8-403-2) S 0'(0.Pedestrian pipe handrail, Type A1 with wheel guide for private pedestrian

32 ramp per DWG. No. C-5, Sections G and Hand DWG. No. C-6, Sections J LF 55 !~O./" ,/"""and K; (City of LA Sid. Plan S-463-2) y; '600.Raised truncated dome pattern (in llne] detectable warning surface (3W X 40

,33 feet); (City of Los Angeles Standard Plan 8-442-3) EA 6 L(3o.f JS'i?D_ .--

Adjust and lor relocate private water service pipe only on private side of meter34 fronting 11867 Balboa BI (WIS) to avoid CIDH foundation (2 -inch diameter EA 1

::< ::21 SOD .max.) S/l}') / .~. 35 Grade, re-sod and relocate sprinkler heads; including grading in front of SF 210 _"? 0 I ....--.reJaining wall (All work back of East RIW Balboa BI) , f/3

Work site traffic control plan and implementation; Including banne-rs,./36 delineators, K-rail, changeable message boards, and other required LS

~,{)DO.,/

equipment.

F-2 b

SCHEDULE OF WORK AND PRICESCity of los Angeles - Department of Publlc Works - Bureau of Engineering

Balboa Boulevard at Knollwood Plaza Drivewayw.o. No. E1907276; Federal Project No. HPLUL-5006(534)Balboa Boulevard and San Fernando Road Intersection Improvementw.o. No. E1906350 ; Federal Project No. HPLUL-5006(490)

". ··C. BALBOA BOULEVARD AT KNOLLWOOD PLAZADRIVEWAyi:':':":"::'Y:""':':':':::':: '.::'.:::,TRAFFIC STRIPING

37 Signage and striping LS 3J.e.=. ...---TRAFFIC SIGNAL

38 Install F~1 foundation EA 1 4>:0_ -: Lfso. ~39 Install FM7 foundation EA 1 LfDO, ./"' LJex:.>- ----40 Install 19-24 CIDH (Pile) foundation EA 2 . -» )., r: C. Ljoo.----;) CO.41 Install F-332 foundation EA 1 J=. r-- /."~,, ---42 Install Type 111A or 9 Standard and cable EA .1 ;;'75/" 27S_-43 Install Type 7 standard and cable EA 1 4(.,0. --- 4(00.-44 Install 19~4-100 Standard and cable with mast arm and !umlnalre EA 2 Y,JoO' 8' COCU. .-45 Install 2070 controller (332 Cabinet wlth wire) EA 1 I(~5'= --/' S=o. I-46 Install 25 -foot mast arm EA 1 ;;( ClOD.' J ~coo.47 Install 30 -foct mast arm EA 1 ~ IcY',. ,--- :J /06, /'

48 Install one-way, 12 -inch vehicle head EA 5 ISSD./" Lf .;l.SD.-49 Install 12 -lnch mast arm head EA 2 7SD. r- t. SOD.·-50 Install 12 -Inch, -t-secton head EA 1 '7'50. /' 750. ./"'

51 Install one-way pedestrian head EA 4 530. r- ~ /,;)0. »>:52 InstaliAPS EA 4 t . '-100. -: S"&= ..--

;

53 Install vehicle detector loop; including 2 loops back of East RfW Balboa BI EA 8 19co. /" '7 )..DO. /54 Install pedestrian push button EA 1 1'60, r- 1:

Install 2 -lnch conduit and pulling wires 500 7/. /' ;>DO ...-I-

57 LF 3558 Install 3 -lnch conduit and pulling wires LF 100 lifo. r: /L(CCD. ->59 PuUing cables/wires In existing conduit LF 500 15~50 1752) .....-60 Intercept conduit and install pull box EA 2 (;7>' ~ I 3>0, -

F-2 c


Balboa Boulevard at Knollwood Plaza Drivewayw.o. No. E1907276 ; Federal Project No. HPLUL-5006{534}

Balboa Boulevard and San Fernando Road Intersection improvementW.o. No. E1906350 ; Federal Project No. HPLUL-5006(490}

'. .. _ ~~' ::.;"',r."1;!:::':::;:r,:," .. ':::%"..l'o"' ..5..'1'i:D'.;~::ITEM

"DESCRIPTION UNIT QTY. ,U!lJTPRICE, ." ,·'IIl,~:rPT!>,L;!"c~

'- _ ~".",~oJ,",,,,,''. """'BALBOA BOULEVARD AT KNOLLWOOD ·PLAZA DRIVEWAYi'; ,.'"

....., ,

BALBOA BOULEVARD AND SAN FERNANDO ROAD INTE,RSECTION IMPROVEMENTSSTREET

76 MOBILIZATION per General Requirements, Sections 01292 and 01721 LS [7 ClOO. .---LS !"f coo, ---LS $ 3,500.00

LS $ 1,250.00

LS $ 1,500.00

77 Modified Class B Office wI Air Conditioning

ALLOWANCE to protect unknown and'or relocate prior to construction78 substructures with approved materials (estimated 40 GY) per General

Requirements, Sections 01212, 01253, and 01732

79 ALLOWANCEto pothole unknown substructures (estimated 4 potholes)per General Requirements Sections 01212, 01253 and 01732

ALLOWANCE for preparing and imp[ementing a Wet Weather Erosion80 Control Plan fOT unlimited storm occurrancee per General

Requirements, Sections 012~2and 01571

1"-2 d


Balboa Boulevard at Knollwood Plaza Drivewayw.o.No. E1907276; Federal Project No. HPLUL-5006(534)Balboa Boulevard and San Fernando Road Intersection Improvementw.o.No. E1906350; Federal Project No. HPLUL-5006(490)

81 ALLOWANCE for providing, Installing and maintaining required projectsigns per General Requirements

1Sections 01212 and 01581 1s250.00

82 ALLOWANCE for payment for permits per General Conditions, Section $ 2,500.0000217 and General Requirements, Section 01212

REMOVALS

BALBOA BOULEVARD AND SAN FERNANDO ROAD INTERSECTION IMPROVEMENTS

83 Grading, Clearing and grubbing including concrete wall.

84 Curb and Gutter

85 AC Pavement

86 Remove existing Asphatt Concrete Pavement by Cold Planer

CONSTRUCTION

87 Unclassified Excavation

88 AC Pavement

89 Detectable Warning Surfaces at Curb Ramp per Latest City Standard.

90 8" Crushed Miscellaneous Base (Under Curb, Gutter, and Pavement)

91 4" Crushed Miscellaneous Base (Under Sidewalk and Curb Ramps)

92 Modified Cone Slough wall

93 a" Cone, Pavement

94 Curb Ramp

95 Integral sidewalk and Retaining curb

96 Type C Integral Curb and Gutter (a=2'; b=8" min. 6" Curb Face)

97 Relocate Ballards

98 3 inch Cone Walk

99 Type A Cur"

100 Relocate Culvert

101 Work Site Traffic Control lmplementatlon for all removals, construction, andpotholing{including temporary traffic loops and banners)

TRAFFIC STRIPING

102 Traffic Striping

LS 1 c: ./OCO.LF 730 17, -

SCHEDULE OF WORK AND PRICESCity of Los Angeles - Department of PublIc Works - Bureau of Engineering

Balboa Boulevard at Knollwood Plaza DrivewayW.o. No. E1907276; Federal Project No. HPLUL-5006(534)

Balboa Boulevard and San Fernando Road Intersection Improvementw.o. No. E1906350; Federal Project No. HPLUL-5006(490)

10'( 000.

TRAFFIC SIGNAL

103 Traffic Signal System

STREET LIGHTING AND DWP

2104 StreetLighting Relocation EA

TOTAL BID AMOUNT: 7c;, 7Unit Abbreviations: LF = linear fool, TON"" tons. SF ""square foot, CY = cubic yards, TF "" track foot, EA = each, ana LS '" lump sumother Abbreviations: APS =Accessible Pedestrian Signa!. SSL = Bureau of Street Ughting. CAL"" caltrans, CIDH "" Casf-ln-Drtll-Hcle, OLe = Detector Lead-lnGable. LED := Ught Emitting DiodellorlEs:aALBOABLVDATKNOLLWOODPLAZADl

W.O. No. E1907276, FP No. HPLUL-5006(534)W.O. No. E1906350; FP No. HPLUL-5006(490)

CONSTRUCTIONCITY OF LOS ANGELES

RESPONSIBILITY QUESTIONNAIRE

RESPONSES TO THE QUESTIONS CONTAINED IN THIS QUESTIONNAIRE MUST BE SUBMITTED ON THIS FORM.In responding to the Questionnaire, neither the City form, nor any of the questions contained therein,may be retyped, recreated, modified, altered, or changed in any way, in whole or in part, Bidders orProposers that submit responses on a form that has been retyped, recreated, modified, altered, orchanged in any way shall be deemed non-responsive.The signatory of this questionnaire guarantees the truth and accuracy of all statements and answers to theQuestions herein. Failure to complete and return this questionnaire, any false statements, or failure to answer(a) question(s) when required, may render the bid/proposal non-responsive. All responses must be typewrittenor printed in ink. Where an explanation is required or where additional space is needed to explain an answer,use the Responsibility Questionnaire Attachments. Submit the completed form and all attachments to theawarding authority. Retain a copy of this completed form for future reference. Contractors must submit updatedinformation to the awarding authority if changes have occurred that would render any of the responsesinaccurate in any way. Updates must be submitted to the awarding authority within 30 days of the change(s).

A. CONTACT INFORMATION

CITY DEPARTMENT INFORMATION

Department of Public Works/Bureau of Engineering Carlos De La FuenteCity.DeQ..artmentiDivisionAWarding Contract Ci\v COJ]tactPer.son . PhoneBalboa·t:llvd. at Knollwocid I-'Iaza Driveway (W.O. No. E19U727o, Fed. Aid i-ro]. No. HPLUL-5006(534)Balboa Blvd. & San Fernando Rd. Intersection Improvements (W.O. No. E1906350, Fed. Aid Proj.City Bid or Contract Number and ProjectTitie (if applicable) Bid DateHPLUL-5006(490) Nov. 13,2013BIDDER/CONTRACTOR INFORMATION

Sully-Miller Contracting Compariy 747612-A, C-10

Bidder/P[oposer Business Name

135 S. State College Blvd., Ste. 400, Brea, CA 92821

Contractor's License Number

Street Address Cily

Raymond Sanchez, Assistant Secretary/Chief Estimator

State Zip

714/578-9672714/578-9600Contact Person, Title Phone Fax

TYPE OF SUBMISSION:

The Questionnaire being submitted is:o An initial submission of a completed Ouestionnaire.D An update of a prior Questionnaire dated / / .129 No change. I certify under penalty of perjury unde the laws of theState of California that there has been

no change to any of the responses since the I t espo si ility Que nnaire dated ~ 25 / 13was submitted by the firm. Attach a copy of that estion i and siq elow.

Raymond Sanchez, Assistant SecretaryPrint Name, Title

November 12, 2013'Date

TOTAL NUMBER OF PAGES SUBMITTED, INCLUDING ALL .l\TTAGHMENTS: _2;...4 _

Responsibility Questionnaire {rev 1/25112) F-3a

CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT

STATE OF CALIFORNIA }On November 12, 2013 before me, J. Daniels, Notary Public, personally appeared Raymond Sanchez

who proved to me on the basis of satisfactory evidence tobe the person(s) whose name is/are subscribed to thewithin instrument and acknowledged to me thathe/she/they executed the same in his/her/their authorizedcapacity(ies), and that by his/her/their signature(s) on theinstrument the person(s), or the entity upon behalf ofwhich the person(s) acted, executed the instrument.

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

COUNTY OF ORANGE

r~-"--T.DANri'it~""l"' COMM # 1989544 >-

Notary Public M California trt'" ORANGE COUNTY :if MyCommi,slo11 ExpfresSept .24, 2016t_.... ..- - ~

Notary Seal

Signature

OPTIONAL

Description of Attached Document

Title or Type of Document: Responsibility Questionnaire

Document Date: November 12, 2013

Signer(s) Other Than Named Above:

Number of Pages:

Capacity(ies) Claimed by Signer(s):

Signer's Name _R=ay"-m:.:,o"'n""d:..S;::,a"'n""c:ch"'e:=.z Signer's Name

o IndividualIJ9 Corporate Officer - Title(s) Assistant Secretary

o Individualo Corporate Officer - Title(s)

o Partner - Limited/Generalo Attorney In Fact Right Thumbprint

of Signero Trusteeo Guardian or Conservatoro Other

Signer is Representing: SULLY-MILLER CONTRACTING COMPANY

o Partner - Limited/Generalo Attorney In Fact Right Thumbprint

of Signero TrusteeD Guardian or Conservatoro Other

street Resurfacing and Repalr of 14 Mllee of Local and Residential Streets f,JV.o. E1907607)

CONSTRUCTIONCITY OF LOS ANGELJ::S

.RESPONSIBIUTY QUESTIONNAIRE

RESPONSES TO THE QUESTIONS CONTAINED IN THIS QUESTIONNAIRE MUST BE SUBMITTED ON THIS FORM.In responding to the Questionnaire, neitherthe City form, nor any of the questions contained therein,may be retyped, recreated, modified, altered, or changed in any way, in whole or in part. Bidders orProposers that submit responses on a form that has been retyped, recreated, modified, altered, orchanged in any way shall be deemed ncrr-rssponslve,The signatory of this questionnaire gUarantees the truth and accuracy of all statements and answers to theQuestions herein. Failure to complete and return this quastlonnalre, any false statements, or failure-to answer(a) questiorus) when required, may render the bidlproposal non-responsive. All responses must be typewrittenor printed in ink. IJ\/here an explanation is required or where additional space is needed to explain an answer,Lise the Responsibility Questionnaire Attachments. Submit the completed form and all attachments to theawarding authority. Retain a copy of this completed form for future reference. Contractors must submit updatedinformation to the awarding authority if changes have occurred that would render any of the responsesinaccurate in any way. Updates must be submitted to the awarding authority within 30 days of the change(s).

A. CONTACT INFORMATION

CITY DEPARTMENT INFORMATION

Department of Public Works/Bureau of Engineering Mark Chmielowiec

City Department/Dlvision Awarding Contract City Contact Person

Street Resurfacing and Repair of 14 Miles of Local and Residential Streets W.O. E1907607City Bid or Contract Number and Project Title (if applicable)

Phone

January 30, 2013

Bid Date

l3IDDER/CONTRACTOR INFORMATION

Sully-Miller Contracting Company 747612-A, C-10

Bidder/Proposer Buslness Name

135 S, State College Blvd" Ste. 400, Brea, CA 92821

Contractor's License Number

Street Address City

Raymond Sanchez, Assistant Secretary/Chief Estimator

State Zip

714/578·9672714/578-9600Contact Person, Title Phone Fax

TYPE OF SUBMISSION:.The Questionnaire being submitted is:129 An inttial submission of a completed Questionnaire.o An update of a prior Questionnaire dated f 1 .o No change, I certify under penalty of perjury under the laws of the State of California that there has been

no change to any of the responses since til last Respo ibility Q tionnaJre dated / !was submitted by the firm, Attach a copy of Ques n Oreand si below.

Raymond Sanchez, Assistant SecretaryPrint Name, Tille

January 25, 2013Date

TOTAL NUMBER OF PAGES SUBMITTeD, INCLUDINGALL ATTACHMENTS: j.~

ResponslbU~y Oueeuonnalra (rev 1210111i) 1-3 a

W,O. No. E1907276; FP No. HPLUL-5006(534)W.O. No. E1906350; FP No. HPLUL·5006(490)

CONSTRUCTION

ATTACHMENT C: GOVERNMENTAL ENTITIES FOR QUESTION NO. 21

Check Yes in response to Question No. 21 if your firm or any of its owners, partners or officers, have everbeen investiqated, cited, assessed any penalties, or found to have violated any laws, rules, or regulationsenforced or administered, by any of the govemmental entities listed below (or any of its subdivisions), includingbut not limited to those examples specified below. The term "owner" does not include owners of stock in yourfirm if your firm is a publicly traded corporation. If you answered Yes, provide an explanation on Attachment Bof the circumstances surrounding each instance, including the entity involved, the dates of such instances, andthe outcome.

FEDERAL ENTITIES

Federal Department of Labor• American with Disabilities Act• Immigration Reform and Conlrol Act• Family Medical Leave Act• Fair Labor Standards Act• Davis-Bacon and laws covering wage requirements

for federal government contract workers• Migrant and Seasonal Agricultural Workers'

Protection Act• Immigration and Naturalization Act• Occupational Safety and Health Act• anti-discrimination provisions applicable to

government contractors and subcontractors• whistleblower protection laws

Federal Department of Justice• Civil Rights Act• American with Disabilities Act• Immigration Reform and Control Act of 1986• bankruptcy fraud and abuse

Federal Department of Housing and UrbanDevelopment (HUD)• antt-dlsorlmlnatlon provisions in federally

subsidized/assisted/sponsored housing programs• prevailing wage requirements applicable to HUD

related programs

Federal Environmental Protection Agency• Environmental Protection Act

National Labor Relations Board• National Labor Relations Act

Federal Equal Employment OpportunityCommission• Civil Rights Act• Equal Pay Act• Age Discrimination in Employment Act• Rehabilitation Act• Americans with Disabilities Act

Responsibility Questionnaire (rev tl25/12)

STATE ENTITIES

California's Department of Industrial Relations• wage and labor standards, and licensing and

registration• occupational safety and health standards• workers' compensation self insurance plans• Workers' Compensation Act• wage, hour, and working standards for apprentices• any provision of the California Labor Code

California's Department of Fair Employment andHousing• California Fair Employment and Housing Act• Unruh Civil Rights Act• Ralph Civil Rights Act

California Department of Consumer Affairs• licensing, registration, and certification requirements• occupational licensing requirements administered

and/or enforced by any of the Department's boards,including the Contractor's State Licensing Board

California's Department of Justice

LOCAL ENTITIES

City of Los Angeles or any of its subdivisions forviolations of any law, ordinance, code, rule, or regulationadministered and/or enforced by the City, including anyletters of warning or sanctions issued by the City of LosAngeles for an unauthorized substitution ofsubcontractors, or unauthorized reductions in dollaramounts subcontracted.

OTHERS

Any other federal, state, local governmental entity forviolation of any other federal, state, or local law orregulation relating to wages, labor, or other terms andconditions of employment. .

F-3 j

W.O. No. E1907276; FP No. HPlUl·5006(534)VV.O':No. E1906350; FP i\r6~'HPLUL~5006(490)

CITY OF LOS ANGELES

PLEDGE OF COMPLIANCE WITH CONTRACTOR RESPONSIBILITY ORDINANCE

Los Angeles Administrative Code (LAAC) Section 10.40 et seq. (Contractor Responsibility Ordinance) providesthat, unless specifically exempt, City contractors working under service contracts of at least $25,000 and threemonths, contracts for the purchase of goods and products of at least $100,000, contracts for the purchase ofgarments of at least $25,000, and construction contracts of any amount; public lessees; public licensees; andcertain recipients of City financial assistance or City 'grant funds, shall comply with all applicable provisions ofthe Ordinance. Upon award of a City contract, public lease, public license, financial assistance or grant, thecontractor, public lessee, public licensee, City financial assistance recipient, or grant recipient, and any itssubcontractor(s), shall submit this Pledge of Compliance to the awarding authority.

The contractor agrees to comply with the Contractor Responsibility Ordinance and the following provisions:

(a) To comply with all federal, state, and local laws in the performance of the contract, including but not llrnltedto laws regarding health and safety, labor and employment, wage and hours, and licensing laws, whichaffect employees.

(b) To notify the awarding authority wi.thin 30 calendar days after receiving notification that any governmentalagency has initiated an investigation which may result in a finding that the contractor did not comply withany federal, state, or local law in the. performance of the contract, including but not limited to laws regardinghealth and safety, labor and employment, wage and hours, and licensing laws, which affect employees.

(c) To notify the awarding authority within 30 calendar days of all findings by a govemmental agency or courtof competent jurisdiction that the contractor has violated any federal, state, or local law in the performanceof the contract, including but not limited to laws reqardinq health and safety, labor and employment, wageand hours, and licensing laws which affect employees.

(d) If applicable, to provide the awarding authority, within 30 calendar days, updated responses to the. Responsibility Questionnaire if any change occurs which would change any response contained within the

Responsibility Questionnaire and such change would affect the contractor's fitness and ability to continuethe contract.

(e) To ensure that subcontractors working on the City agreement (including contractors or subcontractors of apublic lessee, licensee, sublessee, or sublicensee that perform, or assist in performing services on tileleased or licensed premises) shall comply with all federal, state, and local laws in the performance of thecontract, including but not limited to laws regarding health and safety, labor and employment, wage andhours, and licensing laws, which affect employees.

(f) To ensure that subcontractors working on the City agreement (including contractors or subcontractors of apublic lessee, licensee, sublessee, sublicensee that perform or assist in performing services on the leasedor licensed premises) submit a Pledge of Compliance.

(g) To ensure that subcontractors working on the City agreement (including contractors or subcontractors of apublic lessee, licensee, sublessee, or sublicensee that perform or assist in performing services on theleased or licensed premises) shall comply with paragraphs (b) and (e).

Failure to complete and submit this form to the Awarding Authority may result inwithholding of payments by the City Controller, or contract termination.Sully-Mill Contr 135 S. State College Blvd., Ste.400, Brea, CA 92821Compan umber

sentativeNovember 12, 2013

Date

Raymond Sanchez, Assistant SecretaryPrint Name and Title of Officer or Authorized Representative

Department of Public Works/Bureau of Engineering W.O. No's. E1907276 & E1906350Awarding City Department Contract Number

eRO Pledge of Compliance (Rev. 09113101)

F-31


On November 12, 2013 before me, J, Daniels, Notary Public, personally appeared Raymond Sanchez

who proved to me on the basis of satisfactory evidence tobe the person(s) whose name is/are subscribed to thewithin instrument and acknowledged to me thathe/she/they executed the same in his/her/thelr authorizedcapacity(ies), and that by his/her/their signature(s) on theinstrument the person(s), or the entity upon behalf ofwhich the person( s) acted, executed the instrument.


WITNESS my hand a0te;I.~~:1

Signature ~ _

STATE OF CALIFORNIA

COUNTY OF ORANGE}

Number of Pages:

r--:---TDANlELsl- . COMM # 1989544 >

Notary Public- California gj'" ORANGE COUNTY -! MyCommission Expires Sept.24, 2016t--...---.....--.-.--~

Notary SealOPTIONAL



Title or Type of Document: Pledge of Compliance with Contractor Responsibility Ordinance

1

Signer( s) Other Than Named Above:


Signer's Name -'..:R"'ayz:.m=on"'d::-:::S"'an"'c"'-h"'e"'z Signer's Name

o Individual[EJ Corporate Officer - Title(s) Assistant Secretary


o Partner - Limited/General o Partner - Limited/Generalo Attorney In Fact RightThumbprint

of Signero Attorney In Fact Right Thumbprint

of Signero Trustee o Trusteeo Guardian or Conservatoro Other


o Guardian or Conservatoro Other

I C,ityiEthlcsCornmission Bidcier Certificliltion200 ~,~pringStreetCity H~I.I,...24th FloorLo:,;"~11~~le~,jCA 90012 CECForm50Niail $t()p129(213j 9.1a-l~60 . .'"This form must be submitted to the awarding authority with your bid

or proposal for the contract noted below. Please write legibly.

J2g Original filing CJ Amended filing (original signed on ; last amendment signed on )

Bid/ContractlBAVN Number: Awarding Authority (Department):

W.O. E1907276 & E1906350 Department of Public Works/Bureau of Engineering

Name of Bidder: I Phone:ISully-Miller Contracting Company ,714/578-9600

Address:

135 S. State College Blvd., Ste. 400, Brea, CA 92821

I Email:I, [email protected]

CERTIFICATION

I certify the following on my own behalf or on behalf of the entity named above, which I am authorized to represent:

A. I am a person or entity that is applying for a contract with the City of Los Angeles.

B. The contract for which I am applying is an agreement for one of the following:1. The performance of work or service to the City or the public;2. The provision of goods, equipment, materials, or supplies;3. Receipt of a grant of City financial assistance for economic development or job growth, as further described

in Los Angeles Administrative Code § 10.40.1 (h) [see reverse]; or4. A public lease or license of City property where both of the following apply, as further described in Los

Angeles Administrative Code § 10.37.1 (I) [see reverse]:a. I provide services on the City property through employees, sublessees, sublicensees, contractors, or

subcontractors, and those services:i. Are provided on premises that are visited frequently by substantial numbers of the public; orii. Could be provided by City employees if the awarding authority had the resources; oriii. Further the proprietary interests of the City, as determined in writing by the awarding authority.

b. I am not eligible for exemption from the City's living wage ordinance, as eligibility is described in LosAngeles Administrative Code § 10.37.1 (I}(b).

C. The value and duration of the contract for which I am applying is one of the following:1. For goods or services contracts-a value of more than $25,000 and a term of at least three months;2. For financial assistance contracts-a value of at least $100,000 and a term of any duration; or3. For construction contracts, public leases, or licenses-any value and duration.

D. I acknowledge and agree to comply with the disclosure requirements and prohibitions established in the LosAngeles Municipal Lobbying Ordinance if I qualify as a lobbying entity under Los Angeles Municipal Code §48.02.

I certify under penalty of perjury under the laws of the City of Los ~Ies and t st~ e of California ~ at theinformation in this form is true and complete.

Date: November 12, 2013 Signature: fA ~ ~~ VName:

Raymond San;~ez JTitle:

Assistant Secretary

Revised October 2013 Los Angeles MunicIpal Code § 48.09(H),

F-31

1 of 1

ADDENDUM NO.1


STATE OF CALIFORNIA }On November 12, 2013 before me, J. Daniels, Notary Public, personally appeared Raymond Sanchez

who proved to me on the basis of satisfactory evidence tobe the personts) whose name islare su bscribed to thewithin instrument and acknowledged to me thathe/she/they executed the same in hisiRefltheif authorizedcapacityties), and that by hislRer-AAeif signaturefs) on theinstrument the personjs), or the entity upon behalf ofwhich the person-s) acted, executed the instrument.


COUNTY OF ORANGE

r_m--'~TDANfEtn~ COMM # 1989544 ".

Notary Public ~California !B.. ORANGE COUNTY ~I MyCommission Expires Sept. 24, 2016:..............-...........~.....................-.......:

Notary Seal

Signature

OPTIONAL



Title or Type of Document: Bidder Certification CEC Form 50

Number of Pages:



Signer's Name . Ray-'-!m"'o"'n"'d..,S"a"'n""c"'he"'z"- Signer's Name

o Individual[R] Corporate Officer - Title(s) Assistant Secretary


o Partner - Limited/Generalo Attorney In Fact RightThumbprint




of Signero TrusteeD Guardian or Conservatoro Other

Los Angeles Administrative Code § 10.40.1

(h) "'City Financial Assistance Recipient" means any person who receives from the Citydiscrete financial assistance in the amount of One Hundred Thousand Dollars($100,000.00) or more for economic development or job growth expressly articulatedand identified by the City, as contrasted with generalized financial assistance such asthrough tax legislation.

Categories of such assistance shall include, but are not limited to, bond financing, planning assistance, taxincrement financing exclusively by the City, and tax credits, and shall not include assistance provided by theCommunity Development Bank. City staff assistance shall not be regarded as financial assistance forpurposes of this article. A loan shall not be regarded as financial assistance. The forgiveness of a loanshall be regarded as financial assistance. A loan shall be regarded as financial assistance to the extent ofany differential between the amount of the loan and the present value of the payments thereunder,discounted over the life of the loan by the applicable federal rate as used in 26 U.S.C. Sections 1274(d),7872(1). A recipient shall not be deemed to include lessees and sublessees.

Los Angeles Administrative Code § 10.37,1

(I) "Public leaseor license".

(a) Except as provided in (I)(b), "Public lease or license" means a lease or license of City property onwhich services are rendered by employees of the public lessee or licensee or sublessee orsublicensee, or of a contractor or subcontractor, but only where any of the foHowing applies:

(1) The services are rendered on premises at least a portion of which is visited bysubstantial numbers of the public on a frequent basis (including, but not limited to,airport passenger terminals, parking Jots, golf courses, recreational facilities); or

(2) Any of the services could feasibly be performed by City employees if the awardingauthority had tHe requisite financial and staffing resources; or

(3) The DM has determined in writing that coverage would further the proprietaryinterests of the City.

(b) A public lessee or licensee will be exempt from the requirements of this articlesubject to the following limitations:

(1) The lessee or licensee has annual gross revenues of less than the annualgross revenue threshold, three hundred fifty thousand dollars ($350,000), from businessconducted on City property;

(2) The lessee or licensee employs no more than seven (7) people total in thecompany on and off City property;

(3) To qualify for this exemption, the lessee or licensee must provide proof of its gross revenuesand number of people it employs in the company's entire workforce to the awarding authorityas required by regulation;

(4) Whether annual gross revenues are less than three hundred fifty thousand dollars ($350,000)shall be determined based on the gross revenues for the last tax year prior to application orsuch other period as may be established by regulation;

(5) The annual gross revenue threshold shall be adjusted annually at the skama rate and at thesame time as the living wage is adjusted under section 10.37.2 (a);

(6) A lessee or licensee shall be deemed to employ no more than seven (7) people if thecompany's entire workforce worked an average of no more than one thousand two-hundredfourteen (1,214) hours per month for at least three-fourths (3/4) of the time period that therevenue limitation is measured;

(7) Public leases and licenses shall be deemed to include public subleases andsublicenses;

(8) If a public lease or license has a term of more than two (2) years, the exemption grantedpursuant to this section shall expire after two (2) years but shall be renewable in two-yearincrements upon meeting the requirements therefor at the time of the renewal application orsuch period established by regulation.

F-31 ADDENDUM NO.1

w.o. No. E1907276; FP No. HPLUL~5006(534)W.O. No. E1906350; FP No. HPLUL-5006(490)

SIGNATURE SHEET AND AFFIDAVIT

VWe, Michael Edwards/Raymond Sanchezdepose andsaythat I amA'!eare Vice President/Insert Nrulle(s)

Assistant Secretary of Sully-Miller Contracting Company7(1ll="",;";'iSi,o;r.I,;'OT,'~'lli;i"io'iiC".piP;;;"~"'''''';''',"1I1p;"t,'t;sm,al


STATE OF CALIFORNIA

COUNTY OF ORANGE}

On November 12, 2013 before me, J, Daniels, Notary Public, personally appeared Michael Edwards &Raymond Sanchez

rT'''',--Ti)ANiEts···-l:;: • •• COMM # 1989544 ".

Notary Public ¥ California m« ORANGE COUNTY :?~ MyCommissionExpiresSepr.242016t........... _ ............ __ :... ...t

Notary Seal

who proved to me on the basis of satisfactory evidence tobe the person(s) whose name isJare subscribed to thewithin instrument and acknowledged to me thathe/she/they executed the same in his/heG/their authorizedcapacity(ies), and that by his/her/their signature(s) on theinstrument the person(s), or the entity upon behalf ofwhich the person(s) acted, executed the instrument.


WITNESS my hand an,(;official, seal

Signature ~~~i8T1iels, Notaryblic

OPTIONAL


Title or Type of Document: Signature Sheet and Affidavit



Number of Pages: 1


Signer's Name _M:.:.::.:ic,,-h:.;:a:.;:e:.--I=E"'dw=a:.:rd:.:s'-- Signer's Name

o Individual[g] Corporate Officer - Title(s) Vice President

Raymond Sanchez

o Individual[g] Corporate Officer - Title(s) Assistant.Secretary

Signer is Representing:

o Partner - limited/Generalo Partner - limited/Generalo Attorney In Fact Right Thumbprint

of Signero Attorney In Fact Right Thumbprint


o TrusteeD Guardian or Conservatoro Other

SULLY-MILLER CONTRACTING COMPANY

CERTIFICATE OF INCUlVJ.BENCY AND RESOLUTION

l, Anthony L. Martino, II, do hereby certify that 1 am the Secretary of Sully-Miller ContractingCompany, a Delaware corporation, and that as such Ihave access to and custody ofthe corporaterecords and minute books of said corporation.

And I do hereby further certify that the following persons arc duly elected officers of saidcorporation,

TULE NAME

Chairman of the BoardPresidentVice President, Chief Financial Officer and TreasurerVice President and Assistant SecretaryVice PresidentSecretaryAssistant SecretaryAssistant SecretaryAssistant Secretary

Gordon R. CrawleyDavid MartinezTimothy P. OrchardMichael EdwardsScott BottomleyAnthony L. Martino IIGeorge AldrichRaymond SanchezDennis Gansen

r further certify that the following is a true and correct copy of a resolution duly adopted by theBoard of Directors of said Company at a meeting held on February 15, 2012, and that thisresolution has not been in any way rescinded, annulled, or revoked but the same is still in fullforce and effect:

"BID TENDERS: GENERAL

RESOLVED, that any officer of the Corporation be' and they hereby areauthorized in the name and on behalf of the Corporation, under its corporate sealor otherwise (i) to prepare proposals and bids for the supplying of constructionmaterials and the performance by itself or in joint venture, of work of whatsoevernature in connection with the construction or paving of highways, roads andairports and in connection with earthworks and civil engineering projects of allkinds, together with all work incidental thereto, (ii) to execute and submit any andall such proposals and bids to any governmental authority, instrumentality, oragency of the United Stales, its several states, territories and possessions,including without limitation, any municipality or other political or corporatesubdivision thereof, and to any corporation, partnership, sole proprietorship, orother business entity, (iii) in connection with any such submission, to deliver biddeposits or bonds as may be required and (iv) to execute and deliver definitiveagreements binding the Corporation to perform work in accordance with anyproposals and bids authorized hereby."

IN WITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal this 23rdday of April 2012.

(SEAL)

Balboa Boulevard at Knollwood Plaza DrivewayW.O. No. E1907276; Federal Project No. HPLUL-5006(534)

&Balboa Boulevard and San Fernando Road

Intersection ImprovementW.O. No. El906350 ; Federal Project No. HPLUL-5006(490)

EIDBOND

(Not necessary when certified check or cashier's check accompanies bid)

We, the principal and undersigned Surety, acknowledge ourselves jointly and severally bound to theDepartment of Public Works of the City of Los Angeles, for an amount not less than ten percent (10%) of thetotal bid, to be paid to said Department ifthe proposal shall be accepted and the proposed contract awarded tothe principal, and the principal shall fail to execute the contract within the time specified by the generalinstructions in the proposal; and to furnish the required faithful performance and labor and material bonds,within the time specified. It is hereby agreed that bid errors shall not constitute a defense to forfeiture, exceptas provided by the State of California Public Contracting Code Sections 5101 through 5105, or as they may beamended.

WITNESS our hands this __ 14_th day of October ,20_13__ .

By: Sully-MillerContractingCompany

1. prilltNf)' of01\er ~±~",.eS=id=el~'t:=:'f\- _

~Signature

LibertyMutualInsurance CompanyPrint Surety's Name

8044 MontgomeryRd., Ste 150E, Cincinnati,OH45236Mailing Address

RAYMOND S.~NCHEZ, ASSISIf\NT SECRETARYTide

By: VictoriaM.CampbellPrint Narne

13Date Signature

2. Attorney-in-FactTitle

Michael Edwards, Vice PresidentSecond Signature Title Title

November 12, 2013Second Signature Date Title

NOTE: SIGNATURE OF THE AUTHORIZED AGENT OF THE SURETY MUST BE WITNESSED BY A NOTARY. If a bid bcud issubmitted on a form other than this form, the hid bond nmv not be acceptable. See Note 9 in the General Instructions andIufonnation for Bidders of tills proposal for more information.

07/03/06F-5


On November 12, 2013 before me, J. Daniels, Notary Public, personally appeared Michael Edwards &Raymond Sanchez

STATE OF CALIFORNIA }

who proved to me on the basis of satisfactory evidence tobe the person(s) whose name is/are subscribed to thewithin instrument and acknowledged to me thathe/she/they executed the same in his/her/their authorizedcapacity(ies), and that by his/her/their signature(s) on theinstrument the person(s), or the entity upon behalf ofwhich the person(s) acted, executed the instrument.

Icertify under PENALTY OF PERJURY under the laws ofthe State of California that the foregoing paragraph is trueand correct.

WITNESS my hand ?::!al

Signature -----,~'fT'-.-=--=...:..:.="'- _

COUNTY OF ORANGE

r-·----T.i:iXNlELsl." COMMif 1989544 ".w{~;.., Notary Public - California ~'" .,;,;;' ORANGE (OUN1Y ~I My Commission Expires Sept. 24, 2016;............-......._-_.-.--',~=-

Notary SealOPTIONAL


Title or Type of Document: --=.B"'id:.,:B;:,:o::.:,n"'dc-- _

Document Date: October 14, 2013


Number of Pages:


Signer's Name _M=ic::,:h.::ae.:::I:.,:E=d:..:w"'a"'rd:::s"- Signer's Name

D IndividualD IndividualQ9 Corporate Officer - Title(s) Vice President

Raymond Sanchez

Q9 Corporate Officer - Title(s) Assistant Secretary

D Partner - Limited/General D Partner - Limited/GeneralD Attorney In Fact Right Thumbprint

of SignerD Attorney In Fact Right Thumbprint

of Signer

D Trustee D TrusteeD Guardian or ConservatorD Other


D Guardian or ConservatorD Other

CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT

State of __ -'C,..,a"'li.,.,fo"-r"'ni"'a _

Countyof_~O~ffi~n~g~e~ __

OCT 142013On before me, Magali Melchor, Notary Public

----:::-DA;-:;T:;OE-~------- NAME, TITLE OF OFFICER - E.G., "JANE OOE, NOTARY PUBLIC"

personally appeared Victoria M. Campbell , whoproved to me on the basis of satisfactory evidence to be the person(s) whose names (s) is/aresubscribed to the within instrument and acknowledged to me that l1e/she/lMy executed the same inRis/her/tAeif authorized capacity(ies), and that by Ris/her/tAeif signature(s) on the instrument theperson(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

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

WITNESS my~d a I'd ~cial seal.

II --4 / ()\\) X"> J

r-- SIGN TU E OF NOTARY\

OPTIONALThough the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form.

CAPACITY CLAIMED BY SIGNERDINDIVIDUAL

DCORPORATE OFFICER

DESCRIPTION OF ATTACHED DOCUMENT

TITLE OR TYPE OF DOCUMENT

.. TITLE(S)

0 PARTNER(S) o LIMITEDo GENERAL[gJ A TIORNEY-IN-FACT

0 TRUSTEE(S)

NUMBER OF PAGES

o GUARDIAN/CONSERVATORo OTHER: __ OCT 14 2013

DATE OF OOCUMENT

SIGNER IS REPRESENTING:NAME OF PERSON(S) OR ENTITY(IES)

u~ ~lj)L5. CD SIGNER(S) OTHER THAN NAMED ABOVE

THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND,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.

Certificate No, 5952652

American Fire and Casualty CompanyThe Ohio Casualty Insurance Company

Uberty Mutual Insurance CompanyWest American Insurance Company

POWER OF ATTORNEYKNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casually Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws ofthe State of New Hampshire, that Uberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Companyis a corporation duly organized und~r the Jaws of the State of Indiana (herein collectively called the "Companies"), pursuentjo and by authority herein set forth, does hereby name, constituteand appoint, Christina Johnson; Erik Johansson; Kim Heredia; Linde Hotchkiss; Melissa Tetzlaff; Shirley Bauman; Victoria M. Campbell

aUofthecityof!rvine ..' state ofCA each individually if there be more than one named, its true and lawful atlorney-in-fact to make, execute, seal, acknowledgeanddeliver, for and on its behalf as surety and as its act and deed, any and aUundertaldngs, bonds, recognizances and other surety obligalions,in pursuance of these presents and shallbe 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 affixedthereto this 16th day of January ,~.

American Fire and Casualty CompanyThe Ohio Casualty Insurance CompanyUberty Mutual Insurance CompanyWest American Insurance Company

By: G~--:-sec,eta;y

~'00oe,OJ"0,~,.t/)c:(l)IIlJ!l.c c: STATE OF WASHINGTON.....!!! COUNTY OF KING,- IIIe 5, On this J§.!!l..... day of January , 2013 , before me personally appeared Gregory W. Davenport, who acknowledged himself to be the Assistant Secretary of AmericanU e Fire and Casualty Company, Uberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do,'O.=: execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.s.,;. .. ctJ4). > !N WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Seattle, lNashington, on the day and year first above written.~I l/::;i§(~;~;;""l By: ~e~~~bIiCSe.... ~ ..~.l...U.sf .~ ~';;:,~';)N;,:;;;~;~;~~~>'g.«; This Power of Attorney is made an~ executed pursuant to and by authority of the following By-laws and Authorizations of American Fire and Casualty Company, The Ohio Casualty Insuranceort Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:~ ~ ARTICLE IV - OFFICERS - Section 12. Power of Attorney, Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject~ -2 to. such limitation as the Chairman or the President may prescribe, shall appoint such attcrneya-ln-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal,0;5 acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such ahorneys-in-fact, subject to the limitations set forth in their respectiveE . ~ powers of attorney, shall 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

....5~ executed, such instruments shall be as binding as jf signed by the President and attested to by the Secretaiy. Any power or authority granted to any representative or attorney-In-fact underthe 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."0>-~ g ARTICLE XU! -: Execution of Contracts - SECTION 5. Surety~onds and Undertakings. Any officer of the Company authorized for that purpose in wrlting by the chairman orthe president,>. e:! and subject to such limitations as thechairman Of the president may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, execute,d 5 seal,ack~owledge and deliver as surety. any and all undertakings, bonds, recognizances and other surety obligations. Such atlorneys-ln-tact subject to the limitations set forth in theirZ (J respectve powers of attorney, shaH havefuU power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so

executed suchinstrumenls shall be as binding as if signed by the president and attested by the secretary.Certi~cateofDesignation - The Presldent of the Company, acting pursuant to the Bylaws of the Company, authorizes Gregory W, Davenport, Assistant Secretary to appoint suchanomeys-ln-fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and dellver as surety any and all undertakings, bonds, recognizances andother 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 theCompany, 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 withthe same force and effect as though manually affixed.

I, David M. Carey, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Uberty Mutual Insurance Company, and WestAmerican Insurance Company do hereby certify that the original power of attorney bfwhith the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies,is in ful! force and effect and has not been revoked. 1/111.. "2IN TESTIMONY WHEREOF, ! have hereunto set my hand and affixed the seals of said Companies this ~day of Cf.:\P ~( ,20~ .

By: d!/(~David M. Carey;"'Assistant Secretary

ss

475 of 500

Notice to Obligee: At all times herei~}fPted, any and all references to "Surety" shall incorporate "Co-Surety"

\U-uutrac-inr1~ 1lllnu~ Cfw"* I~~i~


State of __ -"C'-"a"'lif"'o"-'rn"'ia"- _

County of _--"02r"'a"'ng""e"- _

MAR 18 2014On _-;:;:-:;:;:- before me, V.M. Campbell, Notary Public ,

DATE NAME. TITLE OF OFFICER - E.G., "JANE DOE. NOTARY PUBLIC"

personally appeared Erik Johansson , whoproved to me on the basis of satisfactory evidence to be the person(s) whose names (s) is/aresubscribed to the within instrument and acknowledged to me that he/&lle/#1ey executed the same inhis/herltheir authorized capacity(ies), and that by his/llef/theif signature(s) on the instrument theperson(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

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

WITNESS my hand and official seal.

\Jv\;\,,~OPTIONAL

Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form,


DCORPORATE OFFICER



TITLE(S)

o PARTNER(S) o LIMITEDo GENERALNUMBER OF PAGESo ATTORNEY-IN-FACT

o TRUSTEE(S)o GUARDIAN/CONSERVATORo OTHER: _ MAR 18 2014

DATE OF DOCUMENT

SIGNER IS REPRESENTING:NAME OF PERSON(S) OR ENTITY(lES)

Liberty Mutual Insurance Company_Fidelity and Deposit Company of Maryland

SIGNER(S) OTHER THAN NAMED ABOVE


STATE OF CALIFORNIA }COUNTY OF ORANGE

On March 19, 2014 before me, M. Sykes, personally appeared Michael Edwards and Raymond Sanchezwho proved to me on the basis of satisfactory evidence tobe the person(s) whose name(s) islare subscribed to thewithin instrument and acknowledged to me thattlel&Aelthey executed the same in hislherltheir authorizedcapacity(ies), and that by his/hm/their signature(s) on theinstrument the person(s), or the entity upon behalf ofwhich the person(s) acted, executed the instrument.


WITNESS my hand anj:l 0rCial seal

Signature Ii A _ [;A;/'. A ~M.-s, es, Nr!Jt Public

Notary SealOPTIONAL


Title or Type of Document: Contractor's Bond

1March 18, 2014Document Date:

Sig ner( s) Other Than Named Above: _E",r",ik-,-J",o"-,h",a",n""ss,,,o,,-,n,,-,"-.A"'tt"'o"-rn"'e:Ly.c,-in"---'-F..o:a""ct'--- _


Signer's Name Raymond SanchezMichael Edwards

D Individual~ Corporate Officer - Title(s)

D Individual~ Corporate Officer - Title(s) Assistant SecretaryVice President

D Partner - Limited/GeneralD Partner - Limited/GeneralD Attorney In FactD Attorney In Fact Right Thumbprint

of SignerD TrusteeD Trustee

D Guardian or Conservator o Guardian or ConservatorD Other D Other


Notice to Obligee: At all times herein stated, any and all references to "Surety" shall incorporate "Co-Surety"cAe> ofJ {


State of __ ...!C",aS!!l!.!.ifo>!!r,",n~iaL...._

County of _~O!Lra!;!Jnwg,!JeL- _

MAR 18 2014On before me, V,M, Campbell, Notary Public ,

DATE NAME, TITLE OF OFFICER - E,G" "JANE DOE, NOTARY PUBLIC"

personally appeared Erik Johansson , whoproved to me on the basis of satisfactory evidence to be the person(s) whose names (s) is/aresubscribed to the within instrument and acknowledged to me that he/sI:le/#1ey executed the same inhis/her/their authorized capacity(ies), and that by his/J:!ef/tReiFsignature(s) on the instrument theperson(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

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

WITNESS my hand and official seal,

OPTIONALThough the data below is not required by law, it may prove valuable to persons relying on the document and could proven fraudulent reattachment of this form.


DCORPORATE OFFICER



TITLE(S)

o PARTNER(S) o LIMITEDo GENERALNUMBER OF PAGES

t8J ATTORNEY-IN-FACTo TRUSTEE(S)o GUARDIAN/CONSERVATORo OTHER: _ MAR 18 2014

DATE OF DOCUMENT

SIGNER IS REPRESENTING:NAME OF PERSON(S) OR ENTITY(IES)

Liberty Mutual Insurance Company_Fidelity and Deposit Company of Maryland

SIGNER(S) OTHER THAN NAMED ABOVE


. STATE OF CALIFORNIA }COUNTY OF ORANGE

On March 19, 2014 before me, M. Sykes, personally appeared Michael Edwards and Raymond Sanchez

who proved to me on the basis of satisfactory evidence tobe the person(s) whose name(s) is/are subscribed to thewithin instrument and acknowledged to me thathe/she/they executed the same in his/her/their authorizedcapacity(ies), and that by rnsthefitheir signature(s) on theinstrument the person(s), or the entity upon behalf ofwhich the person(s) acted, executed the instrument.J@ M.SYKES f I certify under PENALTY OF PERJURY under the laws ofCommission 111991623 the State of California that the foregoing paragraph is trueI'~.. Notary Public -California ~ and correct.

. Orange County !';My Comm. EXPires 00115, 2016 f WITNESS my hand and official seal

Signature M, ~N'l. Sykes, NotaPUbllC

Notary SealOPTIONAL


Title or Type of Document: Payment Bond

Document Date: March 18, 2014 Number of Pages: 1

Signer(s) Other Than Named Above: Erik Johansson, Attorney-in-Fact


Signer's Name Michael Edwards Signer's Name Raymond Sanchez

o Individual o Individual[g] Corporate Officer - Title(s) Vice President [g] Corporate Officer - Title(s) Assistant Secretar~

o Partner - Limited/General o Partner - Limited/Generalo Attorney In Fact .iK'~'~t.'~i$~~i•.·!> o Attorney In Fact RightThumbprintof Signero Trustee o TrusteeD Guardian or Conservator o Guardian or Conservatoro Other o Other


. tHiS POWER OF ATTORNEY IS NOT VALID UNLESS ITIS PRINTED ON RED BACKGROUt-lD.This poWer of Attorney limits the acts of those named herein, and they have nc authority to bind the Comp/l:ny except in the manner and to the extent herein stated.

Certificate No. 6417161 .American Fire and Casualty CompanyThe Ohio Casualty Insurance Company

Uberty Mutual Insurance CompanyWest American Insurance Company

, : , ,-:", .... .:POWER OF ATTORNEY

KNQWNALL PERSONS BYTHESE PRESENTS: ThatAmerican Fire & Casualty Company and The Ohio Casualty InsuranceCompany are corporations duly organized unde; the laws of.t~~,$t~e, ofNe~ f1aI!1P?hire-',thatPb~.rty fIilutgal ,!n~uranG~_qompany is l:' 9ofp9ra~on q~J!Y~~anizedJl~~~r.th~:,I~~ ofUJ~,(?ta,feQf Mas;3a¥D!1Sett$,_a~q_W~stAme~rican_1_nsu~nGeComp~~iis} ~9ip?~~9ndU.lY-?,rga~ize,~u~~,er:,t~~lawsof llie Sl~~eofl~,diana (h~re.in,(;o.lI~ctJv.e)H~lIed}~e~Co~p~r~,e~),p~~~9~ntti? an~,bY:i~th9~ty",~e~in~~tfo~h"do~.sherebY,'na,m,~,qonst,iWte

" ~M' appoirit; ,,'Christina JOhnso~;: Erik Johansson;. Jacqueline Kirkj:Unde ,H6fchkiss; Mel1ssa-Tetzlaff;'Shirley ~auman;, Victoria M.-Campbell, ' " ",', '" "

(,1\1 of ,t~e ?itY of}ivi6e , , _, ' ~ttlt~,,~!:::_',CA, , ", ,~,achf!)diy'idua'liy if there-'be',roof~t~anqn'~ __n~m~df _its ti1ie and lawfUl ~ttQm~y/l}-fact. to"Il1,ake,e,xe'cute;,s'~'~t.~~knbvi!e'cig~-'~ti~,~~,I!v~r,for.~nd ~njts ,~~,ha!fas,~urey~~n.~ a?:lt?,:~?tand de~_~"~.nyand aU,undertakjng,s'/q_9~~s,recP~i;i~(ln~e9"ai19,o_thersweti.Oblig§tlon,~;·in,.p.~fSt~an,9~pfthese ,Pre~~n~s,~nd,shal!

-__"-,~~p;s'_,9indl~~llPO',n,t~eCOhl~an!es ~s.jft.n~y,~a~e :~een_~ulysigne,~ bi;'the president, and _~~~,s!~tIby th~ '~e_cretaryoPD,~Compani~s ln ~h~rtp'~ry proper persons.

. IN 'WiTNE$$ W8EREOt; -this PO¥Je't'of Ait~o,eyh~S' been'_subscri~'edbX a,n:~uth,q~~e,~',;9ffiG~['or ciffiGi~i-Qt,the,CQri,p~ili~s a,nd':tfl~·(;prnq~a~5~~'ls:of the' C6'mpanies have been ~ffixedtFierelo'Jhis 'i5jb dayof,' JanLislry :,' ,~; .: ',:-'~ "'" ' , . :;;

."~~ 1fiJ!J~~~.~~~" ::::;:::=~::~':1:',::, ~{~C )JI1{C"'" )iJ ri",,''c)}) :~~Y~~;i~:~~~~~~~~~eC~:~;~~y .~.'u), ;,::Y"·7-:&~J10~~$:£:fJ,,,\~~¥:i:~~A3~::;\>y{,', ~'/'~!'01',~'f~:/,;/ ,,~:.e ,'~,~~~,:'" :'~"~, :- ,·~,.:;:::7: By: -;!~~f4-!;;;r.-,-::-------- '>;

.: -E STATEOF PENNSYLVANIA ss .1ii.;:.:E COUNTY OF WIJNTGOMERY c~ ~ Qn this 1;'h day~IJanuary , 2014" before me personally appeared David M" Carey, who acknowledged himself to be the Assistant Secretary of American Fire ~ ~'~' :'~' a,iid .t;~su_a!tyCo.~~any, Up~rty 'Mutua!.ln~.u.r~nc(Compariy,The Ohio,Gas_ualty C~nip~nYt:and vvest American Insurance Compa,~y, ,~nd t~at, he,' as sw;:h, 'be,ln9 aut~()~~ed' sf? to"do;-, .....v,~,:~ ~xec_~t~,theforeg()in9, irl~rument for ~,epurposes therein contained _bYSigningonbeha!f.oft~e,corporati,ons by himself ~~,a ~u!~aufhOriz_e~officir. ':, __ ' E:_::~;

',!J::~ IN'W1T.N$S_§~ERE9F,,J have hereuht~"su " afflxed ~ynotarial, ~_~aiat'Plymouth Meeting, ,PE;;nns;",ania,o~ th'e d~¥,a!1dyear fI,':S1. a,bove,:~en: , , E':,~,]r,~ ~g~~~9~,Vl!~AP'~~f_r~,N.!~?::f:~"lJA!'l~~~~--,:__,-::",;;,,,.:,,:',-"::-li~" -:,',',' - _ +01,0

~ "I,i()h·lrh;I~;r;,"i '. _. - _. :"'.":;--;:o"':':.u:€',- '1~)m~"jPt';?~"u,~.N(:(,,(yF',: r::~,:.~, " . " \' - ,'\ ~ , 'OF M'it"t;"~;,,"f"Gl~;~i;i'i;;:;;,~i;,c,

;;" _~ )he p:r9vls10~softhis erficle maybe revo~ed ~tanr-Utne by the Boam, the Chainnan; the Pre~id~~t 9f,by the officer or o~cers_gr~nting ,such p~,~ro~ a(J~hoiity, i{~,~,,:gARTI~,L~"XIJI-: Ex~cution ofContr~cts :~,~E9TIO~_5, Sur~ty Borids a,nd Undertakings~ Any _officer~fthe ,c;ompany authorized f()f that P~rp9S~,in ~riting by_thecQsirrnan Qrth~;preslden(~ 'i';t2:,?,j~:!'~hd_s~~j~ctto such limitatipns asihe_,chain:na'nQ~t~e president may prescribe, shaU appoint s'u~11,~ttomeys~jn~fact,as_may be necessary to'_sctin behalf of the C0!llpany to)'nake; ,execute; ';!::-~

_0 ,,,3 s~a!, :?G~!io\fJ!~ge, ,an9,d~liver as,sure~ _~nyand ,all uQdertakings, bonds, ,iec,ogni~ahg_~s~~d",oth~r s~r~ty obiigationsi __,SUCh"trtt?f}leXS:in_~fapt.s~bjectto the IimHatipns ~et fonh ilJ'ihei,r' ,t:,~.~-"9 r~sp:ct!ve, p~Wer~of a~?rney, s~~n hav¢ ,fti1!.:powerto bind t~e Co~pany ,byIheir:~!~_~atu~ ,an9~~xecl1tionqf any,such lnFfliinents_~i1,dto _?~,@cht~,~re~Q_the .se~~of the' Company. ,whe,~-so :'8'~

e~ecutfID'S~Ch instruT_ents shall be aS~bin~:i_~g_,aSifsigned ~~thepresid,ent arid, ~tte,sted bYIh,~,sec~tary: ": ~- ',_' ,:',':: ":" :"

ZURICH AMERICAN INSURANCE COMPANYCOLONIAL AMERICAN CASUALTY AND SURETY COMPANY

FIDELITY AND DEPOSIT COMPANY OF MARYLANDPOWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of NewYork, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITYAND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), byJAMES M. CARROLL, 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 Victoria M. CAMPBELL, Erik JOHANSSON and Christina JOHNSON, all of Irvine, California, EACH itstrue and lawful agent and Attorney-in-Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: anyand all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding uponsaid Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly electedofficers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of theCOLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly electedofficers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own properpersons.

The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, ofthe By-Laws of said Companies, and is now in force.

IN WI1NESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the saidZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, andFIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 5th day of September, A.D. 2013.

ATTEST:

ZURICH AMERICAN INSURANCE COMPANYCOLONIAL AMERICAN CASUALTY AND SURETY COMPANY

FIDELITY AND DEPOSIT COMPANY OF MARYLAND

Assistant SecretaryGregory l!. Murray

Vice PresidentJames M Carroll

State of MarylandCity of Baltimore

On this 5th day of September, A.D. 2013, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, JAMES M.CARROLL, Vice President, and GREGORY E. MURRAY, Assistant Secretary, of the Companies, to me personally known to be the individuals andofficers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith,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, andthat the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the saidCorporations.

IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written.\\'I\~!H~/f~I'11

(!~j~:;;;~Ii)'''HIII11'

Constance A. Dunn, Notary PublicMy Commission Expires: July 14,2015

POA-F 012·81230

CERTIFICATE OF INCUMBENCY AND RESOLUTION

I, Anthony L. Martino, II, do hereby certify that I am the Secretary of Sully-Miller ContractingCompany, a Delaware corporation, and that as such I have access to and custody ofthe corporaterecords and minute books of said corporation.

And I do hereby further certify that the following persons are duly elected officers of saidcorporation.

TITLE NAME

Chairman of the BoardPresidentVice President, Chief Financial Officer and TreasurerVice President and Assistant SecretaryVice PresidentSecretaryAssistant SecretaryAssistant SecretaryAssistant Secretary

Gordon R. CrawleyDavid MartinezTimothyP. OrchardMichael EdwardsScott BottomleyAnthony L. Martino IIJaeWonRaymond SanchezDennis Gansen

I further certify that the following is a true and correct copy of a resolution duly adopted by theBoard of Directors of said Company at a meeting held on December 12, 2013, and that thisresolution has not been in any way rescinded, annulled, or revoked but the same is still in fullforce and effect:

"BID TENDERS: GENERAL

RESOLVED, that any officer of the Corporation be and they hereby areauthorized in the name and on behalf of the Corporation, under its corporate sealor otherwise (i) to prepare proposals and bids for the supplying of constructionmaterials and the performance by itself or in joint venture, of work of whatsoevernature in connection with the construction or paving of highways, roads andairports and in connection with earthworks and civil engineering projects of allkinds, together with all work incidental thereto, (ii) to execute and submit any andall such proposals and bids to any governmental authority, instrumentality, oragency of the United States, its several states, territories and possessions,including without limitation, any municipality or other political or corporatesubdivision thereof, and to any corporation, partnership, sole proprietorship, orother business entity, (iii) in connection with any such submission, to deliver biddeposits or bonds as may be required and (iv) to execute and deliver definitiveagreements binding the Corporation to perform work in accordance with anyproposals and bids authorized hereby."

IN WITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal this 7th

"Y of February 2014. ~~

(SEAL) Anthony L. Ma , IISecretarySully-Miller Contracting Company135 S. State College Blvd., Ste. 400Brea, CA 92821

iN ,0, rco.:f.1BO·12tti; fJnw::~..H1-::'JJJL,5(!.g6(',r:'i~~'1},.w.o. No. E1906350; FP No. HPLUL-5006(490)

Noncollusion Affidavit(Title 23 United States Code Section LlZ and

Public Contract Code Section 7106)

To the CITY / COUNTY of LOS ANGELESDEPARTMENT OF PUBLIC WORKS.

In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares

that the bid is not made in the interest of, or 011 behalf of. any undisclosed persou, 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, and has not directly or

indirectly colluded, conspired. connived, or agreed with any bidder or anyone else to put in a sham bid, or that

anyone shall refrain from bidding; that the bidder bas 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 ill the proposed contract; that all

statements contained hi the bid are true; and. further, that the bidder has not, directly or indirectly, submitted his

Dr her bid price or any breakdown thereof, 01' the contents thereof: or divulged information or data relative

thereto, 01' 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.

Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal 011 the signatureportion thereof shall also constitute signature of this Noncollusion Affidavit. Bidders are cautioned thatmaking a false certification may subject the certifier to criminal prosecution.

Rev. 06/29/12F-G

. W,O, No, E1907276: FP No. HPLUL,5006(534)., "J' c .'! 'W:ct' No. ·E:f~u6350;-FI;;>NCi.''HPLUL-5006(490)

LIST OF SUBCONTRACTORS

In accordance with provisions pertaining to the listing of Subcontractors, the bidder shall list herein each first tierSubcontractor to whom it proposes to subcontract portions of the work in an amount in excess ofY, of 1% of theContractor's total bid or $10,000.00. whichever is greater, and the dollar value of each listed subcontract.

No DEE credit will be given unless the subcontracting amount is listed.

Name, Business Address, Telephone Subcontractor (1)Certification Dollar Value of SubcontractNumber, and Contact Person License Number Agency and

,rl C. .Date Certification #

W5 tea Yo ("", ~ " .....,./ License Number: LA CT MTA 1$7. '-/0. ---f""v,A," f/a-I/.. ~ C4 '1(7)"). f ~G.'13>;),q,{

W.O. No. E1907276; FP No. HPLUL-5006(534)W.O. No. E1906350; FP No. HPLUL-5006(490)

LIST OF SUBCONTRACTORS (continued)

VENDOR AND/OR SUPPLIER AND BROKER PARTICIPATION RECOGNITION

The bidder must list herein names of'vendors andlor suppliers and brokers and the dollar amounts for which the bidder hasobligated itself (list manufacturers on page F-7).

Vendor/Supplier/Broker Name, Business Address, Telephone number, and Certification Supplier/Broker Subcontract InformationContact Person Agency and

Certification # (1)

1&lue.- o: ) ;VI _-f-.P~,'", (

w.o. No. E1907276: FP No. HPLUL-5D06(534)W.O. No. E1906350; FF No. HPLUL~5006(48(j!

CITV OF Los ANGELESDEPARTMENT OF PUBLIC WORKS

FEDERALLY ASSISTED PROJECTS

EQUAL EMPLOYMENT OPPORTUNITY CERTIfiCATION

The I2lIbidderiDproposed subcontractor hereby certifies that he I1(jhaslD has not participated in a

previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders

10925, 11114, or 11246, and that, where required, he Im5 filed with the Joint Reporting Committee, theDirector of the Office of Federal Contract Compliance, a Federal Government contracting or

administering agency, or "the former President's Committee on Equal Employment Opportunity, all

reports due under the applicable filling requirements.

Note: The above certification is required by the Equal Employment Opportunity Regulations of theSecretary of Labor (41 CFR 60-1.7(b) (I», and must be submitted by bidders aud proposedsubcontractors only in connection with contracts and subcontracts, which are subject to the equalopportunity clause. Contracts and subcontracts which are exempt from the equal opportunityclause are set forth in 41 CFR 60-LS. (Generally only contracts or subcontracts of $10,000 orunder are exempt)

Currently, Standard Form 100 (EEO-l) is the only report required by the Executive Orders ortheir implementing regulations.

Proposed prime contractors and subcontractors who have participated in a previous contract orsubcontract subject to the Executive Orders and have 110tfiled tile required reports should notethat 41 CPR 60-L7(b) (1) prevents the award of contracts and subcontracts unless such contractorsubmits a report covering the delinquent period or such other period specified by the FederalHighway Administration or by the Director, Office of Federal' Contract Compliance, U.S.Department of Labor.

EQUAL EMPLOVMENT OPPORTUNITY OFFICER

Project Title: Balboa Blvd @ Knollwood Plaza Driveway & Balboa Blvd. and San Fernando Rd.OCCNo.: Work Order No.: E1907276& E1906350 Intersection Improv.Please be advised that Sully-Miller Contracting Co. hereby appoints Mary Lawson, Human Resources Director

Company Name

as its Equal Employment Opportunity Officer. The Officer may be contacted at 714/[email protected] Phnnc Namber

or concerning matters related to this fum's efforts to administer ande-mail

promote an active Equal Employment Opportunity Progrardeclares under penalty of perjury that the information contain

Upor siereon i tr

ing below,and correct.

ecretary

June 29,2012

F-9


STATE OF CALIFORNIA

COUNTY OF ORANGE}

On November 12, 2013 before me, J. Daniels, Notary Public, personally appeared Raymond Sanchezwho proved to me on the basis of satisfactory evidence tobe the person(s) whose name is/are subscribed to thewithin instrument and acknowledged to me thathe/she/they executed the same in his/her/their authorizedcapacity(ies), and that by his/her/their signature(s) on theinstrument the person(s), or the entity upon behalf ofwhich the person(s) acted, executed the instrument.


r-..·_...---,..........-l- cJd~'im~'g44,.Notary Public ~California fa

'" . '. ORANGE COUNTY -I "'!ii.\i.li~ My (omml)~io!'l Expires Sept. 24, 2016:_________ •__ ;.1

Notary Seal

WITNESS my han~al

Signature ~

OPTIONAL



Title or Type of Document: Equal Employment Opportunity Certification/Egual Employment Opportunity Officer

Number of Pages:



Signer's Name ...:R:..:a:::.y,-,-m:.:..o",n.::d,-S::::a",n.::c",h",e::.zSigner's Name

o Individual[]I Corporate Officer - Title(s) Assistant Secretary







"iV.O. No, E!9DT2T6··;··FEN6:·HPtU.f·.,"{im.'8{5·:~!'!.) .W.O. No. E1906350; FP No. HPLUL-5006(490)

NONLOBBYING CERTIFICATIONFOR FEDERAL-AID CONTRACTS

The prospective participant certifies, by signing and submitting this bid or proposal, to the bestof his or her knowledge and belief; that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of theundersigned, to any person for influencing or attempting to influence an officer oremployee of any Federal agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with the awarding ofany Federal contract, the making of any Federal grant, the making of any Federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, 103n, or cooperativeagreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to anyperson for influencing or attempting to influence an officer or employee of any Federalagency, a Member of Congress, all officer or employee of Congress, or an employee of aMember of Congress in connection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard FOTIll-LLL, "Disclosureof Lobbying Activities," in conformance with its instructions.

This certification is a material representation of fact upon which reliance was placed when thistransaction was made or entered into. Submission of this certification is a prerequisite formaking or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Anyperson who fails to file the required certification shall be subject to a civil penalty of not lessthan $10,000 and not more than $100,000 for each such failure.

The prospective participant also agrees by submitting his or her bid or proposal that he or sheshall require that the language of this certification be included in all lower tier subcontracts,which exceed $100,000 and that all such subrecipients sl1311certify and disclose accordingly.

Rev. 06/29/12F-IO

W.O. No. E1.9072.76; FP No. HPLUL-5006(534jvv_v.No'. EHJ{jBs~SO;'FP N'6: fiPLUL~5006(4'90)

" .. -1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:D fl. contract D8. bid/offbr/aoulication D a. initial

b. grant b. initial award b. material c~augee. cooperative agreement c. post-awardd. loan For Material Change Only:e, loan guarantee year __ quarterf. loan insurance date of last report

4. Name and Address of Repcrtlng Entity 5. If Reporting Entity in No.4 is Subawardee,Enter Name and Address of Prime:o Prime o Subawardee

Tier ___ , ifknown

Ccuzressional District, ifknown N/A Congressional Dlsrrlcr, ifknown6. Federal Department/ Agency; 7. Federal Program Name/Desceiptioru

CFDA Number, if applicable

8. Federal Action Number, ifknown: 9. Award Amount, :ifkuown:

H. a. Name and Address of Lobby Entit)' b. Individuals Performing S~rvices (including(If individual, last name, first name, NIl) address if different from No. lOa)

(last name, first name, MI)

(attach Continuation Sheeus) ifnecessery)

11. Amount of Payment (check 1111that


On November 12, 2013 before me, J. Daniels, Notary Public, personally appeared Raymond Sanchezwho proved to me on the basis of satisfactory evidence tobe the person(s) whose name is/are subscribed to thewithin instrument and acknowledged to me thathe/she/they executed the same in his/her/their authorizedcapacity(ies), and that by his/her/their signature(s) on theinstrument the person(s), or the entity upon behalf ofwhich the person(s) acted, executed the instrument.


WITNESS my hand~1

Signature .. Danie!s, Notary Public

STATE OF CALIFORNIA }

OPT/ONAL

COUNTY OF ORANGE

r---"-J.DANl€L§-l- COMM# 1989544 "ffi Notary Public ~California ~'" ORANGE COUNJY -! MyCommi5sion Expires Sept. 24, 2016:_ .... __ .- • ....--..._._ .......

W.O. No. E1907276; FP No. HPLUl.-5006(531)W.O. No. E1906350; FP No. HPLUL-5006(490)

INSTRUCTIONS FOR C01VIPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiationor receipt of covered Federal action or a material change to previous filing pursuant to title 31 U.S.C. section 1352. The filingof a form is required for such payment 01' agreement to make payment to lobbying entity for influencing or attempting toinfluence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of aMember of Congress in connection with a covered Federal action. Attach a continuation sheet for additional information if the'pace on the form is inadequate. Complete all items that apply for both the initial filing and material change report, Refer tothe implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence, theoutcome of a covered Federal action.

2. Identify the status of the covered Federal action.3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the

information previously reported, enter the year and quarter ill which the change OCCUlTed. Enter the date of the last,previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city. state and zip code of the reporting entity. Include Congressional District if known.Check the appropriate classification of the reporting entity that designates ifit is or expects to be a prime or subawardrecipient. Identify the tier of the subawardee, e.g-, the first subawardee of the prime is the first tier. Subawardsinclude but ere not limited to subcontracts. subgrants and contract awards under grants.

5. If the organization filing the report ill Ite1l14 checks "Subawardee" then enter the full name, address, city, state and zipcode of the prime Federal recipient Include Congressional District, if known.

6. Enter the name of the Federal agency making the award or loan commitment Include at least one organization levelbelow agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known. enter the fullCatalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loancommitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identification in item 1 [e.g.,Request for Proposal (RFP) number, Invitation for Bid (IPB) number, grant announcement DUmber,the coutract grant.or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes,e.g., "RFP-DE-90-001." _

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, eater theFederal amount of the award/Joan commitments for the prime entity identified in item 4 or S.

10. (a) Enter the full name, address, city. state and zip code of the lobbying entity engaged by the reporting entityidentified in item c to influenced the covered Federal action.(b) Enter the full names of the iudividual(s) performing services and include full address if different fromlO (a). EnterLast Name, First Name and Middle Initial (MI).

11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to thelobbying entity (item 10). Indicate whether the p

contract summary sheetclkrep.lacity.org/onlinecontracts/2014/c-123891_c_03-28... · 2014-05-07 ·...

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