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HomeMy WebLinkAboutJob 2. John Madonna Construction Co. Inc. North ChorroBID FORMS — ADDENDUM NO. 1 BID FORMS — ADDENDUM NO. 1 All bid forms must be completed and submitted with your bid. Failure to submit these forms and required bid bond is cause to reject the bid as nonresponsive. Staple all bid forms together. THE UNDERSIGNED, agrees that they have carefully examined: 1. the location of the proposed work 2. the plans and specifications 3. read the accompanying instructions to bidders and propose to furnish all: materials labor to complete all the required work satisfactorily in compliance with plans specifications special provisions for the prices set forth in the bid item list: BID ITEM LIST FOR NORTH CHORRO NEIGHBORHOOD GREENWAY, SPECIFICATION NO. 1000036 Item Item Unit of Estimated Item Price Total No. SS,� � Description p Measure Quantity y (in figures) in fiaures 1 7 9, TRAFFIC CONTROL PLAN AND LS 1 12 IMPLEMENTATION C60 2 5,9 CONSTRUCTION SURVEY LS 1 o 3 5, 9, 7 COMPLY WITH CALTRANS LS 1 ENCROACHMENT PERMIT 2000 7D00 COMPLY WITH GRANT DEED AND 4 5, 9, 7 RIGHT OF WAY AGREEMENT — LS 1 / . 6mO BIKE PATH 5 9, 15, CLEARING, GRUBBING, AND LIMB LS 1 17 REMOVAL 4vbD 4,DObQ 6 9 15 CHORRO STREET SQFT 10000 26, 39 RECONSTRUCTION �$ Woo 9, 15, 7 26, CLASS I BIKE PATH (OPTION 2) SQFT 6600 73, 90 9, 15, 8 26, MINOR CONCRETE (SIDEWALK) SQFT 1700 73,90 21 • 37400 9, 15, 9 26, MINOR CONCRETE (CURB AND LF 2355 39, GUTTER) 73, 90 1 1 1�iC7, 17io b2 BID FORMS —ADDENDUM NO. 1 A BID FORMS - ADDENDUM NO. 1 9, 15, 10 26, MINOR CONCRETE (CROSS LF 250 39, GUTTER) 73, 90 7UU06 9, 15, 11 26, MINOR CONCRETE (DRIVEWAY SQFT 800 39, RAMPS) 73,90 12 9, 73, MINOR CONCRETE (1.25' LF 1600 it... 90 CONCRETE BIKE MEDIAN) , 13 9, 73, MINOR CONCRETE (T CONCRETE LF 1650 90 BIKE MEDIAN) to 14 9, 15, MINOR CONCRETE (SIDEWALK EA 1 73,90 UNDERDRAIN) woo 1400D 9, 15, 20, MINOR CONCRETE (ENERGY 15 26, DISSIPATION STRUCTURE AND EA 1 73, 90 COBBLE) i00� �UDD 9, 15, 26, STRUCTURE CONCRETE (CURB & 16 GUTTER RETAINING WALL - LF 172 73, 90 BROAD ST - STA 21+40 TO 23+12) (p00 j03200 9, 15, 26, STRUCTURE CONCRETE 17 (RETAINING WALL - BIKE PATH - LF 180 73, 90 STA 1+00 TO 2+80) lbcD 144Mo 9, 15, 26, STRUCTURE CONCRETE 18 (LANDSCAPE HIGH CURB - LF 123 73190 CHORRO/101) voo. 1*ram 9, 15, 19 26, STRUCTURE CONCRETE (CMU EA 1 51, PILASTER - BIKE PATH) � 73, 90 (� 20 9,37 TYPE II SLURRY SEAL SQYD 30,440 �$Z 21 9, 15, BIKE LANE AND EXISTING CURB LS 1 37 RAMP EDGE GRIND �D� 20060 22 9, 12 TEMPORARY STRIPING AND PAVEMENT MARKINGS LS 1 �020DD �OZOOc> 23 9, 15, 39 MINOR HOT MIX ASPHALT (CASE 1 -10" THICK) SQFT 2,330 27. (GIt110 24 9, 39 MINOR HOT MIX ASPHALT (SPEED EA 7 HUMP - TYPE 2) 25 9,15 ADJUST STORMDRAIN MANHOLE EA 6 TO GRADE G�IbO 26 9,15 ADJUST SANITARY SEWER MANHOLE TO GRADE, EA 3 ZG�jO 27 9, 15 ADJUST COMMUNICATION VAULT/MANHOLE/BOX TO GRADE EA 36 28 9,15 ADJUST WATER VALVE TO GRADE EA 12 IpO(j. �ZOp BID FORMS -ADDENDUM NO. 1 -mp BID FORMS - ADDENDUM NO. 1 29 9,15 ADJUST WATER METER TO GRADE EA 11 DO. WOOD 30 9764' 18" HDPE STORM DRAIN PIPE LF 63 Q*O 25-3� 31 9 15, MINOR CONCRETE (STORMDRAIN EA 1 39,77 CATCH BASIN) 2000o ZDOao 32 9 15, MINOR CONCRETE (STORMDRAIN EA 2 39,77 MANHOLE) ZOG,(;0 40100 33 9 64, 6" PERFORATED UNDERDRAIN LF 62 77 PIPE Tlr2 0 34 9 15, MINOR CONCRETE (12" MIDSTATE EA 3� I�00 77 STORMDRAIN CATCH BASIN) 35 9, 15, MINOR CONCRETE (24" MIDSTATE EA 1D� 77 STORMDRAIN CATCH BASIN) REMOVE AND REPLACE 36 9, 64, STORMDRAIN INLET GRATE AND EA 17 77 INSTALL FILTEREXX STORMEXX 7Lo4D• 44M FILTER 37 9, 82 12' PUNCH POST EA 45 I DZlvp 38 9,82 14' PUNCH POST EA 3 IZ 39 9, 82 R1-1 SIGN 18" EA 2 40 9, 82 R1-1 SIGN 30" EA 4 1po. tGo 41 9,82 R1-2 SIGN 25" EA 1 lo0. UD 42 9, 82 R1-3P PLAQUE EA 4 I I Irg. 4(po . 43 9, 82 R4-11 SIGN EA 7 'LOp , 140b 44 9, 82 R5-3 SIGN EA 2 Atco 45 9, 82 R7-9 SIGN EA 18 1 ZG�LV 46 9, 82 R10-15 (MODIFIED) "YIELD TO EA 5 BIKE" SIGN 1000 47 9,82 R81 (CA) SIGN EA 3 14%0. 48 9, 82 R81A (CA) SIGN EA 2 IGI, Z?10 49 9, 82 R81 B (CA) SIGN EA 5 50 9, 82 W1-1 SIGN EA 2 TOx 51 9, 82 W1-2L SIGN EA 2 1.530 52 9, 82 W44P SIGN EA 1 1Z0. I -lb 53 9, 82 W11-2 SIGN EA 8 130. IW 54 9, 82 W16-7P SIGN EA 8 13(vo 55 9,82 W84 (CA) SIGN EA 3 Vi0 • (AD 56 9, 82 GREENWAY ARROW PLAQUE EA 8 1140. 1 lu 57 9, 82 GREENWAY SIGN EA 19 'L�j, rj 58 9, 82 PEXCO CITY POST MODEL EAC, EA 23 qzoo 36" WHITE WITH 2 GREY WRAPS -4oD 59 9, 82 72" WHEEL STOP EA 8 140. 1 IZo 6" YELLOW TACTILE GUIDE STRIP, 60 9,82 VANGUARD ADA SYSTEMS OR LF 82 �$�� APPROVED EQUAL$' BID FORMS -ADDENDUM NO. 1 BID FORMS - ADDENDUM NO. 1 61 9,82 INSTALL EXISTING / RELOCATED SIGN EA 16 2 4P,4,o0 62 9,84 CURB PAINT LF 200 . 63 9,84 PREFORMED THERMOPLASTIC SHEETS (BROAD/MURRAY) SQFT 120 • tAw 64 9, 84 ZICLA ZEBRA CYCLE TRACK LANE SEPARATORS EA 48 �v 11040 65 9,84 4" YELLOW STRIPING LF 1,300 I •-70 1140 66 9,84 DETAIL 1 LF 2,750 I •gyp 67 9,84 DETAIL 8 LF 50 '1.*o U441r j*r 68 9,84 DETAIL 22 LF 2,450 -Z• ,"Do 69 9,84 DETAIL 39 LF 3,750 110 lv%j,Ty 70 9,84 BIKE BUFFER LF 1,360 '3•40 4t 71 9,84 BIKE BUFFER AT DRIVEWAY SQFT 1,140 ,IGJ *q1 72 9,84 HI-VIS CROSSWALK EA 35 1 4y. mclOp 73 9,84 STOP BAR LF 465 Gj•_10 Z(pljv- 74 9,84 STOP LEGEND EA 32 1.500. 13(60 75 9,84 STOP LEGEND (1/2 SCALE) EA 7 1-70 • 11010 76 9,84 BIKE / PED DIRECTIONAL SYMBOL EA 2 4.00. Q)OD 77 9,84 TYPE II ARROW EA 1 2Qfj 75r7 78 9,84 TYPE IV ARROW EA 1 I-f0 110 79 9,84 HUMP LEGEND EA 12 80 9,84 PED LEGEND EA 2 Gf%p. 81 9,84 XING LEGEND EA 4 '7gr-7 1140 82 9, 84 SLOW LEGEND EA 2 Zmj• FljV, 83 9, 84 SCHOOL LEGEND EA 4 84 9,84 TURNING BIKE BOX EA 3 14m. 47co 85 9,84 BIKE SYMBOL & ARROW EA 23 loo. (pi06 86 9,84 GREENBACK CHEVRON EA 25 ( p. 1(pz*o 87 9,84 GREENBACK SHARROW EA 2 Gj(�, 1 m 88 9,84 GREENWAY SYMBOL EA 22 ?1+00 %4U0 89 9,84 GREEN BIKE LANE MARKINGS (CASE 1) LF 118 1.11. 10?3$ 90 9,84 GREEN BIKE LANE MARKINGS (CASE 2) LF 286 q 1• 7&07- 6 91 9,84 GREEN BIKE LANE MARKINGS (CASE 3) LF 364 1 • %f3(?J� 92 9,84 GREEN SEALMASTER COLOR SAFE PAVEMENT MARKING SQFT 5,640 l i. w 93 9, 84 YIELD LINE EA 5 94 9, 84, 87 RELOCATE RRFB SOLAR CROSSWALK (RAMONA) LS 1 95 9, 84, 87 RRFB SOLAR CROSSWALK (CHORRO/MILL) LS 1 MOW. BID FORMS -ADDENDUM NO. 1 BID FORMS — ADDENDUM NO. 1 FOOTHILL TO RAMONA BIKE PATH 96 9,86 LIGHTING / CHORRO LIGHTING / LS 1� CHORRO PG&E SERVICE 97 9, 20 BENCHES (BIKE PATH & CHORRO/MOUNTAIN VIEW) EA 3 �GJ00 p 98 9,20 TRASH CONTAINER (BIKE PATH) EA 2 b 99 9,20 METAL PATH) PICKET FENCING (BIKE LF 136 100 9,20 CHAINLINK FENCE (CHORRO /101) LF 297 ( I$ 101 9,20 CHAINLINK GATES (CHORRO /101) EA 6 CT70. 1;pb p 102 9,20 SOIL PREPARATION (NON- BIORETENTION & TREE PITS) CY 130 =0. 2$1000 103 9,20 BIORETENTION SOIL MIX CY 90 tie? (mlpr;;p 104 9,20 CLASS II DRAIN ROCK TON 200 (06 p 105 9,20 ENERGY DISSIPATOR ROCK TON 5 p I Ipcv 106 9,20 IRRIGATION LS 1 *900 141;qCo 107 9,20 TREE WATERING BAGS (NON- EA 35 ItAt IRRIGATED TREES) 108 9,20 PLANTING (SHRUBS - ALL AREAS) SQFT 10,672 144 ZDZ? 109 9,20 PLANTING (TREES - ALL AREAS) EA 63 28 110 9,20 GREENWAY PLANTERS/SOIL/PLANTS EA 285 Tfr7. ?2081 111 9,20 MULCH (BIORETENTION AREAS) CY 9 Ilo. loft 112 9,20 MULCH (CONVENTIONAL CY 96 PLANTING AREAS & TREES) 113 9, 20 GREENWAY PLANTERS MAINT/WATERING (1-YR) LS 1 (moo b 114 9, 20 ESTABLISHMENT/MAINTENANCE LS 1� 3a1 ALL TREES & PLANTS (1 YR) 115 9,20 HAND WATER NON -IRRIGATED EA 35 TREES (1-YR)i� 116 9,20 HAND WATER NON -IRRIGATED LS 1V (d80D UNDERSTORY PLANTINGS (1-YR) 117 9,73 CURB RAMP ALMOND -MISSION (E) C-4.17 LS 1ppp tilfxjU 118 9, 73 CURB RAMP BROAD -MISSION (E) LS 1 2100d ZI DUO C-4.16 119 9,73 CURB RAMP BROAD -MISSION (N) LS 1 ZJ pp0 ZIG�O C-4.15 120 9,73 CURB RAMP CENTER-CHORRO LS 1 vpg�bo zjvr� (NE) C-4.26 121 9,73 CURB RAMP CENTER-CHORRO (NW) C-4.25 LS 1 143w0 Y-3(cCD 122 9,73 CURB RAMP CENTER-CHORRO LS 1 (SE) C-4.27 rjilco viloo 123 9,73 CURB RAMP CENTER-CHORRO (SW) C-4.28 LS 1 23700 ✓ r�6 124 9,73 CURB RAMP CERRO ROMAULDO- LS 1 yZGJDD Z2SC0 FERRINI (NW) C-4.4 BID FORMS -ADDENDUM NO. 1 Q. BID FORMS - ADDENDUM NO. 1 125 9,73 CURB RAMP CERRO ROMAULDO- LS 1 -x9,-.o svzlio FERRINI SE C-4.3 126 9,73 CURB RAMP FELTON-FERRINI LS 1 0(7) (NW) C-4.2 ODOM 127 9,73 CURB RAMP FELTON-FERRINI LS 1 (SW) C-4.1 10000 Uoua 128 9, 73 CURB RAMP LINCOLN-CHORRO LS 1 27rJQ0 .� (NE) C-4.35 129 9,73 CURB RAMP LINCOLN-CHORRO LS 1 (NW) C-4.34 TZPVW zumo 130 9,73 CURB RAMP LINCOLN-CHORRO LS 1 2?CV0 (SE) C-4.36 230W 131 9, 73 CURB RAMP LINCOLN-CHORRO LS 1 Zp ?-7�00 (SW) C-4.37 132 9, 73 CURB RAMP MEINEKE-BROAD (N) LS 1 Z4,qDO 74,q C-4.8 dcj 133 9, 73 CURB RAMP MEINEKE-BROAD (S) LS 1 ZO?UC) C-4.9 U10U 134 9,73 CURB RAMP MEINEKE C-4.10 LS 1 ZZOOD 135 9, 73 CURB RAMP MILL-CHORRO (NW) LS 1 zo-J00 Zo30D C-4.46 136 9, 73 CURB RAMP MILL-CHORRO (NE) LS 1 C-4.49 f &oov Zfccm 137 9, 73 CURB RAMP MILL-CHORRO (SE) LS 1 7-5coD Z30M C-4.48 138 9, 73 CURB RAMP MILL-CHORRO (SW) LS 1 IZW()O p,(vOCJ� C-4.47 139 9,73 CURB RAMP MISSION-CHORRO LS 1 vcrvcv �GJCO (NE) C-4.20 140 9,73 CURB RAMP MISSION-CHORRO LS 1 2u�� (NW) C-4.19 141 9,73 CURB RAMP MISSION-CHORRO LS 1 (SE) C-4.21 2�l�ci�o ?.hoed 142 9,73 CURB RAMP MISSION-CHORRO LS 1 (SW) C-4.22 143 9, 73 CURB RAMP MISSION BULBOUT LS 1 700M wvvo C-4.18 144 9,73 CURB RAMP MOUNTAIN VIEW- LS 1 I&CD VFW CHORRO (NE) C-4.30 145 9,73 CURB RAMP MOUNTAIN VIEW- LS 1 7-:300D CHORRO (NW) C-4.29 Z-60M 146 9,73 CURB RAMP MOUNTAIN VIEW- CHORRO (SE) C-4.31 LS 1 .69?00 --3q7w 147 9,73 CURB RAMP MOUNTAIN VIEW- LS 1 CHORRO (SW) C-4.33 148 9,73 CURB RAMP MURRAY-BROAD (E) LS 1 22S�oo C-4.12 Z?500 149 9, 73 CURB RAMP MURRAY-BROAD (N) LS 1 Zp7DD OD100 C-4.11 150 9,73 CURB RAMP MURRAY-BROAD (S) LS 1 IZ= ZeoQO C-4.13 BID FORMS -ADDENDUM NO. 1 BID FORMS — ADDENDUM NO. 1 151 9,73 C URB RAMP MURRAY-BROAD (W) LS 1 ZO�E'.14 OD 152 9, 73 CURB RAMP PEACH-CHORRO LS 1 le-rco (SE) C-4.43 Z�:s�-T6100 153 9,73 CURB RAMP PEACH-CHORRO LS 1 (NW) C-4.45 154 9,73 CURB RAMP PEACH-CHORRO LS 1 (SW) C-4.44 155 9,73 CURB RAMP PEACH-CHORRO LS 1 (NE) C-4.42 156 9,73 CURC 4 6B RAMP RAMONA-BROAD (E) LS 1 7D7 7021�0 157 9, 73 CURB RAMP RAMONA-BROAD (W) LS 1 C-4.7 158 9,73 CURB RAMP RAMONA CROSSING LS 1 C-4.5 23000 159 9,73 CURB RAMP VENABLE-CHORRO LS 1 ZZa� (NE) C-4.23 =ow 160 9,73 CURB RAMP WALNUT-CHORRO LS 1 (SE) C-4.40 161 9,73 CURB RAMP WALNUT-CHORRO LS 1 2!7000 ZZWD (SE) C-4.24 162 9,73 CURB RAMP WALNUT-CHORRO LS 1 4I�pF.X� (N) C-4.38 163 9,19 GRADING CUT (BIKE CY 300 6t0[, 7-17O0 PROUGH 164 9,19 ROUGH GRADING CUT (STORM CY 200 WATER MITIGATION AREAS) 165 9,77 REMOVE EXISTING MANHOLE EA 1 AND INSTALL (N) SEWERU MANHOLE 166 9,77 INSTALL COATING ON (N) SEWER EA 1 I�OCV 110L7D MANHOLE 167 9.77 REMOVE EXISTING CLEANOUT EA 1 AND INSTALL (N) SEWER �Ocv fmo CLEANOUT 168 9,77 REMOVE EXISTING 12" CMP AND LF 45 INSTALL (N) 12" PVC �r_ 440 lgeM STORMDRAIN • 169 9,77 ABANDON EXISTING SEWERLINE LF 275 AND INSTALL (N) 6" HDPE 3�• �3�� SEWERLINE 170 9,77 CONNECT TO EXISTING SDMH EA 1 PER ENG. STD. 3540 171 9,77 CONNECT EXISTING SEWER EA 4 1000 4= LATERAL TO SEWER MAIN 172 9,77 RE -GRADE SEWER LATERAL LF 10 BEYOND 6 FEET 173 9,77 REMOVE EXISTING CONCRETE LS 1 OUTLET STRUCTURE 174 9,77 INSTALL (N) CATCH BASIN EA 1 �Cj(y,�p IFA" 175 9,73 REMOVE AND REPLACE SQFT 60 IA Lao, SIDEWALK BID FORMS -ADDENDUM NO. 1 BID FORMS — ADDENDUM NO. 1 176 9,77 BYPASS PUMPING LS 1 JOCO -.5gCW 177 9,77 POTHOLING LS 1 pp «70p Bid Total (or Base Bid) $ r? qr�q C)OU. Company Name: ThVIVI Ml1(jhY1V1/l. (%h4S,:1' j_rgjj- j An. j hU (1) refers to section in the Standard Specifications, with modifications in the Special Provisions, that describe required work. Contractor shall provide a schedule of values for all LS items before or at the pre -construction meeting. BID FORMS —ADDENDUM NO. 1 H BID FORMS LIST OF SUBCONTRACTORS Pursuant to Section 4100 of the Public Contracts Code and section 2-1.33C of the standard specifications, the Bidder is required to furnish the following information for each Subcontractor performing more than 1/2 percent (0.5%) of the total base bid. Do not list alternative subcontractors for the same work. Subcontracting must not total more than fifty percent (50%) of the submitted bid except as allowed in section 5-1.13 of the standard specifications. For Streets & Highways projects, subcontractors performing less than ten thousand dollars ($10,000) worth of work need not be mentioned. Subcontractors required to pay prevailing wage, must be registered with the Department of Industrial Relations pursuant to Labor Code section 1725.5 to be listed. NOTE: If there are no subcontractors, write "NONE" and submit with bid. DIR Public % of Works Address and Phone Specific Total Name Under Which Registration Number of Office, Mill or Description of Base Subcontractor is Licensed License Number Number Shop Subcontract Bid CI aZM6 - 10000 l o2(v C&AcY.k, 1'1. 9 ?Akwtw , 99�� iOCOO Ye� cos �Sas OS 368 Attach additional sheets as needed DDO(7U5G-19 TOGS qt*y [aAL, �51,(k�l� I .Z 61k.10 S Lyj 44 BID FORMS H BID FORMS LIST OF SUBCONTRACTORS Pursuant to Section 4100 of the Public Contracts Code and section 2-1.33C of the standard specifications, the Bidder is required to furnish the following information for each Subcontractor performing more than 1/2 percent (0.5%) of the total base bid. Do not list alternative subcontractors for the same work. Subcontracting must not total more than fifty percent (50%) of the submitted bid except as allowed in section 5-1.13 of the standard specifications. For Streets & Highways projects, subcontractors performing less than ten thousand dollars ($10,000) worth of work need not be mentioned. Subcontractors required to pay prevailing wage, must be registered with the Department of Industrial Relations pursuant to Labor Code section 1725.5 to be listed. NOTE: If there are no subcontractors, write "NONE" and submit with bid. DIR Public Works Address and Phone Specific Name Under Which Registration Number of Office, Mill or Description of Subcontractor is Licensed License Number Number Shop Subcontract $RS �f'73 o g8�1 li,go�ly. 318y34 1�000 ►3�1'� Poor 40r7 V YAI&h 6017 100000 _M711 LIZ V11, Attach additional sheets as needed. BID FORMS H VQS' y44 1'l9 I % of Total Base Bid 1.3 bA lc�2�lo �� 51:r�►d � L � � 'llq s2tP l T "� P6,CA 11 ?474 BID FORMS LIST OF SUBCONTRACTORS Pursuant to Section 4100 of the Public Contracts Code and section 2-1.33C of the standard specifications, the Bidder is required to furnish the following information for each Subcontractor performing more than 1/2 percent (0.5%) of the total base bid. Do not list alternative subcontractors for the same work. Subcontracting must not total more than fifty percent (50%) of the submitted bid except as allowed in section 5-1.13 of the standard specifications. For Streets & Highways projects, subcontractors performing less than ten thousand dollars ($10,000) worth of work need not be mentioned. Subcontractors required to pay prevailing wage, must be registered with the Department of Industrial Relations pursuant to Labor Code section 1725.5 to be listed. NOTE: If there are no subcontractors, write "NONE" and submit with bid. Name Under Which Subcontractor is Licensed License Number Attach additional sheets as needed. DIR Public % of Works Address and Phone Specific Total Registration Number of Office, Mill or Description of Base Number Shop Subcontract Bid BID FORMS H BID FORMS PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In compliance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder, or any subcontractor to be engaged by the bidder, has , has not ,,/ been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. NOTE: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Bid. Signing this Bid on the signature portion constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE In compliance with Public Contract Code Section 10162, the Bidder must complete, under penalty of perjury, the following questionnaire: Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation? Yes ✓ No If the answer is yes, attach a letter explaining the circumstances PUBLIC CONTRACT CODE SECTION 10232 STATEMENT In compliance with Public Contract Code Section 10232, you hereby state under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against you within the immediately preceding two-year period because of your failure to comply with an order of a federal court which orders you to comply with an order of the National Labor Relations Board. LABOR CODE SECTION 1725.5 STATEMENTS The bidder has delinquent liability to an employee or the state for any assessment of back wages or related damages, interest, fines, or penalties pursuant to any final judgment, order, or determination by a court or any federal, state, or local administrative agency, including a confirmed arbitration award. Any judgment, order, or determination that is BID FORMS I BID FORMS under appeal is excluded, provided that the contractor has secured the payment of any amount eventually found due through a bond or other appropriate means. Yes No The bidder is currently debarred under Section 1777.1 or under any other federal or state law providing for the debarment of contractors from public works. Yes ✓ No NOTE: The above Statements and Questionnaire are part of the Bid. Signing this Bid on the signature portion constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. BID FORMS J BID FORMS NON -COLLUSION DECLARATION I. ;Tf i HAAonvin- declare that am Cit of T0!yl Hael y"a st- to • In(, 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, 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 refrained 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. Executed on Zl0 , 20 'L3 , inSM S I declare under penalty of perjury u th is true and correct. r ��"CiAG�'ED CC�i1�(CA'� State of California that the foregoing M (Signature and Title of Declarant) Subscribed and swo fore me �h' _ day of 20 Notary Public Company Name: 7Ghn Madonna, l wsI . BID FORMS K A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Luis Obispo Subscribed and sworn to (or affirmed) before me on this ;Nil day of _ SOlX1VLA.N_, 20 Z 3 , by SOhVI Madcn6 proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. *my COUItTNEY YANU Notary Public • California San Luis Obispo County Commission M 2393705 Comm. Expires Feb 11. 2026 (Seal) Signature__ BID FORMS BIDDER ACKNOWLEDGEMENTS By signing below, the bidder acknowledges and confirms that this bid is based on the information contained in all contract documents, including the notice to bidders, plans, specifications, special provisions, and addendum number(s) _! (Note: You are responsible to verify the number of addenda prior to the bid opening.) The undersigned further agrees that in case of default in executing the required contract, with necessary bonds, within eight days, (not including Saturdays, Sundays, and legal holidays), after having received a mailed notice that the contract is ready for signature, the proceeds of the check or bond accompanying his bid will become the property of the City of San Luis Obispo. Licensed in accordance with an act providing for the registration of contractors, License No.,"Eation Date. The above statement is made under pen of pe G n y b' not containing this information "will be considered non -responsive and will be r cte e i Signature of Bidder ITOM Madmvia.. WED (Print Name and Title of Bidder) DIR— Public W s Registratio o: ( VVW0"-J-7 Business Name (DBA): Owner/Legal Name: J-0(IVI HOLAO nta, CW tv 01on Co• Inc - Indicate One: ❑Sole -proprietor ❑ Partnership E3Corporation List Partners/Corporate Officers: awn Hadmna. W Name Title Connie Wad c,�o Name Title Name Title Business Address TO eral b ' / Street Address .I' eO, Los OS6 s V & Mailing Address (`0 -To( 1 1�i C) City, State, Zip Code SQL L.w $ Obl sVp 4 CA q-W3 Phone Number cbcr� 647J -1-IrA Fax Number Email Address (Aony la • CaYL Date 3 (- BID FORMS L BID FORMS QUALIFICATIONS Failure to furnish complete reference information ON THIS FORM, as specified in this project's Notice to Bidders and indicated below, is cause to reject the bid. Additional information may be attached but is not a substitute for this form. Reference Number 1 Customer Name & Contact Individual Telephone & Email Y 1-73 4poc� E1 Project Name (Site Address): Did this project include curb ramp construction? Yes v' No ❑ Was this contract for a public agency? Yes V No ❑ Reference Number 2 c�.vtc�.Gw ®�IfnYlUb�acVl Describe the services provided and how this project is similar to that which is being bid: CWsb .I,ch'ccn 00 cmcx Px �tcQ,2vUcLt.k-, C(.�Vb qLt . , A -Ph rAMP3 1 WWt+c, JK.vt-Wtj Date oroiect com Customer Name & Contact Individual. Telephone & Email 4x* -TV 4-7 t9 J4CMC .c @ ao • S to . OA - u-4-, Project Name (Site Address): mA i caqucvs Ne mw-ranla , li-mv ict&-pY. Ca.Uuem, Did this project include curb ramp Describe the services provided and how this project is sir construction? that which is being bid: Yes rl No ❑- - - - - yucifo 1 �b'tVUW Wd.� -fnry(,I,d Was this contract for a public agency? +"V— GUCM "cl- v—" rom Yes Ee' No ❑ Reference Number 3 Customer Name & Cont R t a -Yo-" Individual Telephone & Email q I Go 21 Ib 2440 Project Name (Site Address): Attu t Cas11t U",l Did this project include roadway maintenance by slurry sealing? Yes ❑ No @T Was this contract for a public agency? Yes e( No ❑ Date project completed: 4(2ost . M. 60 a mm2a -. "m;v 1i'CFAw+- Wte.- 12ct. SOIt(1 So Describe the services provided and how this project is similar to that which is being bid: Pam IN .e-i r�1WA, �m cu-ct,�,ri, -Fcpcx�y 4yepa�,r ra 'CLWGLA Date project completed: l 1 =7,4 BID FORMS M C+ cOA BID FORMS ATTACH BIDDER'S BOND TO ACCOMPANY BID Know all men by these presents: Thatwe JOHN MADONNA CONSTRUCTION CO., INC. AS PRINCIPAL, and THE OHIO CASUALTY INSURANCE COMPANY AS SURETY, are held and firmly bound unto the City of San Luis Obispo in the sum of: TEN PERCENT OF AMOUNT BID Dollars ( 10% OF BID_) to be paid to said City or its certain attorney, its successors and assigns; for which payment, well and truly to be made, we bind ourselves, our heirs, executors and administrators, successors or assigns, jointly and severally, firmly by these presents: THE CONDITION OF THIS OBLIGATION IS SUCH, that if the certain bid of the above bounden PRINCIPAL to construct NORTH CHORRO NEIGHBORHOOD GREENWAY, SPEC NO. 1000036 (insert name of street and limits to be improved or project) dated JANUARY 31 ST, 2023 is accepted by the City of San Luis Obispo, and if the above bounden PRINCIPAL , his heirs, executors, administrators, successors, and assigns shall duly enter into and execute a contract for such construction and shall execute and deliver the two bonds described within ten (10) days (not including Saturdays, Sundays, or legal holidays) after the above bounden, PRINCIPAL , has received notice by and from the said City of San Luis Obispo that said contract is ready for execution, then this obligation shall become null and void; otherwise, it shall be and remain in full force and virtue. IN VVITNESSVAVFGR, we hereunto set our hands and seals this 23 day of JAN. , 20 23 13idder,-Kr-jd9"/,0HN)(4ADONNA CONSTRUCTION CO., INC. A E Surety: THE OHIO CASUALTY INSURANCE COMPANY BRITTON CHRISTIANSEN, ATTORNEY -in -FACT Bidder's signature is not required to be notarized. Surety's signature must be notarized. Equivalent form may be substituted (Rev. 6-3414) BID FORMS H 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. Liberty Mutual, SURETY Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY Certificate No: 8201903-969577 KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Britton Christiansen; Myma Smith; Philip E. Vega; Kevin E. Vega all of the city of Covina state of Califomia each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 15th day of August , 2019 Liberty Mutual Insurance Company 1NSUR �ZY INSU d tNS(igq The Ohio Casualty Insurance Company �Jp`°aP°R�fgZc yJQ`°aP°R�r�9y `<+P V°aPO�rr �n West American Insurance Company `�o `"o � a 1912 � 0 1919 � 1991 0 N d�e7) Drug* da �o�y! ^*peta�a�o fs�M°*Mt•�aa By: (� c David M. Carey, Assistant Secretary i- State of PENNSYLVANIA � County of MONTGOMERY ss v1 L) aD On this 15th day of August 2019 before me personally appeared David M Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance o 23 Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes > therein contained by signing on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written rn PAt O COMMONWEALTH OF PENNSYLVANIA �'0 V ��•s Notarial Seal T /��?Q%� O ~ ._- t Teresa Pastella, Notary Public O " Upper Merton Twp , Montgomery County By: C (D pT J My Commission Expires March 28, 2021 Teresa Pastella, Notary Public N to Member, Peormyhanta Aesocalron of Nola b� � aD This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual o .S Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: E - ARTICLE IV — OFFICERS: Section 12 Power of Attorney. o m Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the v > President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety > C: any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall ` have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation When so executed, such Z � instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 23RD day of JANUARY , 2023 1NSUA �SY INSU a %NSuo �Jp4°avar----- 0 oiJ�o°avogrrQyy VP`oaPory- 4r% u� 3 ``o m 'Mu 1912 c s 1919�y, o 1991 a�� 'y'y�CNU4F'�da SOhAMP��`e L� 'l �h01ANP S By: i �aa Renee C. Llewellyn, Assistant Secretary If H N w oC:) Q� O� C L r0 tl (a 0 d/ O ,= rn w c Da) v� >o w� N M O O H19 LMS-12873 LMIC OCIC WAIC Multi Co 062018 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of LOS ANGELES On JAN 13 2023 Date personally appeared before me, Kevin Vega, Notary Public Here Insert Name and Title of the Officer Britton Christiansen, Attorney -in -Fact Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the personK whose nameN is/arm subscribed to the within instrument and acknowledged to me that he/&.Q/f tw executed the same in his/hi%/their authorized capacity(les) and that by his/he;/biei4� signatureN on the instrument the personN, or the entity upon behalf of which the personN acted, executed the instrument. KEVIN EDWARD VEGA Notary Public - California j., Los Angeles County > Commission K 2326181 My Comm. Expires Apr 29. 2024 — Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and icial s l� Signature SigrAffture of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: ©2014 National Notary Association • www.NationalNotary.org - 1-800-US NOTARY (1-800-876-6827) Item #5907