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Vance Corporation BidSECTION 1200 BID DATE: 07/23/2020 The undersigned, as bidder, declares it has received and examined the Contract Document entitled Project No. 2020-04, Washington Street Pavement Rehabilitation, and will contract with the City, on the form of Contract provided herewith, to do everything required for the fulfillment of the contract for said work at the prices and on the terms and conditions herein contained. We have included the following items and agree that they shall form a part of this bid: SECTION TITLE 1200 Bid 1210 Bid Schedule 1220 Bid Guaranty Bond 1230 Certification of Bidder's Experience and Qualifications 1240 Proposed Subcontractors 1250 Non -Collusion Affidavit 1260 DIR Project Vendor Information We acknowledge that the following addenda have been received and have been examined as part of -the -Contract Documents. Bidders must be off- the -Plan Holders List with the City of La Quinta in order to receive addenda. Addendum # n Date Received 07/24/2020 Initials Attached is a bid guaranty bond as required by Paragraph 1110-15.0, BID GUARANTY. Vance Corporation Name of Bidder (909) 355-4333 Bidder's Telephone Number Bid 1200-1 If our bid is accepted, we agree to sign the contract without qualifications and to furnish the performance and payment bonds and the required evidence of insurance within 10 calendar days after receiving written notice of the award of the contract. 'We further agree, if our bid is accepted and a Contract for performance of the work is entered into with the City, to so plan work and to prosecute it with such diligence that the work shall be completed within the time stipulated. Vance Corporation Name of Bidder 17761 Slover Avenue Bidder's Address 414567 Contractor's License No. California State of Incorporation 4- Sigil'ature of Bidder Verner E. Thomas Printed Name of Signatory -- Preside ----- Title of Signatory (909) 355-4333 Bidder's Telephone Number vthomas@vancecorp.net Bidder's Email Address 11 /30/2021 Contractor's Expiration Date Vice President of Operations Title of Witness Bid 1200-2 ADDENDUM 01 — JULY 24, 2020 SECTION 1210 BID SCHEDULE PROJECT NO. 2020-04 WASHINGTON STREET PAVEMENT REHABILITATION City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 To Whom It May Concern: Pursuant to the Invitation to Bid, and in accordance with the provisions therein stated, the undersigned hereby proposes and agrees that on award by the City under this Bid, to execute a Contract, with necessary bonds, to furnish and install any and all labor, materials, transportation and services for Project No. 2020-04, Washington Street Pavement Rehabilitation, in accordance with the plans and specifications therefore adopted and on file with the City within the time hereinafter set forth and at the prices named in this Bid. It is understood that the basis of award shall be the lowest total price of the Base Bid Area plus All Additive Alternates. Unit prices in each and every case represent the true unit price used in preparing the bid schedule totals (Bid Form). Unit prices listed herein include material, installation and appurtenant work as is necessary to have the item complete and in place meeting the full intent of the plans and specifications. We acknowledge that unbalanced unit prices shall be sufficient cause for the rejection of our bid. Bid Schedule 1210-1 ADDENDUM 01 - DULY 24, 2020 BASE BID - WASHINGTON STREET PAVEMENT REHABILITATION Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars I Dollars 1 Mobilization 1 LS $ : cm- $ 54- Ooo - 2 Traffic Control 1 LS $-78"000 3 Dust Control 1 LS $ ow, - $ -Ig ox 4 2" Grind and Overlay 360,479 SF $ a� $ icy' Continue to Full Depth Asphalt Concrete Grind 5 (3.5"f), Compact Existing 1,275 SF $ 6a ] $ Aggregate Base, and 5.5" �1� Asphalt Concrete Overlay to Bottom of Final Lift Remove and Construct 5.5" 6 AC over 6.5" AB, CLQ STD. 321 SF $aL�" $ 78g� 195 7 Remove Existing Concrete Sidewalk, Ramps, and 5,105 SF oo $ S _ $,5� Cross -Gutters 8 Remove Existing Curb and Curb & Gutter (Regardless 307 LF ZF $ of Height) 9 Crack Seal and Type II 11,157 SF Slurry Seal Construct Curb & Gutter per 10 City of La Quinta Std. Dwg. 307 LF $ �� $ ��0� 201and 202 (Regardless of Hei ht Construct Sidewalk per City o 11 of La Quinta Standard 240 615 SF $ /�'� $-7,3Q- Mod. / Construct Concrete Curb , 12 Ramps per City of La Quinta 9 EA $� �Q(� $ 900' Standard 250 Mod. ' Construct Portion of Cross- ,So 13 Gutter per City of La Quinta 735 SF $'� ' $ lo? <�7 STD 230 Mod. and 231 Mod. 14 Lower and Raise Drainage 1 EA lob $ j aoo Manhole to Grade r 15 Striping and All Incidentals 1 LS $ 0D- $ 39, 00- Total Amount of Bid Items 1 - is $ 767X'33 Bid Schedule 1210-2 ADDENDUM 01 - JULY 24, 2020 City may award all or none of the following additive alternates: ADDITIVE ALTERNATE No. 1 — 7Item Item Description No. 1 Lower Sewer Manhole per CVWD Standards 2 Raise Sewer Manhole per CVWD Standards AnnTTTVF All TFRNATF Nn_ 7 - Est. Unit Unit Price Qty. (in figures) Dollars 9 EA $ J. 9 EA $ �ls/ Total Amount of Bid Items 1 — 2 Item Total (in figures) Dollars Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Lower Water Valve per 19 EA C ;o $ 00, $ CVWD Standards 2 Raise Water Valve per 19 EA $ $7�' / $ �ro,s�' CVWD Standards Total Amount of Bid Items 1 — 2 I $�1p�030 °a AnnTTTVF ALTERNATE Nn. 3 - Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Lower Irrigation Valve per 3 EA oc $ jQQ'� $ 1,SOD CVWD Standards 2 Raise Irrigation Valve per 3 EA $ g7(�' °� $ a��Q CVWD Standards Total Amount of Bid Items 1 — 2 $ q AnnTTTVF All TFRNATF Nn_ 4 - Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Lower Frontier Manhole with 1 EA Vehicle Traffic Rated Ca Total Amount of Bid Items 1 $ 7/0 ' Bid Schedule 1210-3 ADDENDUM 01 - JULY 24, 2020 AnnTTTVE ALTERNATE No. 5 - Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 2" Grind and Overlay with 504 SF oo $ aL�' $ 096 Pavement Fabric Replace obliterated striping, pavement markings, and 2 pavement markers in 2" 1 LS $ $ Grind and Overlay with Pavement Fabric construction area. Total Amount of Bid Items 1 — 2 $'cif pO GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES(Figures): 7?ff 3D . P3 GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Words): n 11 - I _ _a 1. Bid Amount of each of the above Bid Items must be filled in and completed. It is understood that the quantities shown hereon are but estimates and the bidder is responsible to verify quantities prior to submitting a bid. Final payment will be based upon actual work performed, subject to such adjustments and alterations as elsewhere provided herein. Verner E. Thomas (909) 355-4333 VthomasawancecoKp.net Signature of Bidder (Ink) Name of Bidder (Printed or Typed) Bidder Telephone Number Bidder Email Address Bid Schedule 1210-4 SECTION 1220 BID GUARANTY BOND Vance Corporation, PRINCIPAL, and SureTec Insurance Company , as SURETY, are held and firmly bound unto the City in the penal sum of TEN (10) PERCENT OF THE TOTAL AMOUNT OF THE BID of the Principal above named, submitted by said Principal to the City for the work described below, for the payment of which sum in lawful money of the United States, well and truly to be made to the City to which said bid was submitted, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT WHEREAS, the Principal has submitted the above -mentioned bid to the City, for certain construction specifically described as follows, for which bids are to be opened at La Quinta, California. PROJECT NO. 2020-04 WASHINGTON STREET PAVEMENT REHABILITATION NOW, THEREFORE, if the aforesaid Principal is awarded the contract and, within the time and manner required under the specifications, after the prescribed forms are presented to him/her for signature enters into a written contract in the prescribed form, in accordance with the bid, and files two bonds with the City, one to guarantee faithful performance, and the other to guarantee payment for labor and materials as required by law, and provide certificate of insurance coverage required by the Contract Documents, then this obligation shall be null and void; otherwise, it shall be and remain in full force and virtue. IN WITNESS WHEREOF, we have hereunto set our hands on this 20th day of JUN . 2020. Vance Corporation President Title of Signatory SureTec Insurance Company Jeri Apodaca, Attorney -in -Fact Title of Signatory I G)r) k- ` Signature of Principal Verner E. T arnas Si ature o€S ety 17761 Slover Ave., Bloomington, CA 92316 3131 Camino del Rio N., #1450, San Diego, CA 921,08 Address Address Note: Signatures of those executing for the surety must be properly acknowledged. Bid Guaranty Bond 1220-1 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 ------------- r 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 Bernardino On July 23rd, 2020 before me, Date personally appeared ) Macawi Muhammad, Notary Public Here Insert Name and Title of the Officer Verner E. Thomas Name(ssj;of Signer(SX who proved to me on the basis of satisfactory evidence to be the person(* whose name(*X ism subscribed to the within instrument and acknowledged to me that hehish>mW executed the same in hiskjerftotixauthorized capacity( and that by hisDfMR signature* on the instrument the personfq or the entity upon behalf of which the personft acted, executed the instrument. MACAWI MUHAMMAD Notary Public -California San Bernardino County z z Commission # 2168128 r My Comm Expires Oct 15, 2020 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 official seal. Signature "Signaturec ry 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 DocumentBid Bond; City of La Quinta Title or Type of Document: Washington St. Rehab- 42020-04 Document Date: 07/20/2020 Number of Pages: ] Signer(s) Other Than Named Above: Jeri Apodaca, Attorney -in -Fact Capacity#es)cClaimed by SignerN Signer's Name: Verner E. Thomas X Corporate Officer — Title(s): President C I Partner — ❑ Limited J General _l Individual ❑ Attorney in Fact Trustee ❑ Guardian or Conservator -i Other: Signer Is Representing: Vance Corporation Signer's Name: 0 Corporate Officer — Title(s): 1 7 Partner — Ll Limited ❑ General C Individual Ll Attorney in Fact Trusteej Guardian or Conservator ❑ Other: Signer Is Representing: 02014 National Notary Association • www.Nationa]Notary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL ., A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of �_ Orange ) On _ JUL 2 0 2020 —before me, _ Heather Rose Saltarelli, Notary Public � Date Here Insert Name and Title of the Officer personally appeared Jeri Apodaca Name(s) of Signer(s) — who proved to me on the basis of satisfactory evidence to be the person(} whose name(* is/axe subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(bW, and that by his/her/tkodr signature(s) on the instrument the person(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 foregoing paragraph is true and correct. WITNESS my hand and official seal. HEATHER ROSE SALTARELLI T Notary Public - California Cf Y A�n {� PhIt6"I-aw Orange CountySignatures w LY- '!`"-� 5 Commission # 224E219 Signature of Notary Public My Comm. Expires Jul 27, 2022 Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: __ Document Date- Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ---- Corporate Officer — Title(s): Partner — i_] Limited ; General Individual x[ Attorney in Fact Trustee f,.i Guardian or Conservator Other: Signer Is Representing: Signer's Name: Corporate Officer — Title(s): l Partner — Limited General Individual ! _i Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing: 02014 National Notary Association • www.NationaiNotary.org a 1-800-US NOTARY (1-800-876-6827) ltem #5907 p0A #: 510761 -Newport Beach SureTec Insurance Company LIMITED POWER OF ATTORNEY Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents make, constitute and appoint Rhonda C. Abel, Kim Luu, Michael Parizino, Rachelle Rheault, James A. Schaller, Maria Guise, Heather Saltarelli, Jeri Apodaca, Reece Joel Diaz its true and lawful Attorney -in -fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for, providing the bond penalty does not exceed Five Million and 00/100 Dollars ($5,000,000.00) and to hind the Company thereby as fully and to the same extent as if such bond were signed by the CEO, sealed with the corporate sea[ of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney -in -Fact may do in the premises. Said appointment is made under and by authority of the following resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys) -in -Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney -in -Fact may be given full power and authority for and in the name of and of behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or abligatory undertakings and any and ail notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held an 20, of April 1999.) In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its CEO, and its corporate seal to be hereto affixed this 30th day of March A.D. 2020. SURETECINSt NY }�URAN�.0 Cl % 1.+ a Wr q Lri By: w w a` John Kno ., CE State of Texas ss: 7 County of Harris ..........x f On this 30th day of March •, A.D. 2020 before me personally came John Knox Jr., to me known, who, being by me duly swom, did depose and say, that he resiaes in Houston, Texas, that he is CEO of SURETEC INSURANCE COMPANY, the company described in and which executed the above instrument; that he knows the seal of said Company; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said Company; and that he signed his name thereto by like order. JACOLJELYN GREENLEAF � ,YiY gU�li + -u�?yf flotary Public, State of Texas •": I' ir` Comm. Expires 05-18 2021 j •,;A�ti;;`••` Notary ID 126903029 "—A M L��_ Jacq elyn Greenleaf, Notary Public L My commission expires May 18, 2021 I, M. Brent Beaty, Assistant Secretary of SURETEC INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Company, which is still in full force and effect; and furthermore, the resolutions of the Board of Directors, set out in the Power of Attorney are in full force and effect. Given under my hand and the seal of said Company at Houston, Texas this ^day of JUL 2 U 20 4 A.D. — ' ;I . Brenf Beaty, A`Kistant SecVetary Any instrument issued in excess of the penalty stated above is totally void and without any validity. 510761 For verification of the authority of this power you may call (713) 812-0800 any business day between 8:30 am and 5:00 pm CST. SECTION 1230 CERTIFICATION OF BIDDER'S EXPERIENCE AND -QUALIFICATIONS The undersigned Bidder certifies that he is, at the time of bidding, and shall be, throughout the period of the contract, licensed under the provisions of Chapter 9, Division 3, of the Business and Professions Code of the State of California, to do the type of work contemplated in the Contract Documents. Bidder shall further certify that it is skilled and regularly engaged in the general class and type of work called for in the Contract Documents. The Bidder represents that it is competent, knowledgeable, and has special skills on the nature, extent, and inherent conditions of the work to be performed. Bidder further acknowledges that there are certain peculiar and inherent conditions existent in the construction of the particular facilities, which may create, during the construction program, unusual or peculiar unsafe conditions hazardous to persons and property. Bidder expressly acknowledges that it is aware of such peculiar risks and that it has the skill and experience to foresee and to adopt protective measures to adequately and safely perform the construction work with respect to such hazards. The Bidder shall list below four (4) projects completed in the last seven (7) years of similar size and complexity that indicate the Bidder's experience as a General Contractor. 1. Project Name: 2019 Citywide Street Improvements Owner: City of Perris 2. Construction Cost: $--2.355,371.40 Construction Time: 100 working days C�ldx� Owner's Representative: Brad Brophy, P. E. Owner's Telephone No.: 951 943-6504 Date of Substantial_ Completion: 03/20/2020 Project Name: Victoria Avenue Pavement Rehabilitation Owner: City of Highland Construction Cost: $ 1,439,981.92 Construction Time: 45 working days Owner's Representative: S_,9rin�_7,,9rn,9no, P. E- Owner's Telephone No.: (909) 864-6861 Date of Substantial Completion: 10/10/2018 CaIltmyg Bidders Experience & Qualifications 1230-1 3. 4. Project Name: Dinah Shore Drive Pavement Rehabilitation Owner: City of Rancho Mirage Construction Cost: $ 1,439,981.92 Construction Time: 60 __Calendar Days Owner's Representative: Lelan Cole, P. E. Owner's Telephone No.: (760) 770-3224 x 272 Date of Substantial Completion: 02/03/2019 Project Name: Newport Road Widening Owner: City of Menifee Construction Cost: $, 3,051,579.90 Construction Time: 70 working days Owner's Representative: Carlos Geronimo Owner's Telephone No.: (951) 723-3722 Date of Substantial Completion: 05/02/2017 Signed this 23rd day of Jul 2020. Vance Corporation 414567 1000008103 Name of Bidder Contractor's License No. DIR Reg No. 11/30/2021 Signature of Bidder Expiration Date Verner E. Thomas President Printed Name of Bidder Title of Signatory Bidders Experience & Qualifications 1230-2 SECTION 1240 PROPOSED SUBCONTRACTORS Pursuant to California Public Contracting Code, Section 4100 et. seq., the following list gives the name, business address, and portion of work (description of work to be done) for each subcontractor that will be used in the work if the bidder is awarded the Contract. (Additional supporting data may be attached to this page. Each page shall be sequentially numbered and headed "Proposed Subcontractors" and shall be signed.) The Contractor shall perform, with its own organization, Contract work amounting to at least 50 percent of the Contract Price except that any designated `Specialty Items" may be performed by subcontract and the amount of any such "Specialty Items" so performed will be deducted from the Contract Price before computing the amount required to be performed by the Contractor with its own organization. "Specialty Items" will be identified by the Agency in the Bid or in the Special Provisions. Where an entire item is subcontracted, the value of work subcontracted will be based on the Contract Unit Price. Subcontractor/Business Address/Description of ork�oof Work/License No./DIR Reg No. M Signature of Bidder Verner omas Vance Corporation Name of Bidder Proposed Subcontractors 1240-1 SECTION 1240 PROPOSED SUBCONTRACTORS Pursuant to California Public Contracting Code, Section 4100 et. seq., the following list gives the name, business address, and portion of work (description of work to be done) for each subcontractor that will be used in the work if the bidder is awarded the Contract. (Additional supporting data may be attached to this page. Each page shall be sequentially numbered and headed "Proposed Subcontractors" and shall be signed.) The Contractor shall perform, with its own organization, Contract work amounting to at least 50 percent of the Contract Price except that any designated "Specialty Items" may be performed by subcontract and the amount of any such "Specialty Items" so performed will be deducted from the Contract Price before computing the amount required to be performed by the Contractor with its own organization. "Specialty Items" will be identified by the Agency in the Bid or in the Special Provisions. Where an entire item is subcontracted, the value of work subcontracted will be based on the Contract Unit Price. Subcontractor/Business Address/Description of Work/% of Work/License No./DIR Reg No. ZZ2---- --,6�7- , Signature of Bidder erner E: Thomas Vance Corporation Name of Bidder Proposed Subcontractors 1240-1 SECTION 1240 PROPOSED SUBCONTRACTORS Pursuant to California Public Contracting Code, Section 4100 et. seq., the following list gives the name, business address, and portion of work (description of work to be done) for each subcontractor that will be used in the work if the bidder is awarded the Contract. (Additional supporting data may be attached to this page. Each page shall be sequentially numbered and headed "Proposed Subcontractors" and shall be signed.) The Contractor shall perform, with its own organization, Contract work amounting to at least 50 percent of the Contract Price except that any designated "Specialty Items" may be performed by subcontract and the amount of any such "Specialty Items" so performed will be deducted from the Contract Price before computing the amount required to be performed by the Contractor with its own organization. "Specialty Items" will be identified by the Agency in the Bid or in the Special Provisions. Where an entire item is subcontracted, the value of work subcontracted will be based on the Contract Unit Price. Subcontractor/Business Address/Description of Work/% of Work/License No./DIR Reg No. /,,! � -, � �� 7 Signature of Bidder Verner E. as Vance Corporation Name of Bidder Proposed Subcontractors 1240-1 SECTION 1250 NON -COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ss. County of San Bernardino Verner E. Thomas being first duly sworn, deposes and say that he or she is President of Vance Corporation ., 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 shall refrain from bidding; that the bidder has not in any manner, directly or indirectly sought by contract, 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. le— Switure Vance Corporation Name of Bidder President Title 07/23/2020 Date Non -Collusion Affidavit 1250-1 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 N See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) 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 Subscribed and sworn to (or affirmed) before me County of San Bernardino on this 23rd day of July , 2020 , by (and (2) Date Month Year Verner E. Thomas Name of Signer(sX proved to me on the basis of satisfactory evidence to be the person(: who appeared before me. Signature Place Notary Seal Above Signature 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 Non -Collusion Affidavit City of La Quinta; Washington St., Rehab Title or Type of Document: Project # 2020-04 Document Date: 07/23/2020 Number of Pages: 1 Signer(s) Other Than Named Above: No other singer 02016 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5910 Vendor Information: Name; SECTION 1260 DIR Project Vendor Information Vance Corporation Address: 17761 Slover Avenue Zip: 92316 Project Manager: Bruce Barrie Phone: (909) 355-4333 City: Bloomington ST: CA Email: bbarrie@vancecorp.net CSLB/Certification Number: 414567 Public Works Registration No.: 1000008103 Classification: Asbestos Boilermaker Bricklayers Carpenter Carpet/Linoleum Cement Masons Drywall Finisher Drywall/Lathers Electricians Elevator Mechanic Glaziers Iron Workers Laborers X Millwrights Operating-EngX Painters Pile Drivers Pipe -Trades Plasterers_ Roofer SheetMetal Sound/Com Surveyor Teamster X Tile Worker Prevailing Wages and Payroll: -_The_project_is-s_ubject-to-pr_evailing_wa-ge_ rates -and -enforcement -by the Department___ ____ of Industrial Relations (DIR). Prevailing wage rates can be obtained at: http://www.dir.ca.gov/Public-Works/Prevailing-Wage.html. Contractors and subcontractors on most public Works projects are required to submit certified payroll records to the Labor Commissioner using DIR's electronic certified payroll reporting system. For your convenience, the link for reporting certified payroll is: htt www.dir.ca. ov Public -Works Certified -Pa roll- Reporting.html. A copy of certified payroll, including the names and addresses of employees and/or subcontractors working on the job must be included with invoices submitted to the City of La Quinta. DIR Project Vendor Information 1260-1