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2022-18 DBX, Inc. BidSECTION 1200 BID DATE: 07/26/2022 The undersigned, as bidder, declares it has received and examined the Contract Document entitled Project No. 2022-18, SilverRock Park Venue Wi-Fi and Camera Backbone, 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 1270 Iran Contracting Act of 2010 1280 Russian Aggression Against Ukraine Sanctions We acknowledge that the following addenda have been received and have been examined as part of the Contract Documents. Bidders must be on the Plan Holders List with the City of La Quinta in order to receive addenda. Addendum # Date Received Initials i ►� Attached is a bid guaranty bond as required by Paragraph 1110-15.0, BID GUARANTY. DBX, Inc. 951-296-9909 Name of Bidder 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. DBX, Inc. Name of Bidder 42024 Avenida Alvarado, Suite A Temecula, CA 92590 Bidder's Address 240547 Contractor's License No. California ate of Incorporation V' r gnature of Bidder James C. Perry Printed Name of Signatory President/Secretary/Treasurer Title of Signatory 951-296-9909 Bidder's Telephone Number dbxinc(d),hotmail. com Bidder's Email Address 07/31 /23 Contractor's Expiration Date Office Assistant Title of Witness Bid 1200-2 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 ® 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) I 1 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 County of Riverside STEPHANY BRAVO Notary Public - California Riverside County — Comrnissivn 4 234SU14 QPMV Comm. Expires Feb 14, 2025 Seal Place Notary Seal Above Subscribed and sworn to (or affirmed) before me on this 26th day of July , 20 22 by Date f Month Year (1) James C. Perry (and (2) ) Name(s) of Signer(s) proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Signature .Signat re o N tary 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: Document Date: Number of Pages: Signer(s) Other Than Named Above: ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5910 SECTION 1210 BID SCHEDULE PROJECT NO. 2022-18 SILVERROCK PARK VENUE WI-FI AND CAMERA BACKBONE 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. 2022-18, SilverRock Park Venue Wi-Fi and Camera Backbone, 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. 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 BASE BID — SILVERROCK PARK VENUE WI-FI AND CAMERA BACKBONE Item Item Description Est. Unit Unit Item Total No. Qty. Price (in figures) (in Dollars figures) Dollars 1. Mobilization 1 LS $%W0 00 $ q 00p, 0p 2. Traffic Control 1 LS $ 1 90p. 00 $1,1app. 00 3. Dust Control 1 LS $1,500.0D $ 1 ,SOO. 00 4' Remove and Replace 6" Thick 36 SF $ 2C0 UU $ 7 20p 00 Concrete Sidewalk • Furnish and install 2" High - Density Polyethylene (HDPE) 5 Conduit, grey color, pull tape, 304 LF $l'-10.00 $42,5�0.Oc� and tracer wire; Including Trench Repair (Replace Landscape/Irrigation in -kind 6 Furnish and Install No. 6 Pull 2 EA $2 100.00 $y 2p0.00 Box 1 r Building Modification, 7. Connection, and Electrical 1 LS $ 1,500.00 $ *71SOO.00 Modification Furnish and Install 24 Strand $' Single Mode Fiber Optic Cable 900 LF $ l0.00 $S,RICO .Dv and pull tape in existing/proposed conduit Furnish and Install 24 Port 9 Fiber Patch Panel complete 2 EA $3,2.00•00 $ (PM00 00 (shelf mount). Terminate fiber optic cable Furnish and Install 24 Port Hardened Managed Gigabit 10. Aggregate Switch, SFP 1 EA MP00,00 $ 12,000.00 Modules, power supply, and patch cords complete 11. Test Network Equipment and 1 LS $3,SQp -CO $ 3,500.00 System Documentation 12. As -Built Plans 1 LS $1,500.00 $ 11500 .0o Furnish to City Hall minimum 13. 2-strand single mode fiber 50 LF $ W- 00 $ 500.Ob maximum 24-strand to be installed by others Total Amount of Bid Items 1 — 13 $k03I0(v0.00 Bid Schedule 1210-2 GRAND TOTAL BASE BID (Figures): $ kO-b iM90. 00 GRAND TOTAL BASE BID (Words):_OV�,Q. 1 uloarga 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. Signature of Bidder (Ink) James C. Perry Name of Bidder (Printed or Typed) 951-296-9909 Bidder Telephone Number dbxinc (a,hotmai 1. com Bidder Email Address Bid Schedule 1210-3 Bond #N/A Premium: Nil SECTION 1220 BID GUARANTY BOND PRINCIPAL, and The Ohio Casualty 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. 2022-18 SILVERROCK PARK VENUE WI-FI AND CAMERA BACKBONE 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 14th day of July , 2022, DBX, Inc. (Principal) President/Secretary/Treasurer Title of Signatory The Ohio Casualty Insurance Company (Surety) Spencer Flake,Attorne -In-Fact Title of Signatory nature of Principal Si nature of urety 2024 Avenida Alvarado, Suite A., Temecula, CA 92590 P.O. Box 34526, Seattle, WA 98124 Address Address Note: Signatures of these, executing for the surety must be properly acknowledged. Bid Guaranty Bond 1220-1 CALIFORNIA 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 Riverside On 07/26/22 before me, Date personally appeared James C. Perry Stephany Brava, Notary Public Here Insert Name and Title of the Officer Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. *my STEPHANY BRAVO Notary Public • California Riverside County Commission p 234807a Comm. Expirei Feb 19, 20251 Place Notary Seal and/or Stamp 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 1�1�sign#ure & 40tcry Public — OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to on unintended document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Number of Pages: Capacity(ies) Claimed b Signer(s) Signer's Name: James �. Per Signer's Name: ® Corporate Officer — Title(s):President/Secretaryl'rreasurer ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Trustee ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer is Representing: Signer is Representing: 02019 National Notary Association CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County 9 of Orange On 07/14/2022 Date before me, Erin Sherwood , Notary Public, Insert Name of Notary exactly as it appears on the official seal personally appeared Spencer Flake Name(s) of Signer(s) ERIN SHERWOOD CC vi;' #2292388 cn NOTARY PURL C CALIFORNIA OhANCE COUNTY 1 MY COMM EXPIRES JULY 06, 2023 I who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their 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 s-01 Signature Place Notary Seal Above S&Ina re of Notary PoRK Erin Sherwood OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of the form to another document. Description of Attached Document Title or Type of Document - Document Date: Signer(s) Other Than Named Above: _ Capacity(ies) Claimed by Signer(s) Signer's Name- . ❑ Individual ❑ Corporate Officer—Title(s):_ ❑ Partner ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing. Top of thumb here Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer—Title(s): ❑ Partner ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: ONLibertX Mutual. SURETY 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 Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY Certificate No: 8205649-971919 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, Charles L Flake, David L. Culbertson, Heather Willis, Lexie Sherwood, Spencer Flake all of the city of Anaheim state of CA each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge and deliver, for and on %i behalf as surety and as its act and deed, any and all undertakings, bands, reoogni¢ances 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 25th day of May , 2021 . State of PENNSYLVANIA County of MONTGOMERY ss Liberty Mutual Insurance Company hio Casualty INS �P4 ap° 4P4a1ePnry�Qy P�oOr�� WestAmericanInsuranceCompanyce opony c� '�4r n y c y c C� JS `"atn tea' Fan -0C � 'afi 1912 0 a 1919 0 � 1991 n ❑ d / d,3p$aACHllg�da yp ��Huc'� L � h �� By:yl Rt _ 7 David M. Carey, Assistant Secretary Cr On this 25th day of May , 2021 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execule the foregoing instrument for the purposes ?� therein contained by signing on behalf of the corporations by himself as a duly authorized officer. N M 3 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. em p r4�'�olrA r�r commomreallh of Penn"ania - Nolary Seal N 0O ��p Y Teresa PastMontgomery County Montgomery County 1 O 4% OF My commission expires March 28, 2025 By: trsv C t`6pv Commission number 1126044 Wnmber, PeAwyarma ASsa Dwn of Nolanes Notary Public iCRY 1 Q1 t: (D 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: a3 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 to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety M N 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 a " 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 L) 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 attomey-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 14th day of July 2022 P41NS(7� aI't INS& 1H8U/fi acanrak�}�d-m � �cpAro�fFRyyfi � 3'°oaPo�Tc'yE 1912 0 0 1919 1991 0.Cy� Y - : ¢w �❑ A By: Yd�"ms4ec,,g� as O N�µpBN a rs "acjj6� as Renee C. Llewellyn, Assistant Secretary LMS-12873 LMIC OCIC WAIC Multi Co 02121 v O Id- N Cl) rb 0 m m U 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: HSIP Interconnect Improvement project Owner: City of La Quinta Construction Cost: $ 1,612,316.00 Construction Time: 90 Calendar Days Owner's Representative: Leonard St. Sauver Owner's Telephone No.: 760-275-2143 Date of Substantial Completion: 05/24/2020 2. Project Name: Intelligent Transportation Systes Owner: City of Pasadena Construction Cost: $ 1, 916,044.50 Construction Time: 180 Calendar Days Owner's Representative: John Ramey Owner's Telephone No.: 626-744-6912 Date of Substantial Completion: 07/31/2018 Bidders Experience & Qualifications 1230-1 3. Project Name: Regional Traffic Signal Synchronization Owner: City of Irvine Construction Cost: $ 1,054,653.00 Construction Time: 100 Owner's Representative: Alex Salazar Owner's Telephone No.: 949-724-7408 _Calendar Days Date of Substantial Completion: 08/23/2019 4. Project Name: Regional Traffic Signal Synchronization Owner: Cityof Fullerton Construction Cost: $ 1,352,784.54 Construction Time: 90 _Calendar Days Owner's Representative: David Langstaff Owner's Telephone No.: 714-738-6899 Date of Substantial Completion: 07/01/2019 Signed this 26th day of July , 2022. _ DBX, Inc. 240547 1000004242 Name of Bidder Contractor's License No. DIR Reg No. 4nalunrLe'6of Bidder DBX, Inc. Printed Name of Bidder 07/31 /2023 Expiration Date President/Secretary/Treasurer 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 Work/% of Work/License No./DIR Reg No. nature of Bidder DBX, Inc. Name of Bidder Proposed Subcontractors 1240-1 SECTION 1250 NQN-COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ) ss. County of Riverside ) James C. Perry , being first duly sworn, deposes and say that he or she is President/Secretary/Treasurer of DBX, Inc. f 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. Ignature James C. Perry Name of Bidder President/Secretary/Treasurer Title 07/26/2022 Date Non -Collusion Affidavit 1250-1 CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies onlythe identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Riverside On 07/26/22 before me, Stephany Bravo, Notary Public Date Here Insert Name and Title of the Officer personally appeared James C. Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. STEPHANY BRAVO r Notary Publid • California �4 Riverside County Commission M 2348074 ' ��•"� My Comm, Expires Feb 19, 2025 Place Notary Seal and/or Stamp 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 ---- — -- OPTIONAL — Notary Public Completing this information can deter alteration of the document or fraudulent reattachment of this form to on unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: James C. Perry Signer's Name: M Corporate Officer — Title(s): President/Secretary/Treasurer ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Trustee ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer is Representing: Signer is Representing: _ ©2019 National Notary Association SECTION 1260 PIR Proiect Vendor Information Vendor Information: Name: DBX, Inc. Address: 42024 Avenida Alvarado, Ste A City: Temecula ST: CA Zip:92590 Project Manager: Tim Seaman Email:_ dbxinc@hotmail.com Phone: 951-296-9909 CSLB/Certification Number: 240547 Public Works Registration No.: 1000004242 Classification: Asbestos Boilermaker Bricklayers Carpenter Carpet/Linoleum Cement Masons Drywall Finisher Drywall/Lathers Electricians X Elevator Mechanic Glaziers Iron Workers Laborers X Millwrights Operating Eng X Painters Pile Drivers Pipe Trades Plasterers Roofer SheetMetal Sound/Com Surveyor Teamster Tile Worker. Prevailing Wages and Payroll: The project is subject to prevailing wage rates and enforcement by the Department of Industrial Relations (DIR). Prevailing wage rates can be obtained at: http://www.dir.ca.gov/Public-Works/PrevEi'iring-Wage.htm1. 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: http:J�www.dir.ca.4ovlPubfic-WorkslCertified-Payroll- Reporting.html. A copy of certified payroll, including the employees and/or subcontractors working on with invoices submitted to the City of La Quinta. names and addresses of the job must be included DIR Project Vendor Information 1260-1