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2022-10 Bid Prestige Striping Services Inc.11 /2/2022 DATE: SECTION 1200 BID The undersigned, as bidder, declares it has received and examined the Contract Document entitled Project No. 2022-10, Moon River Drive 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 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 1 10/28 Initial A -_ F. Attached is a bid guaranty bond as required by Paragraph 1110-15.0, BID GUARANTY. 951-270-2999 Prestige Striping Services Inc. dba Prestige Paving Company 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. Prestige Striping Services Inc. dba Prestige Paving Company Name of Bidder 1054 Railroad St Corona CA. 92882 Bidder's Address 827632 Contractor's License No. California State of Incorporation .. e�� Signature of Bidder Anthony Trujillo Printed Name of Signatory RMO Title of Signatory 951-270-2999 Bidder's Telephone Number griffin@prestigecompany.net Bidder's Email Address 11 /30/2023 Contractor's Expiration Date G f, i ,V1 -9t ti 6c-- Witness Title of Witness Bid 1200-2 SECTION 1210 BID SCHEDULE PROJECT NO. 2022-10 MOON RIVER DRIVE 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 2022-10, Moon River Drive 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 BASE BID - MOON RIVER DRIVE PAVEMENT REHABILITATION Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Mobilization 1 LS $ &tM' $ 6� 30 2 Traffic Control 1 LS $ 1 �� 365� $360� 3 Dust Control 1 LS $ i1'72 0 $ I� 7 -2ti 4 Earthwork 1 LS $ Z, $ 2, 5 Pulverize 10" of Road 5 Section - Three Step 33,449 SF $ _ $ q 2' (4 Process Construct 4.5" Asphalt 6 Concrete Over Pulverized 33,449 SF $ 40 $14:1/412.7`r Base 7 Striping and All Incidentals 1 LS $ Cyr to 2_ $ 111 10.2 Total Amount of Bid Items 1 - 7 $ ?7 5-1 �►-7,31 City may award all or none of the following additive alternates: ADDITIVE ALTERNATE NO. 1 Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Lower Water Valve to Grade 8 EA $ 1 1-2-3 � $ 9, Zg1,04 per CVWD Standards 2 Raise Water Valve to Grade g EA $ 1 ( 1(,'1, 3t $ 11 2q9 64 per CVWD Standards Total Amount of Bid Items 1 - 2 $ 101" , 016 Bid Schedule 1210-2 ADDITIVE ALTERNATE NO. 2 Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars Sawcut, Remove, and Dispose of Existing Concrete 1 Curb Ramp, Includes Curb 1,322 SF and Gutter (Limits 5' beyond BCR to 5' beyond ECR Construct Concrete Curb Ramp per City of La Quinta 2 Std. No. 250, Case A, 2 EA $ q`w7 $19/4.11 including 5' of sidewalk beyond the BCR to ECR Total Amount of Bid Items 1 — 2 $Z4-q1i,i-4- GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Figures): GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Words): i-6tJ 4:4 Amf,,,( �L l% +{�sir�gVf2 � ft r�[7 IiTf�� C�c�j14rS `tyln� 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. Bid Schedule Signature of Bidder (Ink) Anthony Trujillo Prestige Striping Services Inc. dba Prestige Paving Company Name of Bidder (Printed or Typed) 951-270-2999 Bidder Telephone Number griffin@prestigecompany.net Bidder Email Address 1210-3 SECTION 1220 BID GUARANTY_ BON© The Ohio Casualty PRINCIPAL, and 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. 2022-10 MOON RIVER DRIVE 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 1st day of November , 2022. Prestige Striping Services, Inc. dba Prestige Paving Company The Ohio Casualty Insurance Company Scott Salandi, Attorney -in -fact Title of Signatory Title of Signatory Signature of Principal re of Surety 1054 Railroad Dr. Corona, CA 92882 Address 790 The City Drive South, Suite 200 Orange, CA 92868 Address Note: Signatures of those executing for the surety must be properly acknowledged. Bid Guaranty Bond 1220-1 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 of Orange On 2 0M c« h'r,'1 T01-1-before me, Lauren Emily Bierman, Notary Public (insert name and title of the officer) personally appeared Scott Salandi who proved to me on the basis of satisfactory evidence to be the person(s) whose name(x) is/Spa subscribed to the within instrument and acknowledged to me that helgbiel" executed the same in his/kimMair authorized capacity(k*, and that by his/Ne;EKOeeW 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. cv �a�FyP` LAUREN EMILY BIERMAN WITNESS my hand and official seal. COMM. ## 2271982 ;0w o NOTARY PUBLIC-CALIFORNIA � r1' r ORANGE COUNTY N MY COMM. CUP. JAN 15, 2023 Signature (Seal) This Power of Attomey limps the ads of those named herein, and they have no authority to bind the Company except In the manner and to the extent herein stated. LibertX Liberty Mutual Insurance Company Mutual. The Ohio Casualty Insurance Company Certificate No_8202672-977490 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duty organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duty 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'Companiesl, pursuant to and by authortty herein set forth, does hereby name, constitute and appoint, David S. Jacobson; Scott Salandi; Leonard E. Ziminsky all of the dty of Irvine state of CA each individually if there be more than one named, its true and lawful attom son -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 'd 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 3rd day of December 2019 . Liberty Mutual Insurance Company — tNsu �YY INSU 1Nsuq The Ohio Casualty Insurance Company ��aR„„�ynm a PL�RP�R4� P 4opvny t qy� West American Insurance Company o 1912 1991 YdyTY�g�CNuB b 'Lp �h'nnrnP�•`�.{a� 'ry+ ''''a�nerP da C David M. Carey, Assistant Secretary State of PENNSYLVANIA c ' CourdyofMONTGOMERY as rn U y On this 3rd day of Decembcr 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance O o? 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 — U) p� > therein contained by sfgning on behalf of the corporations by himself as a duly authorized officer. kit a, N 0 IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seat at King of Prussia, Pennsylvania, on the day and year first above written. a v oCD m y �5' w y,6�` COMMpNWEALTH OF FENNSYLVANtA Q Notarial seal d7 O lhI' Teresa Pastaila, Notary Public �2�--� a1 O N Upper Merion Twp , Montgomery County By: _ C �s My Commission Exp res March 29, 21121 I'm Pastella, Notary Public o kip rry ` Meffiti . p/nllylea bAmm ,v,: - 1 Nolarles a p � Vl 0 w This Power of Attorney is made and executed pursuant to and by authority of the following Byaaws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual « cn ❑ c Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ow 2 Qi ARTICLE IV —OFFICERS: Section 12. Power of Attorney. : y v Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or tihe President, and subject to such limitation as the Chairman or the -o President may pirssalbe, 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 � o M any and al! undertakings, bonds, recognrcances and other surety obligations. Such attor eys-in•fact, subject to the limitations set Earth in their respective powers of attorney, shall C have full power to bind the Corporation by their signature and execution of any such instruments and to attach itiereto the seal of the Corporation. When so executed, such 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 C 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 YJII — Execution of Contracts: Section 5. Surety Bonds and Undertakings. a co Any officer of the Company authorized for that purpose in writing by the chalmian or the presidan1, and subject to such limitations as the chalrman or the president may prescribe, r shall appoint such attorneys -in -fast, as may be necessary to act in behalf of the Company to make, execute, seat, acknowWge and deliver as surety any and all undertakings, bonds, recognIzances and other surety obligations. Such attomeys-in-fact subject to the Ilmltalions 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 N signed by the president and attested by the secretary. Certificate of Des lgnatlon -- The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such atiomeys-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, fecognaances 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 effaced. 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 aftomay of which the foregoing is a full, true and correct copy of the Power of Atmmey executed by said Companies, !s in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seats of said Companies this r day off 4 INSyR Ih'qG ,A t"SU4' oRvou�rq¢r sa`YrP°vv�tPyy �'PcP���'r9yn 1912 0 1919 ' 1991 By: dhl c ug �� HA Renee C. Llewellyn, Assistant Secrelary e17 * �,� H� � 1•� °tiM + 1•a LMS-12873 LMIC OCIC WAIC Multi Co_082018 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 ofhavloI r On Ur before me, UI t Date --rye,e 1 Sert ame and Title of the rcer personally appeared �' 0 Name 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. ERIKA 1EI"To s Notary Public - California y I.oS Angeles County, Commission X 2368654 +.y Comm. Exoires Jul 37 Comm. Jul 25z5 Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State ali rnia that theAregoing paragraph is tj6e andQ6rrect. WITNESS Signature OPTIONAL official f Notary Public Completing this information can deter alteration of the docurilent or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document:, 921)) Document Date: Signer(s) Other Than Named Above: Number of Pages: Capacity(ies) Claa Si ner(s �r ` Signer's Name: �ligner's Name: ❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ Gener I ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Trustee ❑ Guardian or Conservator ❑ Other: ❑ Other: fl�r)e6ios I�gaewntirg: �► _ _i,,, 4j Signer is Representing: ©2019 National Notary Association 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. L Project Name: Golden West College Owner: Coast Community College District Construction Cost: $1,483,175.00 Construction Time: 13 Calendar Days Owner's Representative: Joseph Dowling Owner's Telephone No.: (714)892-7711 Date of Substantial Completion: 06/30/2021 2. Project Name: Mckinley Elementary School Owner: Santa Monica Malibu School District Construction Cost: s 340,763.20 Construction Time: 8 Owner's Representative: Christopher Diaz Owner's Telephone No.: (310)450-8338 Date of Substantial Completion: 08/17/2022 Calendar Days Bidders Experience & Qualifications 1230-1 3. Project Name: Desert Sands Unified School District Owner: Desert Sands Unified School District Construction Cost: $ 187,154.00 Construction Time: 8 Calendar Days Owner's Representative: Yasmin Henry Owner's Telephone No.: 760)771-8515 Date of Substantial Completion: 07/27/2022 4. Project Name: Asphalt Concrete Paving of Access Road Owner: Sanitation Districts of Los Angeles Construction Cost: $ $184,273.14 Construction Time: 3 Calendar Days Owner's Representative: Tantoco Gwen Owner's Telephone No.: (951)285-7936 Date of Substantial Completion: 04/10/2021 �l Signed this _ �Z day of Anthony Trujillo Name of Bidder QJ e V--I -b 64-i 827632 Contractor's License No. , 2022. 1000015267 11/30/2023 Signature of Bidder Expira ion Date j ���s Ise -Ta Printed Name 4 Bidde Title of Signatory DIR Reg No. Bidders Experience & Qualifications 1230-2 Prestige Striping Services, Inc. DBA Prestige Paving Company - Subcontractor Prequalification List of Customer References: Customer Name: Contact Name: Phone Number: Email Address: The Bedrock Company Steve Mesner (951) 273-1931 stevem@thebedrockco.com Jamboree Housing Corporation Nick Haddock (949) 214-2357 nhaddock@jamboreehousing.com Irvine Apartment Company Salvador Diaz (714) 454-0750 sdiaz@irvinecompany.com South Coast Plaza Kevin Halcomb (714) 313-6620 holcombk@southcoastplaza.com United Paving Company Rob Ruwe (714) 576-5412 rob@united-paving.com 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. Mi�1.Pr u.'N�i� Co►��ar��, 1 to U Gk �i �� ���r+c�s ✓ c i�. ti'3y 35l�klr�e�� 2r� /3%/ 431��2��da4ol37ij 14tec /134-q 64. if hi (,,,,,-A 42s75/Old,I w llwee eik M rk4_S [ 12 C-rnr+�ss 54 !�r, IKS Ca 11 "1yw,k �L4r4y 'Jf- J.Ws k 2(-? Irkr-eks1? A0 Ohw-ir-, eA `d 5YI3275x l i"a6Qa 6 176,306 / 160WO 14-7(� f/ % 1 m/10d374b* V,' ii, cW t A" V• dle V*- Ukcfie &e44 Pr, &I A vt (4, 1 Aor,,F V, 11�� Cm j'? s� 3 I ����01?2Vi 1000 ]0GOd(0 e!!2L Signature of Bidder Anthony Trujillo RMO Name of Bidder Proposed Subcontractors 1240-1 SECTION 1250 NON -COLLUSION AFFIDAVIT TQ BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ) ss. County of LoS A,,15eles ) Anthony Trujillo , being first duly sworn, deposes and say that he or she is RMO of Prestige Striping Services Inc. dba Prestige Paving Company 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. Signature Anthony Trujillo Name of Bidder RMO Title 11 /2/2022 Date Non -Collusion Affidavit 1250-1 SECTION 1260 DIR Project Vendor Information Vendor Information: Name: Prestige Striping Services Inc. dba Prestige Paving Company Address: 1054 Railroad St Zip: 92882 Project Manager: Griffin Christensen Phone: 951-270-2999 City: Corona ST: CA Email: griffin@prestigecompany.net CSLB/Certification Number: `827632 Public Works Registration No.:. 1000015267 Classification: Asbestos Boilermaker Bricklayers Carpenter Carpet/Linoleum Cement Masons Drywall Finisher Drywall/Lathers Electricians Elevator Mechanic Glaziers Iron Workers Laborers * Millwrights Operating Eng Painters Pile Drivers Pipe Trades Plasterers _ Roofer SheetMetal Sound/Com Surveyor Teamster Tile Worker Prevailing Wdnes and Pavrail: 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:/Iwww.dir.ca.gov/Public-Works/Prevailing-Wage.htmi. 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://www.dir.ca.gov/Public-WorkslCertified-Payroll- Regorting.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 SECTION COMPLIANCE WITH IRAN-CONTRACTING ACT OF 2011, Pursuant to the Iran Contracting Act of 2010 (Pub. Contract Code, § 2200 et seg.), (a) Contractor shall be ineligible to bid on or submit a proposal for any contract for One Million Dollars ($1,000,000) or more if Contractor engages in investment activities in Iran as defined in Public Contract Code Section 2202.5, and/or if Contractor is identified on the list of persons engaging in investment activities in Iran prepared by the State of California pursuant to Public Contract Code Section 2203 subdivision (b). (b) For bids of One Million Dollars ($1,000,000) or more, Contractor must certify that it is not on the list of ineligible vendors prohibited from doing business with the State of California and shall complete the Iran Contracting Act Certification and submit with their proposal at the time of bid. Contractor shall obtain the Iran Contracting Act Certification in the form approved by the State of California, or upon written request to the City Clerk's Office, a copy of the form will be provided to Contractor. Failure by Contractor to provide the certification required by this Section may deem Contractor's bid non -responsive. (c) Nothing in this Section is intended pursuant to Public Contract Code on a case -by -case basis. to prevent the City from exercising its rights section 2203, subdivision (c) or (d), or both, Iran Contracting Act Certification 1270-1 IRAN CONTRACTING ACT CERTIFICATION Pursuant to the Iran Contract Act of 2010 (Public Contract Code 2200- 2208), Vendors/Bidders are ineligible to bid on or submit a proposal for any contract with a public entity for goods or services of one million dollars ($1,000,000) or more if the Vendor/Bidder engages in investment activities in Iran. MUST BE SUBMITTED WITH BID PROPOSAL IF BID AMOUNT IS $1,000,000 OR MORE Prior to bidding on, submitting a proposal, or executing a contract or renewal for a public entity contract for goods or services of $1,000,000 or more, a vendor must either: a) certify it is = on the current list of persons engaged in investment activities in Iran created by the California Department of General Services ("DGS") pursuant to Public Contract Code section 2203(b) and is not a financial institution extending $20,000,000 or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS; or b) demonstrate it has been exempted from the certification requirement for that solicitation or contract pursuant to Public Contract Code section 2203(c) or (d). To comply with this requirement, please insert your vendor or financial institution name and Federal ID Number (if available) and complete one of the options below. Please note: California law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made, contract termination, and three-year ineligibility to bid on contracts. (Pub. Cont. Code § 2205.) OPTION #1 - CERTIFICATION I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person/vendor, for 45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS. I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Vendor �a �Finan lal Znstitutio (Panted) { Federal ID Number (or n/a) Prestige�triping rServices Inc. �ba �restige Paving Company I 330847505 By (AuthDrizCOSignature) rintea Name and Title of Person Signing — Date Executed Anthony Trujillo RMO 11/2/2022 Iran Contracting Act Certification 1270-2 OPTION #2 — EXEMPTION Pursuant to Public Contract Code sections 2203(c) and (d), a public entity may permit a vendor/financial institution engaged in investment activities in Iran, on a case -by -case basis, to be eligible for, or to bid on, submit a proposal for, or enters into or renews, a contract for goods and services. If you have obtained an exemption from the certification requirement under the Iran Contracting Act, please fill out the information below, and attach documentation demonstrating the exemption approval. Vendor Name/Financial Institution (Printed) By (Authorized Signature) Printed Name and Title of Person Signing Federal ID Number (or n/a) Date Executed Iran Contracting Act Certification 1270-3 SECTION 1280 COMPLIANCE WITH CALIFORNIA EXECUTIVE ORDER N-6-22 RUSSIAN AGGRESSION AGAINST UKRAINE (a) Contractor shall comply with California Governor Executive Order N-6-22 regarding sanctions in response to Russian aggression in the Country of Ukraine, and any implementing guidelines and/or economic sanctions imposed by the United States government in response to Russian actions in Ukraine, as well as any sanctions imposed under California law (collectively "economic sanctions"). Contractor shall comply with all such economic sanctions. By submitting a bid to the City, Contractor agrees to take any and all actions to support the Ukrainian government and people as required by law, including by refraining from new investments in, and financial transactions with, Russian institutions or companies that are headquartered or have their principal place of business in Russia (Russian entities), not transferring technology to Russia or Russian entities, and directly providing support to the government and people of Ukraine. (b) If bidding on a contract for Five Million Dollars ($5,000,000) or more, Contractor shall submit a written report to the City on Contractor's compliance with the economic sanctions, and the steps Contractor has taken in response to Russia's actions in Ukraine, including, but not limited to, desisting from making new investments in, or engaging in financial transactions with, Russian entities, not transferring technology to Russia or Russian entities, and directly providing support to the government and people of Ukraine as required by law. Failure to submit the report required by this Section may deem Contractor's bid non- responsive. Please include a written report to the City if this section is applicable.