Desert Concepts Construction, Inc. BidSECTION 1200
BID
DATE: 11/3/22
The undersigned, as bidder, declares it has received and examined the Contract
Document entitled Project No. 2022-22, Blackhawk Way School Crossing, 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
Attached is a bid guaranty bond as required by Paragraph 1110-15.0, BID
GUARANTY.
Desert Concepts Construction, Inc.
Name of Bidder
760-200-9007
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.
Desert Concepts Construction, Inc.
Name of Bidder
79775 Ave 40
Bidder's Address
849837
Contractor's License No.
California
State ncor oration
Sig ure of I idder
Regina Castro
Printed Name of Signatory
Vice President
Title of Signatory
760-200-9007
Bidder's Telephone Number
mail(q).desertconcepts.net
Bidder's Email Address
11/30/22
Contractor's Expiration Date
Title of Witness
Bid 1200-2
SECTION 1210
BID SCHEDULE
PROJECT NO. 2022-22
BLACKHAWK WAY SCHOOL CROSSING
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 2022-22, Blackhawk Way
School Crossing, 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 — BLACKHAWK WAY SCHOOL CROSSING
Item Item Description
Est.
Unit
Unit Price
Item Total
No.
Qty.
(in figures)
(in figures)
Dollars
Dollars
1 Mobilization
1
LS
$14,500.00
$ 14,500.00
2 Traffic Control
1
LS
$20,000.00
$ 20,000.00
Sawcut, Remove, and
3 Dispose of Existing
Sidewalk, Ramp, and
410
SF
$10.00
$ 4,100.00
Driveway
Sawcut, Remove, and
4 Dispose of Existing Asphalt
880
SF
$io.00
$ 8,800.00
Concrete Pavement
Remove Existing Traffic Pole
5 and Footing, Salvage Pole to
2
EA
$4,000.00
$ 8,000.00
City and Reuse LED Signs
Remove and Dispose
6 Existing Detection Bollard
3
EA
$1,800.00
$ 5,400.00
with Footing
Construct Sidewalk per City
7
186
SF
$25.00
$ 4,650.00
of La uinta Std. No. 240
Reconstruct Curb Ramp Per
8 City of La Quinta Std. No.
2
EA
$ 9,500.00
$ 19,000.00
250 Mod., Case B (Retaining
Curb Included
Construct Portion of
9 Driveway Approach per
32
SF
$ 58.00
$ 1,856.00
Riverside Co. Std. Plan 207A
Mod.
Construct 6" Concrete
10 Pavement over 6" Class II
704
SF
$ 28.00
$ 19,712.00
Aggregate Base Per Plan
11 Construct Full Depth Asphalt
176
SF
$ 20.00
$ 3,520.00
Concrete Pavement
Install Dual Flashing Beacon
and In -Road Warning Light
12 (IRWL) Systems Complete
1
LS
$ 53,000.00
$ 53,000.00
(Poles and IRWL Markers
Furnished by City)
13 Signing and Striping
1
LS
$ 18,000.00
$ 18,000.00
Total Amount of Bid Items 1 — 13
$ 180,538.00
Bid Schedule 1210-2
GRAND TOTAL BASE BID (Figures):
$ 3V.D0
GRAND TOTAL BASE BID (Words):
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, djustments and alterations as
elsewhere provided herein. / % Z--�
of Bidder (Ink)
Desert Concepts Construction, Inc.
Name of Bidder (Printed or Typed)
760-200-9007
Bidder Telephone Number
mail@desertconcepts.net
Bidder Email Address
Bid Schedule 1210-3
SECTION 1220
6I0GUARANTY BOND
PRINCIPAL, and MERCHANTS BONDING COMPANY (MUTUAL)_, 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. 2022-22
BLACKHAWK WAY SCHOOL CROSSING
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 3rd day of
November , 2022.
DESERT CONCEPTS CONSTRUCTION, INC.
Title of Signatory
Sig t of Pri cip
79-775 Avenue 40, Indio, California 92203
Address
MERCHANTS BONDING COMPANY (MUTUAL)
Attorney -in -Fact
Title of Signatory
SI atur rety Douglas J. Rothey�
P O. Box 14498. Des Moines, Iowa 50306-3498
Address
Note: Signatures of those executing for the surety must be properly acknowledged.
Bid Guaranty Bond 1220-1
*DESERT CONCEPTS CONSTRUCTION, INC.
State of COLORADO )
) ss.
County of BOULDER )
On November 3, 2022, before me, a Notary Public in and for said County and State, residing therein, duly
commissioned and sworn, personally appeared Douglas J. Rothey
known to me to be Attorney -in -Fact of MERCHANTS BONDING COMPANY (MUTUAL)
the corporation described in and that executed the within and foregoing instrument and known to me to be
the person who executed the said instrument on behalf of the said corporation, and he duly acknowledged
to me that such corporation executed the same.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal, the day and year stated
in this certificate above.
My Commission Expires: July 9, 2025
Kimberly Payt Notary Public
KIMBERLY PA—Y- -
NOTARY PUBLIC
STATE OF COLORADO
NC7'1'ARY ID 20x1Ab275UEi
�•irnE ulv Ov.l92!;
MERCHANTS k
BONDING COMPANY,.
POWER OF ATTORNEY
Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually,
Cynthia M Burnett; Douglas J Rothey; Erik Ulibarri; Kim Payton; Wesley J Butorac; Zach Rothey
their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings,
contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity
of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any
actions or proceedings allowed by law.
This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board
of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors
of Merchants National Bonding, Inc., on October 16, 2015.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority
to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and
undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof."
"The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney
or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually fixed."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the
Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction
contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department
of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of
its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given
to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner -
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 23rd day of June 2020
,... to N •. �o.. •.
........... �•.' •. .@..•
y �.QRpd►r►q. Q .� ��q; �%IP�A . MERCHANTS BONDING COMPANY (MUTUAL)
►.: G i . y . G 9J .yam • MERCHANT NATIONAL BONDING, INC.
a_ -a-
2003 1933 : c: By
... � •..' tie: ••,aday� { ��a• President
STATE OF IOWA •'''•••e•.+•■■'+'• ...
• •
COUNTY OF DALLAS ss.
On this 23rd day of June 2020 before me appeared Larry Taylor, to me personally known, who being by me duly sworn
did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the
seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors.
AP'PAt POLLY MASON
0 Commission Number 750576
My Commission Expires
�OWp • January 07, 2023 Notary Public
(Expiration of notary's commission
does not invalidate this instrument)
I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby
certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full
force and effect and has not been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 3rd day of November 2022
agti0Nq� • ,.
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POA0018 (1/20) ""'
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 of Riverside
On 11/32022
before me, Linda Rocha
Date Insert Name of Notary exactly as it appears on the official seal
personally appeared Regina Castro
Name(s) of Signer(s)
, Notary Public,
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
....�, �-. tP�Qn ca
�Eota Public - CaliforniaCs
�'
person(s), or the entity upon behalf of which the person(s)
;r r
z � Rerside County
iv ;
acted, executed the instrument.
• t:ommisstan
my Comm. Expires Nov 2Q, 2Q23
1 certify under PENALTY OF PERJURY under the laws of
---
the State of California that the foregoing paragraph is true
and correct.
Witness mv_Lndfan offi,ciai se .
Place Notary Seal Above / Signgfure bf Notary
Though the information below is not required by law it may prove valuable to persons relying on the document
and could prevent fraudulent removal an 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:
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:
Owner:
Construction Cost:
Construction Time:
***See Attachment A***
Owner's Representative: .
Owner's Telephone No.:
Date of Substantial Completion:
2. Project Name:
Owner:
Construction Cost: $_
Construction Time:
Owner's Representative:
Owner's Telephone No.:
Date of Substantial Completion:
Calendar Days
Calendar Days
Bidders Experience & Qualifications 1230-1
3. Project Name: ***See Attachment A***
Owner•
Construction Cost:.
Construction Time:
Owner's Representative:
Owner's Telephone No.:
Date of Substantial Completion:
4. Project Name:
Owner•
Construction Cost:
Construction Time:
Owner's Representative:
Owner's Telephone No.:
Date of Substantial Completion:
Signed this 3rd day of
Desert Concepts Construction, Inc.
Regina Castro
Printed Name of Bidder
Bidders Experience & Qualifications
November
Calendar Days
Calendar Days
, 2022.
849837 1000006619
Contractor's License No. DIR Reg No.
11/30/22
Expiration Date
Vice President
Title of Signatory
1230-2
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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.
Desert Concepts Construction, Inc.
Name of Bidder
Proposed Subcontractors
1240-1
SECTION 1250
NON -COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTE❑
WITH BID
State of California )
ss,
County of ] wp"rolde- )
I'lPA Ina Oqoyb_ being first duly sworn, deposes nd say that
he or'he is ofJ&_�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 sha bid.
r"
S I a��
1 _6 -
Name of Bidder
_Uec.�;' Lf-_Icb�
Title
I(-,,zQ2�7_
Date
Non -Collusion Affidavit 1250-1
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 of Riverside
On 11/32022 before me, Linda Rocha
Date
personally appeared Regina Castro
Ny LINaA ROCHA
Notary public . California
Riverside County
'
'My
Cornmission 4 2310332 ir
Comm. Expires Nov 20, 2023
Place Notary Seal Above
Insert Name of Notary exactly as it appears on the official seal
, Notary Public,
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 n d raffcR se
Signat e ���
sign, uref of Notary Public Unda Rocha
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:
Number of Pages:
Signer's Name:
❑ Individual
❑ Corporate Officer—Title(s):
❑ Partner ❑ Limited ❑ General
❑ Attorney in Fact
We ❑ Trustee
Top of thumb here ❑ Guardian or Conservator
❑ Other:
Signer is Representing: I I Signer is Representing:
SECTION 1260
DIR Project Vendor Information
Vendor Information:
Name: Desert Concepts Construction, Inc.
Address: 79775 Ave 40
Zip:_ 92203
Project Manager:
Pedro Loaiza
Phone: 760-200-9007
_ City:. Indio ST: CA
Email: mail@desertconcepts.net
CSLB/Certification Number: 849837
Public Works Registration No.: 1000006619
Classification:
Asbestos Boilermaker Bricklayers Carpenter Carpet/Linoleum
Cement Masons X Drywall Finisher Drywall/Lathers Electricians
Elevator Mechanic _ Glaziers __ ._Iron Workers Laborers X Millwrights
Operating Eng Painters Pile Drivers Pipe Trades Plasterers
Roofer SheetMetal Sound/Com Surveyor Teamster Tile Worker.
Prevailing Wades 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:
httl2://www.dir.ca.goy/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: htti2://www.d i r. cagov/Public-Works/Certified-_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
SECTION 1270
COMPLIANCE WITH IRAN CONTRACTING ACT OF 2010
Pursuant to the Iran Contracting Act of 2010 (Pub. Contract Code, § 2200 et seq.),
(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 to prevent the City from exercising its rights
pursuant to Public Contract Code section 2203, subdivision (c) or (d), or both,
on a case -by -case basis.
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 not 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 Na ncial Inst* 'on (Printed) Federal ID Number (or n/a)
_ D ert Co ce t tr ,Inc. 56-2307703
S or' d 5i
Pri ame an Title o Person Signing Date Executed
gins Cast Vice President 11/3/22
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) Federal ID Number (or n/a)
By (Authorized Signature)
Printed Name and Title of Person Signing
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.