Jacobsson Engineering Construction, Inc. BidSECTION 1200
BID
DATE: 4/24/2023
The undersigned, as bidder, declares it has received and examined the Contract
Document entitled Project No. 2022-08 and CDBG Project No. 4.LQ.47.22,
Citywide Miscellaneous ADA Improvements, 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
1290 B-4 Certification of Bidder Regarding Non -Segregated Facilities (Required for
all Projects)
1290 B-7 Bidder's Certification on Federal Contract Requirements (Required for all
Projects)
1290 B-8 Questionnaire Regarding Bidders (Required for all Projects)
1290 B-9 List of Subcontractors and Suppliers (Required for all Projects)
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
4/19/2023
__;J
Bid 1200-1
Attached is a bid guaranty bond as required by Paragraph 1110-15.0, BID
GUARANTY.
Jacobsson Engineering Construction, Inc.
Name of Bidder
760-345-8700
Bidder's Telephone Number
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.
Jacobsson Engineering Construction, Inc.
Name of Bidder
P.O. Box 14430
Bidder's Address
CA #650389 A&B
Contractor's License No.
State of Incorporation
L5d--
Signature of Bidder
Erik Jacobsson
Printed Name of Signatory
CFO/Treasurer
Title of Signatory
760-345-8700
Bidder's Telephone Number
erik@jacobssoninc.com
Bidder's Email Address
7/31 /2024
Contractor's Expiration Date
fitness
Renee Breifing - Engineering Assistant
Title of Witness
Bid 1200-2
SECTION 1210
BID SCHEDULE
PROJECT NO. 2022-08 AND PROJECT NO. 4.LQ.47.22
CITYWIDE MISCELLANEOUS ADA IMPROVEMENTS
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. 2022-08 and CDBG
Project No. 4.LQ.47.22, Citywide Miscellaneous ADA Improvements, 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 — WORK SHOWN ON SHEET 2
Item
Item Description
Est.
Unit
Unit Price
Item Total
No.
Qty.
(in figures)
(in figures)
Dollars
Dollars
1
Mobilization
1
LS
$ 17,000.00
$ 17,000.00
2
Traffic Control
1
LS
$ 10,500.00
$ 10,500.00
3
Dust Control
1
LS
$ 2,250.00
$ 2,250.00
Sawcut, Remove, and Dispose of
4
Existing Cross -Gutter, Sidewalk,
2,488
SF
$ 12.00
$ 29,856.00
Ramp,Driveway,and Pavers
Sawcut, Remove, and Dispose of
5
Existing Curb; and Curb & Gutter
167
LF
$ 52.00
$ 8,684.00
6
Construct Sidewalk per City of La
1,251
SF
$ 13.00
$ 16,263.00
uinta Std. No. 240 Mod.
Construct Portion of Cross -Gutter
7
per City of La Quinta Std. No. 230
49
SF
$ 29.00
$ 1,421.00
Mod. and 231 Mod.
Construct Concrete Curb Ramp
8
per City of La Quinta Std. No. 250
5
EA
$ 4,600.00
$ 23,000.00
Mod., Case A
Construct Concrete Curb Ramp
9
per City of La Quinta Std. No. 250
3
EA
$ 4,600.00
$ 13,800.00
Mod. Case B
Construct Driveway Approach per
10
City of La Quinta Std. No. 221
320
SF
$ 33.00
$ 10,560.00
Mod.
Remove, Regrade, and Reset
11
Street Pavers per City of La
88
SF
$ 51.00
$ 4,488.00
Quinta Std. 206
Sawcut, Remove, and Dispose of
Existing Concrete Ramp; Furnish
12
and Install Truncated Dome
15
SF
$ 60.00
$ 900.00
Concrete Tiles per City of La
Quinta Std. No. 250 Mod.
Full Depth Grind Asphalt Concrete
13
Pavement (3"), Compact Existing
80
SF
$ 40.00
$ 3,200.00
Base and Overlay 3"
Modify Ex. Landscape, Hardscape,
14
and Irrigation as Needed
1
LS
$ 2,750.00
$ 2,750.00
Signing and Striping, Including All
15
Incidentals
1
LS
$ 12,000.00
$ 12,000.00
Total Amount of Bid Items 1 — 15
$ 156,672.00
Bid Schedule 1210-2
City may award all or none of the following additive alternates:
ADDITIVE ALTERNATE NO. 1 — AVE. MONTEZUMA AND AVE. NAVARRO
Item
Item Description
Est.
Unit
Unit Price
Item Total
No.
Qty.
(in figures)
(in figures)
Dollars
Dollars
1
Mobilization
1
LS
$ 650.00
$ 650.00
2
Traffic Control
1
LS
$ 2,700.00
$ 2,700.00
3
Dust Control
1
LS
$ 225.00
$ 225.00
4
Sawcut, Remove, and Dispose of
96
LF
$ 29.00
$ 2,764.00
Existing Curb and Gutter
Construct Curb and Gutter
5
Transitions per City of La Quinta
96
LF
$ 12.00
$ 1,152.00
Std. No. 250 Mod.
Sawcut, Remove, and Dispose of
Existing Concrete Ramp; Furnish
6
and Install Truncated Dome
72
SF
$ 50.00
$ 3,600.00
Concrete Tiles per City of La
uinta Std. No. 250 Mod.
Full Depth Grind Asphalt Concrete
7
Pavement (3"), Compact Existing
977
SF
$ 23.00
$ 22,471.00
Base and Overlay 3"
Modify and Restore Existing
8
Landscape, Hardscape, and
1
LS
$ 650.00
$ 650.00
Irrigation as Needed
9
Signing and Striping, Including All
1
LS
$ 2,750.00
$ 2,750.00
Incidentals
Total Amount of Additive Alternate Bid Items 1-9
$ 36,982.00
ADDITIVE ALTERNATE NO. 2 — PUBLIC PARKING LOT DRIVEWAY
Item
Item Description
Est.
Unit
Unit Price
Item Total
No.
Qty.
(in figures)
(in figures)
Dollars
Dollars
1
Mobilization
1
LS
$ 650.00
$ 650.00
2
Traffic Control
1
LS
$ 2,700.00
$ 2,700.00
3
Dust Control
1
LS
$ 225.00
$ 225.00
Sawcut, Remove, and Dispose of
4
Existing Driveway
278
SF
$ 13.00
$ 3,614.00
Bid Schedule 1210-3
Item
Item Description
Est.
Unit
Unit Price
Item Total
No.
Qty.
(in figures)
(in figures)
Dollars
Dollars
5
Sawcut, Remove, and Dispose of
40
LF
$ 55.00
$ 2,200.00
ExistingCurb and Gutter
Construct Driveway Approach per
6
City of La Quinta Std. No. 221
278
SF
$ 37.00
$ 10,286.00
Mod.
Total Amount of Additive Alternate Bid Items 1-6
$ 19,675.00
ADDITIVE ALTERNATE NO. 3 — DESERT CLUB DRIVE AND SPRINGTIME WAY
Item
Item Description
Est.
Unit
Unit Price
Item Total
No.
Qty.
(in figures)
(in figures)
Dollars
Dollars
1
Mobilization
1
LS
$ 650.00
$ 650.00
2
Traffic Control
1
LS
$ 2,700.00
$ 2,700.00
3
Dust Control
1
LS
$ 225.00
$ 225.00
Sawcut, Remove, and Dispose of
4
Existing Sidewalk and Ram
703
SF
$ 14.00
$ 9,842.00
5
Unclassified Fill
2
Cy
$ 250.00
$ 500.00
Construct Sidewalk per City of La
6
Quinta Std. No. 240 Mod.
527
SF
$ 13.00
$ 6,851.00
Construct Concrete Curb Ramp
7
per City of La Quinta Std. No. 250
2
EA
$ 3,900.00
$ 7,800.00
Mod. Case A
Sawcut, Remove, and Dispose of
Existing Concrete Ramp; Furnish
8
and Install Truncated Dome
47
SF
$ 51.00
$ 2,397.00
Concrete Tiles per City of La
Quinta Std. No. 250 Mod.
Modify and Restore Existing
9
Landscape, Hardscape, and
1
LS
$ 650.00
$ 650.00
Irrigation as Needed
Signing and Striping, Including All
10
Incidentals
1
LS
$ 950.00
$ 950.00
Total Amount of Additive Alternate Bid Items 1-10
$ 32,565.00
Bid Schedule 1210-4
GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Figures):
245,894.00
GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Words):
Two Hundred Forty Five Thousand Eight Hundred Ninetv Four Dollars and 00/100 ------------------------------------------
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)
Erik Jacobsson
Name of Bidder (Printed or Typed)
760-345-8700
Bidder Telephone Number
erik@jacobssoninc.com
Bidder Email Address
Bid Schedule 1210-5
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: Sundance Corta Bella
Owner: City of Indio
Construction Cost: $ 562.000.00
Construction Time:
40
Owner's Representative:
Owner's Telephone No.: 760-391-4018
Date of Substantial Completion: TBD
2. Project Name: Pedestrian Roadway & Safety
Owner: City of Coachella
Construction Cost: $ 1,498,267,00
Construction Time: 60
Owner's Representative:
Leonard St. Sauver
Owner's Telephone No.: 760-398-3502
Date of Substantial Completion: March 2023
Calendar Days
Calendar Days
Bidders Experience & Qualifications 1230-1
3. Project Name: Jefferson Street @ Avenue 53 Roundabout
Owner: City of La Qunita
Construction Cost: $ 2,697,119.00
Construction Time: 120 Calendar Days
Owner's Representative: Ubaldo Ayon
Owner's Telephone No.: 760-770-7000
Date of Substantial Completion: February 2023
4. Project Name: Cedar Sinai Medical Center
Owner: Cedar Sinai Medical Center
Construction Cost: $ 501,058.00
Construction Time: 60 Calendar Days
Owner's Representative: Chris Goggin
Owner's Telephone No.: 615-917-2111
Date of Substantial Completion: Au ust 2020
Signed this 24th day of April, 2023 2021.
Jacobsson Engineering Construction, Inc. CA #650389 A&B 1000008233
Name of Bidder Contractor's License No. DIR Reg No.
G1f c= f 7/31 /2024
Signature of Bidder Expiration Date
Erik Jacobsson CFO/Treasurer
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 Work/% of Work/License No./DIR Reg No.
LA -
Signature of Bidder
Erik Jacobsson
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 Riverside )
Erik Jacobsson , being first duly sworn, deposes and say that
he Or she is CFO/Treasurer of Jacobsson Engineering Construction, Inc. 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
Erik Jacobsson
Name of Bidder
CFO/Treasurer
Title
4/24/2023
Date
Non -Collusion Affidavit 1250-1
SECTION 1260
DIR Project Vendor Information
Vendor Information:
Name: Jacobsson Engineering Construction, Inc.
Address: RO. Box 34430 City: Palm Desert
Zip: 92255
Project Manager: Erik Jacobsson
Phone: 760-345-8700
Email: erik@jacobssoninc.com
ST: CA
CSLB/Certification Number: CA #650389 A&B
Public Works Registration No.: 1000008823
Classification:
Asbestos Boilermaker Bricklayers Carpenter Carpet/Linoleum
Cement Masons Drywall Finisher Drywall/Lathers Electricians
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:
jlttp://www.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:Z/www.dir.ca.gov/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
CO
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 Name/Financial Institution (Printed)
Jacobsson Engineering Construction, Inc.
By (A thorized Signature)
Printed Name and Title of Person Signing
Erik Jacobsson, CFO/Treasurer
Federal ID Number (or n/a)
33-0509430
Date Executed
4/24/2023
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)
N/A
By (Authorized Signature)
Printed Name and Title of Person Signing I 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.
Russian Aggression Against Ukraine Sanctions Certification 1280-1
EXHIBIT B-4
Required Bid Form
CERTIFICATION OF BIDDER
REGARDING NONSEGREGATED FACILITIES
Project Name: Citywide Miscellaneous ADA Improvements
Name of Bidder: Jacobsson Engineering Construction, Inc.
The above named Bidder hereby certifies that:
I do not maintain or provide for my employees any segregated facilities at any of
my establishments, and that I do not permit my employees to perform their
services at any location, under my control, where segregated facilities are
maintained. As used in this certification, the term "segregated facilities" means
any waiting rooms, work areas, rest rooms, wash rooms, restaurants and other
eating areas, time clocks, locker rooms or other dressing areas, parking lots,
drinking fountains, recreation or entertainment areas, transportation, and housing
facilities provided for employees which are segregated by explicit directive or are
in fact segregated on the basis of race, color, religion, national origin, or because of
habits, local customs, or otherwise.
I further agree to obtain identical certifications from all proposed subcontractors
prior to the award of subcontracts exceeding $10,000.
Signature: kA, _
Name (Print): Erik Jacobsson
Title: CFO/Treasurer
Date: 4/24/2023
CDBG Required Bid Form 1290-1
EXHIBIT B-7
Required Bid Form
COUNTY OF RIVERSIDE
CDBG PROGRAM
BIDDER CERTIFICATION ON
FEDERAL CONTRACT REQUIREMENTS
PROJECT NAME: Citywide Miscellaneous ADA Improvements
CERTIFICATION:
I hereby certify that I have reviewed and understand the diversified Federal
construction contract related requirements imposed on the Contractor(s) of HUD -
funded construction projects, including but not limited to the following:
1. The subject project is being financed with Community Development Block
Grant funds (24 CFR Part 570);
2. This project and all related construction contracts are subject to the U.S.
Department of Housing and Urban Development's Federal Labor Standards
Provisions (HUD 4010 — revised 06/2009); and
1. This project is subject to all applicable laws and regulations as listed in the
General Summary of these Special Federal Provisions; and
2. If my bid is $200,000 or more, this project and all related contracts will
subject to Section 3 requirements (12 U.S.C.1701u).
CONTRACTOR'S NAME: Jacobsson Engineering Construction, Inc.
CONTRACTOR'S LICENSE NO.: CA #650389 A&B
ADDRESS: P.O. Box 14430, Palm Desert. CA 92255
AUTHORIZED REPRESENTATIVE: Erik Jacobsson (Type Name)
SIGNATURE:
DATE: 4/24/2023
CDBG Required Bid Form 1290-2
QUESTIONNAIRE REGARDING BIDDERS
Bidder has been engaged in the contracting business under the present name of
Jacobsson Engineering Construction, Inc.
, since 1992
Present business address is: P.O. Box 14430, Palm Desert, CA 92255
Physical: 73-310 Varner Road, Thousand Palms, CA 92276
Federal Tax ID: 33-0509430
Amount of Bid $
EXHIBIT B-8
Required Bid Form
California Contractor's License No.: CA #650389 A&B Expiration Date: 7/31/2024
DUNS Number: 82-511-6387
or CAGE Code:
(Date).
Because this project is Federally -funded, it is necessary to obtain information concerning minority and
other group participation for statistical purposes. The U.S. Department of Housing and Urban
Development (HUD) uses this information to determine the degree to which its programs are being
utilized by minority business enterprises and targeted group contractors.
A minority enterprise is defined by the Federal Government as a business that is fifty-one percent (51%)
or more "minority -owned". Please check applicable box concerning the ownership of your business:
❑ American Indian or Native Alaskan
❑ Asian or Pacific Islander/Native Hawaiian
❑ Black/African American
❑ Hispanic
® White
❑ Hasidic Jews
❑ Other
A woman -owned enterprise is defined by the Federal Government as a business that is fifty -
percent (50%) or more woman -owned. Please check applicable box concerning the ownership
of your business:
® Woman/Female owned ❑ Male owned
A Section 3 Contractor or Subcontractor is a business concern that is more than fifty-one percent (51%)
owned by a low or very low-income person, or a business concern that provides economic opportunities
to low and very low-income residents. Please check applicable box concerning the ownership of your
business:
❑ Section 3 Business concern ® Non -Section 3 Business concern
The United States Department of Housing and Urban Development (HUD) is authorized to solicit the information
requested in this form by virtue of Title 12, United States Code, Section 1701 et seq., and other regulations. It will not be
disclosed or released outside of HUD without your consent, except as required or permitted by law.
CDBG Required Bid Form 1290-3
EXHIBIT B-9
Required Bid Form
LIST OF SUBCONTRACTORS
SUBCONTRACTOR FED. I.D.# AMOUNT ADDRESS/PHONE NO.
Superior Pavement Markings 20-4518251 $9.600.00 P.O. Box 278, Beaumont, CA 92223
SUPPLIERS
NAME OF SUPPLIER ADDRESS/PHONE NO, CONTRACT AMOUNT
1564 Mission Road
Superior Ready Mix Escondido, CA 92029 $10,000.00
760-343-3418
This form is to be completed and submitted with the bid package.
CDBG Required Bid Form 1290-4
SECTION 1220
BID GUARANTY BOND
PRINCIPAL, and The Ohio Casualty Insurance*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. 2022-08 AND CDBG PROJECT NO. 4.LQ.47.22
CITYWIDE MISCELLANEOUS ADA IMPROVEMENTS
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 10th day of
April 1 2023.
Jacobsson Engineering Construction Inc.
T)"To �JC" ec bssen Pre st 4e ,j-
Title of Signatory
!Signature of Principal
P O Box 14430
Palm Desert, CA 92255
Address
The Ohio Casualty Insurance Company
Diane M Nielsen - Attorney in Fact
Title of Signatory 1.
'gnature of Surety
175 Berkeley St
Boston, Massachusetts 02116
Address
Note: Signatures of those executing for the surety must be properly acknowledged.
* The Ohio Casualty Insurance Company
Bid Guaranty Bond 1220-1
CALIFORNIA ALL-PU RPOSE 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 before me, Linda Rocha Notary Public,
❑ate Insert Name of Notary exactly as it appears on the official seal
personally appeared Diane M. Nielsen
Name(s) of Signer(s)
•� �LINDA ROCHA
° ;`�
Notary Public California x
Y �=
Riverside County s
J
Commission ; 2310332
My Comm, Expires Nov 20, 2023
Place Notary Seal Above
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 ha rrd oftici i eaKer—
Signature
1S gnatur of N tary Public Linda ROC a
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:
0 Liberty
�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: 8205922-972035
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, Diane M.
Nielsen; Matthew S. Costello; Sal C. Sandoval
all` of the city of Palm Desert 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 its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 9th day of July , 2021 .
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m State of PENNSYLVANIA
:c3n, County of MONTGOMERY
Liberty Mutual Insurance Company
P4 IHSU DIY INS& A 1Nsiuk The Ohio Casualty Insurance Company
4oEwon4,-VP IIaro
sa r �� West American Insurance Company
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Y 7s1912 s s 1919 1991
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By:
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oOn this 9th day of July 2021 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance
m Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes
therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
a� to
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written.
'rn
O 5� PAg7
Commonwealth of Pennsylvania - Notary Seat
O �tV Lp� GCS p Teresa Pastels,Montgomery
Notary Public
� of
p Montgomery County
@ My commission expires March 28, 2025 By
` Commission number 1126044
VIA fJ MOMW,PmvrsylvanisAuockt*nofN*taMl eresaPastella,Notary Public
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C 2 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 •� Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
°? ARTICLEIV— OFFICERS: Section 12. Power of Attorney.
o co 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
o U President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety
> C: any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall
o have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such
z instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the
provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE XIII — Execution of Contracts: Section 5, Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe,
shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings,
bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in -
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this loth day of April 2023
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Y���• 7 * +c�11Sf'�.a� h'A MPS �,aa Ys� 4DIAT PNya Renee C Llewellyn, Ass skanE Secretary
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LMS-12873 LMIC OCIC WAIC Multi Co 02/21
CALIFORNIA ACKNOWLEDGMENT
CIVIL CODE g 1189
�r'Y{•YIYiC]??sW:ttty
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 1
County of Riverside J}
On QLf- f f �5 _ _ _ before me, Fran M. Brown Notary Public
Date Here Insert Name and Title of the Officer
personally appeared Dan Jacobsson
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.
FRAN M. BROWN
" Notary Public • California
Riverside County
_ Commission # 2349232
My Comm. Expires Aug 3, 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 �Aw Y i- r
Signature of Notary Public
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:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer - Title(s):
❑ Partner - ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer is Representing:
Number of Pages:
Signer's Name:
❑ Corporate Officer - Title(s):
❑ Partner - ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer is Representing: _
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