Loading...
Pavement Coatings Co. BidSECTION 1200 BID DATE: 5/25/2023 The undersigned, as bidder, declares it has received and examined the Contract Document entitled Project No. 2021-08, PMP Slurry Seal 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 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 # 0V E Date Received Initials Attached is a bid guaranty bond as required by Paragraph 1110-15.0, BID GUARANTY. PAVEMENT COATINGS CO. Name of Bidder 714-826-3011 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. PAVEMENT COATINGS CO. Name of Bidder 10240 San Sevaine Way Jurupa Valley, CA 91752 Bidder's Address 303609 Contractor's License No. CALIFORNIA �t of Incorpora ' n Siyn4WX isf adder 714-826-3011 Bidder's Telephone Number JVBIDS@PAVEM ENTCOATINGS.COM Bidder's Email Address 9/30/2024 Contractor's Expiration Date VI'V jA-rJ TA+A7 Witness (5 t% A tv- Name of Signatory Title of Witness VICE PRESIDENT Title of Signatory Bid 1200-2 SECTION 1210 BID SCHEDULE PROJECT NO. 2021-08 PMP SLURRY SEAL IMPROVEMENT 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. 2021-08, PMP Slurry Seal 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 B I D - PMP SLURRY SEAL IMPROVEMENTS Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars GENERAL 1 Mobilization 1 LS $ &0l Dad, `° $ 60, ooU. 2 Traffic Control 1 LS $ $ Z b5 , vov .�-' 3 Crack Seal and Type I, Latex 58,120 SF $ p, Wr $ t o Emulsion Aggregate Slurry 4 Crack Seal and Type 11, Latex Emulsion Aggregate Slurry-- 1,415,835 SF $ Q. 24 $ y jo �s 592.— Pavement Repair Type 1: 2" 5 Grind and Asphalt Concrete 3,302 SF $ (c, 2 5 $ Zd!03? 50 Overlay Pavement Repair Type 11: Edge Repair AC Shoving; 6 Grind AC Shoving 2" Below 140 SF _ $ 'L� , ob $ 4 D(oO , — Adjacent Surface and 2" Overlay Pavement Repair Type 111 : 7 Remove AC (4 1/2"), Compact Existing Base, and Overlay (5 60 SF $ �7 $ 3, ¢ZO. 1/2 " ) Remove Roadway Section to 8 Full Depth Required for 3,175 SF $ 44. "S $ /3/76 25 Proposed Roadway Section 9 Remove, Regrade, and Reset 751 SF $ !e' So $ Pavers Sawcut, Remove, and 10 Dispose of Existing Concrete 118 SF $ o}i So vo $ t4, 977, — Sidewalk/Ram Sawcut, Remove, and 11 Dispose of Existing Concrete 42 LF $ S j, a� $ 3, q S6 °O Curb; and Curb and Gutter Sawcut, Remove, and 12 Dispose of Existing Concrete 192 LF $ qg, $ Ribbon Gutter Remove Sidewalk Pavers, Salvage to City Yard as 50 13 Requested, Existing Pavers 105 SF $ /,S $ Installed per City of La Quinta Standard Plan 206 Bid Schedule 1210-2 Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars Construct 6" Curb per City of La Quinta Standard 210, 3" 14 Dowel into Adjacent 42 LF $ $ t f, 3&8 °o Existing/Proposed Concrete Curb Construct 6" Monolithic 15 Retaining Curb with Dowels 22 LF $ 93, $ 2 pq(p e° at All Corners Construct Sidewalk per City 16 of La Quinta Standard 240 77 SF and as Modified by the Plans Construct Portion of Cross 17 Gutter per City of La Quinta 244 SF oo $ Lf4, — $ Qj,-TLtD. — Standard Plan 230 and 231 Modified per Plans Construct Curb Ramp per City of La Quinta Standard 18 Plan 250 Mod., Place Domes 2 EA $ ��� 250 D0 $ ZD� GOO.00l 3' Wide Along 0" Back of Curb Construct 3' Wide Concrete Ribbon Gutter per Plan 19 Details, 3" Dowel (Slip Joint) 190 LF $ �� $ 7� o0 into Adjacent Existing/ Proposed Concrete Gutter Construct 3" AC over 4" AB 20 over 12" scarified and compacted native, CLQ STD. 3,008 SF $ `'✓� 12 • — $ ao — 195 Install Salvaged Pavers per 21 City of La Quinta Standard 20 SF $ $ 31 Q vo Plan 206 Modify and Restore Existing 22 Landscape, Hardscape, and Irrigation to Satisfaction of 1 LS 00 $ /f7, 25D. — 00 $1L7, 2SO. — City Striping and Pavement 23 Markings, Including All 1 LS $ 9g�000. "= $ gg,aua Incidentals Total Amount of Bid Items 1 — 23 $1,oy0,3ZS.36 Bid Schedule 1210-3 City may choose to award all, portion, or none of the following additive alternates: Additive Alternate 1 Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Lower Water Valve 4 EA $ I,v2S. $ 41 2 Raise Water Valve to Final 4 EA $ It $ L 1w. 00 Grade per CVWD Standards Total Amount of Additive Alternate 1 Bid Items 1 — 2 $ g21?0 0_ Additive Alternate 2: Item Item Description Est,, Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars Adjust Water Meter Box to 1 Final Grade per CVWD Standards. Meter to remain 1 EA $ �ro�' $ l,o� in place Total Amount of Additive Alternate 2 Bid Items 1 $ 11000• Additive Alternate 3: SilverRock Maintenance Yard Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Crack Seal and Type I, Latex 60,650 SF $ �2 $ `0 D0 25 3 Emulsion Aggregate Slurry Striping and Pavement 2 Markings, Including All 1 LS $ 1tr��V,m� Incidentals Total Amount of Additive Alternate 3 Bid Items 1 — 2 00 $ 99, 005. — Bid Schedule 1210-4 GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Figures): $ 11149, 3 28. 30 GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Words): OAIC- MIL1-1ON1 ONE UuNDlLEy Fv&-TY NINE T1-4or,(5A;ND, TN1t-EE ilikkibrLuoTw ENTY =1 y Do Qom- A N A T14ULFY GE AI T 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 base upon actual work performed, such ad' stments and alterations as elsewhere provided herein. Signature of Bidder (Ink) PAVEMENT COATINGS CO. Name of Bidder (Printed or Typed) 714-826-3011 Bidder Telephone Number JVBIDS@PAVEMENTCOATINGS.COM Bidder Email Address Bid Schedule 1210-5 SECTION 1220 BID GUARANTY BOND 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. 2021-08 PMP SLURRY SEAL 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 25th day of May 2023. Pavement Coatings Co. JAMAs"S LvLk f V 5i0�l�Tf Title of Signatory Sign,p�of,Pfincipal San Sevaine Way, Jurupa Valley CA 91752 Address The Ohio Casualty Insurance Company Brian A. McGoldrick, Attorney -in -Fact Title of Signatory Signature of Surety 175 Berkeley St., Boston, MA 02116 Address Note: Signatures of those executing for the surety must be properly acknowledged. Bid Guaranty Bond 1220-1 CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of over, de On T, Date personally appeared - before me, JQmPs VJV Jiro Jamero , N04ar9 PA11C Here Insert Name and Title of the Officer Nome(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. *my JIRA JAMERQ Notary Public . CaUforniaZ Riverside County T.Commission # 2304923 Comm. Expires Nov 30. 2025 M Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature OPTIONAL of Notary Public Completing this information can deter alteration of the ument or fraudulent reattachment of this form to an unintGr6ed document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Capacity(ies) Claimed by Si er(s) Signer's Name- ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: ©2019 National Notary Association 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- CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 :YSLer.�:rvCCcar� - ��YxRcz�rrr .�c`� A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Bernardino On May 25, 2023 before me, .Sri , id Lo ex Nota P►�blic , Date Here Insert Name and Title of the Officer personally appeared Brian A. McGoldrick Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/aae subscribed to the within instrument and acknowledged to me that he/she/try executed the same in his/Mr/Nxk,ir authorized capacity(w,), and that by his/*mrl*mir signature(s) on the instrument the person(6), or the entity upon behalf of which the person(s) acted, executed the instrument. BRIGID LOPEZ 6.,Ay Notary Public •California Orange County Commission 1244463G Comm. Expires May 2, 2027 Place Notary Seal Above rfD' 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 Sign Lure of N;tagpPubfic Though this section is optional, completing this inf ation can deter alteration of the document or fraudulent reattachment of this f rm to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) OthjO Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: _ Corporate Officer — Title(s): Partner — Limited Ge/nerIndividual Attorney iTrustee i_ Guardian nservator i i Other: Signer Is Representing: Signer's Name: Corporate Officer — Title(s): _ Partner — Limited i i General Individual _i Attorney in Fact -i Trustee 0 Guardian or Conservator Other: Signer Is Representing: 02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 0 Liberty RMUtum. 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: 8208193-971991 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, Brian A McGoldrick, Brigid Lopez, Evett Lam, Marisella Rivera all of the city of Pktcci1tm state of CA each individually if there be more than one named. its true and lawful attomey-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 21 st day of June 2022 Liberty Mutual Insurance Company J�aINS& o�4t+vsU�v P� %Nsb?,y The Ohio Casualty Insurance Company West American Insurance Company Y y 1912 0 0 1919 0 a 1991 Y¢y TsBd CXu .ab�N a3 'h�µag ,aa �y� ''bola%a ,fib B �77 * >� h1 * t� �,yr * f� y: m David M. Carey, Assistant Secretary m SlateofPENNSYLVANIA SS m County of MONTGOMERY On this 21 st day of June , 2022 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes thereln contained by signing on behalf of the corporations by himself as a duly authorized officer 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 may. ffi p111Yp• ( k7F Commorwmalih of Panns yhmnia - Nnlary SIlal Teresa Pastella, Notary Public Montgomery County My commission expires March 28, 2025 Lqg Commission number 1126044 4; _ �:'•K` Member, Pennsylvania Associabon of Notaries By: - Teresa Pastella, Notary Public 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 ance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV — OFFICERS: Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation 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 Corporation by their signature and execution of any such instruments and to attach thereto 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 attomey-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-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 attomeys-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 25th day of May , 2023 . INSU a orgR9'kn� yS �Loµvn qyn vP c°a °� yn 1912 0 1919 „ 1991 a By: atom'. Renee C, uewellyn, Assistant Secretary - CD EE 00 Q o O N P p; cam') kp o c(0 >b — -0 3 LMS-12873 LMIC OCIC WAIC Multi Co 02/21 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: SLURRY SEAL GROUP 2121 Owner: CITY OF SAN DIEGO Construction Cost: $ 3,796,322 Construction Time: 110 WD Owner's Representative: Owner's Telephone No.: EDGAR PUENTE 619-527-7527 Date of Substantial Completion: 4/1 /2022 2. Project Name: _ SLURRY SEAL GROUP 2024 Owner: CITY OF SAN DIEGO Construction Cost: $ Construction Time: 4,605,610 110 WD Owner's Representative: EDGAR PUENTE Owner's Telephone No.: 619-527-7527 Date of Substantial Completion: 8/5/2022 _Calendar Days Calendar Days Bidders Experience & Qualifications 1230-1 3. Project Name: 2021 ANNUAL STREET MAINTENANCE PROJECT Owner: CITY OF MALIBU Construction Cost: $ 660,485 Construction Time: _ 45 WD Calendar Days Owner's Representative: JENNA SOBRIERAY Owner's Telephone No.: 310-458-2489 Date of Substantial Completion: 11/2/2021 4. Project Name: 2021-2022 STREET MAINTENANCE Owner: CITY OF POWAY Construction Cost: $ 1,084,416 Construction Time: 40 WD Calendar Days Owner's Representative: JEFF BEERS Owner's Telephone No.: 858-668-4624 Date of Substantial Completion: 9/15/2021 Signed this 25 day of MAY , 2023. PAVEMENT COATINGS CO. 303609 1000003382 Name of Bidder Contractor's License No. 09/30/2024 Expiration Date VICE PRESIDENT Title of Signatory DIR Reg No. 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. PAVE14CPr P-L-If1V3 C.C.Mt>4NY1 Ero E. MAAIO&Vru_.A WfiY, C4LMA.r GA 92f37Y� GL�i G1L --s cit C W _ �-r—,r�rrrr r� G DNS_!t-� ! E r `"' •r,-. .T�- •�r� �1��r±-: ►—�tr+�lrs�s �Dfc.�sT ,� 3D.Z �o I lo5«"r�r � lvaa���23 SWE/ 40A- P1 VENEA T MAR-M-It465 L 5!,l Z GYPll-ESS 51. , CYPR.-FSS, C-A ; J s7RlPrNi� z t N- 57Ar L-Aanr �8 6 � /77& 3QL r�r r SierM'aare. uMidder JAMES WIJ - VICE PRESIDENT NT COATINGS CO. e of Bidder Proposed Subcontractors 1240-1 SECTION 1250 NON -COLLUSION AFFIDAVIT TO„BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ) County of RIVERSIDE ss. ) JAMES WU , being first duly sworn, deposes and say that he or she is VICE PRESIDENT of PAVEMENT COATINGS CO. 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. Signa A NT COATINGS CO. ame of Bidder VICE PRESIDENT Title 5/25/2023 Date Non -Collusion Affidavit 1250-1 CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189 M.~ 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 I County of R1vecnk, On 'rO I_2-5 I23 —before me, Nita JCemeto , Wr3 C(Xfyi ?001; C Date Here Insert Name and Title of the Officer personally appeared Jam-s Wv Nome(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. JIRA JAMER4 •= e< Notary Public -California R$verslde County T o•''` INy Commission rk 2184823 Comm. Expires Nov 30, Z025 Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature OPTIONAL �2 � - S. ature 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: ©2019 National Notary Association 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: SECTION 1260 DIR Project-Vengor Information Vendor Information: Name: PAVEMENT COATINGS CO. Address: 10240 SAN SEVAINE WAY City: Zip: 91752 Project Manager: TOM MUCENSKI 714-826-3011 Phone: JURUPA VALLEY ST: CA Email: TOM@PAVEMENTCOATINGS.COM CSLB/Certification Number: Public Works Registration No.: 1000003382 Classification: 303609 Asbestos Boilermaker Bricklayers Carpenter Carpet/Linoleum Cement Masons 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 Prmilin4 Wage -and Payroll: The project is subject to prevailing wage rates and enforcement by the Department of Industrial Relations (DIR). Prevailing wage rates can be obtained at: http://www.dir.ca.gov/Pu lic-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.ciov/Pubic Works/Certified-Pavroll- 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 iU A► .C► i# A ► ■ ■ ■ 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 N ncial Institu ' (Printed) PAV T COATI S CO. { vri r Printe e d Title of Person Signing JA U - ICE PRESIDENT Federal ID Number (or n/a) 95-2916670 Date Executed 5/25/2023 Iran Contracting Act Certification 1270-2 OPTION #Z — 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 FXFCUT I VE ORDER N-6-22 RUSSIAN AGGRESSION AGAINST U RAINF_ (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, l2piicable