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Tri Star Contracting II, Inc. BidSECTION 1200 BID DATE: The undersigned, as bidder, declares it has received and examined the Contract Document entitled Project No. 2022-30, COVE TRAILS PARKING LOT 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 # Date Received Initials Attached is a bid guaranty bond as required by Paragraph 1110-15.0, BID GUARANTY. Name of Bidder Bidder's Telephone Number Bid 1200-1 If our bid is accepted, we agree to sign the contract without qualifications and to furnish the performance and payment bonds and the required evidence of insurance within 10 calendar days after receiving written notice of the award of the contract. We further agree, if our bid is accepted and a Contract for performance of the work is entered into with the City, to so plan work and to prosecute it with such diligence that the work shall be completed within the time stipulated. V R•. ' Name of Bidder I1 I b�1 LA I�nuvL�cAC) Q-C.XmrA Bidder's Address 1� C)q \C-�S Contractor's License No. C' A OV S Printed)Name of Signatory �4�1 Title of Signatory � � 1 Bidder's elephone Number Bidder's Email Address � 1 � Contractor's Expiration Date Witness Title of Witness Bid 1200-2 SECTION 1210 BID SCHEDULE PROJECT NO. 2022-30 COVE TRAILS PARKING LOT 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 2022-30, COVE TRAILS PARKING LOT 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. 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 — COVE TRAILS PARKING LOT IMPROVEMENTS Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Mobilization 1 LS $,3LP\a L-)0 $ 2 Site Control 1 LS $1'520-00 $--1 1SI (600 3 Dust Control 1 LS $ l q ton 4 Clearing and 1 LS Grubbing/Earthwork s ' . - 5 Furnish and Install 4" Class II 857 CY $' 4D — Aggregate Base Total Amount of Bid Items 1 — 5 GRAND TOTAL BASE BID (Figures): $ k (Dns A GRAND TOTAL BASE BID (Words): i�e,,V lu V'�AveA- lrxwf v [ ll a V- Ct V\A 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) Name of Bidder (Printed or Typed) ;�-) t `IJ-1—J�1 Bidder Telephone Number �- Ow enr\'�'�� \' SN�V Bidder Email Address Bid Schedule 1210-2 SECTION 1220 BID GUARANTY BOND *PRINCIPAL, and HARCO NATIONAL INSURANCE COMPANY, as SURETY, are held and firmly bound unto the City in the penal sum of TEN (10) PERCENT OF THE TOTAL AMOUNT OF THE BID of the Principal above named, submitted by said Principal to the City for the work described below, for the payment of which sum in lawful money of the United States, well and truly to be made to the City to which said bid was submitted, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT WHEREAS, the Principal has submitted the above-mentioned bid to the City, for certain construction specifically described as follows, for which bids are to be opened at La Quinta, California. PROJECT NO. 2022-30 COVE TRAILS PARKING LOT 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 5th day of October . 2023. TRI -STAR CONTRACTING II, INC. HARCO NATIONAL INSURANCE COMPANY Title o Sig By Sign1url o Principal 15-501 Little Morongo Road Desert Hot Springs, California 92240 Address Attorney -in -Fact Title of Signatory Signature(pf,Sur4ty /bouglos J. Rothey 4200 Six Forks Road, Suite 1400 Raleigh, North Carolina 27609 Address Note: Signatures of those executing for the surety must be properly acknowledged. Bid Guaranty Bond *TRI -STAR CONTRACTING II, INC., as 1220-1 State of COLORADO } )ss. County of ARAPAHOE } On October 5, 2023, 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 HARCO NATIONAL INSURANCE COMPANY 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: December 8, 2026 Cyrithia M. Burnett, Notary Public Cynthia M. Burnett NOTARY PUBLIC STATE OF COLORADO NOTARY ID# 19844019211 MY COMMISSION EXPIRES DECEMBER 8, 2028 POWER OF ATTORNEY Bond# Not Applicable HARCO NATIONAL INSURANCE COMPANY INTERNATIONAL FIDELITY INSURANCE COMPANY Member companies of IAT Insurance Group, Headquartered: 4200 Six Forks Rd, Suite 1400, Raleigh, NC 27609 KNOW ALL MEN BY THESE PRESENTS: That HARCO NATIONAL INSURANCE COMPANY, a corporation organized and existing under the laws of the State of Illinois, and INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and having their principal offices located respectively in the cities of Rolling Meadows, Illinois and Newark, New Jersey, do hereby constitute and appoint DOUGLAS J. ROTHEY, CYNTHIA M. BURNETT, KIM PAYTON, ERIK ULIBARRI Denver, CO their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 13th day of December, 2018 and by the Board of Directors of HARCO NATIONAL INSURANCE COMPANY at a meeting held on the 13th day of December, 2018. "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY have each executed and attested these presents on this 31st day of December, 2022 SEAL ,1934 ati4 .. Lr1.0. . STATE OF NEW JERSEY STATE OF ILLINOIS County of Essex` County of Cook Kenneth Chapman Executive Vice President, Harco National Insurance Company and International Fidelity Insurance Company On this 31st day of December, 2022 , before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly sworn, said he is the therein described and authorized officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. ` of, 0., IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark, .... . QT''y New Jersey the day and year first above written. W JE�i55,� Shirelle A. Outley a Notary Public of New Jersey My Commission Expires April 4, 2023 CERTIFICATION I, the undersigned officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said mower of Attorney has not been revoked and is now in full force and effect. IN TESTIMONY WHEREOF, I have hereunto set my hand on this day, October 5, 2023 A00911 Irene Martins, Assistant Secretary ACORO� TRISCON-02 CERTIFICATE OF LIABILITY INSURANCE D IELSEN DATE (MM/DDrCM) 9/28/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0757776 CONTACT Diane Nielsen NAMFm HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 PHONE , Ext): (760 360 4700 4742 FAX 760 200-9706 ) (A/C, No):(760) di2ne.nielsen@hUbinternational.com Palm Desert, CA 92211 URFR S AFFORDING COVERAGE Nmc it sURERA.United Specially Insurance Company 12537 wsuRFR B. Wesco Insurance Company 25011 INSURED Tri-Star Contracting II, Inc. Telar, Inc. 15-507 Little Morongo Road 1604 INSURER c.Everest Premier Insuran-ce Company . INsuRERD: Travelers Property Casualty Company of America 25674 INSURER E: Desert Hot Springs, CA 92240 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.. INSR TYPE OF INSURANCE ADDL JAISD SUOR Vivo POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEF^] OCCUR ATN2376531 6/26/2023 6/26/2024 EACH OCCURRENCE $ 1000'000 PAMAGET� EBF° $ 50,000 X $5,000 Ded BI $ PD MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 EN'LAGGREGATE! LIMIT APPLIES PER : POLICY l X JEOT u LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG 2,000,00a OTHER: B AUTOMOBILE LIABILITY COMBINEOSINGLELIMIT$ 1,000,000 (Es oocidsnoX BODILY INJURY (Perperson) $ ANY AUTO WPP1987680-00 11/23/2022 11/23/2023 OWNED SCHEDULED AUTOS ONLY ALT BODILY INJURY Per acciden $ BODILY Pe�rac[duenl E $ X p AUTOS ONLY X AUTOS E9 X No Deductible A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 X EXCESS LIAB CLAIMS -MADE BTN2370408 6/26/2023 6/26/2024 X DED F RETENTION$ 0 Following Form $ 7600005937221 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE j -f -"'j OFFICER/MEMBER EXCLUDED? u (MandatorymNH) N I A 1011/2022 10/1/2023 X PEROTH- E.L. EACH ACCIDENT $ 1,000,000 E-L_DIS EASE -EA EMPLOYEE $ 1,000,000 1,000,000 E.l` DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION F OPERATIONS below D Equipment Floater 6606072C693 1/11/2023 1/11/2024 Leased/Rented 250,000 ) DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 161, Additional Remarks Schedule, may be attached if more space is required) Project No. 2022-30, Cove Trails Parking Lot Improvements TE City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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: � , OA �e- hA(MCM(An - 2. Owner: Construction Cost: $ C�-o 1 ` -ub Construction Time: `---x Calendar Days Owner's Representative: e 1 Owner's Telephone No.: Date of Substantial Completion: Project Owner: Construction Cost: $5�, Construction Time: Calendar Days Owner's Representative: Owner's Telephone No.: � 1 t nb) tL-A( 6 — Date of Substantial Completion: Bidders Experience & Qualifications 1230-1 3. Project Name: Owner: MfW ee�8- Construction Cost: $ Construction Time: Calendar Days Owner's Representative: -.C-L/ V Owner's Telephone No.:3�t�-��_ Date of Substantial Completion: 4. Project Name: Owner: v l Construction Cost: $ oL UV Construction Time: —R Calendar Days Owner's Representative: Owner's Telephone No.: L 1 Date of Substantial Completion: Gald Signed this t �day of Lc,�C�1% , 2023. Name of Biddpr-� Contractor's License No. DIR Reg No. Sign Iture f Bidder Printed Name of Bidder � I-� I Expiration bate Title of Signatory Bidders Experience & Qualifications 1230-2 1 V� 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. N I 11 Proposed Subcontractors 1240-1 SECTION 1250 NON -COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ) ) ss. County ofw,arslc�t ) AS , being first duly sworn, deposes and say that he or she is the party making the foregoing bid that the bid is not made in the interest 60, 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 steam bid. Name of Bidder 1 Title oc � P21�: Date Non -Collusion Affidavit 1250-1 SECTION 1260 DIR Proiect Vendor Information Vendor Information: Nan e 1 V( Address.l 50 \L 1 zip �0 Project Manager ��-�' Phone-LLP-JC�;�J CSLB/Cer Email A �V .N4D Fication Number: A' OR Public Works Registration No.:I SQ Classification: Asbestos Boilermaker Bricklayers Carpenter Carpet/Linoleum Cement Masons Drywall Finisher Drywall/Lathers Electricians Elevator Mechanic Glaziers Iron Workers Laborers Millwrights Operating Eng v Painters Pile Drivers Pipe Trades Plasterers Roofer SheetMetal Sound/Com Surveyor Teamster Tile Worker Prevailing Wages and Payroll: The project is subject to prevailing wage rates and enforcement by the Department of Industrial Relations (DIR). Prevailing wage rates can be obtained at: http://www.dir.ca.gov/Public-Works/Prevailing-Wa-qe,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: htt ://www.dir.ca, ov/Public-Works/Certified-Pa roll -Re ortin .html. A copy of certified payroll, including the names and addresses of employees and/or subcontractors working on the job must be included with invoices submitted to the City of La Quinta. DIR Project Vendor Information 1260-1 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 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 Y By Prin d (Printed) Federal ID Number (or n/a) rVe and Title of Person Signing Date Executed 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) y ��4 !A By (Authorized Signature) Printed Name and Title of Person Signing Federal ID Number (or n/a) Date Executed Iran Contracting Act Certification 1270-3 SECTION 1280 COMPLIANCE WITH CALIFORNIA EXECUTIVE ORDER N-6-22 RUSSIAN AGGRESSION AGAINST UKRAINE (a) Contractor shall comply with California Governor Executive Order N-6-22 regarding sanctions in response to Russian aggression in the Country of Ukraine, and any implementing guidelines and/or economic sanctions imposed by the United States government in response to Russian actions in Ukraine, as well as any sanctions imposed under California law (collectively "economic sanctions"). Contractor shall comply with all such economic sanctions. By submitting a bid to the City, Contractor agrees to take any and all actions to support the Ukrainian government and people as required by law, including by refraining from new investments in, and financial transactions with, Russian institutions or companies that are headquartered or have their principal place of business in Russia (Russian entities), not transferring technology to Russia or Russian entities, and directly providing support to the government and people of Ukraine. (b) If bidding on a contract for Five Million Dollars ($5,000,000) or more, Contractor shall submit a written report to the City on Contractor's compliance with the economic sanctions, and the steps Contractor has taken in response to Russia's actions in Ukraine, including, but not limited to, desisting from making new investments in, or engaging in financial transactions with, Russian entities, not transferring technology to Russia or Russian entities, and directly providing support to the government and people of Ukraine as required by law. Failure to submit the report required by this Section may deem Contractor's bid non-responsive. Please include a written report to the City if this section is applicable. 1\\ I P� - l Al I, OR IA - FTAIQ01:101Big] A1011 TO: All Prospective Bidders and Plan Holders FROM: Ubaldo Ayon, Assistant Construction Manager DATE: September 29, 2023 SUBJECT: Project No. 2022-30 Cove Trails Parking Lot Improvements The following shall be considered as incorporated into the project plans and specifications for the above referenced project. Portions of plans and specifications not specifically mentioned in this Addendum remain in force. PROJECT SPECIFICATIONS Section 1340: Sheet 1340-3, Section 2.2: Insurance, replace paragraph 2 per the following: As Reads: Commercial General Liability (at least as broad as ISO CG 0001) $5, 000, 000 (per occurrence) $5, 000, 000 (general aggregate) Must include the following endorsements: General Liability Additional Insured General Liability Primary and Noncontributory. Amended to Read: Commercial General Liability (at least as broad as ISO CG 0001) $2,000,000 (per occurrence) $4,000,000 (general aggregate) Must include the following endorsements: General Liability Additional Insured General Liability Primary and Noncontributory. Section 3000: Sheet 3000-8, Section 4.4: Permits, Licenses and Inspection Fees, add the following paragraph after arab The Contractor will be required to obtain a Coachella Valley Water District Temporary Encroachment Permit and is responsible for the fees. (2aifa -- i[ ❑ORXIA -- Section Section 4000: Sheet 4000-2, Section 5: Clearing and Grubbing, Subsection 300-1.3.1, General, add the following paragraph after paragraph 1: ' All material less than 4" in size taken from the daylight grading area will need to be legally disposed off-site. All rock 4" and larger can be placed along the edge of the parking lots. The Contractor is hereby notified; Addendum No. 1 must be acknowledged and initialed as stipulated under the instructions to Bidders and submitted as part of the Bid. Failure to do so shall result in the City designating said bid as "Non -Responsive." APPROVED: Digitally signed by Ubaldo Ayon Jr j Date: 2023.09.29 15:57:14 -07'00' Ubaldo Ayon Assistant Construction Manager Attachments: 1. CVWD Construction Encroachment Permit END OF ADDENDUM NUMBER 1 ,NATER COACHELLA VALLEY WATER DISTRICT 4�STR% INSTRUCTIONS TO APPLICANT CONSTRUCTION ENCROACHMENT PERMIT Applicant shall provide one (1) set of approved CVWD Drawings. 2. Applicant shall submit a completed Construction Encroachment Permit application and obtain an executed Construction Encroachment Permit ("Permit") prior to construction. Permit will be released by the Inspection Division during the preconstruction meeting*. 3. Applicant shall have insurance carrier provide an Acord certificate including required endorsements as stated in the Coachella Valley Water District Insurance Requirements. 4. Applicant shall pay a $346 non-refundable permit processing fee at the time of submitting the application. (Applicant will be given instructions to pay via credit card) 5. Processing can take up to thirty (30) days from the receipt of all required documents (application, approved CVWD drawings, processing fee, and insurance forms and endorsements). NOTE: If permanent improvements are being installed within CVWD or United States Bureau of Reclamation ("USBR') right-of-way, the responsible party may be required to obtain a separate authorization (Permanent Encroachment Permit, Noninterference Review Letter, USBR Right -of -Use, etc.) prior to the start of construction. CVWD WILL NOT PROCESS THE PERMIT UNLESS THE PACKAGE SUBMITTED IS COMPLETE. ENG EP -002 (Rev. 09/1/21) APPLICATION FOR CONSTRUCTION ENCROACHMENT PERMIT (Use separate application for each project) Permission is requested to encroach on CVWD/USBR right-of-way as indicated below. Complete all items; insert N/A if not applicable. Application may be returned if all required attachments are not included. Location: City CVWD/USBR Facility Nearest Cross Streets County APN(s) Date (NE) (NW) (SW) (SE) Quarter(s) of Section , Township South, Range East (Check all that apply) FULLY DESCRIBE WORK WITHIN CVWD/USBR RIGHT-OF-WAY. Attach approved CVWD drawings (one 11" x 17" set), specifications, calculations, maps, etc., if applicable. Estimated Dates: Start Complete Application shall be submitted a minimum of 30 days before construction is scheduled to start. PERMIT FEE: There shall be a $346.00 non-refundable processing fee paid at the time this application is submitted (Applicant will be given instructions to pay via credit card). CONSTRUCTION INSPECTION: Will be performed by CVWD at the Permittees expense as required by CVWDC 3.05.210. (Ord. 1399.13 § 8-1, 2019) PERFORMANCE WARRANTY: Bond may be required of the Permittee whenever in the judgment of CVWD it becomes necessary or advisable to guarantee performance. INSURANCE REQUIREMENTS: Must be met at the time this application is submitted. THE UNDERSIGNED AGREES THAT THE WORK WILL BE DONE IN ACCORDANCE WITH CVWD ENCROACHMENT PERMIT AND SUBJECT TO INSPECTION AND APPROVAL. Applicant / Company Name L --)— Phone Number Mailing Address City, State, and Zip Code Authorized Name and Title (print) Authorized Signature Email Address If you have any questions in regard to the preparation of this application or if you need any information, please contact the Right -of - Way Division at (760) 398-2651. ENG EP -002 (Rev. 09/1/2 1) COACHELLA VALLEY WATER DISTRICT INSURANCE REQUIREMENTS MINIMUM SCOPE AND LIMIT OF COVERAGE. Prior to and at all times after executing the Permit, Permittee shall procure and maintain, at its sole cost, for the duration of Permittee's obligations hereunder, not less than the following coverage and limits of insurance, with insurers and under policy forms satisfactory to CVWD. (a) Commercial General Liability Insurance written on an occurrence basis of at least $1,000,000 per occurrence/$2,000,000 aggregate including ongoing operations, products and completed operations, property damage, bodily injury, personal and advertising injury, and premises/operations liability. (i) Coverage for Commercial General Liability insurance shall be at least as broad as Insurance Services Office Commercial General Liability coverage form (Occurrence Form CG 00 01) or exact equivalent. (ii) The policy shall contain no endorsements or provisions limiting coverage for (1) contractual liability; (2) cross liability exclusion for claims or suits by one insured against another; (3) products and completed operations liability; or (4) contain any other exclusion contrary to the Permit. (iii) The policy shall be endorsed to name Coachella Valley Water District, its employees, directors, officers, agents, and volunteers as additional insureds using ISO endorsement forms CG 20 10 10 01 and 20 37 10 01, or endorsements providing the exact same coverage. (b) Commercial Automobile Liability Insurance written on a per occurrence basis of at least $1,000,000 per occurrence for bodily injury and property damage. (i) Coverage for automobile liability insurance shall be at least as broad as Insurance Services Office Form Number CA 00 01 covering automobile liability (Coverage Symbol 1, any auto) (ii) The policy shall be endorsed to name Coachella Valley Water District, its employees, directors, officers, agents, and volunteers as additional insureds. (c) Workers' Compensation Insurance/Employers Liability as required by the State of California with statutory limits or be legally self-insured pursuant to Labor Code section 3700 et seq. along with Employer's Liability limits of no less than $1,000,000 per occurrence for bodily injury or disease. The workers compensation insurer shall agree, using form WC 00 03 13 or the exact equivalent to waive all rights of subrogation against Coachella Valley Water District, its employees, directors, officers, and agents. OTHER INSURANCE PROVISIONS. All of Permittee's policies shall meet the following requirements and contain all specified provisions/endorsements noted hereunder. (a) Insurers shall provide CVWD at least thirty (30) days prior written notice of cancellation of any policy required by this Permit, except that insurers shall provide at least ten (10) days prior written notice of cancellation of any such policy due to non-payment of premium. In the event any insurer issuing coverage hereunder does not agree to provide notice of cancellation to CVWD, Permittee shall assume such obligation and provide written notice of cancellation in accordance with the above. If any of the required coverage is cancelled or expires during the term of this Permit, Permittee shall deliver renewal certificate(s) including endorsements to CVWD at least ten (10) days prior to the effective date of cancellation or expiration. ENG EP -002 (Rev. 09/1/21) (b) The Commercial General Liability Policy and Automobile Policy shall each contain a provision stating that Permittee's policy is primary insurance and that any insurance, self-insurance or other coverage maintained by CVWD or any additional insureds shall not be called upon to contribute to any loss. (c) All required insurance coverages shall contain a provision, or be endorsed, to waive subrogation in favor of the Coachella Valley Water District, its employees, directors, officers, and agents or shall specifically allow Permittee to waive its right of recovery prior to a loss. Permittee hereby waives its own right of recovery against Coachella Valley Water District, its employees, directors, officers, and agents. (d) If at any time during the life of the Permit, any policy of insurance required under this Permit does not comply with these specifications or is canceled and not replaced, CVWD has the right but not the duty to obtain the insurance it deems necessary and any premium paid by CVWD will be promptly reimbursed by Permittee. In the alternative, CVWD may cancel this Permit. (e) CVWD may require Permittee to provide complete copies of all insurance policies and endorsements in effect for the duration of the Permit. (f) The general liability and automobile liability programs may utilize either deductibles or provide coverage excess of a self-insured retention, subject to written approval by CVWD, and provided that such deductibles shall not apply to CVWD as an additional insured. (g) Claims made policies are not acceptable (h) Permittee shall not allow any of its contractors, consultants, subcontractors or subconsultants to commence work under this Permit until Permittee has required and verified that contractors, subcontractors, consultants, or subconsultants have secured all insurance required under this Section, including waivers of subrogation and other endorsements. Policies of commercial general liability insurance provided by such contractors, consultants, subcontractors or subconsultants shall be endorsed to name Coachella Valley Water District, its employees, directors, officers, and agents as additional insureds using ISO form CG 20 38 04 13 and CG 20 10 11 85, or an endorsement providing the exact same coverage. If requested by Permittee, CVWD may approve different scopes or minimum limits of insurance for particular contractors, consultants, subcontractors or subconsultants. VERIFICATION OF COVERAGE. Prior to execution of the Permit, Permittee shall file with CVWD evidence of insurance from an insurer or insurers certifying to the coverage of all insurance required herein. Such evidence shall include original copies of the Certificate of Insurance (Acord Form 25-5 or equivalent), together with required endorsements. All evidence of insurance shall be signed by a properly authorized officer, agent, or qualified representative of the insurer and shall certify the names of the insured, any additional insureds, where appropriate, the type and amount of the insurance, the location and operations to which the insurance applies, and the expiration date of such insurance. All policies required shall be issued by acceptable insurance companies, as determined by CVWD. Each such policy shall be from a company or companies with a current A.M. Best's rating of no less than A:VII and admitted to transact in the business of insurance in the State of California, or otherwise allowed to place insurance through surplus line brokers under applicable provisions of the California Insurance Code or any federal law. LIABILITY NOT LIMITED. Defense costs shall be payable in addition to the limits set forth herein. Requirements of specific coverage or limits contained herein are not intended as a limitation on coverage, limits, or other requirement, or a waiver of any coverage normally provided by any insurance. The limits set forth herein shall apply separately to each insured against whom claims are made or suits are brought, except with respect to the limits of liability. Further the limits set forth herein shall not be construed to relieve Permittee from liability in excess of such coverage, nor shall it limit Permittee's indemnification obligations to ENG EP -002 (Rev. 09/1/21) CVWD and shall not preclude CVWD from taking such other actions available to CVWD under other provisions of the Permit or law. AVAILABLE LIMITS. Notwithstanding the minimum limits set forth above, any available insurance proceeds in excess of the specified minimum limits of coverage shall be available to the parties required to be named as additional insureds. RESERVATION OF RIGHTS. CVWD reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. ENG EP -002 (Rev. 09/1/21) INSURANCE SUBMISSION" It is IMPORTANT to know that CVWD requires that ENDORSEMENT FORMS be attached behind the Certificate of Insurance. A statement on an insurance certificate will not be accepted in lieu of the actual endorsement forms. INSURANCE BROKERS should contact their insurance company UNDERWRITERS if they have questions. Every underwriter, regardless of the insurance company, has great knowledge of what endorsement forms are and can provide the forms to the broker. The endorsement forms are necessary and required. Please use the CHECKLIST below to verify that you have obtained and attached each of the proper items. Please submit the insurance as one (1) packet. ❑ General Liability Insurance Certificate in the amount of $1,000,000 ❑ Additional Insured Endorsement Form ❑ Waiver of Subrogation Endorsement Form ❑ Automobile Liability Insurance Certificate in the amount of $1,000,000 ❑ Additional Insured Endorsement Form ❑ Waiver of Subrogation Endorsement Form ❑ Workers' Compensation statutory limits, Employers liability $1,000,000 ❑ Waiver of Subrogation Endorsement Form Additional insured: Coachella Valley Water District, its employees, directors, officers, and agents. "This document is a short synopsis of CVWD's insurance requirements and is not intended to limit CVWD's liability in any way. ENG EP -002 (Rev. 09/1/21) COACHELLA VALLEY WATER DISTRICT_ INSPECTION *An estimated inspection deposit will be collected at the preconstruction meeting. Construction inspection will be performed by CVWD at the Applicant's expense as required by Coachella Valley Water District Code (CVWDC) 3.05.210. (Ord. 1399.13 § 8-1, 2019) Inspection ehurae - A. Amount. The charge for inspection of Construction Encroachment Permits, as provided in CVWDC 3.05.330(B), is based on an hourly rate. See Appendix P. A deposit is required as described below. B. Deposit. The Applicant shall deposit the estimated cost of the inspection prior to the start of construction. When the inspection charges exceed 90 percent of the deposit, the Applicant shall make additional deposits prior to any additional inspection. C. Refund. CVWD will refund any excess funds within 30 days of acceptance of the facilities by CVWD. All outstanding invoices need to be paid prior to release of the deposit. (Ord. 1399.13 § 5- 8,2019) ENG EP -002 (Rev. 09/1/21)