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Roy Allan Slurry Seal Inc.SECTION 1200 BID DATE: The undersigned, as bidder, declares it has received and examined the Contract Document entitled Project No. 2023-16, FY23/24 Pavement Management Plan, 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. Roy Allan Slurry Seal, Inc. Name of Bidder 562-864-3363 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. Roy Allan Slurry Seal, Inc. Name of Bidder 12643 Emmens Way, Santa Fe Springs 90670 Bidder's Address 372798 Contractor's License No. California State of Incorporation Signature of Bidder Lawrence Allan Printed Name of Signatory President Title of Signatory Bidder's Telephone Number lawrence@raslurry.com Bidder's Email Address 4/30/25 Contractor's Expiration Date Title of WitnGds Bid 1200-2 SECTION 1210 BID SCHEDULE PROJECT NO. 2023-16 FY23/24 PAVEMENT MANAGEMENT PLAN 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. 2023-16, FY23/24 Pavement Management Plan, 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 — FY23/24 PAVEMENT MANAGEMENT PLAN Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Mobilization 1 LS $ 6� N ,U $ 6� bb1. n 2 Traffic Control 1 LS Al. q,l $1191(51-Q 3 Crack Seal and Type II, Latex 2,168,500 SF $ �� (� $ Emulsion Aggregate Slurry 4 Pavement Repair Type I: 2" Grind 19,960 SF $ 3.60 $71,856.00 and Asphalt Concrete Overlay Pavement Repair Type II: Edge 5 Repair AC Shoving; Grind AC 70 SF $55 $ 3,850.00 Shoving 2" Below Adjacent .00 Surface and 2" Overlay Pavement Repair Type III: 6 Remove Existing AC, Compact 370 SF $ 33.00 $12,210.00 Existing Base, and Variable Overlay (Depth Per Plan 7 Signing and Striping, Including All 1 t i ::LS:I:$ (`IU/ k),n $ Incidentals Total Amount of Bid Items 1 — 7 $ �l Va NA City may award all or none of the following additive alternates: ADDITIVE ALTERNATE NO. 1 Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Lower Sewer Manhole to Grade 1 EA $ 1,650.00 $ 1,650.00 per CVWD Standards 2 Raise Sewer Manhole to Grade 1 EA $ 1,650.00 $ 1,650.00 per CVWD Standards Total Amount of Additive Alternate 1 Bid Items 1 — 2 $ 3,300.00 Bid Schedule 1210-2 N ADDITIVE ALTERNATE NO. 2 — AVENUE 60 Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Mobilization 1 LS $ LK� - 2 Traffic Control 1 LS $ T40-� $a�,) a`'�l�• �� Sawcut, Remove, and Dispose 3 of Existing Concrete Sidewalk, 1,490 SF $ 11.00 $ 16,390.00 Ramp, and Cross -Gutter 4 Construct Sidewalk per City of 55 SF $ 38.50 $ 2,117.50 La Quinta Standard 240 Construct Concrete Curb Ramp 5 per City of La Quinta Standard 1 EA $16,500.00 $ 16,500.00 250, Case A 6 Crack Seal and Type II, Latex 345,470 SF $ $dri Emulsion Aggregate Slurry ,�,i® Pavement Repair Type I: 2" 7 Grind and Asphalt Concrete 12,990 SF $ 3.30 $ 42,867.00 Overlay Pavement Repair Type III: 8 Remove Existing AC, Compact 140 SF $ 33.00 $ 462.00 Existing Base, and Variable Overlay (Depth Per Plan Construct 5"-6" Asphalt 9 Concrete Over Recompacted 780 SF $ 16.50 $ 12,870.00 Existing Base Grade Parkway, Remove, Modify, and Replace 10 Landscape and Irrigation In 1 LS $ 11,000.00 $ 11,000.00 Kind to Furthest Extent Possible to Join Proposed Curb Ram 11 Signing and Striping, Including 1 LS $ All Incidentals Total Amount of Additive Alternate 2 Bid Items 1 —11 $ S51 q 01 .0 Bid Schedule 1210-3 AnnITIVE ALTERNATE NO. 3 -APPENDIX D Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Mobilization 1 LS $ $ �� ��� • �V 2 Traffic Control 1 LS $ S & 0\3 $ a.� j Ob . 0b 3 Striping and Pavement Markings, Including All 1 LS $a,jW - 0� $ �'5j 6V) b� Incidentals Total Amount of Additive Alternate 3 Bid Items 1 -3 1 $ GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Figures): $ I,`i\k5 Ik.k---�0 GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Words): Ono, VV\"kCt\JV' �6\.kv -Nt V_ �Viotxs �evtv\ \0 v J A\ It_ � '& 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) Roy Allan Slurry Seal, Inc. Name of Bidder (Printed or Typed) 562-864-3363 lawrence@raslurry.com Bidder Telephone Number Bidder Email Address Bid Schedule 1210-4 SECTION 1220 BID GUARANTY BOND PRINCIPAL, and Contractors Bonding 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. 2023-16 FY23/24 PAVEMENT MANAGEMENT PLAN 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 2nd day of May , 2024. Roy Allan Slurry Seal, Inc. Contractors Bonding and Insurance Company Title of Signatory Signature of Principal 12643 Emmens Way, Suite A, Santa Fe Springs, CA 90670 Address Ryan Butterfas, Attorney -in -Fact -� Title of Signatory - 9025 N. Lindbergh Dr., Peoria, IL 61615 Address Note: Signatures of those executing for the surety must be properly acknowledged. Bid Guaranty Bond 1220-1 CALIFORNIA ALL-PURPOSE 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 Orange On MAY 0 2 2024 before me, Adelaide C. Hunter, Notary Public Date Here Insert Name and Title of the Officer personally appeared _— Ryan Butterfas 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. 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. ADELAIDE C. HUNTER Notary Public . California Orange County Commission # 2343124 k4yy6 r My Comm. Expires Jan 23, 2025 Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, 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: Number of Pages: 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: _ Signer's Name: __ ❑ Corporate Officer — Title(s): Partner -- ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: ©2014 National Notary Association - www.NationaiNotary.org - 1-800-US NOTARY (1-800-876-6827) Item #5907 POWER OF ATTORNEY RLI Insurance Company Contractors Bonding and Insurance Company 9025 N. Lindbergh Dr. Peoria, IL 61615 Phone: 800-645-2402 Know All Men by These Presents: That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That RLI Insurance Company and/or Contractors Bonding and Insurance Company, each an Illinois corporation, (separately and together, the "Company") do hereby make, constitute and appoint: Linda D. Coats, Matthew J, Coats.comer Reyes, Man Butterfas, jointlyr severally in the City of Laguna Hills State of California its true and lawful Agent(s) and Attorney(s) in Fact, with full power and authority hereby conferred, to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds and undertakings in an amount not to exceed Twenjy Five Million Dollars ( S25,000,000.00 ) for any single obligation. The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon the Company as if such bond had been executed and acknowledged by the regularly elected officers of the Company. RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have each further certified that the following is a true and exact copy of a Resolution adopted by the Board of Directors of each such corporation, and is now in force, to -wit: .......... _ ..................... .. ..........._.... .......... .......... .......... _ _ _ _...... ......... All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board I of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Company. The corporate iseal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." ..... ... ..... _ IN WITNESS WHEREOF, the RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have caused these presents to be executed by its respective Sr. Vice President with its corporate seal affixed this 19th day of March _ 2024 . ""kit III nO" SEAL `_ �r I ,SEAL State of Illinois "' �.�;; ",;°�"` p„" SS County of Peoria On this 199 th day of March 2024 , before me, a Notary Public, personally appeared Eric Raudins . who being by me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of the RLI Insurance Company and/or Contractors Bonding and Insurance Company and acknowledged said instrument to be the voluntary act and deed of said corporation. By:. Jill A. Scott Notary Public AL A SCOTT 4°' M Notary Public „ - State of Ohio Y3 30, My Comm. Expires ve o Seotember 22, 2025 RLI Insurance Company Contractors Bonding and In nee Company By: Eric Raudins Sr. Vice President CERTIFICATE 1, the undersigned officer of RLI Insurance Company and/or Contractors Bonding and Insurance Company, do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable; and furthermore, that the Resolution of the Company as set forth in the Power of Attorney, is now in force. In testimony whereof, I have hereunto set my hand and the seal of the RLI Insurance Company and/or Contractors Bonding and Insurance Company this Znd day of May 1 2024 . RLI Insurance Company Contractors Bonding and Insurance Company By: 94k±!A 1) +_`• e JeffreyDUiclki �U v �& Corporate Secretary 0475404020212 A0058D 19 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: Pavement Resurfacing Lewis Road Owner: County of Ventura Construction Cost: $ 559 160.00 Construction Time: Calendar Days Owner's Representative: Term Hanser Owner's Telephone No.: 805-504-5434 Date of Substantial Completion: 9/3/21 2. Project Name: FY 2022-23 Slurry Seal Project Owner: City of Solvang Construction Cost: $ 447,078.00 Construction Time: Calendar Days Owner's Representative: Rodger Olds Owner's Telephone No.: 805-688-5575 Date of Substantial Completion: 12/13/22 Bidders Experience & Qualifications 1230-1 3. 4. Project Name: Slurry Seal Project FY 21 /22 Owner: City of Dana Point Construction Cost: $ 410,137.00 Construction Time: Owner's Representative: Scott Fisher Owner's Telephone No.: 949-248-3558 Calendar Days Date of Substantial Completion: 8/26/22 Project Name: FY 2022 Major Street Maintenance Owner: City of San Clemente Construction Cost: $ 1,063,986.00 Construction Time: Owner's Representative: Masako Hennequin Owner's Telephone No.: 949-361-6133 5/31 /22 Date of Substantial Completion: Calendar Days Signed this g day of 2024. Roy Allan Slurry Seal, Inc. 372798 1000001156 Name of Bidder Contractor's License No. DIR Reg No. Signature of Bidder Lawrence Allan Printed Name of Bidder 4/30/25 Expiration Date President 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 Re No. 1 v/ Uj-X t�AI�I ,,. (oVWC� T l n r /Ai n I� � ► r.�, n . ,, Q� -KPP ra��c i i�O°1n % (7 J 0 3 17 i- � H o � r - - • " Q � ,�# � O D � xl � ' (� 1 ' a ��, o0A►� lb ',1� f,L; Signature of Bidder Roy Allan Slurry Seal, Inc. 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 Orange > Lawrence Allan being first duly sworn, depos s and say that he or she is President of Roy Allan Slurry Seal, InQ. 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 Roy Allan Slurry Seal, Inc. Name of Bidder President Title S/ V L4 Date Non -Collusion Affidavit 1250-1 Vendor Information: Name: RO SECTION 1260 DIR Project Vendor Information f Allan Slurry Seal, Inc. Santa Fe Address: 12643 Emmens Way City: Springs ST: Ca. zip: 90670 Project Manager: Porfirio Heredia Email: porfirio@raslurry.com Phone: 562-864-3363 CSLB/Certification Number: 372798 Public Works Registration No.: 1000001156 Classification: 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 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-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.d ir.ca.gov/Public-Works/Certified-Payroll-Reporti ng. html. A copy of certified payroll, including the names and addresses of employees and/or subcontractors working on the job must be included with invoices submitted to the City of La Quinta. DIR Project Vendor Information 1260-1 SECTION 1270 COMPLIANCE WITH IRAN CONTRACTING ACT OF 2010 Pursuant to the Iran Contracting Act of 2010 (Pub. Contract Code, § 2200 et seq. ), (a) Contractor shall be ineligible to bid on or submit a proposal for any contract for One Million Dollars ($1,000,000) or more if Contractor engages in investment activities in Iran as defined in Public Contract Code Section 2202.5, and/or if Contractor is identified on the list of persons engaging in investment activities in Iran prepared by the State of California pursuant to Public Contract Code Section 2203 subdivision (b). (b) For bids of One Million Dollars ($1,000,000) or more, Contractor must certify that it is not on the list of ineligible vendors prohibited from doing business with the State of California and shall complete the Iran Contracting Act Certification and submit with their proposal at the time of bid. Contractor shall obtain the Iran Contracting Act Certification in the form approved by the State of California, or upon written request to the City Clerk's Office, a copy of the form will be provided to Contractor. Failure by Contractor to provide the certification required by this Section may deem Contractor's bid non -responsive. (c) Nothing in this Section is intended to prevent the City from exercising its rights pursuant to Public Contract Code section 2203, subdivision (c) or (d), or both, on a case -by -case basis. Iran Contracting Act Certification 1270-1 IRAN CONTRACTING ACT CERTIFICATION Pursuant to the Iran Contract Act of 2010 (Public Contract Code 2200-2208), Vendors/Bidders are ineligible to bid on or submit a proposal for any contract with a public entity for goods or services of one million dollars ($1,000,000) or more if the Vendor/Bidder engages in investment activities in Iran. MUST BE SUBMITTED WITH BID PROPOSAL IF BID AMOUNT IS $1,000,000 OR MORE Prior to bidding on, submitting a proposal, or executing a contract or renewal for a public entity contract for goods or services of $1,000,000 or more, a vendor must either: a) certify it is not on the current list of persons engaged in investment activities in Iran created by the California Department of General Services ("DGS") pursuant to Public Contract Code section 2203(b) and is not a financial institution extending $20,000,000 or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS; or b) demonstrate it has been exempted from the certification requirement for that solicitation or contract pursuant to Public Contract Code section 2203(c) or (d). To comply with this requirement, please insert your vendor or financial institution name and Federal ID Number (if available) and complete one of the options below. Please note: California law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made, contract termination, and three-year ineligibility to bid on contracts. (Pub. Cont. Code § 2205.) OPTION #1 - CERTIFICATION I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person/vendor, for 45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS. certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. i Vendor Name/Financial Institution (Printed) Roy Allan Slurry Seal, Inc. By JAuthorized Signature) Printed Name and Title of Person Signing Lawrence Allan / President Federal ID Number (or n/a) 95-3297484 Date Executed s/9/- 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 NamelFinancial Institution (Printed) I Federal ID Number (or n/a) By (Authorized Signature) Printed Name and Title of Person Signing Date Executed Iran Contracting Act Certification 1270-3 Ir 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 Compliance 1280-1