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LC Paving & Sealing Inc. April 2, 2025 LC Paving & Sealing, Inc. 620 Alpine Way Escondido, CA 92029 SUBJECT: BID BOND RELEASE – PROJECT NO. 2024-05 CITYWIDE MISCELLANEOUS ADA IMPROVEMENTS To Whom It May Concern: Thank you for submitting your proposal for the above referenced project. The La Quinta City Council, at its regular meeting of April 1, 2025, awarded the contract to the lowest responsive bidder, CT&T Concrete Paving Inc. The above-mentioned original Bid Bond, which accompanied your proposal, is enclosed. Your interest in working with the City of La Quinta is greatly appreciated, and we hope that you will accept future opportunities to bid on other city projects. Sincerely, Olivia Rodriguez, Acting Deputy City Clerk City Clerk’s Office Enclosure c: Great Midwest Insurance Company File SECTION 1200 BID DATE: 1 7 �� The undersigned, as bidder, declares it has received and examined the Contract Document entitled Project No. 2024-05 and CDBG Project No. 4.LQ.50-24, Citywide Miscellaneous ADA Improvements, and will contract with the City, on the form of Contract provided herewith, to do everything required for the fulfillment of the contract for said work at the prices and on the terms and conditions herein contained. We have included the following items and agree that they shall form a part of this bid: SECTION TITLE 1200 Bid 1210 Bid Schedule 1220 Bid Guaranty Bond 1230 Certification of Bidder's Experience and Qualifications 1240 Proposed Subcontractors 1250 Non -Collusion Affidavit 1260 DIR Project Vendor Information 1270 Iran Contracting Act of 2010 1280 Russian Aggression Against Ukraine Sanctions 1290 B-4 Certification of Bidder Regarding Non -Segregated Facilities (Required for all Projects) 1290 B-7 Bidder's Certification on Federal Contract Requirements (Required for all Projects) 1290 B-8 Questionnaire Regarding Bidders (Required for all Projects) 1290 B-9 List of Subcontractors and Suppliers (Required for all Projects) We acknowledge that the following addenda have been received and have been examined as part of the Contract Documents. Bidders must be on the Plan Holders List with the City of La Quinta in order to receive addenda. Addendum # #1 Date Received 3/21 /2025 Initi s /V_­ Bid 1200-1 Attached is a bid guaranty bond as required by Paragraph 1110-15.0, BID GUARANTY. LC Paving & Sealing, Inc. Name of Bidder 760-752-1743 Bidder's Telephone Number If our bid is accepted, we agree to sign the contract without qualifications and to furnish the performance and payment bonds and the required evidence of insurance within 10 calendar days after receiving written notice of the award of the contract. We further agree, if our bid is accepted and a Contract for performance of the work is entered into with the City, to so plan work and to prosecute it with such diligence that the work shall be completed within the time stipulated. LC Paving & Sealing, Inc. Name of Bidder 620 Alpine Way Escondido CA 92029 Bidder's Address 621610 A,B, & C-12 Contractor's License No. CaVonia State of Incorporation 760-752-1743 Bidder's Telephone Number Marisa@lcpaving.com Bidder's Email Address 08/31 /2026 Contractor's Expiration Date Sign re of Bidder Witness Jose Salinas Printed Name of Signatory President, Vice President, Secretary Title of Signatory ("qPiA- Title of Witness Bid 1200-2 SECTION 1210 BID SCHEDULE PROJECT NO. 2024-05 AND CDBG PROJECT NO. 4.LQ.50-24 CITYWIDE MISCELLANEOUS ADA IMPROVEMENTS City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 To Whom It May Concern: Pursuant to the Invitation to Bid, and in accordance with the provisions therein stated, the undersigned hereby proposes and agrees that on award by the City under this Bid, to execute a Contract, with necessary bonds, to furnish and install any and all labor, materials, transportation and services for Project No. 2024-05 and CDBG Project No. 4.LQ.50-24, Citywide Miscellaneous ADA Improvements, in accordance with the plans and specifications therefore adopted and on file with the City within the time hereinafter set forth and at the prices named in this Bid. It is understood that the basis of award shall be the lowest total price of the Base Bid Area plus all additive alternates. Unit prices in each and every case represent the true unit price used in preparing the bid schedule totals (Bid Form). Unit prices listed herein include material, installation and appurtenant work as is necessary to have the item complete and in place meeting the full intent of the plans and specifications. We acknowledge that unbalanced unit prices shall be sufficient cause for the rejection of our bid. Bid Schedule 1210-1 BASE BID — CITYWIDE MISC. ADA IMPROVEMENTS — NAVARRO PLAZA Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Mobilization 1 LS $ 43,000.00 $ 43,000.00 2 Traffic Control 1 LS $ 20,000.00 $ 20,000.00 3 Dust Control 1 LS $ 15,000.00 $ 15,000.00 4 Earthwork 1 EA $ 15,000.00 $ 15,000.00 5 Sawcut, Remove, and Dispose of 20 LF $ 110.00 $ 2,200.00 ExistingCurb 6 Sawcut, Remove, and Dispose of 855 SF $ 5.75 $ 4,916.25 Existing Sidewalk and Ram 7 Construct Sidewalk per City of La 845 SF $ 17.00 $ 14,365.00 Quinta Std. No. 240 Mod. Construct Concrete Curb Ramp per 8 City of La Quinta Std. No. 250 Mod. 1 EA $9,950.00 $ per Plan, Case B (Including Curb 9,950.00 along Ram Full Depth Grind Asphalt Concrete 9 Pavement (3"), Compact Existing 35 SF $ 171.00 $ 5,985.00 Base, and Variable Overlay (Y — 4" Grade Parkway, Remove, Modify, 10 and Replace Landscape, 1 LS $ 10,400.00 $ 10,400.00 Hardscape, and Irrigation in Kind to Furthest Extent Possible 11 Signing and Striping, Including All 1 LS $ 5,600.00 $ 5,600.00 Incidentals Total Amount of Bid Items 1 — 11 $ 146,416.25 Bid Schedule 1210-2 City may award all or none of the following additive alternates: ADDITIVE ALTERNATE NO. 1 — AVENIDA LA FONDA SPEED TABLES Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Mobilization 1 LS $43,000.00 $ 43,000.00 2 Traffic Control 1 LS $ 27,500.00 $ 27,500.00 3 Dust Control 1 LS $ 15,000.00 $ 15,000.00 4 Sawcut, Remove, and Dispose of 90 LF $ 49.00 $ 4,410.00 Existing Curb; and/or Curb & Gutter 5 Sawcut, Remove, and Dispose of 785 SF $ 6.00 $ 4,710.00 Existing Ramp and Pavers 6 Construct Sidewalk per City of La 450 SF $ 19.50 $ 8,775.00 Quinta Std. No. 240 Mod. Remove and Dispose of Existing 7 Roadway Section to Depth 750 SF $ 12.50 $ 9,375.00 Required 8 Construct 5.5" Asphalt Concrete 460 SF $ 32.00 $ 14,720.00 over 6.5" Aggregate Base Construct Two (2) Concrete Speed 9 Tables (Including All Concrete 1 LS $ 36,500.00 $36,500.00 Work, Aggregate Base, Grading, Rebar, and Conduit Furnish and Install Truncated Dome 10 Concrete Tile per City of La Quinta 75 SF $112.00 $ 8,400.00 Std. 250 Mod. Remove, Regrade, and Reset 11 Sidewalk Pavers Per City of La 275 SF $ 30.00 $ 8,250.00 Quinta Std. 206 Salvage to City Existing Pull Box 12 and Furnish and Install New No. 6 1 EA $ 1,750.00 $ 1,750.00 Pull Box per Caltrans Std. Plan ES- 8A Grade Parkway, Remove, Modify, 13 and Replace Landscape, 1 LS $ 11,500.00 $ 11,500.00 Hardscape, and Irrigation in Kind to Furthest Extent Possible 14 Signing and Striping, Including All 1 LS $ 8,000.00 $ 8,000.00 Incidentals Total Amount of Additive Alternate Bid Items 1 — 14 $ 201,890.00 Bid Schedule 1210-3 GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Figures): $ 348, 306.25 GRAND TOTAL BASE BID PLUS ALL ADDITIVE ALTERNATES (Words): Three Hundred Forty -Eight Thousand Three Hundred Six Dollars and Twenty Five Cents 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. Jose Salinas 760-752-1743 L t , VAQ J Name of Signature of Bidder (Ink) `A G er (Printed or Typed) Bidder Telephone Number Marisa@Icpaving.com Bidder Email Address Bid Schedule 1210-4 SECTION 1220 BID GUARANTY BOND PRINCIPAL, and Great Midwest 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. 2024-05 AND CDBG PROJECT NO.4.LQ.50-24 CITYWIDE MISCELLANEOUS ADA IMPROVEMENTS NOW, THEREFORE, if the aforesaid Principal is awarded the contract and, within the time and manner required under the specifications, after the prescribed forms are presented to him/her for signature enters into a written contract in the prescribed form, in accordance with the bid, and files two bonds with the City, one to guarantee faithful performance, and the other to guarantee payment for labor and materials as required by law, and provide certificate of insurance coverage required by the Contract Documents, then this obligation shall be null and void; otherwise, it shall be and remain in full force and virtue. IN WITNESS WHEREOF, we have hereunto set our hands on this 24th day of March , 2025. LC Paving & Sealing, Inc. Title of Sianatory SigpAture of Principal 620 Alpine Way _Escondido. CA 92029 Address Great Midwest Insurance Company Attorney -in -Fact Title of Signatory nature of Surety Lawrence F. McMahon, Attorney -in -Fact 800 Gessner Road, Suite 600 Houston, TX 77024 Address Note: Signatures of those executing for the surety must be properly acknowledged. Bid Guaranty Bond 1220-1 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of SAN DIEGO On 7i�, Z� before me, MARISA HAAS, NOTARY PUBLIC (insert name and title of the officer) personally appeared DOSE SALINAS 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. MARISAANN HAAS Notary Public • California San Diego County COmmissi0n N 2466839 Comm. Expires oct 17, 2027 Signature/II (Seal) ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego On March 24, 2025 before me, personally appeared Lawrence F. McMahon Minna Huovila, Notary Public (insert name and title of the officer) 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. r Signature MINNA HUOVILA ,' i�. COMM. #2473536 n NNOTARY PUBLIC-CALIFORNIA n U SAN DIEGO COUNTY My Commission Expires (Seal) 10 0 DECEMBER 6. 2027 POWER OF ATTORNEY Great Midwest Insurance Company KNOW ALL MEN BY THESE PRESENTS, that GREAT MIDWEST INSURANCE COMPANY, a Texas Corporation, with its principal office in Houston, TX, does hereby constitute and appoint: Sarah Myers, Janice Martin, Maria Guise, Ryan Warnock, Lawrence F. McMahon, Maria Hallmark true and lawful Attorney(s)-In-Fact to make, execute, seal and deliver for, and on its behalf as surety, any and all bonds, undertakings or other tings obligatory in nature of a bond. This authority is made under and by the authority of a resolution which was passed by the Board of Directors of GREAT MIDWEST INSURANCE COMPANY, on the 111 day of October, 2018 as follows: Resolved, that the President, or any officer, be and hereby is, authorized to appoint and empower any representative of the Company or er person or persons as Attorney -In -Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or other tings obligatory in nature of a bond not to exceed Ten Million dollars ($10,000,000.00), which the Company might execute through its duly elected cers, and affix the seal of the Company thereto. Any said execution of such documents by an Attorney -In -Fact shall be as binding upon the mpany as if they had been duly executed and acknowledged by the regularly elected officers of the Company. Any Attorney -In -Fact, so appointed, y be removed in the Company's sole discretion and the authority so granted may be revoked as specified in the Power of Attorney. Resolved, that the signature of the President and the seal of the Company may be affixed by facsimile on any power of attorney granted, nd the signature of the Secretary, and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such ower or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed nd certificate so executed and sealed shall, with respect to any bond of undertaking to which it is attached, continue to be valid and binding on the ompany. IN WITNESS THEREOF, GREAT MIDWEST INSURANCE COMPANY, has caused this instrument to be signed by its President, and its rporate Seal to be affixed this 11th day of February, 2021. GREAT MIDWEST INSURANCE COMPANY BY H*- V) Vats L - Mark W. Haushill President ACKNOWLEDGEMENT On this 11th day of February, 2021, before me, personally came Mark W. Haushill to me known, who being duly sworn, did depose and that he is the President of GREAT MIDWEST INSURANCE COMPANY, the corporation described in and which executed the above instrument; he executed said instrument on behalf of the corporation by authority of his office under the By-laws of said corporation. CHRIST— INA BISHOP Notary Public, State BY of Texps Comm. Expires 04-14-2025 11 Christina Bishop Notary ID 131090488 Notary Public CERTIFICATE I, the undersigned, Secretary of GREAT MIDWEST INSURANCE COMPANY, A Texas Insurance Company, DO HEREBY CERTIFY that the original Power of Attorney of which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions as set forth are now in force. Signed and Sealed at Houston, TX this 24th Day of March 2025 BY Leslie K. Shaunty Secretary "WARNING: Any person who knowingly and with intent to defraud any insurance company or other person, files and application for insurance of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. 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. Project Name: Owner: Construction Cost: $ Construction Time: Owner's Representative: Owner's Telephone No.: Date of Substantial Completion: 2. Project Name: Owner: Construction Cost: $ Construction Time: Owner's Representative: Owner's Telephone No.: Date of Substantial Completion: Calendar Days Calendar Days Bidders Experience & Qualifications 1230-1 REFERENCES CITY OF HEMET 445 E FLORIDA AVENUE HEMET, CA 92543 *CDBG 2021/22 ACCESSIBLE SIDEWALK $461,852.50 - APRIL 2023 CITY OF TEMECULA 41000 MAIN STREET TEMECULA, CA 92590 *CITYWIDE CONCRETE REPAIRS $272,369.97 - APRIL 2023 CITY OF SAN CLEMENTE 910 CALLE NEGOCIO, STE 100 SAN CLEMENTE, CA 92673 *CALLE DEL CERRO $792,396.00 - OCTOBER 2023 CITY OF SANTEE 10601 MAGNOLIA AVENUE SANTEE, CA 92071 *PROSPECT AVE & MESA RD INTERSECTION *750,927.00 - FEB 2024 CITY OF RIVERSIDE 3900 MAIN STREET RIVERSIDE, CA 92522 *2023/2024 CDBG STREET IMPROVEMENTS *1,412,036.00 - JANUARY 2025 DARYL SCHOLES DScholes@hemetca.gov 951.765.2361 RYAN CASTILLO ryan.castillo@temeculaca.gov 951.693.3964 MASAKO HENNEQUIN hennequinM@san-clemente.org 949.361.6133 TAYLOR CARRICO Tcarrico@cityofsanteeca.gov 619-258-4100 DAVID HATCH dhatch@riversideca.gov 951-826-5723 CITY OF BRAWLEY JUAN CABRERA 180 S WESTERN AVENUE JCabrera@brawley-ca.gov BRAWLEY, CA 92227 760-344-5800 *STREET IMPROVEMENTS VARIOUS LOCATIONS *1,177,956.00 - NOVEMBER 2024 CITY OF POWAY MIGUEL SOLANO 13325 CIVIC CENTER DRIVE msolano@Poway.org POWAY, CA 92064 858-668-4653 *NEIGHBORHOOD SIDEWALK POWERS ROAD *$204,898.75 - NOV 2025 3. Project Name: Owner: Construction Cost: $ Construction Time: Owner's Representative: Owner's Telephone No.: Date of Substantial Completion: 4. Project Name: Owner: Construction Cost: $ Construction Time: Owner's Representative: Owner's Telephone No.: Date of Substantial Completion: Calendar Days Calendar Days Signed this day of I V m c `, V , 2025. . (. �(A,\) 0G Name of Bidder Signa ure of Bidder V A � Printed Name of Bidder UIU l( 0 10,0d69Q5Z I Contractor's License No. DIR Reg No. q I ZJ ZB 1-0 Expiration Date T (,e�l di A Title of Signatory Bidders Experience & Qualifications 1230-2 SECTION 1240 PROPOSED SUBCONTRACTORS Pursuant to California Public Contracting Code, Section 4100 et. seq., the following list gives the name, business address, and portion of work (description of work to be done) for each subcontractor that will be used in the work if the bidder is awarded the Contract. (Additional supporting data may be attached to this page. Each page shall be sequentially numbered and headed "Proposed Subcontractors" and shall be signed.) The Contractor shall perform, with its own organization, Contract work amounting to at least 50 percent of the Contract Price except that any designated "Specialty Items" may be performed by subcontract and the amount of any such "Specialty Items" so performed will be deducted from the Contract Price before computing the amount required to be performed by the Contractor with its own organization. "Specialty Items" will be identified by the Agency in the Bid or in the Special Provisions. Where an entire item is subcontracted, the value of work subcontracted will be based on the Contract Unit Price. Subcontractor/Business Address/Description of Work/% of Work/License No./DIR Reg No. (t787!`ta �tvC—S .�rZ-lov���3i�o�� zqz Sign re of Bidder LC Paving & Sealing, 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 5('D - KVy ) Jose Salinas being first duly sworn, deposes and say that he or she is President of LC Paving & Sealing. Inc. the party making the foregoing bid that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly sought by contract, agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Signatvfe LC Paving & Sealing, Inc. Name of Bidder President Title r Date Non -Collusion Affidavit 1250-1 SECTION 1260 DIR Proiect Vendor Information Vendor Information: Name: LC Paving & Sealing, Inc. Address: 620 Alpine Way City: Escondido ST: CA Zip: 92029 Project Manager: _� 1(x_ f-tL(� Email: Phone. 760-752-1743 CSLB/Certification Number: 621610 Public Works Registration No.: 1000004325 Classification: Asbestos Boilermaker Bricklayers Carpenter X Carpet/Linoleum Cement Masons X Drywall Finisher Drywall/Lathers Electricians Elevator Mechanic Glaziers Iron Workers Laborers X Millwrights Operating Eng X Painters Pile Drivers Roofer SheetMetal Sound/Com Surveyor Prevailinq Wages and Payroll: Pipe Trades Plasterers Teamster X Tile Worker 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 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: http://www.dir.ca.gov/Public-Works/Certified-Payroll-Reporting.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 Exhibit B-4 Required Bid Form CERTIFICATION OF BIDDER REGARDING NONSEGREGATED FACILITIES Project Name:` 9v� ZDA- Z� Name of Bidder. LC Paving & Sealing, Inc. The above named Bidder hereby certifies that: I do not maintain or provide for my employees any segregated facilities at any of my establishments, and that I do not permit my employees to perform their services at any location, under my control, where segregated facilities are maintained. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, rest rooms, wash rooms, restaurants and other eating areas, time clocks, locker rooms or other dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, national origin, or because of habits, local customs, or otherwise. I further agree to obtain identical certifications from all proposed subcontractors prior to the award of subcontracts exceeding $10,000. Signature: a�� Name (Print): Jose Salinas Title: President Date: CDBG Required Bid Form 1290-1 Exhibit B-7 Required Bid Form BIDDER CERTIFICATION ON FEDERAL CONTRACT REQUIREMENTS Project Name:'_W V4 76Y' b� Bid/Solicitation #: CERTIFICATION: I hereby certify that I have reviewed and understand the diversified Federal construction contract related requirements imposed on the Contractor(s) of HUD - funded construction projects, including but not limited to the following- 1. The subject project is being financed with Community Development Block Grant funds (24 CFR Part 570); and 2. This project and all related construction contracts are subject to the U.S. Department of Housing and Urban Development's Federal Labor Standards Provisions (HUD 4010 — revised 10/2023); and 3. This project is subject to all applicable laws and regulations as listed in the General Summary of these Special Federal Provisions; and 4. If my bid is $200,000 or more, this project and all related contracts will be subject to Section 3 requirements (12 U.S.C.1701 u); and 5. If the project is $250,000 or more, this project and all related contracts will be subject to comply with the requirements of the Build America, Buy America (BABA) Act (41 USC 8301). CONTRACTOR'S NAME: LC Paving & Sealing, Inc. CONTRACTOR'S LICENSE NO.: 621610 ADDRESS: 620 Alpine Way Escondido CA 92029 AUTHORIZED REP I 7NTATIVE: Jose Salinas // (Print Name) SIGNATURE: DATE: CDBG Required Bid Form 1290-2 Exhibit B-8 Required Bid Form QUESTIONNAIRE REGARDING BIDDERS Bidder has been engaged in the contracting business under the present name of LC Paving & Sealing, Inc. , since 06/1991 (Date). Present business address is: 620 Alpine Way Escondido CA 92029 Federal Tax ID: 27-2327769 Amount of Bid $ 348,306.25 California Contractor's License No.: 621610 UEI Number: Expiration Date: 08/31/2026 or CAGE Code: L1 I t 1 � Because this project is Federally funded, it is necessary to obtain information concerning minority and other group participation for statistical purposes. The U.S. Department of Housing and Urban Development (HUD) uses this information to determine the degree to which its programs are being utilized by minority business enterprises and targeted group contractors. A minority enterprise is defined by the Federal Government as a business that is fifty- one percent (51 %) or more "minority -owned". Please check applicable box concerning the ownership of your business: ❑ American Indian or Native Alaskan ❑ Asian or Pacific Islander/Native Hawaiian ❑ Black/African American 0 Hispanic ❑ White ❑ Hasidic Jews ❑ Other A woman -owned enterprise is defined by the Federal Government as a business that is fifty -percent (51 %) or more woman -owned. Please check applicable box concerning the ownership of your business: ❑ Woman/Female owned ® Male owned A Section 3 Contractor or Subcontractor is a business concern that is more than fifty- one percent (51 %) owned by a low or very low-income person, or over 75 percent of the labor hours performed for the business over the prior three-month period are performed by Section 3 workers. Please check the applicable box concerning the ownership of your business: ❑ Section 3 Business concern ER Non -Section 3 Business concern The United States Department of Housing and Urban Development (HUD) is authorized to solicit the information requested in this form by virtue of Title 12, United States Code, Section 1701 et seq., and other regulations. It will not be disclosed or released outside of HUD without your consent, except as required or permitted by law. CDBG Required Bid Form 1290-3 Exhibit B-9 Required Bid Form LIST OF SUBCONTRACTORS SUBCONTRACTOR FED. I.D.# AMOUNT ADDRESS/PHONE NO. �J-..> s �.1� S�� � , .�.. �3� - 3 2/ � � 3 � _ 7u�� %`-" 4 i8 � r a � �u- •�1v� SUPPLIERS NAME OF SUPPLIER ADDRESS/PHONE NO. CONTRACT AMOUNT Superior Ready Mix 1564 W Mission Rd Escondido CA 92029 Granite Construction Company 35100 Dillon Rd Indio CA 92201 Martin Marrieta 88200 Fargo Canyon Rd Coachella CA 92236 This form is to be completed and submitted with the bid package. CDBG Required Bid Form 1290-4 SECTION 1270 COMPLIANCE WITH IRAN CONTRACTING ACT OF 2010 Pursuant to the Iran Contracting Act of 2010 (Pub. Contract Code, § 2200 et seq.), (a) Contractor shall be ineligible to bid on or submit a proposal for any contract for One Million Dollars ($1,000,000) or more if Contractor engages in investment activities in Iran as defined in Public Contract Code Section 2202.5, and/or if Contractor is identified on the list of persons engaging in investment activities in Iran prepared by the State of California pursuant to Public Contract Code Section 2203 subdivision (b). (b) For bids of One Million Dollars ($1,000,000) or more, Contractor must certify that it is not on the list of ineligible vendors prohibited from doing business with the State of California and shall complete the Iran Contracting Act Certification and submit with their proposal at the time of bid. Contractor shall obtain the Iran Contracting Act Certification in the form approved by the State of California, or upon written request to the City Clerk's Office, a copy of the form will be provided to Contractor. Failure by Contractor to provide the certification required by this Section may deem Contractor's bid non -responsive. (c) Nothing in this Section is intended to prevent the City from exercising its rights pursuant to Public Contract Code section 2203, subdivision (c) or (d), or both, on a case -by -case basis. Iran Contracting Act Certification 1270-1 IRAN CONTRACTING ACT CERTIFICATION Pursuant to the Iran Contract Act of 2010 (Public Contract Code 2200-2208), Vendors/Bidders are ineligible to bid on or submit a proposal for any contract with a public entity for goods or services of one million dollars ($1,000,000) or more if the Vendor/Bidder engages in investment activities in Iran. MUST BE SUBMITTED WITH BID PROPOSAL IF BID AMOUNT IS $1,000,000 OR MORE Prior to bidding on, submitting a proposal, or executing a contract or renewal for a public entity contract for goods or services of $1,000,000 or more, a vendor must either: a) certify it is not on the current list of persons engaged in investment activities in Iran created by the California Department of General Services ("DGS") pursuant to Public Contract Code section 2203(b) and is not a financial institution extending $20,000,000 or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS; or b) demonstrate it has been exempted from the certification requirement for that solicitation or contract pursuant to Public Contract Code section 2203(c) or (d). To comply with this requirement, please insert your vendor or financial institution name and Federal ID Number (if available) and complete one of the options below. Please note.. California law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made, contract termination, and three-year ineligibility to bid on contracts. (Pub. Cont. Code § 2205.) OPTION #1 - CERTIFICATION I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person/vendor, for 45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS. I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Vendor Name/Financial Institution (Printed) LC Paving & Sealing, Inc. By (Authoni nature) Printed Na a and Title of Person Signing Jose alinas; President Federal ID Number (or n/a) 27-2327769 DateEx Wed 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) 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. Russian Aggression Against Ukraine Sanctions Certification 1280-1