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Bid - Pavement Coatings Co. June 4, 2025 Pavement Coatings Co. 10240 San Seviane Way Jurupa Valley, CA 91752 SUBJECT: BID BOND RELEASE – PROJECT NO. 2024-03 FY 24/25 PMP SLURRY SEAL 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 June 3, 2025, awarded the contract to the lowest responsive bidder, Roy Allan Slurry Seal, 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: The Ohio Casualty Insurance Company File SECTION 1200 BID DATE: 5121 120�_ S The undersigned, as bidder, declares it has received and examined the Contract Document entitled Project No. 2024-03, FY24/25 PMP Slurry Seal Improvements, and will contract with the City, on the form of Contract provided herewith, to do everything required for the fulfillment of the contract for said work at the prices and on the terms and conditions herein contained. We have included the following items and agree that they shall form a part of this bid: SECTION TITLE 1200 Bid 1210 Bid Schedule 1220 Bid Guaranty Bond 1230 Certification of Bidder's Experience and Qualifications 1240 Proposed Subcontractors 1250 Non -Collusion Affidavit 1260 DIR Project Vendor Information 1270 Iran Contracting Act of 2010 1280 Russian Aggression Against Ukraine Sanctions We acknowledge that the following addenda have been received and have been examined as part of the Contract Documents. Bidders must be on the Plan Holders List with the City of La Quinta in order to receive addenda. Addendum # Date Received Initials NONE Attached is a bid guaranty bond as required by Paragraph 1110-15.0, BID GUARANTY. Pavement Coatings Co. (714)826-3011 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. Pavement Coatings Co. Name of Bidder 10240 San Sevaine Way Jurupa Valley, CA 91752 Bidder's Address 303609 - A, C-32 Contractor's License No. California State of Incorporation idder mimes Wu - Vice President Printed Name of Signatory Vice President Title of Signatory (714)826-3011 Bidder's Telephone Number lwu@pavementrecycling.com Bidder's Email Address 9/30/2026 Contractor's Expiration Date Witness ��,h�r►,a�a►2 Title of Witness Bid 1200-2 SECTION 1210 BID SCHEDULE PROJECT NO. 2024-03 FY24/25 PMP SLURRY SEAL 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. 2024-03, FY24/25 PMP Slurry Seal Improvements, in accordance with the plans and specifications therefore adopted and on file with the City within the time hereinafter set forth and at the prices named in this Bid. It is understood that the basis of award shall be the lowest total price of the Base Bid Area. 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 — FY24/25 PMP SLURRY SEAL IMPROVEMENTS Item Item Description Est. Unit Unit Price Item Total No. Qty. (in figures) (in figures) Dollars Dollars 1 Mobilization 1 LS $ SD000,ocl $ 60000' o0 2 Traffic Control 1 LS $ ioV 000. fO $ J p(.1000.O° 3 Crack Seal and Type II, Latex 2,080,510 SF $D. 2 ( $+3(.,go7. � Emulsion Aggregate Slurry Full Depth Grind AC (3 1/2"), 4 Compact Existing Base, and 140 SF $ 7R• 00 $ 11, 04vo • " Variable Overlay 3 1 /2"-4 1 /2" 5 Signing and Striping, Including 1 LS $ 57,0oo. p° $ 57, opo. ov All Incidentals Total Amount of Bid Items 1 — 5 $ (o(,0,947.10 GRAND TOTAL BASE BID PLUS (Figures): $ l(C 0, 01o"7 , io GRAND TOTAL BASE BID (Words): S 1 Y, 0woJre4 G;X:fi�T�o""WA1lIf'Ie- S',IX1!4 Seycn .bollar.f A.Kd Tzh Cc n+s 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, ec t such adjustments and alterations as elsewhere provided herein. James Wu - Vice President Signature of Bidder (Ink) Pavement Coatings Co. Name of Bidder (Printed or Typed) (714)826-3011 Bidder Telephone Number wu@pavementrecycling.com Bidder Email Address Bid Schedule 1210-2 SECTION 1220 BID GUARANTY BOND PRINCIPAL, and The Ohio Casualty 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. 2024-03 FY24/25 PMP SLURRY SEAL IMPROVEMENTS NOW, THEREFORE, if the aforesaid Principal is awarded the contract and, within the time and manner required under the specifications, after the prescribed forms are presented to him/her for signature enters into a written contract in the prescribed form, in accordance with the bid, and files two bonds with the City, one to guarantee faithful performance, and the other to guarantee payment for labor and materials as required by law, and provide certificate of insurance coverage required by the Contract Documents, then this obligation shall be null and void; otherwise, it shall be and remain in full force and virtue. IN WITNESS WHEREOF, we have hereunto set our hands on this 13 day of May , 2025. James Wu - Vice President Title of Si ry ement Coatings Co Sign an Seviane Way Vallev, CA 91752 Brigid Lopez, Attomey-in-Fact Title of Signatory The Ohio Casualty Insurance Company Signat# of Sur ty 175 Berkeley Street, Boston, Massachusetts 02116 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 Z 11Q��.. _ _ _ _ I OnI_before me, Michelle D. Taylor, Notary Public Date Here Insert Name and Title of the Officer personally appeared Wes' Names) 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. >:? , f MICHELLE 0, TAYLOR Notary Public • California =' Rive,sice Ccunty Commiss.cn ; 2388964 My Comm. Expires Jan 5, 2026 Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. SignaturYNZ� OPTIONAL - of Notary Public Completing this information con deter alteration of the document or fraudulent reattachment of this form to on unintended document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer - Title'-" itle'. ❑ Partner - ❑ Li General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: ©2017 National Notary Association Number of Pages: Signer's Name: ❑ Corporate Officer - ❑ Partner - ❑ Limite ❑ Individual ❑ Trustee ❑ Other: Signer is Representing d Title(s): ❑ General ❑ Attorney in Fact ❑ Guardian of Conservator 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 13, 2025 Date before me, Evett Lam, Notary Public , Here Insert Name and Title of the Officer personally appeared Brigid Lopez Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(2) whose name(S) is/mac subscribed to the within instrument and acknowledged to me that DWshe/tbey executed the same in /her/authorized capacityW, and that by IM/her/#fir- signature(s) on the instrument the person(29, or the entity upon behalf of which the person( acted, executed the instrument. r� Votary P..blic California i Orange Count' 80930 Mr so52380930 025 Ccrrr. Expxpre I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my han and official seal. Signature Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of fraudulent reattachment of this form to an unintende ment. Description of Attached Document Title or Type of Document: - Number of Pages: Signer(s) Other, Capacity(ies) Claimed by Signer(s) Signer's Name: -i Corporate Officer — Title( Partner — Limit_ed General i I Individual Itorney in Fact - Trustee Guardian or Conservator Ll Other: _ Signer Is epresenting: Document Date: Named Above: t or Signer's Name: ❑ Corporate Officer — Title(s): 101 Partner — -1 Limited _ General ❑ Individual Attorney in Fact ❑ Trustee C' Guardian or Conservator ❑ Other: Signer Is Representing: ©2014 National Notary Association • www.NationaiNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 Liberty POWER OF ATTORNEY Mutual. Liberty Mutual Insurance Company Certficate No: 8214065 - 971991 SURETY The Ohio Casualty Insurance Company West American Insurance Company KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Brian A. McGoldrick, Brigid Lopez, Evett Lam, Marisella Rivera all of the city of Placentia state of CA each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 20th day of May , 2025 . us Q) c r0 c`o State of PENNSYLVANIA County of MONTGOMERY Liberty Mutual Insurance Company 1NSUR 01 INS&qa 1NsuR The Ohio Casualty Insurance Company �JP40µPogq,. SOP ovkpo/fgT `yy GP `011 R4 Ain West American Insurance Company J r FO t� Q = FO Ct ? FO to 1912h 0 0 1919 0 f 1991 0 � : � O Q 2/h ~d�'s'4q CMrl`�� .aa SO ,-YAMP`�� , r'S �NMAW' aayl By: Mafhan 17anncrin Accictanf Sar-fan, � On this 20th day of May 2025 before me personally appeared Nathan J Zangerle, who acknowledged himself to be the Assistant Secretary of Liberty Mutual 1 -5 Company, The Ohio Casualty Company, and West American Insurance Company, and that he as such, being authorized so to do, execute the foregoing instrument for the > therein contained by sionina on behalf of the corporations by himself as a duly authorized officer i� _-p i(n a1 m� C O._ E IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written 9P PAST QFi NWF lC� Commonwealth of Pennsylvania - Notary Seal Up q!y Teresa Pastella, Notary Public OF Montgomery County (/ � My commission expires March 28, 2029 B �C Commission number 1126044 y- yo�nsnvvA�c Member Pennsylvania Association of Notaries eresa Pastella, Notary Public �fq, � This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV - OFFICERS: Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose In writing by the Chairman or the President, and subject to such limitation as the Chairman or President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as su any and all undertakings, bonds, recognizances and other surety obligations Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, s have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, s instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Nathan J. Zangede, Assistant Secretary to appoint such attorneys -in -fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN T ESTIMONY'iNHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 13th day of May 2025 P� 1NS11R9 POSY INS&,p a 1NS4q �J GOfcPOlfgf .0 yJ GORP OAtgr 'qy VP 40pPO(tq'C, UQ rtt W 3 FO to 1912 o Z 1919 o a 1991 0 dj1 �s4CHU`��.da yOhAMPs�P D� `l �HOANP L3 By: I * *ad Renee C. Llewellyn, Assistant Secretary LMS-12873 LMIC OCiC WAIC Multi Co 02/24 >E )O S`o 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: 2. Owner: **See Attached** Construction Cost: $ Construction Time: Owner's Representative: Owner's Telephone No.: Date of Substantial Completion: Project Name: **See Attached** 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 3. Project Name: **See Attached** Owner: 4. Construction Cost: $ Construction Time: Owner's Representative: Owner's Telephone No.: Date of Substantial Completion: Project Name: **See Attached** Owner: Construction Cost: $ Construction Time: Owner's Representative: Owner's Telephone No.: Date of Substantial Completion: Calendar Days Calendar Days Signed this 21 day of Mai , 2025. Pavement Coatings Co. 303609 — Exp. 9/30/2026 1000003382 Name of Bidder Contractor's License No. DIR Reg No. `— James Wu P--rin ed Name of Bidder 6/30/2026 Expiration Date Vice President Title of Signatory Bidders Experience & Qualifications 1230-2 �+ A N a C) i Q D O G c D O m v A O r (1 „ D O 1p WO O W m V O O 0 �' A D m N Q D N A D tD < p CI ➢ 1c p N o O D Gi r�Oi o 3 N pu �n p 8< G _v T (n a m o• _v o o o. Li ^ d �W. gCI od 0 A o'D <c 0 3 �n; W N oD ^ N O _ d O 3• N o A 3 S q C d l S o T jG> G m D?v nN vn DCD a mS D A N Oo ~ CI O j N ry A O° m d 0 _ < N m y - N w q e • 3 d � c o A c c o O 3 a m o O 3 D 3 0 3o o P o N N O d J 9 O N N C y OO Y= N N C W c Y c 3 K V< 0 °f V 9 � .5 N 9 y V W a 0 O' Z S O A OI y O n n m O n N W wrg S {L D S OI S 6 c t0 an O c 0 � ° n W N c S W 0 y N AF r; fly S 9, O' G7 pp O N O_ V �' — N D7 N .Oi N ry N N d N!"i O N O � V p D O N Pri W a d P7 (p O re) _ p -• N N 3 m 0 ou Is d p � () Dp D ii A N y W 3 y N OOn c N y N 3 - 3 v d c N Z 0 N W .z Fi m » O Z Z •� N d NJ. 0 d 1D y° n y a m N n a O N 3p' a x 3 N m 0 1 w d N a< n C N? 0 y D 6 d W A �% Z O> A Z O Qo 9 w A N 3 w A O ^ o0 w 7% N d n T m c O d ET rn GZi W ~ a A N� VJ SZ 3 m > n N d N O O O N N ti J ' lA W ei � v N sA N m w r ip M o0 N O N C v o A O O N W N W N fA A m w N C W N V � tp N f11 O 3o r L tali N O V OT O N A A N O O N O N N O N " N N N O p N O °l O W N O Ol H T O N � O N fw0 O N N N O O N P W N O N W D n s J O N W CQ e h°i W n w N W A N 1.3 O N W ,p N a O N N g ,O N N N O N N N N .0 N O N .0 N N N N N 6 H 90' O n N O w ft O N w o ° O 0 ° C o. o, O H � � � C m C m C m C m o y �. � a y A 10 c O O p� py➢ H A 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. P"e4herjf ;L ettrr. & 4 S�as.l I o5� 37� j e l/0 soowJ®�Reh" Coek 4CA92BoS, 3 �ny1c Pc+,ui..y 2�4D 6. (�,,CiGsfaA✓c�/ ,,LI, / Co.�pR•�y rnc. II+N.4rCirri�CA 9 28ai �s!"'""�'�/DD'2 / �3o3Lo�/oD000•µ� 9a �14T 17Cam►•+mtrziG,l Ave JV4.r,prn IbD!!7o a2 1 4Y12or&D1l7So fMCW I%4 . /i2 vt,�rs� al a CA f 25D-1 9 ignatVpdXB*der James Wu - Vice President dement Coatings Co. ame 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 jZgsu xbp- ) James Wu , being first duly sworn, deposes and say that he or she is Vice President of Pavement Coatings Co. , the party making the foregoing bid that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly sought by contract, agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or shag -bides Siapgfure ,Ool/ James wu - Vice President Pav6-Kent Coatings Co. N.rte of Bidder James Wu - Vice President Title 5121 � 2p2S Date Non -Collusion Affidavit 1250-1 CALIFORNIA JURAT GOVERNMENT CODE § 8202 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 off[Q,(�IdC.. yam,. F MICHELLE D. TAYLOR /F' \ Notary P_b6c - Ca6fornia Z Rrversice C01-nty > I ; Commission = 2388964 My Comm. Expires Jan 5. 2026 Place Notary Seal and/or Stamp Above Subscribed and sworn to (or affirmed) before me on this day of 20_- by Date Mo h Year (and (2) Nome(s) of Signer(s) proved to me on the basis of satisfactor be the person(s) who appeared befor me. 1.1 OPTIONAL Completing this information can deter alteration of the fraudulent reattachment of this form to an unintendec Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Na,WAbove: ©2019 National Notary Association of Notary Public Number of Pages: t E SECTION 1260 DIR Project Vendor Information Vendor Information: Name: Pavement Coatinqs Co . Address: 10240 San Sevaine way City: Jurupa Valley ST: CA Zip: 91752 Project Manager: Tom Mucenski Email:Tom@pavementcoatings.com Phone: (714) 8 2 6 -3 011 CSLB/Certification Number: 303609 Public Works Registration No.:-1 0 0 0 0 0 3 3 8 2 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.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.htm1. 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 SECTION1 CO 11 _ ► 1 ■ ► • ► ► ► • I I 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) Federal ID Number (or n/a) Pavement Coatings Co. 195-2916670 By (Authorize a _ %% 9ofteNa5941dPffe of Person Signing James u -,-'Vice President Dated y AS 1122n5 Iran Contlaetfng 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) I Federal ID Number (or n/a) By (Authorized Signature) Printed Name and Title of Person Signing I Date Executed Iran Contracting Act Certification 1270-3 SECTION 1280 COMPLIANCE WITH CALIFORNIA EXECUTIVE ORDER N-6-22 RUSSIAN AGGRESSION AGAINST UKRAINE (a) Contractor shall comply with California Governor Executive Order N-6-22 regarding sanctions in response to Russian aggression in the Country of Ukraine, and any implementing guidelines and/or economic sanctions imposed by the United States government in response to Russian actions in Ukraine, as well as any sanctions imposed under California law (collectively "economic sanctions"). Contractor shall comply with all such economic sanctions. By submitting a bid to the City, Contractor agrees to take any and all actions to support the Ukrainian government and people as required by law, including by refraining from new investments in, and financial transactions with, Russian institutions or companies that are headquartered or have their principal place of business in Russia (Russian entities), not transferring technology to Russia or Russian entities, and directly providing support to the government and people of Ukraine. (b) If bidding on a contract for Five Million Dollars ($5,000,000) or more, Contractor shall submit a written report to the City on Contractor's compliance with the economic sanctions, and the steps Contractor has taken in response to Russia's actions in Ukraine, including, but not limited to, desisting from making new investments in, or engaging in financial transactions with, Russian entities, not transferring technology to Russia or Russian entities, and directly providing support to the government and people of Ukraine as required by law. Failure to submit the report required by this Section may deem Contractor's bid non -responsive. Please include a written report to the City if this section is applicable. ! 02s Russian Aggression Against Ukraine Compliance 1280-1 5/13/25, 4:13 PM 1000003382 - PAVEMENT COATINGS CO. 0 D"R ft" of Cam" Public Works Support Log in WENW RIddlM eCPR Search Contractor Registration Search Project Registration Search Register ,F wnp i Cu. tq„rragrA co , t,Look l,p i 1000003382 - PAVEMENT COATINGS CO. 1000003382 - PAVEMENT COATINGS CO. Customer Account Lookup PWCR Lrc0003382 Contractor Status D I R Approved CSLB 303609 Business Phone 9516821091 hftps:/Iservices.dir.ca.gov/gsp?id=dir—public_form&table=x_cdoi2_cMportal_customer_account_lookup&sys_id=3c3cafaOc3cf4210cee47433e40131 f... It 5/13/25, 4:13 PM Ext Registration Start Date 2023-07-01 Legal Entity Name PAVEMENT COATINGS CO. Doing Business As (DBA) PAVEMENT COATINGS CO. Business Structure Corporation President 1000003382 - PAVEMENT COATINGS CO. Timothy Schmid Email smain@pavementrecycling.com Registration End Date 2026-06-30 Crafts Parking and Highway Improvement Address Mailing Address 10240 SAN SEVAINE WAY Mailing Address - City JURUPA VALLEY https://services.dir.r-a.gov/gsp?id=dir_public form&table=x_cdoi2_csm_portal_customer_account_lookup&sys_id=3c3cafaOc3cf4210cee47433e40131 f... 2/, 5/13/25, 4:13 PM 1000003382 - PAVEMENT COATINGS CO. Mailing Address -State CA Mailing Address -Zip 91752 Mailing Address - Country United States of America Physical Address 10240 SAN SEVAI N E WAY Physical Address - City JURUPA VALLEY Physical Address - State CA Physical Address - Zip 91752 Physical Address - Country United States of America Related Lists Rf:gi5.tration.QatQ5. https:Hservices.dir.ca.gov/gsp?id=dir_public_form&table=x_cdoi2_csm_portal_customer_account lookup&sys_id=3c3cafaOc3cf4210cee47433e40131f... 3/ 5/13/25.4:13 PM 1000003382 - PAVEMENT COATINGS CO. 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