HomeMy WebLinkAboutKern County Custom ConcreteSECTION 1200
BID
DATE: -I 1N /Lv
The undersigned, as bidder, declares it has received and examined the Contract
Document entitled Project No. 2024-06, Citywide Miscellaneous Concrete
Improvements, and will contract with the City, on the form of Contract provided herewith,
to do everything required for the fulfillment of the contract for said work at the prices and
on the terms and conditions herein contained.
We have included the following items and agree that they shall form a part of this bid:
SECTION TITLE
1200
Bid'
1210
Bid Schedule,
1220
Bid Guaranty Bond
1230
Certification of Bidder's Experience and Qualifications`
1240
Proposed Subcontractors
1250
Non -Collusion Affidavit
1260
DIR Project Vendor Information
1270
Iran Contracting Act of 2010 .
1280
Russian Aggression Against Ukraine Sanctions
We acknowledge that the following addenda have been received and have been
examined as part of the Contract Documents. Bidders must be on the Plan Holders List
with the City of La Quinta in order to receive addenda.
Addendum #
Date Received
Initials
Attached is a bid guaranty bond as required by Paragraph 1110-15.0, BID GUARANTY.
Name of Bidder
Bidder's Telephone Number
Bid 1200-1
If our bid is accepted, we agree to sign the contract without qualifications and to furnish
the performance and payment bonds and the required evidence of insurance within 10
calendar days after receiving written notice of the award of the contract.
Having examined the bid documents, we certify that we have acquainted with the nature,
geographical and exact location of the works; the general conditions of execution; the
neighboring buildings and other constraints that might affect the construction methods;
the obligation not to obstruct the traffic where requested, or the flow of any water; the
physical conditions specific to the construction sites; the climatic conditions; local
conditions; means of communication and transport; the possibility of supplying water,
electricity and fuel; the availability of labor sufficient in number and quantity; all constraints
and obligations resulting from social, tax and customs legislation; and all conditions and
circumstances which might influence the execution or price of the works.
We certify that we are satisfied with the description of the works and the Project
Engineer's explanations and that we understand perfectly the works to be undertaken as
specified and implied in the execution 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.
off'N%M W- kAW
Name of Bidder Bidder's Telephone Number
�Tn'4 *f\
Bidder's Address
Contractor's License No.
M
State of Incorporation
411 u I
of Bidder
Printed Nam6 of Signatory
�V-�\&"
Title of Signatory
NuWus@ cum
Bidder's Email Address
° 15-0 �v
Contractor's Expiration Date
wtw vvam
Witness
Title of Witness
Bid 1200-2
SECTION 1210
BID SCHEDULE
PROJECT NO. 2024-06
CITYWIDE MISCELLANEOUS CONCRETE 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. 2024-06, Citywide Miscellaneous
Concrete 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 — CITYWIDE MISCELLANEOUS CONCRETE IMPROVEMENTS
Item
Item Description
Est.
Unit
Unit Price
Item Total
No.
Qty.
(in figures)
(in figures)
Dollars
Dollars
1
Mobilization
1
LS
$ '
$
2
Traffic Control
1
LS
$
$
3
Dust Control
1
LS
$
$ UVU
4
Sawcut, Remove, and Dispose
of Existing Concrete Curb &
120
LF
$
Gutter; and/or Rolled Curb
V
5
Sawcut, Remove, and Dispose
of Existing Concrete Sidewalk,
840
SF
$
$
Ramp, Driveway, and Cross -
Gutter
( U0
Construct Curb and Gutter per
6
City of La Quinta Std. No. 201,
50
LF
$
3" Dowel into Adjacent Existing
Concrete Curb
7
Construct Type 'C' Curb per
City of La Quinta Std. No. 203,
40
LF
3" Dowel into Adjacent Existing
J 9
Concrete Curb
Construct Curb Transition per
8
City of La Quinta Std. No. 205,
10
LF
$
$
3" Dowel into Adjacent Existing
Concrete Curb
9
Construct Driveway per City of
220
SF
$ i
$
La Quinta Std. No. 221 Mod.
l
Construct Portion of Cross-
10
Gutter per City of La Quinta
30
SF
$
$ d U U
Std. No. 230 Mod. and 231
Mod.
11
Construct Sidewalk per City of
380
SF
$ <
$3a
La Quinta Std. No. 240 Mod.
Construct Concrete Curb Ramp
1
12
per City of La Quinta Std. No.
1
EA
$ 10 �i1�
rp�
$
250 Mod., Case B (Including
Curb and Gutter Along Ram
Construct Concrete Curb Ramp
13
per City of La Quinta Std. No.
1
EA
$ C �(,�
$ G Li
250 Mod., Case E (Including
Curb and Gutter Along Ram
Bid Schedule 1210-2
Item
Item Description
Est.
Unit
Unit Price
Item Total
No.
Qty.
(in figures)
(in figures)
Dollars
Dollars
Sawcut, Remove, and Dispose
14
of Existing Concrete Ramp;
Furnish and Install Truncated
40
SF
$J
$
Dome Concrete Tile per City of
La Quinta Std. 250 Mod.
Full Depth Grind Asphalt
Concrete Pavement (4"),
_`
15
Compact Existing Base,and
570
SF
$
$
Variable Overlay (4 — 5, ). 2 x1-
1/2" Header Cut incidental.
Grade Parkway, Remove,
16
Modify, and Replace
Hardscape, Landscape and
1
LS
$ cot 060
(�/��
$ 10 VUk
Irrigation in Kind to Furthest
Extent Possible. 6" Under -
sidewalk Drain incidental.
17
Striping and Pavement
Markings, Including All
1
LS
$ 10111 O
$ Car +
Incidentals
Total Amount of Bid Items 1 —17
$ 7
Bid Schedule 1210-3
GRAND TOTAL BASE BID (Figures):
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. I _
V U Signature of Bidder (Ink)
Name of Bidder (Printed or Typed)
Bidd Telephone Number
ti SrC� v► r'
Bidder Email Address
Bid Schedule 1210-4
SECTION 1220
BID GUARANTY BOND
Merchants Bonding Company(MUTUAL)
PRINCIPAL, and
unto the City in the penal
THE BID of the Principal a
work described below, for
States, well and truly to be
, as SURETY, are held and firmly bound
um of TEN (10) PERCENT OF THE TOTAL AMOUNT OF
)ove named, submitted by said Principal to the City for the
:he payment of which sum in lawful money of the United
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. 2024-06
CITYWIDE MISCELLANEOUS CONCRETE 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. 1 7th
IN WITNESS WHEREOF, we have hereunto set our hands on this day of
July , 2026.
YW t Michael James Melshenker, Attorney in Fact
itle of Signatory Title of Signatory
atu of Principal Si nature of Surety
7505 TERRY JOHN AVE BAKERSFIELD, CA 93308 6700 Westown Parkway, West Des Moines, IA 50266
Address 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 Ventura
County of )
On 0 before me, Shannon Katrina Martinez, Notary Public
�( (i sert name and title of the offic )
narcnnally annParPci !/ Q`� � �`��� C� l `�`G f�f4e
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.
j0°� +� SHANNON KATRINA MARTINEZ
WITNESS my hand and official seal. J Notary public - Calilorni�
' Ventura County
= Commission # 2494t 17
+u o +� My Comm. Expires Jul 9, 1028
Signature (Seal)
MERCHANT-S"%�,
BONDING COMPANY,
POWER OF ATTORNEY
Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
both being corporations of the State of Iowa, d/b/a Merchants National Indemnity Company (in California only) (herein collectively called the
"Companies") do hereby make, constitute and appoint, individually,
Michael James Melshenker
their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings,
contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of
persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions
or proceedings allowed by law.
This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of
Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and April 27, 2024 and adopted by the Board of
Directors of Merchants National Bonding, Inc., on October 16, 2015 and amended on April 27, 2024.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and
authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto,
bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof."
"The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney
or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually fixed."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the
Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction
contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department
of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of
its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given
to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner -
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 29th day of July 2024
........... .. • • • • MERCHANTS BONDING COMPANY (MUTUAL)
•..••Q.(�ON'q�••'• �•�Q\N0'.�OiyjA. MERCHANTS NATIONAL BONDING, INC.
'RPOR' ep: O,d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY
co
O 4j 9 .2
LZ': �z: �• 1933
2003 :��: : • c: By
•..oi `1a• President
STATE OF IOWA •••'•� it
COUNTY OF DALLAS ss. ••""""��,
On this 29th day of July 2024 before me appeared Larry Taylor, to me personally known, who being by me duly sworn
did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the
seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors.__
�Pa`A� sm Penni Miller
z Commission Number 787952
• • My Commission Expires
lowA January 20, 2027 ^-Notary Public `+-
(Expiration of notary's commission does not invalidate this instrument)
I, Elisabeth Sandersfeld, Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do
hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies,which is still
in full force and effect and has not been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 17th day of July 2026
9 Z': .•�o�o�POg9�9y�:
o
2003 �L?• •� _ 1933 3• Secretary
J . ; •. y� j. 1
44
y:
POA 0018 (6/24) ""
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: PIM, -ISW WkL
Owner: K\( \M-,9U WML\ my .4-u
Construction Cost: $ \ TV 72� b ,(�)
Construction Time:
Owner's Representative:
Owner's Telephone No.:
Date of Substantial Completion:
2. Project Name:
Owner: -e—�
Construction Cost: $-A,
Construction Time: i�
Owner's Representative:
A
Calendar Days
Calendar Days
t V(1dA
Owner's Telephone No.: —�,%A' 15 -`\ • J1�'1�Z
Date of Substantial Completion: �) I aflA,
Bidders Experience & Qualifications 1230-1
3. Project Name:
Owner: O
C�-
Construction Cost: $\n,�e,-)D
Construction Time: G 7
Q Calendar Days
Owner's Representative: (1
C)oL
Owner's Telephone No.: �,�� ' �J�Z�ykkZ-A
Date of Substantial Completion:
4. Project Name:
Owner: �-
�`�- �� Uy)
Construction Cost: $ 60U.P0
Construction Time:
Calendar Days
Owner's Representative:
Owner's Telephone No.: CA , - --\O2
• "D�I
Date of Substantial Completion: L
117 l ?,q
Signed this day of
2026.
4,W Wn �NJ1v Nwu—�L
J1 J�
Name of idder Contractor's License No. DIR Reg No.
� 150 1 IL-1
!S}gnatur�bf Bidder
Printed Name of Bidder
Expiration Date
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.
SiAkdrel6f Bidder
Name of Bid
Proposed Subcontractors 1240-1
SECTION 1250
NON -COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED
WITH BID
State of California )
ss.
County of )
beipq first duly sworn, deposes a d say that he
or she is of �MLR-,k, 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
9 collusive or sham bid.
' VV
ftbature
uc�� U%U#
Name of Bid er
Title
---�j/� Vt,,,v
Date
Non -Collusion Affidavit 1250-1
SECTION 1260
DIR Project Vendor Information
Vendor Information:
Name:
—I�Ac) �Y'
Address:
Project Manager:&060
Phone:*-
Public Works Registration No.:
Classification:
City: b&kVMQ0 ST:& Zip: `1b%
Emai1:f �\0, �A(6 � �CCU�S�oMCO�1CRQ
CSLB/Certification Number:
Asbestos Boilermaker Bricklayers Carpenter Carpet/Linoleum_
Cement Masons)—bDrywall Finisher Drywall/Lathers Electricians
Elevator Mechanic Glaziers Iron Workers Laborers 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.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.
cool
DIR Project Vendor Information 1260-1
SECTION
CO 11 ► ■ ► • ► ► • 1 1
Pursuant to the Iran Contracting Act of 2010 (Pub. Contract Code, § 2200 et seq.),
(a) Contractor shall be ineligible to bid on or submit a proposal for any contract for One
Million Dollars ($1,000,000) or more if Contractor engages in investment activities
in Iran as defined in Public Contract Code Section 2202.5, and/or if Contractor is
identified on the list of persons engaging in investment activities in Iran prepared
by the State of California pursuant to Public Contract Code Section 2203
subdivision (b).
(b) For bids of One Million Dollars ($1,000,000) or more, Contractor must certify that
it is not on the list of ineligible vendors prohibited from doing business with the State
of California and shall complete the Iran Contracting Act Certification and submit
with their proposal at the time of bid. Contractor shall obtain the Iran Contracting
Act Certification in the form approved by the State of California, or upon written
request to the City Clerk's Office, a copy of the form will be provided to
Contractor. Failure by Contractor to provide the certification required by this
Section may deem Contractor's bid non -responsive.
(c) Nothing in this Section is intended to prevent the City from exercising its rights
pursuant to Public Contract Code section 2203, subdivision (c) or (d), or both, on
a case -by -case basis.
Iran Contracting Act Certification 1270-1
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) I Federal ID Number (or n/a)
By (Authorized Signature)
Printed Name and Title of Person Signing I Date Executed
Iran Contracting Act Certification 1270-2
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 (Printed6, ldecal ID Number (or n/a)
U_U\ LW" 122
8 ( t or Signatu )
PriPMOVaWand Title of Person Signing Date Executed
Vie 2
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 Compliance 1280-1