CONTRACT SUMMARY SHEET TO: THE OFFICE OF THE CITY CLERK, COUNCIL/PUBLIC SERVICES DIVISION ROOM 395, CITY HALL DATE: 11/17/2011 FROM (DEPARTMENT): BOARD OF PUBLIC WORKS CONTACT PERSON: MARY CARTER PHONE: 213-978-0262 CONTRACT NO.: C-119868 COUNCIL FILE NO.: _ ADOPTED BY COUNCIL: ~ _ o NEW CONTRACT D AMENDMENT NO. D ADDENDUM NO. - D SUPPLEMENTAL NO. D CHANGE ORDER NO. DATE APPROVED BY BPW: 11/14/2011 DATE CONTRACTOR NAME: SIMGEL CO., INC. ----------------------- TERM OF CONTRACT: 247 WORKING DAYS THROUGH: DECEMBER 27,2012' TOTAL AMOUNT: $797,247.20 ------------------------------ PURPOSE OF CONTRACT: FOR THE SOUTH SAN FERNANDO VALLEY PARK & RIDE NOTE: CONTRACTS ARE PUBLIC RECORDS· SCANNED AND UPLOADED TO THE INTERNET
Transcript
CONTRACT SUMMARY SHEETTO: THE OFFICE OF THE CITY CLERK,
COUNCIL/PUBLIC SERVICES DIVISIONROOM 395, CITY HALL
DATE: 11/17/2011
FROM (DEPARTMENT): BOARD OF PUBLIC WORKS
CONTACT PERSON: MARY CARTER PHONE: 213-978-0262
CONTRACT NO.: C-119868 COUNCIL FILE NO.: _
ADOPTED BY COUNCIL: ~ _o NEW CONTRACTDAMENDMENT NO.DADDENDUM NO. -D SUPPLEMENTAL NO.D CHANGE ORDER NO.
DATE
APPROVED BY BPW: 11/14/2011
DATE
CONTRACTOR NAME: SIMGEL CO., INC.-----------------------TERM OF CONTRACT: 247 WORKING DAYS THROUGH: DECEMBER 27,2012'
TOTAL AMOUNT: $797,247.20------------------------------PURPOSE OF CONTRACT:
FOR THE SOUTH SAN FERNANDO VALLEY PARK & RIDE
NOTE: CONTRACTS ARE PUBLIC RECORDS· SCANNED AND UPLOADED TO THE INTERNET
ORIGINAL CONTRi\e}DOCUMENt
SOUTH SAN FERNANDO VALLEY PARK & RIDE
BID PROPOSALPARTIOFID
:;ERTIACATE OF LIABILITY INSURANCEAPPROVED AND ON FILE. W.O. No. E1906116
Federal Transit AdministrationProject ID Nos. CA-95-X090-00 & CA-03-0733-01
Approved
O::--\- '2.2-.__ ,20 l\CARIVIEN A. TRUTANICH, City-;;"Att':-o-rn-ey
BY&aJt~ In and for theCity of Los Angeles
California
TYPE OF CONTRACT CASH
PROPOSAL ATTACHMENTS Plan Drawings Index No. MF 300371 (21 sheets)
SPECIFICATIONS General Conditions, General Requirements, Construction Sign Detail andExhibits, Standard Specifications for Public Works Construction(Greenbook) 2009 edition as amended by the January 6, 2011 edition ofthe City's Brown Book. *
PROJECT LOCATION 2006 Thomas Guide page no. 561-E3
COMPLETION TIME
LIQUIDATED DAMAGES
274 working days
$1,500 per calendar day
BID DATE Bids must be received no later than 10:00 a.m. on Jnly 27, 2011 at Los Angeles City Hall;200 North Spring Street, Room 355; Los Angeles, California 90012.
I Firm Name: 51noet- Co. /U._L IAddress:
~Jestvo»d~3S u: {# J../;" LA .. c:::.A -, 90v;}--5Telephone Number ( 3 i0 ) ?f7S- 7663 Fax Number (310 )475~? 8] (
D58371 Classification:t< cfj Expiration Date: 2./ /& ~I.A, u, 2..'J zo I
Business Tax Registration Certificate (BTRC) No. .>34 it 675- 9;;'"
* Part 1 of the Greenbook and Brown Book are not a part of the Specifications.Rev. 02/24111
ADDENDUM NO.2REVISED 7/13/11
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-=DULE OF WORK AND PRICES-sAngeles - Department of Public Works - Bureau of Engineering
oouth San Fernando Valley Park and Ridew.o. No. E1906116.,-,
leral Transit Project Administration Project ID Nos. CA-95-X090-00 & CA-03-0733-01
29Natural gray 6" concrete street curb (City Std. Plan S-410- 40,00 I, 80 o.0 a2. Type A curb) LF 45
30Natural gray concrete street gutter (City Std. Plan S-410- 40,,\l1l i IBoO.oC2; concrete nutter) LF 45
31 New concrete whee! stops 10 GilO 2, lo 0, Q oEA 21
32New plastic header 2-0 Sf\) 500·0\)LF 25
33 New wood rail fence /00);)1.1 6,500,00LF 65
34New 4" high chain link fence along channel boundary ,)0,00 15.000,00LF 500
35New bollards at electrical service pedestal I,o a I) ,0 0 4, 000,00EA 4
36New removable bollards at entry driveway 'l,OOO,OIl i4,ooo.,OOEA 7
37 New bike lockers 800.00 9, 600, cOEA 12
38 New concrete bench 2,000,011 2 000, ()OEA 1 •39 New concrete trash receptacle 1,000,.00 4,ooo.l1VEA 4
/'" I, ')..00, ClO1 Parking stall line striping (ADA) 'bOO./JOEA 6
41Parking stall line striping (standard) 50,0 o 4,000.00EA 80
42 Parking stall line striping (compact) 50,00 3, '700,00EA 74
43 HD symbol paint marking 50,00 "300.00EA 6
44 Arrow symbol paint marking "30,00 660.00EA 22
45 Compact symbol paint marking to,QO 740,00EA 74
46"IN/OUT" symbol paint marking 50,00 " 00,00
EA 2
47"NO PARKING" symbol paint marking 2.0,00 100,00EA 5
484" "NO PARKING" zone striping 500,OiJLS
49HC parking post signage 150.00 900, (Ii)
EA 6
50"PARKING AT YOUR RISK" post signage 150,,00 i50.ooEA 1
51"TOW AWAY" post signage /50.00 /S 0,00EA 1
52. vio.« 340.00"STOP" post signage EA 2
Parking Lot Drainage53 Allowance for potholing work to locate existing 18"
'cas line LS $5,000,00,...,..,
Shoring of Open Excavation, Depth 8'-10' 15.00 3. ooo.»- LF 200
55 Shoring of Open Excavation, Depth 5'-7' I0 .011 t"OO().OOLF 200
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SCHEDULE OF WORK AND PRICESCity of Los Angeles - Department of Public Works - Bureau of Engineering
South San Fernando Valley Park and Ridew.o. No. E1906116~
deral Transit Project Administration Project ID Nos. CA·95·X090·00 & CA·03·0733-o1
LF 8,00 ',320. co57 12" dia. Schedule.80 PVC Pipe and Fitting; Invert Depth = I )O,QI) 64,350,004' to 10'; Case 2 Bedding per LACFCD Std. 3080-2 LF 429
5812" dia. Schedule 80 PVC Pipe and Fitting; Invert Depth 35.00 ~ 860,00Less Than 5'; Case 5 Bedding per LACFCD Std. 3080-2 LF 116Grating Catch Basin (SPPWC 304-2; One Grate) with
4,000,0059 Bike Safe Grating (City Std. Plan 8-342-4) per Plan Z 00000Drawin SD-3 EA 2 ¥ •
60 Manhole Pipe to Pipe (SPPWC 321-1) per Plan SD-3 2.,000,00 4,OeO.OOEA 2
61Pipe Connection to Existing Storm Drain (SPPWC 335-1) Cj ,000,01) 5,000 ..ODper Plan Drawing SD-3 EA 1
62STORMCEPTOR Model STC 450i Or Equal per Plan 15,000,00 150oo.ol.lDrawing SD-3 EA •Remove & Haul Away Existing Concrete Sidewalk, Curb &Gutter along Hayvenhurst Avenue per Plan Drawing SD-3;
63Site Cleaning and Restoration Including Concrete 14( 000,00Sidewalk and Curb & Gutter and CMB (Match the ExistingConditions); Temporary Trench Resurfacing (onHayvenhurst Avenue) LS
Electricalrr=
3/000,00 45. 000. 017.4 New single light poles EA 15
65 New double light poles EA 1 3,50D,00 3 500,00j
66 New electrical service LS l-4,500.0067 New EV Charging outlets with 2' SQ. concrete pad EA 2 .)., 000.00
Irrigation & Landscaping
68 Shrub or small turf irrigation system SF 11,648 3,00 34,944,0069 Backflow unit with encl. on slab, w/pressure reg./strainer EA 3,000,\1\1 3 000,00•70 Controller with enc!. on slab, stainless steel EA 3,ooO.oa 3,000.00
71 Rain Sensor w/slab EA ',OGO,Qe i,o OO.·II~'
72 Quick Couplers in box EA 8 5DI/.()/) 4,000.00
73 Trees (2x staking & backfill) 24" box EA 43 800.00 34,400.00
74 Trees (2x staking & backfill) 36" box EA 4 2-00.,00 ~OO. /)7)
75 1 gal Shrubs EA 517 10,00 5 110,00,
76 5 gal Shrubs EA 439 30,.00 13,110,(}O77 5gal Vines EA 22 30.00 660" 00,-. o 00 920,00Groundcover from Hat (64 plants per flat) EA 92 I ,
Total Bid Amount:Unit Abbreviations: LS = lump sum, LF = Linear Foot, EA = Each, SF = Square Foot and CY=Cubic Yards
3,813,00
1,183.905, 9/5', So4,000. DO2,367.80
7, 2-2.0,00
A. MOBILIZATION: If the successful bidder shows an amount in excess of $25,000 for Mobilization (Bid Item No.1), Hie bidder will be paid$25,000 per General Requirements, Section 01292. The difference between the Contractor's bid amount for the Bid Item No.1 and $25,000 willbe:paid after the Statement of Completion has been issued.
C.SPECIAL TY ITEMS: Bid Item Nos. 40 to 52, 62, and 64 to 88 are designated as "Specialty Items".
B, FIXED COST ITEM: Bid Item No. 53 is considered a Fixed Cost Item at the time of bid. The pre-printed dollar amount listed in the "Scheduleof Work and Prices" shall not be changed or deleted.
D. ENHANCED ELECTRICAL SAFETY POLICY is applicable on this project for on-site electrical work. See Bid Proposal Part III "GeneralInstructions and Information for Bidders", subsections 15d and 16b.
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South San Fernando Valley Park and RideW.O. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01 CONSTRU C.TION
CITY OF LOS ANGELESRESPONSIBILITY QUESTIONNAIRE
··keSPONSES TO THE QUESTIONS CONTAINED IN THIS QUESTIONNAIRE MUST BE SUBMmED ON nilS FORM.In responding to the Questionnaire, neither the City form, nor any of the questions contained therein,may be retyped, recreated, modified, altered, or changed in any way, In whole Of in Part. Bidders orPrQPosel'S th",t submit responses on a form that has been retyped, recreated, modified, artered. orchanged In any way shall be deemed non-responsive.
The l>ignatory of thil> questionnaire guarantees the truth and accura9Y of all l>tatements and answers to thequel>tlons herein. Failure to <;ampleteand retum this quel>tionnaire, anY fa!l>.e$latemenls, Of f~lilLlfeto answer(a) questlQn(sj when required, may render the bId/proposal non"rel'iponsive. All tesponses mus~be typewrittenor printed in ink. Where an explanation is required or where additional space is needed to eXpfain an answer,Ul>ethe Responsibility Questionnaire Attachments. Submit the completed f9r1n and aU Illtachinents to theawarding authority. Rl'it<'liha C9PY ofjhis completed form for Mure reference. ContractQr~ must submitupdated information to the awarding authority if changes have.oocurred that would render any oHhe responsesinaccurate in any way. Updatel>must be submitted to the awarding authority within 30 days of the change(s).
A. CONTACT INPQRMATIOJlj
CITY DEPARTMENT INFORMATION
Puh Ii CWOflz.Ph60fi!
7rn '2.0 IISidP'<!te
City DepattmentiDivislon AWarding Gtmlrac!IN,O, It t 0 b 1/ h So 7l S(/~V1 FfOlCl/ILri
i?i;iikl\yBld pr.Cpntract Number end Ptoj!';ct Title. (ifappI1Cllple)'~'i;':~:',}?
OM initialsubrhissitln ofa ¢6mprete~Que$tionnaite.o An update.of a pnpr Questipnnalre dati;ld I I§?l NOchange. ItierUtYl!nqerpenalt~of perj\.io/ Unger the laWsofthe~tfjt~~f()~(ifqrlija (h~tt~ete I)~s~$$jj. no
chan~etoanyt)fthere~~onsessincethelast Responsibility QUestiennairedafed .2. I I ~ I ~o iPwas submitted bylhenrmi Attach a copy ofthatQuestronnaire<ll'J¢!s" n b' ·W;
E W\t'lYl lie / )' SO .s Pres,dwl-PrlntNsme, Title Slgnature
South San Fernando Valley Park and RideW.O. No. E1906116Federal Transit Admin Project 10 Nos. CA-95-X090-00 & CA-03-0733-01
B. BUSINESS ORGANIZATION/STRUCTURE
,;'ndh:;atEi the organizational structure ofyoytffrm. "fIrm' .includes a sole proprietorship, corporation, jOintventure. consortium; assoelatlon, or any comblnatioh there.of. .
Treasurer: k W\A"111-e.., I SaS6 (J ~
o Check the bo~ only ifydur firlll is apublicJY~$dEldi¢prp?ratlpi'l.Ust those who own 5% Of more of the corppratio~'s 'stocks~Use Attachment, A if mote ~paceis needed,Publicly traded corporations need not Ilstt~eow~Elr$of5%.pr moreofthe cprpor';ltiqO'SS!pCks.
o Partnership: Date formed: I I $t$t\i1pf fprtl1&tioh:~_-"""~~List all partners in your firm. Use AttachmentJ\.Ifmdre sp$¢e Is heeded,
o Sale Proprietorship: Datastarted; 1 !:-"--~Ust any firm(s) that you have been associated with as an-owner; parther, oi'bffrcetrbnhetlas! five years.Use Attachment A if more space is needed, Do no,t inCfU.deownership of $toOK·in a publicly tradedcompany in your response to this question.
o Joint Venture: Date formed: f I.~.,,-c;'list: (1) each·firm tha,t is a,m~mbl:lr brth\i1jbl~t yehfllrea/ld (2)' th.¢ PElt~n~~~~f!::1Wller~lilp. ih$Jftrri Willhave. in the joint venturE!. Use Attachment· A ·jf .more $PflCOis ne~dEld, . Eaqh.' ..mElmflElfQf tilE! JpintWl1tUfEl. must cpmplEltE! a .separ;:iw. C!!lEl~tlorlnaJ~for the JQ\nt VElnture'$$f,lQmiS$iQn to bElconsidered as responsivEi to tl1E1inVifatj0I1'
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South San Fernando Valley Park and RideW.O. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01 CONSTRl)CTlON
c..OWNERSHIPANO NAME OHANGES
Is yourftrm a$~bsidii;ny, par~nt. hol<:lihgcompahy, or ~ffiliata of another firm?qVi;ls I!(No
If Ves,axpl!ilI1Qf1 A!tMhrnent A the relationship .b~"tWe.en.yo9r.firmandth~. ~~o~iafed firms. .IncludeihfQrmatiooj'lPQqt; arl !:jffjJiateq firm POly if on!;l tlrm PWI)EI$0% or more Qf!:jnpthl'lr firm, OF If an owner,partner or offiCer Of your firm holds. a similar position ih anctherflrm.
2. Ha~ ~nYoUh~firm's. owners, partners; or offlcet'soperafed as/mila!: bUsiness it) the past five years?CJ Yes td'NoIf Y!is. ristOt) A~a¢hmE!ht.A the .names ?ht:l~ddrEiElses of al.1SQ.chb4$iiJ.E!$$9si.and tha person whooperatedthe.busihass,. Include lnformaticn about a similar buslness only if an owner, partner or officer ofyour firm holds a similar position in another firm;
3. H<ls the firrnchanged names in the past five years?D Ves E!f"NoIf Yes. lIst on Att<lchment A all prior names, addresses, and the dates thl'lY were used. Explain the-reasonfor eachnamecllange in the last five years.
4. Are anyof Y()yPfirm's li~nst:')s held in the n~meQfac:otPOl"atloh or ParthEirship?D Ves llfNo
If Yes,lil:;t oh Atta~hm~l1t Athe name of thecQrpdtationor par!nt:')rshipthat~ct(jaflY holds the license.
Ellcfders/Contractors. must continue' on to Section 0 and answer aU remaining questionsc()t1t<lined hi tillS Questionnaire... . . . ..
Tile responseslf'l ~hisQuestiQf'll1airewiJl l')()tb!!; made aVllUable to the pUl:l1ic for review. This isnota PUblic document. [epee §20101(Il) 1
South San Fernando Valley Park and RideW.O. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733·01 ccn>nHRVCTION
In the past five Yean~,ha$.your ffrmever been o~nieqbonding?DYes 0No
If Yes. explaih on AttaGhrnent$ th¢ Gircum$t?nces s\JrrQUnQit)geach lostanCl;l.
6. Isyi;iurfinn now, Or has it IilvetbeeI) $t.?I1Ytili)a.in ~fjelastfi\ililyeat$. th.ed¢bfoJ in a bankruptoy case?DYes rn-NoIfYesi explain (jn Atta¢fjli)ant.~ m~(:;irqYll1st~ljcessyrtoYfidingaa(:;fj i)'jsfahce;
7. IsyolJr firm in the proGessof, or in nef)otiations towarO.beihgsold?DYes IZ1'No:
(rYes, explain the GircumstanceS on Attachment B.
E; INSURANCE
13. Ihlhepasffiveyears, has any bonoing company made anypaymentsid satisfy any claims made against 8bondlssued On your firm's Jjehalf? . .DYall dNa
9.1.l1d1cp1tewhetheryourfirm currentl~has ?wQtkers'compensationlnsuraOcePdllc;y in effec;t,wh(fjther it ISlesallyself4fhsured, Or whether itcurrently has no workers' Cdmpensat10n insurance Pdlicy in effect.riWorkl;ll'$' CompensatiottlrisUi'ance Policy Currently tn Effe~t
o Legally Self-Insured
o NOWorkel'$'CQmpenslition Policy Currently il'l Effect
If you h,we nqworkerscolnpensaliol1 insurance Pdricy currently Ineffe-ct, and you ·are not legaUyself-iOs\clred,PfqYidea.n explan!'!fion On Attacnment B, .
10: /"Iriitthe IExperienceModif,cati()nRate (EM~) l!1sueq tp your firm allnu.aUy by your WQrkets' c()mpensatloninsurance carrier for the last Ihreayeal'$, Begin with them~stl'ec~ntyear(YR1) that. an ~MR.rate wasissved. (EMR-1), If any ·9f tlletl;ifes fortfj(;l!hreeY(;lars is PfWas t:.90 or higner,yoq rnay proVide anexplallatipnqnAttachment B. . . .Y~.1;J2.. EMR~1;ill YR2jO» E;MR-2:.114 YFk3;Ot> f2MR-'4;/]l
11.Y\llthil1 thepastfiveyear~,ha$ yourffrrnil;lver had emPlOyees but waswilhout wprkers'cotnpensationinsurance or state approvedseJr-ihsuraliCe?DYes 0f.loIfY~~HeXplajn on Attachment ·Beach. instance .. /fNo, ..attaCh .8.statementfrorrfy.outWorkers'. compensationinsutance PtoViqertha.tYou have beef) cPntinUpuslylrlsUred for me Pa~tflvl;l years.
South San Fernando Valley Park and RideW.O. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01 CONSTRI1CTION
F. PERFORMANCE HISTORY
1.2,How many years has your firm been in business? J... 0 Years
Has your firm ever held any contracts with the CityofLos·Angell"s or anyofits depacitn€:}llts7ifYes 0 No
If, Yes, Jist on Attachment B all contracts yourftttn h~shadWiththe C)tyPfLps A!1g~k~$fb!, the l~st10years, For each contract listed inrt:'sppnsetothil?qllesjiol)' inc!lI~e: (li\)t:'httty.~.film!i;@ n~?1.eof a.contactand phone number; (c) purpose of contract; (d}totalcost;(e)slaytin(lQat€:}; and (f)€:}fl\IlinQ.dl\lte,
14, List Oil Attach mellt B aUconttfilP!Sypur firm hiis",~~ with ~nyptlv?~~(,ir~~V~rn.ti1~nt~I.~rtittl<?tMtthl'ln theCity of Los An9€:}le:;;).oVer the. ia~\fiveye<ilrsth<ilt<ilre.:;;itnilfilr.toUie\IV9rktqpe.perf9rm~ 9tttpe.Qolltr<il9t ~orwhich you are bidding or proposing. For each contractHstlall(n response to this 9uestio!1; Include: {a} entitynafl')e; (b) name pf a contact.and phone numbe!'; (C) purpc>se9f'c<?[Jtra9t;.(\Il) tot~'~():;;t;.(~) ~t<ilrtingdate;and (0 e!i\:lihg date,o Check the box if you have not had anY similar contractsln Ine I~stfhle ye<lrs;
15. In the pastfive years, has a governmental or private elltitybr1ndlllldoaHei1'11jn~teq YQurfitm'scontract priorto its completion. of the contract?DYes 0"No
IfYes, explain on Attachment 13the circumstances surrbl.lhqing each ihstl\ll1ce.
In the past fiVe years, ..has yOur firm used any subcontfactor to peifOirt\ Work?n!agoyernment contractwhell you knew that the subcontractor had been debarre\:! l)y agovemr:nenfal$ntlty?OVes It! No
IfYes, explain on Attachment 8 the circumstances $urrbunqing each instance.
17" In the past five years, has your firm defaulted on a contract orbeen debarred ordelefr:11fned to be a non-responsible bidder or contractor?
t1Yes 0 No
If Ves, explain on Attachment 8 the circumstances surrOullqlng sa.tin [nst$n¢i>;
(3, DISPUTES
1$" In the past five years, has your firm been thedefendant irLqpurtpnl\l matt€:}rTe[a~€:}dt?>aQY9fth~follpWil1Qissues? For parts (a) and (b) below, check Veseyen if the matt~r proceeded tparbitratlbl1 \VithoutcourtlItigation, ..For part(c ),c:h~ck Ye~ only jf the rnatterproce~qed tbP()llr,tll~j9~\t~q\.'fY9W-a!J.~lJ'ferYe~tOl:lnypftheql.lt:'Strons beloW, eXplain tht:' circl.lmliitanceSsurrburj~lnge~ch.lfl$$nQebnAttaOtJffl.ent~., You. mustinclude thefollowing inVourresponse:the nameoHhepi~intiffs iheachcourtcase,lhlaspedfic causes ofaction in .eachcase; the da!eeach .basewas filed: and the (jisOOsilion/cutrenl'statu$ oreaCh case,
($l Payment to subcontractors?DYes ifN<>(1:>). Work performance on a. contract?DY'$s 0No(c) EmplOyment-related litigation brought by l\lnemploy€:}eZJj Yes 8f'No
South San Fernando Valley Park and RideW.O. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01 CONSTRUCTION
19. Does your firm .hav~.any outstanding JUdflements Pllndingagainst I.t?DYes 01110
If Yes,tlxplaio on Attachmllnt a; thll otrcumstances surrounclingtlac;h instance;
29. In the past five ye<:1~ihas your fiNn.b$Elhasses:>~d.liquld<:ltlldcfamagEls<:1n.apantfact?DYes B'N&
If Yes, explain 6n Attaqhment B the circum$tanc;es surrounding each instance and identify all suchprojects, the amount assessed and paid, and the name and address of the project owner.
H.COMPLIANCE21. In the pasffiW years! ~as Xourflim or any Ofits6wnel's1. pMnei'S orofflCers,Elvefbeeninvestigated, cited,
assesS!ld arw pef1<:lI!i~s.or ~een. fq\Jnd to raVe viplaled any laws, ..rules, (ir ragul<:1tionsenforced oradministered, py anyqfl/le !llOYllrnmenjal,eniitills listel'j on Attachment d (Page 10)? Forthls.qullstion. theterm "owner" does not include owners of stock in your film if your firm is a pUblicly traded corporation.DYes s'No
IfYes, explain on Altachmenf Sthe drcumstancessurroundihg each instance,.includihg the entity that waslnvolved, the dates 6fstlCh instances,and the 6utGbme. '
22.ff a license fsteCjuiredtopetfbtm any s~i'vices. pl'ovlded by your firm: tras your firm; orahy persdnernPI<.)yedbyyour firm; been investigatep, f<.)undto naVe vipl<iJtecl,qited;<iJSs(:}$,S~cla~y penalties, or SLibj(:}clto any dif>ciplinary aq;ion by a Ih::(:}nsin9agemw'for violation of any licensing laws Jnlne past five years?DYes [Z(No
If Yes, explain on AttaChment a the circumstances i>urroundlng each lhstl;lnce In the Il;lstflve years.
23, If! the paSt five yelilfs,.tta$ Y9l,lrfirm, any qfits oWn~(l?,paJ1f!ers,or ~fflcers,everqElel1 P$naliZed or given iiiletter of warninf,l. py the Gity of LOl}J\!lgelel?rprf<:jlling to obtain <:11.lth()\i~tion.frqm th,e Gity. for thesubstitution ofa Minority.:owned (MBE), Women"owned (wElE), or Other (OaE) ousinesl?tlnterprise?DYes 0"1\10' . .
If Yes, explain on Atta¢hrnent8 the circUm$I<iJ.I1cessurrol.mdingel;leh·instanceinthll[asfffve years.
4'k provide on. Attaj).liro~l1t.B. to.e, h~m!;)(s), aqdress(:§)a.Qdt~lePhone QLi/ril:lgr'(l:}}of the apprefitiC.ashipprogram l?ponSQr(s)l;lpproveg by the Californja PMl}ign. ()fApp~emic~l'iip$tand<:jrds ttl'll Willpr(i)videapprentices. to' your' companyfof use on any public works projects that youareawatded by the Cily Of LosAhgeles;
Provide on ..Attacliment B, .the n<iJme(sJ,address(s)al1d ,telephone.number(s);9ftne,apprenticeshipprqgramSpqnS?f(~) ~pPrbved. by.t.he~lif~r~il;l PiVi~!9.hof.APPfE:l9tI~§hip.$taf19~t<:l~Joat nl;lv~ pr().v!d~dl;lppr~f1ti¢esto yourpart!pany onanypUb.lic works projecton wHIGnyour firm has Patf19fpat~dwithin the ll;'lst$YearsJ
South San Fernando valley Park and RideW.O. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01 caNST RU eTlaN
I, aUSINES.SINTEGRITY
:::C·::.'."'. For questtons (i:l), (0). and (c) below, cheqkYl;!$ in~!:lsitu~tiqh~pPli§~fpiQllr firm, Fqr th~s.~ql.le$ttQn.~,th!ilterm "firm".lncludesany owners, partnefs,ofoffiGlirs inttwfi.rm, Thgferm"owner"does not inclut;!eowners of stock in your firm if your fjrmis aPllbliGlytn:lded corporaUcm,lf'louCheCk vesto anyoflhe threequestions below, explain.on Attachment B thetircums!ancessurroundil1g each instance;
(a) Is <1governmental entity or public utility currentlylnvestig<1t1ngyourfihnfor making M falsedaitrt(s)ormalerial misrepresentatlorus)? .
D Yes0No
(b) In the past five ¥ears, has <1governm(;')ntalentitY9i' public\.ltiliW 'alleget,iordel$'mihed thatyour firmmade (a).false claim(s) or material misr.E;lpresePlllticm(S)?·· .DYesEi'No
(c) In the past five years, has your fifm c060:cted of, or fotil1t,iJt~9!~.in El..~~ilslli~fot,rnak,ing (a) falseclaim(s) or material misrepresentation(s)to any m~vemmentalentityor pllolic utilily?DYes!6No
26. In the past five years, has your firm. any <:W its owner(l or offlGlirs beenconvlpt$t;!'9fa crilTlEillnvolving:.!.h~bidding of a gCllfElmmentcontract, the awarding of 8g.overnmElI1t:c/Jntract; the perfGrmanceofagovernment contract, or thElcrime of thElft,fralld!~m~e~lfi.'lmert~.p~rjllry';or~fi~$t.Y?F<;jr tbi(lqU$stioh, tbeterm "owner' joe.s not include owners of stock inYotirfirm ifYolif fihnisf:\ ~ti~lfcly!rl'l~Eil(lGorporation. .DYes SNa
If Yes, explain on Attachment B the clrcumstances sqtrouilding e~ch iilstf:ihc.$.
I !';eJiifYunder penalty of P(;')tjur}i under the laws oftre8ta!a ofCatitbrhia\hatJ~~~a ~d~l1dund~r$t~l1t;!thaqUEil(iltl9nsqontained in this questionnaire and theres.pon!:lEilsq9nt~iHEl.1:jh$f£lln:a!JI;i9n~!lAttaqhm.$n!§, I f9iibi::lfGlirtifythat I have providecl {ulland compl(;')teansWEilfsjo~~ch qllEilstion;..~n<t:atallll'lf9rrnation provfcledinresponse to this QUestionnaire is true and accurate to the best '.y .. owle' e·and bEllief.
South San Fernando Valley Park and RideW.O. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01 CO lit STR U C TI ON
ATTACHMENT AFORSt:CTI()N$ ATHR.<lllClH C
..Whef(~ aqdltlooallnfonnation or an exp!an<;tliooj;;,reCly.ired,U§flthE!spaGe.PE!loWJqproYlclet\1e InTofl11a\ipnprn;".xplanation.lnformalion submitted. on .thiS~heet must be ~ypeWtitten; .'l'Jcl~dethe' nUmber of the qu~stion for.. ' which y~lIare. subl11ittiO!lacfqiti.onalinfofmatlon' ....'flfopnaq0)1 supmitti¥i pi} ~hj~ ~~~Chri'lentjo .r~$8op$e.t~
Questipns ill $ec~oos A thcPuQhQ will pe PPsted en th~ IQternet for pupUc reYiew.Make copies orlhl;;Attachment if <;tdoillonalP0l9.esare.needed.
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F·3h
South San Fernando Valley Park and RideW.O. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01 CONSTRU OTION
Wh~r" additional information or an explanation ls required, I.IlS~th~lSpaQeP~lowtopro~!id~tl"1~.inforrna~ionor'.'/'~xplanatlon., Information submitted on this sheet must PEltypewtltfen: ,.Includethe nUn1b~rof the question fOf'iVhibh you. l;\re subrnitting adqitional infurmation. Informl;\tio~~u9f1ijtt~d on this Atta('lf}n1.ertin reSr9i'llS6 to
QuelStionsin,SectiotiSD tfiro\.lghH wIn not pe posted on tne internet t>lItwillberT)l;\del;\\'l;\ilabl"Jolhe PYQJio forreview-upon request; Makecoplesofthls Attachment ifadditionalpages are needed,
Pag~_~
plw~
F-3i
Attachment BQuestion 10 , Page F_ 3J
EMR for year 2007-08 is 135.We had a labor on site working with a walker compactor. He ran on over his foot with thecompactor and hurt himself.
Our EMR for 2007-08 became 135.
Attachment BQuestion #13 , Page F:_ 3e.
The history of contracts we had with the City of Los Angeles for the last 10 years: .
Project:Amount:Owner:Location:
Crenshaw Off-Street Parking Lots$434,925.00The City of Los Angeles, The Department of Public WorksCrenshaw Blvd., Los Angeles
ProjectDescription: This project consisted of the remodeling of three existing parkinglots one block away from another,
We provided new property block walls, lighting, landscaping and irrigation for the threelots. Also removed and poured back wall concrete side walls around the lots and pavednew asphalt cap on them
Name of owner's contact person:Phone Number:
Mr. Richard Proctor2l3.978.1312
Project:Amount:Owner:Location:
Venice Parking Lots #701 and #731$858,308
. City of Los Angeles, Department of Public WorksCity of Venice
Project Description: The work on the Parking Lot # 701 consisted of the removal of theexisting pavement and constructing the new parking lot along with sidewalks,landscaping, irrigation and lighting as well as anew special drainage system. Thisdrainage system consisted of collecting the surface run-off through a sandy/rocky path tothe depressed landscaping areas which were designed to detain the surface run-off and toprevent this run-off from entering the ocean.
The work on Parking Lot # 731 consisted of the installation of two storm sewersinterceptors to intercept the entire surface run-off from this parking lot which is locatedadjacent to the ocean. The surface run-off collection system was designed so that it woulddrain the surface run-off intothese interceptors and would subsequently enter the city'sunderground storm sewer system after filtration.
Name of owner' s contact person:Phone number:
Mr. Bill Lukehart213.847.5316
Project:Amount:Owner:Location:
,
Hollywood Shortcrete Wall$214,622City of Los Angeles, Public Works DepartmentHollywood
Project Description: This project consisted of the construction of a 6" thick to 40" highshot Crete wall along Hollywood Boulevard. Prior to the construction of this wall, theWest side of Hollywood Boulevard was closed to the thorough traffic. Initially, all of theloose materials and debris were removed from a 3000 sq. ft. hillside section. Then, theentire hill was stabilized by means of installation of 'Soil Nailing', followed by theinstallation of reinforced concrete slope protection over the entire hill. This project alsoincluded new drain pipes and water proofing systems.
Name of owner's contact person:Phone number:
Mr. Naser Razcepour213.847.8946
Project:Amount:Owner:Location:Contact:
Griffith Park Ferraro Fields, Restrooms$745,145.00The City of Los Angeles, Department of Recreation and ParksGriffith Park, Los Angeles .Mr. Gary Halladjian ,Project manager 213-978-2738
Project Description: This project consisted about 3,000 square feet office maintenanceand restrooms facility fOIthe City of Los Angeles, Griffith Park. The buildingwas an exposed concrete block with steel structure (combined). Including allutility lines, power and water. The power was provided from an existingelectrical rooms about 700' from the new building. We ran all 3' conduits tobring the power to the building. Also Irrigations System and Landscaping.
Project:Amount:Owner:Contact:
Hansen Dam Playground Restrooms$1,974.809.00The City of Los Angeles, Department of Recreation and ParksMr. Sam Vohra , Project manager 213c978-1936
Project Description: Project consisted of a garage and restroom building. Exposedconcrete block wall about 17' height with steel columns and structures with all utilityl1np:~fU)'$1t-P.r Anil nnU1P.T' )Ann Cl,P:[email protected] linp'. {',nnnP:('.tinn tn thp. L1 fpp:t niA111P'.tP:1" T ,oCl. Ano-p.1p.Cl.
Attachment BQuestion #14, PageF-3e
The history of contracts we had with the other Public Agencies to perform the similarproject:
Year 1999
Project:Amount:Owner:Location:
California High School Student Parking Lots$1,769.743Whittier High School, Union DistrictCalifornia High School Student Parking Lot
Project Description: This project consisted of the remodeling of an existing 150,000 sq.feet parking lot at California High School.
The existing pavement was removed and the new parking lot, consisting of 8" thickcolored concrete and 3,000 linear feet of curbing, was constructed. Additionally, theproject included the installation of landscaping, an irrigation system and lighting.Furthermore, 400 feet of 8'tall, red brick retaining wall coated with anti-graffiti surfacewas constructed as apart of this project.
Name of owner's contact person:Phone number:
Mr. Dough Orndoff562.698.8121 (x 2300)
Year 2007
Project: Keuneth Halm Soccer Fields Parking ExpansionContract Amount: $ 390,881.00Owner: The County of Los Angeles, Public WorksLocation: Kenneth Halm Park - 5401 S. Fairfax Ave. Los AngelesContact: Ms. Hoda Hassan , Project manager 626-458-4955
Project Description: This project consisted of creating a new parking lot in part of thePark grass area for the soccer players , plus all new landscaping and new Lightstands, Block wall retaining walls, Landscaping and irrigation.
Year 2008Project:Amount:Owner:Location:Contact:
Sheriff Parking Lot Phase I$5,356,857.93The County of Los Angeles, Sheriff DepartmentEast LAMs. Lucila Thielen , Project manager 626-224-1103
Project Description: Project consisted of 200,000 square feet of demolition, grading,paving with three thousand feet of curbs and gutters. Two thousand feet of drain linesup to 36' diameter, manholes and catch basins. The project also included 22 site lightpoles and security cameras with 25' walls attached to existing building and installationof a new elevator.
I<:r.~ II.... 07'=1iSIMGELi
alMBEl CO.INC.General Building Contractor
State License #638371
Date: July 27 ,2011Ref. project: S. San Fernando Valley Park and Ride W.O.# E1906116Owner: The City of Los Angeles, Public WorksExplanation for Debarment
DEBARMENT INFORMATIONQuestion 17 Page F-3e
Date of Debarment : August 1,2006 Through July 31,2009
Project name: M.T.A. Greenline Stations, MTA Bus Divisions 2,3,5,9 and 15
Debarment agency: M.T.A.
Reason of Debarment : Alleged misrepresentation of utilization of Disadvantage BusinessEnterprises .
Information: Simgel Co. Inc. denied the MTA's allegations. For expedience and to avoidthe substantial expenditure of attorney's fees when the MTA would be the trier of fact inany event, Simgel Co. Inc. and MTA agreed to mutually stipulated shortened period ofDebarment with no admission that any of the allegations asserted by the MT A were true.
Note: This Debarment period is over and we have bidding to MTA sinceAugust 0112010.
2035 Westwood Blvd., • Suite 212 • Los Angeles, CA 90025Tel: (310) 475-7663 • Fax: (310) 475-3831
Attachment BQuestion 24 'P<LJL r. 3f
Name, address of the apprentice programs sponsor:.. Construction Laborers Trust Fund for S.CaL
4399 Santa Anita Ave. #200El Monte, CA 91731(626) 279-3007
.. Cement Masons S. Cal. Trust Fundl333 S. Mayflower Ave. #35DMonrovia, CA 91016(626) 305-5700
South San Fernando Valley Park and RideW.o.. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01 C o fIl S T R U OT ION
ATTA¢IiMENT C: GQVERlIIlIIIEN'fAL ENTITIES FOR QUEstioN NO. 21Ght':l9kYes. in resPQrysElto Question No. 21 if YotJrflnn.or any of its qWl1er!\, partht':ll'1?orgffiCt':lfS,hlWeeiter
Y-'.)een inVt':lsti9at~tltc;jtt':ldt asst':lssed any penalties,. or found to have violafEilqaflY l~wst.ruIEl$; qf rt':l9vl?tiQ(1senforced or administered; by any of the !,Jovernmental entities listed below (or any of itS~Ubdl\lfsIOhs}i.Includjhl;!tJutnot .Umileqtg thQ§~ fl~atJ1Plesspeclfled below, The term "owner" dQe~ (1qt1tlQI.udt;!OV\ltlElf§of st9c~inY9urfirm ifYPUf flrl)l Is.a PVPliolytrf'loed corporation. IfYQV answered Y'I1S, provide <Int;!xpl.anatiQnon Atlaohmt':lntJ;lQf th!;l:Circumstances surrQunding each Instance, including the entity involved, thedalEisofsuch instancesiandtheovtcQ'me;
FEDERAL ISNtrflES
Feder~1 ()ep.l'lrtment ofLll~or• American with Pisabm!tEr~.",ct• Inu'nigra!io!) Refotril and C.ontrol Act• Family Medical LeaveAct• Fair LaborStl.lhqarOi? A9f• Pav[s-Ba90n and Ii,JWi?<;overingwagereqwiremef)ls
for federat governmentcof)\tact workers• Migr~jOtancl Seasom~l.Agricultural Workers
F'roteO\iof)Act• Immigretion ~mi:lNat~ralization. Act• OCcupational Safety and Health Act• ahti'dlscriminatlOrtprovillibnll applicable to
government contractors and subcontractors• whistlel>loWer prote6!lot) laws
~~~ii!edel'al Departmellt o~ JlIstlce......• qivil RightsAc't• AmeflCqn with Pisllbilittfll> Act• lmmi~ratjon Reform!lnQ'Con!rol Act of 1986• bankruptcy frllud and.abuse
fecleral [)epartm!i!nt of Housing arid urbanDevelopment (HUD)• anti-discrhttinatlon proviSions in federally
and/or enforced P¥ anyoftneDeP?t!tnant'sboards, ioclu(jing the Contractors' StElle Lican;>IJjgBoard
California's Department of JU.stice
LOCAL ENTitiES
City pf Los J\Pgelesor~ny. ()f its l;lllPqlitl~loru; f9fviolations ofapy la'W.-. brdl!'l<!llce, ..cpt:le, fgle, qrfagul<\lion administereg~ndI9ren(orc~q.I?Y· t~e .t:::il.Y,including any letters pf 'Warning()f$<!nq!1pfl~ i~ll!lfild bYthe City of Lo.!3Angeles~pr an unauth(')ri.*~~~yb~f1(4tj60of s(.Jbcontraptors, or unauthori.z;e'dredtlclionili!1 cl.()lIaramounts sUQ()Onlra6ted,· . ..'.
OTHERSAny other federal, SUIte, tocal governmental entityfor violalion of any other federal, state, or local law orregulalion relating to wages, labor, ()r other terms andconditions of employment.
F.aj
South San Fernando Valley Park and RideW.O. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & C6M38jl1 LOS ANGELES
PLEPGE OF CO~LIANCE WITH CON'l'R2I.CTORRESPOl'TSIBILITY OlU)INAlITCE
"Ol? An9Eiles AdmihistratiVe Code (WC) SeC!ioh 1MOat s~q, (Coptfi:\c!or Respoft$ibility Ordifl'ilI1c~)'proVidesDr:-~h~t,uple$S ~pecifically exempt, City cpntractorswqrklng um;IE1.fllervicepqnt!'a.$ of CItlE1allt$25,aOOandlhree
'in.onth~ •.contracts for the purchaseot.qoodsand products of a! least $1OO,OOO,cohtractsfor the purchase ofgarments of at 1E;li;Jst$25.000; and constructjonco[ltrac\s ofi:lnyainount; puo!icfe$sees; publil:! licehllee~; andcertain. rE;lcipientsof.City financlal assisti:lnceor C!tygr1lnt.fum;!ll, shClUcomplywi~,,1t C\ppllc;qbleprovi$)ons oftheOrdihance •. Upon award of a City contract, puolic lease,public limmse,. flnanclal assistance or grant, thecoOtra¢iot, public Il'lsSE;le,public licensee, ..City fjnanci1ll.assi~t1lncE;l••recipien~,prgrant recipient; atidany itsSllPcontractor(s). shallstibmit this Pledge of Compli!;lnce to the i\lwarding atithority,
TM contractor agrees to complywiththe Contractor RespohSibility Ordinance and the following provillions:.
(~) Toqpmply with all fed.eral, state, aod 10Ql;tIII.lW$.inthepenorinanceof\hec¢otri;JCt; including but not limited. to' lawsregardinll health and safety; labor and employment, wage. and hOur$, and licensing laws,. which
agency has initiated an investigation .which may result in a finding that the contractor did not comply withany federal~ state, or local law in the performance ofthe contract,inctudingb~t notfirnited to laws regardinghealth <lrtdsatElly, I<)oqrand emploYment,Wage and hours; and licensing li\lws,which affecfemployees,
{cJ To notify thea\@rdingauthority within 3Q calendar days orall findings by agovernmental agency or courtof competent jurisdiction that the contractor has violated any federal, state, or local. law in the performanceofthecqntract, ;including but not limiledtq laws re9i\lrding health and safety, labor and employment, wagE;l<lnt;!hours, and lic;enlling lawl>which affec;temploYE;les.
(d) If. applicable~ to provide the awarding aulhotity, within 30 .calendar day~j updated responses. to the~~po~sibility QUElstionnaire if anych ange o¢c;uts 'Nhich would oo!;lng.eany response cOntained withinthe!3esponsipiltW Q.oestlonn1lire and such <ihange would affect the contractor's fitness and ability !() COn!inllethe contract,
(e) Tcensure thatsuboonfraetors working on the City agreement (inclUding COntractors or subcontraetors ofaPtiPHc lessee, 1iC;E!nsee,sublessee, or sublloensee that perform or assist in Perfohtling seryiceson loeleased or ficen:;;E;ldpremises) llhaJl comply with all fE;ldera!,lltGlte,and local '~W$in the performance of thecontract, including but not limited to lawsrellarding health and safety, labor and employment, wa!;le andhouts,Glnd I.icensing laws, which 1lffect emploYE;les,
(f) To ensure toatsllbcontrGlctors working 00 the City agreement (including corittl:lctors or sqbcontractors ofapublic leSSleE;l,IlCE;ln$ee,sublessee, SUblicensee that perform or assist in performing services on the leasedor licensed premises) submit a Pledge of Compliance.
(9) To ensure that..~!JbcontrGlctorsworking on the City i1greeinent .(including cotitractor's or sllbcontractors Of a. pllblic lessee, Jiclil!1See,.sublessee, or Sllblic;ensE;lethaJ perform or asslst in pE;lrforming services on tOE!
leased or licensed premises) shan comply with paragraphs (b) and (c),
~~.tl'lirl'! \;Q (i0ll1lilete <1-n,dSUP11'l~tt:Ji.i;l1I.~1!>l1;il•. to '*E! 1I,ward,ing 1I,!J,tM:ti~:y %!1iI,¥ ;,e$'\ll~ ii).W.tlilJ.h01dil,n,g 0.:1:pa,~ent:$ by ~ll,E! Cit:Y COi).t:roller i I:lr cqn,tra(jt t:ermin,at:.tl:l;!'l. 3SIM.66L ft. IVIC. ),035 w~5tt/{)(}d gir, # ;)-1"), L,A, 0\. P002S lo.475~7 ~
Cbm~AddreSS a Phone er J U J- 7/iJ.,. 0 I J
PrihfN;;\tnelll1dTitJe Iilf Officer or Authorized RepresenfatiVe
.Bidderee-rtjfie~tio,j ". .;.CiC Form .5Q .....•.•..
CER.tIFICATION
I certify the following on my own behalf or on behalf of the entity named above, which 1 am authorized torepresent:
A. lama' person or entity that is applying for ;1 contract with the City of'Los Angeles.
B. The contract forwhich 1 am applying is-an agreement for one of the following;1. The performance Of work or servlce totbe City or jllC public;2. The provisionof goods, eql1ipme~t, materials. or supplies;3; Receipt ofa grant of City financial assistance for economic development or job growth, as further de"
scribed in Los Angeles Administrative-Code § 1(l.40.I(b) !seerevcrse);or4, A public !<.l;1SC or license of City property where ~lltbofthe foJlbwing apply, as.further described in
Los Al1geles Administratlve code § 10.3 7.1(1) [see reverse]:a, I provide services on the City property through employees, sublessees, sublicensees, contractoraor
subcontractors, and those services:i, Are provided onpremises thatarevisited frequently by substantialrrumbers of'thepublic; orii. COUldbe provided by City employees if'the awarding. authority had the resources; oriii. Further the proprietary interests ofthe City, as determined in writing by !h.e awarding ~~lhO*i~,
h. 1 am not eligible for exemption fromthe City's living wage ordinance, as eligibility is described inLos Angeles Administrative Co~e § Ip.:37(i)(b),
C. Tlievalueand duration of'the conttact for which I amapplyingis one of'the folloMng:1. Fot goodsor servicescontracts=-avalue of more than. $2:;,000 and a tel:InQf at least three months;2, For fiMl)CiaJ assistance conttacrs=-a value ofat least $1OO,QOOand a. tennofan~Y'd~'ra.tilm; or3; Fat consttudtioli contracts, public leases.or licensee=sny-value and duration,
.D. 1 ~cJm()wtedge;ilid a!>,ee to comply witb jill' disclosurereql!iremeilt~ andprohibitions Iislabl.is4edllifheLosAn~eles Municipal LobbyingOrdinance.if'I quallfyas.a lobbying entity under L9s Angel Munl!)!-pal C(jrl¢§ 4$'()2, .
pate: J~ :h 7 /J-.o IIName:
Title:
Under Los Anf!eles Municipa' Code~4ItJ)~(f/), thi~foflnlIlystM s!!btn!(t~dto the awarding Butholitjt withyiJurfjid or Pi'OP9$algn tlit>l1f>nth!lftliiJ@:I.i>I>IlV/>,
(h) "City FinancialAsslstance Recfl'ij!ilt" [1l~~t\saWI'¢f~nYilhi.i[$<:elYesfl'oijttfie90/discrete financial assistance m the amol.!"r·of QneHuiidh;:dTltous<\od Qollars($tOq,o(jQ.oq)or more for econorntc development or jl)l>grQwtheXPfe~$ly.~rti~~t\lt<ld .~ndi.~<lntif1El.~.~ythe City! ill; contrasted with generaltzed fin~1ici<J!as$i~t!.lnce.such.s thr()4!thJ~ IE1gi~t\\(j"!l;
Categories of S\lCh<Jssistahce shall lhdut,le,pl.ll.atehotJl.mRedto, p<irid.~h.<\I1¢irygjpl<1htiili~assistance tax incremerytfinancing~(;IM~V~I¥byt~~9J¥'1\nt'j.t<t!<.Hedi~, ;tl)~sl)~tlnptinclucle assiStance provided!:>ythe CbmmQnltypevel?p[(l~nt~hk.C}~~Wf lI~is~~ceishall not betegaided as financial assjsti!11~f6rplil'Plis.esofttil$iit'tlde; Ii. tQ~ri~hal(nli~ peregardeda$fjn~ncial ill;slst.nce. Th~Jorgjv!!n~~.~f••a,..I(!~n~I'j~I.I.be r~ilrd!!~i!$fi\W\¢fqrassistance. A.lpansh"ll be r~g",rded~~ 'fin~nc:li!t,'l~SJ~J• .o.c~tP t~e'1!<t!!!1~lif~nY(qj~f..re;)~jtilbetweenthe amount.Ofthe Iqan andtnept~s~Plv.~I~e?ttli~ paymeo~ ~hereu.r\iler,discounted over th~ .!ife pf the loan py tile applkal>lefederaltate;a~!ls<iiljh 26 tJ.S.t;,Se~tlons 1274(d), l87l(f). A recipients~all.r16tl:iI!l.'t'jei!me(lt().jn~14de.tes~e~a.l'ldsublessees,
Los ~geles AdministrativeCode § 10.37J(i)
(i) "Public lease or Ilcl!lilse".(a) Except as provlde,d in (l)(b), "Pubtk leeseor Ilcen$e"rheansll(easeprHri<inseiJfCity
property on whi,h services are rendered byemploy,*,s of the P4Plic {es$ee.oTUct'!oS$eor sublessee or sublicensee, or of" contract()rorsubc()!'l~racton ~ut9nly where·any!:)!the (ollowing applies:(1) The services are rendered on premises at [easla pi)rti9hiO( whit~lsV!siteij by
substantial numbers of the public (Jnafr¢qu~ntfiasls(i(lct\l~mg, 9ytr(>tJitn!t(ol~i.to, airport passenger terrninals, patkjn~ lp!:$,golfcpur¥is; ~reWo!iat f~cmtiesl;or
(2) AnY of the services could fea~jblypepeH'9rmedbyt;ltyjjmp(oY¢i1!tlfthe"w~r~1rigauth()rity had the requisite financliil and stllffing f!i$lf(jrces;pF
(3) The OM has determined in writin!ithatcovera!t¢ W9iJ11lfurrlJeft~El.iiroi-lrk\ti1o/interests of the City. .... i . .... . ....
(b) Apublic lesseeorlicensee Willbe exemptfr(Jmtlje reQi./irementsof.thf$artlc[esuQjectto the folloWinglimitations:(1) The lessee or licensee hasanrtual !ltossfi!?"eflO~sdflEiSsi\f!ah t~earinuar~ross
revenue threshold, threehundrell fif~y ,hdusar\<:! dp!lats ($~llQiaoO},.from busmessconducted on q~yproperty;
. (2) the lessee or ttcensee employs no mote than s¢v(!nt7i peppl~t4t.allnth¢company lin.andOff City properm . .• . ... .
(3) To qu~lifyfor this exemptiqry, the l"ssee Of lit;e~see lTluStproVlil~p,rQOKQnt$grossfev~nuesand nQ01b~rof people it ~J)1ploysjntr~..~otnP9rY.'.$e!l~ireworkfon;e t" tlJeaWarlliii~ ~uthQrl~ as re!)~lredt>yrcig4t~tion,
(4) \'I1]E!ther.annualgrossreveJiue~jl.te.lesscthanttir.jjehundredfj(o/th<i\isailqdollals($3~,OOO)shajl be determine~ J:ja~e9o(l\hegr9?S r~'(!!.nq~Sf9(1;il!l.[~~~~!'l<'yearpriQr to appli~~tlPnor sucll pther .):it'!r!o(l".$01a¥~~~t~bt)~Ii~~pY.~~~~tiltloni
(5) The atmuat~r(jss revenuethreshold shatlbe ~~iJste~arlii.li\IIY1!tth~~a01erateqnd!It the ~rrie tim.ea~.thIi!IMl1l1wage i$'ldj~~eIlMd¢rs$;1iiPn.c1q\}7,~W;
(6) A lessee or !fc<ln~~e~~'lltb". clee!iJ1.e<Jt9"m~lilY}l.~m9re.~~.~n~Y"!1q:lp~0I'\"lfthec()mpfl~Y'~"lltire.VI'()'kf9rc~V1rir~~al1.·~V,,~~g~Qfp()m<jt#i1;il'~h:··~rl~••·t(tQ~~al)~tv.'o-hund\e~.fourt.een(1;214) lioUrsper 1l10h:~hJqrat [$ilsitbr~;fi)Urt!is(~/4)ofthe.time period that thereVehYE! limjtationl&m\l~Wecl;. ... . ... . .. ...• .
(7) Pub{jc.I"1\$e5 and licenses Shallb~<leeme<l t()·ind\1t;!epuQ!ksiJ!Jt~ijsI'San~sublicenses;
(8) lfapubll!J lea$¢ or lit;!msehl\s.<\~el"lJ1dfmqre~Hliqtw0.(2J Yea~i ~I-lil..e*,ilml'jt!pngranted pwruant '<:I.' this ~ectiofl.sh~ll ..~J<l'jt,,,.aft~f~\\("my~~~~yt~MJ~g~renewable in tWo,yea:rincrE1m~n~ Uponl!l~tin!lttjerE1q~irell1eh\$J:Mteforatthetime of the renewal application Or such period e,stabliShi!dbY(i~l)lation;
South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Admin Project 10 Nos. CA-95-X090-00 & CA-03-0733-01
SIGNATURE SHEET AND AFFIDAVIT;':-~:':;">'
\~e, f.ma/ld/(" I 5a.soO"l1-(J deposeandsayth,;(i~reare Pres ,difInsert Name(s) l~vr
-r(l"'n"'se"'rt~""So"le'"O"w'"'n'"'e"'r,r, "lO,p'-"'rtn=eS*','=re"'Sl"',"'n"'t+O,"'lc".),--------"(1"'ns""'rt firm ~!me ,~ !a!::!g,!;/-- Lo . 1tL(,
Contractor'S License No. 6Jg 3 '7 I , License Classification A, B, (8 ,Expiration Date z,;29b 0/.1-who submit this proposal to the Board of Public Works and hereby declare:
(1) That I1We have read this proposal and have abided by and agree to the conditions herein and have carefully examined the projectplans and read the specifications and IfWe hereby propose to furnish all materials and do all the work required to complete thework in accordance with the plans and specifications, for the unit prices or lump sums named in the Schedule of Work and Prices.Furthermore, IfWE have read and understand Ordinance No. 173677 of the "Determination of Contractor Responsibility Policy" ofthe City of Los Angeles and IfWE understand my/our obligations under this policy as a bidder and as a contractor should thiscontract be awarded to my/our firm.
(2) That this proposal is genuine, and not sham or collusive, nor made in the interest or in behalf of any person not herein named, andthat I1We have not directly or indirectly induced or solicited any other bidder to put in a sham bid, or any other person, firm orcorporation to refrain from bidding, and that IfWe have not in any manner sought by collusion to secure for myself/ourselves anadvantage over any other bidder.
(3) This contract is expressly made for the benefit of the signatory parties only. It is not the intent of any of the signatory parties tocreate or discharge any duty, express or implied, to any party other than the signatory parties. Any benefit derived from thiscontract by a third party is unintended and incidental to the purpose for which this contract is made.
That IfWe as principal(s), acknowledge myself/ourselves as being bound by the accompanying Bid Bond when completed by theSurety.
(5) That I have read and understand the provisions of the Pollution Control - Sewage Spill Prevention and Response Requirementsand the Board of Public Work's Policy of "Zero Spill" requirements as contained in this Proposal. Ifawarded this contract, I1Weagree to furnish all ofthe materials, supplies, tools, equipment, labor and other services necessary for the containment and clean upof any sewage or other pollutants spills or leaks occurring during the performance of this contract. IfWE further agree to actimmediately, without instructions from City staff, to contain and clean up any spill in anyway involved with my/ our activities onthis project without concern for who or what caused the spill.
ADDENDA - This proposal is submitted with respect to the changes to the contract included in Addenda numbers:
I :J-(Fill in Addenda received)
I1We certify or declare under penalty of perjury that the foregoing is true andcorrect, and that if only one signature is provided, it is provided in accordancewith Note 8 in the General Instructio Information for Bidders of thisproposal.
.---:7 In ',;).01/
Date
Second Signature Title Date
e: ALL SIGNATURES MUST BE PROPERLY COMPLETED AND WITNESSED BY A NOTARY
07/03/06F-4
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
@]~~@]
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~ ~;;. ~ State of California ~
~ County of Los Angeles ~! On cfub 6>5"ltOt>,l\ beforerne, ffiib '-lJ&l::.\.mi !~ 0 (here insert name and title of the officer), ~
; personally appeared ZmOlv\\ld 0G\.SD b "e r , ;~ who proved to me on the basis of satisfactory evidence to be the personj85 ~~ whose name~ is/are. subscribed to the within instrument and acknowledged ~~ to me that he/sRe.4hey executed the same in his/hof/thQir authorized ~~ capacityues), and that by his/her.lthoir slqnaturets) on the instrument the per- ~
.~ sonjs) , or the entity upon behalf of which the person}$) 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. ~
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~ ~ ~ ~~ Signature ~-4 ~ (Seal) ~; ;~ ~~ .~M'~"'_'_~_""'"""~~··'···""'··~ ~~i MITRA HAKIM! I ~~ N COMM.#1772305 )} ~@ :~ NOTARY PUBLIC· CALIFORNIA ~ ~
@l( LOS ANGELES COUNTY t' ~~ My Comm. Expire, OCT 31, 2011 ~~-~--. -.--~-.. .. ~
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S/MOll co. INC., .... ~ •• j
ISIMGELiGeneral Building Contractor
State License #638371.
Date: July 27, 2011To: The City of Los Angeles- Department of Public Works
200 N Spring St # 355,Los Angeles, CA. 90012
Ref.: South San Fernando Valley Park and Ride W.O.# E1906116
Dear Gentlemen,
It is confirmed that all documents and contracts signed by Mr. Emanuel Sasoones(The President of Simgel Co. Inc.) are official and He is authorized to sign them with hisonly signature.
2035 Westwood Blvd., • Suite 212 • Los Angeles, CA 90025Tel: (310) 475-7663 • Fax: (310) 475-3831
07/08/2011 12:25 310-475-3831 SIMGEL CO. INC. PAGE 133
SOUTH SAN FERNANDO VALLEY PARK AND RIDE
W.O. No. E19061l6
Federal Transit AdministrationProject 1D Nos. CA95-X090-00 & CA-03-0733-01
BID BOND
(No'1 necessary when certified check or cashier's check accompanies bid)
We, th: principal ar.d undersigned Surety, acknowledge ourselves jointly and severally bound to theDeparti nent of Public Works of the City of Los Angeles, for an amount not less than ten percent (10%) of the
. total bir I,to be paid to said Department if the proposal shall be accepted and the proposed contract awarded tothe prir cipal, and the principal shall fail to execute the contract within the time Specified by the generalinstructions in the proposal; and to furnish the required faithful performance and labor and material bonds,within t tie time specif ed, It is hereby agreed that bid errors shall not constitute a defense to forfeiture, exceptas provi tied by the Stae of Cali forni a Public Contracting Code Sections 5101 through 5105, or as they may beamende:l,
WITNE SS our hands ':his 8c.:;th.:.:..-__ day of JULy .20_1_1-'
"7- 2.)_1/---- Date Sign e
- '---"i;ecofld Signature Title2.
Title
Se,':md Signature Date Title
NOTE: 51( m!\TURE OF TT: IE AU'frrORlZED AGENT OF THE SURETY MUST n.E WITNESS.ED BY A NOTARY. Jr. bid bond 19sulluitted On ~ forlt other thnh this form, the bid bond Olny not be acceptable, See Note 9 in the General Instruction~ andInti .rmation for Bidd~\:s of this proposal for more informatiol1.
07/03/06.F-S
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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~ ~~ State of California ~~ County of Los Angeles ~
~ ~I ~~ On (jU/l( c?Sid>o/1 before me, m\~ \ldfl\:::..\.~\ ~~ V (here insert name and title of the officer), rn.J
~ personally appeared &ntlV\vJ $.::isl)o\'\es , ~~ who proved to me on the basis of satisfactory evidence to be the person(:il)' ~~ whose nameVIJ is/ate subscribed to the within instrument and acknowledged ~~ to me that he/she.4hey executed the same in his/hor/-their authorized ~~ capacityQe5), and that by his/l:lefI#teir siqnaturess) on the instrument the per- ~~ sonPl) , or the entity upon behalf of which the person(.s1 acted, executed the ~jjj] instrument. jjj]
~ I certify under PENALTY OF PERJURY under the laws of the State of ~~ California that the foregoing paragraph is true and correct. ~I WITNESS my hand and official seal. I~ ~ t1. ~I Signature ~ b "" (Seal) I~ ~
~ ~~ ~"<"' #, .. -=- . ~~ jI MITRA;;Ai(iMi-- , ~@ ~ COMM. #1772305 " @rn.J W NOTARY PU - P ~~ ~ LO BUe . CAUFOFlNfA (fj@ S ANGELES COUNTY (! @~ My ComH-. Expires OCT31.2011 r ~
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CALIFORNIA ALL·PURPOSE ACKNOWLEDGMENTR - me 'E §: 73 C FZG'®X?W
State of California
County of _0.::ciRAN=c.;GE= _
On July 8,2011Date
33
}before me, MEG QUIGLEY, NOTARY PUBLIC
Here Insert Nama and Tille 01 the Officer
personally appeared MICHAEL 1<. QUIGLEY
MEG QUIGLEY IlCOMM ...1786547 ~
NOTARY PUBlIC'CAlIFORNIA -iORANGE COUNTY W
",=~YJ~~f~~~
Place Notary Seal Above
Name(s) 01 Signer(s)
who proved to me on the basis of Satisfactory evidence tobe the person(z) whose name(:s) istEm subscribed to thewithin instrument and acknowledged to me thathe/~ executed the same in hisJ1mdll><eirauthorizedcapacity(tex), and that by his/~signature(§(} on theinstrument the person(§(}, or the entity upon behalf ofwhich the persones) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the lawsof the State of California e foregoing paragraph istrue and correct.
Signer's Name: _o Individualo Corporate Officer - Title(s):o Partner - 0 Limited 0 Generalo Attorney in Facto Trusteeo Guardian or Conservatoro Other: _
RIGHTTHUMBPRINTOFSJGNER
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Signer Is Representing: _
Signer'sName: ----'-----o Individualo CorporateOfficer- Title(s): _o Partner- 0 Limited 0 Generalo Attorney in Facto Trusteeo Guardian or Conservatoro Other: _
RIGHTTHUMBPRINTOFS[GNER
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Signer Is Representing: _
§bJ:§;!6:Q b. 2 '" gog;;; ~ 2 Zb$C _ _ _ _
(92007 National Notary Association' 9350 De SOloAve., P.O. Box 2402oChalsworlh, CA 91313-2402· www.NationalNotary.org Item #5907 Reordel:CalITol!-Frea 1-800--876-6627
Power of AttorneyFIDELITY AND DEPOSIT COMPANY OF MARYLAND
KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, acorporation of the State of Maryland, by THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY,Assistant Secretary, in pursuance/of authority granted by Article VI, Section 2, of the By-La . id Company, which areset forth on the reverse side h<!repf and are hereby certified to be in full force and e f t 'tl tili reof, does herebynominate, constitute and appoi¥ Michael A. QUIGLEY, of Laguua N' 0 . , . s lawful agent andAttorney-in-Fact, to make, execute, seal and deliver, for, and' . Y IS" eed: any and allbonds and undertakings, and tbe execution of sue e n ese presents, shall be asbinding upon said Company, as fully an ,.!l' ~s a ~ i ey had been duly executed andacknowledged by the re~ularl . ee e t 't Ice in Baltimore, Md., in their own proper persons.This power of attor tti. e . e A. QUIGLEY, dated March 17, 2005.
The said ASSistant~~o h~~~~ that the extract set forth On the reverse side hereof is a true copy of Article VI,Section 2, of the By- I'i" ~ is now in force.
IN WITNESS W R OF, the said Vice-President and Assistant Secretary have hereunto subscribed their names andaffixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 4th day of March,A.D. 2008.
ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By:Gregory E. Murray Assistant Secretary Theodore G. Martinez
State of Maryland }ss.Baltimore County .
On this 4th day of March, A.D. 2008, before the subscriber, a Notary Public of the State of Maryland, dulycommissioned and qualified, came THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY, AssistantSecretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me persona1Jy known to be the individualsand officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same,and being by me duly sworn, severa1Jy and each for himself deposeth and saith, that they are the said officers of the Companyaforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the saidCorporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authorityand direction of the said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first abovewritten.
Dennis R. Hayden Notary PublicMy Commission Expires: February 15,2013
POA-F 012-0626
OlO':ttfr~tfnr'$ ~nlt!t~nLlfu all 4ffilen htl t42S£ JIr£s£ttis:
BONO NO. 07626023PREMIUM $7,851.00EXECUTED IN DUPLICATE
and " fJ:1J.~r.TI ..~ ..I?J;;.P.Q~r.:r.,.S:p1:1!?.ffi:!X.gf....M.~EYL.~ , a corporation
orgnni7.e~..under the laws oflhe :;;1Ut~of 1I!Il:f~~." "'" , and duly authorized totransact 'busine~s (j',ider Ih~ laws 0'[ Ihe State ?f Callforhia. as surety, arc hdd and firmly bound unto THECITY Of LO:;; ANCELES. A MUNICIPAL c.:ORPORATION, as obligee, ill the just and full sum ofSEVEN HUNDRED NINETY SEVEN THOUSAND, TWO HUNDRED FORTY SEVEN AND 201100-
,--:-::~ .. ~.~ ::::::.::::: : :..:.: :.::: :::: =:::::'::::=::= " ::-:.==.:::=:~:::::::.:.....Doll ars (S .7.?.?:?~7-:o. ),for the paymenl whereof well and truly to be made said principal and surcly bind themselves, their heirs. executors.administrators, successors, and a,.igns.jointly and severally firmly by the.sepresents.
THE CONDITION afthe foregoing obligation is such, that, wbereas:rhe above bounded principal is abeur te enter intoa contract. anached hereto, wjth said obligee to do an'd perform the f<lUowing,lo-wit:FOR THE SOUTH SAN FERNANDO VALLEY pARK & RIDE- W.O.# E1906116
as wilLmore fully appear frorn said contmct. reference to which is hereby made, anli whleh ~aid COlli rae! apd all documentsincorporated therein by reference are expressly made a Part hereof.
The said sur,etyJor va,lue "ceived, hereby stipulates ans!,agte!'s lhal no change, e~tcl)sion of time" alteration or additionto arms of the cqntract, or tj) the,workto be p.erformcd thereunder shall in 'lnywis. affopt its,obUgarions on this bond. andit docs hereby waive notice of any such cha~ge, extension of lime, alteration,or .ddilio·n Ie the terms ot th~ contract or thework.
NDW,THEREFORE. If the above bounded principal shall well and truly perform Ihe work contracted to be done undersaid .contraet, and shall fuJly nnci faitbfully carry out and wrform all of the terms. covenantS and cOhditions of saidcOhtract upon its or his part to be performed. then this obligation to be null and void, otherwise to remain in full forceand efTect, , ' ,
No right of action shall accrue under this bond to or for the use of any person other than the obligee named herein,
Signed and scaled this 3.~.i:J:1 m day of.. ~.E3I'.~ m m , , .. A.D, 20 ..1.1..CORPORATE SEAL SIMGEL CO., INC.. a corporatio
Cbrporale Sealml1stba·ini'pres:redhereon in case,diporjJpratlOit.
Power of AttorneyFIDELITY AND DEPOSIT COMPANY OF MARYLAND
KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, acorporation of the State of Maryland, by THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY,Assistant Secretary, in pursuance of authority granted by Article VI, Section 2, of the By-Law id Company, which areset forth on the reverse side hereof and are hereby certified to be in full force and eft 'tlt au reof, does herebynominate, constitute and appoint Michael A. QUIGLEY, of Laguna N' ., . s lawful agent andAttorney-in-Fact, to make, execute, seal and deliver, for, and ts eed: any and allbonds and nndertakings, and the execution of sue 0 n ese presents, shall be asbinding upon said Company, as fully an it.s a \; i ey had been duly executed andacknowledged by the regular! ee t it . Ice in Baltimore, Md., in their own proper persons.This power of attor'l"2\ e A. QUIGLEY, dated March 17, 2005.
The said Assistant'sli'c at the extract set forth on the reverse side hereof is a true copy of Article VI,Section 2, of the By- a a pany, and is now in force.
IN WITNESS W R OF, the said Vice-President and Assistant Secretary have hereunto subscribed their names andaffixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 4th day of March,A.D. 2008.
ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By:Gregory E. Murray Assistant Secretary Theodore G. Martinez
State of Maryland }ss.Baltimore County .
On this 4th day of March, A.D. 2008, before the subscriber, a Notary Public of the State of Maryland, dulycommissioned and qualified, came THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY, AssistantSecretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individualsand officers described in and who executed the preceding instrument, and they eachacknowledged the execution of the same,and being by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Companyaforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the saidCorporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authorityand direction of the said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first abovewritten.
Dennis R. Hayden Notary PublicMy Commission Expires: February 15,2013
POA·F 012·0626
CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT7 7 cnww Ef§?
State of California
County of _O=RAN="'GE= _
On October 24,2011 before me,Oate
? E?
}MEX; QUIGLEY, NorMY PUBLIC
Here Insert Nama and llUe olihe Officer
personally appeared MICHAEL A. QUIGLEY
::0 m ...... ., r
MEG QUIGLEY 1COMM...1786547 ~
NOTARY PUBlIC.CALIFORNIA -IORANGE COUNTY W
M Term Ex . J'i1,;'ary 10, 2012 f
Place Notary Seal Above
Name{s) of Signer{s)
who proved to me on the basis of satisfactory evidence tobe the person(s) whose name(s) is/6m subscribed to thewithin instrument and acknowledged to me thathe/~ executed the same in hisibBdttl9ir authorizedcapacity(i5I, and that by hisilistlllmli:K"ignature('il;) on theinstrument the person('il;),or the entity upon behalf ofwhich the personts) acted, executed the Instrument.
I certify under PENALTY OF PERJURY under the lawsof the State of California that for oing paragraph istrue and correct.
'WITNEssm~
Signature ....li~d~~@.~I\- -:c-
---------------------opnONAL--------~--~~~~~---Though the information below is not required by law, it may prove valuable to persons relying on t
and couki prevent fraudulent removal and reattachment of this form to anot er documen
Description of Attached Document
Title or Type of Document: -----"":::::::::::;;>"L.-
Document Date: Number of Pages: _
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: _
o Individualo Corporate Officer - Title(s):o Partner - 0 Limited 0 Generalo Attorney in Facto Trusteeo Guardian or Conservatoro Other: _
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Signer Is Representing: _
Signer's Name: ~-----'-----o Individualo Corporate Officer - Title(s): _o Partner - 0 Limited 0 Generalo Attorney in Facto Trusteeo Guardian or Conservatoro Other: _
RIGHTTHUM8PRINTOF SIGNER
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Signer Is Representing: _
a 2... 2 ~; 2 2~Q2007 National Notary Association. 9350 De acto Ave., P.O. Box 2402 -Chatsworth, CA 91313--2402·www.NaUonalNotary.org Item 85907 Reoroar:calIToll·Frea 1-800-87&5827
CALlF6RNIA ALL-PURPOSE ACKNOWLEDGMENT
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~ ~~ State of California ~~ County of Los Angeles ;
~ On [Ol?s/ cJ.o\\ before me, \'f\i~ \kd-A~~\ ~I Cf n (her;ert name and title of the officer), II1ll personally appeared CX'o£x'O\/!.A. ",o,.soo'(\e.8 , ~~ who proved to me on the basis of satisfactory evidence to be the person~ ~~ whose narnejs) is/ase subscribed to the within instrument and acknowledged ~ml to me that he/sI=lelthey executed the same in his/herAheir authorized ~~ capacityQes), and that by his/her/their signature(sj on the instrument the per- ~~ sonjs), or the entity upon behalf of which the personW acted, executed the mlfijJ instrument. ~~ I certify under PENALTY OF PERJURY under the laws of the State of ~I California that the foregoing paragraph is true and correct. Ii WITNESS my hand and official seal. ~
~ r-, jJ IiI s;gnaturn~j'A - (Seal) IIi Ii~ Ii~ ~
~~ ~-'-"'~~~A #~~~~:~ Iffi] "I NOTARY PUBLIC. CALIFORNIA 00 @1~~ -( LOS ANGELES COUNTY f ~
My Oomm. EJlpJres OCT 31,2011 I' ~
~ ...-'- - ~
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as sureL)! .. are held and firmly bound unto the CITY OF LOS ANGELES, Californi~, a municipal
_;~;;.l~;;~,t~;;~Q~;_=_~~~~:;=.~~~!:~=_-~_~~:~:~;_~~~~;~_~~~~~~:~.;_~~;.-~~:~:~.~~_;.;~~~~;~~:($7.9..7 ....G_4:l., __2,Q ... _.. ) lawful money of the United States, for which, payment well and truly to be made, we bind
ourse]lfC$,jo~ptly and severally, fimlly by these presents,
The e~dltipns -ofthe above obligation is such that, whereas said principal has been awarded and is about to enter i11tO•;0.>" _',':_',~'-, ':' , '_",_, ': _ ,_' ,",' ,: " ,,:,,"", '::._:_"': .: _,' :' " '_ _',' '::' " _': '_'" :_," _ ',_"a written cotttraet with the City of Los Angeles for _.T.H_!:;__.J'i@]J.:l:!!_J?AN.._:EJ;;~MI.IJ?Q...¥~kk!;:.¥:-:R!.\J!~------..---- ...._
which is hereN attach~q, and to vyhichre~erettce is hereby mage ~oqllltia;ti~ulars, and is required by said city to give thisbond in cOlrnection'with--the-'execution_9f~aid contract; -- - '
,- " ' -,'.' "", .
Now, therefore, it: s'lid ptirtclpai as contractor in said contract, or "__.__,,__.__.__.. . . ._. _
__________, --,_. ,-''"' ~.-----------,.--_----.,.."" subcontractor, tails to pay tor any,materials, ,provisions, Provender or othersupjl!ies or teams used in, up,on or fo):or about the performance of work contracted to be done, or for any work or labordone t [anJ:',-:a11'f<)unts:dlle, under th" Unemployment Insurance Act with respect to such work or labor, or forar;ty \. a . Ieq,iired to be deducted, withhelq, and paid. over to the Franchise Tax Board from the wages ofcmpib tIle. "j and his stibconqaqtors pursuant to sec. 18806 of the Revenue and Taxation Code of the State of
California with respect to such work and labor, said suret ._'1- . .__. . .__. ; _wi]! pay the same in an amount not exceedln,g the sum set forth above, and also in case suit is brought upon this bond; areason~ble attorney!s fee to be fixed by the court. This bond shall insure to the benefit of any and all persons, companiesand corpoyatiol;lS-entitle_G:to file claims under and by virtue of the appHc;ibte prOVisions of Division !II, Part 4, Title 15(commeNcing with Section No. 3082) ,of the Civil Code ofthe State of California, or their assigns,
WiTNESS .our hands this . :__f:1tll day of .__..,..ocmHEIL . ...,__..._.._..., .__.... .. ..,__.---------20 _11..._
SIMGET:. tO~N\!-e.,~-~---'i-I?~E-?" -.eoR~@A~E SEAL :::;;.:~~~\::::S~p;::::::::-:
Carporation, Partnership or Individual.;;'f,J!iJ,W!ff{iSj7FJ.~lfli;ratures acknowledgedin the appropriate blankon'lh~ tev~rsehl;reof
If a Corporation - Cvrporate Seal must be ,mpressed h?l-evn_
Power of AttorneyFIDELITY AND DEPOSIT COMPANY OF MARYLAND
KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, acorporation of the State of Maryland, by THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY,Assistant Secretary, in pursuance of authority granted by Article VI, Section 2, of the By-Law id Company, which areset forth on the reverse side hereof and are hereby certified to be in full force and eff t 't)t e::l:! reof, does herebynominate, constitute and appoint Michael A. QUIGLEY, of Laguua N' "'~ ',' s lawful agent andAttorney-in-Fact, to make, execute, seal and deliver, for, and' '~\d~ tJ; 0 eed: auy aud allhouds aud undertakings, and the execution of suc 0 u in ese presents, shall be asbinding upon said Company, as fully an , ~s is i ey had been duly executed andacknowledged by the regular] ee t ~ t it Ice in Baltimore, Md., in their own proper persons.This power of atto tli e . e A. QUIGLEY, dated March 17,2005.
The said Assistan~c . ~~~ that the extract set forth on the reverse side hereof is a true copy of Article VI,Section 2, of the By- . 0 ~~d is now in force.
IN WITNESS W R OF, the said Vice-President and Assistant Secretary have hereunto subscribed their names andaffixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 4th day of March,A.D. 2008.
ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By:Gregory E. Murray Assistant Secretary Theodore G. Martinez
State of Maryland } S8'Baltimore County .
On this 4th day of March, A.D. 2008, before the subscriber, a Notary Public of the State of Maryland, dulycommissioned and qualified, came THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY, AssistantSecretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individualsand officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same,and being by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Companyaforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the saidCorporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authorityand direction of the said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first abovewritten.
Dennis R. Hayden Notary PublicMy Commission Expires: February 15,2013
POA-F 012-0626
CALIFORNIA ALL·PURPOSE ACKNOWLEDGMENT5 w F 3 3 @ T 7 -4
State of California
County of _O::.RAN=GE= _
On October 24,2011Date
}before me, MEG QUIGLEY, NarARY PUBLIC
Here Insert Name and TItle 011110 Ofncer
personally appeared MICHAEL A. QUIGLEY
r"MEG"QUIGLEvPCOMM...1786547 ~
NOTARY PUBlIC.CALIFORNIA -tORANGE COUNTY W
M Term Exp. Januar 10,2012
Piece Notary Seal Above
Name{s) 01 Slgnar(s)
who proved to me on the basis of satisfactory evidence tobe the person(s) whose name(s) islom subscribed to thewithin instrument and acknowledged to me thathe/~ executed the same in hislbedtt!air authorizedcapacity(m), and that by hiS/~signature(§() on theinstrument the person(i\l, or the entity upon behalf ofwhich the personjs) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the lawsof the State of California t the foregoing paragraph istrue and correct.
Signature -\J-'~~~l;;;;;;=;;;;;:_-----
---------------------opnONAL--------~~~~---------Though the informatlon below ts not required by law. it may prove valuable to persons relYI
and could prevent fraudulent removal and reattachment of this Iorm to another d
Description of Aliached Document
Title or Type of Document: ~-..:::::::::::==-------
Signer(s) Other Than Named Above:
Document Date: Number of Pages: _
Capacity(ies) Claimed by Signer(s)
Signer's Name: _
o Individualo Corporate Officer - Title(s):o Partner - 0 Limited 0 Generalo Attorney in Facto Trusteeo Guardian or Conservatoro Other: _
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Signer Is Representing: _
Signer's Name: ----'-----o Individualo Corporate Officer - Title(s): _o Partner - 0 Limited 0 Generalo Attorney in Facto Trusteeo Guardian or Conservatoro Other: _
R!GHTTHUMBPRtNTOFS!GNER
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Signer Is Representing: _
G. _ 2 Q t 2 cas _ _ 2 S:C _ 2~2007National Notary Association' 9350 De sctc Ave., P.O. Box 2402-Chatsworth, CA 91313-2402owww.NatlonalNotary.0I'9 Item 115907 Reorder:CaltTolt·Free 1-800-876-6821
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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~ On JQLa.·d ~6\1 before rne,JY)i~ 'l-d.BI:::.\~\· ~ml (here insert name and title of the officer), ~
~ personally appeared &o.,v\V,J ~oo~ , ~~ who proved to me on the basis of satisfactory evidence to be the person.\,l>Y ~~ whose name(~ is/aoe subscribed to the within instrument and acknowledged ~
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Ii1l capaci """'}, an a y IS "en ~81rsigna urejs on t e Ins rurnent e per- iilI~ son~, or the entity upon behalf of which the personjsi acted, executed the ~~ instrument. ill!~ 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. ~
~ ~~ ~ jJ ~~ Signature ~ ihvt M. --- (Seal) ~
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~ ~~ ,~~61r:' ~~~:~~ ~mJ 0 NOTARY PUBLIC" CALIFORNIA r'o mJill! m LOS ANGELES COUNTY" ill!ill! ~ My Com"'. Expiles OCT 31, 2011 ill!~ ~
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South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01
Noncollusion Affidavit(Title 23 United States Code Section 112 and
Public Contract Code Section 7106)
To the CITY / COUNTY of LOS ANGELESDEPARTMENT OF PUBLIC WORKS.
In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares
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, cormived, 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
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.
Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signatureportion thereof shall also constitute signature of this NoncollusionAffidavit. Bidders are cautioned thatmaking a false certification may subject the certifier to criminal prosecution.
Rev. 07/03/06F-6
LIST OF SUBCONTRACTORS South San Femando Valley Park and RideW,O, No, E1906116
Federal Transit Admin Project 10 Nos. CA-95-X090-00 & CA-03-0733-01
In accordance with provisions pertaining to the listing of Subcontractors, the bidder shall list herein each first tierSubcontractor to whom it proposes to subcontract portions of the work in an amount in excess of Y, of 1% of theContractor's total bid or $10,000.00. whichever is greater, and the dollar value of each listed subcontract.
No DBE credit will be given unless the subcontracting amount is listed.
Name, Business Address, Telephone Subcontractor (1 )Certification Dollar Value of SubcontractNumber, and Contact Person License Number Agency and
and Exp. Date Certification #
(' " N (:-t (~c:r; V cJZ::,. License Number: ' LA CT MTA $ 2..4 ')00.011
(1) S~eciflr Certiflring Agency: LA - City of Los Anqeles, Public of Public works; CT State Department of Transportation (Callrans);MTA - Los Angeles County Metropolitan Transportation Authority
Rev. 02/22/07F-7
LIST OF SUBCONTRACTORS (continued)
South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01
- ~,
,.0VENDOR AND/OR SUPPLIER AND BROKER PARTICIPATION RECOGNITION
The bidder must list herein names of vendors andlor suppliers and brokers and the dollar amounts for which the bidder hasobligated itself (list mannfacturers on page F-7).
VendorlSupplierlBroker Name, Business Address, Telephone number, and Certification Supplier/Broker Subcontract InformationContact Person Agency and
Certification# (1)
f;~1~tjfu"-::.---------------------+----'--""""-+-'+-++-++-+--'*'·'~'J;%{bescription of material/service rendered: Gen.!Eth.:
Description of material/service rendered:
LA T MTA Total Dollar Amount of Subcontract
Cert# Iz-o<!. 6 $
LA CT MTA
Cert#
DBE
Exp.:
Description of material/service rendered: Gen.lEth.:
(1) Specify Certifying agency: LA - City of Los Angeles, Bureau of Contract AdministrationCT - State of California, Department of Transportation (Caltrans)MTA - Los Angeles County Metropolitan Transportation Authority
(2) DBE participation credit for a vendor and/or supplier isLIMITED TO 60% of the amount paid, unless thevendor/supplier manufactures or substantially alters the materials/supplies. Multiply the "Total DollarAmount of Subcontract" by 0.6 if applicable.
(3) DBE participation credit for brokers is LIMITED TO THE FEE OR COMMISSION charged forproviding the desired service. Multiply the "Total Dollar Amount of Subcontract" by the broker'scommission percentage.
07/03/06
Preuw }10-4-75-766]TITLE TELEPHONE NO.
F-8
07/12/2011 09:41 5624932610 PAGE 02/03
SUPPLIER CLEARiNGHOUSECERTiFlCAXS OF ELIGIBILiTY
Cli.lnWICATIl f.XI'JRATlON ))A1'E: 1l·JS-2U13
11,e S~W'!ier cleertngbousc for the utiHIy Supplier Diversity Program of the california Public trtUi1ic!1Comnussloa herebytcrtifics.1hat tt has audited and verified the eligihility of:
Montc Col/if,s BllcAhoe &; EfJllipment;lnc_(If Las Alamitos, California as a WlJE
pursuant tc Commission General Order 156~nnd the terms om] conditiQTlss!ipututcd m rhe Verification Application Package.This Certificate. sbnll be vutid only 'with the Clearinghouse seal ~ffixed hcrw.
EligibHity mum be ttutiotnined.at an thnes, and renewed within 30 da.y$:ofmlY changes in ownership or control. F~ihm: 10comply may result in a d~rli~t of~1t8ihility, The Cls:::aringhonsemay reconsider cCI1Uiot\tLcn irit is determined that such status 'WIJSObtained P,)I [(lise. misleading or incOll'.¢ct inlbrmlltion. Decertification may oecer if any verification critefrnn uncler which.eligibilil.)' was ;t\'I.-.at'ilcdlater becomes invali~ due 1QCornmi!:slon ruling, The CJellnnghbu!lc may request addhiorml inmr.matil;1nor couduct on- site vbit's during; l_h~term or"crlfication tv verify eligibility.
This cerrlftceticn is valid only for the period that the nbove named firm remains eHgihlJ;:Btl derermmed by '1heClearinghouse.Utility r;ompante.!; mey direct inql.lirieR: concerning thi~ Certificate to tl1QClcarjnghcusc at 800·359 ..7998 in Los An~lcs.
VON: {()/I0120 iJetermlltlItioJl Date; 11·(8·2010
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South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01
EQUAL EMPLOYMENT OPPORTUNITY OFFICER
PURSUANT TO EXECUTIVE ORDER 11246, THE BIDDER SHALL DESIGNATE ARESPONSIBLE OFFICIAL TO MONITOR ALL EMPLOYMENT RELATED ACTIVITY TOENSURE EQUAL EMPLOYMENT OPPORTUNITY IS BEING CARRIED OUT.
Please be advised that E Wtatl vel saro0 VlL J( Print Name and Title)
____________________________ hereby appoints
E IMal4 vI / fanurvt?;2(Name of Appointee)
, as its Equal Employment Opportunity Officer.
The Officer has been given the authority to establish, disseminate and enforce the EqualEmployment and Affirmative Action Policies of this firm. The Officer may be contactedat the location below concerning matters related to any affirmative actions taken by thisfirm to increase the utilization of minorities and women in its employment.
Work Location: _~_~~Wd~~~~LLL_~~~~ ___Hu Ve-v,./a{/Uf .~IE- vu: ( ~d' CA--~77---~~~----------~----
Phone No.: (1/0 ) 13o~;)-681
Rev. 07/03/06F-9
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South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Adrnin Project ID Nos. CA-95-X090-00 & CA-03-0733-01
EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION
The bidder 5 I t1ub t. t!...a , I VLL , proposed
subcontractor , hereby certifies that he has _ ,
.has not L, participated in a previous contract or subcontract subject to the equal opportunity clauses, as
required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the
Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal
Government contracting or administering agency, or the former President's Committee on Equal
Employment Opportunity, all reports due under the applicable filling requirements.
Note: The above certification is required by the Equal Employment Opportunity Regulations of theSecretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposedsubcontractors only in connection with contracts and subcontracts which are subject to the equalopportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clauseare set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under areexempt.)
Currently, Standard Form 100 (EEO-l) is the only report required by the Executive Orders or theirimplementing regulations.
Proposed prime contractors and subcontractors who have participated in a previous contract orsubcontract subject to the Executive Orders and have not filed the required reports should note that 41CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits areport covering the delinquent period or such other period specified by the Federal HighwayAdministration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor.
Rev. 07/03/06 F-IO
South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01
DEBARMENT AND SUSPENSION CERTIFICATION
TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29
The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other personassociated therewith in the capacity of owner, partner, director, officer, manager:
• is not cnrrently under suspension, debarment, voluntary exclusion, or determination ofineligibility by any Federal agency;
has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federalagency within the past 3 years;
• does not have a proposed debarment pending; and
has not been indicted, convicted, or had a civil judgement rendered against it by a court ofcompetent jurisdiction in any matter involving fraud or official misconduct within the past3 years.
If there are any exceptions to this certification, insert the exceptions in the following space.
Exceptions will not necessarily result in denial of award, but will be considered in determining bidderresponsibility. For any exception noted above, indicate below to whom it applies, initiating agency, anddates of action.
Notes: Providing false information may result in criminal prosecution or administrative sanctions.The above certification is part of the Proposal. Signing this Proposal on the signature portionthereof shall also constitute signature of this Certification.
Rev. 07/03/06
r-n
South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Admin Project ID Nos. CA-95-X090-00 8. CA-03-0733-01
CERTIFICATION OF NON-SEGREGATED FACILITIES
(Applicable to federally assisted construction contracts and related subcontractsexceeding $10,000 which are not exempt from the Equal Opportunity Clause.)
The federally assisted construction contractor certifies that he does not maintainor provide for his employees any segregated facilities at any of his establishments, andthat he does not permit his employees to perform their services at any location, under hiscontrol, where segregated facilities are maintained. The federally assisted constructioncontractor certifies further that he will not maintain or provide for his employees anysegregated facilities at any of his establishments, and that he will not permit hisemployees to perform their services at any location, under his control, where segregatedfacilities are maintained. The federally assisted construction contractor agrees that abreach of this certification is a violation of the Equal Opportunity Clause in this contract.As used in this certification, the term "segregated facilities" means any waiting rooms,work areas, restrooms and wash rooms, restaurants and other eating areas, time clocks,locker rooms and other storage or dressing areas, transportation, and housing facilitiesprovided for employees which are segregated by explicit directive or are in factsegregated on the basis of race, creed, color, or national origin, because of habit, localcustom, or otherwise. The federally assisted construction contractor agrees that (exceptwhere he has obtained identical certifications from proposed subcontractors for specifiedtime period) he will obtain identical certifications from proposed subcontractors prior tothe award of subcontracts exceeding $10,000 which are not exempt form the provisionsof the Equal Opportunity Clause, and that he will retain such certifications in his files.
The above certification is required by the Equal Employment Opportunity Regulations ofthe Secretary of Labor 41 CFR 60-1.8b, and must be submitted by the bidder andproposed subcontractors only in connection with contracts and subcontracts which aresubject to the equal opportunity clause. Contracts and subcontracts which are exemptfrom the equal opportunity clause are set forth in 41 CFR 60-1.5 (Generally onlycontracts or subcontracts of $1 0,000 or under are exempt).
Note: The above certification is part of the Proposal. Signing this Proposal on thesignature portion thereof shall also constitute signature of this Certification.Bidders are cautioned that making a false certification may subject the certifier tocriminal prosecution.
Rev. 07/03/06F-12
South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01
The prospective participant certifies, by signing and submitting this bid or proposal, to the bestof his or her knowledge and belief, that:
(I) No Federal appropriated funds have been paid or will be paid, by or on behalf of theundersigned, to any person for influencing or attempting to influence an officer oremployee of any Federal agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with the awarding ofany Federal contract, the making of any Federal grant, the making of any Federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, or cooperativeagreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to anyperson for influencing or attempting to influence an officer or employee of any Federalagency, a Member of Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosureof Lobbying Activities," in conformance with its instructions.
This certification is a material representation of fact upon which reliance was placed when thistransaction was made or entered into. Submission of this certification is a prerequisite formaking or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Anyperson who fails to file the required certification shall be subject to a civil penalty of not lessthan $10,000 and not more than $100,000 for each such failure.
The prospective participant also agrees by submitting his or her bid or proposal that he or sheshall require that the language of this certification be included in all lower tier subcontracts,which exceed $100,000 and that all such sub-recipients shall certify and disclose accordingly.
Rev. 07/03/06F-13
South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Admin Project ID Nos. CA-95-X090-00 & C 33-01
DISCLOSURE OF LOBBYING ACTIVITIES IV . Is,COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 USC 1352..
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
Da. contract D a. bid/offer/auulication ri.initialb. grant b. initial award b. material changec. cooperative agreement c.· post-awardd. loan For Material Change Only:e. loan guarantee year __ quarterf. loan insurance date of last report
4. Name and Address of Reporting Entity 5. If Reporting Entity in No.4 is Subawardee,Enter Name and Address of Prime:
D Prime o Subaward~eTier ___ • ifknown
Congressional District, if known Ceagresstonal District, ifknown
6. Federal Department/Agency: 7. Federal Program NarnelDescription:
CFDA Number, if applicable
8. Federal Action Number, ifknown: 9. Award Amount, ifknowri:
10. a. Name and Address of Lobby Entity b. Individuals Performing Services (including(If individual, last name, first name, MI) address ifdifferentfrom No. lOa)
(last name, first name, MI)
(attach Continuation Sheet(s) if necessary)
!l. Amount of Payment (check all that apply) 13. Type of Payment (check all that apply)
$ o actual o planned - a. retainer- b. one-time fee12. Form of Payment (check all that apply): - c. commission-B a. cash . - d. contingent fee
h. in-kind; specify: nature - e deferredvalue f. other, specify
14. Brief Description of Services Performed or to be performed and Date(s) of Service, includingofficer(s), employee(s), or member(s) contacted, for PaymentIndicated in Item 11:
(attach Continuation Sheet(s) if necessary) ...15. Continuation Sbcct(s) attached: Yes 0 No 181 /'16. Information requested through this fonn is authorized by Title ~/~/731 U.S.c. Section 1352. This disclosure oflobbying reliance Signature: '"'-<,.,-
was placed by the tier above when his transaction was made or
Print Name: £ VVl.tf/l/I/".viJ.l /lcl$t)"ovvL.-:?entered into. This disclosure is required pursuant to 31 U.S.c.1352. This information will be reported to Congresssemiannually and will be available for public inspection. Any
Title: £ r't.r l-de.".rperson who fails to file the required disclosure shall be subjectto a civil penalty of not less than $10,000 and not more than
Telephone No.: 310. 475' .lt6:'; Date} ,1."1. (/$100,000 for each such failure.
Authorized for Local ReproductionFederal Use Only: Standard Form - LLL
Standard Form LLL Rev. 09~12~97
F-14
South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure fonn shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiationor receipt of covered Federal action or a material change to previous filing pursuant to title 31 U.S.C. section 1352. The filingof a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting toinfluence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of aMember of Congress in connection with a covered Federal action. Attach a continuation sheet for additional information if thespace on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer tothe implementing guidance published by the Office of Management and Budget for additional information.
I. Identify the type of covered Federal action for which lobbying activity is andlor has been secured to influence, theoutcome of a covered Federal action.
2. Identify the status of the covered Federal action.3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the
information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last,previously submitted report by this reporting entity for this covered Federal action.
4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if known.Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subawardrecipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawardsinclude but are not limited to subcontracts, sub grants and contract awards under grants.
5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state and zipcode of the prime Federal recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organization levelbelow agency name, if known. For example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item I). If known, enter the fullCatalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loancommitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identification in item I (e.g.,Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcemeut number, the contract grant.or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes,e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter theFederal amount of the award/loan commitments for the prime entity identified in item 4 or 5:
10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entityidentified in item 4 to influenced the covered Federal action.(b) Enter the full names of the individualts) performing services and include full address if different from 10 (a). EnterLast Name, First Name and Middle Initial (MI).
II. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to thelobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check allboxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to bemade.
12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution,specify the nature and value of the in-kind payment.
13. Check the appropriate box( es). Check all boxes that apply. If other, specify nature.14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to
perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent inactual contact with Federal officials. Identify the Federal officer(s) or employee(s) contacted or the officer(s)employee(s) or Member(s) of Congress that were contacted.
IS. Check whether or not a continuation sheet(s) is attached.16. The certifying official shall sign and date the form, print his/her name title and telephone number.
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time forreviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing andreviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection ofinformation, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork ReductionProject (0348-0046), Washington, D.C. 20503.
F-15
South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Adrnin Project 10 Nos. CA-95-X090-00 & CA-03-0733-01
CERTIFICATION OF COMPLIANCE WITH CHILD SUPPORT OBLIGATIONS
The undersigned hereby agrees that __ 0-=-'·'_1 _IVJ.......U_/ _6.,...,.L-:__ lo_·_,__ 1 tl_/L-=- .. _- _ will:Name of Business
I. Fully comply with all applicable State and Federal employment reporting requirements for itsemployees.
2. Fully comply with and implement all lawfully served Wage and earnings Assignment Orders andNotices of Assignment.
3. Certify that the principal owner(s) of the business are in compliance with any Wage and EarningsAssignment Orders and Notices of Assignment applicable to them personally.
4. Certify that the business will maintain such compliance throughout the terms of the contract.
5. This certification is a material representation of fact upon which reliance was placed when the partiesentered into this transaction
6. The undersigned shall require that the language ofthis Certification be included in all subcontracts andthat all subcontractors shall certify and disclose accordingly.
Upon signing below, the bidder by his/her signature affixed hereto declares under penalty of perjury thathe/she has read the Child Support Assignment Orders contained in the Citya s Ordinance No. 172401 andaccepts all the Citya s requirements contained therein throughout the duratio this project.
:)IH 6El- Cs.Company Name
'7LJ-7/J--O IIate I
07/03/06F-16
10/31/07
South San Fernando Valley Park and RideW.O. No. E1906116
Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01
NOT USED
F-17
CITY OF LOS ANGELESDepartment of Public Works
Bureau of Contract AdministrationOffice of Contract Compliance
1149 S. Broadway, 3rd Floor, Los Angeles, CA 90015Phone: (213) 847-1922 - Fax: (213) 847-2777
EQUAL BENEFITS ORDINANCE COMPLIANCE FOR~Your company must be certified as complying with Los Angeles Administrative Code Section 10.8.2.1, EqualBenefits Ordinance, prior to the execution of a City agreement. This form must be returned to the City departmentawarding the agreement. If responding to a request for bid/proposal, submit this form with the bid/proposal.
City Dept. Awarding Contract: _________ Contact/Phone:
SECTION 1. CONTACT INFORMATIONCompany Name: Si f/1 ct 17[·- . ('-o~ (v~--CCompany Address: ,;!-033 wf3TuvOoJ If I" #" ,)-1-'-City: t·-A ,,, State: (;0 Zip: ~2,-(-",O-"iJ...±;}-.~5c..·· ----:---=::----~::_::_-:_c_,--Contact Person: E vv\..o.", vd 5 tIS 00'v--.1.4 Phone: :3 iV- .+') S· 76(,,\ Fax:) /0 "VIS, . ."I'd II am a one-person contractor, and I have no employees. DYes li8. No (if you answered "Yes," go to Section 3)Approximate Number of Employees in the United States: L:;Are any of your employees covered by a collective bargain-in~g~aLg-re-e-m-en-t-o-r-u-n-io-n-t-ru-s-t-fu-n-d-?-D-Y-e-s--JZ(i-;'~N-o-
SECTION 2. COMPLIANCE QUESTIONSHas your company previously submitted a Compliance Form and all supporting documentation? 0Yes D NoIf Yes, AND the benefits provided to your emplovees have not changed since that time, continue onto Section 3. IfNo, OR if the benefits provided to your employees have changed since that time, complete the rest of this form.
0"201:"\:\;:);0~:ithe table below, check all benefits that your company currently provides to employees or to which your
employees have access. Provide information for each benefits carrier if your employees have access tomore than one carrier. Note: some benefits are available or apply to employees because they have a spouse ordomestic partner to whom the benefit applies, such as bereavement leave that allows an employee time offbecause of the death of a spouse or domestic partner; other benefits are provided directly to the spouse ordornesti h dl I' h th d r rt ddtornestic partner, suc as me ica Insurance t at covers e spouse or omes IC pa ner as a epen en.
BENEFIT(S) YOUR This Benefit is This Benefit is Available/Applies Available/Appliesto DomesticCOMPANY CURRENTLY Not Offered Available to to Spouses of Partners ofOFFERS to Emplc~.yees Employees. Employees Employees
1 Health Insurance (List Name of Carrier sn ,,<\IS&YHealth Carrier 1: [J D D DHealth Carrier 2: D D D DDadditional carriers on attachment.
2 Dental Insurance (List Name of carrlertsj)Dental Carrier 1: D D D DDental Carrier 2: D D D DD additional carriers on attachment.
3 Vision Plan (List Name of Carrieres))Vision Carrier 1: D D D DVision Carrier 2: D D D D
4 Pension/401 kl Plans D 0 0 05 Bereavement Leave D 0 0 06 Famil Leave D 0 0 D7 Parental Leave 0 0 0 08 Em lovee Assistance Proorarn D 0 0 09 Relocation & Travel D 0 D 0
10 Comoanv Discount Facilities& Events 0 0 0 0'",••'1 Credit Union 0 0 0 D
'I{f Child Care 0 D 0 0Other: D D 0 0
14 Other: D 0 0 D
F·18 aForm OCC/EBO·1 (Rev, 06/06) Page 1
W.O. No. E1906116Federal Transit Admin Project ID Nos. CA-95-X090-00 & CA-03-0733-01 COMPLIANCEYOU MUST SUBMIT SUPPORTING DOCUMENTATION TO VERIFY EACH BENEFIT MARKED. Without properdocumentation for each carrier and each benefit marked, your company cannot be certified as complying with theEBO. If documentation for a particular benefit does not exist, attach an explanation. Refer to the "Documentation to
"""yerify Compliance with the Equal Benefits Ordinance" fact sheet for more information on the type of documentation""·'~{·ihatmust be submitted to verify compliance with the EBO.
If in the Table in Section 2 you indicated that your company does not provide all benefits equally throughout itsentire operations to all your employees with spouses and employees with domestic partners of the same anddifferent sex, you may:
D a. Request additional time to comply with the EBO. Provisional Compliance may be granted toContractors who agree to fully comply with the EBO but need more time to incorporate the requirements ofthe EBO into their operations. Submit the Application for Provisional Compliance (OCC/EBO-3) andsupporting documentation with this Compliance Form.
D b. Request to be allowed to comply with the EBO by providing affected employees with the cashequivalent. Your company must agree to provide employees with a cash equivalent. In most cases, thecash equivalent is the amount of money equivalent to what your company pays for spousal benefits that areunavailable for domestic partners, or vice versa. Submit a completed Application for Reasonable MeasuresDetermination (OCC/EBO-21 and supporting documentation with this Compliance Form.
D c. Comply on a Contract-by-Contract Basis. Compliance may be granted on a contract-by-contract basisfor those Contractors who have multiple locations in the U.S. but cannot comply with the EBO throughoutthe Contractor's operations. Indicate below the compliance category you are requesting:D Contractor has multiple operations located both within and outside City limits. Contractor will comply with
the EBO only for the operation(s) located within City limits and for employee(s) located elsewhere in theUnited States who perform work relating to the City agreement. Supporting documentation for theaffected operation(s)/employees must be submitted.
D Contractor has no offices within City limits but does have (an) employee(s) working on the Cityagreement located elsewhere in the United States. Contractor will comply with the EBO only foremployee(s) located elsewhere in the United States who perform work relating to the City agreement.Supporting documentation for the affected employee(s) must be submitted.
SECTION 3. EXECUTE THE DECLARATION AND SUBMIT THE FORM TO THE AWARDING DEPARTMENTThis form must be returned to the City departrnent awarding the agreernent. .. If responding to a request forbid/proposal, subrnit this form with the bid/proposal to the awarding department. The awarding departrnent willforward the forrn to the Department of Public Works, Bureau of Contract Administration, Office of ContractCompliance for review.
DECLARATION UNDER PENALTY OF PERJURYI declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, andthat I arn authorized to bind this entity contractually.
d-~?day J U 0 , in the year ...~ 0 I I ,at l. /<~ (:""'1 .<r=>: (Ci,ty) (State)
e: vvta ,·1 Vi,:I ScM (J 0 i, '-£;1Name of Signatory (please print) City. State, Zip Code
y)- 43 5 9!l6 c'Federal 10 Number
F-18 bForm OCC/EBO-1 (Rev. 06106) Page 2
CITY OF LOS ANGELESDepartment of Public Works
Bureau of Contract AdministrationOffice of Contract Compliance
1149 S. Broadway, 3rd Floor, Los Angeles, CA 90015Phone: (213) 847-1922 - Fax: (213) 847-2777
DOCUMENTATION TO VERIFY COMPLIANCE WITH THE EQUAL BENEFITS ORDINANCESection 2 of the Equal Benefits Ordinance Compliance Form (Form OCC/EBO-1) requires that you submitsupporting documentation to the Office of Contract Compliance to verify that all benefits marked in your response(s)are offered in a nondiscriminatory manner. This list is intended to be used only as a guide for the type ofdocumentation needed.
Health, Dental, Vision Insurance: A statement from your insurance provider that spouses and domestic partnersreceive equal coverage in your medical plan. This may be in a letter from your insurance provider or reflected in theeligibility section of your official insurance plan document. Note that "domestic partner" includes same-sex as wellas different-sex partners so that the definition of "domestic partner" contained in the plan document must includedifferent-sex partners.
Pension/401 (k) Plans:. Documentation should indicate that participating employees may designate a beneficiary toreceive the amount payable upon the death of the employee. Submit a blank beneficiary designation form.
Bereavement Leave: Your bereavement leave or funeral leave policy indicating the benefit is offered equally. Ifyour policy allows employees time off from work because of the death of a spouse, it should also allow for time offbecause of the death of a domestic partner. If the policy allows time off for the death of a parent in-law or otherrelative of a spouse, it must include time off for the death of a domestic partner's equivalent relative .
.,Family Leave: Your company's Family and Medical Leave Act policy. All companies with 50 or more employees\Jl!;i~i)ustoffer this benefit. Your policy should indicate that employees may take leave because of the serious medical"''''C'ondition of their spouse or domestic partner.
Parental Leave: Your company's policy indicating that employees may take leave for the birth or adoption of achild. If leave is available for step-children (the spouse's child) then leave should also be made available for thechild of a domestic partner.
Employee Assistance Program (EAP): The benefit typically refers to programs that allow employees and theirfamily members access to counselors who provide short-term counseling and referrals to assist in dealing withissues such as family problems, addiction, and financial and legal difficulties. Your company's EAP policy mustconfirm that spouses, domestic partners and their parents and children are equally eligible (or ineligible) for suchbenefits. If provided through a third party, a statement from the third party provider regarding eligibility is required.
Relocation & Travel: Your company's policy confirming that expenses for travel or relocation will be paid on thesame basis for spouses and domestic partners of employees.
Company Discounts; Facilities & Events: Your company's policy confirming that to the extent discounts, facilities(such as a gym) and events (such as a company holiday party) are equally available to spouses and domesticpartners of employees.
Credit Union: Documentation from the credit union indicating that spouses and domestic partners have equalaccess to credit union services.
Child Care: Documentation that the children of spouses (step-children) and children of domestic partners haveequal access to child care services.
,'«"'~>
. tither Benefits: Documentation of any other benefits listed to indicate that they are offered equally.
F-18 cForm OCCIEBO·1 (Rev. 06106) Page 3
CITY OF LOS ANGELESDepartment of Public Works
Bureau of Contract AdministrationOffice of Contract Compliance S···
1.149 S. Broadway, 3rd Floor, Los Angeles, CA 90015 /'\;/ \A9..·Phone: (213) 847-1922 - Fax: (213) 847-2777
APPLICATION FOR PROVISIONAL COMPLIANCE WITH EQUAL BENEFITS ORDINANCECOMPLETE AND SUBMIT THIS FORM ONLY IF APPLICABLE. Contractors entering into, amending, or biddingon a City contract who agree to comply with the Equal Benefits Ordinance ("EBO") but need more time toincorporate the requirements of the EBO into their operations must submit this form, and supporting documentation,to the Department of Public Works, Bureau of Contract Administration, Office of Contract Compliance ("OCC").(This form must be submitted with the EBO Compliance Form OCC/EBO-1.) The Contractor may be grantedadditional time to incorporate the requirements of the EBO only in the circumstances indicated below. Fill out allsections that apply. Attach additional sheets if necessary.
__ A. OPEN ENROLLMENT FOR HEALTH, DENTAL ANDIOR VISION INSURANCE PLANSThe Contractor may be granted additional time to implement the requirements of the EBO if equal benefits cannotbe provided until after the first open enrollment process following the date the contract with the City is executed. Toqualify, the Contractor must submit evidence that reasonable efforts are being undertaken to implement therequirements of the EBO. Additional time granted may not exceed two years from the date the contract with the Cityis executed, and applies only to benefits for which an open enrollment period is applicable.
_____ - Date domestic partner (same and different sex) coverage will become effective.
You must submit copies of correspondence between your company and your insurance provider(s)documenting your effort to obtain domestic partner coverage for same- and different-sex couples. You
,,' ,';1ould also submit verification of the next open enrollment date or the date the benefits become available.
=--= B. ADMINISTRATIVE ACTIONS AND REQUESTS FOR EXTENSIONThe Contractor may be granted additional time to implement the requirements of the EBO if the administrativeactions necessary to incorporate the EBO cannot be completed prior to the date that the contract with the City isexecuted. Additional time granted for the completion of the administrative action shall apply only to those benefitsthat require administrative actions and may not exceed three months. Upon written request by the Contractor and atthe discretion of the OCC, the Contractor may be granted additional time to complete the administrative actions.Administrative actions may include personnel policy revisions and the development and distribution of employeecommunications.
Describe below or on an attachment the administrative actions needed and the anticipated completion dates.Attach supporting documentation such as the relevant portions of your current policy and the changes youplan to make.
If you are requesting an extension beyond three months, explain why more than three months is needed and attachany supporting documentation that may be relevant.
Form OCC/EBO·3 (Rev. 06/06)F-18 d
Page 1
II 11"_. .......... .•.. _Ii"" •• __-=---: C. COLLECTIVE BARGAINING AGREEMENTSCompliance with the EBO may be delayed untiUheexpiration of a Contractor's current collective bargainingagreement(s) (CBA). When the CBA is renegotiated, the Contractor must propose to the union for incorporationinto the CBA the EBO requirements so that all benefits provided to employees with spouses are also extended to
,,,,"";;,employeeswith domestic partners. Provisional compliance status may be granted if all of the following conditions"'(!?are met.
1. The provision of some or all of the benefits offered to the Contractor's employees are governed by one or moreCBA(s) but domestic partner coverage for same- and different-sex couples is not offered under the CBA(s).
Required Information: Indicate below the name of each CBA for which Provisional Compliance is beingrequested and the tirne period the CBA covers.
Name of Bargaining Unit: ~ Start date: End date: _Name of Bargaining Unit: Start date: End date: _Name of Bargaining Unit: Start date: End date: _
2. The Contractor agrees to propose to the union that the EBO requirernents be incorporated into each of theCBA(s) by signing the staternent below.
When the CBA is renegotiated, we will propose to the union that the EBO requirements beincorporated into the CBA so that all benefits provided to employees with spouses will be extendedto employees with same or different sex domestic partners. After the CBA expires, we will provide,upon request by the City, reports on the status of the efforts to incorporate the EBO requirementsinto the CBA.
By the end of negotiations, we agree to notify the OCC of the result by submitting a statement whichwill indicate: (1) when the issue of same and different sex domestic partners was raised duringnegotiations; and (2) whether or not the EBO requirements was incorporated into the CBA. Weunderstand that a separate statement must be submitted for each CBA for which ProvisionalCompliance was requested.
Name of Signatory (Print) , Signature Title Date
3. For benefits not strictly governed by a CBA, the Contractor must establish policies so that those benefits areprovided in accordance with the requirements of the EBO. For example, the Contractor may be required toexpand the existing bereavementleave policy to allow an employee with a domestic partner time off in event ofthe domestic partner's death even if the CBAdoes not require the employer to do so.
Required documentation: A listing of benefits not strictly governed by the CBA along with the Contractor'spolicies as they relate to those benefits.
EXECUTE THE DECLARATION AND SUBMIT THE FORM TO THE AWARDING DEPARTMENT: This form, andthe Equal Benefits Ordinance Compliance Forrn (Form OCC/EBO-1) must be returned to the City departmentawarding the agreernent. If responding to a request for bid/proposal, submit this form with the bid/proposal to theawarding department. The awarding department will forward the form to the OCC for review.
DECLARATION UNDER PENALTY OF PERJURYI declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, andthat I am authorized to bind this entity contractually.
Executed this 3--7 d~y of J:j;, , _"in t~~ year ~ I / "••;;--;-;(c'C:ityCC)-[-·-'./'::...:(,-:}-T"--- (S:~~~'5IH6/;/ C ",f., :8f}HUH't Sa5ilIHL'J ~ !Jil};de"" ne of Company Name of Signatory (Print) Signature Title
Form OCC/EBO-3 (Rev. 06/06)F-18 e
Page 2
CITY OF lOS ANGELESDepartment of Public Works
Bureau of Contract AdministrationOffice of Contract Compliance
1149 S. Broadway, 3d Floor, LoS Angeles, CA 90015Phone: (213) 847-1922 - Fax: (213) 847-2777
APPLICATION FOR REASONABLE MEASURES DETERMINATION - CASH EQUIVALENT COMPLIANCE
51 Jv1ubt Co . I be_C. ?5- '+.3' ') ;) (j"6"8Name of Company" FederallD Number
,3-0 3 5 ~AJ'e :/f;:/D b ,/ /11)'; r »t» i.",<0- . {h)J 0 (i)...SStreet Address '" " , City, State Zip
E-~'\;t[U1i/i'; )ct3iJO.t01 frh·ide,.ff' }/(/ ,/17) 766; .,>It) ·-""17S' ,.,J g'JjContact PersonlTitle Telephone Number Fax Number
Before the Department of Public Works. Bureau of Contract Administration. Office of Contract Compliance (OCG) will approvea contractor's application to comply with the Equal Benefits Ordinance (EBO) by paying a cash equivalent, the OCC mustdetermine that: (a) the contractor has made a reasonable yet unsuccessful effort to provide equal benefits; or (b) under thecircumstances, it would be unreasonable to require the contractor to provide benefits to domestic partners (or spouses ifapplicable). To apply, contractors must submit:
1. An explanation and documentation that demonstrates: (a) the Contractor has made a reasonable, yet unsuccessful,effort to provide equal benefits; or (b) under the circumstances, it would be unreasonable to require the contractor toprovide equal benefits rather than paying the cash equivalent. See EBO Regulation #2B(1 )(a) and #2B(1 )(b).
2. This completed application. Fill in the company's information, then read and sign the acknowledgement below.3. A completed Equal Benefits Ordinance Compliance Form (Form OCC/EBO-1). Be certain that box "b" on page two of the
form is checked.4. A draft of the memorandum that will be distributed to affected employees informing them of the cash equivalent option.
Copies of the revised policies, such as bereavement, for which the cash equivalent is not applicable.
If approved by the OCC, a contractor will be allowed to comply with the EBO by paying its employees with domestic partnersthe cash equivalent of benefits made available to the spouses of its employees. The cash equivalent is the difference betweenthe amount an employer pays to provide an employee with spousal or family coverage and the amount that an employer paysto provide an employee with employee-only coverage. For example, an employer pays $200 per month to provide benefits foran employee and his/her spouse, and $150 per month to provide benefits for an employee with employee-only coverage. Thecash equivalent that must be paid to the employee with a domestic partner is $50 per month.
For benefits for which a cash equivalent is not applicable, such as bereavement leave, the employer must amend its policies sothat domestic partners are treated in the same manner as spouses. For example, if the policy allows an employee three daysoff in the event of the death of a spouse or the spouse's parents, the policy must be amended to allow an employee three daysoff in the event of the death of a domestic partner or the domestic partner's parents.
ACKNOWLEDGEMENT REGARDING APPLICATIONI declare under penalty of perjury under the laws of the State of California that I am authorized to bind thecompany/entity listed above. I understand that this Application must be approved by the OCC before compliance bypaying the cash equivalent will be allowed. By Signing below, I agree on behalf of the company that ifthis Applicationis approved by the OCC, the company will comply with the EBO by providing employees with domestic partners thecash equivalent of the benefits that are made available to employees with spouses. For those benefits to which thecash equivalent is not applicable, such as for bereavement leave' or family leave, the company agrees to amend itspolicies so that the domestic partners of employees will be treated in the same manner as the spouse of an employee.The relatives of domestic partners will be treated in the same manner as relatives of spouses. The company furtheragrees to provide a memorandum notifying our affected employees of the availability of the cash equivalent option ifthey have domestic partners for whom equal benefits cannot be provided.
EX:cut: :~(:?:~;~of ~!().' " ---,-L~-'-~';;(C""it:-;Y)-------Z-'-i -J~(-~;-::!-2l/-Name of Signatory (Print)~' Signature Title ate
Form OCC/EBO-2 (Rev. 06/06) F-18 f
Department of Public WorksBureau of Contract Administration
Office of Contract Compliance1149 S. Broadway, 3,d Floor, Los Angeles, CA 90015
Phone: (213) 847-1922 - Fax: (213) 847-2777
INSTRUCTIONS FOR COMPLETING EQUAL BENEFITS ORDINANCE FORMS
1. Start with the Equal Benefits Ordinance (EBO) Compliance Form (Form OCC/EBO-i). Your companymust bedetermined to be in compliance with the EBO before a contract with the City may be executed. In Section 2 of theform, indicate what benefits your company currently offers its employees. If a benefit is not offered, indicate thebenefit is not offered.
If your company currently does not offer equal benefits to employees with spouses and employees with same ordifferent sex domestic partners, you may, on page two of the EBO Compliance Form, request one of the followingby checking the appropriate box on the form:a. Request additional time to come into compliance with the EBO. This is available to contractors who agree
to fully comply with the EBO but need additional time to add domestic partner coverage, to change companypolicies, or to negotiate the addition of domestic partner coverage to a collective bargaining agreement.Complete the Application for Provisional Compliance (Form OCC/EBO-3) and' return it with the EBOCompliance Form (Form OCC/EBO-1). You must submit supporting documentation to verify why additional timeis needed.
b. Request to be allowed to comply with the EBO by providing employees the cash equivalent. This isavailable to contractors who meet both of the following: (1) agree to provide ernployees with domestic partnersthe cash equivalent of the. benefits offered to employees with spouses; and (2) have demonstrated that theyhave taken reasonable yet unsuccessful efforts to cornply, or that it would be unreasonable under thecircumstances to require the contractor to provide equal benefits rather than pay the cash equivalent toemployees. Complete the Application for Reasonable Measures Deterrnination (Form OCC/EBO-2) and returnit with the EBO Compliance Form (Form OCC/EBO-1). You must submit the supporting docurnentationrequested in the Reasonable Measures Form.
c. Request to be allowed to comply with the EBO on a contract-by-contract basis. If your company can onlycomply with the EBO for those locations or employees covered by the EBO, you may apply for cornpliance on acontract-by-contract basis. Contact the Department of Public Works, Office of Contract Compliance foradditional information. Check the appropriate box on the EBO Compliance Form (Form OCC/EBO-1) andsubmit supporting documentation regarding the locations and employees affected by the EBO.
2. Obtain supporting documentation. The City must verify that each benefit offered by your cornpany is offeredequally. Haterto the EBO supporting documentation information sheet for the type of documentation that will berequired. You must submit supporting documentation for each benefit checked in Question 2 of the EBOCompliance Form (Form OCC/EBO-1).
Unless otherwise specified in the RFB/RFP/RFQ, you do not need to submit supporting docurnentation with thebid or proposal. However, because supporting documentation will be required if you are. selected for award of acontract, you must have the supporting documentation readily available for subrnission. A delay in the submission ofdocumentation will result in a delay in the execution of your contract. If you have already been notified that youhave been selected for the award of a contract, supporting documentation must be submitted immediatelyto avoid delays.
3. Submit the EBO Compliance Form (Form OCC/EBO-i) to the awarding department. If you are requestingadditional time to comply or to be allowed to pay employees the cash equivalent, you must also submit theappropriate forms (see #1 above) and supporting documentation with the EBO Compliance Form.
4. The forms and documentation will be forwarded to the Office of Contract Compliance for review. If additional''lformation or supporting documentation is needed, the Contractor Enforcement Section will contact you to obtain
, .•ie information. Because your contract cannot be executed until you have been determined to be incompliance with the EBO, you must respond promptly to any request for additional information.
Form OCC/EBO-10 (Rev. 06/06) F·18 9
Eel, 168(06/11/07)
r-ecerat I ransn Anrnm i-rojecr IU I\lOS. vf\-::10-AV~U-VV at Vf'\-V0-V' oc-v I
D.EPARTMENT OF PUBLIC WORKSBureau of Contract Administration
ELECtRICAL SAFETY POLICY IMPLEMENTATION PLAN
PRdJECT:~_,-,S::;o",u:!t!!h-"S::::a!!n.!.F-"e!!rn:!!a"-n:.::d:.:::o-,V:.:a",lI",ey,-,-P",,a!!rk,-,aO!n",d,-,R-"i::::d,,-e~W,o, f.:,. l90 6 i IbINSPECTdR:_· ~ __ ---~_------~DATE:---_------
THE CONTRACTDRSHALL: .PI-AN AND IMPLEMENT THE ELECTRICAL SAFETYPOLICY IN ACCORDANCE WITH THE BOARD OF PUBLlCWPRKS POLICY:
EI~ctric".1W6* I~IiibeperfQrm~d by.JQurneymanElectricia"s, Transportation Sy~ternElectrician;Transportation System Technici.ry,or"pprenticescurrently being trained ina Californi. Approved ElectricalApprenticeship Prograryl,underthe· supervislonef a Journeyman Electri~ian.
APPRENTICES AND JOURNEY-",EVEI- WORKERS:
All apprenllces Will be re,9istered In a State of California Approved Apprentlceshtp Program
The use of Journey-Level worKetSwillcomply Withall State of California labor laws,
TIi.E W()RKfO!,\CE ..QF PROJECTS DE:;IGNAJED AS REQUIRING "ENHANCED ELECTRICALSAFETY CRITERIA "SHALL COMPLY WITH TfiE FOLLOWING
70'(. ofall,iJourneymanWiremao" will be graduates of a state of California Approved ElectricalA~prMti*"sl1jp Program 0' bold .'I;IUd C-10 California ccntraeter'e Licens e Issued by theStateofCallfornl,,_
20% ofthe job$ileelectrical workers willbe .oSHA 1o-hcur General Industry Safety and HealthCertified
AU.asforie [obsiteelectrlcal worker willbe .oSHAao-tiour Generallndu$lrySafety and HealthCertified
Ther¢qujred:workforce ratios-wm be determined by verifYing the wOfkforcet::~mpo$ition on adaily basis
Eiet:tHcaJ WO.rJi::fs-defirie~'as placement, instaliat!90, erection, or cennectlon ~fany electrical wires, fixtures I
,appti~li~s. apparatli's; ta~~aY5i c.onduit$\ sol;'itPbQt()votta,ic cells, or'a.ny part the.~()f;_:wtiich' ge'lerates, tranmits,transforms, ofuti1iZes: electrical enerqy In.any form or for any purpose reqardtess cf-voltage.
