ATTACHMENT 5 BID/BIDDER CERTIFI CATION SHEET Invitation For Bid IFB Number 04A5359 Page I of 2 Only an individual who is authorized to bind the bidding fim1 contractually shall sign the Bid/Bidder Ce11ification Sheet. The signature mu st indicate the title or position that the individual holds in the fim1. Thi s Bid/Bidder Cc11ification Sheet must be signed and return ed al ong with a ll "required attachments" as an entire package wit h original signat ures. The bid must be trans mi tted in a sea led envelope in accordance with IFB instructions. A. Our a ll -inclusive bid is submitted in a seal ed envelope marked "Bid Submittal - Do Not Open". B. All required attachments are included with this certification shee t. C. 1 have read and understand the DVBE participation requireme nts and have included documentation demon strating that 1 have met the participation goa ls. D. The signature affixed hereon and dated certifies co mpliance with all the req uirements of this bid do cu me nt . The signature below authorizes the verification of thi s ce11i fica ti on. E. The signature and date affi xed hereon certifies that this bid is a firm offer for a 90-day period. An Unsigned Bid/ Bidder Certific ation Sheet Mav Be Ca use for Bid Rejection I. Co mpany Name 2. Telephone Number 2a. Fax Number AH "- tr-«- <; ' ·, sh. ) '3 - c; I LI ( lb'!J Indi cate your organiza ti on type: 4. So le Proprietorship I 5. 0 Partnership Corporation Indicate the applicable employee and/or corporation number: 7. Federal Employee ID No . (FEI N) "2.o - I 18 4 7_ <..o / J 8. California Co rporation No . Indicate the Department of lndusn-ial Relations in formation: 9. Co ntractor Registra ti on N umber \ ObC>O O IO 1' lo Indicate applicab le li cense and/ or certification information: I 0. Contractor 's State Licensing Boa rd Number 12. Bidder' Name (Print) 'R.\ lAr ovJ\ s .\ 11. PUC Li cense Number CAL-T- 0 13 . T itle 0 \N 1--l €'('.__ 15 \ Date l- 11 - 11 16. Are you certifi wi th the Department of Ge neral Services, Office of Sma ll Business and Disabled Veteran Business Enterprise Services (O SDS) as: a. Sma ll Business Enterp ri se If yes, enter certification number: L-\L.102 Yes 2SI No 0 b. Disabled Veteran Business Enterprise Yes 0 If yes, e nter your service code below: NOTE: A cop y of yo ur Ce11ification is required to be includ ed if either of the above items is checked "Yes". Date application was submitted to OSD S, if an application is pending: 17. Arc you a Non-Sma ll Bus ine ss committing to the use of 25% Certifi ed S mall Busines s Subcontractor Participation? Yes 0 No D If Yes, complete and return the Bidder Declaration form, GSPD-05- 105 with your bid.
Transcript
ATTACHMENT 5 BID/BIDDER CERTIFICATION SHEET
Invitation For Bid IFB Number 04A5359
Page I of 2
Only an individual who is authorized to bind the bidding fim1 contractually shall sign the Bid/Bidder Ce11ification Sheet. The signature must indi cate the title or position that the individual holds in the fim1. This Bid/Bidder Cc11ification Sheet must be signed and returned along with all "required attachments" as an entire package with original signatures. The bid must be transmitted in a sealed envelope in accordance with IFB instructions.
A. Our all-inclusive bid is submitted in a sealed envelope marked "Bid Submittal - Do Not Open". B. All required attachments are included with this certification sheet. C. 1 have read and understand the DVBE participation requirements and have included documentation
demonstrating that 1 have met the participation goals. D. The signature a ffixed hereon and dated certifies compliance with all the requirements of this bid document. The
signature below authorizes the verification of this ce11ifica ti on. E. The s ignature and date affixed hereon certifies that this bid is a firm offer for a 90-day period.
An Unsigned Bid/Bidder Certification Sheet Mav Be Cause for Bid Rejection
I. Company Name 2. Telephone Number 2a. Fax Number
~ AH "- tr-«- <; ' ~ ·, sh. (~ ) '3 1~ - c; I LI (lb'!J 'lZ.~-1-s--q~
Indicate your organ ization type: 4. ~ Sole Proprietorship I 5. 0 Partnership Corporation
Indicate the appl icable employee and/or corporation number:
7. Federal Employee ID No. (FEIN) "2.o - I 18 4 7_ <..o / J 8. California Corporation No.
Indicate the Department of lndusn-ial Relations information: 9. Contractor Registration Number \ ObC>O O IO 1' lo Indicate appl icable license and/or certification information:
I 0. Contractor 's State Licensing Board Number
12. Bidder ' Name (Print)
'R.\ lAr ovJ\ s ~ .\ ~
11. PUC License Number CAL-T-
0 ~s~Y'°2..S 13. T itle
0 \N 1--l €'('.__
15\ Date l - 11 - 11
16. Are you certifi with the Department o f General Services, Office of Small Business and Disabled Veteran Business Enterprise Services (OSDS) as: a. Small Business Enterprise If yes, enter certifica tion number:
L-\L.102
Yes 2SI No 0 b. Disabled Veteran Business Enterprise Yes 0 No ~ If yes, enter your service code below:
NOTE: A copy of your Ce11ification is required to be included if either of the above items is checked "Yes" .
Date application was submitted to OSDS, if an application is pending:
17. Arc you a Non-Small Business committing to the use of 25% Certified Small Business Subcontractor Participation? Yes 0 No D
If Yes, complete and return the Bidder Declaration form, GSPD-05- 105 with your bid.
STATE OF CALIFORNIA · DEPARTM ENT OF TRANSPORTATION
BID PROPOSAL ATTACHMENT 1 A DM-141 2 (REV. I 1/2015)
CONTRACTOR'S NAME (Please Print)~ A --r-;:-:_ $oe_. 1· ;b,. CONTRACT NO. 0LJ(\S5s-4 ·\,,.;') rea._ (~ V1tr I")
ITEM ESTIMATED UNIT OF ITEM
NO. QUANTITY MEASURE
Tree Trimming/Thinning : I 500 Each
One (I ') to Twenty Five (25 ') ta ll
Tree Trimming/Thinning: 2 300 Each
Twenty Six (26') lo Fifty (50 ' ) ta ll
3 200 Each Tree Trimming/Thinning: Fi fty One (5 1 ' )to One Hundred ( I 00 ' ) ta ll
4 100 Each T ree Trimming/Thinning: Above One Hundred ( I 00") tall
Tree Removal
5 500 Each Up to Twelve ( 12") diameter a t Four (4') h igh up to Fifty Feet (50') high.
Tree Removal
6 200 Each From T hirteen ( 13'' ) ro Twenty Four ( 24") diameter at Four (4') high up to Seventy Five (75 ') high
I rce J<emoval
7 60 Each Twenty Five (25") and above diamete r at Four ( 4') high and above Seventy Five (75') ta ll .
Stump Removal 8 200 Each
Up to Twelve ( 12") in diameter.
Stu mp Removal 9 150 Each Thirteen ( 13'") lo Twenty Four (24") in diameter.
Stump Removal IO 100 Each
Over Twenty Four (24") in diameter.
Traffi c Control II 20 Each
One way flagging operation per day.
UN IT PRICE ( Price Per Uni t of Measure)
$ /s;~
$ z <.•<..> C>O -
$ ~D~
$°I IS c::=.
$ Zc.::v ~
$ '91~~
.. $ lj 4 !<)'° -
$ So .. <>
co $ (_p~-
t:1"
$ 1s;- -
$ l ,?i&o "'~
Invitation For Bid IFS Number 04A5359
Page 1of 2
TOTAL (Estimated Quantity X Unit Price \
~o
$ ~ l I S"(:)o -
& 0 0 $ o,ooo ~
$ I z._01 o~ ~.,
$°It, SOo~0
$ /001 0oo~
cKJ
$ / q <;;1 ooo -
$ i~ c;-Cb ~ (
•·o s 10,oco -
s 91~~o~ I
$ I, S-00~
t>o $ 'Z{ ( 000-
12 10 Each Traffic Control s r, s <g o ~ Single lane closure per day
Traffic Control ..,
13 5 Each Mul ti lane closure per day s i
14-S-O
14 50 Each Crane $ 2 l..O<:> ~ Per day
' Grubbing vegetat ion around identified Trcc(s), \);:)
15 2000 Each ten ( IO' ) radius. $ loo -
$ ico ~ Cert ified Tree Arborist Evaluat ion 16 50 Each Per Shift
$ ioo~ 17 20 Each Ccnificd "Master" Arborist Eva luation Per sh ift
Ccrti lied Orn ithologist for Tree Task Order $ 1~~ 18 800 Each evaluation (for the Migratory Treaty Act. )
(I l THE ABOVE QUANTITIES ARE ESTIMATES ONLY AND ARE GIVEN AS A BASIS FOR COMPARISON OF BIDS. NO GUARANTEE JS MADE OR IMPLIED AS TO THE EXACT QUANTITY Tl I/\ TWILL BE NEEDED.
(2) IN CASE OF DISCREPANCY BETWEEN THE UN IT PRICE AND THE TOTAL SET FO RTH FOR A UNIT BASIS ITEM, THE TOTAL Tlll S
UNIT PRICE Sl l/\LL PREY /\IL. PROPOSAL
(3) PLEASE DO NOT ALTER, MODffY, OR CHANGE TH E BID PROPOSAL SHEET. ANY ALTERATIONS, MODfflCATIONS. OR CHANGES TO Tl-llS 131D PROPOSAL SHEET WILL BE GROUNDS TO REJECT TH E BID.
(4) EACH LI NE ITEM MUST BE BID. PLEASE DO NOT LEAVE ANY UNIT PRJCE COLUMN BLANK OR TH IS BID PROPOSAL Sll EET WILL BE DISQUALIFIED FROM COMPETITION FOR CONTRACT/\ WARD.
(5) LINE ITEMS ARE AS DESCRIBEDN IN SCOPE OF WORK FOUN D IN THE PROPOSED FORM OF AGREEMENT, ATTACHMENT 12,.
(6) TllE SYMBOL " EQUALS INCHES IN MEASUREMENT /\ND Tll E SYMBOL· EQUA LS FEET IN MEAS UREMENT.
Invitation For Bid IFB Number 04A5359
Page 2of2
s Is 18'00 ~
-, "2....S-0 ~ S I
G I..>
$ 110,0ao -
CX:>
$ Z.ao / o:o , -
b e
$ s,oo-c -
s f &1 ODD '"'"' -
s LJ,01
o oo u v -
$1, (fo), 400 ~
State of California-Department of General Services, Procurement Division GSPD-05-105 (REV 08/09)
Attachment 2
BIDDER DECLARATION
1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form):
Invitation for Bid IFB Number 04A5359
Page I of2
Solicitation Number 0 ci A S- ~S-4
a. Ident ify current California certification(s) (MB, SB, NVSA, DVBE): ~g or None 0_ (lf "None·; go to Item #2)
b. Will subcontractors be used for this contract? Yes~ No D (If yes, indicate the distinct element of work your firm wi ll perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, identify which solicit d services your firm will perform, etc.). Use additional sheets, as necessary.
~ ~ h ~
c. If you are a California certified DVBE: (1 ) Are you a broker or agent? Yes D Nojg]_ (2) If the contract includes equipment rental, does ~r cop:w,any own at least 5 1 % of the equipment provided in this contract (quantity and value)? Yes jAl No LJ N/A D
2. If no subcontractors w ill be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary):
Subcontractor Name, Contact Person, Subcontractor Address CA Certification (MB, SB, Work performed or goods provided Corresponding Good 51% Phone Number & Fax Number & Email Address NVSA, DVBE or None} for this contract % of bid price Standing? Rental?
bV P.Je- <;µpf/If-~ °t sttz 7~h>ut-Gr. [1J [ill N c;;:t-vio."1 U ec.11 u- ~s--1.)1.\lL. 1 CA q o·~ix- -Su~\~ 7 equ:~rn~ C?°lo CJfv -~&- z.'1 s.?
N c:.\R..c.. v ~ €. c).. v bt.. s~~~ s~~ ~ \~~s . ~\t'S.(.})IV\ ,_
~ @] Sq,~ c:vv.. L I CA ~orve CrCJVc <e.I\~( W:i.«-a-
'19:>t/l.. .S 010
5\0 - l)S--lO '3/
Hz:~.ttvv uo i....)e_ 61.u t} s ~~ bl- iJ . 8J t-J
fv\ll.W..,l~ \\~'1.~o-r~ 1 ~ °'-uS-tl)
NO(')'G° CftAtJ~ ~AL- c;o . 1~
510- to10-01~/ ~·~\NJ~~ V\~u. C.<>n
CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct. PageL of 3
State of California-Department of General Services, Procurement Division GSPD-05-1 OS (REV 08/09)
BIDDER DECLARATION
1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form):
Solicitation Numberc:JI A S--~ S"' '7
a. Identify current California certification(s) (MB, SB, NVSA, DVBE): 5l3. or None Q (If "None'; go to Item #2)
b. Will subcontractors be used for this contract? Yes 0 No D (If yes, indicate the distinct element of work your fi rm will perform in this contract e.g., list t he proposed products produced by your firm, state if your firm owns the t ransportation vehicles that will deliver the products to the State, identify which solicited services your firm w ill perform, etc.). Use add itional sheets, a lf r ·'
c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes 0 No~ (2) If the contract includes equipment rental, does ~r co0any own at least 51% of the equipment provided in this contract (quantity and value)? Yes No N/A 0
2. If no subcontractors wi ll be used, skip to certifi cation below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary):
Subcontractor Name, Contact Person, Subcontractor Address CA Certification (MB, SB, Work performed or goods provided Corresponding Good 51% Phone Number & Fax Number & Email Address NVSA, DVBE or None) for this contract % of bid price Standing? Rental?
~A.\.<> . '-IL/ 800 J_nd1.o\.vi~I O/".
i)·~~""~ . e"'J-"' he~o-"t [A CJi.t.J. 5'"3 S ;r.J otJG° J(~f?il- [O>"\.trl)/ .3 % [] El I
A 1']p1-+-tA-e.. {1'° l::Y-1-s · N l t-5lD..,. (p) 7- 7...5t/ > M .A . t-.> . -n"" c.X:1v-y 8LJ % d~~~~ Gt-- .
Jk.,_\,, [] ~ --ro " '\ ~d-;ut-J Ml>"j"'t\ -lb H, (A '1 ~cB I t-}Ol..:>~ 1~6 J..i.og - 19 g 7 - 100£.._
Lt..~ V\ w-iA L. lA (p({{ s 6f-\-. ~ V>i· 1J Ii k iSi j <>J, SI)
Q::(c..~ CA Ot...+~l:P/ f...) 010~ . s .. ,I) IT] ~ I
CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct.
Page-Z. of~
State of California-Department of General Services. Procurement Division GSPD-05- 105 (REV 08/09)
Solicitation Num ber 04 A S- 3 ) C\
BIDDER DECLARATION
1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form):
a. Identify current California certification(s) (MB, SB, NVSA, DVBE): .S i5 or None _0_ (If "None'; go to Item #2)
b. Will subcontractors be used for this contract? Yes~ No D (I f yes, indicate the distinct element of work your firm will perform in this contract e.g., l ist the proposed products produced by your firm, state if you r firm owns the transportation vehicles that will de liver the products to the State, identify which solicited services your firm wi ll perform, etc.). Use additional sheets, as necessary. ' f rh =r-r~~ -s-er~,\:'£ , remoVtt \$,. -ycv<.N1'v1j , sfi4mp remoVttlJ arbac1c repo ~
c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes 0 No~ (2) If the contract includes equipment rental, does .®Jr co0any own at least 51 % of the equipment provided in this contract (quantity and va lue)? Yes No N/A D
2. If no subcontractors w ill be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary):
Subcontractor Name, Contact Person, Subcontractor Address CA Certification (MB, SB, Work performed or goods provided Corresponding Good 51% Phone Number & Fax Number & Email Address NVSA, DVBE or None) for this contract % of bid price Standing? Rental?
CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct.
Pages of ~
. \ ttachnll:nt 11
5TATE OF CAI IFORNIA - OEPARTMfN'"" OF GENE.RA, SERVICES P~OCURCMEN7 DIVISION
DISABLED VETERAN BUSINESS ENTERPRISE DECLARATIONS SIO. S43 (Ru, . 5i2006J
Im tt:nion for B1<l ffB \umbN IVl.-\5359
?ai;\' I ol 1
ln$trucu ons: The d1s;:mled ~elernn (OV\ owner{s) •md DV milnnger(.;) of the D 1sa o1ed Veteran Business Enrerpnsf: (DVBE:) must complete l hLc; neclarat1cn when .'l DVBE. contractor or :;vbcontractor will provide materials. supplies, St!rvice::. or r:qv1pmon1 (Military and l/c!erans Code Soclion 999.2) l/:olallons a rc misdemeanors and pumsnoblc by 1mpnsonmo11l or fine ard violators aro habte for c1v1l penalties. AU signature$ are maae under oenaJty of peaury
APPLIES TO ALL DVBEs. Cheek only £1.ll.! boll in Section 2 and provide original signatures.
[19. I (we ) oedaro lh31 the D,VaF 1s not a b_r<>kercr agent. as definod 1n M1llHl'Y s nd V P.lercins Code s~c:tton 999.2 (b). of materials. suppl.cs. sorv1cas or equipment hstod ;ibove Also. complete sectror1 3 below 1i renting equ1pmon:.
[j Pursuanl to Military <ind Vtllcr.1ns Cooe Section 999.2 tfl. l !we) declare thar tht:l OVBE .~a broker or agol}t for 1h1:1_ pnr.c1pal{s) lis1Art t~low or on ::in att~h<?d <;ha11!1s t. (Purliv<lnt to Military oncl Veterans Code 999.2 fo). Stale f:mds exoendc:d for equrpmuni ctmted from ~qu1pment brokers pursuant to con/r;icts awardr:1d under this soctmn :;hall nqJ ba credited ICJwilrd the 3-porccnt DVB£ p<irt1c1patio11 gov1.J
All DV owners and managors ::ii ltie DVBE (3tt~c h Addlllonal P-'!il~s with ou~iant al9n
~l±Aw C. k~ufCiL ·=>r:r;o~ N:)rfr6 er J 1l o~,,.~'·'M.)r.1"]or1
i=1 rr-i/P,.,ncq.Ja l IC! whom rho DVBE is acl !'lg 135 a brokt)r or .agent. ~ moro -:nan .01h.: !111r. 41 :>:"" e,_;r.l '.~·ftO . ..,.
Flml1Prmr;1oal Phone·
Sf:CTION 3
APPLIES TO ALL OVBEs THAT RENT EQU IPMENT~ DECLARE THE OVBE IS NOT A. BROKER.
10a1& S1gnou)
0 Pur!;uant to Military nnd Veterans Cort~ Se<:lion 999 2 \::J. (Cl <tnt1 {[]).I am (v.e ar~} tne DV1s1w1tn al le;;ii;t 51°m ownership of trw DVBE . or a DV rnananer(s} of the DVBE. Tl"I& DVBE mninlo1n\i cortJlicat10'1 re<iwemenrn 1r acc:orcance wiin M11il;)ry .ind Ve:ternns Code Section 999 et. Seq
0 The undersigned ovmeris) own1s) <1t fr ;<1st 51% of the gu:innr:v ana VAlul:l of e:icn_p1C'!cn of ~gu 1.12mont th<tl ·.v•ll oc rented for use in the con1ract 1dcnliiied above. I lwvl. the DV cwncrs of the CQu pment. have sut.nnitted to lho ndmin1sttlnn9 agency my 'our) personal federal tax retum(s) a! tim~ ot cemficat1on and <1nnually thereaf\er as defined •n MiliU1fl/ and Voror.1ns Code 999.2 subsections (c) :md (g). Fa1J11re by !fie a1SE1t>lect wJtoran 13qwpment owncr(s} to submit :ne1r pcrsondl fCJdurrll f<1x retum(S) to me admin;srenng agoncy as defined m Military and Veterans Cooe 999.2. subscc11ons (c) .inrt (f]}. 1v11/ rcs111t 1n tho DVB£ berng deemed an equipmenl bf(}k~r
Disabled Veteran Owr.er(s i of the DV6E !>.11.ach 11dd111ona1 pay"" witn 11gnai..n1 bl0<:k~ <or aaeh pc~ to "9fl).
! C.~~tur<:-
IJ1~abled Veteran Managcr~S) of the DVSE l~naeh ~dt1111an~1 pasr-es with su!lle1om 11ona1ur• blocks tor e~ch pet~on lo .,9nr.
DVBE Suppliers Resale Permit 102-529882 Nathan Cleaver 9362 Parkstone Circle Roseville, CA 95747
