2020/04/15 Elecnor Belco Electric, Inc. CIP16-07 Citywide Traffic Signal Communications (West) DocuSign Envelope ID:C27036FA-EB34-453F-ADC5-5B738A9D660C
CITY OF MENIFEE BID AND CONTRACT DOCUMENTS
OWNER-CONTRACTOR AGREEMENT
CIP 16-07 CITYWIDE TRAFFIC SIGNAL COMMUNICATIONS (WEST)
This Owner-Contractor Agreement ("Agreement") is made and entered into for the above
referenced Project by and between the City of Menifee ("Agency"), and ELECNOR BELCO
ELECTRIC, INC ("Contractor"), whose principal business address is 14320 ALBERS WAY,
CHINO, CA 91710 on the 15th day of April 2020.
In consideration of the mutual covenants and agreements set forth herein, the Agency and
Contractor have mutually agreed as follows:
1. CONSTRUCTION
The Contractor agrees to do all the Work and furnish all the labor, services, materials and
equipment necessary to construct and complete the Project in accordance with the Contract
Documents (as hereinafter defined), including all work, labor, services, materials and equipment
described and reasonably inferable from documents enumerated in Exhibit "A" attached hereto
and incorporated herein by reference(such construction and furnishing of labor, service,materials
and equipment hereinafter referred to as the"Work")in a good worker-like and substantial manner
and to the satisfaction of the Agency, in connection with the CIP 16-07 CITYWIDE TRAFFIC
SIGNAL COMMUNICATIONS(WEST)to be constructed at the Specific project site locations
within in the City of Menifee, California. The term Contract Documents shall mean this
Agreement,and all of the items enumerated in Exhibit"A"and all change orders or addenda issued
by the Agency with respect thereto. Agency must consent in writing to any changes in the scope
of Work. Exhibit "A" shall be deemed revised in accordance with any revisions for which
Agency's consent has been issued. Any revisions to the scope of Work for which Agency's
consent has not been issued shall be null and void.
2. CONTRACT PRICE
Agency hereby agrees to pay and the Contractor agrees to accept as full compensation for all Work
performed in accordance with these Contract Documents the Contract Price as set forth in Exhibit
"B", Contract Price, attached hereto and incorporated herein by reference. Payments to the
Contractor shall be made in the manner described in the Special Provisions.
3. TIME FOR PERFORMANCE
Time is of the essence in the performance of Work for this Agreement and all timing requirements
shall be strictly adhered to unless otherwise modified by the Agency in accordance with these Bid
and Contract Documents.
The Contractor shall complete the Work in every detail to the satisfaction of the Agency,exclusive
of maintenance periods, within the specified duration set forth in the Notice to Proceed.
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4. DELAYS AND EXTENSIONS OF TIME
See Section 6-6 of the Special Provisions.
5. LABOR CODE REQUIREMENTS
Pursuant to Labor Code Section 1771.1, the Contractor and all subcontractors shall be registered
with the Department of Industrial Relations. Pursuant to Labor Code Section 1771.4, the
Contractor is hereby notified that this Project is subject to compliance monitoring and enforcement
by the Department of Industrial Relations. [EFFECTIVE APRIL 1, 2015.]
6. NON-DISCRIMINATION
In the performance of this Agreement,the Contractor shall not refuse or fail to hire or employ any
qualified person, or bar or discharge from employment any person, or discriminate against any
person,with respect to such person's compensation,terms,conditions or privileges of employment
because of such person's race, religious status, sex or age.
7. AUTHORIZED AGENCY REPRESENTATIVES
On behalf of the Agency,the City Engineer of the City of Menifee shall be the Agency's authorized
representative in the interpretation and enforcement of all Work performed in connection with this
Agreement. The City Engineer may delegate authority in connection with this Agreement to
his/her assigned designees.
8. WORKERS' COMPENSATION INSURANCE
a) By my signature hereunder,as Contractor,I certify that I am aware of the provisions
of Section 3700 of the Labor Code, which requires every employer to be insured against liability
for Workers' Compensation or to undertake self-insurance in accordance with the provisions of
that Code, and I will comply with such provisions before commencing the performance of the
Work of this Agreement.
b) The Contractor shall require each subcontractor to comply with the requirements
of Section 3700 of the Labor Code. Before commencing any Work, the Contractor shall cause
each subcontractor to execute the following certification:
"I am aware of the provisions of Section 3700 of the Labor Code, which
requires every employer to be insured against liability for worker's
compensation or to undertake self-insurance in accordance with the
provisions of that Code, and I will comply with such provisions before
commencing the performance of the Work of this Agreement."
9. ENTIRE AGREEMENT; CONFLICT
The Contract Documents comprise the entire agreement between the Agency and the Contractor
with respect to the Work. In the event of conflict between the terms of this Agreement and the bid
of the Contractor, then this Agreement shall control and nothing herein shall be considered as an
acceptance of the terms of the bid conflicting herewith.
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10. MAINTENANCE OF AGREEMENT DOCUMENTATION
Contractor shall maintain all books, documents,papers, employee time sheets, accounting records
and other evidence pertaining to costs incurred and shall make such materials available at its office
at all reasonable times during the term of this Agreement and for three (3) years from the date of
final payment under this Agreement, for inspection by Agency and copies thereof shall be
furnished to Agency if requested.
11. INDEPENDENT CONTRACTOR
At all times during the term of this Agreement, Contractor shall be an independent contractor and
shall not be an employee, agent, partner or joint venturer of the Agency. Agency shall have the
right to control Contractor insofar as the results of Contractor's services rendered pursuant to this
Agreement; however, Agency shall not have the right to control the means by which Contractor
accomplishes such services.
12. LICENSES AND PERMITS
Contractor represents and declares to Agency that it has all licenses, permits, qualifications and
approvals of whatever nature which are legally required to practice its profession. Contractor
represents and warrants to Agency that Contractor shall, at its sole cost and expense,keep in effect
at all times during the term of this Agreement, any licenses, permits, qualifications or approvals
which are legally required for Contractor to practice its profession.
13. GOVERNING LAW, VENUE
This Agreement and the Contract Documents shall be construed under and in accordance with the
laws of the State of California,and the appropriate venue for any action or proceeding arising from
this Agreement and/or the Contract Documents shall be had in the Superior Court of Riverside,
Temecula Branch
14. COUNTERPARTS
This Agreement may be executed in any number of counterparts, each of which shall for all
purposes be deemed to be an original.
15. FALSE CLAIMS
Contractor acknowledges that if a false claim is submitted to the Agency, it may be considered
fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that the
False Claims Act,California Government Code sections 12650,et seq.,provides for civil penalties
where a person knowingly submits a false claim to a public entity. These provisions include within
their scope false claims made with deliberate ignorance of the false information or in reckless
disregard of the truth or falsity of the information. In the event the Agency seeks to recover
penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including
attorneys' fees. Contractor hereby acknowledges that the filing of a false claim may the Contractor
to an administrative debarment proceeding wherein Contractor may be prevented from further
bidding on public contracts for a period of up to five (5) years.
I have read and understood all of the provisions of this Section 15, above:
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(Initial) (Ini ial)
16. AGREEMENT MODIFICATION
This Agreement and the Contract Documents may not be modified orally or in any manner other
than by an amendment in writing and signed by the Agency and the Contractor.
IN WITNESS WHEREOF this Agreement is executed as of the date first written above.
AGENCY: CONTRACTOR:
City of Menifee
DocuSigned by: tbwa:::5-�
By QV*�,j a. V(� By. Name: Alb9 to Garcia,
1' d'i&d46?Villa, City Manager Its: Preside C
APPROVED AS TO FORM: By:
DocuSigned by: me: ]ero l a
By Its: Chief' i� ncial Ofi:} er
9
°Celching, City Attorney
ATTEST:
B
DocuSigned by: 041006
f
asra 9, A4,4 . M- Contractor's City Business License No.
a "A221' hwaring, City Clerk
738518, Class A
State Contractor License No. & Class
14320 ALBERS WAY
Street Address
CHINO, CA 91710
City, State, Zip Code
[NOTE: In the event the Contractor is a Corporation,the signatures of two separate
persons holding different offices must be provided.]
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EXHIBIT A
CONTRACT DOCUMENTS
Owner-Contractor Agreement
Bid Schedule
Addenda
Plans
Special Provisions (Specifications)
Standard Specifications for Public Works Construction and Regional Supplements
State Standard Specifications
State Standard Plans
Permits issued by jurisdictional regulatory agencies
Electric, gas, telephone, and cable television company specifications and standards
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EXHIBIT B
CONTRACT PRICE
Four Hundred Twelve Thousand Six Hundred Five Dollars and Zero Cents ($412,700.00)
The Contract Price for performing all Work described in the Contract Documents, including labor,
materials, services and equipment is the total amount of all lump sum items and of all unit price
sums,determined by multiplying the unit price for each item times the actual quantity of each such
item, as determined by the Agency.
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APPENDIX 1
BID PROPOSAL DOCUMENTS
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The undersigned hereby proposes to furnish any and all labor,materials,and equipment for the
CITYWIDE TRAFFIC SIGNAL COMMUNICATION (WEST) - HS1P 7, C1P NO. 16-07, FEDERAL
PROJECT NO,HSIPL-5483(003),and appurtenant work in connection therewith,said work to be
done and materials to be furnished in strict conformity with the plans, specifications, all other
referenced documents and all codes and regulations the prices shown on this proposal.
The undersigned has examined the location of the proposed work,and is familiar with the plans
and specifications and the local conditions at the place the work is to be done, and also
understands that the project will be completely constructed in turn-key condition acceptable to
the Owner be for the price of the proposal,including all fees and sales tax upon any materials
so furnished. The undersigned has also carefully checked all of the figures given and
understands that the Owner will be responsible for any errors or omissions on the part of the
undersigned in submitting this proposal.
The Contractor confirms that his/her bid is submitted with respect to the changes to the
contract included in all addenda issued by the Owner.
Receipt is hereby acknowledged of Addenda No.(s) 1
The undersigned has examined the current State of California schedule of prevailing wage rates
for the types of work to be done on this project and agrees to pay not less than these rates.
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City of Menifee
CIP 16-07: Citywide Traffic Signal Communications(West) MENIFEE
Addendum #1 (02/07/2020� New.Better.Best.
The following modifications/cloriflcalions are made to the Notice Inviting Bids.
Notice Inviting Bids:On the second page,7h paragraph:
"This is a prevailing wage project under the laws of the State of California and the
Federal Davis-Bacon Act. In addition a Disadvantage Business Enterprise(DBE)
requirement of 12%minimum has been established for this project."
Replace with:
"This is a prevailing wage project under the laws of the State of California and the Federal
Davis-Bacon Act.In addition a Disadvantage Business Enterprise(DBE)requirement of
11%minimum has been established for this project."
Thank you,
L-•l
Carlos E.Geronimo,PE
Principal Engineer
John Wong
lecnor elco Electric,Inc.
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BID SCHEDULE
BID EST.
ITEM DESCRIPTION CITY UNIT UNIT PRICE
NO.
1 Mobilization(Max 5%of bid amount) 1 L5 U o 00 5f G o o•U U
2 Traffic Control 1 LS l� GoCj" 0 U L�1 OU(?-f10
3 Remove Existing Components Per Plan 1 L5 f UUCJ, GU � I 11 U_00
Furnish and Install 333-JP controller cabinet on
4 existing foundation complete and relocate all 2 EA O!, LfLf I Q(j .06
existingwire. V
5 Furnish and Install 2070 ATC Controller 22 EA rr OU
Assembl �Q Q(JQ Q l�I OW
6 Furnish and Install Fiber Field Ethernet Switch 19 EA 230,60 -L p0•a 0
7 Furnish and Install VDSL Field Ethernet Switch 5 0(),aU tUJSGO-go
8 Furnish and Install Ethernet Conflict Monitor Unit 26 EA o U 5L bbo.00
9 Furnish and Instal]Ethernet Extender 6 EA 00 7t ZO v-46
10 Furnish and Install Type 1 Radio(Price to 15 EA C)Q
5u
include bracketry and Cat6 cabling) V ��2
Furnish and Install Type 2 Radio(Price to
11 include bracket and Cat6 cabling) 1 EAcl
C)o Z,Zv�CJO
12 Furnish and Install Type 3 Radio(Price to 12 EA z(y��tUG.GO
include bracketry and Cat6 cabliin (}_
13 Furnish and Install Type 7 Radio(Price to 2 EA
include bracketry and Cat6 cabling) 1, 7U U.d
14
Furnish and Install Type 8 Radio(Price to 2 EA l(r'-[Uf!'C0
include bracketry and Cat6 cabling) 5 �]
15 Furnish and Install CCTV Camera 6 EA 71 9 oo o q"1,g00.OQ
16 Fumish and Install Video Detection Camera 4 EA q 0 cv-06
Encoder 000, U
17 Fumish and Install AC to DC Adapter 1 EA Soo Q Q SW,04
18 Fumish and Install 1.5"Sch.80 PVC Conduit 210 LF �� ��(J V•C+�
19 Furnish and Install 1.5"Rigid Metallic PVC 35 LF 60 .00Conduit r{V a C Q
1-3
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20 Furnish and Install 1"Rigid Metallic Surface 35 LF S -4�
Mounted Conduit 56,00 f 1? U
21 Furnish and Install#5 Pull Box 2 EA 500 Uo
22 Furnish and Install#S Wire 700 LF 3 oo 4/ oo o C
23 Furnish and Install 12"x 12"x B"NEMA 4 1 EA S00. �
Enclosure on Pole. 5a D•6U
24 Wireless Radio Management Software 1 AL $2,500
TOTAL tZy7l D a
TOTAL BID AMOUNT SCHEDULE(in words):
1POV r k"A J rf� 4wc t VC�o Al Oollars and Z ro Cents
In the event of a variation between the unit price and extended total,the unit price will be used
and the corrected extension will be considered as the amount bid. If the bid is illegible and
cannot be reconciled it will be considered non-responsive and will not be considered for award.
The lowest responsive bidder shall be determined by comparing sum of the base bid amount(s)
with that of all additive or alternative bids (if any) of bidders deemed by the Owner to be
responsive in all other aspects. If equal low bids are received from responsible and responsive
bidders the selection shall be made by drawing lots, or other similar random blind method
selected by the Owner. If only one responsive bid is received from a responsible bidder the
award shall not be made unless the price can be determined to be reasonable based on an
analysis by the Owner. The Owner's determination as to the reasonableness of any such bid
shall be final.
All bids received shall be recorded on an abstract(tabulation)of bids,and then made available
for public inspection.
The quantities listed in the bid proposal are provided to give a general indication of the scope of
the work and for the comparison of bids. No warranty is made, either expressed or implied,
that the actual quantities of work to be done will correspond therewith. Item numbers
followed by"(S)"are designated as specialty items.
By signing and submitting this bid the Contractor confirms that they are familiar with the work
site and all existing conditions that may affect their work and that they have read and agree to
all the terms, conditions and requirements contained or referenced herein and that all the
aforementioned has been included in the bid prices listed above including items of work that
may not have a specific pay line item and that there shall be no additional costs to the Owner.
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WARNING:if an addendum or addenda have been issued by the owner and not noted above
as being received by the bidder,this Bid may be rejected.
Complete the following:
Elecnor Belco Electric,Inc.
Legal name of the business
Business Type(Corporation,Partnership,Sole Proprietor)
MA
DBA(if any)
NIA
Name and title of the owner
John Wong,Vice President
Name and title of second partner or officer
14320 Albers Way,Chino,CA 91710
Business Address
909-993-5470
Telephone number
909-993-5476
Facsimile number
jwong@elecnor.com
Email address of primary contact
www.elecnor.com
Company web address
)4rot'
2/13/2020 211812020
Si na ure of Prime ;trfor Date Signature of Prime Contractor Date
Wong,Viceident Alberto Garcia de Los Angeles,President
Print name and title Print name and title
(if the Prime Contractor is a corporation two signatures of corporate officers are required.)
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i
i
UNANIMOUS WRITTEN CONSENT IN LIEU OF
2019 ANNUAL MEETING OF THE BOARD OF DIRECTORS
OF
ELF CNOR BELCO ELECTRIC,INC.
January 1,2019
The undersigned,being all of the members of the Board of Directors(thc"Board")of Elecnor Belco !
Electric,Inc.,a California corporation(the"Company"),in lieu of holding a meeting of the Board,hereby
take the following actions and adopt the following resolutions by unanimous written consent:
WHEREAS, the Board has determined that it is in the Company's best interests to appoint a
revised slate of Officers of the Company.
NOW,THEREFORE, UE 1T RESOLVED, that the following persons be, and hereby are,
elected to the offices set forth opposite their respective names,to hold such offices until their respective
successors are elected and qualified at or before the next annual meeting ofthe Board,or until their earlier
respective deaths,resignations or removals:
President and Chief Executive Officer Alberta Garcia De Los Angeles
Chief Financial Officer Ieroni Gervilla
Senior Vice President,General Counsel Roger Devito
and Assistant Secretary
Vice President for Construction Iohn Wong
Secretary Pedro Endle
FURTHER RESOLVED,that Alberta Garcia De Los Angeles,Jeroni Gervilla,Alberto Garcia
and Roger Devito in their respective capacities(listed above)subject to such supervisory powers of the
Board of directors,hereby are authorized and directed to perform all the duties commonly incident to that
office-,shall have authority to execute in the name of the Company contracts,leases and other written
instruments to be executed by the Company; and, shall perform such other duties as the Board of
Directors may from time to time determine.
FURTHER RESOLVED,that the President and Chief Executive Officer may delegate authority
to any Chief Financial Officer or Chief Operating Officer or Senior Vice President or Vice President as
and within their authority levels as set forth in(lie Company's Bylaws,as the same may be amended from
time to thne;
FURTHER RESOLVED, that Roger DeVito, in his capacity of Senior Vice President, is
hereby authorized and directed to:
i. Negotiate,sign,amcnd and terminate agreements in connection with the purpose of the Company,
for all contracts up to $250,000,00, and acting jointly with Alberto Garcia Dc Los Angeles or
Jeroni Gervilla for all contracts in amounts greater than$250,000.00.
2. Execute,amend and finalize bid proposals in connection with the purpose of the Company,for all
proposals up to$1,000,000.00,and acting jointly with Alberto Garcia De Los Angeles or Jeroni
Gervilla for all proposals in amounts greater than$1,000,000.00.
1
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3. Acting jointly with Alberto Garcia De Loa Angeles or Jeroni Gervilla,execute,amend and finalize
purdmse orders for materials and equipnlent ill conacction with the purpose ofthe Company.
4. Acting jointly with Alberto Garcia De Los Angeles or Jeroni Gervilla, execute, amend and
terminate agreements far the lease of real estate to be used as offices or job related temporary
yards.
5. Acting jointly with Alberto Garcia Do Los Angeles or Jeroni Gervilla, execute, amend and
terminate insurance andfor hid bonds arrangements in connaction with the purpose ofthe Company.
6. Acting jointly with Alberto Garcia Do Los Angeles or Jeroni Gervilla, hire, suspend,impose
sanctions and dismiss the adminislrntive personnel of the Company, setting forth their
employment terms and conditions,obligations and remuneration.
7. Acting jointly with Alberto Garcia De Los Angeles or Jeroni Gervilla,settle and claims on behalf
ofthe Company.
AND IT IS FURTHER RESOLVPD,that all actions heretofore taken by Elie officers of the
Company on behalf of and in the name of the Company,relating to the conduct of the business of the
Company,the expenditure of money,the making of contracts and all other acts taken or omitted in the
performance of chair duties to the Company be,and the some hereby are,in al I respects,approved,ratified
and of i nted,as ofthe date taken,done or omitted,respectively.
The actions taken by the Board Consent shall have the same force and effect as if taken by the
undersigned at a meeting ofthe Board of Dhcciors,duly called and constituted pursuant to the Bylaws of
the Company and the lows of the State of California. This Board Consent may be executed in
counterparts,each of which shall be deemed an original,but all ofwhich together shall constituteone and
the same document.
IN WITNESS WIILrREOF,the undersigned,being all oftho members ofthe Board ofbireotors
of Eleanor Relco Electric,Inc„have executed these actions by written consent as of the date first written
above.
ARamon, ctor Luis Alcibar,Director
-(V--
Alexander Arrola,Director
2
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PUBLIC CONTRACT CODE
PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT
In conformance with Public Contract Code Section 10285.1 (Chapter 376,Stats.1985),the bidder hereby
declares under penalty of perjury under the laws of the State of California that the bidder has X ,has not
been convicted
within the preceding three years of any offenses referred to in that section,including any charge of fraud,
bribery,collusion,conspiracy,or any other act in violation of any state or Federal antitrust law in
connection with the bidding upon,award of,or performance of,any public works contract,as defined in
Public Contract Code Section 1101,with any public entity,as defined in Public Contract Code Section
1100,including the Regents of the University of California or the Trustees of the California State
University. The term"bidder"is understood to include any partner,member,officer,director,responsible
managing officer,or responsible managing employee thereof,as referred to in Section 10285.1.
Note: The bidder must place a checkmark after"has"or"has not"in one of the blank spaces provided.
The above Statement is part of the Proposal. Signing this Proposal on the signature portion
thereof shall also constitute signature of this Statement.Bidders are cautioned that making a false
certification may subject the certifier to criminal prosecution.
PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE
In conformance with Public Contract Code Section 10162,the Bidder shall complete,under penalty of
perjury,the following questionnaire:
Has the bidder,any officer of the bidder,or any employee of the bidder who has a proprietary interest in
the bidder,ever been disqualified,removed,or otherwise prevented from bidding on,or completing a
federal,state,or local government project because of a violation of law or a safety regulation?
Yes No X
If the answer is yes,explain the circumstances in the following space.
PUBLIC CONTRACT CODE 10232 STATEMENT
In conformance with Public Contract Code Section 10232,the Contractor,hereby states under penalty of
perjury,that no more than one final unappealable finding of contempt of court by a federal court has been
issued against the Contractor within the immediately preceding two-year period because of the
Contractor's failure to comply with an order of a federal court which orders the Contractor to comply with
an order of the National Labor Relations Board.
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Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal
on the signature portion thereof shall also constitute signature of this Statement and
Questionnaire.
Bidders are cautioned that making a false certification may subject the certifier to
criminal prosecution.
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CERTIFICATE REGARDING CONTRACTOR'S LICENSE
1. Contractor is required to possess one of the following State Contractor's License:
State of California Class"A"and/or"C-10"Contractor's License
2. A failure to possess the required license, a failure to truthfully set forth the following
information, or a failure to execute this Certificate renders the proposal nonresponsive and
requires the City to reject the proposal.(Business and Professions Code Section 7028.15)
3. Contractor declares, under penalty of perjury, that he possesses the required
Contractor's license(s)which:
a. Bears the license number(s): 738518
b. Expires on: 7/31/21
�40zl�
211812020 2//812020
SigIatre of Ptvice-)resident
e Ctractor ❑ate Signature of Prime Contractor bate
Won Alberto Garcia de Los Angeles,President
Print name an isle Print name and tWe
(if the Prime Contractor is a corporation two signatures of corporate officers are required.)
This required license determination has been made by the Owner. Any Contractor holding a
different license who feels he is qualified to bid on this work must so advise the owner at least
seven (7) days prior to the bid opening.A review of the contemplated work will be made and
the Owner's decision as to the required license will be final.
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DEBARMENT AND SUSPENSION CERTIFICATION
TITLE 49,CODE OF FEDERAL RP.CULATIONS,PART 29
The bidder,under penalty of perjury,certifies that,except as noted below,he/she or any other
person associated therewith in the capacity of owner,partner,director,officer,manager:
• is not currently under suspension,debarment,voluntary exclusion, or determination of
ineligibility by any Federal agency;
• has not been suspended,debarred,voluntarily excluded or determined ineligible by any
Federal agency within the past 3 years;
• does not have a proposed debarment pending;and
• has not been indicted, convicted,or had a civil judgment rendered against it by a court
of competent jurisdiction in any matter involving fraud or official misconduct within the
past 3 years.
If there are any exceptions to this certification,insert the exceptions in the following space.
NIA
Exceptions will not necessarily result in denial of award, but will be considered in determining
bidder responsibility. For any exception noted above, indicate below to whom it applies,
initiating agency,and dates of action.
Age n cy:
Date 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 portion thereof shall also constitute signature of this Certification.
Contractor Signature: John Won
Title: 4.e'
resident
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NONLOBBYING CERTIFICATION
FOR FEDERAL-AID CONTRACTS
The prospective participant certifies,by signing and submitting this bid or proposal,to the best of his or her
knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any
person for influencing or attempting to influence an officer or employee of any Federal agency,a Member
of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection
with the awarding of any 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 cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any Federal agency,a Member of
Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with
this Federal contract,grant,loan,or cooperative agreement,the undersigned shall complete and submit
Standard Form-LLL,"Disclosure of Lobbying Activities,"in conformance with its instructions.
This certification is a material representation of fact upon which reliance was placed when this transaction was made
or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed
by Section 1352,Title 31,U.S.Code. Any person who fails to file the required certification shall be subject to a
civil penalty of not less than S 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 she shall require that the
language of this certification be included in a[I lower tier subcontracts,which exceed 5100,000 and that all such
subreeipients shall certify and disclose accordingly.
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DISCLOSURE OF LOBBYING ACTIVITIES
COMPLETE THIS FORM TO DISCLOSr LORRYINO AC11VITILS PURSUANT TO 31 U.S C.1352
1. Type of Federal Action: 2. Status of Federal 3. Report Type-
Action-
contract a.bid/offer/application r7 a.initial
b. ant b. initial award b_ material change
C. co crative agreement c. post-award
d_ loan For Material Chan Only:
C. loan gu tce year q er
f loan incur cc date oflast r ort
4. Name and Ad ss of Reporting Entity 5. If Reporting Entity in No.4 is bswardee,
Enter Name and Address of P ime:
Prime Subawardee
Tier ,ifknown
Congressional District,if known Congressional D' rict,ifknown
6. Federal DepartmentlAgency: 7. Federal Pragr m Name/Description:
CFDA mber,if applicable
S. Federal Action Number,ifknowm 9. Awn Amount,if known:
10, a. Name and Address of Lobby Entity dividuals Performing Services (including
(If individual,last name,firs[name,MI) a ass if different from No,lila)
(last me,first name,MI)
(attach Continu on Sheet(s)ifoccess )
11. Amount of Payment(check all that apply) 13. Type of Ps ant(check all that apply)
S actual ❑pla ed a. retaincr
b. one-lime
12, Form of Payment(check all that ap y): C. commission
Ba. cash d. contingent fee
b- in-kind, specify; not c e deferred
uc f. other,specify
14. Brief Description of Serv'as Performed or to he performed and Datc(s)of Service,including
offtcer(s),employee(%), member(s)contacted,for Payment Indicated in Item 11:
(attach Continuation Sheet(s)ifnecessary)
15. Continuation eet(s)attached: Yes ❑ No
l6, tnformation stud Through this form is authorized by
'title 31 U.S. .Section 1352.This disclusure orluhbying Signature'.
reliance placed by the tier above when his transaction
was mad r entered into. This disclosure is required 9
pursue to 31 U-S-C.1352.This information will be Print Nara �O
.111, d to Congress semiannually and will be available for Presiden
pu c inspection Any person who Fails to file the required Title:
losurc shall be subject to a civil penalty of not less than
I0,000 and not more than$100,000 for each such failure Telephone No. 909-993-5470 Date:2/18I2020
Authorized for Local Reproduction
ederal Use Only: Standard Form-LLL
S1a 4,rd F, 1.1,LgqRev.09-12-97
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INSTRUCTIONS FOR COMPLETION OF SF-LLL,
DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity,whether suhawardee or prime Federal recipient,at the
initiation or receipt of covered Federal action or a material change to previous tiling pursuant to title 31 U.S.C.section
1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing
or attempting to influence an officer or employee of any agency,a Member of Congress an Officer or employee of
Congress or an employee of a Member of Congress in connection with a covered Fcderal action. Attach a continuation
sheet for additional information if the space on the form is inadequate, Complete all items that apply for both the initial
filing and material change report. Refer to the 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 and/or has been secured to influence,
the outcome of a covered Federal action.
2. Identity 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 subaward recipient. Identify[he tier of the subawardee,e.g.,the first subawardee of the prime is the first tier.
Subawards include but are not limited to subcontracts,subgrants 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 zip code of the prime Fcderal 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
level below 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 1), If known,enter the full
Catalog of Federal Domestic Assistance(CFDA)number for grants,cooperative agreements,loans and loan
commitments.
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 announcement 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 the
Federal 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 entity
identified in item 4 to influenced the covered Federal action.
(b)Enter the full names of the individual(s)pertbrming services and include full address if different from 10(a).
Enter Last Name,First Name and Middle Initial(MI).
11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity(item 4)to the
lobbying entity(item 10). Indicate whether the payment has been made(actual)or will be made(planned),
Check all boxes that apply. If this is a material change report,enter the cumulative amount of payment made or
planned to be made.
12. Check the appropriate box. 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. Check all boxes that apply. lfather,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
in actual 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.
15. Check whether or not a continuation shect(s)is attached.
16, The certifying official shall sign and date the form,print hislher name title and telephone number.
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Public reporting burden for this collection of information is estimated to average 30 minutos per response,including time
for reviewing instruction,searching existing data sources,gathering and maintaining the data needed,and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this
collection of information,including suggestions for reducing this burden,to the Office of Management and Budget,
Paperwork Reduction Project(0348-0046),Washington,D.C.20503.
SF-I. lrsin i— Rr Vv4--AaENDIFn
1-13
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BID SECURITY FORM FOR CHECK
NU I t: I HE FULLOWIN6 FURM SHALL BE USED IN THE CASE OF CHECK ACCOMPANYING BID
Accompanying this proposal is a Certified Check or Cashiers Check payable to the order of the
City of Menifee,hereinafter referred to as"Owner",for
dollars($ ),this
amount being 10 percent(10%)of the total amount of the bid.This check shall be returned to
the undersigned only if either of the following occur:
A. if said Bid shall be rejected by the Owner,or,in the alternate
B. if said Bid shall be accepted by the Owner and the Undersigned shall execute and
deliver a Contract in the form attached hereto(properly completed in accordance with
said Bid) and shall furnish bonds required for his/her faithful performance of said
Contract and for the payment of all persons performing labor or furnishing materials in
connection therewith, and shall in all other respects perform the Contract created by
acceptance of said Bid;otherwise,said check shall become the property of the Owner.
Said check shall also become the property of the Owner if the Undersigned shall withdraw
his/her bid within the period of sixty (60) calendar days after the date set for the opening
thereof, unless otherwise required by law, and notwithstanding the award of the Contract to
another bidder.
Signature of Prime Contractor Date Signature of Prime Contractor Date
Print name and title Print name and title
(If the Prime Contractor is a corporation,two signatures of corporate officers are required.)
1-14
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BID SECURITY FORM FOR BOND
KNOW ALL MEN BY THESE PRESENTS
That we Elecnur Aelco Electric,Inc. as
Principal,and Fidelit and Deposit Cont any of Maryland as surety,
are held and firmly bound unto CITY OF MENIFEE hereinafter called the"Owner"in the penal
sum of TEN PERCENT(10%)OF THE TOTAL AMOUNT OF THE BID or the principal above named,
submitted by said Principal to the County for the work described below, for the payment of
which sum in lawful money of the United States,well and truly to be made,we bind ourselves,
our heirs, executors, administrators and successors, jointly and severally, firmly by these
presents.
In no case shall the liability of the surety hereunder exceed the sum of$ 10%of Amount laid
THE.CONDITION OF THIS OBLIGATION IS SUCH,
That whereas the Principal has submitted the above mentioned bid to the Owner for
certain construction specifically described as follows, for which bids are to be opened on the
27th day of February_ ,20 00,for
CITYWIDE TRAFFIC SIGNAL COMMUNICATION(WEST)-NSIP 7,C1P NO.16-07
Federal Project No.HS1PL 54831003)
NOW, THEREFORE, IF the aforesaid principal shall not withdraw said bid within the period
specified therein after the opening of the same, or, if no period be specified, with sixty (60)
days after said opening, and shall within the period specified therefore, or, if no period be
specified, within ten (10) days after the prescribed forms are presented to him for signature,
enter into a written contract with the Owner in the prescribed form,in accordance with the bid
as accepted,and file the two bonds with the Owner,one to guarantee faithful performance and
the other to guarantee payment for labor and materials,as required by law,then this obligation
shall be null and void;otherwise it shall be and remain in full force and virtue.
In the event suit is brought upon this bond by the Owner and judgment is recovered,the surety
shall pay all costs incurred bythe Owner in such suit,including a reasonable attorney's fee to be
fixed by the Court.
IN WITNESS WHEREOF, we have hereunto set our hands and seals on this 19th day
go, 12020,
lactric,Lx. (SEAL)Fidelity and Deposit Company ofMaryland(SEAL)
(SEAL)
r Donna M,Planeta,Attorney-in-Fact
1-15
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT Civil Code§ 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached,and not the truthfullness,accuracy or validity of that document.
State of Nta
County of&Y1 &_V-W l Vl -
On 0 2fnd before me, t lsa Notary Public
o.a Na and rdwa awry
personally appeared Jahn w �
uanw one ar Namas of 5ipnm�
Who proved to me on the basis of satisfactory evidence
to be the persona whose nameA�e subscribed
to the within instrument and a owledged to me that
tt lill executed the same iM' �rltt�eir authorized
paat�i I and that by h�Itl)�signature<on the
instrument the person or the entity upon behalf of EL}SA BETH LIM
which the person,�Wacted, executed the instrument. Commlasbn No. 22$1937
I certify under PENALTY OF PERJURY under the laws of � NTARY�wuwo�w o
the State of California that the foregoing paragraph is truep{y Conxa-Eep nsAA►liGti 21.1a28�
and correct.
Witness my hand aide
Signature I
Notary PaW 6jna1_ Place Notary P.M.seal AL-
OPTIONAL
Though the information below is not required bylaw,it may prove valuable to the persons relying on the document and could prevent fraudulent removal
and reattachment of this fort to another document.
Description of Attached Document F r ` /n�� J
Title or Type of Document. lid � `vI12nIT�R.. 6,1� &YJ
Document Date Number of Pages:
Signer's Name:
❑ Individual ❑Individual
❑Corporate Officer—Title(s): ❑Corporate Officer—Title(s):
❑ Partner-❑Limited❑General ❑Partner-❑Limited❑General
❑ Guardian or Conservator Toe of thumb ❑Guardian or Conservator Top of Rwmb
❑Attorney-in-Fact ❑Attorney-in-Fact
❑Trustee ❑Trustee
❑Other: ❑Other:
Signer is representing Signer is representing
290/031858-0008
7645681.2 a00/00/00 Page 25
BID SECURITY FORM FOR BOND
ATTORNEY-IN-FACT ACKNOWLEDGEMENT OF SURETY
STATE OF CT )
ss
COUNTY OF Hartford )
On this day 19th of February 2020
. 20M, before me, the undersigned, a Notary
Public in and for said County and State, personally appeared
Danna M.Planeta known to me to be the person whose
name is subscribed to the within instrument as the attorney-in-fact of the
Fidelity and Deposit Company of Maryland ,the corporation named as Surety in said
instrument,and acknowledged to me that he subscribed the name of said corporation thereto
as Surety,and his awn name as attorney-in-fact.
NOTE:Signature of those executing for NOTE:The Attorney-in-fact must attach a
Surety must be properly certified copy of the Power of
acknowledged. Attorney.
Signature:
Name(Type or Print): Danielle D.Johnson
Notary Public in and for said County and State DANIELLE D.JOHNSON
WOTARY PUBLIC-CT 175556
:v MMMiSSiON EXPIRES JAN.9t,2028
My Commission expires: 1/31/2023
1-16
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ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNUW ALL MEN BY THESE FRhShN'1'S:'Ihat the ZURICH AMERICAN iNSURANCE CUMPANY,a corporation of the State of New
York,the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY,a corporation of the State of Illinois,and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois(herein collectively called the"Companies"),by
Robert D.Murray,Vice President,in pursuance of authority granted by Article V,Section 8,of the Hy-Laws of said Companies,which arc
set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof,do hereby nominate,constitute,
and appoint, Donna M. PLANETA, Joshua SANFORD, Aimee R. PERONDINE, Danielle D. JOHNSON,
Michelle Anne MCMAHON,Bethany STEVENSON,Bryan M.CANESCHT,Kristopher PISANO,Rebecca
M.STEVENSON,Nicholas TURECAMO and Tanya NGUYEN,all of Hartford,Connecticut,EACH,its true and
lawful agent and Attorney-in-Fact,to make,execute,seal and deliver,for,and on its behalf as surety,and as its act and deed: any and all
bonds and underlaldngs,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said
Companies,as fully and amply,to all intents and purposes,as if they bad been duly executed and acknowledged by the regularly elected
officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York.,the regularly elected officers of the
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills,Maryland.,and the regularly elected
officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland.,in their own proper
persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V.Section 8,of
the By-Laws of said Companies,and is now in force.
IN WITNESS WHEREOF,the said Vice-Preaident has hereunto subseribcd hislber names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 4th day of October,A.D.2019.
�'r +-•>},' -o Oil
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By, Robert D.Murray
Yice President
By: Dawn E.Brawn
Secretary
State of Maryland
County of Baltimore
On this 4th day of October, A.D.2019, before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,Robert D.
Murray,Vice President and Dawn E,Hrown,Secretary of the Companies,to me personally known to be the individuals and officers described in and wbo
executed the pmecding instrument.and acknowledged the execution of same,and being by me duty sworn,deposeth and saith,that he/she is the said officer of
the Company aforesaid,and tbat the seals affixed to the preceding instrument an the Corporate Seals of said Companies,and that the said Corporate Seals and
the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations.
W TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Scat the day and year first above written.
Constance A.Dunn,Notary Public
My Commission Fxpires:July 9,2023
290/031858-0008
7645681.2 a00/00/00 Page 27
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V,Section 8,Attornc4-in-Fact. The Chief Executive Officer,the President,or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies,
recognizances,stipulations,undertakings,or other like instruments on behalf of the Company,and may authorize any officer or any such
attomey-in-fact to affix the corporate scat thereto;and may with or without cause modify of revoke any such appointment or authority at any
lime."
CERTIFICATE
1, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY,and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND,do hereby certify that the
foregoing Power of Attomey is still in full force and effect on the date of this certificate;and I do further certify that Article V,Section 8,of
the By-Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1999.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company maybe affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may he signed by facsimile under and by authority of the fallowing resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May,1994,and the following resolution of the Beard of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the l Oth day of May,1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice-President,Secretary,or Assistant Secretary of the Company,whether made heretofore or hereafter,wherever appearing upon a
certif ed copy of any power of attomey issued by the Company,shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this kcOl day
rysu,y '
Brian M.Hodges,Vice President
TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT A COMPLETE DESCRIPTION
OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND,THE BOND NUMBER,AND YOUR CONTACT
INFORMATION TO;
Zurich Surety Claims
1299 Zurich Way
Schaumburg,IL 60196.1056
wwRv.rc ltsfclaiins(u)zurichna.com
800-6264577
290/031858-0008
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NON-COLLUSION AFFIDAVIT
The undersigned,in submitting a bid for performing the following work by Contract,being duly
sworn,deposes and states:
That he/she has not, either directly or indirectly, entered into any agreement, participated in
any collusion,or otherwise taken any action in restraint of free competitive bidding and has not
accepted any deposit from any Subcontractor or Materialman through and bid depositary,the
bylaws, rules and regulations of which prohibit or prevent the Contractor from considering any
bid from any Subcontractor or Materialman, which is not processed through said bid
depository,of which prevent any Subcontractor or Materialman from bidding to any Contractor
who does not use the facilities or accept bids from or through such bid depositary in connection
with this o tract
4e��
2/18/2020 2/18/2020
Sign to a of Pr me ontractor Date Signature of Prime Contractor Date
3 Won ,Vic President Alberto Garcia de Los Angeles,President
Print name and tiffe Print name and title
(if the Prime Contractor is o corporation two signatures of corporate officers are required.)
14320 Albers Way,Chino CA 91710
Business address
Rowland Heights
Place of residence
Subscribed and sworn to before me this 19At "l day off c
Notary Public in and for the County of Ir't.mo
State of Njfty 1)6k,
(NOTE:AFFIDAVIT MUST BE ATTACHED TO BIDDER'S PROPOSAL)
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JURAT
A notary public or other officer completing this certificate verifies only the identity of
the individual who signed the document to which this certificate is attached, and not
the truthfulness, accuracy, or validity of that document.
State of California
County of San Bernardino
Subscribed and sworn to(or affirmed)before me on this 18th day of February
2020 by John Wong and Alberto Garcia de los Angeles
proved to me on the basis of satisfactory evidence to be the persons)who appeared
before me.
Ei SETH UM
commw4 n No. 2"1939
NorMv vuw c4ALtpom"
say sE1iNARD11140 CAt1MTr
Sig Ai Q (Sea) My Comm expire MMCH 21,2023
OPTIONAL INFORMATION INSTRUCTIONS
The wading of alr Jurafs completed in California after January 1,2015 must be in the
farm as set forth within Ibis Jwat.There are no excepfi'ons.If a Jurat to be ctimpiated
does not follow this form,the notary must conic?than verbiage by using a NMI stamp
containing fhe correct wording or allwtdng a separate jural form such as this one with
does contain the proper wording. In addition, the notary most require an oath or
DESCRIPTION OF THE ATTACHED DOCUMENT alftrmalfon kom the document signer regerdng the truthfulness of the contents of the
documem The documenf must be signed AFTER the oath or aNrmauon If the document
City of Menifee-Non-Collusion Affidavit was previously signed,it must be resigned in konf of the notary pobhic during the/oral
(Tile or description of attached document) process
• State and county intormation must be the state and county where the
(Tile or description of attached document continued) document signers)personally appeared before the notary public,
• Date of notarization must be the date the signers) personally
appeared which must also be the same dale the jurat process is
completed.
Number of Pages Document Date Print the names)of the document signers)who personally appear at
the time of notarization.
• Signature of the notary public must match the signature on file with the
Additional information office of the county clerk.
• The notary seal impression must be clear and photographically
reproducible.Impression must not cover text or lines.If seal impression
smudges, re-seal if a sufficient area permits, otherwise complete a
different jurat form.
�• Addilional Information Is not required but could heip
to ensure this jurat is not misused or attached to a
different document.
Indicate title or type of attached document,number of
pages and date.
www NotaryCiasses com 806-873-9865 • Securely allach this document to the signed document with a staple.
290/031858-0008
7645681.2 a00/00/00 Page 30
CONTRACTOR'S REFERENCE LIST
Attach to this bid a list of three(3)projects in the past five(5)years on which the bidder and
his subcontractor(s) have successfully constructed and completed projects with the same type
(elements),size and complexity of work. The City Engineer will make the final determination of
whether the projects listed here are of the same type,size and complexity as this project.
Failure of bidder to supply sufficient documentation of similar electric, telephone, cable and
sanitary sewer underground facilities experience shall be considered grounds for a
non-responsive bid and,at the City's discretion,said bid will be disqualified.
Project Name: Traffic Signal Improvements on Mojave Drive at East Trail
Contract Price: $447,200 Date of Completion:_March 2018
Name,Address,and Telephone Number of Owner's Representative:
City of Victorville 14343 Civic Center Drive,Victorville,CA 92393 760-955-5000
Project Name: Traffic Signal Infrastructure Upgrades Phase III
Contract Price: P3R9 928 Date of Completion: September 2M18
Name,Address,and Telephone Number of Owner's Representative:
City of Diamond Bar 21810 Copley Drive,Diamond Bar,CA 91765 909-839-7042
Project Name: Olympiad and Felipe Road Traffic Signal Infrastructure
Contract Price:-$ 7.900 Date of Completion: September 2018
Name,Address,and Telephone Number of Owner's Representative:
City of Mission Viejo 200 Civic Center,Mission Viejo,CA 92691 949-470.3068
(Attach additional pages as necessary)
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CONTRACTOR'S CERTIFICATE OF WORKER'S COMPENSATION INSURANCE
Section 3700 of the Labor Code provides in part as follows:
"Every employer except the state shall secure the payment of compensation in one or more of
the following ways:
(a) By being insured against liability to pay compensation to one or more insurers duly
authorized to write compensation insurance in this state.
(b) By securing from the Director of Industrial Relations a certificate of consent to self-insure,
which may be given upon furnishing proof satisfactory to the Director of Industrial Relations
of ability to self-insure and to pay any compensation that may become due to his
employees.
am aware of the provisions of Section 3700 of the Labor Code, which require every employer
to be insured against liability for worker's compensation or to undertake self-insurance in
accordance with the provisions of that code, and I will comply with such provisions before
commencing the performance of the work of this contract. I further certify that if I should
contract or subcontract with any person,including firm or company,to do all or any part of the
work for which this proposal covers, I shall assure compliance by that contractor or
subcontractor with the provisions of Section 3700 of the Labor Code,
Elecnor Belco Electric,Inc.
(Legal Name of Bidder)
By: John Won
0 Title: Vi Pre ant
(In accordance with Article 5,commencing at Section 1860,Chapter 1, Part 7,Division 2,of the
Labor Code, the above certificate must be signed and filed with the awarding body prior to
performing any work underthis contract.)
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EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION
The bidder Elecnor Belco Electric Inc. proposed
subcontractor hereby certifies that he has
X , has not 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 the
Secretary of Labor(41 CFR 60-1.7(b)(1)),and must be submitted by bidders and proposed
subcontractors only in connection with contracts and subcontracts which are subject to the equal
opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity
clause are set forth in 4t CFR 60-1.5. (Generally only contracts or subcontracts ef$10,000 or
under are exempt.)
Currently,Standard Farm 100(EEO-1)is the only report required by the Executive Orders or
their implementing regulations.
Proposed prime contractors and subcontractors who have participated in a previous contract or
subcontract subject to the Executive Orders and have not filed the required reports should note
that 41 CFR 60-1.7(b)(1)prevents the award of contracts and subcontracts unless such contractor
submits a report covering the delinquent period or such other period specified by the Federal
Highway Administration or by the Director,Office of Federal Contract Compliance,U.S.
Department of labor.
3.-20
290/031858-0008
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Exhibit 12-B Bidder's List of subcontractor(DBE and Non-DUE)
Part I
As of March I,2015 Contractors(and sub contractors)wishing to bid on Public wmrks a ntracis shall be registered with[be State Division of Industrial Relations and certified
to bid on Public Worksconiraets.Please register it:hues:l/e1iGn�.dir.ca.povlPWCWAeIiuuScnlcl?aclion�lisplavMCRexislralionForm
In accordance with Till.49,Section 26 11 of the Code of Federal Regulations,and Section 4104 of the Public Contract Cade orthe State orcahromis,as amended,the
following information is required fw each sub-contractor who will perform work amounting to more than one half of one paregn�[111)5%)of the T tat Rase Bid or S10 000
whichever is greater), Pbotoce this form for additional firma. Federal PmimLNumber Fi51PL-5483 803
Sohmntr.etar Name and[..cation Line Item&oarriptian Subcontract Percentage of Contrartar License ➢EE ➢BE Cc" Annual Gros nereipte
Amount Bid It..Sub Number (YIN) Namh.r
c.ntraehed BIB Rn Number
Name_
1 millron
<S S mi]lian
City,State LJ 'Slo million
<SIS million
n rnFivm. rs
Nome:
<SI million
�5 million
�r°—� <Slp million
<St5 miiii.
A.of Firm_
Nae. <S1 minor s
m
155 million
City.Stair. ❑ <510 million
❑ <SIS million
Am of Firm: Y.
Nomc <$1 million
65 milb.n
Ciry,51tic: <Si0 mdbon
<S15 minion
Agc.rFi-: yra.
Nome:
<SI million
<SS million
city.Stem: <S 10 milEi.n
Fj b15 mdni
Aire of Finn
Name: U <SI million
ASS million
City,Sta[e. <S I0 miNi
<S 15 m13imon
-
A of fine
Distribution:])Original•Lacal Agm,y Ftle 2)Copy-DLAEw1 Award Package
290/031858-0008
7645681.2 a00/00/00 Page 34
Exhibit 12-B Bidder's List of subcontractor(DBE and Non-DBE)
Part
in accordance with Title 49,Section 26 of the Code of Federal Regulations,the Bidder shell list all subcontractor who provide a quote or hid but were not selected to participate
as asubconliactur on this project Photocopy this form for additional firms
Subcontractor Name and L.-tin. line loam&Dmriptlon Suhmnt—I Perceataee of Contractor License DBE DBE Cart Annual Grose Aecelpu
Amount Hid item Sob Number JVIN) Number
rontraeled ➢IH Rag Number
Name: - <il million
QS million
City,Stara: 410million
IS 15 mil lion
e o[F
Name: - <%I m�lliane
45 million
a la miuinn
U <f 15 mllion
Ate ofFitm: s
Name: I <sl million
155 million
Ct,Slide: 410 odllion
L} <615 million
Age of Firm: yrs
Name IS null-
f 45 million
City.sole:
t� <s lS million
A.. fFi—:
Name: 41 million &
45 million
City,Sute. <s]0 mi]}iao
<sl5 million
Am of Firm s
Name. Ll 41 mlltean
<15 million
Clh,Suter - 4in miliian
4l5 million
AjgeufFi--Y,s
Distribution:l)Originai-Local Agency File 2)Copy-DLAE w/Award Package
1-28
290/031858-0008
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Percentage(%)of total contract amount that is.vuhrnntrartpd %
(Do not include specialty items in the calculation)
Signed thi 8th day of February 20 20.
2/18/2020 2/18/2020
Sign to of Prime on ractor Date Signature of Prime Contractor Date
Joh on Vie Pr sident Alberto Garcia de los Angeles,President
Print name and titl Print name and title
(if the Prime Contractor is a corporation,two signatures of corporate officers are required.)
290/031858-0008
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APPENDIX 5
FORM 12G— FEDERAL-AID CONTRACT LANGUAGE
2019
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract Language
FHWA-1273--Revised May 1,2012
REQUIRED CONTRACT PROVISIONS
FEDERAL-AID CONSTRUCTION CONTRACTS
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract Language
I. General II.NONDISCRIMINATION
ll. Nondiscrimination
III. No segregated Facilities The provisions of this section related to 23 CFR Part 230 are applicable
IV. Davis-Bacon and Related Act Provisions to all Federal-aid construction contracts and to all related construction
V. Contract Work Hours and Safety Standards Act Provisions subcontracts of$10,000 or more.The provisions of 23 CFR Part 230
VI. Subletting or Assigning the Contract are not applicable to material supply,engineering,or architectural
VII. Safety:Accident Prevention service contracts.
VIII. False Statements Concerning Highway Projects In addition,the contractor and all subcontractors must comply with the
IX. Implementation of Clean AirAct and Federal Water Pollution following policies:Executive Order 11246,41 CFR 60,29 CFR 1625
Control Act 1627,Title 23 USC Section 140,the Rehabilitation Act of 1973,as
X. Compliance with Government wide Suspension and Debarment amended(29 USC 794),Title VI of the Civil Rights Act of 1964,as
Requirements amended,and related regulations including 49 CFR Parts 21,26 and
XI. Certification Regarding Use of Contract Funds for Lobbying 27;and 23 CFR Parts 200,230,and 633.
ATTACHMENTS The contractor and all subcontractors must comply with:the
A.Employment and Materials Preference for Appalachian Development requirements of the Equal Opportunity Clause in 41 CFR 60-1.4(b)and,
Highway System or Appalachian Local Access Road Contracts for all construction contracts exceeding$10,000,the Standard Federal
(included in Appalachian contracts only) Equal Employment Opportunity Construction Contract Specifications in
41 CFR 6G}4.3.
I.GENERAL Note:The U.S.Department of Labor has exclusive authority to
determine compliance with Executive Order 11246 and the policies of
1.Form FHWA-1273 must be physically incorporated in each the Secretary of Labor including 41 CFR 60,and 29 CFR 1625-1627.
construction contract funded under Title 23(excluding emergency The contracting agency and the FHWA have the authority and the
contracts solely intended for debris removal).The contractor(or responsibility to ensure compliance with Title 23 USC Section 140,the
subcontractor)must insert this form in each subcontract and further Rehabilitation Act of 1973,as amended(29 USC 794),and Title VI of
require its inclusion in all lower tier subcontracts(excluding purchase the Civil Rights Act of 1964,as amended,and related regulations
orders,rental agreements and other agreements for supplies or including 49 CFR Parts 21,26 and 27;and 23 CFR Parts 200,230,and
services). 633.
The applicable requirements of Form FHWA-1273 are incorporated by The following provision is adopted from 23 CFR 230,Appendix A,with
reference for work done under any purchase order,rental agreement or appropriate revisions to conform to the U.S.Department of Labor(US
agreement for other services.The prime contractor shall be responsible DOL)and FHWA requirements.
for compliance by any subcontractor,lower-tier subcontractor or service
provider.
1.Equal Employment Opportunity:Equal employment opportunity
Form FHWA-1273 must be included in all Federal-aid design-build (EEO)requirements notto discriminate and to take affirmative action to
contracts,in all subcontracts and in lower tier subcontracts(excluding assure equal opportunity as set forth under laws,executive orders,
subcontracts for design services,purchase orders,rental agreements rules,regulations(28 CFR 35,29 CFR 1630,29 CFR 1625-1627,41
and other agreements for supplies or services).The design-builder shall CFR 60 and 49 CFR 27)and orders of the Secretary of Labor as
be responsible for compliance by any subcontractor,lower-tier modified by the provisions prescribed herein,and imposed pursuant to
subcontractor or service provider. 23 U.S.C.140 shall constitute the EEO and specific affirmative action
standards for the contractor's project activities under this contract.The
Contracting agencies may reference Form FHWA-1273 in bid proposal provisions ofthe Americans with Disabilities Act of 1990(42 U.S.C.
or request for proposal documents,however,the Form FHWA-1273 12101 et seq.)set forth under 28 CFR 35 and 29 CFR 1630 are
must be physically incorporated(not referenced)in all contracts, incorporated by reference in this contract.In the execution of this
subcontracts and lower-tier subcontracts(excluding purchase orders, contract,the contractor agrees to comply with the following minimum
rental agreements and other agreements for supplies or services related specific requirement activities of EEO:
to a construction contract).
a.The contractor will work with the contracting agency and the Federal
2.Subject to the applicability criteria noted in the following sections, Government to ensure that it has made every good faith effort to
these contract provisions shall apply to all work performed on the provide equal opportunity with respect to all of its terms and
contract by the contractor's own organization and with the assistance conditions of employment and in their review of activities underthe
of workers under the contractor's immediate superintendence and to contract.
all work performed on the contract by piecework,station work,or by
subcontract. b.The contractor will accept as its operating policy thefollowing
statement:
3.A breach of any ofthe stipulations contained in these Required
Contract Provisions may be sufficient grounds for withholding of "It is the policy of this Company to assure that applicants are employed,
progress payments,withholding offinal payment,termination ofthe and that employees are treated during employment,without regard to
contract,suspension I debannent or any other action determined to their race,religion,sex,color,national origin,age or disability.Such
be appropriate by the contracting agency and FHWA. action shall include:employment,upgrading,demotion,or transfer;
recruitment or recruitment advertising;layoff or termination;rates of pay
4.Selection of Labor:During the performance of this contract,the or other forms of compensation;and selection for training,including
contractor shall not use convict labor for any purpose within the limits apprenticeship,pre-apprenticeship,and/or on-the-job training."
of a construction project on a Federal-aid highway unless it is labor
performed by convicts who are on parole,supervised release,or
probation.The term Federal-aid highway does not include roadways
functionally classified as local roads or rural minor collectors.
FHWA-1273--Revised May 1,2012
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract Lanauaae
2.EEO Officer:The contractor will designate and make known to
the contracting officers and EEO Officer who will have the c.The contractor will encourage its present employees to refer
responsibility for and must be capable of effectively administering minorities and women as applicants for employment.
and promoting and active EEO program and who must be assigned Information and procedures with regard to referring such
adequate authority and responsibility to do so. applicants will be discussed with employees.
5.Personnel Actions:Wages,working conditions,and employee
3. Dissemination of Policy:All members of the contractor's staff benefits shall be established and administered,and personnel
who are authorized to hire,supervise,promote,and discharge actions of every type,including hiring,upgrading,promotion,
employees,or who recommend such action,orwho are transfer,demotion,layoff,and termination,shall be taken without
substantially involved in such action,will be made fully cognizant of, regard to race,color,religion,sex,national origin,age or disability.
and will implement,the contractor's EEO policy and contractual The following procedures shall be followed:
responsibilities to provide EEO in each grade and classification of
employment.To ensure that the above agreement will be met,the a.The contractor will conduct periodic inspections of project sitesto
following actions will be taken as a minimum: insure that working conditions and employee facilities do not
indicate discriminatory treatment of project site personnel.
a.Periodic meetings of supervisory and personnel office
employees will be conducted before the start of work and then b.The contractor will periodically evaluate the spread of wagespaid
not less often than once every six months,at which time the within each classification to determine any evidence of
contractor's EEO policy and its implementation will bereviewed discriminatory wage practices.
and explained.The meetings will be conducted by the EEO
Officer. c.The contractor will periodically review selected personnel actions
b.All new supervisory or personnel office employees will be given in depth to determine whether there is evidence ofdiscrimination.
a thorough indoctrination by the EEO Officer,covering all major Where evidence is found,the contractor will promptly take
aspects of the contractor's EEO obligations within thirty days corrective action.If the review indicates that the discrimination
following their reporting for duty with the contractor. may extend beyond the actions reviewed,such corrective action
shall include all affected persons.
c.All personnel who are engaged in direct recruitment for the
project will be instructed by the EEO Officer in thecontractor's d.The contractor will promptly investigate all complaints of alleged
procedures for locating and hiring minorities and women. discrimination made to the contractor in connection with its
obligations under this contract,will attempt to resolve such
d.Notices and posters setting forth the contractor's EEO policywill complaints,and will take appropriate corrective action within a
be placed in areas readily accessible to employees,applicants reasonable time.If the investigation indicates that the
for employment and potential employees. discrimination may affect persons other than the complainant,such
e.The contractor's EEO policy and the procedures to implement corrective action shall include such other persons.Upon
such policy will be brought to the attention of employees by completion of each investigation,the contractor will inform every
means of meetings,employee handbooks,or other appropriate complainant of all of their avenues of appeal.
means.
6.Training and Promotion:
4.Recruitment:When advertising for employees,the contractor a.The contractor will assist in locating,qualifying,and increasing
will include in all advertisements for employees the notation:"An the skills of minorities and women who are applicants for
Equal Opportunity Employer."All such advertisements will be employment or current employees.Such efforts should be aimed
placed in publications having a large circulation among minorities at developing full journey level status employees in the type of
and women in the area from which the project work force would trade or job classification involved.
normally be derived.
b.Consistent with the contractor's work force requirements and as
a.The contractor will,unless precluded by a valid bargaining permissible under Federal and State regulations,the contractor
agreement,conduct systematic and direct recruitment through shall make full use of training programs,i.e.,apprenticeship,and
public and private employee referral sources likely to yield on-the-job training programs for the geographical area of contract
qualified minorities and women.To meet this requirement,the performance.In the event a special provision for training is
contractor will identify sources of potential minority group provided under this contract,this subparagraph will be
employees,and establish with such identified sources superseded as indicated in the special provision.The contracting
procedures whereby minority and women applicants may be agency may reserve training positions for persons who receive
referred to the contractor for employment consideration. welfare assistance in accordance with 23 U.S.C.140(a).
b.In the event the contractor has a valid bargaining agreement c.The contractor will advise employees and applicants for
providing for exclusive hiring hall referrals,the contractor is employment of available training programs and entrance
expected to observe the provisions of that agreement to the requirements for each.
extent that the system meets the contractor's compliance with
EEO contract provisions.Where implementation of such an J.The contractor will periodically review the training andpromotion
agreement has the effect of discriminating against minorities or potential of employees who are minorities and women andwill
women,or obligates the contractor to do the same,such encourage eligible employees to apply for such training and
implementation violates Federal nondiscrimination provisions. promotion.
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract Lanauaae
FHWA-1273--Revised May 1,2012
7.Unions:If the contractor relies in whole or in part upon unionsas 10.Assurance Required by 49 CFR 26.13(b):
a source of employees,the contractorwill use good faith efforts to
obtain the cooperation of such unions to increase opportunities for a.The requirements of 49 CFR Part 26 and the State DOT's U.S.
minorities and women.Actions by the contractor,either directly or DOT-approved DBE program are incorporated by reference.
through a contractor's association acting as agent,will include the
procedures set forth below: b.The contractor or subcontractor shall not discriminate on the
basis of race,color,national origin,or sex in the performance of
a.The contractor will use good faith efforts to develop,in this contract.The contractor shall carry out applicable
cooperation with the unions,joint training programs aimed requirements of 49 CFR Part 26 in the award and administration
toward qualifying more minorities and women for membership of DOT-assisted contracts.Failure by the contractor to carry out
in the unions and increasing the skills of minorities and women these requirements is a material breach of this contract,which
so that they may qualify for higher paying employment. may result in the termination of this contract or such other remedy
as the contracting agency deems appropriate.
b.The contractor will use good faith efforts to incorporate an EEO
clause into each union agreement to the end that such union 11.Records and Reports:The contractor shall keep such records
will be contractually bound to refer applicants without regard to as necessary to document compliance with the EEO requirements.
their race,color,religion,sex,national origin,age ordisability. Such records shall be retained for a period of three years following
the date of the final payment to the contractor for all contract work
c.The contractor is to obtain information as to the referral and shall be available at reasonable times and places for inspection
practices and policies of the labor union except that tothe by authorized representatives of the contracting agency and the
extent such information is within the exclusive possession of FHWA.
the labor union and such labor union refuses to furnish such
information to the contractor,the contractor shall so certify to a.The records kept by the contractor shall document the following:
the contracting agency and shall set forth what efforts have
been made to obtain such information. (1)The number and work hours of minority and non-minority group
members and women employed in each work classification on
d.In the event the union is unable to provide the contractor with a the project,
reasonable flow of referrals within the time limit set forth in the
collective bargaining agreement,the contractor will,through (2)The progress and efforts being made in cooperation with
independent recruitment efforts,fill the employment vacancies unions,when applicable,to increase employment opportunities
without regard to race,color,religion,sex,national origin,age for minorities and women;and
or disability;making full efforts to obtain qualified and/or
qualifiable minorities and women.The failure of a union to (3)The progress and efforts being made in locating,hiring,training,
provide sufficient referrals(even though it is obligated to qualifying,and upgrading minorities and women.
provide exclusive referrals under the terms of a collective
bargaining agreement)does not relieve the contractor from the b.The contractors and subcontractors will submit an annual report
requirements ofthis paragraph.In the event the union referral to the contracting agency each Julyfor the duration of the
practice prevents the contractorfrom meeting the obligations project,indicating the number of minority,women,and non-
pursuant to Executive Order 11246,as amended,and these minority group employees currently engaged in each work
special provisions,such contractor shall immediately notify the classification required by the contract work.This information is
contracting agency. to be reported on Form FHWA-1391.The staffing data should
represent the project work force on board in all or any part of the
8. Reasonable Accommodation for Applicants!Employees last payroll period preceding the end of July.If on-the-job
with Disabilities:The contractor must be familiar with the training is being required by special provision,the contractor will
requirements for and comply with the Americans with Disabilities be required to collect and report training data.The employment
Act and all rules and regulations established there under. data should reflect the work force on board during all or any part
Employers must provide reasonable accommodation in all of the last payroll period preceding the end of July.
employment activities unless to do so would cause an undue
hardship. III.NONSEGREGATED FACILITIES
9.Selection of Subcontractors,Procurement of Materials and This provision is applicable to all Federal-aid construction contracts
Leasing of Equipment:The contractor shall not discriminate on and to all related construction subcontracts of$10,000 or more.
the grounds of race,color,religion,sex,national origin,age or
disability in the selection and retention of subcontractors,including The contractor must ensure that facilities provided for employees
procurement of materials and leases of equipment.The contractor are provided in such a manner that segregation on the basis of
shall take all necessary and reasonable steps to ensure race,color,religion,sex,or national origin cannot result.The
nondiscrimination in the administration of this contract. contractor may neither require such segregated use by written or
oral policies nor tolerate such use by employee custom.The
a.The contractor shall notify all potential subcontractors and contractor's obligation extends further to ensure that its employees
suppliers and lessors of their EEO obligations under this contract. are not assigned to perform their services at any location,under the
contractor's control,where the facilities are segregated.The term
b.The contractor will use good faith efforts to ensure subcontractor "facilities"includes waiting rooms,work areas,restaurants and
compliance with their EEO obligations. other eating areas,time clocks,restrooms,washrooms,locker
rooms,and other storage or dressing areas,parking lots,drinking
fountains,recreation or entertainment areas,transportation,and
housing provided for employees.The contractor shall provide
separate or single-user restrooms and necessary dressing or
sleeping areas to assure privacy between sexes.
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract LanauaBe
FHWA-1273--Revised May 1,2012
IV. DAVIS-BACON AND RELATED ACT PROVISIONS (i)The work to be performed by the classification requested is not
performed by a classification in the wage determination;and
This section is applicable to all Federal-aid construction projects
exceeding$2,000 and to all related subcontracts and lower-tier (ii)The classification is utilized in the area by the construction
subcontracts(regardless of subcontract size).The requirements industry;and
apply to all projects located within the right-of-way of a roadway that
is functionally classified as Federal-aid highway.This excludes
roadways functionally classified as local roads or rural minor (iii)The proposed wage rate,including any bona fide fringe benefits,
collectors,which are exempt.Contracting agencies may elect to bears a reasonable relationship to the wage rates contained in
apply these requirements to other projects. the wage determination.
The following provisions are from the U.S.Department of Labor (2)Ifthe contractor and the laborers and mechanics to be
regulations in 29 CFR 5.5"Contract provisions and related matters" employed in the classification(if known),or their
with minor revisions to conform tothe FHWA-1273 format and representatives,and the contracting officer agree on the
FHWA program requirements. classification and wage rate(including the amount designated
for fringe benefits where appropriate),a report of the action
1. Minimum wages taken shall be sent by the contracting officer to the Administrator
of the Wage and Hour Division,Employment Standards
Administration,U.S.Department of Labor,Washington,DC
a. All laborers and mechanics employed or working upon the site 20210.The Administrator,or an authorized representative,will
of the work,will be paid unconditionally and not less often than approve,modify,or disapprove every additional classification
once a week,and without subsequent deduction or rebate on any action within 30 days of receipt and so advise the contracting
account(except such payroll deductions as are permitted by officer or will notify the contracting officer within the 30-day
regulations issued by the Secretary of Labor under the Copeland period that additional time is necessary.
Act(29 CFR part 3)),the full amount of wages and bona fide fringe
benefits(or cash equivalents thereof)due at time of payment
computed at rates not less than those contained in the wage (3)In the event the contractor,the laborers or mechanics to be
determination of the Secretary of Labor which is attached hereto employed in the classification or their representatives,and the
and made a part hereof,regardless of any contractual relationship contracting officer do not agree on the proposed classificationand wage rate(including the amount designated for fringe
which may be alleged to exist between the contractor and such benefits,where appropriate),the contracting officer shall refer
laborers and mechanics. the questions,including the views of all interested parties and
the recommendation of the contracting officer,to the Wage and
Contributions made or costs reasonably anticipated for bona fide Hour Administrator for determination.The Wage and Hour
fringe benefits under section 1(b)(2)of the Davis-Bacon Act on Administrator,or an authorized representative,will issue a
behalf of laborers or mechanics are considered wages paid to such determination within 30 days of receipt and so advise the
laborers or mechanics,subject to the provisions of paragraph 1.d. contracting officer or will notify the contracting officer within the
of this section;also,regular contributions made or costs incurred for 30-day period that additional time is necessary.
more than a weekly period(but not less often than quarterly)under
plans,funds,or programs which cover the particular weekly period, 4 The wage rate(includingfringe benefits where appropriate)
are deemed to be constructively made or incurred during such O g g (
weekly period.Such laborers and mechanics shall be paid the determined pursuant to paragraphs p erform or p work of this
appropriate wage rate and fringe benefits on the wage section,shall be paid to all workers performing work in the
determination forthe classification of work actually performed, classification under this contract from the first day on which work
without regard to skill,except as provided in 29 CFR 5.5(a)(4). is performed in the classification.
Laborers or mechanics performing work in more than one
classification may be compensated at the rate specified for each c.Whenever the minimum wage rate prescribed in the contract for
classification for the time actually worked therein:Provided,That a class of laborers or mechanics includes a fringe benefit which
the employer's payroll records accurately set forth the time spent in is not expressed as an hourly rate,the contractor shall either
each classification in which work is performed.The wage pay the benefit as stated in the wage determination or shall pay
determination(including any additional classification and wage another bona fide fringe benefit or an hourly cash equivalent
rates conformed under paragraph 1.b.ofthis section)and the thereof.
Davis-Bacon poster(WH-1321)shall be posted at all times by the
contractor and its subcontractors at the site of the work in a d.If the contractor does not make payments to a trustee or other
prominent and accessible place where it can be easily seen by the third person,the contractor may consider as part of the wages of
workers. any laborer or mechanic the amount of any costs reasonably
anticipated in providing bona fide fringe benefits under a plan or
b. (1)The contracting officer shall require that any class of program,Provided,That the Secretary of Labor has found,upon the
laborers or mechanics,including helpers,which is not listed in the written request ofthe contractor,that the applicable standards of
wage determination and which is to be employed under the contract the Davis-Bacon Act have been met.The Secretary of Labor may
shall be classified in conformance with the wage determination.The require the contractor to set aside in a separate account assets for
contracting officer shall approve an additional classification and the meeting of obligations under the plan or program.
wage rate and fringe benefits therefore only when the following
criteria have been met:
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract LanauaBe
FHWA-1273--Revised May 1,2012
2. Withholding
current address of each covered worker,and shall provide them
upon request to the contracting agency for transmission to the
The contracting agency shall upon its own action or upon written State DOT,the FHWA or the Wage and Hour Division of the
request of an authorized representative of the Department of Labor, Department of Labor for purposes of an investigation or audit of
withhold or cause to be withheld from the contractor under this compliance with prevailing wage requirements.It is not a violation
contract,or any other Federal contract with the same prime of this section for a prime contractor to require a subcontractor to
contractor,or any other federally-assisted contract subject to Davis- provide addresses and social security numbers to the prime
Bacon prevailing wage requirements,which is held by the same contractor for its own records,without weekly submission to the
prime contractor,so much of the accrued payments or advances as contracting agency.
may be considered necessary to pay laborers and mechanics,
including apprentices,trainees,and helpers,employed by the
contractor or any subcontractor the full amount of wages required (2)Each payroll submitted shall be accompanied by a"Statement
by the contract.In the event of failure to pay any laborer or of Compliance,"signed by the contractor or subcontractor or his
mechanic,including any apprentice,trainee,or helper,employed or or her agent who pays or supervises the payment of the
working on the site of the work,all or part of the wages required by persons employed under the contract and shall certify the
the contract,the contracting agency may,after written notice to the following:
contractor,take such action as may be necessary to cause the
suspension of any further payment,advance,or guarantee of funds
until such violations have ceased. (i)That the payroll for the payroll period contains the information
required to be provided under§5.5(a)(3)(ii)of Regulations,29
CFR part 5,the appropriate information is being maintained
3. Payrolls and basic records under§5.5(a)(3)(i)of Regulations,29 CFR part 5,and that such
information is correct and complete,
a. Payrolls and basic records relating thereto shall be maintained
by the contractor during the course of the work and preserved for a (ii)That each laborer or mechanic(including each helper,
period of three years thereafter for all laborers and mechanics apprentice,and trainee)employed on the contract during the
working at the site of the work.Such records shall contain the payroll period has been paid the full weekly wages earned,
name,address,and social security number of each such worker, without rebate,either directly or indirectly,and that no
his or her correct classification,hourly rates of wages paid deductions have been made either directly or indirectly from the
(including rates of contributions or costs anticipated for bona fide full wages earned,other than permissible deductions as set
fringe benefits or cash equivalents thereof of the types described in forth in Regulations,29 CFR part 3;
section 1(b)(2)(B)of the Davis-Bacon Act),daily and weekly
number of hours worked,deductions made and actual wages paid. (iii)That each laborer or mechanic has been paid not less than the
Whenever the Secretary of Labor has found under 29 CFR applicable wage rates and fringe benefits or cash equivalents
5.5(a)(1)(iv)that the wages of any laborer or mechanic include the for the classification of work performed,as specified in the
amount of any costs reasonably anticipated in providing benefits applicable wage determination incorporated into the contract.
under a plan or program described in section 1(b)(2)(B)of the
Davis-Bacon Act,the contractor shall maintain records which show
that the commitment to provide such benefits is enforceable,that (3)The weekly submission of a properly executed certification set
the plan or program is financially responsible,and that the plan or forth on the reverse side of Optional Form WH-347 shall
program has been communicated in writing to the laborers or satisfy the requirement for submission of the"Statement of
mechanics affected,and records which show the costs anticipated Compliance'required by paragraph 3.b.(2)of this section.
or the actual cost incurred in providing such benefits.Contractors
employing apprentices or trainees under approved programs shall (4)The falsification of any of the above certifications may subject
maintain written evidence of the registration of apprenticeship the contractor or subcontractor to civil or criminal prosecution
programs and certification of trainee programs,the registration of under section 1001 of title 18 and section 231 of title 31 of the
the apprentices and trainees,and the ratios and wage rates United States Code.
prescribed in the applicable programs.
b. (1)The contractor shall submit weekly for each week in which c.The contractor or subcontractor shall make the records
any contract work is performed a copy of all payrolls to the required under paragraph 3.a.of this section available for
contracting agency.The payrolls submitted shall set out accurately inspection,copying,or transcription authorized
and completely all of the information required to be maintained representatives of the contracting agency,the State DOT,the
under 29 CFR 5.5(a)(3)(i),except that full social security numbers FHWA, t the Department of Labor,and shall permit such
and home addresses shall not be included on weekly transmittals. representatives to interview employees during working hours
Instead the payrolls shall only need to include an individually re the job.If the contractor or them
available,
th fails to submit the
identifying number for each employee(e.g.,the last four digits of required records or to make them available,the FHWA may,
the employee's social security number).The required weekly payroll after written notice to the contractor,the contracting agency or
the State DOT,take such action as maybe necessary to
information may be submitted in any form desired.Optional Form
WH-347 is available for this purpose from the Wage and Hour cause the suspension rt any further payment,advance,or
Division Web site at guarantee of funds.Furthermore,failure to submit the required
Division
We site/esahmhd/forms/wh347instr.htm or its successor records upon request or to make such records available may
site.The prime contractor is responsible for the submission of be grounds for debarment action pursuant to 29 CFR 5.12.
copies of payrolls by all subcontractors.Contractors and
subcontractors shall maintain the full social security number and
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract Lanauaae
FHWA-1273--Revised May 1,2012
4. Apprentices and trainees The ratio of trainees to journeymen on thejob site shall not be
greater than permitted under the plan approved by the Employment
a.Apprentices(programs of the USDOL). and Training Administration.
Apprentices will be permitted to work at less than the predetermined Every trainee must be paid at not less than the rate specified in the
rate for the work they performed when they are employed pursuant approved program for the trainee's level of progress,expressed as
to and individually registered in a bona fide apprenticeship program a percentage of the journeyman hourly rate specified in the
registered with the U.S.Department of Labor,Employment and applicable wage determination.Trainees shall be paid fringe
Training Administration,Office of Apprenticeship Training,Employer benefits in accordance with the provisions of the trainee program.If
and Labor Services,or with a State Apprenticeship Agency the trainee program does not mention fringe benefits,trainees shall
recognized by the Office,or if a person is employed in his or her be paid the full amount of fringe benefits listed on the wage
first 90 days of probationary employment as an apprentice in such determination unless the Administrator ofthe Wage and Hour
an apprenticeship program,who is not individually registered in the Division determines that there is an apprenticeship program
program,but who has been certified by the Office of Apprenticeship associated with the corresponding journeyman wage rate on the
Training,Employer and Labor Services or a State Apprenticeship wage determination which provides for less than full fringe benefits
Agency where appropriate)to be eli eligible for probationary for apprentices.Any employee listed on the payroll at a trainee rate
g y( g p ry who is not registered and participating in a training plan approved
employment as an apprentice. by the Employment and Training Administration shall be paid not
less than the applicable wage rate on the wage determination for
The allowable ratio of apprentices tojourneymen on the job site in the classification of work actually performed.In addition,any trainee
any craft classification shall not be greater than the ratio permitted performing work on the job site in excess of the ratio permitted
to the contractor as to the entire work force under the registered under the registered program shall be paid not less than the
program.Any worker listed on a payroll at an apprentice wage rate, applicable wage rate on the wage determination for the work
who is not registered or otherwise employed as stated above,shall actually performed.
be paid not less than the applicable wage rate on the wage
determination forthe classification of work actually performed.In In the event the Employment and Training Administration withdraws
addition,any apprentice performing work on the job site in excess approval of a training program,the contractor will no longer be
of the ratio permitted under the registered program shall be paid not permitted to utilize trainees at less than the applicable
less than the applicable wage rate on the wage determination for predetermined rate for the work performed until an acceptable
the work actually performed.Where a contractor is performing program is approved.
construction on a project in a locality other than that in which its
program is registered,the ratios and wage rates(expressed in
percentages of the journeyman's hourly rate)specified in the c.Equal employment opportunity.The utilization of apprentices,
contractor's or subcontractor's registered program shall be trainees andjourneymen under this part shall be in conformity
observed. with the equal employment opportunity requirements of Executive
Order 11246,as amended,and 29 CFR part 30.
Every apprentice must be paid at not less than the rate specified in
the registered program for the apprentice's level of progress, d.Apprentices and Trainees(programs of the U.S.DOT).
expressed as a percentage ofthe journeymen hourly rate specified
in the applicable wage determination.Apprentices shall be paid Apprentices and trainees working under apprenticeship and skill
fringe benefits in accordance with the provisions of the training programs which have been certified by the Secretary of
apprenticeship program.If the apprenticeship program does not Transportation as promoting EEO in connection with Federal-aid
specify fringe benefits,apprentices must be paid the full amount of highway construction programs are not subject to the requirements
fringe benefits listed on the wage determination for the applicable of paragraph 4 of this Section IV.The straight time hourly wage
classification.If the Administrator determines that a different rates for apprentices and trainees under such programs will be
practice prevails for the applicable apprentice classification,fringes established by the particular programs.The ratio of apprentices and
shall be paid in accordance with that determination. trainees to journeymen shall not be greater than permitted by the
terms of the particular program.
In the event the Office of Apprenticeship Training,Employer and
Labor Services,or a State Apprenticeship Agency recognized by 5.Compliance with Copeland Act requirements.The contractor
the Office,withdraws approval of an apprenticeship program,the h the requirements of 29 CFR part 3,which are
contractor will no longer be permitted to utilize apprentices at less incorporated shall comply with
reference in this contract.
than the applicable predetermined rate for the work performed until
an acceptable program is approved.
6.Subcontracts. The contractor or subcontractor shall insert
b.Trainees(programs of the USDOL). Form FHWA-1273 in any subcontracts and also require the
subcontractors to include Form FHWA-1273 in any lower tier
subcontracts.The prime contractor shall be responsible for the
Except as provided in 29 CFR 5.16,trainees will not be permitted to compliance by any subcontractor or lower tier subcontractor with all
work at less than the predetermined rate for the work performed the contract clauses in 29 CFR 5.5.
unless they are employed pursuant to and individually registered in
a program which has received prior approval,evidenced by formal 7.Contract termination:debarment.A breach of the contract
certification by the U.S.Department of Labor,Employment and clauses in 29 CFR 5.5 may be grounds for termination of the
Training Administration. contract,and for debarment as a contractor and a subcontractoras
provided in 29 CFR 5.12.
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract Lanauaae
FHWA-1273--Revised May 1,2012
8.Compliance with Davis-Bacon and Related Act requirements. 3.Withholding for unpaid wages and liquidated damages.The
All rulings and interpretations of the Davis-Bacon and Related Acts FHWA or the contacting agency shall upon its own action or upon
contained in 29 CFR parts 1,3,and 5 are herein incorporated by written request of an authorized representative of the Department of
reference in this contract. Labor withhold or cause to be withheld,from any moneys payable
on account of work performed by the contractor or subcontractor
9.Disputes concerning labor standards.Disputes arising out of under any such contract or any other Federal contract with the
the labor standards provisions of this contract shall not be subject to same prime contractor,or any other federally-assisted contract
the general disputes clause of this contract.Such disputes shall be subject to the Contract Work Hours and Safety Standards Act,
resolved in accordance with the procedures of the Department of "Which is held by the same prime contractor,such sums as may be
Labor set forth in 29 CFR parts 5,6,and 7.Disputes within the determined to be necessaryto satisfy any liabilities of such
meaning of this clause include disputes between the contractor(or contractor or subcontractor for unpaid wages and liquidated
any of its subcontractors)and the contracting agency,the U.S. damages as provided in the clause set forth in paragraph(2.)of this
Department of Labor,or the employees or their representatives. section.
10.Certification of eligibility. 4.Subcontracts.The contractor or subcontractor shall insert in
any subcontracts the clauses set forth in paragraph(1.)through(4.)
of this section and also a clause requiring the subcontractors to
a.By entering into this contract,the contractor certifies that neither it include these clauses in any lower tier subcontracts.The prime
(nor he or she)nor any person or firm who has an interest in the contractor shall be responsible for compliance by any subcontractor
contractor's firm is a person or firm ineligible to be awarded or lower tier subcontractor with the clauses set forth in paragraphs
Government contracts by virtue of section 3(a)of the Davis- (1.)through(4.)of this section.
Bacon Act or 29 CFR 5.12(a)(1).
b.No part of this contract shall be subcontracted to any person or VI.SUBLETTING OR ASSIGNING THE CONTRACT
firm ineligible for award of a Government contract by virtue of
section 3(a)of the Davis-Bacon Act or 29 CFR 5.12(a)(1). This provision is applicable to all Federal-aid construction contracts
on the National Highway System.
c.The penalty for making false statements is prescribed in the U.S. 1 The contractor shall perform with its own organization contract
Criminal Code,18 U.S.C.1001. work amounting to not less than 30 percent(or a greater
percentage if specified elsewhere in the contract)of the total
V.CONTRACT WORK HOURS AND SAFETY STANDARDS original contract price,excluding any specialty items designated
ACT by the contracting agency. Specialty items may be performed
by subcontract and the amount of any such specialty items
The following clauses apply to any Federal-aid construction contract performed may be deducted from the total original contract price
in an amount in excess of$100,000 and subject to the overtime before computing the amount of work required . performed
provisions ofthe Contract Work Hours and Safety Standards Act. by the contractor's own organization(23 CFR 635116).
These clauses shall be inserted in addition to the clauses required a.The term"perform work with its own organization"refers to
by 29 CFR 5.5(a)or 29 CFR 4.6.As used in this paragraph,the workers employed or leased by the prime contractor,and
terms laborers and mechanics include watchmen and guards. equipment owned or rented by the prime contractor,with or
without operators.Such term does not include employees or
1.Overtime requirements.No contractor or subcontractor equipment of a subcontractor or lower tier subcontractor,
contracting for any part of the contract work which may require or agents of the prime contractor,or any other assignees.The
involve the employment of laborers or mechanics shall require or term may include payments for the costs of hiring leased
permit any such laborer or mechanic in any workweek in which he employees from an employee leasing firm meeting all relevant
or she is employed on such work to work in excess of forty hours in Federal and State regulatory requirements.Leased
such workweek unless such laborer or mechanic receives employees may only be included in this term if the prime
compensation at a rate not less than one and one-half times the contractor meets all of the following conditions:
basic rate of pay for all hours worked in excess of forty hours in
such workweek. (1)the prime contractor maintains control over the supervision of
the day-to-day activities of the leased employees,
2.Violation;liability for unpaid wages;liquidated damages.In (2)the prime contractor remains responsible for the quality of the
work of the leased employees;
the event of any violation of the clause set forth in paragraph(1.)of
(3)the prime contractor retains all power to accept orexclude
this section,the contractor and any subcontractor responsible individual employees from work on the project;and
therefor shall be liable for the unpaid wages.In addition,such (4)the prime contractor remains ultimately responsible forthe
contractor and subcontractor shall be liable to the United States(in payment of predetermined minimum wages,the submission of
the case of work done under contract for the District of Columbia or payrolls,statements of compliance and all other Federal
a territory,to such District or to such territory),for liquidated regulatory requirements.
damages.Such liquidated damages shall be computed with respect
to each individual laborer or mechanic,including watchmen and b."Specialty Items"shall be construed to be limited to work that
guards,employed in violation of the clause set forth inparagraph(1.) requires highly specialized knowledge,abilities,or equipment
of this section,in the sum of$10 for each calendar day on which not ordinarily available in the type of contracting organizations
such individual was required or permitted to work in excess of the qualified and expected to bid or propose on the contract as a
standard workweek of forty hours without payment of the overtime whole and in general are to be limited to minor components of
wages required by the clause set forth in paragraph(1.)of this the overall contract.
section.
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract Lanauaae
2.The contract amount upon which the requirements set forth in Vill.FALSE STATEMENTS CONCERNING HIGHWAY
paragraph(1)of Section VI is computed includes the cost of PROJECTS
material and manufactured products which are to be purchasedor
produced by the contractor under the contract provisions. This provision is applicable to all Federal-aid construction contracts
and to all related subcontracts.
3.The contractor shall furnish(a)a competent superintendent or
supervisor who is employed by the firm,has full authority todirect In order to assure high quality and durable construction in conformity
performance ofthe work in accordance with the contract with approved plans and specifications and a high degree of
requirements,and is in charge of all construction operations reliability on statements and representations made by engineers,
(regardless of who performs the work)and(b)such other of its contractors,suppliers,and workers on Federal-aid highway projects,
own organizational resources(supervision,management,and it is essential that all persons concerned with the project perform
engineering services)as the contracting officer determines is their functions as carefully,thoroughly,and honestly as possible.
necessary to assure the performance of the contract. Willful falsification,distortion,or misrepresentation with respect to
any facts related to the project is a violation of Federal law.To
4.No portion of the contract shall be sublet,assigned orotherwise prevent any misunderstanding regarding the seriousness ofthese
disposed of except with the written consent ofthe contracting and similar acts,Form FHWA-1022 shall be posted on each
officer,or authorized representative,and such consent when Federal-aid highway project(23 CFR 635)in one or moreplaces
given shall not be construed to relieve the contractor of any where it is readily available to all persons concerned with the project:
responsibility for the fulfillment ofthe contract.Written consent
will be given only after the contracting agency has assured that
each subcontract is evidenced in writing and that it contains all 18 U.S.C.1020 reads as follows:
pertinent provisions and requirements ofthe prime contract.
"Whoever,being an officer,agent,or employee ofthe United
5.The 30%self-performance requirement of paragraph(1)is not States,or of any State or Territory,or whoever,whether a person,
applicable to design-build contracts;however,contracting association,firm,or corporation,knowingly makes any false
agencies may establish their own self-perform ancerequirements. statement,false representation,or false report as to the character,
quality,quantity,or cost ofthe material used or to be used,or the
quantity or quality ofthe work performed or to be performed,or the
VII.SAFETY:ACCIDENT PREVENTION cost thereof in connection with the submission of plans,maps,
specifications,contracts,or costs of construction on any highway or
This provision is applicable to all Federal-aid construction contracts related project submitted for approval tothe Secretary of
and to all related subcontracts. Transportation,or
1.In the performance of this contract the contractor shall comply Whoever knowingly makes any false statement,false
with all applicable Federal,State,and local laws governing safety, representation,false report or false claim with respect to the
health,and sanitation(23 CFR 635).The contractor shall provide character,quality,quantity,or cost of anywork performed or to be
all safeguards,safety devices and protective equipment and take performed,or materials furnished or to be furnished,in connection
any other needed actions as it determines,or as the contracting with the construction of any highway or related project approved by
officer may determine,to be reasonably necessary to protect the the Secretary of Transportation,or
life and health of employees on the job and the safety of thepublic
and to protect property in connection with the performance of the Whoever knowingly makes any false statement or false
work covered by the contract. representation as to material fact in any statement,certificate,or
report submitted pursuant to provisions of the Federal-aid Roads Act
2.It is a condition of this contract,and shall be made a condition of approved July 1,1916,(39 Stat.355),as amended and
each subcontract,which the contractor enters into pursuant to this supplemented,
contract,that the contractor and any subcontractor shall not permit
any employee,in performance ofthe contract,to work in Shall be fined under this title or imprisoned not more than 5 years
surroundings or under conditions which are unsanitary,hazardous or both."
or dangerous to his/her health or safety,as determined under IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL
construction safety and health standards(29 CFR 1926) IX.IX.ITER POLLUTION CONTROL ACT
promulgated by the Secretary of Labor,in accordance with
Section 107 of the Contract Work Hours and Safety Standards Act This provision is applicable to all Federal-aid construction contracts
(40 U.S.C.3704). and to all related subcontracts.
3.Pursuant to 29 CFR 1926.3,it is a condition of this contract that 6y submission of this bid/proposal or the execution of this contract,
the Secretary of Labor or authorized representative thereof,shall or subcontract,as appropriate,the bidder,proposer,Federal-aid
have right of entry to any site of contract performance to inspector construction contractor,or subcontractor,as appropriate,will be
investigate the matter of compliance with the construction safety deemed to have stipulated as follows:
and health standards and to carry out the duties ofthe Secretary
under Section 107 of the Contract Work Hours and Safety 1. That any person who is or will be utilized in the
Standards Act(40 U.S.C.3704). performance of this contract is not prohibited from receiving an
award due to a violation of Section 508 of the Clean Water Act or
Section 306 of the Clean Air Act.
2. That the contractor agrees to include or cause to be
included the requirements of paragraph(1)of this Section X in every
subcontract,and further agrees to take such action as the
contracting agency may direct as a means of enforcing such
requirements.
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract Language
FHWA-1273--Revised May 1,2012
X.CERTIFICATION REGARDING DEBARMENT,SUSPENSION, transaction,without modification,in all lower tier covered
INELIGIBILITY AND VOLUNTARY EXCLUSION transactions and in all solicitations for lower tier covered
transactions exceeding the$25,000 threshold.
This provision is applicable to all Federal-aid construction contracts, h.A participant in a covered transaction may rely upon a certification
design-build contracts,subcontracts,lower-tier subcontracts, of a prospective participant in a Iowertier covered transaction that
purchase orders,lease agreements,consultant contracts or any is not debarred,suspended,ineligible,or voluntarily excluded from
other covered transaction requiring FHWA approval or that is the covered transaction,unless it knows that the certification is
estimated to cost$25,000 or more—as defined in 2 CFR Parts 180 erroneous.A participant is responsible for ensuring that its
and 1200. principals are not suspended,debarred,or otherwise ineligible to
participate in covered transactions.To verifythe eligibility of its
1.Instructions for Certification—First Tier Participants: principals,as well as the eligibility of any lower tier prospective
participants,each participant may,but is not required to,checkthe
a.By signing and submitting this proposal,the prospective first tier Excluded Parties List System website(https://www.epls.gov/),which
participant is providing the certification set out below. is compiled by the General Services Administration.
b.The inability of a person to provide the certification set out below i.Nothing contained in the foregoing shall be construed to require
will not necessarily result in denial of participation in this covered the establishment of a system of records in order to render in good
transaction.The prospective first tier participant shall submit an faith the certification required by this clause.The knowledge and
explanation of why it cannot provide the certification set out below. information of the prospective participant is not required to exceed
The certification or explanation will be considered in connection that which is normally possessed by a prudent person in the
with the department or agency's determination whether to enter ordinary course of business dealings.
into this transaction.However,failure of the prospective first tier
participant to furnish a certification or an explanation shall j.Except fortransactions authorized under paragraph(f)ofthese
disqualify such a person from participation in this transaction. instructions,if a participant in a covered transaction knowingly
enters into a lower tier covered transaction with a person whois
c.The certification in this clause is a material representation of fact suspended,debarred,ineligible,or voluntarily excluded from
upon which reliance was placed when the contracting agency participation in this transaction,in addition to other remedies
determined to enter into this transaction.If it is later determined available to the Federal Government,the department or agency
that the prospective participant knowingly rendered an erroneous may terminate this transaction for cause ordefault.
certification,in addition to other remedies available to the Federal
Government,the contracting agency may terminate this
transaction for cause of default. 2. Certification Regarding Debarment,Suspension,lneligibility
d.The prospective first tier participant shall provide im mediate written and Voluntary Exclusion—First Tier Participants:
notice to the contracting agency to whom this proposal is a.The prospective first tier participant certifies to the best ofits
submitted if any time the prospective first tier participant learns that knowledge and belief,that it and its principals:
its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances. (1)Are not presently debarred,suspended,proposed for
debarment,declared ineligible,or voluntarily excluded from
e.The terms"covered transaction,""debarred,""suspended," participating in covered transactions by any Federal department
"ineligible,""participant""person,""principal,"and"voluntarily or agency;
excluded,"as used in this clause,are defined in 2 CFR Parts 180
and 1200."First Tier Covered Transactions"refers to any covered (2)Have not within a three-year period preceding this proposal
transaction between a grantee or subgrantee of Federal funds and been convicted of or had a civil judgment rendered againstthem
a participant(such as the prime or general contract)."Lower Tier for commission offraud or a criminal offense in connection with
Covered Transactions"refers to any covered transaction under a obtaining,attempting to obtain,or performing a public(Federal,
First Tier Covered Transaction(such as subcontracts)."First Tier State or local)transaction or contract under a public transaction,
Participant"refers to the participant who has entered into a violation of Federal or State antitrust statutes or commission of
covered transaction with a grantee or subgrantee of Federal funds embezzlement,theft,forgery,bribery,falsification or destruction
(such as the prime or general contractor)."Lower Tier Participant" of records,making false statements,or receiving stolen
refers any participant who has entered into a covered transaction property,
with a First Tier Participant or other Lower Tier Participants(such
as subcontractors and suppliers). (3)Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity(Federal,State or local)with
f. The prospective first tier participant agrees by submitting this commission of any of the offenses enumerated in paragraph
proposal that,should the proposed covered transaction be entered (a)(2)of this certification;and
into,it shall not knowingly enter into any lower tier covered
transaction with a person who is debarred,suspended,declared (4)Have not within a three-year period preceding this
ineligible,or voluntarily excluded from participation in this covered application/proposal had one or more public transactions
transaction,unless authorized by the department or agency (Federal,State or local)terminated for cause ordefault.
entering into this transaction. b.Where the prospective participant is unable to certify to any of
g.The prospective first tier participant further agrees by submitting the statements in this certification,such prospective participant
this proposal that it will include the clause titled"Certification shall attach an explanation to this proposal.
Regarding Debarment,Suspension,Ineligibility and Voluntary
Exclusion-Lower Tier Covered Transactions,"provided by the
department or contracting agency,entering into this covered
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Required Federal-Aid Contract Lanauaae
FHWA-1273--Revised May 1,2012
h.Nothing contained in the foregoing shall be construed to require
2.Instructions for Certification-Lower Tier Participants: establishment of a system of records in order to render in good
faith the certification required by this clause.The knowledge and
(Applicable to all subcontracts,purchase orders and other lower tier normally possessed by a prudent person in the ordinary course of
transactions requiring prior FHWA approval or estimated to cost business dealings.
$25,000 or more-2 CFR Parts 180 and 1200)
i.Except for transactions authorized under paragraph a of these
a.By signing and submitting this proposal,the prospective lowertier instructions,if a participant in a covered transaction knowingly
is providing the certification set out below. enters into a lower tier covered transaction with a person who is
suspended,debarred,ineligible,or voluntarily excluded from
b.The certification in this clause is a material representation of fact participation in this transaction,in addition to other remedies
upon which reliance was placed when this transaction was available to the Federal Government,the department or agency
entered into.If it is later determined that the prospective lower tier with which this transaction originated may pursue available
participant knowingly rendered an erroneous certification,in remedies,including suspension and/or debarment.
addition to other remedies available to the Federal Government,
the department,or agency with which this transaction originated
may pursue available remedies,including suspension and/or Certification Regarding Debarment,Suspension,Ineligibility
debarment. and Voluntary Exclusion--Lower Tier Participants:
c.The prospective lower tier participant shall provide immediate 1.The prospective lower tier participant certifies,by submission of
written notice to the person to which this proposal is submitted if this proposal,that neither it nor its principals is presently
at any time the prospective lower tier participant learns that its debarred,suspended,proposed for debarment,declared
certification was erroneous by reason of changed circumstances. ineligible,or voluntarily excluded from participating in covered
transactions by any Federal department or agency.
d.The terms"covered transaction,""debarred,""suspended," 2.Where the prospective lower tier participant is unable to certify to
ineligible,""participant,""person,""principal,"and"voluntarily any of the statements in this certification,such prospective
excluded,"as used in this clause,are defined in 2 CFR Parts 180 participant shall attach an explanation to this proposal.
and 1200.You may contact the person to which this proposal is
submitted for assistance in obtaining a copy of those regulations.
"First Tier Covered Transactions"refers to any covered
transaction between a grantee or subgrantee of Federal funds XI.CERTIFICATION REGARDING USE OF CONTRACT FUNDS
and a participant(such as the prime or general contract)."Lower FOR LOBBYING
Tier Covered Transactions'refers to any covered transaction This provision is applicable to all Federal-aid construction contracts
under a First Tier Covered Transaction(such as subcontracts). and to all related subcontracts which exceed$100,000(49 CFR
"First Tier Participant"refers to the participant who has entered 20).
into a covered transaction with a grantee or subgrantee of
Federal funds(such as the prime or general contractor)."Lower 1.The prospective participant certifies,by signing andsubmitting
Tier Participant"refers any participant who has entered into a this bid or proposal,to the best of his or her knowledge and
covered transaction with a First Tier Participant or other Lower belief,that:
Tier Participants(such as subcontractors and suppliers).
a.No Federal appropriated funds have been paid or will be paid,
e.The prospective lower tier participant agrees by submitting this by or on behalf of the undersigned,to any person for influencing
proposal that,should the proposed covered transaction be or attempting to influence an officer or employee of any Federal
entered into,it shall not knowingly enter into any lower tier agency,a Member of Congress,an officer or employee of
covered transaction with a person who is debarred,suspended, Congress,or an employee of a Member of Congress in
declared ineligible,or voluntarily excluded from participation in connection with the awarding of any Federal contract,the
this covered transaction,unless authorized by the department or making of any Federal grant,the making of any Federal loan,
agency with which this transaction originated. the entering into of any cooperative agreement,and the
extension,continuation,renewal,amendment,or modification of
f.The prospective lower tier participant further agrees by submitting any Federal contract,grant,loan,or cooperative agreement.
this proposal that it will include this clause titled"Certification b.If any funds other than Federal appropriated funds have been
Regarding Debarment,Suspension,Ineligibility and Voluntary paid or will be paid to any person for influencing or attempting to
Exclusion-Lower Tier Covered Transaction,"without modification, influence an officer or employee of any Federal agency,a
in all lower tier covered transactions and in all solicitations for Member of Congress,an officer or employee of Congress,or an
lower tier covered transactions exceeding the$25,000threshold. employee of a Member of Congress in connection with this
Federal contract,grant,loan,or cooperative agreement,the
g.A participant in a covered transaction may rely upon a undersigned shall complete and submit Standard Form-LLL,
certification of a prospective participant in a lower tier covered "Disclosure Form to Report Lobbying,"in accordance with its
transaction that is not debarred,suspended,ineligible,or instructions.
voluntarily excluded from the covered transaction,unless it knows
that the certification is erroneous.A participant is responsible for
ensuring that its principals are not suspended,debarred,or
otherwise ineligible to participate in covered transactions.To
verify the eligibility of its principals,as well as the eligibility of any
lower tier prospective participants,each participant may,but is
not required to,check the Excluded Parties List System website
htt s://www.euls.aov/),which is compiled by the General Services
Administration.
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Local Assistance Procedures Manual Exhibit 12-G
Required Federal-Aid Contract Language
2.This certification is a material representation offact upon which
reliance was placed when this transaction was made or entered
into.Submission of this certification is a prerequisite for making
or entering into this transaction imposed by 31 U.S.C.1352.
Any person who fails to file the required certification shall be
subject to a civil penalty of not less than$10,000 and not more
than$100,000 for each such failure.
3.The prospective participant also agrees by submitting its bid or
proposal that the participant shall require that the language of
this certification be included in all lower tier subcontracts,which
exceed information of participant is not required to exceed that
which is$100,000 and that all such recipients shall certify and
disclose accordingly.
LPP 18-01 Page 19 of 23
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